Hormone replacement therapy in hypopituitarism

This article brings an updated review of hypopituitarism with emphasis in hormone replacement therapy. The physiological basis of hormone replacement therapy and practical aspects of treating hypopituitary patients were both taken into account to provide a rational strategy for treatment. The review is organized by individual pituitary hormone deficiency and covers epidemiology, etiology, clinical presentation, and diagnosis of hypopituitarism, as well as the most relevant hormone preparations currently available for treating each hormone deficiency. Practical guidelines to hormone dosing, routes of administration, side effects and clinical and laboratory monitoring during the entire lifespan are given for each individual hormone replacement therapy: growth hormone in GH-deficient children and adults, thyroid hormone in central hypothyroidism, glucocorticoid in central hypoadrenalism, vasopressin analogs in diabetes insipidus, sex hormones in man and women from puberty to senescence, and gonadotropins for treating infertility. In addition to the literature review, we took into account our own experience of more than two decades in investigating, diagnosing, and treating hypopituitary patients at the Universidade Federal de São Paulo (UNIFESP).Esse artigo traz uma revisão do hipopituitarismo com ênfase na terapia de reposição hormonal. O conhecimento das bases fisiológicas da terapia de reposição hormonal, assim como dos aspectos práticos do tratamento, constitui o suporte racional para tratar esses pacientes. Essa revisão foi organizada por deficiência hormonal e cada um desses tópicos inclui epidemiologia, etiologia, apresentação clínica, diagnóstico, preparações hormonais disponíveis para o tratamento de cada deficiência, dosagens, vias de administração, efeitos colaterais e monitorização clínico-laboratorial durante os diferentes períodos da vida para cada reposição hormonal: hormônio de crescimento na criança e no adulto, hormônios tiroideanos no hipotiroidismo central, glicocorticóides no hipoadrenalismo central, análogos de vasopressina no diabetes insípidus central, esteróides sexuais no homem e na mulher, da puberdade à senescência e gonadotrofinas no tratamento da infertilidade. As informações aqui contidas resultam de uma revisão crítica da literatura aliada à nossa experiência de mais de duas décadas no diagnóstico e tratamento do paciente hipopituitário na Unidade de Neuroendocrinologia da Universidade Federal de São Paulo (UNIFESP).Universidade Federal de São Paulo (UNIFESP) Departamento de Medicina Unidade de NeuroendocrinologiaUNIFESP, Depto. de Medicina Unidade de NeuroendocrinologiaSciEL

Hormonal control of pituitary adenomas by transsphenoidal surgery: results of the first five years of experience

OBJETIVO: Avaliar os resultados iniciais de uma equipe cirúrgica no controle hormonal dos adenomas hipofisários secretores. MATERIAIS E MÉTODOS: Em cinco anos, foram operados 51 adenomas secretores (31 GH, 14 ACTH, 5 prolactina, 1 TSH). O controle hormonal foi GH basal < 2,5 ng/dL, cortisol livre urinário normal, redução dos níveis de prolactina, e T3 e T4 livre normais. RESULTADOS: As taxas de controle foram 36% na acromegalia e 57% no Cushing. Dois prolactinomas (40%) normalizaram a prolactina. Os hormônios tiroidianos normalizaram no adenoma secretor de TSH. O controle do hipercortisolismo correlacionou-se com o tempo de experiência da equipe (p = 0,01). CONCLUSÃO: Nossos resultados, limitados aos primeiros anos de experiência cirúrgica, situam-se abaixo da variação reportada em grandes casuísticas com maior tempo de experiência. Ao longo do tempo, observou-se melhora progressiva nos níveis de cortisol urinário no pós-operatório inicial da doença de Cushing em função da experiência cirúrgica.OBJECTIVE: To evaluate the initial results of a surgical team in the hormonal control of secreting pituitary adenomas. MATERIALS AND METHODS: In five years 51 functioning adenomas were operated (31 GH-secreting, 14 ACTH-secreting, 5 PRL-secreting and 1 TSH-secreting). Hormonal control was defined as GH < 2,5 ng/mL, normal free-urinary cortisol, lower prolactin and normal T3 and FT4. RESULTS: Control rates were 36% in acromegaly, and 57% in Cushing's disease. Two prolactinomas normalized prolactin levels. Thyroid hormone levels were normalized in the TSH-secreting adenoma. Control of hypercortisolism was positively correlated with years of experience (p = 0.01). CONCLUSION: Our results, although restricted to the beginning of our experience, lie below the reported range of other surgical series with much longer experience. During these years, there was a significant improvement in initial post surgery urinary cortisol levels in Cushing's disease as a function of surgical experience

Convergência local de renda no Brasil

Several works verify the hypothesis of income convergence for Brazilian regions. However, income inequality's persistence can still be verified. In this context, using the methodology of Geographically Weighted Regression (GWR), this study aims to analyze the local income convergence among the Brazilians areas (AMCs). The main results indicate multiple equilibria hypotheses. But, in a more sophisticated manner than convergence clubs analysis, local analysis results indicate that each AMC would be converging to its specific steady state.Diversos trabalhos verificam a hipótese de convergência de renda para as regiões brasileiras. Contudo, a persistência da desigualdade de renda ainda é verificada entre as regiões. Nesse contexto, utilizando a metodologia de Regressões Ponderadas Geograficamente (RPG), o presente trabalho busca analisar a hipótese de convergência local para as áreas mínimas comparáveis (AMCs). Os principais resultados confirmam a hipótese de múltiplos equilíbrios. Entretanto, de maneira mais sofisticada que a análise de clubes de convergência, os resultados da análise local indicam que cada AMC estaria convergindo para o seu específico estado estacionário

Avaliação da legislação e normas vigentes para bioensaios aplicados em pesquisa clínica: um estudo de caso para comprovação de imunogenicidade de vacinas

Vaccines are immunobiologicals products considered safe, effective and essential to control and / or eradication of vaccine-preventable diseases, and they were submitted to analytical tests and bioassays to check the quality and therapeutic efficacy. In this study was evaluated the applicability of the Executive Director Resolution  of the National Health Surveillance Agency, (Anvisa), RDC nº 27 May 17, 2012 and analyzed the other standardized bioassays documents recommended to the World Health Organization, Food and Drug Administration, United States Pharmacopeia, European Medicines Agency and data literature. The analyses of data literature and regulation statutes showed inconsistent guidelines. This study showed that is essential create a more targeted legislation to respond the particularities of bioanalytical assays in clinical trials to ascertain the vaccines immunogenicity. In order to corroborate with this guideline elaboration was carried out a case study by a standardized measles virus plaque reduction neutralization test in a 96-well plates (Micro-PRNT) to measure vaccinia neutralization according to RDC nº 27 May 17, 2012, 27 focus on the effectiveness of tests that is used in vaccine generated immune responses studies. The results showed that the method provides the selectivity and specificity required for applicability in combination vaccines as MMR (mumps, measles and rubella) or MMRV (measles, mumps, rubella and varicella vaccine).As vacinas são produtos imunobiológicos reconhecidamente seguros, eficazes e fundamentais no controle e/ou erradicação de doenças imunopreveníveis, sendo submetidas a testes analíticos e bioensaios para comprovação da qualidade e eficácia terapêutica. Neste trabalho foi avaliada a aplicabilidade da Resolução da Diretoria Colegiada da Agência Nacional de Vigilância Sanitária (Anvisa), RDC nº 27, de 17 de maio de 2012 e analisados os demais documentos de validação de bioensaios preconizados pela World Health Organization, Food and Drug Administration, United States Pharmacopeia, European Medicines Agency e literatura científica. A análise dos artigos e dos documentos regulatórios demonstraram diretrizes incongruentes. Esta análise evidencia que é necessária a elaboração de uma legislação pertinente para atender as particularidades dos bioensaios aplicados nas vacinas para comprovação de imunogenicidade. Foi realizado um estudo de caso, aplicando a validação segundo a (Anvisa), RDC nº 27, de 17 de maio de 2012  para o Teste de Neutralização por Redução de Placa de lise em placas de 96 poços (Micro-PRNT) para sarampo, focando na eficácia dos testes a serem empregados nos estudos de imunogenicidade gerados para o vírus do sarampo após a vacinação.  O estudo evidenciou que o método apresenta seletividade e especificidade necessária para aplicabilidade em amostras de soro de indivíduos vacinados com a vacina combinada tríplice ou quádrupla viral

THE IMPORTANCE OF VACCINATION AGAINST MEASLES, RUBELLA AND MUMPS IN PREVENTING NEUROLOGICAL COMPLICATIONS IN CHILDREN

Childhood vaccination against measles, rubella and mumps has been a crucial measure in preventing neurological complications. These potentially debilitating and, in extreme cases, fatal diseases have significant impacts on public health. Among the most serious complications, the neurological consequences that can affect the cognitive and motor development of children stand out. With the introduction of large-scale immunization programs, there has been a substantial reduction in the incidence of these diseases, providing not only individual protection, but also contributing to the eradication of outbreaks in communities. Objective: To analyze scientific literature from the last 10 years to comprehensively understand how vaccination against measles, rubella and mumps impacts the prevention of neurological complications in children. Methodology: The review was conducted following the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to search for relevant articles. The descriptors were "vaccination", "measles", "rubella", "mumps" and "neurological complications". Inclusion criteria covered studies published in the last 10 years, focused on children and addressing post-vaccination neurological effects. Exclusion criteria included studies with unrepresentative samples and lack of detailed information on neurological outcomes. Results: The analysis revealed a significant reduction in neurological complications associated with measles, rubella and mumps after the implementation of vaccination programs. Studies have highlighted the effectiveness of vaccines in preventing encephalitis and other neurological sequelae. Additionally, a decline in hospitalizations related to these complications was observed. Conclusion: This systematic review reinforces the importance of vaccination in preventing neurological complications in children resulting from measles, rubella and mumps. Analysis of the last 10 years reinforces the effectiveness of vaccines, highlighting not only the individual benefits, but also the public health gains in preventing outbreaks and reducing the serious consequences associated with these diseases.Childhood vaccination against measles, rubella and mumps has been a crucial measure in preventing neurological complications. These potentially debilitating and, in extreme cases, fatal diseases have significant impacts on public health. Among the most serious complications, the neurological consequences that can affect the cognitive and motor development of children stand out. With the introduction of large-scale immunization programs, there has been a substantial reduction in the incidence of these diseases, providing not only individual protection, but also contributing to the eradication of outbreaks in communities. Objective: To analyze scientific literature from the last 10 years to comprehensively understand how vaccination against measles, rubella and mumps impacts the prevention of neurological complications in children. Methodology: The review was conducted following the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to search for relevant articles. The descriptors were "vaccination", "measles", "rubella", "mumps" and "neurological complications". Inclusion criteria covered studies published in the last 10 years, focused on children and addressing post-vaccination neurological effects. Exclusion criteria included studies with unrepresentative samples and lack of detailed information on neurological outcomes. Results: The analysis revealed a significant reduction in neurological complications associated with measles, rubella and mumps after the implementation of vaccination programs. Studies have highlighted the effectiveness of vaccines in preventing encephalitis and other neurological sequelae. Additionally, a decline in hospitalizations related to these complications was observed. Conclusion: This systematic review reinforces the importance of vaccination in preventing neurological complications in children resulting from measles, rubella and mumps. Analysis of the last 10 years reinforces the effectiveness of vaccines, highlighting not only the individual benefits, but also the public health gains in preventing outbreaks and reducing the serious consequences associated with these diseases

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Long-term thermal sensitivity of Earth’s tropical forests

The sensitivity of tropical forest carbon to climate is a key uncertainty in predicting global climate change. Although short-term drying and warming are known to affect forests, it is unknown if such effects translate into long-term responses. Here, we analyze 590 permanent plots measured across the tropics to derive the equilibrium climate controls on forest carbon. Maximum temperature is the most important predictor of aboveground biomass (−9.1 megagrams of carbon per hectare per degree Celsius), primarily by reducing woody productivity, and has a greater impact per °C in the hottest forests (>32.2°C). Our results nevertheless reveal greater thermal resilience than observations of short-term variation imply. To realize the long-term climate adaptation potential of tropical forests requires both protecting them and stabilizing Earth’s climate

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery