Thyroid Metastasis as the Initial Presentation of an Asymptomatic Clear Cell Renal Carcinoma

Introdução: A metastização para a glândula tiroideia de um carcinoma renal de células claras é rara e só diagnosticável após análise imunohistoquímica de uma amostra histológica. O objetivo deste artigo é reportar um caso de metastização tiroideia como primeira manifestação de um carcinoma renal de células claras. Caso Clínico: Doente do sexo masculino com um nódulo sólido no lobo esquerdo da tiróide, com 5,3 cm, suspeito de malignidade, submetido a tiroidectomia total com linfadenectomia do compartimento central. A análise histológica concluiu serem duas metástases de carcinoma renal de células claras. Após estudo dirigido ao rim, o doente foi submetido a nefrectomia radical quatro meses depois. Discussão: O interesse deste caso reside no facto de a metastização para a tiroide como primeira manifestação de carcinoma renal de células claras ser rara mas, se tratada precocemente, permite uma ‘dupla resseção cirúrgica’ que pode levar a sobrevidas aos cinco anos de 80%

The feasibility of using pedometers and brief advice to increase activity in sedentary older women:a pilot study

Background: People over the age of 70 carry the greatest burden of chronic disease, disability and health care use. Participation in physical activity is crucial for health, and walking accounts for much of the physical activity undertaken by sedentary individuals. Pedometers are a useful motivational tool to encourage increased walking and they are cheap and easy to use. The aim of this pilot study was to evaluate the feasibility of the use of pedometers plus a theory-based intervention to assist sedentary older women to accumulate increasing amounts of physical activity, mainly through walking. Methods: Female participants over the age of 70 were recruited from primary care and randomised to receive either pedometer plus a theory-based intervention or a theory-based intervention alone. The theory-based intervention consisted of motivational techniques, goal-setting, barrier identification and self-monitoring with pedometers and daily diaries. The pedometer group were further randomised to one of three target groups: a 10%, 15% or 20% monthly increase in step count to assess the achievability and acceptability of a range of targets. The primary outcome was change in daily activity levels measured by accelerometry. Secondary outcome measures were lower limb function, health related quality of life, anxiety and depression. Results: 54 participants were recruited into the study, with an average age of 76. There were 9 drop outs, 45 completing the study. All participants in the pedometer group found the pedometers easy to use and there was good compliance with diary keeping (96% in the pedometer group and 83% in the theory-based intervention alone group). There was a strong correlation (0.78) between accelerometry and pedometer step counts i.e. indicating that walking was the main physical activity amongst participants. There was a greater increase in activity (accelerometry) amongst those in the 20% target pedometer group compared to the other groups, although not reaching statistical significance (p = 0.192). Conclusion: We have demonstrated that it is feasible to use pedometers and provide theory-based advice to community dwelling sedentary older women to increase physical activity levels and a larger study is planned to investigate this further.Publisher PDFPeer reviewe

Factores asociados al incremento en el uso de la metodología enfermera en Atención Primaria

Introduction: Indicators show a sustained increase in the use of nursing methodology (NM) in the Health Complex in Tenerife.Aim: to identify the factors that may be associated with this growth.Methods and materials: Retrospective analytical study. Area of study: patients with a computerised record of health. Subjects of the study numbered 609,688. Data analysis was performed from March 2005 to February 2010. Measurements: these were analysed monthly for each Basic Health Area (BHA) and measured the relative frequency of records with functional health patterns, (PFS), NANDA diagnoses, NOC objectives and NIC interventions. An NM global index was constructed from the mean value of the indicators and growth was calculated over the 60 months studied. Other variables measured included users of nursing consultations; quotas; patient load; non programmed consultations; consultations from other areas; home visits; presence of link nursing in the BHA; training and assessment in ME in the BHA; computer time. Data processing: variables were summarised as median (P5-P95) due to the non normal distribution. The correlation índex-ME growth and each variable was estimated using the Spearman non parametric linear correlation coefficient. Comparisons were made with the Mann-Whitney U test. All tests were significant at 5%.Results: Findings show a greater percentage of health records with ME and greater monthly growth when computerisation in the area was longer; when the percentage of users of nursing consultancies was higher; when the number of home visits was higher; when patient load was greater; when quotas were smaller; when consultations from other areas were lower. There was a higher percentage of medical records with ME and greater monthly growth in BHAs with ME assessment programme and in areas with ECE.Conclusions: Increased use of ME in the BHA in Tenerife is associated to each of the factors considered in different direction and size.Introducción: Se observa un incremento sostenido en los indicadores de empleo de la Metodología enfermera (ME) en el Área de Salud de Tenerife.Objetivo: Identificar los factores que pudieran asociarse a este crecimiento.Material y métodos: Estudio analítico retrospectivo. Ámbito de estudio: Pacientes con historia de salud informatizada. Los sujetos del estudio fueron 609688. El análisis de los datos se llevó a cabo en el periodo temporal marzo de 2005 a febrero de 2010. Mediciones: Se analizaron, para cada Zona Básica de Salud (ZBS) y mensualmente, la frecuencia relativa de historias con Patrones funcionales de salud (PFS), diagnósticos NANDA, objetivos NOC e intervenciones NIC. Se construyó un índice global de ME con el valor medio de estos indicadores y se calculó el crecimiento a lo largo de los 60 meses a estudio. Se midieron también otras variables: utilizadores de consultas de enfermería; volumen del cupo; presión asistencial; consultas fuera de agenda prevista; consultas de otras zonas; visitas a domicilio; presencia de enfermería de enlace (ECE) en la ZBS; formación-asesoramiento en ME en la ZBS; tiempo de informatización. Procesamiento de datos: Las variables se resumieron como mediana (P5-P95) debido a su distribución no normal. La correlación entre índice-crecimiento ME y cada variable se estimó utilizando el coeficiente de correlación lineal no paramétrica de Spearman. Las comparaciones se realizaron con la prueba U de Mann-Whitney. Todas las pruebas a un 5% de significación estadística.Resultados: Se comprobó un mayor porcentaje de historias de salud con ME así como un mayor crecimiento mensual: a mayor tiempo de informatización en la zona; a mayor porcentaje de utilizadores de consultas deenfermería; a mayor número de visitas a domicilio; a mayor presión asistencial; a menor volumen de cupo; a menor porcentaje de consultas de otras zonas. Igualmente se comprobó mayor porcentaje de historias de salud con ME y mayor crecimiento mensual en las ZBS formadas con un programa de asesoramiento en ME así como en las zonas con ECE.Conclusiones: El incremento en el empleo de la ME en las ZBS de Tenerife se asocia a cada uno de los factores considerados, en diferente sentido y magnitud

Impact of Liver Inflammation on Bile Acid Side Chain Shortening and Amidation

Bile acid (BA) synthesis from cholesterol by hepatocytes is inhibited by inflammatory cytokines. Whether liver inflammation also affects BA side chain shortening and conjugation was investigated. In human liver cell lines (IHH, HepG2, and HepaRG), agonists of nuclear receptors including the farnesoid X receptor (FXR), liver X receptor (LXR), and peroxisome proliferator-activated receptors (PPARs) did not affect the expression of BA-related peroxisomal enzymes. In contrast, hepatocyte nuclear factor 4? (HNF4?) inhibition down-regulated acyl-CoA oxidase 2 (ACOX2). ACOX2 was repressed by fibroblast growth factor 19 (FGF19), which was prevented by extracellular signal-regulated kinase (ERK) pathway inhibition. These changes were paralleled by altered BA synthesis (HPLC-MS/MS). Cytokines able to down-regulate cholesterol-7?-hydroxylase (CYP7A1) had little effect on peroxisomal enzymes involved in BA synthesis except for ACOX2 and bile acid-CoA:amino acid N-acyltransferase (BAAT), which were down-regulated, mainly by oncostatin M (OSM). This effect was prevented by Janus kinase (JAK) inhibition, which restored BA side chain shortening and conjugation. The binding of OSM to the extracellular matrix accounted for a persistent effect after culture medium replacement. In silico analysis of four databases (n = 201) and a validation cohort (n = 90) revealed an inverse relationship between liver inflammation and ACOX2/BAAT expression which was associated with changes in HNF4? levels. In conclusion, BA side chain shortening and conjugation are inhibited by inflammatory effectors. However, other mechanisms involved in BA homeostasis counterbalance any significant impact on the serum BA profile