Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life

The holistic phase model of early adult crisis

The objective of the current study was to explore the structural, temporal and experiential manifestations of crisis episodes in early adulthood, using a holistic-systemic theoretical framework. Based on an analysis of 50 interviews with individuals about a crisis episode between the ages of 25 and 35, a holistic model was developed. The model comprises four phases: (1) Locked-in, (2) Separation/Time-out, (3) Exploration and (4) Rebuilding, which in turn have characteristic features at four levels—person-in-environment, identity, motivation and affect-cognition. A crisis starts out with a commitment at work or home that has been made but is no longer desired, and this is followed by an emotionally volatile period of change as that commitment is terminated. The positive trajectory of crisis involves movement through an exploratory period towards active rebuilding of a new commitment, but ‘fast-forward’ and ‘relapse’ loops can interrupt Phases 3 and 4 and make a positive resolution of the episode less likely. The model shows conceptual links with life stage theories of emerging adulthood and early adulthood, and it extends current understandings of the transitional developmental challenges that young adults encounter

Evaluation of Herpes Simplex Virus Type 2 Serological Tests for Use With Dried Blood Spots in Kenya

We evaluated two assays to detect antibodies to HSV- 2 in dried blood spots (DBS) prepared from blood specimens submitted to a reference laboratory in Kenya. DBS did not perform well with the Kalon HSV-2 assay. Focus HerpeSelect 2 was 98.8% sensitive and 98.9% specific with dried blood spots

Gender and sexual orientation differences in cognition across adulthood : age is kinder to women than to men regardless of sexual orientation

Despite some evidence of greater age-related deterioration of the brain in males than in females, gender differences in rates of cognitive aging have proved inconsistent. The present study employed web-based methodology to collect data from people aged 20-65 years (109,612 men; 88,509 women). As expected, men outperformed women on tests of mental rotation and line angle judgment, whereas women outperformed men on tests of category fluency and object location memory. Performance on all tests declined with age but significantly more so for men than for women. Heterosexuals of each gender generally outperformed bisexuals and homosexuals on tests where that gender was superior; however, there were no clear interactions between age and sexual orientation for either gender. At least for these particular tests from young adulthood to retirement, age is kinder to women than to men, but treats heterosexuals, bisexuals, and homosexuals just the same

Disclosure of HSV-2 serological test results in the context of an adolescent HIV prevention trial in Kenya

HSV-2 biomarkers are often used in adolescent sub-Saharan HIV prevention studies, but evaluations of test performance and disclosure outcomes are rare in the published literature. Therefore, we investigated the proportion of ELISA-positive and indeterminant samples confirmed by Western blot (WB); the psychosocial response to disclosure; and whether reports of sexual behavior and HSV-2 symptoms are consistent with WB confirmatory results among adolescent orphans in Kenya

Gender Differences in COVID-19 Among Liver Transplant Recipients: Results from a Multicenter Brazilian Cohort

Introduction: Existing literature presents varying perspectives on the impact of COVID-19 on liver transplant recipients.However, no research has specifically investigated the role of gender differences in the manifestation of COVID-19 among liver transplant recipients. This study aims to examine the effects of COVID-19 on liver transplant recipients, with a focus on gender differences in disease presentation and progression. Methods: Conducted as a multicenter historical cohort study, this research collected patient records through an online questionnaire. Assessing COVID-related mortality was the main objective. Additionally, demographic, clinical, and laboratory data pertaining to disease presentation and progression werecollected. Results: The study included a total of 283 patients, of whom 76 were female and 206 were male. The median follow-up period for males was 99 days (IQR 38-283), while for females, it was 126 days (IQR 44-291). A higher prevalence of cardiovascular disease was observed in males (p=0.002). Females frequently experienced a loss of smell (p=0.021), whereas males commonly exhibited fever (p=0.031). Levels of ALT and gamma-glutamyl transferase were significantly elevated in males (p=0.008 and 0.004, respectively). Although there was a trend towards increased mortality in males, it did not reach statistical significance. Conclusion: This study is the first attempt to investigate gender differences in COVID-19 among liver transplant recipients. Our findings highlight the need for a comprehensive and personalised approach to treating this patient population and underscore the importance of further elucidating the disease presentation in these individuals

SÍNDROME NEUROPARALITICA AGUDA EM PACIENTE IMUNOCOMPETENTE

Introdução: Botulismo é uma doença rara causada pela ação de toxinas produzidas pela bactéria Clostridium botulinum na junção neuromuscular, resultando em fraqueza muscular ou paralisia de início súbito, que tem alta letalidade. Sua baixa incidência dificulta o seu reconhecimento. Objetivo: Relatar um caso de botulismo com apresentação típica, ocorrido no Rio de Janeiro. Relato do caso: Mulher de 26 anos com quadro súbito de diplopia, vertigem, fala lentificada e um episódio de diarreia e constipação após​. Evoluiu em 24 horas com fraqueza crânio–caudal, disfagia, disartria, sialorreia e insuficiência respiratória, com necessidade de intubação. Transferida para a UTI em RASS -1, sem abertura ocular ou movimentos em face, pupilas midriáticas, força grau 4 nos membros, reflexos profundos normais e​ cognição preservada. Exame do LCR e TC de crânio normais. A investigação epidemiológica encontrou palmito contaminado em restos de alimento ingerido 3 dias antes do início dos sintomas. No D6 de doença, foi administrado soro antibotulínico (SAB). Evoluiu com melhora, mas permaneceu 104 dias internada, tendo apresentado pneumonia por MRSA e crises de ansiedade. Recebeu alta deambulando de forma assistida, ventilando em ar ambiente, com melhora progressiva da fonação e deglutição. O diagnóstico de botulismo foi confirmado no D30 por detecção da toxina em amostra de sangue no LACEN. Discussão: O retardo no início do tratamento do botulismo é responsável, em grande parte, pela alta letalidade da doença. A suspeição clínica deve motivar notificação e início do tratamento imediatos, pois os testes diagnósticos confirmatórios têm baixa sensibilidade e são demorados. O SAB deve idealmente ser administrado dentro de 7 dias do início dos sintomas. O tratamento não reverte a paralisia, mas interrompe sua progressão, causando tempo prolongado de recuperação. O principal diagnóstico diferencial é a síndrome de Muller-Fisher (SMF). Neste caso, o achado clínico determinante na diferenciação foi a midríase bilateral, ausente na SMF, que justificou o não início de tratamento para SMF, mantendo apenas o SAB. A literatura confirma a alta especificidade desse sinal clínico no botulismo. Conclusões: Botulismo deve ser considerado como hipótese diagnóstica em todos os quadros neuroparalíticos agudos com início crânio-caudal. O exame neurológico detalhado pode ser fundamental para a condução dos casos

Evaluation of Herpes Simplex Virus Type 2 Serological Tests for Use With Dried Blood Spots in Kenya

We evaluated two assays to detect antibodies to HSV- 2 in dried blood spots (DBS) prepared from blood specimens submitted to a reference laboratory in Kenya. DBS did not perform well with the Kalon HSV-2 assay. Focus HerpeSelect 2 was 98.8% sensitive and 98.9% specific with dried blood spots