State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS)

PCOS, a heterogeneous disorder characterized by cystic ovarian morphology, androgen excess, and/or irregular periods, emerges during or shortly after puberty. Peri- and post-pubertal obesity, insulin resistance and consequent hyperinsulinemia are highly prevalent co-morbidities of PCOS and promote an ongoing state of excess androgen. Given the relationship of insulin to androgen excess, reduction of insulin secretion and/or improvement of its action at target tissues offer the possibility of improving the physical stigmata of androgen excess by correction of the reproductive dysfunction and preventing metabolic derangements from becoming entrenched. While lifestyle changes that concentrate on behavioral, dietary and exercise regimens should be considered as first line therapy for weight reduction and normalization of insulin levels in adolescents with PCOS, several therapeutic options are available and in wide use, including oral contraceptives, metformin, thiazolidenediones and spironolactone. Overwhelmingly, the data on the safety and efficacy of these medications derive from the adult PCOS literature. Despite the paucity of randomized control trials to adequately evaluate these modalities in adolescents, their use, particularly that of metformin, has gained popularity in the pediatric endocrine community. In this article, we present an overview of the use of insulin sensitizing medications in PCOS and review both the adult and (where available) adolescent literature, focusing specifically on the use of metformin in both mono- and combination therapy

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Grafitos de banheiro: um estudo de diferenças de gênero Restroom graffiti: a study of gender differences

Foram analisadas diferenças de gênero em grafitos de banheiro (N = 1349), focalizando-se aspectos da sexualidade humana. Grafitos foram coletados em banheiros de "cursinhos" pré-vestibulares e de uma universidade, localizados em São Paulo, SP, Brasil. Não foram encontradas diferenças de gênero significativas em termos de freqüência de grafitos sexuais. Contudo, a análise do conteúdo sexual das inscrições revelou diferenças significativas. Foi utilizado o Modelo de Regressão Logística para verificar quais categorias de grafitos sexuais diferenciavam homens de mulheres. Nos "cursinhos", as categorias diferenciadoras foram "analidade" (B: 1,7560, gl = 1, p <= 0,01) e "xingamento" (B: 0,8843, gl = 1, p <= 0,01), temas preferidos pelos homens. Na universidade, as categorias diferenciadoras foram "xingamento" (B: 0,4445, gl = 1, p <= 0,05) e "elogio sexual" (B: -0,7654, gl = 1, p <= 0,05): os homens produziram maior número de xingamentos, enquanto que as mulheres realizaram mais elogios. "Xingamento", portanto, foi uma categoria diferenciadora de gêneros nos dois ambientes: os homens se mostraram mais agressivos que as mulheres ao produzirem grafitos sexuais. Este resultado indica que pode haver alguma relação entre agressividade e sexualidade.<br>Gender differences in restroom graffiti (N = 1349) were analyzed, focusing on aspects of the human sexuality. Graffiti were collected in restrooms from secondary schools ("cursinhos") and from a university, located in São Paulo, SP, Brazil. No significant gender differences were found in terms of frequency of sexual graffiti. However, the analysis of the sexual content of the inscriptions revealed significant differences. We used the Logistic Regression Model to verify the categories of sexual graffiti that differentiated men from women. At the secondary schools, the distinguishing categories were "anality" (B: 1,7560, df = 1, p < .01) and "insult" (B: .8843, df = 1, p < .01), themes preferred by men. At the university, the distinguishing categories were "insult" (B: .4445, df = 1, p < .05) and "sexual compliment" (B: -.7654, df = 1, p < .05): men produced a larger number of insults while women made more compliments. "Insult", therefore, was a category that differentiated genders in both locations: men were more aggressive than women when producing sexual graffiti. This result indicates that there may be some kind of connection between aggressiveness and sexuality