Tamoxifen and Assymptomatic Endometrial Thickness

Tamoxifen is a first-line agent for adjuvant treatment of estrogen-receptor positive breast cancer, and is used to reduce the risk of this condition in high-risk individuals. Retrospective studies established an association between tamoxifen use, endometrial thickness and endometrial cancer. There have been many attempts to identify an effective screening program for tamoxifen-related endometrial cancer, which have led to the use of transvaginal ultrasound and invasive procedures. The use of a 5mm endometrial cut-off in vaginal ultrasound is known to raise the number of endometrial biopsies with no gain in early cancer diagnosis. A review of the scientific literature was performed in order to establish the best available evidence for endometrial evaluation of asymptomatic breast cancer patients on tamoxifen

Different Electroclinical Manifestations of the Epilepsy Associated with Hamartomas Connecting to the Middle or Posterior Hypothalamus

PURPOSE: The epilepsy associated with hypothalamic hamartomas (HHs) has typical clinical, electrophysiologic, and behavioral manifestations refractory to drug therapy and with unfavorable evolution. It is well known that only sessile lesions produce epilepsy, but no correlation has been established between the different types of sessile hamartomas and the diverse manifestations of the epilepsy. We correlate anatomic details of the hamartoma and the clinical and neurophysiologic manifestations of the associated epilepsy. METHODS: HHs of seven patients with epilepsy (ages 2- 25 years) were classified as to lateralization and connection to the anteroposterior axis of the hypothalamus by using high-resolution brain magnetic resonance imaging. We correlated the anatomic classification with the clinical and neurophysiologic manifestations of the epilepsy as evaluated in long-term (24 h) video-EEG recordings. RESULTS: HHs ranged in size from 0.4 to 2.6 cc, with complete lateralization in six of seven patients. Ictal manifestations showed good correlation with the lobar involvement of ictal/interictal EEGs. These manifestations suggest the existence of two types of cortical involvement, one associated with the temporal lobe, produced by hamartomas connected to the posterior hypothalamus (mamillary bodies), and the other associated with the frontal lobe, seen in lesions connecting to the middle hypothalamus. CONCLUSIONS: A consistent clinical and neurophysiologic pattern of either temporal or frontal lobe cortical secondary involvement was found in the patients of our series. It depends on whether the hamartoma connects to the mamillary bodies (temporal lobe cases) or whether it connects to the medial hypothalamus (frontal lobe cases)

Acute Sheehan's Syndrome Presenting as Central Diabetes Insipidus

Sheehan's syndrome occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. Improvements in obstetrical care have significantly reduced its incidence in developed countries, but postpartum pituitary infarction remains a common cause of hypopituitarism in developing countries. We report a case of severe postpartum haemorrhage followed by headache, central diabetes insipidus and failure to lactate, which prompted us to investigate and identify both anterior and posterior pituitary deficiency compatible with Sheehan's syndrome. A timely diagnosis allowed us to implement an adequate treatment and follow-up plan, which are known to improve clinical status and patient outcome

Innovativeness, innovation behavior and performance in the Portuguese hotel industry

This work investigates hotel innovation activity based on 11 hotel-specific innovation dimensions and antecedents. Results from a sample of 326 Portuguese hotels showed a high level of Innovativeness in the Portuguese hospitality industry. Information and Communication Technology, and Marketing were the leading innovation areas. The moderate level of Innovation Behavior demonstrates the dominance of incremental innovations. Hotel Size, Hotel Stars, Hotel Chain, and Personnel Training are significantly related to Innovation Behavior. Hotel Innovativeness positively impacted hotel Innovation Behavior, and hotel Innovation Behavior positively impacted hotel Performance. These findings provide both scholars and practitioners with relevant insights into hotel innovation in Portugal.info:eu-repo/semantics/publishedVersio

Efficacy and tolerability of airway stents

The function of airway stents is to keep the tubular structures open and stable. Their insertion is essentially indicated for intrinsic obstruction or extrinsic compression of the airway, fistulae or tracheobronchomalacia. The aim of this study was to determine the tolera bility and efficacy of airway stents in situations in which their insertion was vital. A retrospective study of airway stent insertion with rigid bronchoscopy (23 patients) was carried out over a two year period (2006-2007) at the Diagnostic and Therapeutic Techniques Unit. We assessed indication, efficacy, tolerability, complications and exact insertion based on chest CT imaging. In all situations Dumon flexible silicon stents (Tracheobronxane were used, with the need for complementary techniques such as laser therapy and mechanical dilation having been previously evaluated by flexible bronchoscopy. The authors conclude that stent insertion has no complications and good tolerability in the majority of advanced stage oncological situations with indication for palliative management

A validade das dimensões culturais do GLOBE na predição de comportamentos de gestão

Neste artigo apresentamos os resultados preliminares da nossa investigação que pretende aferir da validade das dimensões culturais definidas pelo GLOBE (House et al., 2004) na predição de comportamentos de gestão medidos pelo Leadership Practices Inventory (Kouzes & Posner, 2003). Com este projeto pretendemos dar resposta a recentes chamadas da comunidade científica: (1) Hofstede (2010) refere que é necessária a validação externa do Modelo GLOBE; (2) alguns autores reportaram a necessidade de considerar outras variáveis, para além da cultura, na explicação das relações entre indivíduos e culturas, uma vez que a variância explicada pelos valores culturais é geralmente baixa (Kirkman Lowe & Gibson, 2006; Gelfand, Erez & Aycan, 2007; Leung et al., 2005; Gibson, Maznevsky & Kirkman, 2009). Para a realização deste artigo selecionámos duas dimensões culturais definidas pelo GLOBE: In-Group Collectivism e Assertiveness. Para cada dimensão o GLOBE apresenta indicadores para valores culturais e para práticas culturais. Como pretendemos medir práticas de gestão escolhemos apenas os indicadores relativos às práticas culturais. Para medir as práticas de gestão utilizámos o Leadership Practices Inventory (LPI), Self Instrument, 3 rd Edition (Kouzes & Posner, 2003). O questionário é composto por 5 fatores: Model the Way; Inspire a Shared Vision; Challenge the Process; Enable Others to Act and Encourage the Heart. Destes, escolhemos apenas dois: Inspire a Shared Vision e Enable Others to Act. Com base na revisão de literatura efetuada prevemos a existência de correlações positivas entre: (a) a dimensão cultural In-Group Collectivism e o fator Inspire a Shared Vision; (b) a dimensão cultural Assertiveness e o fator Enable Others to Act. O questionário foi aplicado a estudantes de mestrado na área da gestão, tal como outros autores o fizeram em estudos semelhantes (e.g.: Bass, 1985; Dorfman, 1997; Zagorsek, Jaklic & Stough, 2004; Aimar & Stough, 2007; Ergeneli, Gohar & Temirbekova, 2007). A nossa amostra é composta por estudantes pertencentes a 8 países: Brasil; China; Estados Unidos da América; Índia; Indonésia; México; Portugal e Turquia. Os resultados preliminares demonstram que ambas as hipóteses se confirmam, ou seja, as correlações são positivas e significativas. Os modelos de regressão efetuados demonstram que variância explicada pelos indicadores de práticas culturais é de 82% e 45%, respetivamente. Podemos assim concluir que as dimensões escolhidas do Modelo GLOBE são válidas para a predição dos comportamentos de gestão selecionados e que a variância explicada é superior à reportada em estudos similares

Endemic goiter and iodine deficiency status among Guinea-Bissau school-age children

Background/objectives Iodine deficiency disorders are estimated to affect 25% of all school-age children around the world. Current policies concerning iodine deficiency disorders in many countries are not based on robust or recent national data. Our objective was to evaluate the current status of iodine nutrition in Guinea-Bissau (West Africa).Subject/methods A cross-sectional survey including 299 school-age children, aged 6-14 years old, from four distinct regions of Guinea-Bissau across a coast-hinterland gradient (Bolama, Bissau, Cambaju-Bafata, and Gabil) was performed. Several iodine deficiency disorders indicators were used: total goiter rate, median urinary iodine concentration (UIC) and regional iodine content in household salt and drinking water samples. Data on the total goiter rate were obtained by thyroid ultrasound.Results Goiter was found in 73.5% (CI 95%, 68.5-78.2%) of the school-age children. We observed a median urinary iodine concentration of 110 mcg/l, with 7.3% of the studied population presenting urinary iodine concentration = 15 mg/kg. Median well water iodine concentration was 11.7 mcg/l.Conclusions Guinea-Bissau presents high rates of goiter in school-age children despite satisfactory median urinary iodine concentration population levels. Salt and drinking water iodine median content cannot explain these findings. Further studies following the progress in iodine deficiency status and the presence of potential goitrogens in diet of this vulnerable population are in needed.(undefined)info:eu-repo/semantics/publishedVersio

Effects of Municipal Solid Waste Compost Supplemented with Inorganic Nitrogen on Physicochemical Soil Characteristics, Plant Growth, Nitrate Content, and Antioxidant Activity in Spinach.

In this study, we evaluated the effects of municipal solid waste compost supplemented with inorganic N on the physicochemical properties of soil, plant growth, nitrate concentration, and antioxidant activity in spinach. Experiments were carried out in neutral and acidic soils that were low in organic matter. A fertilized soil was used as a control, while four compost treatments—two compost rates of 35 and 70 t ha−1, supplemented or not with inorganic N (92 kg N ha−1 as Ca (NO3)2)—were applied by fertigation. The addition of compost increased the soil organic matter content and pH in both soils. The compost supplementation with N greatly increased the shoot dry weight and spinach fresh yield by nearly 109%. With the highest compost rate and 43% N applied, the yield increased in both soils, similar to results obtained in fertilized soil (3.8 kg m−2). The combined application of compost and N could replace inorganic P and K fertilization to a significant extent. The compost application at both rates and in both soils considerably decreased shoot Mn concentrations