Primary adrenal insufficiency in adults: 150 years after Addison

Thomas Addison first described, 150 years ago, a clinical syndrome characterized by salt-wasting and skin hyperpigmentation, associated with a destruction of the adrenal gland. Even today, over a century after Addison's report, primary adrenal insufficiency can present as a life-threatening condition, since it frequently goes unrecognized in its early stages. In the 1850 s, tuberculous adrenalitis was present in the majority of patients, but nowadays, autoimmune Addison's disease is the most common cause of primary adrenal insufficiency. In the present report, we show the prevalence of different etiologies, clinical manifestations and laboratorial findings, including the adrenal cortex autoantibody, and 21-hydroxylase antibody in a Brazilian series of patients with primary adrenal insufficiency followed at Divisão de Endocrinologia da Universidade Federal de São Paulo (UNIFESP) and at Faculdade de Medicina de Ribeirão Preto - USP (FMRP-USP).Thomas Addison descreveu pela primeira vez, há 150 anos, uma síndrome clínica de perda de sal em indivíduos com hiperpigmentação cutânea, associada à destruição da glândula adrenal. Atualmente, a insuficiência adrenal ainda representa uma condição de risco, pois seu diagnóstico é freqüentemente não reconhecido nas fases iniciais da doença. A adrenalite tuberculosa era a causa mais freqüente na maioria dos casos descritos inicialmente, mas, na atualidade, a doença de Addison auto-imune está presente em uma grande porcentagem de pacientes com insuficiência adrenal primária. No presente trabalho, apresentamos a prevalência das diferentes causas, manifestações clínicas e achados laboratoriais, incluindo a determinação de anticorpos anticórtex adrenal e anti-21-hidroxilase em pacientes acompanhados com insuficiência adrenal primária seguidos nos Ambulatórios das Divisões de Endocrinologia da Universidade Federal de São Paulo (UNIFESP) e da Faculdade de Medicina de Ribeirão Preto - USP (FMRP-USP).Universidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de Clínica MédicaUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto Departamento de FisiologiaUNIFESPSciEL

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults:mediating role of frailty

BACKGROUND: Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly.OBJECTIVE: To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults.METHODS: Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p&lt;0.05.RESULTS: Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities.CONCLUSION: The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.</p

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults:mediating role of frailty

BACKGROUND: Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly.OBJECTIVE: To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults.METHODS: Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p&lt;0.05.RESULTS: Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities.CONCLUSION: The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.</p

Evaluation of the care provided by the outpatient clinic of the league of combat against STD/AIDS, health center, S.P., 1994-1997

Este trabalho analisou a assistência médica prestada pelos alunos da Liga de Combate a DST/AIDS, da Faculdade de Medicina de Ribeirão Preto - USP, no curso de três anos emeio, junto ao Programa de Prevenção e Controle de Aids do Centro de Saúde Escola. Foi utilizada a metodologia de avaliação em saúde (processo e resultados), que contemplou o estudo da assistência médica em um período contínuo de seguimento, sendo analisados os diagnósticos formulados, os exames laboratoriais e complementares prescritos, as medidas curativas e de promoção da saúde e prevenção de doenças. Foram estudados sessenta e seis (66) indivíduos, sendo 48,5% comunicantes de portadores do Vírus da Imunodeficiência Humana ou de doentes de aids, 27,3% portadores do HIV e 24,2% de doentes de aids. Houve maioria de pacientes masculinos, embora a relação homem:mulher cresça de 1:1, 2:1 e 3,5:1 no sentido comunicantes, portadores e doentes, com uma frequência modal de 40,9% na faixa etária de trinta (30) e trinta e nove (39) anos, o grau de escolaridade e as ocupações foram característicos de nível socioeconômico baixo. Formularam-se diagnósticos de deficiência da imunidade celular, exposição a doenças transmissíveis (aids, tuberculose e outras doenças infecciosas), infecções respiratórias agudas, doenças sexualmente transmissíveis, parasitoses, entre as principais. Em média, a clientela permaneceu 3,2 meses em seguimento, recebeu 2,4 consultas e 47,7% dela abandonouo atendimento. Os alunos participaram ativamente da pesquisa; a metodologia e as informações quantitativas contribuíram para a avaliação da qualidade da assistência médica, tendo o serviço de saúde correspondido como alternativa institucional para formação e assistência mais próxima da comunidade.The medical care provided by the students of the League of Combat against STD/AIDS belonging to the Faculty of Medicine of Ribeirão Preto - USP over a period of three and a half years was evaluated. We used the method of health evaluation based on the study of medical care during a continuous period of monitoring. The aim was to assess the quality of the care provided, analyzed in terms of the diagnoses formulated, of laboratory and complementary tests, of curative measures and of health promotion and disease prevention. A total of 66 individuals were studied, 48.5% of them being communicants of patients with HIV and AIDS, 27.3% HIVinfected patients, and 24.2% patients with AIDS. Most patients were males, although the man:woman ratio has been growing from 1:1, 2:1 and 3.5:1 in the following order: communicants, infected subjects and patients, with a modal frequency of 40.9% in the 30 to 39 year age range. Educational level and occupation were characteristic of a low socioeconomic level. The followingdiagnoses were made: cell immune deficiency; contacts with patients with aids, tuberculosis and other infectious diseases; infectious respiratory disease; sexually transmitted diseases; and parasitosis. The clients were followed up on average for a period of 3.2 months and received 2.4 visits, and 47.7% of them abandoned treatment. The students participated actively in the research, the methodology and the quantitative information obtained permitted the assessment of the quality of care, with the health service corresponding to the expectations for an institutional alternative for training and for providing care closer to the community

Hydatidiform mole resulting from sexual violence

<p>Abstract</p> <p>Background</p> <p>Hydatidiform mole (HM) is characterized by abnormal proliferation of human trophoblast with producers functioning tissues of human chorionic gonadotropin. It can evolve with ovarian cysts tecaluteínicos, hypertension of pregnancy or hyperthyroidism. The incidence of HM is variable and its etiology poorly known, associated with nutritional factors, environmental, age, parity, history of HM, oral contraceptives, smoking, consanguinity or defects in germ cells. There is no reference in literature on HM resulting from sexual violence, objective of this report.</p> <p>Method</p> <p>Description of two cases of HM among 1146 patients with pregnancy resulting from sexual violence treated at Hospital Pérola Byington, São Paulo, from July 1994 to August 2011.</p> <p>Results</p> <p>The cases affected young, white, unmarried, low educated and low parity women. Sexual violence was perpetrated by known offenders unrelated to the victims, under death threat. Ultrasound and CT of the pelvis showed bulky uterus compatible with HM without myometrial invasion. One case was associated with theca lutein cysts. The two cases were diagnosed in the second trimester of pregnancy and evolved with hyperthyroidism. There was no hypertension, disease recurrence, metastasis or sexually transmitted infection.</p> <p>Conclusion</p> <p>The incidence of HM was 1:573 pregnancies resulting from rape, within the range estimated for Latin American countries. Trophoblastic material can be preserved to identify the violence perpetrator, considering only the paternal HM chromosomes. History of sexual violence should be investigated in cases of HM in the first half of adolescence and women in a vulnerable condition.</p

Enzymatic inhibition studies of selected flavonoids and chemosystematic significance of polymethoxylated flavonoids and quinoline alkaloids in Neoraputia (Rutaceae)

Our taxonomic interest in the Neoraputia stimulated an investigation of N. paraensis searching for alkaloids. Fractions were monitored by ¹H NMR and ESI-MS/MS and only those which showed features of anthranilate alkaloids and flavonoids absent in the previous investigations were examined. Stems afforded the alkaloids flindersine, skimmianine, 8-methoxyflindersine and dictamnine; leaves yielded 3',4',7,8-tetramethoxy-5,6-(2,2-dimethylpyrano)-flavone, 3',4',5,7,8-pentamethoxyflavone, 5-hydroxy-3',4',6,7-tetramethoxyflavone, 3',4'-methylenedioxy-5,6,7-trimethoxyflavone and 5-hydroxy-3',4'-methylenedioxy-6,7-dimethoxyflavone. The alkaloids have remained undiscovered for 10 years. A number of flavonoids isolated from N. paraensis, N. magnifica, Murraya paniculata, Citrus sinensis graft (Rutaceae), Lonchocarpus montanus (Leguminosae) were evaluated for their ability to inhibit the enzymatic activity of the protein glyceraldehyde-3-phosphate dehydrogenase from Trypanosoma cruzi. Highly oxygenated flavones and isoflavone were the most actives.Nosso interesse quimiotaxonômico sobre Neoraputia nos estimulou a examinar N. paraensis, visando a busca de alcalóides. As frações foram monitoradas via RMN ¹H e ESI-EM/EM e foram analisadas somente aquelas cujos espectros apresentavam características de alcalóides do ácido antranílico e flavonóides não isolados anteriormente. Foram isolados do caule os alcalóides flindersina, skimmianina, 8-metoxiflindersina e dictamnina; das folhas os flavonóides 3',4',7,8-tetrametoxi-5,6-(2,2-dimetilpirano)-flavona, 3',4',5,7,8-pentametoxiflavona, 5-hidroxi-3',4',6,7-tetrametoxiflavona, 3',4'-metilenodioxi-5,6,7-trimetoxiflavona e 5-hidroxi-3',4'-metilenodioxi-6,7-dimetoxiflavona,. Os alcalóides do ácido antranílico não foram encontrados em dez anos. Vários flavonóides isolados de N. paraensis, N. magnifica, Murraya paniculata, enxerto de Citrus sinensis (Rutaceae) e Lonchocarpus montanus (Leguminosae) foram testados frente a gliceraldeído-3-fosfato desidrogenase de Trypanosoma cruzi, visando verificar seus potenciais em inibir a atividade da enzima. Os flavonóides polimetoxilados e um isoflavonóide foram os mais ativos.380387Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

A 46,XX testicular disorder of sex development caused by a Wilms’ tumour Factorâ 1 (WT1) pathogenic variant

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146930/1/cge13459_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146930/2/cge13459.pd