Aderência ao autocuidado em indivíduos diabéticos / Adherence to self-care in diabetic individuals

O autocuidado possui papel fundamental no tratamento do diabete e prevenção de suas complicações. Entre os fatores que apresentam associação com a adesão ao autocuidado está o conhecimento do paciente sobre a doença. O presente trabalho possui como objetivo avaliar o conhecimento sobre diabete melito tipo 2 e adesão ao autocuidado. Estudo analítico, observacional, transversal, descritivo. O conhecimento sobre o autocuidado foi feito através de dois questionários validados para a população brasileira: Diabetes Knowlege Scale (DKN-A) e Questionário de Atividade de Autocuidado (QAD). Participaram 61 pacientes. No QAD, observou-se baixa adesão às práticas diárias de autocuidado, sendo que o domínio da atividade física foi a que obteve menor adesão, seguida pela monitorização da glicemia. Quanto aos resultados obtidos no DKN-A, nota-se que a maioria atingiu pontuação igual ou superior a 8, sugerindo conhecimento satisfatório acerca da doença. Em conclusão, observou-se que a maioria atingiu pontuação igual ou superior a 8, sugerindo conhecimento satisfatório. Apesar disso, também a maioria apresentou baixa adesão frente às modificações esperadas no estilo de vida e autocuidado. Sendo assim, o conhecimento sobre a doença não é o único preditor para que isso ocorra.

Self-care has a fundamental role in the treatment of diabetes and prevention of its complications. Among the factors that are associated with adherence to self-care is the patient's knowledge about the disease. This study aims to assess knowledge about type 2 diabetes mellitus and adherence to self-care. It is analytical, observational, crosssectional, descriptive study. Knowledge about self-care was obtained through two questionnaires validated for the Brazilian population: Diabetes Knowlege Scale (DKN-A) and Self-Care Activity Questionnaire (QAD). 61 patients participated in the study. In the QAD, low adherence to daily self-care practices was observed, and the domain of physical activity was the one with the lowest adherence, followed by blood glucose monitoring. As for the results obtained in the DKN-A, it is noted that the majority reached a score equal to or greater than 8, suggesting satisfactory knowledge about the disease. In conclusion, it is observed that the majority reached a score equal to or greater than 8, suggesting satisfactory knowledge. Despite this, most also showed low adherence to the expected changes in lifestyle and self-care. Therefore, knowledge about the disease is not the only predictor for this to occur.

Synchronous Endometrioid Endometrial and Serous Ovarian Carcinoma: A double gynecologic jeopardy / Philippine Journal of Obstetrics and Gynecology

@#Synchronous malignant tumors are two primary tumors diagnosed at the same time during surgery. A postmenopausal, nulligravid, presented with vaginal bleeding. Ultrasound revealed an endometrial and right ovarian mass, both with nonbenign features. Cancer Antigen 125 and Human Epididymis Protein 4 were elevated. She underwent extrafascial hysterectomy with bilateral salpingo-oophorectomy with the frozen section of the endometrium and right ovary, followed by complete surgical staging. Histopathology report was endometrioid endometrial carcinoma and high-grade serous ovarian carcinoma. The endometrial and ovarian tissues tested positive for vimentin and Wilm's Tumor 1 (WT1), respectively, suggesting both are primary independent tumors. The pelvic lymph nodes and recto-sigmoid lymph nodes tested positive for vimentin and negative for WT1, suggesting endometrial tumor metastasis. The final diagnosis is synchronous endometrioid endometrial carcinoma Stage IIIC1 and high-grade serous ovarian carcinoma Stage IA, right ovary.

Determination of minimal erythema dose of Filipino adults to standardize the initial dose of narrowband ultraviolet B phototherapy in a tertiary hospital

Introduction@#Narrowband ultraviolet B (NBUVB) phototherapy is a well-established treatment option for a variety of dermato- logic conditions. The initial dosage is obtained either by determining the patients’ minimal erythema dose (MED) or their Fitzpat- rick skin phototype (SPT). MED determination is a better way to establish the proper initial dose as it is more objective. However, in practice, SPT is more commonly used as it is more convenient, and MED data in Filipinos are scarce.@*Objectives@#To establish data determining the MED values of Filipino adults that can serve as a basis to standardize the initial dose of NBUVB phototherapy in a tertiary hospital.@*Methods@#We enrolled 86 volunteers in a cross-sectional analytical study to determine their MED and assess if there is any asso- ciation between their MED and the participants’ age, sex, skin prototype, ancestry, and daily duration of sun exposure.@*Results@#The median MED of the participants is 800 mJ/cm2 (IQR 600-800 mJ/cm2 ). A majority of 38 participants (44.19%) have a MED of 800mJ/cm2 followed by 600mJ/cm2 for 23 (26.74%) participants. There was also a significant association between study partici- pants’ MED with respect to their Fitzpatrick skin type (p=<0.001) and ancestry (p=0.03), but with no association with regards to age (p=0.291), sex (p=0.245), and daily duration of sun exposure (p=0.237).@*Conclusion@#Majority of the participants have a median MED value of 800 mJ/cm2. Based on this MED value, the initial dosage of NBUVB at 50-70% of the MED would translate to an initial dose of 400-560 mJ/cm2.

Guidelines for the management of atopic dermatitis: A literature review and consensus statement of the Philippine Dermatological Society

@#Introduction: Atopic dermatitis (AD) is a complex disease with an interplay of genetic and environmental factors. In the United States, AD affects 10.7% of children andyc 7.2% of adults. Similarly in the Philippines, the prevalence of AD is 12.7% in the under 18 population, and 2% in the over 18 population. While AD affects all ages, the burden of the disease is greater in the pediatric population. The pathogenesis of AD is multifactorial. Variations in genes responsible for epidermal barrier function, keratinocyte terminal differentiation, and the innate and adaptive immune responses have been linked to AD. A null mutation involving the filaggrin gene is the strongest known risk factor for AD. This mutation results in a loss of filaggrin (FLG) protein by at least 50%. Filaggrin breakdown products form part of the natural moisturizing factor (NMF) of the skin, which is essential in skin hydration. A decrease in NMF and an increase in transepidermal water loss (TEWL) are observed in AD patients with FLG mutation. The defective barrier in AD patients decreases skin defenses against irritation and allergen penetration. Exposure to certain environmental chemicals like formaldehyde may worsen this barrier. This may lead to increased skin permeability to aeroallergens that leads to dermatitis in sensitized patients. Barrier defects may also play a role in epicutaneous sensitization and the subsequent development of other atopic conditions, such as bronchial asthma and allergic rhinitis. The Philippine Dermatological Society (PDS) consensus on AD aims to provide a comprehensive guideline and evidence-based recommendations in the management of this condition, with consideration of cultural factors that are often encountered in the Philippine setting. These guidelines are intended to provide practitioners with an overview of the holistic approach in the management of AD, ameliorating the negative effects of the disease and improving overall quality of life.. Methodology: A group of 21 board-certified dermatologists from the Philippine Dermatological Society (PDS) convened to discuss aspects in the clinical management of AD. Database and literature search included the full-text articles of observational studies, randomized controlled clinical trials, and observational studies using the Cochrane library, PubMed, Hardin (for Philippine based studies) as well as data from the PDS health information system. The terms used in combinations from the literature included “atopic dermatitis”, “atopic eczema”, “emollients”, “topical corticosteroids”, “topical calcineurin inhibitors”, “anti-histamines” and “phototherapy”. A total of fifty (50) full text articles were reviewed and found applicable for the scope of the study. Articles were assessed using the modified Jadad scale, with score interpretations as follows: (5- excellent, 3- good, 1– poor). Consensus guidelines for AD from within and outside of the region were also reviewed, from the 2013 Asia-Pacific guidelines, 2014 Taiwanese Dermatological Association consensus, 2016 guidelines in the management of AD in Singapore, 2014 American Academy of Dermatology guidelines, and the 2020 Japanese guidelines for AD. From the literature review, proposed consensus statements were developed, and a Delphi survey was conducted over two separate virtual meetings. Individual dermatologists provided Likert Scoring (1- strongly disagree to 5- strongly agree) based on consensus statements. A consensus was deemed reached at mean scores of > 4.00, a near consensus at > 3.5, and no consensus at <3.5. Summary: AD is a chronic relapsing condition with a significant burden of disease, most commonly affecting the pediatric population. The PDS AD Consensus Guidelines summarizes the standards of therapy and the therapeutic ladder in the management of AD based on published clinical trials and literature review. While these modalities remain the cornerstone of therapy, an individualized approach is the key to the holistic management of an AD patient. Knowledge and awareness of frequently associated conditions, whether in the realm of food allergies, contact allergies, or secondary infections, is paramount. In addition to the standard therapeutic armamentarium, the physician must also consider cultural practices and be knowledgeable of alternative therapeutic options. Referral to a specialist is recommended for recalcitrant cases of AD, or when initiation of systemic immunosuppressive agents, phototherapy, or biologic agents is contemplated.

Hepatic and Renal Biochemical Profile of Albino Rats Exposed to Chloroform and Methanol Leaf Extracts of Portulaca oleracea Linn.

Portulaca oleracea Linn. is among the medicinal plants used globally in the treatment of diseases and management of health challenges. The dearth of information on the long term effect of Portulaca oleracea on hepatic and renal toxicity prompted this study. The study investigated the subchronic effect of the oral administration of chloroform leaf extracts of Portulaca oleracea (CLEPO) and methanol leaf extracts of Portulaca oleracea (MLEPO) on plasma activity of some enzymes (ALT, ALP & AST) and levels of other biochemical parameters such as blood electrolytes, total protein, albumin, bilirubin, urea and creatinine in male albino rats. One hundred and twelve (112) animals were randomly divided into seven (7) groups of sixteen (16) rats each. Group A (Control) received 0.5ml/kg of 20% Tween 80 (vehicle), Groups B, C & D received 125, 250 & 500 mg/kg of CLEPO respectively and Groups E, F & G received 125, 250 & 500 mg/kg of MLEPO respectively for 60 days. On days 14, 28, 42 and 60; four rats from each group were anaesthetized and blood samples were collected for plasma biochemical assay. MLEPO caused a significant (p<0.05) decrease in plasma AST and ALP level while CLEPO significantly (p<0.05) decreased the plasma AST level. MLEPO produced a highly significant (p<0.01) reduction in both total bilirubin and conjugated bilirubin levels as well as significant (p<0.05) decline in urea level. CLEPO produced a significant (p<0.05) decrease on conjugated bilirubin. Both extracts significantly (p<0.05) reduced the chloride level. Oral administration of CLEPO and MLEPO over a 60 day period is neither hepatotoxic nor nephrotoxic.

Uterine Isthmic Atresia: Hope for a rare mullerian anomaly

@#The true incidence and prevalence of congenital Mullerian duct anomalies are difficult to determine. Some patients may present as adolescents with apparent primary amenorrhea, cyclical abdominal pain and sexual difficulties. It is important to ascertain a correct diagnosis for timely and appropriate interventions necessary to prevent sequelae that often affect the future fertility of these patients. This is a case of a fifteen year old with severe cyclical pelvic pain and hematuria with amenorrhea. Work up included a transrectal ultrasound and a magnetic resonance imaging of the pelvis revealing presence of a uterine corpus and cervix but absence of uterine isthmus. A conservative surgical approach was planned. The patient underwent end-to-end anastomosis of the cervix and uterine corpus. At present, the patient is regularly menstruating with no pelvic pain.

46, XY Partial Gonadal Dysgenesis diagnosed in adulthood

@#Partial Gonadal Dysgenesis (PGD) is a rare disorder of sexual development defined by sexual ambiguity and the presence of mullerian structures due to variable degrees of testicular dysgenesis in individuals with a non-mosaic 46, XY karyotype. Due to incomplete gonadal development, the external phenotype would rely on the degree of testicular function. The dysgenetic gonads found in PGD have high risk for malignant transformation. Although ambiguous genitalia was noted upon birth, a case diagnosed in adulthood is presented. Discordance between sex of rearing and the psychosexuality of the patient prompted consult. On work up, 46, XY was noted on karyotyping but presence of a uterus was seen on ultrasound. Hormonal assay revealed elevated levels of FSH and LH, while testosterone levels were low and estradiol was high. Gonadoblastoma was noted on final histopathologic evaluation. This report shall tackle thorough preoperative evaluation, surgical and postoperative management of individuals with PGD.

Associação da ocorrência do ectima contagioso (ORF vírus) em ovinos com os cuidadores desses animais / Occurrence of the Association contagious ecthyma (ORF virus) in sheep with these animals' caregivers

A enfermidade ectima contagioso está difundida em todo o estado de São Paulo. Foram amostrados 42 (8,64%) cuidadores de animais e 444 (91,36%) ovinos (n=486). A prevalência de reagentes para vírus-neutralização foi de 67% (IC95%=62-71%) nos ovinos, e em seus cuidadores de 76% (IC95%=63-89%), sendo P=0,22, ou seja, não houve diferença estatística significativa entre as espécies. A distribuição dos títulos teve diferença estatística significativa entre as espécies, com P=0,0048. As variações de titulação foram de 0,6 a 2,1 tanto nos ovinos quanto nos seus cuidadores. Dentre os 42 cuidadores de ovinos participantes do estudo, 32 apresentaram títulos de anticorpos expressos por log10 acima de 0,6.(AU)

These diseases are all widespread in the State of São Paulo. 42 (8.64%) animal caregivers and 444 (91.36%) sheep (n=486) were sampled. The reagents Prevalence paragraph virus neutralization was 67% (95% CI = 62-71%) in sheep and 76% (95% CI = 63-89%) for caregivers, with P=0.22 not being a statistically significant difference between the species. One of the distribution titles had significant difference between statistics as species with P=0.0048. The titration variations were 0.6 to 2.1, both in sheep and their caregivers. Among the 42 sheep caregivers participating in the study, 32 had antibody securities denominated in log10 above 0.6.(AU)

The pitfalls in the diagnosis and management of distal vaginal agenesis: a report of three cases

Vaginal agenesis is an uncommon congenital anomaly and such complex malformations are usually incorrectly identified. Deviations from the normal embryologic events in the reproductive system may result to malformations which may exhibit with the same clinical presentation. A complete history and physical examination coupled with appropriate imaging techniques are necessary to arrive at a correct diagnosis. Physicians must be aware of the differential diagnosis and management options available. A correct diagnosis must be made prior to any surgical intervention to prevent inappropriate surgeries with their anticipated complications. In cases with vaginal outlet obstruction, an accurate diagnosis with the adequate treatment reduces the need for re-operations and subsequent complications. Reported are three misdiagnosed cases of distal vaginal agenesis resulting to unwarranted surgical interventions.

Rothmund-Thomson syndrome in a Filipino child: Report of a rare case

Rothmund-Thomson syndrome (RTS) is a rare, autosomal recessive disorder characterized by early onset of progressive poikiloderma, cutaneous and extracutaneous findings including sparse hair, juvenile cataracts, short stature, skeletal defects, hypogonadism, dystrophic teeth and nails.This is a case of a 4-year-old boy who developed at 2 months of age, reticulated erythematous macules and patches over predominantly sun-exposed areas such as the malar areas, ears, neck, extensor surfaces of the forearms and legs. This later on progressed into poikilodermatous lesions associated with sparse scalp hair, eyebrows, eyelashes and short stature. This is a report on the first documented Filipino patient diagnosed with RTS.

Asymptomatic neurocutaneous melanosis in a Filipino baby girl

Neurocutaneous melanosis (NCM) is a rare congenital syndrome characterized by the development of congenital melanocytic nevi and benign or malignant melanocytic tumors of the central nervous system. Neurologic symptoms usually manifest during the first two years of life with a high mortality rate.This is a case of a 3-year-old girl presenting with generalized large and multiple hyperpigmented macules and patches, some with hair, over the scalp, face, trunk, and extremities, present since birth. Histologic findings of a nodule within a nevus include nested melanocytes at the epidermis, cords and strands of melanocytes extending to the deep reticular dermis showing maturation with descent and lack of mitosis consistent with melanocytic nevi. The cranial magnetic resonance imaging contrast study revealed melanocytic deposits on the cerebellum and amygdala. She has regular follow-up with her dermatologist, pediatrician, and neurologist. The patient has remained asymptomatic of neurological symptoms despite the melanocytic deposits in the central nervous system.

Densidade mineral óssea de crianças e adolescentes com hipotireoidismo congênito / Bone mineral density of children and adolescents with congenital hypothyroidism

Realizou-se estudo transversal com 60 pacientes (9,9 ± 1,8 anos) com hipotireoidismo congênito (HC) (grupo A): 40 meninas (23 pré-púberes) e 20 meninos (18 pré-púberes), com grupo controle (grupo B) constituído por 28 indivíduos (10,4 ± 2,1 anos): 18 meninas (8 pré-púberes) e 10 meninos (9 pré-púberes). OBJETIVOS: Avaliar a densidade (DMO) e o conteúdo mineral ósseo (CMO) e correlacioná-los com idade cronológica e óssea (IO), sexo, maturação sexual, dose de l-T4, TSH, TT4, FT4, e etiologia do HC. IO, DMO e CMO de corpo total (DXA) foram obtidos dos 2 grupos; TSH, TT4 e FT4, apenas dos pacientes. DMO foi menor no grupo A (0,795 ± 0,075 g/cm² vs. 0,832 ± 0,092; p = 0,04) e maior nas meninas púberes do que nas pré-púberes (p = 0,004). Não houve diferença significativa de DMO e CMO quanto ao sexo e etiologia do HC. Nosso estudo mostra que a DMO foi significativamente menor no grupo com HC, diferente dos dados da literatura.

A cross sectional study was made on 60 patients (9.9 ± 1.8 yr-old) with congenital hypothyroidism (CH) (group A): 40 girls (23 prepubertal) and 20 boys (18 prepubertal). Control group (group B) was constituted of 28 healthy children (10.4 ± 2.1 yr-old): 18 girls (8 prepubertal) and 10 boys (9 prepubertal). AIMS: To evaluate bone mineral density (BMD) and content (BMC) and to correlate them with chronological and bone age (BA), sex, sexual maturation, l-T4 dose, TSH, TT4, FT4, and CH etiology. BA, total body BMD, and BMC (DXA) were obtained of both groups. TSH, TT4, and FT4 were measured in patients only. BMD was lower in group A (0.795 ± 0.075 g/cm² vs. 0.832 ± 0.092; p = 0.04) and higher in pubertal than in prepubertal girls (p = 0.004). There was no significant difference between BMD and BMC related to sex and CH etiology. Our data demonstrated that BMD was significantly lower in children with CH, different from what has been published in the literature.

Efecto del contenido en la resolución de tareas de conjunción probabilísticas / Content effects in probability judgments

El error de conjunción (Tversky & Kahneman, 1983) se estudió en dos escenarios de probabilidad que suponen distintos contenidos en las tareas a resolver: ficcional y realista (Teigen, Martinussen & Lund, 1996). Participaron voluntariamente 83 sujetos de ambos sexos, alumnos de Psicología de la Universidad de Buenos Aires, quienes resolvieron ambas tareas. Las diferencias halladas en las cantidades de errores de conjunción al comparar las ejecuciones en los dos escenarios fueron altamente significativas. Los resultados reflejan una disminución de los errores cuando se presentan tareas realistas en lugar de ficcionales. Tales hallazgos indican la relevancia de considerar elementos socioecológicos tanto en razonamientos probabilísticos (Hertwig & Gigerenzer, 1999) como en las estrategias didácticas de enseñanza de probabilidad.

Fatores de virulência em linhagens de Escherichia coli isoladas de mastite bovina / Virulence factors in Escherichia coli strains isolated from bovine mastitis

Avaliou-se a ocorrência de fatores de virulência e do sorotipo O157:H7 em 120 linhagens de Escherichia coli, isoladas de 80 casos de mastite clínica bovina e 40 de mastite subclínica. Verificou-se alfa-hemolisina em oito (6,7 por cento) linhagens, isoladas de cinco casos de mastite clínica e três de mastite subclínica e em nenhuma das estirpes detectou-se enteroemolisina. A presença de sideróforos foi encontrada em 11 (9,2 por cento) linhagens, sete de mastite clínica e quatro de subclínica. Em duas (1,7 por cento) estirpes isoladas de mastite subclínica, identificou-se enterotoxina STa. Observou-se efeito citopático em células vero compatível com a produção de verotoxina-VT em cinco (4,2 por cento) linhagens, duas de mastite clínica e três subclínicas. Em uma (0,8 por cento) linhagem isolada de mastite clínica, detectou-se efeito citopático compatível com o fator necrosante citotóxico. Nenhuma estirpe apresentou-se sorbitol-negativa no MacConkey-sorbitol, tampouco aglutinou com o sorotipo O157:H7. Os antimicrobianos mais efetivos foram polimixina B (97,5 por cento) e norfloxacina (95,8 por cento). Observou-se multi-resistência a dois ou mais antimicrobianos em 24 (20 por cento) estirpes, principalmente com o uso de ampicilina e ceftiofur.

The occurrence of different virulence factors and O157:H7 serotype investigation in 120 Escherichia coli strains isolated from clinical (80 cases) and subclinical (40 cases) bovine mastitis was evaluated. Alpha-haemolysin was detected in 8 (6.7 percent) strains (5 clinical and 3 subclinical cases). None strain showed enterohaemolysin production. E. coli growth under iron restriction conditions (siderophores production) was observed in 11 (9.2 percent) strains (7 clinical and 4 subclinical cases). STa enterotoxin was detected in 2 (1.7 percent) strains from subclinical cases. Cytotoxic effect in vero cells compatible with verotoxin-VT production was observed in 5 (4.2 percent) strains (2 clinical and 3 subclinical cases). One strain (0.8 percent) isolated from clinical mastitis showed cytophatic effect in vero cells compatible with cytotoxic-necrotic-factor production. None strain showed non-sorbitol fermenting colonies using sorbitol MacConkey agar and agglutination with specific anti-sera for E. coli O157:H7 serotype investigation. Polymixin B (97.5 percent) and norfloxacin (95.8 percent) were the most effective drugs. Multiple-drug resistance for 2 or more antimicrobials was observed in 24 (20.0 percent) strains, mainly with use of ampicillin and ceftiofur.

Principais causas de diminuição da massa óssea em mulheres na pré-menopausa encaminhadas ao ambulatório de doenças ósteo-metabólicas de um Hospital Terciário de Curitiba / Main causes of low bone mass in premenopausal women referred to a Metabolic Bone Clinic of Curitiba / Main causes of low bone mass in premenopausal women referred to a Metabolic Bone Clinic of Curitiba

Selecionamos mulheres pré-menopausadas com redução da DMO encaminhadas ao ambulatório de Metabolismo Osseo do Hospital de Clínicas da UFPR, com o objetivo de definirmos o perfil destas pacientes em relação aos fatores de risco e prováveis causas secundárias de osteoporose. Trinta e quatro mulheres foram estudadas (19­48 anos). Em 29 pacientes (85,3 por cento) a coluna lombar estava acometida, 8 (23,5 por cento) apresentaram Z-score < -2,5 e 21 (61,8 por cento) Z-score entre -1,0 e -2,5. Vinte pacientes (58,8 por cento) apresentaram redução da DMO em fêmur, 2 (6,2 por cento) com Z-score < -2,5 e 18 (56,2 por cento) com Z-score entre -1,0 e -2,5. Causa secundária foi identificada em 26 pacientes (76,5 por cento). Este estudo demonstra que a realização de densitometria óssea é importante em mulheres na pré-menopausa com fatores de risco para redução da massa óssea, uma vez que permite o início precoce do tratamento e a prevenção das complicações relacionadas.

We conducted a chart review of premenopausal women with low bone mineral density referred to the Metabolic Bone Clinic of Federal University of Paraná, to determine the outline of these patients regarding their risk factors and secondary causes of osteoporosis. Thirty-four women (19­48 years old) were evaluated. Twenty nine (85.3 percent) patients presented a low bone mineral density (BMD) in lumbar spine, 8 (23.5 percent) had Z-score < -2.5 and 21 (61.8 percent) had Z-score between -1.0 and -2.5. Twenty patients (58.8 percent) had a low bone mass in total femur, 2 (6.2 percent) with Z-score < -2.5 and 18 (56.2 percent) with Z-score between -1.0 and -2.5. A secondary cause could be identified in 26 patients (76.5 percent). This study shows that DMO is important in premenopausal women with risk factors of low BMD because it leads to the best treatment option and follow-up.

Hypoparathyroidism and pseudohypoparathyroidism / Hipoparatiroidismo e pseudohipoparatiroidismo

The principal function of the parathyroid hormone (PTH) is maintenance of calcium plasmatic levels, withdrawing the calcium from bone tissue, reabsorbing it from the glomerular filtrate, and indirectly increasing its intestinal absorption by stimulating active vitamin D (calcitriol) production. Additionally, the PTH prompts an increase in urinary excretion of phosphorus and bicarbonate, seeking a larger quantity of free calcium available in circulation. Two mechanisms may alter its function, limiting its control on calcium: insufficient PTH production by the parathyroids (hypoparathyroidism), or a resistance against its action in target tissues (pseudohypoparathyroidism). In both cases, there are significantly reduced levels of plasmatic calcium associated with hyperphosphatemia. Clinical cases are characterized by nervous hyperexcitability, with paresthesia, cramps, tetany, hyperreflexia, convulsions, and tetanic crisis. Abnormalities such as cataracts and basal ganglia calcification are also typical of these diseases. Treatment consists of oral calcium supplementation associated with increased doses of vitamin D derivatives.

A principal função do paratormônio (PTH) é a manutenção dos níveis plasmáticos de cálcio, retirando-o do tecido ósseo, reabsorvendo-o do filtrado glomerular e, indiretamente, aumentando sua absorção intestinal através do estímulo para a produção de vitamina D ativa (calcitriol). Além disso, o PTH promove um aumento na excreção urinária de fósforo e bicarbonato, objetivando uma maior quantidade de cálcio livre disponível na circulação. Dois mecanismos podem alterar sua função, limitando seu controle sobre o cálcio: produção insuficiente de PTH pelas paratiróides (hipoparatiroidismo), ou uma resistência à sua ação nos órgãos-alvo (pseudohipoparatiroidismo). Em ambos os casos, ocorre uma redução significativa dos níveis plasmáticos de cálcio em associação com hiperfosfatemia. Manifestações clínicas características são: hiperexcitabilidade nervosa, com parestesia, cãimbras, tetania, hiperreflexia, convulsões e crise tetânica. Catarata e calcificação dos gânglios basais são anormalidades típicas dessas doenças. O tratamento consiste da suplementação oral de cálcio, associada com doses elevadas de derivados da vitamina D.

Corynebacterium bovis e os padrões de contagem de células somáticas no Brasil / The corynebacterium bovis and the somatic cell counting standards in Brazil / El Corynebacterium bovis y los paradrones celulares somáticos en brasil

Foram estudadas 60 amostras de leite de glândulas mamárias bovinas naturalmente infectadas pelo Corynebacterium bovis em estado puro, exuberante e que apresentavam pelo menos uma glândula contralateral com cultivo microbiológico negativo, provenientes de cinco propriedades leiteiras localizadas no interior do estado de São Paulo. Essas foram cultivadas em ágar sangue ovino e em agar MacConkey e submetidas à contagem eletrônica de células somáticas. Obtiveram-se medianas de contagens de células somáticas (CCS), 262 x 10³ céls/mL e 806 x 10³ céls/mL de leite, para as amostras negativas e positivas ao Corynebacterium bovis respectivamente, sendo que, em alguns casos positivos, a CCS superou 10.000.000 céls/mL de leite. Os dados obtidos no presente estudo sugerem que o Corynebacterium bovis é responsável por alterações celulares significativas no leite, podendo acarretar prejuízos aos produtores e à indústria de laticínios, na medida que se observam os padrões celulares stabelecidos pelo Ministério da Agricultura, Pecuária e Abastecimento em vigor desde setembro de 2002.

ABSTRACT: Sixty milk samples from bovine mammary glands naturally infected by Corynebacterium bovis in pure state, which presented at least one contralateral gland with negative microbiological culture from fi ve dairy farms in the State of Sao Paulo were studied. These samples were cultivated in MacConkey agar and submitted to an electronic Somatic Cell Counting (SCC). The medians of SCC results were 262 x 103 cells/mL and 806 x 103 cells/mL from negative and positive milk samples to C. bovis respectively. In some positive samples to the agent, it was observed SCC over 10.000.000 cells/mL of milk suggesting that C. bovis may be responsible for signifi cant cell alterations in the milk, which might cause serious economic damages to the producers and to the milk industry, according to the cell standards established by Agriculture Ministry, Brazilian law from September of 2002

RESUMEN: Fueron estudiadas sesenta muestras de leche de glándulas mamarias bovinas naturalmente infectadas por el Corynebacterium bovis en cultivo puro, provenientes de cinco haciendas lecheras localizadas en el interior del estado de São Paulo. Las muestras fueron cultivadas en agar sangre ovino y en agar MacConkey, y sometidas a cómputo electrónico de células somáticas. Se obtuvo medianas de los cómputos de células somáticas, 262 x 103 céls/mL y 806 x 103 céls/mL en la leche, para las muestras negativas y positivas al Corynebacterium bovis respectivamente, siendo que en algunos casos positivos, la CCS superó 10.000.000 céls/mL de leche. Los datos obtenidos en el presente estudio sugieren que el Corynebacterium bovis es responsable por alteraciones celulares signifi cativas en la leche, pudiendo acarrear perjuicios a los productores y a la manufactura de lácteos, en la medida que se observan los moldes celulares establecidos por el Ministerio de la Agricultura, Pecuaria y Abastecimiento en vigor desde setiembre de 2002

Características físico-químicas e contagem de células somáticas de leite proveniente de vacas naturalmente infectadas por streptococcus spp / Physic-chemical characteristics and somatic cell count in bovine milk naturally infected by streptococcus spp / Características físico-químicas y cómputo de células somáticas de leche de vacas naturalmentee infectadas por streptococcus spp

Foram estudadas 1051 vacas da raça Holandesa de seis propriedades leiteiras do estado de São Paulo. As amostras de leite foram cultivadas em ágar sangue ovino 8% e ágar MacConkey, sob aerofilia, por até 96 horas na intenção de isolar Streptococcus spp em estado puro. Confirmada a presença do agente, bem como a ausência de outros microrganismos aeróbicos nas amostras, realizaram-se as seguintes provas: densidade, gordura, extrato seco total (EST), extrato seco desengordurado (ESD), acidez (ºD), crioscopia, prova quantitativa para proteína, prova quantitativa para cloretos, contagem de células somáticas (CCS), bem como a classificação taxonômica do agente. A análise estatística dos resultados revelou que os Streptococcus spp promoveu alterações significativas no que diz respeito aos parâmetros densidade, gordura, teor de cloretos e contagem de células somáticas. Os resultados referentes aos padrões de proteína, EST, ESD e acidez não apresentam alterações estatisticamente significativas entre o grupo de amostras positivas para o agente e o grupo negativo. Com base nas alterações observadas conclui-se que o Streptococcus spp, como agente etiológico das mastites, causa perdas econômicas significativas aos produtores, indústria e consumidores da cadeia do leite.

ABSTRACT: 1051 Holstein cows from six dairy farms in Sao Paulo state - Brazil were studied. Milk samples were cultivated in sheep blood agar and 8% MacConkey agar, under aerobic conditions for 96 hours in order to isolate Streptococcus spp in pure state. All the positive samples and the control group of negative ones were submitted to the following tests: density, fatness, total dry extract (EST), fatless dry extract (ESD), acidity (ºD), cryoscopy, quantitative protein proof, quantitative chlorine proof, somatic cell count (SCC) as well as the taxonomic classifi cation of the agent. The statistical analysis showed that Streptococcus spp was responsible for signifi cant alterations in the parameters of density, fatness, chlorine and CCS. The results from the standards of protein, EST, ESD and acidity didn't present alterations statistically signifi cant among the positive samples for the agent and the negative group. Based on the observed alterations it was concluded that Streptococcus spp, as etiologic agent of mastitis, can cause signifi cant economic losses to producers, industry and milk consumers.

RESUMEN: Fueron estudiadas 1051 vacas de la raza Holandeza de seis propriedades de leche del Estado de São Paulo. Las muestras de leche fueron cultivadas en agar sangre de ovino 8% y agar MacConkey, bajo aerofi lia, hasta 96 horas para intentar aislar Streptococcus spp en estado puro. Confi rmada la presencia del agente, así como la ausencia de otros microorganismos aeróbicos en las muestras, fueron realizadas las siguientes pruebas: densidad, grasa, extracto seco total EST), extracto seco sin grasa (ESD), acidez (D), crioscopia, prueba cuantitativa para las proteinas prueba cuantitativa para los cloretos, cómputo de las células somáticas (CCS), así como la clasifi cación taxonómica del agente. El análisis estadístico de los resultados reveló que los Streptococcus spp promovieron alteraciones signifi cativas para los parámetros densidad, grasa, tenor de cloretos y cómputo de células somáticas. Los resultados referentes a los moldes de proteínas, EST, ESD y acidez no presentaron alteraciones estadísticamente signifi cativas entre el grupo de muestras positivas para el agente y el grupo negativo. Basándose en las alteraciones observadas se conclui que el Streptococcus spp, como agente etiológico de la infección, causa pierdas económicas signifi cativas a los productores, a la industria y a los consumidores de la leche.

Cervical agenesis: a retrospective series

Objective: The objective is to describe the clinical presentation and management of cervical agenesis. Study Design: This is a retrospective analysis of 5 patients with cervical agenesis managed in a university tertiary institution and a review of similar cases cited in literature. Results: There are only 119 cases of cervical agenesis described to date, with pelvic pain and primary amenorrhea as common presenting symptoms. Forty-nine percent presented with associated vaginal agenesis. Successful canalization was performed in 41-46 percent. Nine successful spontaneous pregnancies and by zygote intrafallopian transfer have been cited. Conclusions: Cervical agenesis is a rare condition. Concomitant vaginal agenesis occurs in nearly half of subjects. Results of successful conservative surgery are comparable between cervicovaginal agenesis and cervical agenesis but there are more morbidities and mortalities associated with the former. Hysterectomy is another option. Careful patient selection, psychological support and individualized treatment are key to proper management.

Modified E-test by the addition of EDTA-Tris and dimethyl sulfoxide on the potentiation of the effects of some antimicrobials in Pseudomonas aeruginosa strains isolated from bovine mastitis

A concentração inibitória mínima-MIC em 30 estirpes de Pseudomonas aeruginosa isoladas de mastite bovina foi avaliada utilizando o E-test padrão e o método modificado, pela adição de Tris-EDTA e DMSO. Os métodos modificados apresentaram redução significativa da MIC das estirpes utilizando a gentamicina, a ciprofloxacina e a norfloxacina.