Encefalitis límbica asociada a secreción inadecuada de hormona antidiurética. Reporte de un caso y revisión de la literatura / Limbic encephalitis associated with inappropriate secretion of antidiuretic hormone. A case report and literature review / Encefalite límbica associada à secreção inapropriada de hormônio antidiurético. Relato de caso e revisão da literatura

La encefalitis límbica (EL) autoinmune es una afección neurológica infrecuente de curso subagudo con manifestaciones neuropsicológicas. Actualmente el tratamiento inmunoterápico agudo o de mantenimiento es dirigido según el anticuerpo neural acompañante y la presencia o ausencia de cáncer. Presentamos el caso de una mujer de 52 años con hipotiroidismo autoinmune, síndrome de secreción inadecuada de hormona antidiurética (SIADH) e hiponatremia (hipoNa) persistente, con evolución progresiva de perdida de la memoria y crisis distónicas faciobraquiales (DFBC) a quien se le realiza un diagnóstico oportuno de encefalitis límbica. Recibió tratamiento intravenoso combinado en base a corticoides e inmunoglobulina con buena respuesta y morbilidad mínima neuropsicológica. El reconocimiento de esta patología permite un diagnóstico y tratamiento temprano, imprescindible para mejorar el pronóstico de estos pacientes.

Autoimmune limbic encephalitis is a rather unusual neurological condition with subacute progression and neuropsychological symptoms. Currently, acute or maintenance treatment with immunotherapy is targeted depending on the accompanying neural specific antibody and the presence or absence of cancer. The study presents the case of a 52-year-old woman suffering from autoimmune hypothyroidism, syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) and persistent hyponatremia, with progressive evolution which involved memory loss and faciobrachial dystonic seizures (FBDS). She was timely diagnosed with limbic encephalitis and was treated with intravenous combined corticosteroids and immunoglobulin therapy. Response was good, with minimum neuropsychological. Recognizing this condition allows for early diagnosis and treatment, what is key to improve the prognosis of these patients.

A encefalite límbica (LE) autoimune é uma condição neurológica rara de curso subagudo com manifestações neuropsiquiátrica. Atualmente, o tratamento com imunoterapia aguda ou de manutenção é orientado de acordo com o anticorpo neural e a presença ou ausência de câncer. Apresentamos o caso de uma mulher de 52 anos com hipotireoidismo autoimune, síndrome de secreção inapropriada de hormônio antidiurético e hiponatremia persistente, com evolução progressiva da perda de memória e crises distônicas faciobraquiais que foi diagnosticada oportunamente como encefalite límbica. Recebeu tratamento endovenoso combinado à base de corticoide e imunoglobulina com boa resposta e morbidade neuropsiquiátrica mínima. O reconhecimento desta patologia permite um diagnóstico e tratamento precoces, essenciais para melhorar o prognóstico desses pacientes.

COVID 19 INFECTION IN A PATIENT NEWLY DIAGNOSED WITH HIV/TB COINFECTION – A CASE REPORT

HIV/TB coinfection, COVID 19 with HIV/TB, immune reconstitution inflammatory syndrome (IRIS), TB lymphadenopathy

High prevalence of HIV-associated neurocognitive disorders (HAND) in São Paulo City, Brazil / Alta prevalência de desordem neurocognitiva associada ao HIV (HAND) na Cidade de São Paulo, Brazil

INTRODUCTION: HIV-associated neurocognitive disorders (HAND) are the subject of many studies, some of them reporting a prevalence of up to 50 percent. OBJECTIVES: To determine the prevalence and factors associated with HIV neurocognitive disorders (HAND) in a cohort of HIV-1-infected patients in São Paulo city, Brazil. METHODOLOGY: Descriptive cross-sectional study including 106 HIV-1-infected patients, employing direct interview and neuropsychological tests, applied by trained neuro-psychologists with expertise in the tests. Other, similar assessment tools we used were Brief Neurocognitive Questionnaire, International HIV Dementia Scale, Lawton Instrumental Activities of Daily Living, Hospital Anxiety and Depression Scale, Social Support Scale for People with HIV/Aids, Assessment of Adherence to Antiretroviral Therapy Questionnaire, and a complex neuropsychological assessment. RESULTS: We included 106 patients from May 2015 to April 2018. We found a high prevalence of HAND in our patients (45%), with 27.5% presenting asymptomatic neurological impairment (ANI) and 17.5% mild neurological dysfunction (MND); only one patient presented HIV-associated dementia (HAD) (0.9%). Women were more likely to have MND (52.9%) and the only case of HAD was also female. The high prevalence of neurocognitive disorders was independent of the immunological status, use of efavirenz, or virological control. CONCLUSIONS: This study may mirror the national and international scenarios, showing a high prevalence of HAND (45%) and the prevalence of some risk factors, in special among women

INTRODUÇÃO: As doenças neurocognitivas associadas ao HIV (HAND), são o assunto de muitos estudos, alguns deles relatando uma prevalência de até 50 por cento. OBJETIVOS: Determinar a prevalência e os fatores associados aos distúrbios neurocognitivos do HIV (HAND) em uma coorte de pacientes infectados pelo HIV-1 na cidade de São Paulo, Brasil. METODOLOGIA: Estudo transversal descritivo incluindo 106 pacientes infectados pelo HIV-1, utilizando entrevista direta e testes neuropsicológicos, aplicados por neuropsicólogos treinados com experiência nos testes. Foram utilizados também: Questionário Neurocognitivo Breve, Escala Internacional de Demência do HIV, Atividades Instrumentais de Vida Diária de Lawton, Escala Hospitalar de Ansiedade e Depressão, Escala de Apoio Social para Pessoas com HIV / Aids, Avaliação da Adesão à Terapia Antiretroviral Questionário e uma bateria de avaliação neuropsicológica complexa. RESULTADOS: Foram avalaidos 106 pacientes de maio de 2015 a abril de 2018. Foi observado uma alta prevalência de HAND em nossos pacientes (45%), com 27,5% apresentando comprometimento neurológico assintomático (ANI) e 17,5% comprometimento cognitive leve (MND); apenas um paciente apresentou demência associada ao HIV (DAH) (0,9%). As mulheres eram mais propensas a ter MND (52,9%) e o único caso de HAD também era do sexo feminino. A alta prevalência de distúrbios neurocognitivos foi independente do estado imunológico, uso de efavirenz ou controle virológico. CONCLUSÕES: Este estudo pode espelhar o cenário nacional e internacional, mostrando uma alta prevalência de HAND (45%) e a prevalência de alguns fatores de risco, em especial entre as mulheres

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Prácticas pa ra la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia) / Practices for the prevention of accidents in the home in caregivers of children from 1 to 5 years in a district of Cartagena (Colombia)

Introducción: los accidentes en la población infantil constituyen una importante causa de morbilidad y mortalidad convirtiéndose hoy día en un problema de salud pública mundial, principalmente la población más afectada son los niños en etapa preescolar, por la vulnerabilidad y dependencia del cuidador. Objetivos: describir las prácticas para la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia). Materiales y métodos: estudio cuantitativo descriptivo transversal. Constituido por 354 cuidadores de niños menores de 5 años, se utilizó la técnica de observación y la aplicación del instrumento con base a la práctica N° 15 de AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia). Resultados: socio demográficamente los cuidadores fueron principalmente de género femenino (87%), con 20 ­ 29 años de edad (44,9%), madres de los niños (61,3%), conviven en unión libre (54,2%), son bachilleres (50,3%), de estrato uno (91,8%), amas de casa (62,7%), con hijos (93,8%), residen en casas (54,5%). Los niños de 1 a 5 años fueron mayoritariamente de género masculino (51,7%), y han presentado accidentes (75,1%), sobre todo, caídas (61,9%). El nivel de riesgo de accidentes en el hogar fue bajo (85%), y las prácticas de prevención suelen ser regulares (55,1%). Conclusión: los niños enfrentan relativamente bajo riesgo de accidente en el hogar, sin embargo, las prácticas para prevenirlos resultan ser regulares..(AU)

Introduction: accidents in children are an important cause of morbidity and mortality,becoming today a global public health problem, mainly the most affected population are children in preschool, for the vulnerability and dependence of the caregiver. Objectives:to describe the practices for the prevention of accidents at home in caregivers of children from 1 to 5 years of age, in a neighborhood of Cartagena (Colombia). Materials and methods: quantitative, descriptive and cross-sectional study. Consisting of 354 caregivers of children under 5 years of age, the technique of observation and the application of the instrument was used based on practice No. 15 of IMCI (Integrated Management of Childhood Illness). Results: demographic partner caregivers were mainly female (87%), with 20 - 29 years of age (44.9%), mothers of children (61.3%), live together in a free union (54.2%), are high school graduates (50.3%), of stratum one (91.8%), housewives (62.7%), with children (93.8%), reside in houses (54.5%). Children from 1 to 5 years old were male (51.7%), and had accidents (75.1%), especially falls (61.9%). The level of accident risk in the home was low (85%), and prevention practices are usually regular (55.1%). Conclusion: children face relatively low risk of accident in the home, however, practices to prevent them turn out to be regular..(AU)

Quality of life among patients with age-related severe macular degeneration assessed using the NEI-VFQ, HADS-A, HADS-D and SF-36 tests. A cross-sectional study

ABSTRACT BACKGROUND: Exudative age-related macular degeneration (e-AMD) may cause severe central vision loss. Patients with e-AMD can experience difficulties in daily basic activities and suffer from psychological problems. Our aim was to assess quality of life (QoL) and anxiety and depression status among patients with e-AMD. DESIGN AND SETTING: Cross-sectional study in a state university. METHODS: We included 200 e-AMD patients and 120 age and gender-matched controls. We assessed QoL using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and the Short Form (SF)-36 test; and anxiety and depression status using the Hospital Anxiety Depression Scales A and D (HADS-A and HADS-D). RESULTS: The mean ages in the e-AMD and control groups were 68.40 ± 9.8 and 66.31 ± 8.98, respectively. Visual acuity among e-AMD patients was 0.37 ± 0.31 and 0.39 ± 0.32 in the right and left eyes, respectively. The e-AMD patients performed significantly worse than the controls in NEI-VFQ-25 (P < 0.05 for all items). The proportions of e-AMD patients scoring higher than the cutoffs in HADS-A and HADS-D were significantly higher than among the controls (41.5% versus 12.5% and 63.5% versus 27.5%; P < 0.001). The e-AMD patients had significantly lower mean scores than the controls for each of the SF-36 QoL items (P < 0.001). The NEI-VFQ-25 scores were significantly lower among patients with bilateral e-AMD than among those with unilateral disease (P < 0.05 for all). The HADS scores were positively correlated with duration of e-AMD and patient age, but negatively with vision levels (P < 0.05 for all items). CONCLUSION: The e-AMD patients had higher depression and anxiety scores and lower QoL scores.

Status of HIV infection and its influencing factors in the MSM population of Haikou city, China, in 2018

Objective: To understand the current status of AIDS epidemic among men who had sex with men (MSM) in Haikou, and to analyze the influencing factors to assess the risk of HIV/AIDS infection in MSM group, and then provide a theoretical basis for MSM population to prevent HIV transmission. Methods: Snowball sampling method was used to find men who had homosexual intercourse in oral sex or anal sex in the past year and conducted a questionnaire survey of them. Blood samples were collected to detect three antibodies against: HIV, syphilis and hepatitis C (HCV). Excel 2007 and SPSS22.0 software were used for statistical description, χ2 test and logistic regression analysis. Results: A total of 408 MSMs were investigated in this study, 27 HIV infections were detected, with a positive rate of 6.6%. Univariate analysis showing there were statistically significant differences in the prevalence of AIDS in ethnic minorities, local residence time, condom use for same-sex anal sex in the past 6 months, people with sexually transmitted diseases in recent one year, syphilis, and gonorrhea (P<0.05). Logistic regression analysis showed that minority nationality and HIV infection sexually transmitted disease in the past year were risk factors for HIV infection, and condom use for same-sex anal sex in the past 6 months, the opposite sex occurred in the last 6 months and high education level are protective factors for HIV infection. Conclusion: The HIV infection rate of the MSM population in Haikou is high. It is necessary to increase the use of condoms in the MSM population. For low-education MSM, it is necessary to strengthen the dissemination and education of AIDS-related knowledge, so as to reduce the spread of AIDS in the MSM population.

Syndrome of inappropriate antidiuretic hormone secretion induced by the phytotherapy Harpagophytum procumbers: case report / Síndrome da secreção inapropriada do hormônio antidiurético induzida pelo fitoterápico Harpagophytum procumbers: relato de caso

Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the inability of antidiuretic hormone (ADH) suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.

Resumo Introdução: A síndrome da secreção inapropriada do hormônio antidiurético (SIADH) consiste na incapacidade de supressão do hormônio antidiurético (ADH), comprometendo os mecanismos de excreção da água e concentração urinária. Possui como manifestações a hiponatremia e seus sintomas, sobretudo neurológicos. Há variadas causas que desencadeiam tal distúrbio, a se destacarem: distúrbios do sistema nervoso central, neoplasias malignas e drogas, dentre outros. Relato de Caso: Paciente feminina, 65 anos, hipertensa, apresentando manifestações clínicas e laboratoriais correspondentes à hiponatremia. O fato ocorreu em duas ocasiões em vigência de medicação fitoterápica para tratamento de osteoartrite. Discussão: A hiponatremia relacionada às drogas pode ser provocada pelo efeito direto do medicamento ou por desencadear SIADH. As manifestações clínicas apresentadas poderiam ter sido atribuídas a um quadro psiquiátrico, o que poderia ter desfecho grave, caso não diagnosticada corretamente. A associação de um fitoterápico à SIADH pôde ser confirmada após novo episódio de hiponatremia relacionado à reintrodução do Harpagophytum procumbers. Nossa revisão da literatura não encontrou este fitoterápico associado à SIADH, até o momento. Conclusão: SIADH pode ser ocasionada por medicamento fitoterápico doravante descrita sua associação na literatura.

Analyzing Antenatal Test and Outcomes of Rh-negative Pregnant Women / 实用妇产科杂志

Objective:To study antenatal immunity test and outcomes of Rh-negative pregnant women.Methods:287cases(1.25％ in 22880 cases)of Rh-negative pregnant women delivered in Shanghai Sixth People hospital from January 1 st,2010 to December 31,2016 were retrospectively analyzed.Rh(D) blood group was identified by a micro column gel method,and the same as serum anti-D antibody.The Rh phenotype detection was done Serology method and the hemolytic disease of the newborn was used indirect antiglobulin test,serum free antibody test,absorption and elution test.Some Rh negative pregnant women were implemented autologous blood at 37 weeks of gestation.Results:Among 287 cases of Rh-negative,12 cases had anti-D antibody and the positive rate was 4.18％.Among the 12 cases of anti-D positive,their Rh phenotype were all ccdee and they all had history of childbearing.In 90 cases which had one history of birth,there were ten cases had anti-D antibody (11.11％),in 15 cases which had two history of birth,there were two cases had anti-D antibody(13.33％).287 Rh negative pregnant women had 290 child births,among which 8 newborn had neonatal hemolytic disease,the incidence rate was 2.75％ (8/290).In the 12 cases of anti-D positive,there were 1 case died because of fetal neonatal hemolytic disease and 7 cases were cured and 4 cases were normal with free of jaundice symptoms.There were 146 pregnant women implementation of autologous donation safely.According to the delivery way of childbirth,287 cases were divided by cesarean section and vaginal delivery,comparing postpartum haemorrhage amount with autologous donantion and unautologous donation,respectively,the result showed that they had no significant difference(P ＞0.05).Conclusions:It should be pay attention to the pregnant women who had childbearing history and whose Rh phenotype is ccee,which tend to produce anti-D immune antibody.However,this does not necessarily lead to hemolytic disease.Based on maternal and fetus conditions,autologous donation is safe and valuable in Rh-negative pregnant.

La Escala de Ansiedad y Depresión Hospitalaria (HAD) en fibromialgia: análisis de sensibilidad y especificidad / Hospital Anxiety and Depression Scale (HADS) in fibromyalgia: sensitivity and specificity analysis

La sociedad española de Reumatología (SER) (rivera et al., 2006) recomienda la escala de ansiedad y Depresión Hospitalaria (Hospital anxiety and Depression Scale - HADS, Zigmond y Snaith, 1983) para la evaluación clínica de ansiedad y depresión en Fibromialgia (FM). sin embargo, no constan índices de sensibilidad/especificidad ni puntos de corte en FM. Con el objetivo de comprobar aplicabilidad, propiedades psicométricas y sensibilidad/especificidad del HAD en FM, se evaluó a 131 pacientes ambulatorios del Hospital de san Vicente (alicante, España), utilizando como criterios externos BDI y STAI-E. se analizaron ítems, consistencia interna y estructura factorial mediante análisis confirmatorio y puntos de corte con curvas ROC. Se replicó la estructura de dos factores. La fiabilidad es adecuada (HADA=.80, HADD=.85). Se muestran diferentes puntos de corte con sensibilidad/especificidad superior al 70 por ciento para cada subescala. El Had presenta propiedades psicométricas óptimas en población FM, mostrándose útil como instrumento de "screening" de sintomatología ansioso-depresiva en esta población.

Spanish Society of Rheumatology (SER) (Rivera et al., 2006) suggests the Hospital Anxiety and Depression Scale (HADS, Zigmond y Snaith, 1983) for clinical assessment of anxiety and depression in fibromyalgia (FM). However, there is no HAD-FM cut-off yet. Aiming to assess applicability, psychometric properties and sensitivity/specificity of HADS in FM, 131 outpatients were assessed at San Vicente Hospital (Fibromyalgia service, Alicante, Spain), using like external criteria BDI and STAI-E. Item analysis was performed, calculating the internal consistency and factor structure study by confirmatory factor analysis (CFA). The cut-off points were found by ROC curves. Two-factor structure was replicated. Reliability is adequate (HADA=.80, HADD=.85). Several cut-off points are showed with sensitivity and specificity levels >70 percent for both subscales. HADS has optimal psychometric properties in FM and its useful as a screening tool to assess anxious-depressive symptoms in FM patients.

Effect of 1, 25-dihydroxy vitamin D3 combined with mechanical strain treatment on proliferation, differentiation, and expression of OPG and RANKL in osteoblastic MC3T3-E1 cells / 医用生物力学

Objective To investigate the effect of 1,25-(OH)2-vitamin D3 (VD3) or mechanical strain alone and their combined treatment on proliferation and differentiation of pre-osteoblast MC3T3-E1 cells in vitro, as well as gene and protein expression of osteoprotegerin (OPG) and receptor activator of nuclear factor-кB ligand (RANKL) in those cells. Methods MC3T3-E1 cells were treated with 10 nmol/L VD3, intermitted mechanical strain or with a combination of these two factors. Cell proliferation was assessed with flow cytometry, and alkaline phosphatase (ALP) activity was measured using a fluorometric detection kit. The mRNA expression of ALP, runt-related transcriptional factor 2 (Runx2), OPG, and RANKL genes was determined by real-time PCR. The proteins expression of Runx2, OPG, and RANKL was determined by Western blotting. ResultsVD3 inhibited the proliferation of MC3T3-E1 cells, but the mechanical strain had no effect on cell proliferation. Mechanical strain, VD3, and the combined treatment enhanced the ALP activity of MC3T3-E1 cells as well as the protein expression of Runx2. The effect of combined treatment was less pronounced than the effect of VD3 or mechanical strain alone. Mechanical strain promoted the gene and protein expression of osteoprotegerin (OPG) and increased the ratio of OPG/RANKL. However, the combination of VD3 and mechanical strain led to a decrease in ratio of OPG/RANKL. Conclusions Mechanical strain might be effective in inducing osteogenic differentiation and increasing bone formation. A joint stimulation with VD3 and strain can decrease proliferation and osteogenic differentiation and increase RANKL expression, which might affect bone remodeling. This study supplies some new data, which might be important in theoretical and clinical research of osteoporosis (OP) and other related bone diseases.

Mitochondrial Dysfunction of Immortalized Human Adipose Tissue-Derived Mesenchymal Stromal Cells from Patients with Parkinson's Disease

Mitochondrial dysfunction in dopaminergic neurons of patients with idiopathic and familial Parkinson's disease (PD) is well known although the underlying mechanism is not clear. We established a homogeneous population of human adipose tissue-derived mesenchymal stromal cells (hAD-MSCs) from human adult patients with early-onset hereditary familial Parkin-defect PD as well as late-onset idiopathic PD by immortalizing cells with the hTERT gene to better understand the underlying mechanism of PD. The hAD-MSCs from patients with idiopathic PD were designated as "PD", from patients with Parkin-defect PD as "Parkin" and from patients with pituitary adenomas as "non-PD" in short. The pGRN145 plasmid containing hTERT was introduced to establish telomerase immortalized cells. The established hTERT-immortalized cell lines showed chromosomal aneuploidy sustained stably over two-years. The morphological study of mitochondria in the primary and immortalized hAD-MSCs showed that the mitochondria of the non-PD were normal; however, those of the PD and Parkin were gradually damaged. A striking decrease in mitochondrial complex I, II, and IV activities was observed in the hTERT-immortalized cells from the patients with idiopathic and Parkin-defect PD. Comparative Western blot analyses were performed to investigate the expressions of PD specific marker proteins in the hTERT-immortalized cell lines. This study suggests that the hTERT-immortalized hAD-MSC cell lines established from patients with idiopathic and familial Parkin-defect PD could be good cellular models to evaluate mitochondrial dysfunction to better understand the pathogenesis of PD and to develop early diagnostic markers and effective therapy targets for the treatment of PD.

Hiponatremia: conceitos básicos e abordagem prática / Hyponatremia: basic concepts and practical approach

Hyponatremia is the most common electrolyte imbalance in hospitalized patients. It is associated with several unfavorable endpoints such as: the need for intensive care, longer hospital stay, higher hospitalization costs, discharge to long-term care facilities, and mortality. It is still not clear if there is a direct causal relationship or if hyponatremia is simply a marker of disease severity. Nevertheless, it is quite clear that improper management of a hyponatremic patient may result in severe neurologic damage or death. This paper addresses the basic pathophysiologic concepts about hyponatremia followed by a practical approach to its diagnosis and management.

Hiponatremia é o distúrbio hidroeletrolítico mais comum em pacientes hospitalizados. A presença de hiponatremia está associada a uma série de desfechos desfavoráveis, tais como: necessidade de internamento em unidade de terapia intensiva, hospitalização prolongada e de maior custo, transferência para abrigos e mortalidade. Ainda não está claro se existe relação de causalidade direta ou se a hiponatremia é apenas um marcador de gravidade da doença de base. No entanto, sabe-se que o manejo inadequado de um paciente hiponatrêmico pode causar graves danos neurológicos ou até mesmo a morte. Neste manuscrito, os conceitos básicos sobre a fisiopatologia da hiponatremia serão revisados, seguido de uma abordagem prática sobre sua investigação e tratamento.

Efeito de herbicidas e fungicidas nas curvas de progresso e quantificação de danos causados pela ferrugem asiática da soja / Effect of herbicides and fungicides on progress curves and damage quantification caused by soybean rust

O fungo Phakopsora pachyrhizi Sydow & Sydow representa grande ameaça à sojicultura nas principais regiões produtoras do mundo, onde significativas perdas foram relatadas. Na quantificação de danos causados, muitas são as variáveis a serem estudadas, como área abaixo da curva de progresso da doença (AACPD), absorção de luz da área foliar sadia (HAA) e duração da área foliar sadia (HAD), além das curvas de progresso da doença. Neste trabalho, objetivou-se verificar a influência de diferentes herbicidas e fungicidas no progresso da doença, bem como suas implicações nas variáveis referentes à área foliar sadia e à produtividade da cultura. Os tratamentos testados em duas cultivares ('MG/BR46 Conquista' e 'BRS Valiosa RR') foram: 1. Testemunha; 2. Testemunha com herbicidas; 3. Herbicidas e pyraclostrobin (V4) + pyraclostrobin + epoxiconazole (R2 e R5.1); 4. Herbicidas e pyraclostrobin (V4) + epoxiconazole (R2 e R5.1); e 5. Herbicidas (V4) + pyraclostrobin + epoxiconazole (R2 e R5.1). Os herbicidas utilizados em 'MG/BR-46 Conquista' foram sethoxydim, bentazon e chlorimuron-ethyl, sendo utilizado glyphosate na 'BRS Valiosa RR'. O modelo logístico foi o que melhor se adequou à severidade média das avaliações e à curva de progresso da doença. Para o terço inferior, posição do dossel mais propícia à doença, o modelo logístico com taxa variável foi o que mais se ajustou aos dados. A pulverização de pyraclostrobin + epoxiconazole reduziu a taxa de desenvolvimento de P. pachyrhizi em relação à epoxiconazole. A utilização da mistura influenciou as variáveis AACPD, HAA e HAD, sendo estas consideradas apropriadas para a quantificação dos danos provocados pela ferrugem asiática. Na 'MG/BR-46 Conquista', a ação dos herbicidas afetaram temporariamente a área foliar, atingindo indiretamente as variáveis HAA e HAD.

Phakopsora pachyrhizi Sydow & Sydow is the worst threat for soybean crop in the most important growing regions around the world, where great losses were observed. Many variables are studied in the quantification of damage such as area under the disease progress curve (AUDPC), healthy leaf area absorption (HAA), healthy leaf area duration (HAD), in addition to disease progress curves. The present research aimed to evaluate the effect of several herbicides and fungicides on the progress of the disease and its implications for variables related to healthy leaf area and yield. The treatments were evaluated in two cultivars (MG/BR-46 Conquista e BRS Valiosa RR): 1. Control; 2. Control with herbicides; 3. Herbicides and pyraclostrobin (V4) + pyraclostrobin+ epoxiconazole (R2 and R5.1), 4. Herbicides and pyraclostrobin (V4) + epoxiconazole (R2 and R5.1). 5. Herbicides (V4) + pyraclostrobin + epoxiconazole (R2 and R5.1). The herbicides used in MG/BR-46 Conquista were sethoxydim, bentazon and chlorimuron-ethyl; in BRS Valiosa RR, glyphosate was used. The logistic was the model that best adapted to the mean severity ratings and the disease progress curve. At the bottom of canopy, position more favorable to this disease, the logistic model with variable rate was the model that better explain the data. The spraying of strobilurin's group associated with triazole (pyraclostrobin + epoxiconazole) reduced the rate of asian rust development, in relation to the group of ergosterol biosynthesis inhibitors fungicide (epoxiconazole). The pyraclostrobin + epoxiconazole influenced the variables AUDPC, HAA and HAD, and these can be considered suitable to quantify damage caused by this disease. In MG/BR-46 Conquista, the herbicides action affects temporarily the leaf area, affecting indirectly the HAA and HAD variables.

Síndrome inapropriada do hormônio antidiurético (SIADH) pós-abdominoplastia / Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) post abdominoplasty

Este é um caso de síndrome inapropriada do hormônio antidiurético (SIADH) em umamulher, 39 anos, hígida, sem comorbidades importantes, submetida a abdominoplastia semlipoaspiração associada, que desenvolveu, 30 horas após a cirurgia, hiponatremia aguda(sódio 114,9 mEq/L-1), com importantes manifestações neurológicas. O difícil diagnósticoprecoce desta situação clínica grave, em pacientes saudáveis, pode causar importantes sequelasneurológicas e até mesmo o óbito. O diagnóstico precoce e a instituição de tratamentode reposição corretos são a chave para evitar lesões cerebrais irreversíveis.

This is a case of syndrome of inappropriate anti-diuretic hormone (SIADH) in a healthy woman,39 years old without comorbites, with developed postoperative acute hyponatremia (sodium 114mEq/L-1) after abdominoplasty without liposuction with important neurologic manifestations.The initial diagnosis of this syndrome in normal patients could avoid permanent neurologicdamage. The early recognition and correct treatment are vital to avoid a poor cerebral outcome.

The Extracellular Matrix Affected Proliferation and Cell Adhesion of Human Adipose Tissue Derived Mesenchymal Stem Cells in vitro

PURPOSE: Human mesenchymal stem cells (hMSCs) have the potency for self-renewal and differentiation into various kinds of cells. The hMSCs are obtained from the various tissues, including adipose tissue, bone marrow and cord blood. The extracellular matrix (ECM) is an important factor that affects cell adherence, growth, migration, apoptosis and differentiation both in vitro and vivo. The adipose-derived mesenchymal stem cells (AD-MSCs) have CD29 (integrin) on the cell surface, which is the receptor for fibronectin. The aim of this study is to validate the efficacy of ECM, and especially fibronectin, for cell expansion. METHODS: The AD-MSCs were obtained from the abdominal fat of humans. These cells were seeded onto culture plates coated with fibronectin-Human (FN) and plates without ECM (control). The cells were incubated for 3 passages and the cellular morphology was simultaneously observed with microscopy. CCK-8 assay was performed to compare the proliferation ability in each condition at the same passage. Immunocytochemistry staining for integrin-beta1 was performed to observe the cell to cell interaction. RESULTS: The hAD-MSCs in the FN-coated and non-coated plates exhibited cytoplasm staining for integrin-beta1. In all the cultures, extended fibroblastic-shaped cells that turned into rhomboid cells were most frequently observed. The cell growth rates for the non coated culture plate were lower than those for the FN coated plates. After 72 hour culture under the different coated concentrations of FN and the non coated condition (control), the control group had a lower growth rate. In the culture with a FN coated plate, a significant change was observed as compared with that of the control group. We observed an increase in cell proliferation, with a maximum of 140%, on the FN coated plate by performing CCK-8 assay. In comparison, integrin beta1 on the cells was more expressed in the FN-coated plates than that in the non-coated plates. CONCLUSION: The cell morphology can be changed faster in the FN coated culture plates than that in the non coated culture plates. Because proliferation and adhesion with FN can enhance the expansion, the culture within a FN coated plate is needed to encourage hAD-MSCs to proliferate in vitro.

The Extracellular Matrix Affected Proliferation and Cell Adhesion of Human Adipose Tissue Derived Mesenchymal Stem Cells in vitro

PURPOSE: Human mesenchymal stem cells (hMSCs) have the potency for self-renewal and differentiation into various kinds of cells. The hMSCs are obtained from the various tissues, including adipose tissue, bone marrow and cord blood. The extracellular matrix (ECM) is an important factor that affects cell adherence, growth, migration, apoptosis and differentiation both in vitro and vivo. The adipose-derived mesenchymal stem cells (AD-MSCs) have CD29 (integrin) on the cell surface, which is the receptor for fibronectin. The aim of this study is to validate the efficacy of ECM, and especially fibronectin, for cell expansion. METHODS: The AD-MSCs were obtained from the abdominal fat of humans. These cells were seeded onto culture plates coated with fibronectin-Human (FN) and plates without ECM (control). The cells were incubated for 3 passages and the cellular morphology was simultaneously observed with microscopy. CCK-8 assay was performed to compare the proliferation ability in each condition at the same passage. Immunocytochemistry staining for integrin-beta1 was performed to observe the cell to cell interaction. RESULTS: The hAD-MSCs in the FN-coated and non-coated plates exhibited cytoplasm staining for integrin-beta1. In all the cultures, extended fibroblastic-shaped cells that turned into rhomboid cells were most frequently observed. The cell growth rates for the non coated culture plate were lower than those for the FN coated plates. After 72 hour culture under the different coated concentrations of FN and the non coated condition (control), the control group had a lower growth rate. In the culture with a FN coated plate, a significant change was observed as compared with that of the control group. We observed an increase in cell proliferation, with a maximum of 140%, on the FN coated plate by performing CCK-8 assay. In comparison, integrin beta1 on the cells was more expressed in the FN-coated plates than that in the non-coated plates. CONCLUSION: The cell morphology can be changed faster in the FN coated culture plates than that in the non coated culture plates. Because proliferation and adhesion with FN can enhance the expansion, the culture within a FN coated plate is needed to encourage hAD-MSCs to proliferate in vitro.

Mucocele esfenoidal causando síndrome da secreção inapropriada de hormônio anti-diurético / Sphenoid mucocele causing anti-diuretic hormone inappropriate secretion syndrome

Mucocele é uma lesão benigna que ocorre nos seios paranasais. Comumente acomete os seios frontal e etmóide e, raramente, o esfenóide. É apresentado caso de paciente de 69 anos, do gênero masculino, com queixa de perda visual e cefaléia, que evoluiu com hiponatremia e aumento do sódio urinário, caracterizando a síndrome da secreção inapropriada do hormônio anti-diurético, causada por compressão hipofisária devido à mucocele esfenoidal. Foi submetido a tratamento endoscópico nasal e evoluiu com regressão dos sintomas, mantendo déficit visual parcial unilateral.

Mucocele is a benign lesion which occurs in the paranasal sinuses. It commonly happens in the frontal and ethmoid sinuses and rarely in the sphenoid sinus. It is presented a case of 69 year-old man, complaining of visual loss and headache, which evaluated with hyponatremy and high natrium dosage in urine, characterizing the antidiuretic hormon innapropriate secretion syndrom caused by compression of the hypophysis by the sphenoid mucocele. He was treated through endoscopic sinus surgery and evaluated with regression of the symptoms, but with unilateral partial visual deficit.

Clinical Genetics Education Program in Medical School: A Trial in Nippon Medical School / 医学教育

Advances in genetic medicine has rapidly been applied to clinical practice. However, many medical students have not studied biology or genetics in high school. There is little chance to think in Japan medical education about how to treat genetic information appropriately in the setting of clinical medicine. The timing and contents of a clinical genetics education program in medical school has hardly been discussed in Japan. This paper discusses the clinical genetics educationduring the medical-science and clinical-medicine stages at Nippon Medical School.<BR>1) An exercise on information gathering and role-play (for 180 minutes) about color vision deficiency were performed during the second-year molecular genetics course.<BR>2) A clinical genetics course (45 minutes 18 classes) in the fourth year was started in 2002 as a part of an integrated medical curriculum with courses classified by organ system.<BR>3) This clinical genetics course included systematic lectures for knowledge acquisition, lectures by patient support groups, exercises in drawing pedigrees, role-play, and discussions of ethical issues. Students evaluated this course favorably.<BR>4) Some topics in clinical genetics can be effectively presented at an early stage of medical education as part of an introduction to medicine. To maximize the educational effects and increase the possibility that students understand the importance of medical genetics, clinical genetics education in medical school will be performed after the student have grasped a basic understanding of diseases through lectures about clinical subjects.