Genetic architecture of congenital hypogonadotropic hypogonadism: insights from analysis of a Portuguese cohort.

STUDY QUESTION: What is the contribution of genetic defects in Portuguese patients with congenital hypogonadotropic hypogonadism (CHH)? SUMMARY ANSWER: Approximately one-third of patients with CHH were found to have a genetic cause for their disorder, with causal pathogenic and likely pathogenic germline variants distributed among 10 different genes; cases of oligogenic inheritance were also included. WHAT IS KNOWN ALREADY: CHH is a rare and genetically heterogeneous disorder characterized by deficient production, secretion, or action of GnRH, LH, and FSH, resulting in delayed or absent puberty, and infertility. STUDY DESIGN SIZE DURATION: Genetic screening was performed on a cohort of 81 Portuguese patients with CHH (36 with Kallmann syndrome and 45 with normosmic hypogonadotropic hypogonadism) and 263 unaffected controls. PARTICIPANTS/MATERIALS SETTING METHODS: The genetic analysis was performed by whole-exome sequencing followed by the analysis of a virtual panel of 169 CHH-associated genes. The main outcome measures were non-synonymous rare sequence variants (population allele frequency <0.01) classified as pathogenic, likely pathogenic, and variants of uncertain significance (VUS). MAIN RESULTS AND THE ROLE OF CHANCE: A genetic cause was identified in 29.6% of patients. Causal pathogenic and likely pathogenic variants were distributed among 10 of the analysed genes. The most frequently implicated genes were GNRHR, FGFR1, ANOS1, and CHD7. Oligogenicity for pathogenic and likely pathogenic variants was observed in 6.2% of patients. VUS and oligogenicity for VUS variants were observed in 85.2% and 54.3% of patients, respectively, but were not significantly different from that observed in controls. LARGE SCALE DATA: N/A. LIMITATIONS REASONS FOR CAUTION: The identification of a large number of VUS presents challenges in interpretation and these may require reclassification as more evidence becomes available. Non-coding and copy number variants were not studied. Functional studies of the variants were not undertaken. WIDER IMPLICATIONS OF THE FINDINGS: This study highlights the genetic heterogeneity of CHH and identified several novel variants that expand the mutational spectrum of the disorder. A significant proportion of patients remained without a genetic diagnosis, suggesting the involvement of additional genetic, epigenetic, or environmental factors. The high frequency of VUS underscores the importance of cautious variant interpretation. These findings contribute to the understanding of the genetic architecture of CHH and emphasize the need for further studies to elucidate the underlying mechanisms and identify additional causes of CHH. STUDY FUNDING/COMPETING INTERESTS: This research was funded by the Portuguese Foundation for Science and Technology (grant numbers PTDC/SAU-GMG/098419/2008, UIDB/00709/2020, CEECINST/00016/2021/CP2828/CT0002, and 2020.04924.BD) and by Sidra Medicine-a member of the Qatar Foundation (grant number SDR400038). The authors declare no competing interests.

O trabalho feminino assalariado: a dialética na produção e reprodução / Salaried female work: the dialectic in production and reproduction

Resumo: Neste texto, estamos trazendo alguns apontamentos baseados nas obras de Marx sobre trabalho produtivo e improdutivo. Refletimos também sobre aquele trabalho não remunerado realizado pela mulher no espaço doméstico. Com este pano de fundo, estamos dialogando criticamente com o texto "Salários contra o trabalho doméstico" ("Wages against housework"), presente no livro O ponto zero da revolução: trabalho doméstico, reprodução e luta feminista, de Silvia Federici.

Abstract: In this text we are bringing some notes based on Marx, about productive and unproductive work. We also reflect on the unpaid work performed by women in the domestic space. And against this backdrop, we are critically dialoguing with the text "Wages against housework", present in the book Revolution at point zero: housework, reproduction and feminist struggle by Silvia Federici.

High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal: The PICT2RE observational study.

INTRODUCTION AND OBJECTIVES: Portugal is a country with a high prevalence of type 2 diabetes (T2D) and cardiovascular disease (CVD). The prevalence of CVD and cardiovascular (CV) risk factors among T2D patients followed in hospitals in Portugal is not known. The primary objective of this study was to assess the prevalence of CVD and CV risk factors among T2D patients in a hospital setting in Portugal. The clinical management of CVD in the hospital setting was also assessed. METHODS: We performed a non-interventional, multicenter, cross-sectional study with a retrospective phase. T2D patients were consecutively invited to participate. Data were collected retrospectively. RESULTS: A total of 715 patients were included in the study. Mean age and diabetes duration were 66.6 and 17.4 years, respectively. Of these, 286 patients (40.0%) had been diagnosed with CVD, mostly ischemic heart disease (50.4%). All patients had at least one CV risk factor. CVD was significantly associated with hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, hypertriglyceridemia and smoking. During the three years prior to study inclusion, the incidence of hyperglycemic episodes and T2D complications increased among patients with established CVD, but the numbers of hospitalization episodes and specialist appointments remained stable. An improvement was observed in key cardiometabolic risk factors. CONCLUSIONS: Our study revealed a high prevalence of CVD and CV risk factors among a sample of T2D patients in a hospital setting. Patients with established CVD seem to be adequately managed but further efforts are needed at the prevention stage for better control of risk factors and morbidity.

Maternal height as a predictor of glucose intolerance in the postpartum and its relationship with maternal pre-gestational weight.

PURPOSE: Short stature predicts higher risk of developing type 2 diabetes. We studied the association between height and glucose intolerance in women with gestational diabetes mellitus (GDM) and whether this association differed according to body mass index (BMI). METHODS: Retrospective study of the Portuguese GDM registry. EXCLUSION CRITERIA: missing data on postpartum oral glucose tolerance test (OGTT) or BMI. ENDPOINT: postpartum glucose intolerance (diabetes mellitus or prediabetes on the 6-8 weeks postpartum OGTT). Women were divided by mean height and compared. A multivariate logistic regression was used, and the analysis was stratified by BMI (cut-off: 30 kg/m2) and interaction was tested. RESULTS: We included 7402 women; mean height was 161.9 ± 6.2 cm. Taller women had lower BMI and lower rates of glucose intolerance (6.8 vs. 8.8%, p = 0.002). Women with BMI < 30 kg/m2 were taller than those with obesity. Height associated with glucose intolerance. The multivariate adjusted OR of glucose intolerance was 0.98 (95% CI 0.96-0.99), p = 0.001, per 1 cm increase in height. This association was only observed in women with BMI < 30 kg/m2: OR 0.97 (95% CI 0.95-0.99), < 0.001. There was no such association in women with BMI ≥ 30 kg/m2: OR 0.99 (95% CI 0.97-1.02), p = 0.65. P for interaction between BMI and height was 0.09. CONCLUSIONS: In non-obese pre-gestational women, height is inversely associated with postpartum glucose intolerance. Per 1 cm increase in height, women present a 3% decrease in the risk of developing diabetes mellitus or prediabetes.

First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy.

Hyperglycaemia first detected during pregnancy is either gestational diabetes mellitus (GDM) or previous undiagnosed diabetes. We aimed to study if there were a first trimester fasting glycaemia (FTG) and a glycated haemoglobin (HbA1c) cut-off values associated with type 2 diabetes mellitus (T2DM) or abnormal glucose homeostasis (AGH) at the post-partum oral glucose tolerance test (OGTT) reclassification. We retrospectively studied a group of pregnant women from the Portuguese National Registry of GDM. Receiver-operating characteristic (ROC) curves were used to determine the best FTG and HbA1c cut-offs to predict T2DM and AGH. We studied 4068 women. The area under the ROC curves (AUC) for the association with T2DM was 0.85 (0.80-0.90) for FTG and 0.85 (0.80-0.91) for HbA1c. The best FTG cut-off for association with T2DM was 99 mg/dL: sensitivity 77.4%, specificity 74.3%, positive predictive value (PPV) 4.8%, and negative predictive value (NPV) 99.5%. The best HbA1c cut-off for association with T2DM was 5.4%: sensitivity 79.0%, specificity 80.1%, PPV 5.7%, and NPV 99.6%. The AUC for the association of FTG and HbA1c with AGH were 0.73 (0.70-0.76) and 0.71 (0.67-0.74), respectively. The best FTG cut-off for predicting AGH was 99 mg/dL: sensitivity 59.4%, specificity 76.2%, PPV 17.0%, and NPV 95.8%. The best HbA1c cut-off was 5.4%: sensitivity 48.7%, specificity 81.5%, PPV 17.8%, and NPV 95.1%. We suggest an FTG of 99 mg/dL and an HbA1c of 5.4% as the best cut-offs below which T2DM is unlikely to be present. Almost all patients with FTG < 99 mg/dL and HbA1c < 5.4% did not reclassify as T2DM. These early pregnancy cut-offs might alert the physician for the possibility of a previous undiagnosed diabetes and alert them to the importance of testing for it after delivery.

Concepts, spaces, and leisure practices from the perspective of youth

Abstract Aim: To investigate how the choices of young people for public or private spaces during their leisure practices, regardless of gender and age group, can be a starting point for the definition of agendas for the constitution of governmental public policies. Methods: The empirical task was accomplished through the application of electronic questionnaires to young university students from Portugal (20%), Brazil (70%), and South Africa (10%). The sample consisted of 705 randomly chosen young people, with an average age of 24 years. The data were analyzed using SPSS and content analysis. The analysis was divided into three categories: comprising the student's profile; referring to leisure and relating to the provision of leisure and space. Results: The youngest people choose the public spaces for their leisure practices and conceive leisure as a moment when they can do whatever they want, without obligations, followed by leisure as fun and free time. There is no difference between men and women in the concept of leisure. The main conclusions highlighted that leisure means to 'do what I want without any obligation to do so', followed by 'fun' and 'free time, and young people like to 'go out with friends, 'play sports' and 'do nothing'. The public space is the most used for leisure. Conclusion: The meaning of leisure is loaded with subjectivities, so we understand that the demands for political actions that enable the use of public spaces safely and with quality are the way to guarantee the rights of the population.

Um olhar sociológico sobre o privilégio epistémico da biomedicina: desconstruindo a metanarrativa / A sociological view on the epistemic privilege of biomedicine: deconstructing the metanarrative

Resumo Apesar do crescente reconhecimento público da sua incompletude e da necessidade de a fazer dialogar com outros saberes, a biomedicina continua a figurar como metanarrativa, como modelo médico epistemologicamente superior, definidor e regulador do que se entende por "saber médico". É na persistência dessa representação de superioridade que reside um dos grandes obstáculos - senão mesmo o maior - à criação de uma efetiva ecologia de saberes no campo dos cuidados de saúde. Com base numa revisão da literatura sobre o tema, este artigo toma justamente por objetivo a desconstrução da versão essencialista da superioridade biomédica, evidenciando o modo como essa suposta superioridade é, na verdade, decorrente de um complexo quadro sociocultural de produção histórica. Assim, revisitando a literatura existente, o artigo desenvolve perspectiva condensada em torno dos principais pilares da construção do poder hegemónico da biomedicina no contexto da modernidade ocidental, a saber: (1) a ligação umbilical da biomedicina à ciência moderna e à sua trajetória de colonização; (2) o processo de anatomoclínica e o modo como, por esse processo, a biomedicina se estabeleceu como poder normativo/regulador, passando a auferir legitimidade e proteção por parte dos Estados; (3) a suposta maior eficácia da biomedicina no quadro de sua maior compatibilidade com os novos imperativos capitalistas; e (4) a constituição de forte movimento profissional biomédico e suas estratégias de fechamento na construção de sua hegemonia.

Abstract Despite the growing public recognition of its incompleteness and its need to make it dialog with other knowledges, biomedicine continues to figure as a metanarrative, as an epistemologically superior medical model, defining and regulating what is meant by "medical knowledge". One of the great obstacles - if not the greatest - to the creation of an effective ecology of knowledges in the field of health care lies in the persistence of this representation of superiority. Based on a review of the literature about the subject, this article aims precisely at deconstructing the essentialist version of biomedicine's superiority, showing how this supposed superiority results, in fact, from a complex sociocultural framework of historical production. In this sense, revisiting the existing literature, the article develops a condensed perspective around the main pillars of the construction of the hegemonic power of biomedicine in the context of Western modernity: (1) the umbilical connection of biomedicine to modern science and its colonization trajectory; (2) the anatomical-clinical process and how biomedicine established itself, through this process, as a normative/regulatory power, gaining legitimacy and protection by the States; (3) the alleged greater effectiveness of biomedicine in the context of its greater compatibility with the new capitalist imperatives; and (4) the constitution of a strong biomedical professional movement and its closing strategies in the construction of its hegemony.

Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database.

Acromegaly is a rare disorder caused by chronic growth hormone (GH) hypersecretion. While diagnostic and therapeutic methods have advanced, little information exists on trends in acromegaly characteristics over time. The Liège Acromegaly Survey (LAS) Database, a relational database, is designed to assess the profile of acromegaly patients at diagnosis and during long-term follow-up at multiple treatment centers. The following results were obtained at diagnosis. The study population consisted of 3173 acromegaly patients from ten countries; 54.5% were female. Males were significantly younger at diagnosis than females (43.5 vs 46.4 years; P < 0.001). The median delay from first symptoms to diagnosis was 2 years longer in females (P = 0.015). Ages at diagnosis and first symptoms increased significantly over time (P < 0.001). Tumors were larger in males than females (P < 0.001); tumor size and invasion were inversely related to patient age (P < 0.001). Random GH at diagnosis correlated with nadir GH levels during OGTT (P < 0.001). GH was inversely related to age in both sexes (P < 0.001). Diabetes mellitus was present in 27.5%, hypertension in 28.8%, sleep apnea syndrome in 25.5% and cardiac hypertrophy in 15.5%. Serious cardiovascular outcomes like stroke, heart failure and myocardial infarction were present in <5% at diagnosis. Erythrocyte levels were increased and correlated with IGF-1 values. Thyroid nodules were frequent (34.0%); 820 patients had colonoscopy at diagnosis and 13% had polyps. Osteoporosis was present at diagnosis in 12.3% and 0.6-4.4% had experienced a fracture. In conclusion, this study of >3100 patients is the largest international acromegaly database and shows clinically relevant trends in the characteristics of acromegaly at diagnosis.

Agronomic efficiency of Rhizobium strains from the Amazon region in common bean / Eficiência agronômica de estirpes de Rhizobium isoladas da Amazônia sobre o feijoeiro-comum

To maximize the contribution of biological nitrogen fixation in common bean, it is necessary to use bacterial strains that are more adapted, competitive, and efficient in the symbiotic process. In this regard, the aim of this study was to evaluate the agronomic efficiency (AE) of three bacterial strains isolated from acid soils with high Al content from the Amazon region in an Argissolo Vermelho Distrófico típico soil (Typic Rhodustults - USDA Classification) from the municipality of Formiga, MG, Brazil. We compared their AE to that of the reference strain CIAT 899T and of two controls without inoculation (one without and another with 80 kg ha-1 of N-urea). The results indicated that inoculation with the strains UFLA 02-100 and UFLA 02-127 provides grain yield equivalent to inoculation with the reference strain and to the control with mineral N. Thus, both have potential for recommendation as inoculants for common bean.

Para maximizar a contribuição da fixação biológica de nitrogênio no feijoeiro-comum é necessária a utilização de estirpes de bactérias mais adaptadas, competitivas e eficientes no processo simbiótico. Nesse sentido, objetivou-se avaliar, em um Argissolo Vermelho Distrófico típico do município de Formiga-MG, a eficiência agronômica (EA) de três estirpes isoladas de solos ácidos e com alto teor de Al da Amazônia e comparar suas EA à da estirpe referência CIAT 899T e à de dois controles sem inoculação (um sem e outro com 80 kg ha-1 of N-ureia). Os resultados indicaram que a inoculação com as estirpes UFLA 02-100 e UFLA 02-127 propicia rendimento de grãos equivalente ao da estirpe referência e ao do controle com N mineral e que por isso, ambas têm potencial para ser recomendadas como inoculantes para o feijoeiro-comum.