bluuebunny/crossref_metadata_2025 huggingface dataset:
Women's Participation in Non‐Government Organizations: Implications for Poverty Reduction in Precarious Settlements of Guatemala City
Authors: GOLDÍN LILIANA , ROSENBAUM BRENDA , EGGLESTON SAMANTHA
Published: December 2006

As the poor in Latin American cities continue to struggle, there has been interest in the role of non‐government organizations (NGOs) in addressing their difficult circumstances. This article examines the lives of residents in two peripheral urban neighborhoods of Guatemala City. The hardships posed by urban poverty are documented with a particular focus on women as they struggle to meet their families' needs. The experiences of women in a unique, woman‐centered association are described and compared with women in communities without such associations. The goals of the analysis are (1) to provide an appreciation of the nature and evolution of precarious settlements in Guatemala City, and (2) to consider the role of NGOs in addressing the challenges women face in such settlements. One association (UPAVIM) is described that has addressed these needs through job training and employment while simultaneously providing child care and educational opportunities for children. Emphasis is given to the role of the critical middle sector in offering opportunities to the most marginalized groups. [Non‐government organizations, urban poverty, women and poverty, Guatemala City]
Gendering the City, Gendering the Nation: Contesting Urban Space in Fes, Morocco
Authors: NEWCOMB RACHEL
Published: December 2006

An actor‐centered approach to the gendering of urban spaces demonstrates how individuals respond to competing ideologies in determining the rules that surround women's presence in urban, Muslim spaces. This article examines how women in the Ville Nouvelle of Fes, Morocco draw on local conceptualizations of hospitality, kinship, and shame as they debate the gendering of four urban areas: the street, the café, a cosmopolitan exercise club, and cyber space. Women's tactics for occupying social space indicate the resilience of local culture in the face of ideologies that attempt to posit a specific vision of women in the Moroccan nation state. [Moroccan women, Islam, gender, public space, urban space, Middle East and North Africa]
Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network
Authors: Zupancic John A. F. , Richardson Douglas K. , Horbar Jeffrey D. , Carpenter Joseph H. , Lee Shoo K. , Escobar Gabriel J. ,   Vermont Oxford Network SNAP Pilot Project Participants
Published: December 2006

OBJECTIVES. Our specific objectives were (1) to document the performance of the revised Score for Neonatal Acute Physiology and the revised Score for Neonatal Acute Physiology Perinatal Extension in predicting death in the Vermont Oxford Network, compared with published normative values; (2) to determine whether this performance could be improved through recalibration of the weights for individual score items; (3) to determine the impact of including congenital anomalies in the predictive model; and (4) to compare performance against that of the Vermont Oxford Network risk adjustment, separately and in combination.

METHODS. Fifty-eight Vermont Oxford Network centers collected data prospectively for the revised Score for Neonatal Acute Physiology in the first 12 hours after admission of infants in 2002.

RESULTS. Data were collected for 10469 infants, and analyses were undertaken for 9897 who met inclusion criteria. The median revised Score for Neonatal Acute Physiology was 5, and the mean birth weight was 1951 g. Recalibration of the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension resulted in minimal changes in their discriminatory abilities. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.

CONCLUSIONS. Current score performance was similar to that observed previously, which suggests that the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension have not decalibrated over the 7 years since the first cohort was assembled, despite advances in neonatal care during that period. Addition of congenital anomalies to the revised Score for Neonatal Acute Physiology Perinatal Extension improved discrimination significantly, particularly for infants with birth weights of >1500 g. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.
Pulmonary Endostatin Perinatally and in Lung Injury of the Newborn Infant
Authors: Janér Joakim , Andersson Sture , Haglund Caj , Lassus Patrik
Published: December 2006

OBJECTIVE. Endostatin is a potent angiogenesis inhibitor. Angiogenesis is central for the development of the human lung. The role of endostatin in the development of the human lung and its connection to chronic lung disease remain unclear. We set out to study the role of endostatin in the developing human lung and in acute and chronic lung injury in the preterm infant.

METHODS. Nine fetuses, 14 control neonates without primary lung disease, 14 preterm infants with respiratory distress syndrome, and 8 infants with bronchopulmonary dysplasia were included in the immunohistochemistry study. Tracheal aspirate-fluid samples of intubated very low birth weight infants during postnatal weeks 1 through 5 were analyzed with enzyme-linked immunosorbent assay.

RESULTS. Endothelial cell staining was positive for endostatin in all 45 samples. Staining of epithelial cells (cuboidal, bronchiolar, and alveolar) was seen mostly in fetuses, as well as in infants with late respiratory distress syndrome and bronchopulmonary dysplasia. Staining in alveolar macrophages was most abundant in infants with late respiratory distress syndrome and bronchopulmonary dysplasia. Endostatin was expressed consistently in tracheal aspirate fluid, being highest during the first postnatal day. Higher endostatin concentrations correlated with parameters reflecting lower lung maturity.

CONCLUSIONS. The pattern of pulmonary endostatin protein expression in immunohistochemistry and consistent endostatin protein appearance in tracheal aspirate fluid in human preterm infants indicate a role in the physiologic development of the lung. Preterm birth influences pulmonary endostatin protein expression, which may alter normal lung development and response to lung injury.
The use of rocks to improve family agriculture in Brazil
Authors: Theodoro Suzi H. , Leonardos Othon H.
Published: December 2006

During the second half of the 20th century, the introduction of new chemical agriculture technologies brought about a revolution in food production, but this has also cause deep deterioration in our relationships with the natural environment. In developing tropical countries, record yields were accompanied by rural exodus, widespread deforestation and loss of topsoil. The stonemeal research described herein is an alternative to such practices as it is an environmental friendly and socially responsible technology based on soil rejuvenation and conservation by means of the addition of natural rock powders that are rich in phosphorous, calcium, magnesium, potassium and micronutrients. The research adopted an inter-disciplinary approach and was conducted among small farmers of a rural community located in the state of Minas Gerais, Brazil. The major goal was to demonstrate that there is a harmless cheap and simple alternative to fertilizing degraded or impoverished soils, which allow farmers to sustain high productivity and to remain on their plots of land. Results have confirmed the economic, environmental and productive feasibility and advantage of the stonemeal technique for corn, rise, manioc, sugar cane and horticultural species, when compared to the use of chemical fertilizers. The fertilization of the soil with rocks, allows the understanding of the natural processes, which maintain production levels while building a sustainable fertile soil.
Farming with rocks and minerals: challenges and opportunities
Authors: Van Straaten Peter
Published: December 2006

In many parts of the world food security is at risk. One of the biophysical root causes of falling per-capita food production is the declining quality and quantity of soils. To reverse this trend and increase soil fertility soil and plant nutrients have to be replenished. This review provides a literature survey of experiences of using multi-nutrient rock fertilizers for soil fertility enhancement from temperate and tropical environments. Advantages and limitations of the application of rock fertilizers are discussed. Examples are provided from two successful nutrient replenishment projects in Africa where locally available rock fertilizers are used on highly leached acid soils. The potential of combining organic materials alongside rock fertilizers in soil fertility replenishment strategies is stressed.
Green-tuff landslide areas are beneficial for rice nutrition in Japan
Authors: Tazaki Kazue
Published: December 2006

Japanese Islands are covered with weathered volcanic rocks and soils. Terraced rice field are located in green-tuff areas which are very fertile but where landslides occur associated to strong earthquakes. The Xray diffraction and X-ray fluorescence analyses of the soils in landslide area identified predominant smectite and Mg, Al, Si, K, Ti, Mn and Fe are main components. The rice leaf showed that S, Cl, K and Ca play important roles for nutrients in the area. Drainpipe systems have set up in the green- tuff areas to reduce the risks of landslides. Reddish brown microbial mats inhabited bacteria and diatom in the drainpipe outlets. The microbial mats are rich in Fe and PO4(3-). The iron bacteria in the ground water have a high metabolic rate suggesting that the weathering materials were produced by not only physical and chemical influence but also by microorganism. Many microorganisms attach to mineral surfaces and show their high impact in the water mineral chemistry in the landslide area. Bacteria in the green-tuff over landslide area play important roles for sustainable agriculture including rice nutrition.
Some topics on geochemistry of weathering: a review
Authors: Formoso Milton L.L.
Published: December 2006

Weathering is a complex process comprising physical disaggregation, chemical and biological decomposition of rocks and minerals transforming complex structure minerals in simpler ones. Hydrolysis of silicates is perhaps the most important process but associated certainly to biological weathering. It is discussed the role ofwaters: activities/concentrations of chemical species, pH, Eh, importance of complexes. Weathering is not only a destructive process. It can concentrate chemical species and form mineral deposits (kaolin, bauxite, Fe, Mn, P, Nb, Au). Weathering studies are important in pedology, engineering geology, hydrogeology, paleoclimatology and ecology. The use of stonemeal is based upon the study of rock weathering.
A new concept for insect damage evaluation based on plant physiological variables
Authors: Neves Ademir D. , Oliveira Ricardo F. , Parra José R.P.
Published: December 2006

The objective of this study was to determine the damage levels caused by Orthezia praelonga Douglas, 1891 and Leucoptera coffeella (Guérin-Mèneville 1842), on rangpur lime and Obatã coffee leaves, respectively. Measurements were based on a new concept for the evaluation of the following plant physiological parameters: photosynthesis, stomatal conductance, leaf temperature and transpiration, and internal concentration of CO2 (by infrared analyzer). A negative correlation between infestation level and photosynthesis was found, where the negative inflexion point of the curve was considered as a reference for damage levels. The control level for O. praelonga is below the 7-13% limit for damaged leaf area (40 to 70 scales per leaf), while for L. coffeella it is below the 26-36% limit for the same variable. Photosynthesis provided the best correlation for this type of analysis.
Computation of the sampling distribution of coherence estimate
Authors: Nadarajah Saralees , Kotz Samuel
Published: December 2006

The recent paper published by Miranda de Sa (2004) derived, for the first time, the sampling distribution of coherence estimated between two signals. The paper also considered computational issues of the sampling distribution, using an approximate method. In this short note, we provided several 1-line programs for the exact computation of various measures of the sampling distribution. The advantages of using these programs are discussed.
Articles with authors affiliated to Brazilian institutions published from 1994 to 2003 with 100 or more citations: II - identification of thematic nuclei of excellence in Brazilian science
Authors: Meneghini Rogerio , Packer Abel L.
Published: December 2006

Articles with 100 citations or more in the scientific literature and with at least one author with Brazilian affiliation, were identified in the Thomson-ISI (Institute for Scientific Information) Web of Science bibliometric database covering a 10-year period, from 1994 to 2003 (see Packer and Meneghini 2006); 248 (0.23%) out of a total of 109,916 articles with Brazilian affiliation were identified. This study was primarily carried out to identify thematic nuclei of excellence in research that had major impact in the international literature. Twelve of these nuclei in the fields of Biomedicine, Medicine, Biology, Physic, Chemistry and Astronomy were considered outstanding and their genesis and development were described. The weight of factors such as international collaboration and network organization are distinct in these areas and the reasons for that are discussed.
Bone density testing in clinical practice
Authors: Lewiecki E. Michael , Borges João Lindolfo C.
Published: December 2006

The diagnosis of osteoporosis and monitoring of treatment is a challenge for physicians due to the large number of available tests and complexities of interpretation. Bone mineral density (BMD) testing is a non-invasive measurement to assess skeletal health. The "gold-standard" technology for diagnosis and monitoring is dual-energy X-ray absorptiometry (DXA) of the spine, hip, or forearm. Fracture risk can be predicted using DXA and other technologies at many skeletal sites. Despite guidelines for selecting patients for BMD testing and identifying those most likely to benefit from treatment, many patients are not being tested or receiving therapy. Even patients with very high risk of fracture, such as those on long-term glucocorticoid therapy or with prevalent fragility fractures, are often not managed appropriately. The optimal testing strategy varies according to local availability and affordability of BMD testing. The role of BMD testing to monitor therapy is still being defined, and interpretation of serial studies requires special attention to instrument calibration, acquisition technique, analysis, and precision assessment. BMD is usually reported as a T-score, the standard deviation variance of the patient's BMD compared to a normal young-adult reference population. BMD in postmenopausal women is classified as normal, osteopenia, or osteoporosis according to criteria established by the World Health Organization. Standardized methodologies are being developed to establish cost-effective intervention thresholds for pharmacological therapy based on T-score combined with clinical risk factors for fracture.
The calcium-sensing receptor and related diseases
Authors: D'Souza-Li Lília
Published: December 2006

The calcium-sensing receptor (CASR) adjusts the extracellular calcium set point regulating PTH secretion and renal calcium excretion. The receptor is expressed in several tissues and is also involved in other cellular functions such as proliferation, differentiation and other hormonal secretion. High extracellular calcium levels activate the receptor resulting in modulation of several signaling pathways depending on the target tissues. Mutations in the CASR gene can result in gain or loss of receptor function. Gain of function mutations are associated to Autossomal dominant hypocalcemia and Bartter syndrome type V, while loss of function mutations are associated to Familial hypocalciuric hypercalcemia and Neonatal severe hyperparathyroidism. More than one hundred mutations were described in this gene. In addition to calcium, the receptor also interacts with several ions and polyamines. The CASR is a potential therapeutic target to treatment of diseases including hyperparathyroidism and osteoporosis, since its interaction with pharmacological compounds results in modulation of PTH secretion.
Vitamin D deficiency: a global perspective
Authors: Bandeira Francisco , Griz Luiz , Dreyer Patricia , Eufrazino Catia , Bandeira Cristina , Freese Eduardo
Published: December 2006

Vitamin D is essential for the maintenance of good health. Its sources can be skin production and diet intake. Most humans depend on sunlight exposure (UVB 290315 nm) to satisfy their requirements for vitamin D. Solar ultraviolet B photons are absorbed by the skin, leading to transformation of 7-dehydrocholesterol into vitamin D3 (cholecalciferol). Season, latitude, time of day, skin pigmentation, aging, sunscreen use, all influence the cutaneous production of vitamin D3. Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate. The prevalence of hypovitaminosis D is considerable even in low latitudes and should be taken into account in the evaluation of postmenopausal and male osteoporosis. Although severe vitamin D deficiency leading to rickets or osteomalacia is rare in Brazil, there is accumulating evidence of the frequent occurrence of subclinical vitamin D deficiency, especially in elderly people.
From mild to severe primary hyperparathyroidism: the Brazilian experience
Authors: Bandeira Francisco , Griz Luiz , Caldas Gustavo , Bandeira Cristina , Freese Eduardo
Published: December 2006

Primary hyperparathyroidism often presents as an asymptomatic disorder. In our institution, routine serum calcium measurements have now been used as part of medical examination for 23 years. Out of 124 patients consecutively seen at our institution, 47% presented with no symptoms related to the disease, while 25% presented with severe skeletal involvement and osteitis fibrosa cystica, 25% with renal stone disease without overt bone involvement, and 2% with the typical neuropsychiatric syndrome. This same pattern is seen in the city of São Paulo. In severe disease pathological fractures are frequently seen, especially in long bones of the lower extremities, and also loss of lamina dura of the teeth and salt-and-pepper appearance of the skull. Bone mineral density is extremely low in these patients but usually show remarkable recovery following surgical cure. Serum PTH and bone markers are considerable higher in severely affected patients, who also have a high rate of vitamin D deficiency, and the parathyroid lesion is easier located compared with asymptomatic patients. From pathological specimens 87% had histological confirmation of a single adenoma, 6.4% multiple gland hyperplasia and 3.8% carcinoma.
Hypoparathyroidism and pseudohypoparathyroidism
Authors: Maeda Sergio S. , Fortes Erika M. , Oliveira Ulisses M. , Borba Victoria C.Z. , Lazaretti-Castro Marise
Published: December 2006

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.
Office practice of osteoporosis evaluation
Authors: Lacativa Paulo Gustavo S. , Farias Maria Lucia F. de
Published: December 2006

Osteoporosis is a metabolic disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Bone fragility depends on bone density, turnover and microarchitectural features, such as relative trabecular volume, spacing, number and connectivity. Previous fragility fractures increase the fracture risk irrespective of bone density. Other risk factors must also be considered as many fractures occur in patients with osteopenia on densitometry. On the other hand, the diagnosis of osteoporosis and increased fracture risk should not be based on densitometric data alone when young populations such as men below 65 years, premenopausal women, adolescents and children are considered.
Redefining osteoporosis treatment: who to treat and how long to treat
Authors: Lewiecki E. Michael , Silverman Stuart L.
Published: December 2006

Osteoporosis is a common disease that is associated with increased risk of fractures and serious clinical consequences. Bone mineral density (BMD) testing is used to diagnose osteoporosis, estimate the risk of fracture, and monitor changes in BMD over time. Combining clinical risk factors for fracture with BMD is a better predictor of fracture risk than BMD or clinical risk factors alone. Methodologies are being developed to use BMD and validated risk factors to estimate the 10-year probability of fracture, and then combine fracture probability with country-specific economic assumptions to determine cost-effective intervention thresholds. The decision to treat is based on factors that also include availability of therapy, patient preferences, and co-morbidities. All patients benefit from nonpharmacological lifestyle treatments such a weight-bearing exercise, adequate intake of calcium and vitamin D, fall prevention, avoidance of cigarette smoking and bone-toxic drugs, and moderation of alcohol intake. Patients at high risk for fracture should be considered for pharmacological therapy, which can reduce fracture risk by about 50%.
Estrogen therapy for postmenopausal osteoporosis
Authors: Fitzpatrick Lorraine A.
Published: December 2006

Osteoporosis is a worldwide problem that results in fractures that lead to disability and high costs to society. Estrogen therapy is frequently utilized for postmenopausal symptoms, but also has proven protective effects on the skeleton. The main action of estrogen at the cellular level is to inhibit the osteoclast by increasing levels of osteoprotegerin (OPG). OPG binds to the receptor activator of NFkB and prevents osteoclast differentiation, activity and survival. Numerous trials have demonstrated the positive effect estrogen has on the improvement of bone mineral density, and lower doses have also proven efficacious with fewer side effects. Both observational and randomized clinical trials have demonstrated the ability of estrogen treatment to prevent fractures. Topics that remain controversial include the appropriate length of estrogen treatment for postmenopausal women and the appropriate follow-up after treatment discontinuation.
Bisphosphonates
Authors: McClung Michael
Published: December 2006

Osteoporosis is the result of bone loss due to an imbalance in bone turnover such that bone resorption exceeds bone formation. Bisphosphonates are potent inhibitors of osteoclast activity that reduce bone turnover and re-establish the balance between bone resorption and formation. In clinical studies, several bisphosphonates prevent bone loss, preserve bone structure, improve bone strength and, in patients with osteoporosis, substantially reduce fracture risk. They are effective in multiple clinical settings including postmenopausal osteoporosis, low bone mass in men and drug-induced bone loss. Intermittent oral dosing and intravenous administration are more convenient than the original daily dosing regimen. These drugs are generally well tolerated and have an excellent safety profile in that serious side effects are uncommon. Potent bisphosphonates are generally the preferred treatment option for most patients with or at risk for osteoporosis.
Anabolic skeletal therapy for osteoporosis
Authors: Girotra Monica , Rubin Mishaela R. , Bilezikian John P.
Published: December 2006

Antiresorptive agents for osteoporosis are a cornerstone of therapy, but anabolic drugs have recently widened our therapeutic options. By directly stimulating bone formation, anabolic agents reduce fracture incidence by improving bone qualities besides increasing bone mass. In this article, we review the role of anabolic treatment for osteoporosis. The only anabolic agent currently approved in the United States for osteoporosis, teriparatide [recombinant human parathyroid hormone(1-34)], has clearly emerged as a major approach to selected patients with osteoporosis. Teriparatide increases bone density and bone turnover, improves microarchitecture, and changes bone size. The incidence of vertebral and nonvertebral fractures is reduced. Teriparatide is approved for both postmenopausal women and men with osteoporosis who are at high risk for fracture. Other potential anabolic therapies for osteoporosis, including other forms of parathyroid hormone, strontium ranelate, growth hormone, and insulin-like growth factor-1, are also reviewed in this article.
Low bone mass in children and adolescents
Authors: Borges João Lindolfo C. , Brandão Cynthia M.A.
Published: December 2006

Osteoporosis is a disease characterized by low bone mass and micro architectural alterations of bone tissue leading to enhanced bone fragility and increased fracture risk. Although research in osteoporosis has focused mainly on the role of bone loss in the elderly population, it is becoming increasingly clear that the amount of bone that is gained during growth is also an important determinant of future resistance to fractures. Thus, considerable interest is being placed on defining preventive strategies that optimize the gain of bone mass during childhood and adolescence. Knowledge of the determinants accounting for the physiologic and genetic variations in bone accumulation in children will provide the best means toward the early diagnosis and treatment of osteoporosis. This article reviews the techniques available for bone mass measurements in children and the major determinants and diseases influencing bone accretion during childhood and adolescence.
Glucocorticoid-induced osteoporosis
Authors: Gregório Luiz Henrique de , Lacativa Paulo G. Sampaio , Melazzi Ana Cláudia C. , Russo Luis Augusto Tavares
Published: December 2006

Glucocorticoid-induced osteoporosis is the most frequent cause of secondary osteoporosis. Glucocorticoids cause a rapid bone loss in the first few months of use, but the most important effect of the drug is suppression of bone formation. The administration of oral glucocorticoid is associated with an increased risk of fractures at the spine and hip. The risk is related to the dose, but even small doses can increase the risk. Patients on glucocorticoid therapy lose more trabecular than cortical bone and the fractures are more frequent at the spine than at the hip. Calcium, vitamin D and activated forms of vitamin D can prevent bone loss and antiresorptive agents are effective for prevention and treatment of bone loss and to decrease fracture risk. Despite the known effects of glucocorticoids on bone, only a few patients are advised to take preventive measures and treat glucocorticoid-induced osteoporosis.
Renal stone disease: causes, evaluation and medical treatment
Authors: Heilberg Ita Pfeferman , Schor Nestor
Published: December 2006

The purpose of the present review is to provide an update about the most common risk factors or medical conditions associated with renal stone formation, the current methods available for metabolic investigation, dietary recommendations and medical treatment. Laboratory investigation of hypercalciuria, hyperuricosuria, hyperoxaluria, cystinuria, hypocitraturia, renal tubular acidosis, urinary tract infection and reduction of urinary volume is based on the results of 24-hr urine collection and a spot urine for urinary sediment, culture and pH. Blood analysis for creatinine, calcium and uric acid must be obtained. Bone mineral density has to be determined mainly among hypercalciurics and primary hyperparathyroidism has to be ruled out. Current knowledge does not support calcium restriction recommendation because it can lead to secondary hyperoxaluria and bone demineralization. Reduction of animal protein and salt intake, higher fluid intake and potassium consumption should be implemented. Medical treatments involve the use of thiazides, allopurinol, potassium citrate or other drugs according to the metabolic disturbances. The correction of those metabolic abnormalities is the basic tool for prevention or reduction of recurrent stone formation.
Tratamento da doença de Paget óssea: importância do ácido zoledrônico
Authors: Griz Luiz , Colares Viviane , Bandeira Francisco
Published: December 2006

A doença de Paget é uma doença esquelética, de distribuição monostótica ou poliostótica, podendo ser causada por uma infecção viral e/ou fatores genéticos. É caracterizada por um aumento da remodelação óssea, resultando em anormalidade da arquitetura óssea. A excessiva reabsorção óssea osteoclástica, seguida secundariamente de aumento da atividade osteoblástica, leva à substituição do osso normal por osso desorganizado, aumentado, e com estrutura enfraquecida, propensa a deformidades e fraturas. A doença de Paget pode ser diagnosticada através de exames radiológicos, cintilografia e exames bioquímicos. O objetivo primário do tratamento é reduzir a dor e o risco do aparecimento das complicações a longo prazo. Atualmente dispõe-se de drogas anti-reabsortivas potentes, as quais controlam a reabsorção óssea e proporcionam uma grande melhora no tratamento. O ácido zoledrônico, um bisfosfonato de última geração, tem a vantagem de maior potência e remissão mais prolongada, além de um tempo de infusão curto.
Biodisponibilidade do cálcio dietético
Authors: Buzinaro Elizabeth F. , Almeida Renata N. Alves de , Mazeto Gláucia M.F.S.
Published: December 2006

O cálcio (Ca) dietético é fundamental para a saúde óssea. Tanto o teor como a biodisponibilidade do elemento nos alimentos devem ser considerados. Este artigo objetiva sumarizar os fatores envolvidos na absorção e destacar os alimentos com melhor disponibilidade do Ca. Este é absorvido principalmente no jejuno e o pH baixo parece favorecer sua absorção, que é maior no crescimento, na gestação/lactação e na carência de Ca ou fósforo (P), e menor no envelhecimento. As maiores fontes, e com melhor absorção, são os laticínios bovinos. Outros alimentos apresentam concentrações elevadas de Ca, mas com biodisponibilidade variável: os ricos em ácidos oxálico e fítico apresentariam uma menor absorção, enquanto que os ricos em carboidratos teriam uma absorção maior. Por apresentarem uma biodisponibilidade do Ca mais próxima da do leite bovino, o leite de outros animais, o de soja enriquecido e alguns vegetais, em quantidades adequadas, poderiam ser usados como alternativas a este.
Triagem de mutações nos receptores de Angiotensina II, AGTR1 e AGTR2 e avaliação dos polimorfismos C573T e A1166C do gene AGTR1 em pacientes com adrenarca precoce idiopática
Authors: Moura Mônica S.F. , Melo Mônica B. de , Longui Carlos Alberto , Rocha Mylene N. , Monte Osmar
Published: December 2006

Pubarca precoce é o aparecimento de pêlos pubianos antes dos 8 anos em meninas e 9 anos em meninos, sendo sua etiologia mais freqüente a adrenarca precoce idiopática, a longo prazo, associada à síndrome metabólica. Dentre os fatores envolvidos na gênese da adrenarca precoce podemos citar a Angiotensina II (Ang II), a qual promove proliferação celular e esteroidogênese, podendo agir através de dois receptores, o tipo 1 (AT1) e o tipo 2 (AT2). Com o intuito de estudar mutações dos genes dos receptores da AngII, foram avaliadas 50 crianças com diagnóstico de adrenarca precoce idiopática e comparadas ao grupo controle de indivíduos normais. Não foram detectadas mutações dos genes AGTR1 e AGTR2, contudo dois polimorfismos foram identificados no gene AGTR1: o polimorfismo C573T (localizado no exon 5) e o A1166C (na região 3' não codificadora). A freqüência do alelo polimórfico T573 foi de 35% nos pacientes e 38% nos controles. O alelo polimórfico C1166 esteve presente em 24% dos pacientes e em 26% dos controles. Não houve diferença significante entre os grupos, assim como não houve correlação entre a freqüência dos polimorfismos C573T e A1166C e as variáveis clínicas e laboratoriais dos pacientes, ou com sua história familial de síndrome metabólica.
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
Authors: Cubas Elisangela R. , Boeving Anke , Marcatto Cristina , Santos Carlos M. Correa dos , Borba Victória C.Z. , Kulak Carolina A.M.
Published: December 2006

Selecionamos mulheres pré-menopausadas com redução da DMO encaminhadas ao ambulatório de Metabolismo Ósseo 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%) a coluna lombar estava acometida, 8 (23,5%) apresentaram Z-score < -2,5 e 21 (61,8%) Z-score entre -1,0 e -2,5. Vinte pacientes (58,8%) apresentaram redução da DMO em fêmur, 2 (6,2%) com Z-score < -2,5 e 18 (56,2%) com Z-score entre -1,0 e -2,5. Causa secundária foi identificada em 26 pacientes (76,5%). 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.
Malformations in the offspring of women with thyroid cancer treated with radioiodine for the ablation of thyroid remnants
Authors: Rosário Pedro Weslley S. do , Barroso Álvaro Luís , Rezende Leonardo Lamego , Padrão Eduardo Lanza , Borges Michelle A. Ribeiro , Purisch Saulo
Published: December 2006

RATIONALE: Since ovarian function is only temporarily compromised by radioiodine therapy, many women with thyroid cancer treated with radioiodine can become pregnant. The present study evaluated the evolution of these pregnancies and the consequences for the offspring. PATIENTS AND METHODS: We retrospectively analyzed 78 pregnancies of 66 women submitted to total thyroidectomy, followed by radioiodine therapy (3.75.5 GBq 131I, mean 4.64 GBq). In all patients, conception occurred one year after ablative therapy (mean of 30 months). Age ranged form 19 to 36 years (mean of 30.6 years) at the time of radioiodine treatment and from 23 to 39 years (mean of 32.8 years) at the time of conception. RESULTS: Four (5.1%) of the 78 pregnancies resulted in spontaneous abortions. Three (4%) of the 74 deliveries were preterm and there was no case of stillbirth. The birthweight was > 2500 g in 94.6% of the children (mean ± SD: 3350 ± 450 g) and only one infant (1.3%) presented an apparent malformation at birth (intraventricular communication). No difference in the age at the time of radioiodine therapy or conception or in radioiodine dose was observed between pregnancies with an unfavorable outcome and those with a favorable outcome. CONCLUSION: We conclude that pregnancies that occur 12 months after ablative therapy are safe.
Efeito do perfil de macronutrientes da dieta na leptinemia
Authors: Hermsdorff Helen H.M. , Volp Ana Carolina P. , Santos Rosana G.C. , Viana Mirelle L. , Bressan Josefina
Published: December 2006

O presente estudo teve como objetivo investigar o efeito da ingestão de dietas ricas em sacarose (DRS) e em lipídio (DRL) nas concentrações de glicose e leptina plasmáticas. Foram selecionadas 20 mulheres hígidas, 13 com peso normal (G1) e 7 com sobrepeso (G2). As dietas testes DRS (23,0% de sacarose) e DRL (45,0% de lipídio) foram calculadas para consumo em condições de vida livre, por 14 dias. Foram realizadas determinações de antropometria, de composição corporal, de glicose e leptina plasmáticas. Os valores de leptina plasmática de jejum e pós-prandiais foram maiores em G2 (p< 0,05) e correlacionaram-se positivamente com os dados antropométricos e de composição corporal (p< 0,05), destacando-se sua correlação positiva com a circunferência do quadril. As concentrações de glicose e leptina de jejum e pós-prandiais não diferiram entre as dietas. A glicemia nos tempos de 30 (p< 0,01) e 60 (p< 0,05) minutos após a ingestão de DRS correlacionou-se positivamente com a leptinemia pós-prandial. Os resultados confirmam a relação positiva entre a leptinemia e a gordura corporal, especificamente com o tecido adiposo subcutâneo e indicam que mais estudos são necessários para identificar o papel modulador da ingestão energética e do perfil de macronutrientes na leptinemia.
Deficiência de hormônio do crescimento, hipotireoidismo e cromossomo 18 em anel: relato de caso
Authors: Thomas Juliana V. , Mezzasalma Daniela F.C. , Teixeira Andreza M. , Campos Ludmila N.R. , Luescher Jorge Luiz , Beserra Izabel C.R. , Guimarães Marilia M.
Published: December 2006

INTRODUÇÃO: A associação de síndrome do cromossomo 18 em anel com deficiência de hormônio de crescimento (DGH) é muito rara, com apenas dois relatos na literatura. RELATO DO CASO: Paciente feminina, negra, 1 ano de idade, encaminhada para investigação de crises de hipoglicemia desde os 6 meses, acompanhadas de crise convulsiva. Apresentava atraso do desenvolvimento neuropsicomotor e erro alimentar. Ao exame físico, criança desnutrida (escores z peso/idade de -6,95 e estatura/idade de -5,05), fenda palatina, prega epicântica e hipotonia generalizada. O diagnóstico de DGH foi feito em vigência de hipoglicemia e iniciado o tratamento com somatropina 0,1 U/kg aos 16 meses de idade. A RM do crânio evidenciou neuro-hipófise ectópica. O hipotireoidismo foi diagnosticado com 1 ano e 7 meses, sendo adicionada levotiroxina ao tratamento. O cariótipo 46XX r(18) (p11,2 q.23), estabeleceu o diagnóstico de síndrome do cromossomo 18 em anel. Está em uso de GH há 3 anos, os episódios de hipoglicemia com crise convulsiva desapareceram mas não houve melhora da velocidade de crescimento. DISCUSSÃO: Não foram encontrados na literatura relatos da associação de DGH, hipotireoidismo e cromossomo 18 em anel. Crianças com cromossomo 18 em anel merecem investigação para DGH. A reposição com GH não melhorou o crescimento da nossa paciente.
Síndromes dolorosas em diabéticos por comprometimento de musculatura esquelética
Authors: Pereira Flávia O. , Medeiros Yara S.
Published: December 2006

Em diabéticos, síndromes dolorosas devidas o comprometimento do músculo esquelético sem neuropatia são complicações raras. Neste relato são apresentados dois casos: Caso 1 (piomiosite em panturrilhas) e Caso 2 (infarto muscular em coxa), sendo comentadas as características clínicas e os procedimentos diagnósticos. É necessário um alto índice de suspeita, uma vez que o tratamento de ambas difere significativamente. Além disso, o diagnóstico pode ser inicialmente confundido com tromboflebite, rabdomiólise ou neoplasia, retardando o tratamento correto. O atraso no tratamento da piomiosite com antibiótico e em alguns casos com cirurgia, pode evoluir para infecção sistêmica e até óbito, enquanto o infarto muscular requer apenas repouso e analgesia. Exames de imagem e de laboratório são úteis no diagnóstico diferencial, porém pode haver superposição dos achados. É enfatizada a importância de incluir estas doenças no diagnóstico diferencial de síndromes dolorosas do membro inferior em diabéticos.
Carcinoma mucoepidermóide de tireóide: relato de caso e revisão da literatura
Authors: França Sabrina R. , Caldas Dayse , V. Junior Alcebíades , Oliveira Carlos A.B. de
Published: December 2006

O carcinoma mucoepidermóide é um tipo de neoplasia encontrada geralmente nas glândulas salivares, mamas, pâncreas e trato digestivo. O acometimento primário da glândula tireóide é muito raro, apenas 33 casos na literatura. Embora a maioria dos casos de carcinoma mucoepidermóide de tireóide (CMET) tenha evolução favorável, o caso clínico relatado descreve uma paciente com tumor agressivo e, a partir deste relato, é apresentada revisão da literatura quanto aos aspectos clínico, histopatológico, imunohistoquímico e origem histogenética dessa neoplasia.
Anatomia das vias biliares em doadores e receptores de transplante hepático inter vivos
Authors: Soares Renato Vianna , Coelho Júlio Cezar U. , Matias Jorge E. F. , Freitas Alexandre C.T. de , Zeni-Neto Clementino , Godoy José Luis de
Published: December 2006

RACIONAL: Variações anatômicas das vias biliares são freqüentes e aumentam as complicações dos transplantes hepáticos. OBJETIVO: Avaliar a anatomia das vias biliares nos doadores e receptores do transplante hepático inter vivos realizados no Hospital de Clínicas da Universidade Federal do Paraná e do Hospital Nossa Senhora das Graças de Curitiba, Curitiba, PR. CASUÍSTICA E MÉTODOS: A avaliação foi retrospectiva de março de 1998 até setembro de 2002 (23 transplantes), quando os dados passaram a ser captados de forma prospectiva (17 transplantes), até agosto de 2003. Foram obtidos dados de 80 pacientes consecutivos (40 doadores e 40 receptores), submetidos a transplante hepático inter vivos, sendo 32 transplantes com receptor adulto e 8 transplantes pediátricos (receptor com idade inferior a 15 anos). Entre os 80 pacientes incluídos no estudo, 51 eram do sexo masculino (27 receptores e 24 doadores) e 29 do feminino (13 receptores e 16 doadores). A idade média dos doadores foi de 32,6 anos e a dos receptores de 36,3 anos. RESULTADOS: Nas cirurgias de captação do lobo hepático direito, a via biliar direita foi única em 25 entre 29 casos (86,2%), dupla em dois (6,9%) e tripla em dois (6,9%). Nos oito casos em que o setor lateral esquerdo ou o lobo hepático esquerdo foram captados, a via biliar foi única. Entre os 33 pacientes submetidos a colangiografia por ressonância magnética, variações foram verificadas em três pacientes (9,1%), sendo a mais comum o ducto biliar posterior direito tributário do ducto hepático esquerdo (6,06%; n = 2). CONCLUSÃO: A prevalência de anomalias biliares nos transplantes inter vivos de fígado é elevada e algumas não são diagnosticadas com os exames de imagem pré-operatórios.
Comparison of esophageal motility impairment caused by Chagas' disease in two age groups
Authors: Dantas Roberto Oliveira , Aprile Lilian Rose Otoboni
Published: December 2006

BACKGROUND: Chagas' disease and the aging process cause loss of neurons of the esophageal myenteric plexus. AIM: To evaluate the esophageal motility impairment caused by Chagas' disease in two age groups. Our hypothesis was that the aging process may cause further esophageal motility impairment in patients with Chagas' disease. METHODS: We studied the esophageal motility of 30 patients with Chagas' disease and dysphagia, with esophageal retention of barium sulfate and an esophageal diameter within the normal range. Fifteen were 34 to 59 years old (younger group, median 51 years) and 15 were 61 to 77 years old (older group, median 66 years). As a control group we studied 15 subjects aged 33 to 58 years (median 42 years) and 7 subjects aged 61 to 73 years (median 66 years). The esophageal contractions were measured by the manometric method with continuous perfusion after five swallows of a 5 mL bolus of water at 2, 7, 12 and 17 cm below the upper esophageal sphincter. RESULTS: Patients with Chagas' disease had lower amplitude of contractions and fewer peristaltic, more simultaneous, and more non-conducted contractions than controls. Older patients with Chagas' disease had lower amplitude of contractions in the distal esophagus (mean ± SE: 30.8 ± 4.3 mm Hg) than younger patients (51.9 ± 8.6 mm Hg). From 12 to 17 cm, older patients had more non-conducted (41%) and fewer peristaltic (8%) contractions than younger patients (non-conducted: 16%, peristaltic: 21%). CONCLUSION: Older patients with Chagas' disease with clinical and radiological examinations similar to those of younger patients had motility alterations suggesting that the aging process may cause further deterioration of esophageal motility.
Avaliação clínica e videofluoroscópica de pacientes com distúrbios da deglutição - estudo comparativo em dois grupos etários: adultos e idosos
Authors: Suzuki Heloisa Sawada , Nasi Ary , Ajzen Sérgio , Bilton Tereza , Sanches Elaine Palinkas
Published: December 2006

RACIONAL: As anomalias do processo da deglutição têm etiologia multifatorial e complexa. A videofluoroscopia da deglutição tem sido apontada como o exame de maior utilidade na investigação diagnóstica desses casos. Tal método, quando precedido de anamnese clínica adequada, consegue caracterizar convenientemente o grau de disfunção e, freqüentemente, identificar a causa da anomalia com grande precisão. OBJETIVOS: Estudar as queixas clínicas e os achados da videofluoroscopia em pacientes com distúrbios da deglutição, sem evidências clínicas de afecções neurológicas associadas, distribuídos em duas faixas etárias - adultos e idosos - e analisar as manifestações sintomáticas, o tipo de disfunção (orofaríngea ou esofágica) e a capacidade de elucidação da queixa clínica pelo método de imagem. MATERIAL E MÉTODOS: Foram analisados 70 pacientes com queixa de alteração na capacidade de deglutição, sem evidências clínicas de afecções neurológicas associadas, distribuídos em dois grupos: adultos (GI) - idade inferior ou igual a 65 anos (n = 36) e idosos (GII) - idade superior a 65 anos (n = 34). Todos foram submetidos a anamnese para obtenção de informações sobre queixas em relação à deglutição; as queixas foram caracterizadas como altas ou baixas, de acordo com o local predominante de manifestação. Todos os pacientes foram submetidos a videofluoroscopia da deglutição; as alterações observadas com esse exame foram caracterizadas como orofaríngeas ou esofágicas. Avaliou-se a capacidade de elucidação da queixa clínica pela videofluoroscopia nos dois grupos. RESULTADOS: Dentre as queixas analisadas, a única cuja análise estatística demonstrou diferença significante entre os grupos, foi a de pirose, que ocorreu com maior freqüência no grupo de adultos (oito pacientes (22,2%) do GI e um (2,9%) do GII referiam tal queixa). Ao estudo videofluoroscópico, observou-se maior ocorrência de disfunção orofaríngea no grupo de pacientes idosos (41,2% GII x 13,9% GI) e ocorrência semelhante, nos dois grupos, de disfunção esofágica (35,3% GII x 33,3% GI). Dezenove (52,8%) pacientes do GI e 23 (67,6%) do GII tiveram suas queixas clínicas elucidadas pela videofluoroscopia. CONCLUSÕES: 1. As queixas clínicas associadas ao quadro de dificuldade de deglutição ocorrem com freqüência semelhante em adultos e idosos, com exceção da queixa de pirose que predomina no grupo com idade menos avançada; 2. pacientes idosos apresentam maior ocorrência de alterações altas de deglutição (orofaríngeas); 3. a videofluoroscopia da deglutição representa método de grande importância diagnóstica, pois permite a identificação de alterações morfofuncionais relevantes que não são passíveis de identificação adequada à anamnese, e 4. a capacidade de elucidação diagnóstica da videofluoroscopia da deglutição é maior no grupo com idade mais avançada.