Diretrizes para prevenção e tratamento da osteoporose induzida por glicocorticoide

Os glicocorticoides (GC) são prescritos por praticamente todas as especialidades médicas, e cerca de 0,5% da população geral do Reino Unido utiliza esses medicamentos. Com o aumento da sobrevida dos pacientes com doenças reumatológicas, a morbidade secundária ao uso dessa medicação representa um aspecto importante que deve ser considerado no manejo de nossos pacientes. As incidências de fraturas vertebrais e não vertebrais são elevadas, variando de 30%-50% em pessoas que usam GC por mais de três meses. Assim, a osteoporose e as fraturas por fragilidade devem ser prevenidas e tratadas em todos os pacientes que iniciarão ou que já estejam em uso desses esteroides. Diversas recomendações elaboradas por várias sociedades internacionais têm sido descritas na literatura, porém não há consenso entre elas. Recentemente, o Americam College of Rheumatology publicou novas recomendações, porém elas são fundamentadas na FRAX (WHO Fracture Risk Assessment Tool) para analisar o risco de cada indivíduo e, dessa maneira, não podem ser completamente utilizadas pela população brasileira. Dessa forma, a Comissão de Osteoporose e Doenças Osteometabólicas da Sociedade Brasileira de Reumatologia, em conjunto com a Associação Médica Brasileira e a Associação Brasileira de Medicina Física e Reabilitação, implementou as diretrizes brasileiras de osteoporose induzida por glicocorticoide (OPIG), baseando-se na melhor evidência científica disponível e/ou experiência de experts. DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIA: A revisão bibliográfica de artigos científicos desta diretriz foi realizada na base de dados MEDLINE. A busca de evidência partiu de cenários clínicos reais, e utilizou as seguintes palavras-chave (MeSH terms): Osteoporosis, Osteoporosis/chemically induced*= (Glucocorticoids= Adrenal Cortex Hormones, Steroids), Glucocorticoids, Glucocorticoids/administration and dosage, Glucocorticoids/therapeutic use, Glucocorticoids/adverse effects, Prednisone/adverse effects, Dose-Response Relationship, Drug, Bone Density/drug effects, Bone Density Conservation Agents/pharmacological action, Osteoporosis/ prevention&control, Calcium, Vitamin D, Vitamin D deficiency, Calcitriol, Receptors, Calcitriol; 1-hydroxycholecalciferol, Hydroxycholecalciferols, 25-Hydroxyvitamin D3 1-alpha-hydroxylase OR Steroid Hydroxylases, Prevention and Control, Spinal fractures/prevention & control, Fractures, Spontaneous, Lumbar Vertebrae/injuries, Lifestyle, Alcohol Drinking, Smoking OR tobacco use disorder, Movement, Resistance Training, Exercise Therapy, Bone density OR Bone and Bones, Dual-Energy X-Ray Absorptiometry OR Absorptiometry Photon OR DXA, Densitometry, Radiography, (Diphosphonates Alendronate OR Risedronate Pamidronate OR propanolamines OR Ibandronate OR Zoledronic acid, Teriparatide OR PTH 1-34, Men AND premenopause, pregnancy, pregnancy outcome maternal, fetus, lactation, breast-feeding, teratogens, Children (6-12 anos), adolescence (13-18 anos). GRAU DE RECOMENDAÇÃO E FORÇA DE EVIDÊNCIA: A) Estudos experimentais e observacionais de melhor consistência; B) Estudos experimentais e observacionais de menor consistência; C) Relatos de casos (estudos não controlados); D) Opinião desprovida de avaliação crítica, com base em consensos, estudos fisiológicos ou modelos animais. OBJETIVO: Estabelecer as diretrizes para a prevenção e o tratamento da OPIG.

Dynamics of mother-pup interactions: tradeoff between environment and physiology

The emergence and maintenance of maternal behavior are under the influence of environmental cues such as light and dark periods. This article discusses the characteristic neurobiology of the behavioral patterns of lactating rats. Specifically, the hormonal basis and neurocircuits that determine whether mother rats show typical sequential patterns of behavioral responses are discussed. During lactation, rats express a sequential pattern of behavioral parameters that may be determined by hormonal variations. Sensorial signals emitted by pups, as well as environmental cues, are suggested to serve as conditioned stimuli for these animals. Finally, the expression of maternal behavior is discussed under neuroeconomic and evolutionary perspectives.

Post-partum testosterone administration partially reverses the effects of perinatal cadmium exposure on sexual behavior in rats

This study investigated the effects of perinatal cadmium exposure on sexual behavior, organ weight, and testosterone levels in adult rats. We examined whether immediate postpartum testosterone administration is able to reverse the toxic effects of the metal. Forty pregnant Wistar rats were divided into three groups: 1) control, 2) 10 mg kg-1 cadmium chloride per day, and 3) 20 mg kg-1 cadmium chloride per day. These dams were treated on gestational days 18 and 21 and from lactation 1 to 7. Immediately after birth, half of the offspring from the experimental and control groups received 50 μl (i.p.) of 0.2% testosterone. Male sexual behavior, histological analysis and weight of organs as well as serum testosterone levels were assessed. Results showed that both cadmium doses disrupted sexual behavior in male rats, and postnatal treatment with testosterone reversed the toxic effects of 10 mg kg-1 cadmium and attenuated the effects of 20 mg kg-1 cadmium. Body weight and absolute testis, epididymis, and seminal vesicle weight were decreased by the higher cadmium dose, and testosterone supplementation did not reverse these effects. Serum testosterone levels were unaffected by both cadmium doses. No histological changes were detected in all organs analyzed. Maternal cadmium exposure effects in sexual parameters of male rat offspring were explained by the altered masculinization of the hypothalamus. We suggest that cadmium damaged cerebral sexual differentiation by its actions as an endocrine disruptor and supported by the changes discretely observed from early life during sexual development to adult life, reflected by sexual behavior. Testosterone supplementation after birth reversed some crucial parameters directly related to sexual behavior.

Detection of larvae of Toxocara canis in milk: an experimental study in rabbits.

Toxocariasis, caused most commonly by Toxocara canis, is an important cosmopolitan zoonosis. Paratenic hosts have been employed to provide knowledge regard to the transmission of toxocariasis. Transmammary transmission in murine experimentally infected was observed based on the recovery of larvae from the tissue. The aim of this study was to evaluate the possibility of transmammary transmission of Toxocara canis in rabbits by detecting larvae directly in milk. Seventeen sexually mature virgin white New Zealand female rabbits were divided into two groups. Twelve animals were orally inoculated with 1,000 T. canis embryonated eggs (infected group), and five animals remained uninfected (control group). One month following the infection, the females were mated. Manual collection of 500 ?L of milk from each rabbit was performed on days +7, +14 and +21 of lactation for three consecutive lactations. The recovery of larvae was determined via a centrifuge-sedimentation technique using ether and formalin solutions. ELISA test was run to confirm the production of anti-T. canis antibodies (IgG) by infected rabbits. The presence of larvae was observed in milk samples from 5 (41.7%) of the 12 infected rabbits. The total number of recovered larvae was 20, ranging from 1 to 4 larvae per lactation/rabbit. Larvae were recovered exclusively on days 7 and 14 of lactation. Recovery was verified in different lactations. No significant difference was observed with respect to the number of larvae either in the same lactation period or in different lactation periods. Anti-T. canis antibodies were detected in all infected rabbits. In conclusion, the presence of larvae in rabbit milk samples suggests the possibility of galactogenic transmission of T. canis in paratenic hosts. Moreover, the technique employed in this study allows for the recovery of larvae directly from milk.

Condição corporal ao parto e produção de leite sobre o desempenho reprodutivo de vacas holandesas em lactação

O objetivo, neste estudo, foi avaliar os efeitos da condição corporal ao parto e da mudança de condição corporal sobre o desempenho reprodutivo de vacas leiteiras após o parto. Para tanto, 51 vacas holandesas, de 30 dias pré-parto até 150 dias após o parto, foram distribuídas aleatoriamente de acordo com a condição corporal ao parto nas classes 1 (condição corporal maior ou igual a 3,25) e 2 (condição corporal menor ou igual a 3,0). Dentro das classes de condição corporal ao parto, os animais foram distribuídos quanto à mudança de condição corporal (Categoria 1, igual ou menor que -0,50 e Categoria 2, igual ou maior que -0,75) e à média da produção de leite ajustada para 3,5% aos 150 dias (Grupo 1 = 22,61 e Grupo 2 = 31,65 kg/dia). Não houve diferenças da condição corporal ao parto e da produção de leite ajustada para 3,5% sobre o intervalo parto primeiro estro, intervalo parto primeiro serviço, período de serviço, número de serviço / concepção e taxa de gestação aos 150 dias de lactação. Vacas que ao parto apresentaram média de escore de condição corporal de 3,40 e 2,79 tiveram semelhante desempenho reprodutivo pósparto. Em relação à produção de leite ajustada para 3,5%, vacas com produção média de 22,61 e 31,65 apresentaram similares resultados. A mudança de condição corporal não influenciou o intervalo parto primeiro serviço, o período de serviço e o número de serviço por concepção, mas apresentaram maior intervalo parto primeiro estro e menor taxa de gestação