Hypothalamic integration of body fluid regulation.

The progression of animal life from the paleozoic ocean to rivers and diverse econiches on the planet's surface, as well as the subsequent reinvasion of the ocean, involved many different stresses on ionic pattern, osmotic pressure, and volume of the extracellular fluid bathing body cells. The relatively constant ionic pattern of vertebrates reflects a genetic "set" of many regulatory mechanisms--particularly renal regulation. Renal regulation of ionic pattern when loss of fluid from the body is disproportionate relative to the extracellular fluid composition (e.g., gastric juice with vomiting and pancreatic secretion with diarrhea) makes manifest that a mechanism to produce a biologically relatively inactive extracellular anion HCO3- exists, whereas no comparable mechanism to produce a biologically inactive cation has evolved. Life in the ocean, which has three times the sodium concentration of extracellular fluid, involves quite different osmoregulatory stress to that in freshwater. Terrestrial life involves risk of desiccation and, in large areas of the planet, salt deficiency. Mechanisms integrated in the hypothalamus (the evolutionary ancient midbrain) control water retention and facilitate excretion of sodium, and also control the secretion of renin by the kidney. Over and above the multifactorial processes of excretion, hypothalamic sensors reacting to sodium concentration, as well as circumventricular organs sensors reacting to osmotic pressure and angiotensin II, subserve genesis of sodium hunger and thirst. These behaviors spectacularly augment the adaptive capacities of animals. Instinct (genotypic memory) and learning (phenotypic memory) are melded to give specific behavior apt to the metabolic status of the animal. The sensations, compelling emotions, and intentions generated by these vegetative systems focus the issue of the phylogenetic emergence of consciousness and whether primal awareness initially came from the interoreceptors and vegetative systems rather than the distance receptors.

Qualidade de vida relacionada à saude em mulheres com reações adversas após tratamento com quimioterapia para câncer de mama

Trata-se de estudo descritivo, exploratório, transversal, quantitativo, realizado com mulheres em tratamento quimioterápico para neoplasias de mama, em Aracaju-Sergipe-Brasil. O objetivo foi avaliar a qualidade de vida relacionada à saúde (QVRS) destas mulheres que apresentaram reações adversas pós quimioterapia. Foram utilizados instrumentos contendo dados sócio demográficos, clínicos e terapêuticos, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 e formulário de registro de toxicidades dos antineoplásicos. Na análise dos dados, foram utilizados análise descritiva, cálculos de percentual, teste de Shapiro-Wilk, coeficiente de correlação de Pearson ou de Spearman, teste de ANOVA ou Kruskal-Wallis. Os resultados mostraram dados de 206 mulheres, a partir da segunda sessão de quimioterapia, com média de idade de 53,1 anos, maioria procedente de Sergipe, com Carcinoma Ductal Infiltrante, estadiamento III. A maioria realizou cirurgia oncológica, não realizaram radioterapia devido à grande fila de espera, o protocolo de quimioterapia mais comum foi TAC (docetaxel, doxorrubicina e ciclofosfamida). Quanto às reações adversas, a maioria não apresentou alterações hematológicas e metabólicas no momento da coleta das informações, nas alterações funcionais, a fadiga foi presente em 80,8% dos casos, de forma moderada. Nas alterações gastrintestinais, diarreia, constipação, mucosite, náusea, vômito e dor abdominal foram citadas pela maioria. Nas alterações dermatológicas, a alopecia, hiperpigmentação na pele, alterações nas unhas, prurido na pele, descamação e eritema multiforme foram citadas pelas entrevistadas. Nas alterações cardiovasculares, hipotensão e HAS sobressaíram-se. Nas alterações neurológicas, neuropatia periférica, perda da audição e zumbido foram comuns. Os resultados da avaliação da QVRS foram analisadas à luz do referencial teórico de Ferrel et al. (1995) com os seguintes resultados: média do escore 76,01; escalas funcionais apresentaram escore baixo, com aspectos físico, emocional, cognitivo, funcional e social bastante afetados após o tratamento, o desempenho de papéis e função emocional foram os mais prejudicados; na escala de sintomas, os domínios mais prejudicados foram: dificuldades financeiras, fadiga e insônia. Na análise de correlação, o escore geral da QVRS apresentou correlação estatisticamente significante com a quantidade de reações adversas na medula óssea. Em todos os casos estatisticamente significantes o domínio emocional apresentou correlações positivas e o domínio dor, correlações negativas. A idade apresentou correlação estatisticamente significante e negativa com os domínios físico e dificuldades financeiras e positiva com perda de apetite. Pelo procedimento de comparações múltiplas, as diferenças ocorreram entre os estados civis casado e separado e também casado e solteiro, entre as religiões católica e evangélica, entre os ensinos fundamental e médio e entre médio e superior; para a extensão da doença os domínios dor e insônia apresentaram diferenças estatisticamente significantes entre as categorias de extensão. Para renda mensal, os domínios fisico, desempenho de papel, emocional, constipação e dificuldades financeiras apresentaram diferenças estatisticamente significantes entre as categorias de renda. Nos domínios fisico, desempenho de papel e emocional as diferenças ocorreram entre as faixas de 1 a 3 e mais de 6 salários. Concluiu-se que as reações adversas causadas pelo tratamento antineoplásico com quimioterapia afetaram de algum modo as pacientes, causando déficits em vários domínios, prejudicando assim sua QVRS

Some account of a paper call'd the Telltale, begun in colledge Sept 1721

The small leather-bound volume holds two sections, a manuscript student periodical, and written tête-bêche, an exchange on smallpox inoculation followed by notes on the rules and activities of a Harvard College student club. The volume begins with thirteen numbered manuscript issues, written in one hand, of the Tell-Tale running from September 9, 1721 to November 1, 1721. Prefaced, "This paper was entitl'd the Telltale or Criticisms on the Conversation & Beheavour of Scholars to promote right reasoning & good manner," the work is modeled after literary periodicals of the time, including the "Spectator," and is considered the oldest student publication at Harvard. The periodical appears to have circulated in manuscript form. The content varies in format and includes letters between Telltale and correspondents, short essays, and advertisements. Topics discussed include conversation, detraction, and flattery. While not specifically about Harvard it does provide some information about the College including evidence of various student activities and organizations at Harvard in the 1720s. The entry explaining the rules of the Telltale Club is heavily faded and nearly illegible. The Telltale records multiple dreams, which are populated by various characters, such as “beautiful” Kate, two “learned Physicians” debating inoculation, “four Fellows” “pushing and shoving one another,” and a “person of a very Dark & swarthy complexion in a Slovenly Dress with 7 patches & 5 sparks on his Face.”

Pynchon, John, 1621-1703, autographed letter signed to John Winthrop; Springfield, Mass., 1 side (2 pages), 1663 July 24

Correspondence seeking Winthrop's advice regarding treatment of his daughter, who had been vomiting and suffering insomnia and dry mouth for several days

Smyth, Richard, autographed letter signed to John Winthrop; Wethersfeild [sic], Conn., 1 side (2 pages), 1652 February 21

Correspondence requesting advice on treatment and medicine for his daughter-in-law, who was ill with pain, vomiting, and a cough.

Hiperparatiroidismo primário em doentes jovens

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Doença de Hirschsprung : abordagem sumária de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Conhecimento e atitudes dos pais perante a criança com febre em contexto de serviço de urgência

Enquadramento – A febre na criança constitui uma das principais manifestações que impul-siona os pais na procura dos cuidados de saúde diferenciados, resultando na utilização ina-propriada de recursos. Objetivos – Identificar as variáveis sociodemográficas que interferem no conhecimento e nas atitudes dos pais perante a criança com febre; avaliar a influência do número de filhos no conhecimento e nas atitudes; identificar as fontes de informação que influenciam o conheci-mento e as atitudes dos pais. Material e Método – Estudo quantitativo, transversal, descritivo e correlacional. Recorreu-se ao questionário que inclui a caracterização sociodemográfica, contextual da criança, variá-veis clínicas de fontes de informação e questões que avaliam o conhecimento e as atitudes dos pais perante a febre na criança. A amostragem é não probabilística por conveniência (144 pais/cuidadores). Resultados – Amostra predominantemente feminina (86.8%), os homens são mais velhos (M=34.05 anos .6.45 anos); cerca de 9 em cada 10 das crianças eram acompanhadas pela mãe. Os sintomas que mais preocupam e levaram os participantes a recorrer ao Serviço de Urgência foram: vómitos/desidratação (66.4%), mau estado geral (64.6%), dificuldade respirató-ria (52.1%); em 58.5% dos casos de febre sem foco poder-se-ia ter utilizado os cuidados de saúde primários; a idade da criança e o sexo dummy revelaram-se preditoras dos conhecimen-tos e o sexo preditor das atitudes; as mulheres e os homens com mais idade e com filhos mais jovens possuem melhores conhecimentos; as mulheres têm atitudes mais adequadas. Conclusões – As mulheres possuem conhecimentos intermédios e revelam melhor atitude perante a febre. Quanto maior a escolaridade melhor é o conhecimento e os participantes que procuram como fonte de informação um profissional de saúde, possuem atitudes mais ade-quadas. Assume grande relevância a aquisição de competências que proporcionem aos pais/cuidadores ferramentas que os ajudem a lidar com a fobia da febre. Palavras-chave: Febre; Criança; Pais; Conhecimento; Atitudes; Serviço de Urgência.

De nausea ac vomitu gravidarum : Dissertatio medica /

Mode of access: Internet.

An analysis of clinical characteristics in genetically linked migraine-affected pedigrees

Migraine is a common complex disorder characterized by severe recurrent headache and usually accompanied by nausea and vomiting. Previous studies in our laboratory have utilized three large multigenerational Australian pedigrees affected with migraine to indicate that the disease is genetically heterogeneous, with linkage results implicating genomic susceptibility regions on both chromosomes 19p and Xq. The present study explores the possibility of a correlation between genetic and clinical heterogeneity in these affected pedigrees. Specifically, the clinical characteristics of migraine including subtype, age of onset, frequency, duration, and disease symptoms were compared between the migraine pedigrees, and gender differences were also assessed. Our exploratory analyses revealed no significant differences in any of the clinical characteristics tested between the chromosome 19-linked family and the two X-linked families. Also, we did not detect any differences in male vs. female clinical features for these pedigrees. In conclusion, migraine is considered to be a clinically and genetically heterogeneous disorder; however, our study provided no conclusive evidence that variation in genomic susceptibility region is related to heterogeneity at the clinical level in these migraine-affected pedigrees.

The role of morphine-6-glucuronide (M6G) in pain control

Morphine-6beta-D-glucuronide (M6G) is an analgesically active metabolite of morphine, accounting for approximate to10% of the morphine dose when administered by systemic routes to humans. Although M6G is more hydrophilic than morphine, it crosses the blood-brain barrier, albeit relatively slowly. For this reason, it is generally thought that, after chronic dosing, M6G contributes significantly to the analgesic effects of systemically administered morphine. Owing to its polar nature, M6G is cleared from the systemic circulation primarily via renal elimination. As M6G accumulates in patients with renal impairment, there is an increased risk of M6G-induced respiratory depression in renal failure patients who are being dosed chronically with systemic morphine. Consistent with its analgesic and respiratory depressant properties, M6G binds to the p-opioid receptor in a naloxone-reversible manner. Although the affinity of M6G for the mu-opioid receptor is similar to or slightly less than that of morphine, preclinical studies in rodents show that M6G is one to two orders of magnitude more potent than morphine when administered by central routes. This major discrepancy between the markedly higher intrinsic antinociceptive potency of M6G relative to morphine, despite their similar p-opioid receptor binding affinities, is difficult to reconcile. It has been proposed that M6G mediates its pain-relieving effects through a novel 'M6G opioid receptor', while others have argued that M6G may have higher efficacy than morphine for transduction of intracellular events. When administered by parenteral routes to rodents, M6G's antinociceptive potency is no more than twofold higher than morphine. In humans, the analgesic efficacy and respiratory depressant potency of M6G relative to morphine have been assessed in a number of short-term studies involving the intrathecal or intravenous routes of administration. For example, in hip replacement patients, intrathecal M6G provided excellent postoperative analgesia but the occurrence of late respiratory depression in 10% of these patients raised serious concern about safety. In postoperative patients, intravenous M6G administered by means of patient-controlled analgesia (PCA), or bolus plus PCA, produced no analgesia in one study and limited analgesia in another. Similarly, there was a lack of significant analgesia in healthy volunteers who received intravenous M6G for the alleviation of experimental pain (carbon dioxide applied to the nasal mucosa). In contrast, satisfactory analgesia was produced by bolus doses of intravenous M6G administered to patients with cancer pain, and to healthy volunteers with experimentally-induced ischaemic, electrical or thermal (ice water) pain. Studies to date in healthy volunteers suggest that intravenous M6G may be a less potent respiratory depressant and have a lower propensity for producing nausea and vomiting than morphine. However, it is unclear whether equi-analgesic doses of M6G and morphine were compared. Clearly, more extensive short-term trials, together with studies involving chronic M6G administration, are necessary before the potential clinical utility of M6G as an analgesic drug in its own right can be determined.

A prospective trial of short-fractionation radiotherapy for the palliation of liver metastases

The purpose of this study was to prospectively examine the effectiveness and tolerability of a simple radiotherapy technique for the palliation of symptomatic liver metastases. Twenty-eight patients with symptomatic liver metastases were enrolled from seven centres, and received targeted (partial or whole) liver irradiation consisting of 10 Gy in two fractions over 2 days. Symptoms at baseline were hepatic pain (27 patients), abdominal distension (19), night sweats (12), nausea (18) and vomiting (eight). Twenty-two patients (76%) had failed previous treatment with chemotherapy, hormonal therapy and/or high-dose steroids. Symptoms and potential toxicities were prospectively assessed at the time of treatment, then 2, 6 and 10 weeks later. Individual symptom response rates were 53−66% at 2 weeks. Partial or complete global symptomatic responses were noted in 15 patients (54%) overall. The treatment was well tolerated with two patients (7%) experiencing grade 3 toxicity (one vomiting and one diarrhoea); however, four patients reported temporary worsening of pain shortly after treatment. This simple and well-tolerated treatment achieves useful palliation.

Genomewide significant linkage to migrainous Hheadache on chromosome 5q21

Familial typical migraine is a common, complex disorder that shows strong familial aggregation. Using latent-class analysis (LCA), we identified subgroups of people with migraine/severe headache in a community sample of 12,245 Australian twins (60% female), drawn from two cohorts of individuals aged 23-90 years who completed an interview based on International Headache Society criteria. We report results from genomewide linkage analyses involving 756 twin families containing a total of 790 independent sib pairs ( 130 affected concordant, 324 discordant, and 336 unaffected concordant for LCA-derived migraine). Quantitative-trait linkage analysis produced evidence of significant linkage on chromosome 5q21 and suggestive linkage on chromosomes 8, 10, and 13. In addition, we replicated previously reported typical-migraine susceptibility loci on chromosomes 6p12.2-p21.1 and 1q21-q23, the latter being within 3 cM of the rare autosomal dominant familial hemiplegic migraine gene (ATP1A2), a finding which potentially implicates ATP1A2 in familial typical migraine for the first time. Linkage analyses of individual migraine symptoms for our six most interesting chromosomes provide tantalizing hints of the phenotypic and genetic complexity of migraine. Specifically, the chromosome 1 locus is most associated with phonophobia; the chromosome 5 peak is predominantly associated with pulsating headache; the chromosome 6 locus is associated with activity-prohibiting headache and photophobia; the chromosome 8 locus is associated with nausea/vomiting and moderate/severe headache; the chromosome 10 peak is most associated with phonophobia and photophobia; and the chromosome 13 peak is completely due to association with photophobia. These results will prove to be invaluable in the design and analysis of future linkage and linkage disequilibrium studies of migraine.

Vitamin A supplementation for breastfeeding mothers (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of vitamin A supplementation, alone or in combination with other micronutrients (e.g. iron, folic acid, vitamin E), in mothers during the postpartum period, on maternal and infant health. Specific objectives are to compare the effects of vitamin A supplementation (alone or in combination with other micronutrients) with placebo or no supplementation on: 1. the duration and occurrence of maternal morbidity (xerophthalmia, infection) or illness symptoms (night blindness, fever, nausea, vomiting); 2. the duration and occurrence of neonatal or infant morbidity (respiratory tract infection, diarrhea, measles) or illness symptoms (fever, nausea, vomiting); 3. maternal serum retinol concentration; 4. infant serum retinol concentration; 5. breast milk retinol concentration; and 6. maternal satisfaction.

Clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector in wild dogs

Sodium cyanide poison is potentially a more humane method to control wild dogs than sodium fluoroacetate (1080) poison. This study quantified the clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector. The device delivered a nominal 0.88 g of sodium cyanide, which caused the animal to loose the menace reflex in a mean of 43 s, and the animal was assumed to have undergone cerebral hypoxia after the last visible breath. The mean time to cerebral hypoxia was 156 s for a vertical pull and 434 s for a side pull. The difference was possibly because some cyanide may be lost in a side Pull. There were three distinct phases of cyanide toxicosis: the initial phase was characterised by head shaking, panting and salivation; the immobilisation phase by incontinence, ataxia and loss of the righting reflex; and the cerebral hypoxia phase by a tetanic seizure. Clinical signs that were exhibited in more than one phase of cyanide toxicosis included retching, agonal breathing, vocalisation, vomiting, altered levels of ocular reflex, leg paddling, tonic muscular spasms, respiratory distress and muscle fasciculations of the muzzle.