Clinical features and genetic analysis of four Brazilian kindreds with resistance to thyroid hormone

Objective Resistance to thyroid hormone (RTH) is a dominantly inherited syndrome of reduced tissue responsiveness to thyroid hormone usually due to mutations located in the ligand-binding domain and adjacent hinge region of the thyroid hormone receptor beta (TR beta). In the present report we describe the clinical and laboratory characteristics and the genetic analysis of patients with this rare disorder from a Brazilian population.Patients Four unrelated Brazilian families with diagnosis of RTH were studied. Age at diagnosis varied from 14 months to 29 years.Results All affected individuals were clinically euthyroid, except for one patient who presented immediately after birth with hyperthyroidism. All individuals had tachycardia and goitre, elevated concentrations of free thyroid hormones and reduced sensitivity to thyroid hormone. Direct sequencing analysis of the TR beta gene revealed four previously reported mutations: c.949G -> A, c.1313G -> A, c.1357C -> A and c.1358dupC in families A, B, C and D, respectively.Conclusion the present report shows that the frequent mutations described in the thyroid hormone receptor worldwide are also present in the Brazilian population, which is characterized by a variable ethnic background.

As características dos alunos são determinantes para o adoecimento de professores - um estudo comparativo sobre a incidência de Burnout em professores do ensino regular e especial

The practice of teaching is permeated by adverse working conditions, low wages, inadequacy of material and teaching resources, overcrowded classrooms, tension in relationships with the students, excessive work load, lack of safety in the school environment, insignificant participation in institutional planning and in institutional politics. The objective of the present study was to compare burnout among three groups of teachers who work in elementary grades: a) 20 teachers who teach in regular school classrooms without the inclusion of students with special educational needs - RSI Group; b) 20 teachers who teach in the regular classroom with special needs students - RCI Group; c) 20 teachers who teach in resource classrooms (SR Group). The instruments used for data collection were the Maslach Burnout Inventory -MBI. The data was analyzed by SPSS version 13.0 and Kruskal-Wallis test for comparison of the three groups. The results were organized in the form of figures and tables. In general, the results demonstrated that the groups presented relative similarity. The teachers from the SR Group obtained the best results in the evaluation of the three burnout scales when compared to the RSI Group and RCI Group, that is, there was a prevalence of answers in the lower levels of emotional exhaustion, high level of low personal accomplishment and low level for depersonalization. It is hoped that these results contribute to a better understanding of burnout in teachers from regular classrooms with or without students with educational special needs and/or to indicate new directions for investigation.

High levels of heat shock protein 70 are associated with pro-inflammatory cytokines and may differentiate early- from late-onset preeclampsia

Preeclampsia (PE), a specific syndrome of pregnancy, can be classified into early and late onset, depending on whether clinical manifestations occur before or after 34 weeks' gestation. We determined whether plasma concentrations of Hsp60 and Hsp70 were related to circulating cytokine levels, as well as kidney and liver functions, in early- and late-onset PE. Two hundred and thirty-seven preeclamptic women (95 with early- and 142 with late-onset PE) were evaluated. Plasma levels of Hsp60, Hsp70, and their specific antibodies, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1, IL-10, IL-12, and soluble TNF-α-receptor I (sTNFRI) concentrations, were determined by enzyme-linked immunosorbent assay (ELISA). Concentrations of Hsp70, TNF-α, IL-1β, IL-12, and sTNFRI were significantly elevated in patients with early-onset PE compared with women with late-onset PE; IL-10 levels were significantly lower in the early-onset PE group. Concentrations of urea, uric acid, proteinuria, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and lactate dehydrogenase (LDH) were also significantly higher in early-onset PE. The percentage of infants with intrauterine growth restriction was also significantly higher in women with early-onset PE. There were positive correlations between Hsp70 levels and TNF-α, TNFRI, IL-1β, IL-12, GOT, GPT, LDH, and uric acid concentrations in early-onset PE group. Thus, early-onset PE was associated with greater maternal and fetal impairment. There are differences in pathophysiology between early- and late-onset PE, highlighting by the difference in Hsp70 levels. © 2013 Elsevier B.V. All rights reserved.

Sinking skin flap syndrome with delayed dysautonomic syndrome - An atypical presentation

INTRODUCTION Sinking skin flap syndrome or syndrome of the trephined is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. PRESENTATION OF CASE We report a case of 21 years old man with trefinated syndrome showing delayed dysautonomic changes. DISCUSSION Our patient had a large bone flap defect and a VP shunt that constitute risk factors to develop this syndrome. Also, there is reabsorption of bone tissue while it is placed in subcutaneous tissue. The principal symptoms of sinking skin flap syndrome are severe headache, mental changes, focal deficits, or seizures. Our patient presented with a delayed dysautonomic syndrome, with signs and symptoms very characteristics. Only few cases of this syndrome were related in literature and none were presented with dysautonomic syndrome. CONCLUSION We reported here a very uncommon case of sinking skill flap syndrome that causes a severe dysautonomic syndrome and worsening the patient condition. © 2013 The Authors.

Brachiaria spp. poisoning of ruminants in Brazil

Brachiaria spp. são as forrageiras mais importantes para a pecuária brasileira. Entretanto, um fator limitante para sua utilização é a sua toxicidade. A maioria dos surtos de fotossensibilização hepatógena é causada por Brachiaria decumbens; porém, B. brizantha, B. humidicola e B. ruziziensis podem também causar intoxicação. A intoxicação afeta bovinos, ovinos, caprinos e bubalinos. Os ovinos são mais susceptíveis que as outras espécies, e os animais jovens são mais susceptíveis que os adultos. Existem diferenças na susceptibilidade entre animais da mesma espécie e tem sido sugerido que esta resistência é genética. Sugere-se, também, que búfalos e provavelmente alguns ovinos são resilientes (quando intoxicados apresentam lesões histológicas e aumento das concentrações séricas de GGT, mas não apresentam sinais clínicos). Em geral, a concentração de saponinas é maior nas plantas em crescimento, mas surtos ocorrem durante todo o ano, provavelmente por aumento da concentração de saponinas na planta por alguma causa ainda desconhecida. Uma síndrome clínica com progressiva perda de peso e morte, sem fotossensibilização, tem sido descrita em bovinos intoxicados por B. decumbens. As principais medidas preventivas são baseadas na seleção de animais resistentes ou resilientes e o desenvolvimento de espécies ou variedades de Brachiaria com menores concentrações de saponinas.

Síndrome do esgotamento profissional entre trabalhadores da rede básica de saúde de município do interior paulista

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Long latency auditory evoked potential in Asperger Syndrome: two case studies

Introduction: Auditory Late Responses (ALR) assess central auditory processing by neuro electric activity of the auditory pathway and analyse the activities involved in cortical abilities of discrimination, attention and integration of the brain. Individuals withAsperger Syndrome experience changes in these skills, so it is important to research these potential this population. The objective of this paper was to describe the auditory late responses of two patients with Asperger Syndrome. Methods: The study included two male patients with Asperger Syndrome, of 7 and 12 years of age, treated in a study centre. The patients did not present any auditory complaint detected by an amnesis. The external auditory canal was inspected and audiological and auditory late responses assessed. After evaluation the components P2, N2 and P3 were analysed. Results: In both patients, the latency of the components P2, N2 and P3 were elongated in both ears. Regarding the amplitude of the P2 component, reduced values were found for the left ear of patient 1 and the right ear of patient 2. The N2 amplitude was reduced for both ears of patient 1 and only the right ear of patient 2. The two patients showed a decrease in the amplitude of the P3 only in the right ear. Conclusion:This study concludes that there were changes in the ALR results in both patients with Asperger Syndrome, suggesting alteration of the auditory function at the cortex level.

Student's academic efficacy or Inefficacy? an example on how to evaluate the psychometric properties of a measuring instrument and evaluate the effects of item wording

This study evaluated the effect of item inversion on the construct validity and reliability of psychometric scales and proposed a theoretical framework for the evaluation of the psychometric properties of data gathered with psychometric instruments. To this propose, we used the Maslach Burnout Inventory, which is the most used psychometric inventory to measure burnout in different professional context (Students, Teachers, Police, Doctors, Nurses, etc…). The version of the MBI used was the MBI-Student Survey (MBI-SS). This inventory is composed of three key dimensions: Exhaustion, Cynicism and Professional Efficacy. The two first dimensions—which have positive formulated items—are moderate to strong positive correlated, and show moderate to strong negative correlations with the 3rd dimension—which has negative formulated items. We tested the hypothesis that, in college students, formulating the 3rd dimension of burnout as Inefficacy (reverting the negatively worded items in the Efficacy dimension) improves the correlation of the 3rd dimension with the other two dimensions, improves its internal consistency, and the overall MBI-SS’ construct validity and reliability. Confirmatory factor analysis results, estimated by Maximum Likelihood, revealed adequate factorial fit for both forms of the MBI-SS (with Efficacy) vs. the MBI-SSi (with Inefficacy). Also both forms showed adequate convergent and discriminant related validity. However, reliability and convergent validity were higher for the MBI-SSi. There were also stronger (positive) correlations between the 3 factors in MBI-SSi than the ones observed in MBI-SS. Results show that positively rewording of the 3rd dimension of the MBI-SS improves its validity and reliability. We therefore propose that the 3rd dimension of the MBI-SS should be named Professional Inefficacy and its items should be positively worded.

Endogenous and uric acid-induced activation of NLRP3 inflammasome in pregnant women with preeclampsia

Preeclampsia (PE) is a specific syndrome of pregnancy, characterized by hypertension and proteinuria. This pathology is associated with hyperuricemia and elevated serum levels of inflammatory cytokines. Uric acid crystals may activate an intracellular complex called inflammasome, which is important for processing and release of inflammatory cytokines. This study investigated the state of monocyte activation, both endogenous and stimulated with monosodium urate (MSU), by gene expression of NLRP1 and NLRP3 receptors as well as their association with inflammatory cytokines expression. Monocytes were obtained from peripheral blood of 23 preeclamptic pregnant women, 23 normotensive pregnant women (NT) and 23 healthy non-pregnant women (NP). Inflammasome activation was evaluated by the gene expression of NLRP1, NLRP3, caspase-1, IL-1 beta, IL-18 and TNF-alpha by RT-qPCR in unstimulated monocytes (endogenous expression), or after cell stimulation with MSU (stimulated expression). The concentration of cytokines was assessed by ELISA. In preeclamptic pregnant women, gene expression of NLRP1, NLRP3, caspase-1, IL-1 beta and TNF-alpha by monocytes stimulated or not with MSU was significantly higher than in NT and NP groups. Stimulation of monocytes from preeclamptic and non-pregnant women with MSU induced increased gene expression of NLRP3, caspase-1 and TNF-alpha in relation to the endogenous expression in these groups, while this was not observed in the NT group. The cytokine determination showed that monocytes from women with PE produced higher endogenous levels of IL-1 beta, IL-18 and TNF-alpha compared to the other groups, while the stimulus with MSU led to higher production of these cytokines in preeclamptic group than in the NT group. In conclusion, the results showed increased basal gene expression of NLRP1 and NLRP3 receptors in monocytes from PE group. These cells stimulation with MSU demonstrates that uric acid plays a role in NLRP3 inflammasome activation, suggesting the participation of this inflammatory complex in the pathogenesis of preeclampsia.

The therapeutic potential of exercise to treat cachexia

To discuss the role of physical exercise in the attenuation of cancer cachexia-associated symptoms, and upon the outcome of chemotherapy, with special focus on the anti-inflammatory role of chronic exercise. The review addresses the recent findings regarding the positive effects of endurance and strength exercise training upon metabolic dysfunction, systemic inflammation and body composition alterations in the syndrome of cachexia. The employment of different exercise protocol strategies, in respect to intensity, duration, work load and in concomitance with pharmacological treatment is considered. Cachexia is a multifactorial wasting syndrome afflicting patients with cancer, chronic obstructive pulmonary disease, chronic heart failure, trauma, among other diseases. This condition markedly compromises the quality of life, treatment outcome and survival. Recent literature indicates an unequivocal role of chronic exercise in modulating cachexia and other cancer-associated dysfunctions. Exercise is proposed as a complementary treatment in cancer, and represents a function-preserving, anti-inflammatory and metabolism-modulating strategy with low cost, and high versatility and availability. Furthermore, exercise decreases cancer recurrence and presents a positive impact on public health management, reducing hospitalization and medication costs.

Simultaneous Occurrence of Biphenotypic T Cell/Myeloid Lesions Involving t(12;13)(p13;q14) in a Pediatric Patient

This paper chronicles a 2-year-old girl who presented with acute leukemia/lymphoma syndrome of the T cell immuno-phenotype. At this time, the cytogenetic analysis of her bone marrow cells showed a reciprocal translocation between the short arm of chromosome 12 and the long arm of chromosome 13, t(12;13)(p13;q14). The immunophenotyping of bone marrow blast cells by flow cytometry revealed a population of cells positive for CD56, CD117, CD45, partial CD33, partial HLA-DR, CD13, CD7, CD2 and CD5. Therefore, a diagnosis of acute leukemia with a mixed T cell/myeloid phenotype was made. The patient had a poor response to classic T cell acute lymphocytic leukemia/lymphoma therapy; thus, her treatment was changed to a myeloid leukemia protocol, which produced a good response. She underwent a successful cord blood transplantation from an unrelated HLA partially matched donor. The coexistence of these two phenotypes prompts questions about the existence of clonal instability, which might influence the choice of therapy. The rarity of the t(12;13)(p13;q14) and the coexistence of T cell/myeloid markers suggest a nonrandom association. To the best of our knowledge, this is the first reported case in which a cell clone bearing a t(12;13)(p13;q14) translocation in a mixed T cell/myeloid lesion was detected. Copyright (C) 2012 S. Karger AG, Basel

Caspase-mediated cleavage of the exosome subunit PM/Scl-75 during apoptosis

Recent studies have implicated the dying cell as a potential reservoir of modified autoantigens that might initiate and drive systemic autoimmunity in susceptible hosts. A number of subunits of the exosome, a complex of 3'→5' exoribonucleases that functions in a variety of cellular processes, are recognized by the so-called anti-PM/Scl autoantibodies, found predominantly in patients suffering from an overlap syndrome of myositis and scleroderma. Here we show that one of these subunits, PM/Scl-75, is cleaved during apoptosis. PM/Scl-75 cleavage is inhibited by several different caspase inhibitors. The analysis of PM/Scl-75 cleavage by recombinant caspase proteins shows that PM/Scl-75 is efficiently cleaved by caspase-1, to a smaller extent by caspase-8, and relatively inefficiently by caspase-3 and caspase-7. Cleavage of the PM/Scl-75 protein occurs in the C-terminal part of the protein at Asp369 (IILD369↓G), and at least a fraction of the resulting N-terminal fragments of PM/Scl-75 remains associated with the exosome. Finally, the implications of PM/Scl-75 cleavage for exosome function and the generation of anti-PM/Scl-75 autoantibodies are discussed.

Speckle patterns during the spreading of lung surfactant.

Pulmonary surfactant is a very important product in the medical treatment of the syndrome of insufficiency respiratory in neonates. The synthesis of this surfactant in labs need to optimize the rate of spreading in the alveolar interstitial liquid obtaining a monolayer of the phospholipids membrane base capable to maintains several of the dynamical properties of the respiratory system during breathing. The recover of theses mechanical properties has to be archived using the minimal quantities of product and with the optimal proteins composition (SP-B in special). In this paper we show our results of obtaining and process speckle pattern images of the spreading of phospholipids membrane composed the matrix of this product (DPPC) when physiologic interstitial liquid are presented.

Resiliencia, optimismo y burnout en judokas de competición uruguayos

[ES] Son escasos los estudios de resiliencia en contexto deportivo, siendo este un proceso que corresponde a un funcionamiento psicológico óptimo en los deportistas y representa una característica de la personalidad positiva que favorece su adaptación afrontando eficazmente las adversidades. El análisis de la relación entre resiliencia, optimismo y burnout puede establecer nuevas aportaciones. Es objeto de este estudio caracterizar estos constructos en judokas. Fueron evaluados 45 deportistas (9 mujeres y 36 hombres; edad:M =19.95,DT= 5.34). Los resultados señalan que el 38% de los judokas presenta una elevada resiliencia, con una significativa y negativa relación con sintomatología de burnout, relacionada con bajo optimismo. Se establece la Escala de Resiliencia (Ruíz, De la Vega, Poveda, Rosado y Serpa, 2012) como confiable y se concluye que resiliencia asociada a optimismo protege de sintomatología de burnout. Este trabajo facilita la elaboración de estrategias de intervención para el logro de un rendimiento óptimo deportivo.

Wavelet analysis of heart rate variability related to nocturnal frontal lobe epilepsy seizures

Introduction: Nocturnal frontal lobe epilepsy (NFLE) is a distinct syndrome of partial epilepsy whose clinical features comprise a spectrum of paroxysmal motor manifestations of variable duration and complexity, arising from sleep. Cardiovascular changes during NFLE seizures have previously been observed, however the extent of these modifications and their relationship with seizure onset has not been analyzed in detail. Objective: Aim of present study is to evaluate NFLE seizure related changes in heart rate (HR) and in sympathetic/parasympathetic balance through wavelet analysis of HR variability (HRV). Methods: We evaluated the whole night digitally recorded video-polysomnography (VPSG) of 9 patients diagnosed with NFLE with no history of cardiac disorders and normal cardiac examinations. Events with features of NFLE seizures were selected independently by three examiners and included in the study only if a consensus was reached. Heart rate was evaluated by measuring the interval between two consecutive R-waves of QRS complexes (RRi). RRi series were digitally calculated for a period of 20 minutes, including the seizures and resampled at 10 Hz using cubic spline interpolation. A multiresolution analysis was performed (Daubechies-16 form), and the squared level specific amplitude coefficients were summed across appropriate decomposition levels in order to compute total band powers in bands of interest (LF: 0.039062 - 0.156248, HF: 0.156248 - 0.624992). A general linear model was then applied to estimate changes in RRi, LF and HF powers during three different period (Basal) (30 sec, at least 30 sec before seizure onset, during which no movements occurred and autonomic conditions resulted stationary); pre-seizure period (preSP) (10 sec preceding seizure onset) and seizure period (SP) corresponding to the clinical manifestations. For one of the patients (patient 9) three seizures associated with ictal asystole were recorded, hence he was treated separately. Results: Group analysis performed on 8 patients (41 seizures) showed that RRi remained unchanged during the preSP, while a significant tachycardia was observed in the SP. A significant increase in the LF component was instead observed during both the preSP and the SP (p<0.001) while HF component decreased only in the SP (p<0.001). For patient 9 during the preSP and in the first part of SP a significant tachycardia was observed associated with an increased sympathetic activity (increased LF absolute values and LF%). In the second part of the SP a progressive decrease in HR that gradually exceeded basal values occurred before IA. Bradycardia was associated with an increase in parasympathetic activity (increased HF absolute values and HF%) contrasted by a further increase in LF until the occurrence of IA. Conclusions: These data suggest that changes in autonomic balance toward a sympathetic prevalence always preceded clinical seizure onset in NFLE, even when HR changes were not yet evident, confirming that wavelet analysis is a sensitive technique to detect sudden variations of autonomic balance occurring during transient phenomena. Finally we demonstrated that epileptic asystole is associated with a parasympathetic hypertonus counteracted by a marked sympathetic activation.