ABSTRACT The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure. Medical treatment, radiotherapy and adrenalectomy are the other options when transsphenoidal pituitary surgery fails. There are several options of medical treatment, although cabergoline and ketoconazole are the most commonly used alone or in combination. Novel treatments are also addressed in this review. Different therapeutic approaches are frequently needed on an individual basis, both before and, particularly, after surgery, and they should be individualized. The objective of the present review is to provide the necessary information to achieve a more effective treatment for CD. It is recommended that patients with CD be followed at tertiary care centers with experience in treating this condition.

Physical activity provides benefits, both to healthy as to ill population, but can also lead to psychological and emotional problems in response to stress. Furthermore, those athletes with lower body weight have higher indicators of depression and anger. We propose to relate body fat on the expression of anger and to understand the relationship between different psychological behaviours in physically active people. 264 subjects completed the Anger Expression Inventory State Trait version 2 (STAXI-2), which studies the characteristics of anger and its effects on mental and physical health. Anthropometric measurements (weight, height, BMI, percent body fat, fat-free mass) were taken. Various body fat percentiles, <45, 45 to 55 and >55 were calculated according to gender and age, classifying participants into three percentile groups.Different behaviors were recorded in relation to STAXI-2 and percentiles, but with no significant differences between anger and those groups.

A atividade física proporciona benefícios tanto para pessoas saudáveis como doentes, mas também pode levar a problemas psicológicos e emocionais, como resposta ao estresse. Além disso, os atletas com menor peso corporal têm indicadores mais altos de depressão e raiva. Prevê-se a determinar a influência da gordura corporal sobre a modulação do comportamento e entender a relação entre os vários comportamentos psicológicos entre as pessoas fisicamente ativas. 264 pessoas preencheram um questionário ad hoc, que incluiu Anger Expression Inventory State Trait version 2 (STAXI-2). Medidas antropométricas (peso, altura, IMC, percentual de gordura corporal, massa livre de gordura) foram tomadas. Vários percentis foram calculados por sexo e idade, classificando os participantes em três grupos: percentil <45, 45 a 55 e> 55 de gordura corporal. Diferentes comportamentos foram registrados em relação ao STAXI-2 e os vários percentis, mas sem diferenças significativas entre a raiva e os três grupos.

La actividad física proporciona beneficios, tanto a la población sana como enferma, pero también puede derivar en problemas psicológicos y emocionales como respuesta al estrés. Además, aquellos atletas con menor peso corporal presentan indicadores más elevados de depresión e ira. Se plantea determinar la relación de la grasa corporal sobre la expresión de ira y entender la relación entre distintos comportamientos psicológicos, en personas físicamente activas. 264 sujetos cumplimentaron el Inventario de Expresión de Ira Estado-Rasgo, versión 2, para el estudio sobre las características de la ira y sus efectos en la salud mental y física. Se tomaron medidas antropométricas (peso, talla, IMC, porcentaje de grasa corporal, masa libre de grasa). Se calcularon distintos percentiles en función del género y edad, clasificando a los participantes en tres grupos: percentil <45, entre 45 y 55 y >55 de grasa corporal. Se analizaron distintos comportamientos en relación al STAXI-2 y a los distintos percentiles, pero sin encontrar diferencias significativas entre la ira y los tres grupos.

ABSTRACT Although it is a rare condition, the accurate diagnosis and treatment of Cushing’s disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing’s syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing’s syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing’s disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86

Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”). Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

Ageratina glabrata (Kunth) R.M. King & H. Rob., Asteraceae (syn. Eupatorium glabratum Kunth) is widely distributed throughout Mexico and popularly known as "chamizo blanco" and "hierba del golpe" for its traditional use as external analgesic remedy. Though glabrata species has been chemically studied, there are no experimentally asserted reports about possible analgesic effects which can be inferred from its genus Ageratina. To fill the gap, we evaluated A. glabrata extracts in an animal model of nociception exploiting thermal stimuli. NMR and mass analyses identified a new thymol derivative, 10-benzoiloxy-6,8,9-trihydroxy-thymol isobutyrate (1), which was computationally converted into a ring-closed structure to explain interaction with the COX-2 enzyme in a ligand-receptor docking study. The resulting docked pose is in line with reported crystal complexes of COX-2 with chromene ligands. Based on the present results of dichloromethane extracts from its dried leaves, it is safe to utter that the plant possesses analgesic effects in animal tests which are mediated through inhibition of COX-2 enzyme.

Este artigo explora a técnica de Descoberta de Conhecimento em Base de Dados (Knowledge Discovery in Databases - KDD) com o objetivo de qualificar a informação recolhida durante os trabalhos de recomposição de sistemas de distribuição por equipes de eletricistas. Esta qualificação possibilita a utilização de técnicas de Inteligência Artificial (IA) para apoiar decisões de investimentos em planejamento, operação e manutenção de sistemas de distribuição. Com o objetivo de ilustrar a importância dessa qualificação, este artigo apresenta, adicionalmente, a utilização dos resultados da aplicação de KDD para o treinamento de uma Rede Bayseana (RB). A meta principal da RB é auxiliar no diagnóstico de desempenho das redes elétricas, promovendo uma identificação indireta de causas de desligamentos forçados. A análise dos dados coletados durante uma interrupção forçada de energia elétrica indica que o principal objetivo dos eletricistas em campo é a rápida recomposição da rede e, por muitas vezes, as causas que cercam os eventos que originaram as interrupções possuem um alto nível de subjetividade e incerteza, impossibilitando a sua identificação direta. Para ilustrar essa metodologia é apresentado um caso com 570.000 eventos, ao qual o KDD proporciona um novo ambiente - com um número significativo de dados - mais apropriado para o treinamento e validação da RB para identificação de causas de desligamentos não programados.

This paper tackles the Knowledge Discovery in Databases (KDD) technique in order to qualify the information collected by the field crews during the restoration process of the distribution network. This improvement of the information enables the utilization of Artificial Intelligence (AI) techniques to support decision making in investments planning, operation and maintenance of distribution systems. This qualification allows the use of KDD results to train a Bayesian Network (BN). The aim of the proposed BN is to support the performance diagnostic of electrical networks, promoting an indirect identification of forced outage causes. The analysis of the collected data during a forced outage indicates that the main purpose of field crews is a quick restoration of the network and, several times, the causes surrounding the outage events have a high level of subjectivity and uncertainty, turning impossible its direct identification. To illustrate the methodology, is presented a case with 570.000 events, where KDD provides a new environment - with a significant amount of data - more suitable to train and validate a BN to identification of forced outage causes.

O objetivo deste artigo é discutir a utilização de um conjunto de tecnologias de computação móvel (Mobile Computing) para auxílio nas rotinas de planejamento da operação e manutenção de sistemas de distribuição de energia elétrica. Apresenta-se um resumo das principais tecnologias, discutindo-se definições, serviços e aplicações em potencial na área de sistemas de energia. Para ilustrar o artigo é apresentado um caso de utilização prática da tecnologia de Personal Digital Assistant - PDA, para coleta e validação de dados de eventos não programados em sistemas de distribuição, um sistema para auxílio de rotinas de inspeção e manutenção em redes de distribuição e um sistema de comunicação de dados via telefonia celular para uma pequena central hidrelétrica.

This paper presents an overview on use of mobile computing to support routines of operation and maintenance planning of electrical distribution systems. A review of main technologies is presented, together with a discussion about definitions, services and applications of each one. Some potential utilisation in power system is described. The paper is illustrated with a practical implementation of Personal Digital Assistant - PDA technology to collecting and validation of outage events in electrical distribution systems, another system to aid inspections and maintenance routines using PDA and a communication system to a small hydropower plant using mobile phone network.

A fibromialgia é uma patologia de alta prevalência na população geral, cujo tratamento é feito por meio de medicamentos como antiinflamatórios, antidepressivos e miorrelaxantes, que pode ser complementado por medidas físicas como relaxamento, alongamento e exercícios físicos. A observação de fibromialgia entre atletas constatada em exames de rotina, em especial naqueles que apresentavam lesões musculares de repetição, levou os autores a pesquisar, de maneira prospectiva, um grupo de atletas praticantes de ginástica olímpica e atletismo, nos quais puderam confirmar alta incidência desta síndrome. Como a fibromialgia predispõe ao aparecimento de lesões por contratura muscular, sugerem que ela possa atuar como um mecanismo de indução ao surgimento de lesões musculares de repetição. Ainda devido às semelhanças dos sintomas encontrados na síndrome do supertreinamento, síndrome da fadiga crônica e fibromialgia, propõem uma possível ligação entre estes quadros.

Fibromyalgia syndrome is a very common feature in the daily practice of rheumatologists. Therapy is based on the use of analgesics, anti-depressants, and other drugs. Many physicians indicate exercise, stretching, and relaxing programs as adjuvant therapies. It was surprising to find fibromyalgia in well-trained athletes. The syndrome, however, appears in athletes that reported recurrent tendon-muscle lesions. In this study, the authors analyzed a group of gymnastics and track and field athletes involved in competitive training. They found a significant incidence of the syndrome (7 in 20 subjects) in this group. This is an important finding, since fibromyalgia causes muscular pain and stiffness, and can predispose the athletes to muscle lesions and damage. Another important point regarding the syndrome is that some of its symptoms are related to overtraining and to the chronic fatigue syndrome. Therefore, the authors suggest that there is an important connection between those aspects.

Foram efetuados estudos químicos e farmacológicos dos extratos brutos hidroalcóolicos obtidos das folhas ou das raízes de E. argentinum ou de frações semi-purificadas desta planta. Os testes químicos revelaram a existência de alcalóides, fitoesteróides, leucoantocianidinas, glicosídeos flavonóides, cumarinas e taninos. A análise farmacológica in vivo demonstrou que o extrato das folhas é menos tóxico que o da raiz. Tanto o extrato bruto como as frações semi-purificadas obtidas das folhas reduziram a locomoção e pressão arterial de rato e potenciaram o sono barbiturico em camundongos. O extrato bruto, principalmente o da raiz, reduziu o edema induzido por carragenina na pata de rato. Testes in vitro demonstraram que o extrato bruto ou as frações semi-purificadas das folhas produziram uma ação semelhante à cocaína avaliada no canal deferente de rato. Além disso, o extrato bruto produziu relaxamento inespecífico no útero de rata e contração do íleo de cobaia. Os resultados obtidos sugerem que esta planta possui constituintes ativos dotados de distintas propriedades farmacológicas, destacando-se o efeito anti-inflamatório, além de uma ação tipo cocaína, merecendo, portanto, estudos químicos e farmacológicos complementares.

Chemical and pharmacological studies were carried out using crude hydroalcholic extracts obtained from the leaves or roots of E. argentinum or the semipurified fractions of this plant. Chemical analysis detected the presence of alkaloids, phytosteroids, leucoanthocianidins, flavonoid glycosides, cumarins and tannins. Qualitatively similar pharmacological effects were observed in experiments using both extracts from the leaves or roots. Experiments in vivo revealed that the crude extract and the semipurified fractions from the leaves reduced locomotor activity, blood pressure, carragenin-induced paw edema and potentiated barbiturate-induced sleeping-time in laboratory animals. In vitro studies demonstrated that the leaf extract or the semipurified fractions induced a cocaine-like effects on the rat vas deferens, a non-specific relaxation of the rat uteri and a contraction of the guinea-pig ileum. It is concluded that E. argentinum contains active compounds responsible for the antiinflammatory effect and cocaine-like action observed in vitro, which merit emphasis in future research.