Cushing’s syndrome diagnosed after delivery: a case report

Introduction

During normal pregnancy there are significant changes in hypothalamic-pituitary-adrenal axis, with increased levels of plasma cortisol and adrenocorticotropic hormone which sometimes reach values observed in patients with Cushing’s syndrome. Cushing’s syndrome (CS) is rarely encountered during pregnancy, but is associated with serious maternal and fetal complications.

Case presentation

A 31-year-old female was admitted to our institution four weeks after delivery. Physical examination revealed moon face, purple striae throughout the abdomen, bruising over the legs, a dorsocervical fat pad and hirsutism. She delivered a eutrophic preterm newborn at 34 weeks gestation, without any maternal or fetal complications during delivery. Imaging showed a mass in the right suprarenal gland with a normal pituitary. After four weeks the patient underwent a right adrenalectomy. The mass was eventually identified as an adrenocortical adenoma.

Conclusion

In our case the diagnosis of CS was established only after pregnancy, which enabled the development of numerous adverse consequences secondary to increased plasma cortisol. If CS is recognized during pregnancy, treatment and its timing could be carefully chosen according to the patient’s individual characteristics.     

Transcultural adaptation of the Night Eating Questionnaire (NEQ) for its use in the Spanish population

BackgroundEstablishing valid and reliable methods of assessing night eating symptoms is an important goal to maximize identification and treatment of the night eating syndrome (NES). The 14-item Night Eating Questionnaire (NEQ) is the only published and validated assessment instrument but is not yet adapted to Spanish.MethodsWe examined the factor structure, internal consistency and validity of the NEQ in Spanish. The study had 4 phases: a) translation from English to Spanish; b) back-translation from Spanish to English, c) administration of translated version to a Spanish sample, and d) a re-test in 36 participants two weeks later. Reliability, stability, and scale structure were evaluated by Cronbach's α, test–re-test, and factor analysis, respectively. Divergent validity was assessed by correlation with the Spanish versions of the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II).ResultsTwo-hundred forty-four individuals (181 f; BMI 34.3 ± 10 kg/m²; age 40.5 ± 15 y) completed the questionnaire. The mean NEQ score was 12.5 ± 7. The Cronbach's α coefficient for the total score was 0.79, the intraclass correlation was 0.85, and the factor analysis yielded a similar four factor solution as the original scale. Correlation for the test–re-test total score was 0.86. Total NEQ score was significantly correlated with the BDI-II (r = 0.48 p < 0.001), but this correlation was not significant during the test–re-test (r = 0.28, p = 0.10) or with STAI at either time point (0.05, p = 0.40; r = 0.07, p = 0.69, respectively).ConclusionsThe Spanish version of the NEQ demonstrated adequate internal consistency for the majority of domains and excellent reproducibility. There was divergent validity with anxiety and a relationship between night eating and depression. These results suggest that the Spanish-version of the NEQ is an instrument that is valid for use in clinical research.     

Relevance of O-acetyl and phosphoglycerol groups for the antigenicity of Streptococcus pneumoniae serotype 18C capsular polysaccharide

Capsular polysaccharides are important virulence factors of Streptococcus pneumoniae. The polysaccharide has been used as a component of vaccines against pneumococcal diseases either as plain polysaccharide or better conjugated to a protein. The last one is the vaccine of choice to target child protection. The immune responses depend on several polysaccharide physicochemical properties that can be affected during either purification or modification in the case of conjugate vaccines. In serotype 18C, the repeating unit has a complex structure having a branched pentasaccharide with two apparently labile subtituents: glycerol-phosphate and O-acetyl group. The loss of these groups may potentially reduce the ability of the 18C polysaccharide to induce the desired immune response. Therefore, the relationship of both groups with the antigenicity and immunogenicity of 18C capsular polysaccharide is explored. It is shown that glycerol-phosphate must be preserved for conserving adequate antigenicity of the 18C capsular polysaccharide. At the same time, it was proved that O-acetyl groups do not play any role for the antigenicity and immunogenicity.     

Anti-Helicobacter pylori activity of plants used in Mexican traditional medicine for gastrointestinal disorders

Aim of the study

Helicobacter pylori is the major etiological agent of chronic active gastritis and peptic ulcer disease and is linked to gastric carcinoma. Treatment to eradicate the bacteria failed in many cases, mainly due to antibiotic resistance, hence the necessity of developing better therapeutic regimens. Mexico has an enormous unexplored potential of medicinal plants. This work evaluates the in vitro anti-H. pylori activity of 53 plants used in Mexican traditional medicine for gastrointestinal disorders.

Materials and methods

To test the in vitro antibacterial activity, agar dilution and broth dilution methods were used for aqueous and methanolic extracts, respectively.

Results

Aqueous extracts of Artemisia ludoviciana subsp. mexicana, Cuphea aequipetala, Ludwigia repens,and Mentha × piperita (MIC 125 to <250 μg/ml) as well as methanolic extracts of Persea americana, Annona cherimola, Guaiacum coulteri, and Moussonia deppeana (MIC <7.5 to 15.6 μg/ml) showed the highest inhibitory effect.

Conclusions

The results contribute to understanding the mode of action of the studied medicinal plants and for detecting plants with high anti-Helicobacter pylori activity.     

Therapeutic effect of antisecretory factor-rich egg yolk on the late phases of 2,4,6-trinitrobenzenesulphonic acid colitis in mice

Antisecretory factor (AF) is expressed in all tissues of mammals, inhibits intestinal hypersecretion and has anti-inflammatory properties as well. Endogenous AF synthesis may be stimulated by feeding hydrothermally processed cereals. Alternatively, freeze-dried egg yolk can be used as a source of exogenous AF. Several reports have suggested that AF from freeze-dried egg yolk may be useful in inflammatory bowel disease. We assessed the effect of freeze-dried, AF-rich egg yolk intake on 2,4,6-trinitrobenzenesulphonic acid (TNBS) colitis. Balb/c mice were randomised to receive (1) AF in sterile drinking-water (4?g/l, n 38) and (2) sterile drinking-water alone (vehicle, n 38) from TNBS or saline administration onwards. Different subsets of mice were killed at weeks 1-3 after TNBS or saline administration. Macroscopic and microscopic damage was assessed in colonic specimens. Eicosanoid and cytokine production was evaluated in supernatants of 24?h-incubated colonic explants. Myeloperoxidase activity was measured in frozen colonic samples, while apoptosis was assessed in paraffined samples by the in situ oligoligation method. AF-treated mice showed a milder colonic damage compared with the vehicle group, which became statistically significant at week 3. This was accompanied by decreased IL-2, IL-1 and leukotriene B4 production at weeks 2 and 3, as well as increased interferon-γ at week 1, in AF-treated mice compared with vehicle-treated mice. AF-treated mice had significantly increased counts of apoptotic cells in the lamina propria at weeks 1 and 2 post-TNBS. In conclusion, the administration of AF-rich egg yolk has a therapeutic effect in the late phases of TNBS colitis in Balb/c mice.     

Development and validation of a short form of the Chinese version of the State Anxiety Scale for Children

BACKGROUND: There is a lack of a simplified instrument for use in busy clinical settings to measure and differentiate anxiety levels of children. OBJECTIVES: To develop a short form of the Chinese version of the State Anxiety Scale for Children (CSAS-C) and test psychometric properties of the new form. DESIGN: The study was divided into two phases with phase one aimed at developing a short form of the CSAS-C, while phase two aimed at testing psychometric properties of the new form. A test-retest, within-subjects design was employed. Children (7-12 years of age) admitted for surgery in a day surgery unit during two consecutive years' summer holiday were invited to participate in the study. In phase one, selected participants (N=112) were asked to respond to the CSAS-C. In phase two, selected participants (N=82) were asked to respond to the short form of the CSAS-C. RESULTS: Using exploratory factor analysis, a subset of 10 items, which was highly correlated with scores obtained from the full form (r=0.92) and, which had acceptable internal consistency (r=0.83) was developed. The psychometric properties of this short form have been empirically tested, showing adequate internal consistency reliability, good concurrent validity, and excellent construct validity. CONCLUSION: This study addresses a gap in the literature by developing a 10-item short form of the CSAS-C. Results indicate that this short form is an appropriate and objective assessment tool for measuring anxiety levels of Chinese children in a busy clinical setting where time constraints make unfeasible the use of the full form.     

Insomnia medication: Do published studies reflect the complete picture of efficacy and safety?

Selective publication can have a deleterious effect on evidence based medicine, health policy decision making and treatment guidelines. Using the European Public Assessment Reports (EPARs) as reference, this study examined selective publication and selective reporting of efficacy and safety of insomnia medication.EPARs of with three insomnia medications were used to identify all clinical trials that were performed between 1998 and 2007 for the purpose of registration in the EU. The matching publication for each trial was searched through a systematic literature search. Accuracy of information in the publications was examined by comparison to the information in the EPARs.Only 55% of the trials with insomnia medications identified in EPARs were published. Positive trials were approximately two times more likely to be published. The lag time from study completion to publication was shorter for the positive compared to the negative trials. Sample size did not correlate with publication of negative trials. The meta-analysis of the effect size of insomnia medication was 1.6 times larger in the published data compared to the complete data. While the primary end points of the trials were reported reliably in the publications, remarkable inconsistencies were detected in the reporting of the secondary end points, methods, results and, especially safety. In conclusion, selective publication and reporting lead to an overestimation of efficacy and underestimation of safety of insomnia products. Authors of treatment guidelines should be aware of this bias. EPARs/FDA reviews provide a more unbiased view of the benefit-risk balance of insomnia and other medications and hence these documents should be consulted by e.g. authors of meta-analyses and of treatment guidelines.