Metformin is considered the first-line treatment as a monotherapy for patients with type 2 diabetes mellitus. Emerging evidence suggests that metformin may have a renoprotective role; therefore, understanding the impact of metformin dose and therapy duration on renal function may significantly improve renal outcomes in type 2 diabetes patients. This study aims to investigate the renoprotective effects of metformin by analyzing its dose-dependent impacts on the estimated glomerular filtration rate in patients with type 2 diabetes (...) mellitus. A retrospective cross-sectional study design was used from September 2022 to October 2023. Data from 302 type 2 diabetes patients were collected from patient files at the Benghazi Diabetic Center and the Aljabal Al-Alkdar Diabetic Center, including all with type 2 diabetes mellitus patients on varying doses of metformin. The collected data included age, gender, metformin dose, duration of metformin therapy, urea, and creatinine. Exclusion criteria included patients with significant comorbidities such as chronic kidney disease (other than diabetic nephropathy), liver disease, heart failure, or malignancy; those taking nephrotoxic medications; individuals with recent acute illnesses or surgical procedures; pregnant or lactating women; participants with inadequate medical records; and patients who were non-adherent to metformin therapy. Survival analysis was conducted to evaluate the effect of different metformin doses on the estimated glomerular filtration rate. The study analyzed 302 diabetic patients, of whom 46.0% were male and 54.0% were female. The age was 58.3±11.9 years. The HbA1c was 7.7%±1.3%. The duration of diabetes was 11.4±8.1 years. The creatinine was 1.0±0.9 mg/dL, and the urea was 36.7±23.8 mg/dL. Data analysis revealed a statistically significant difference in survival distribution across the dose groups. Different metformin doses significantly impact the estimated glomerular filtration rate, suggesting that dosage plays a crucial role in maintaining renal function. (shrink)

Aim: Low professional help-seeking intention (PHSI) hinders effective treatment of mental illness. PHSI among Chinese students is still understudied and under-recognized. This study aimed to evaluate the status of PHSI and its associated risk factors among Chinese medical students. -/- Methods: A cross-sectional survey was conducted in Hainan province, South China, between January 1, 2021, and May 31, 2021. A total of 2182 medical students were recruited and surveyed via an anonymous structured questionnaire. Logistic regression analyses were performed (...) to identify the factors associated with PHSI. -/- Results: Among the 2182 medical students (mean age 21.0 years (SD = 3.70), 61.5% females), those with and without PHSI were 72.0% and 28.0%, and 16.4% with moderate to severe depression. Male students, those with a high level of depression stigma, serious family dysfunction, and heavy dependence on mobile phones were significantly less likely to seek professional mental health help, with odds ratios (ORs) of 1.5, 2.0, 2.1, and 1.7, respectively. -/- Conclusion: A significant proportion of Chinese medical students demonstrate low PHSI, influenced by factors such as gender, depression stigma, family dysfunction, and mobile phone dependence. Future interventions aimed at increasing medical students’ PHSI should prioritize reducing depression stigma, mitigating reliance on mobile phone use, and enhancing family function to address these key barriers to seeking professional mental health support. (shrink)

A cross-sectional study was done on 50 ethics committee members from 15 different Ethics Committee (EC) over a period of 6 months from February 2018 to June 2018 to understand the structure and function of ECs in Bangladesh. Most of the ECs were male predominant (66.3%) and maximum ECs had technical members (93.33%). Only 8.3% ECs had lay person. Forty percent of the ECs did not update SOP routinely. Most of the ECs had no provision of training for (...) its members (79.2%) and had no budget (71.8%). Maximum ECs service were voluntary (82.22%). Different ECs had different quorum to start the meeting. A little less than half of the respondents (45.76%) felt that their decision had not been noted down if disagreed against majority of vote in the ECs and did not placed in the meeting’s minutes. Maximum respondents (88.18%) did not know whether there was any law in Bangladesh to create a EC. A big percentage (89%) of ECs did not monitored by authorized body to guide and oversee the functioning of ECs. This article concluded that some ECs followed the international rules and regulation to formation and function the ECs but still a handsome number of ECs were lag behind in Bangladesh. The capacity of ECs can only be strengthened by training and various recognition/accreditation programs. (shrink)

Background: This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM). -/- Methods: This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, (...) and the DASS-21. After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies. -/- Results: In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = −0.236), anxiety (r = −0.243), and stress (r = −0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = −0.192), anxiety (r = −0.238), and stress (r = −0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = −0.251), anxiety (r = −0.257), and stress (r = −0.203) had a significant negative correlation with DQOL (P < 0.001). -/- Conclusion: MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life. (shrink)

Globally, breast cancer is the most common cancer in women worldwide, it represents about 25.0% of all cancer cases. In developing countries, breast cancer is mainly discovered at a late stage, which has a negative impact on the prognosis. To determine the extent of, and the factors contributing to, delay in breast cancer presentation, and to evaluate the mammography screening practice in breast cancer Libyan women. A descriptive cross-sectional study was carried out on five hundred and one (...) breast cancer patients who attended the Oncology Outpatient Clinic of the Medical Department at Tripoli University Hospital and Tripoli Central Hospital during a period between February and August 2019, after the application of inclusion and exclusion criteria enrolled in the study. The mean age of the patients was 47.35±01.0 years, 55.1% of them were diagnosed in late stage (III and IV), and 30.9% of the patients were presented late (≥3 months). The time interval between the initial breast symptom and first presentation to a clinic ranged between 2nd day and up to three years, with a median time of 1.5 months, and the main factor of the delayed presentation to a clinic was a lack of knowledge about symptoms (33.5%). The study revealed a significant association between delayed presentation and older age (P<0.001), low educational level (P<0.001), low family income (P<0.001), unemployed women (P< 0.002), postmenopausal women (P<0.001), patients with negative family history (P<0.05). This study concluded that delayed presentation is found in less than a third of the study population, and lack of knowledge about breast cancer signs and symptoms is a common factor. Age, educational status, family income, unemployed women, menopausal status, and family history of breast cancer were all significant factors for delayed presentation. Improving women's awareness about breast cancer is needed and applying the policy of regular screening mammograms is a useful tool for early diagnosis and early treatment in Libya. (shrink)

Uric acid has increasingly been associated with insulin resistance, hyperinsulinemia, and type 2 diabetes mellitus. Diabetic patients who are hyperuricemic have a risk of developing diabetic complications. Pathogenesis of uric acid may decrease nitric oxide bioavailability in vascular smooth muscle, endothelial cells and direct scavenging of nitric oxide by uric acid. A decrease in endothelial nitric oxide production by uric acid has also been associated with endothelial dysfunction and insulin resistance. This study aims to determine the relationship between uric (...) acid and glucose levels in patients with type 2 diabetes mellitus. The study included 161 Libyan patients (67 males and 94 females) diagnosed with type 2 diabetes mellitus. Both levels of serum uric acid and hemoglobin A1c (HbA1c) were determined. The patients were divided into two groups. The controllable diabetic group with HbA1c of less than 06.0% and the uncontrollable diabetic group with HbA1c of more than 06.0%. Patients who are suffering from type 2 diabetes mellitus without complications were included whereas patients with smoking, alcoholism, nephrotic disease, malignancy, hepatitis, and renal failure or kidney disease were excluded. The mean and standard deviation of uric acid, HbA1c and Pearson correlation coefficient test were considered. In the controllable diabetic group, serum uric acid mean was found to be 4.807±1.39 and HbA1c was found to be 5.032±1.39. In the uncontrollable diabetic group, serum uric acid was 4.897±1.66 and HbA1c was 8.396±1.65. Uric acid level has significantly been correlated with HBA1C in controlled and uncontrolled diabetic patients (p<0.05). In addition, the uric acid level was found to be higher in the uncontrolled diabetic group than that in the controlled group (p<0.05). A possible relationship between serum uric acid and the incidence of type 2 diabetes mellitus was noted. Thus, uric acid can be used as a potential biomarker to indicate impaired glucose metabolism. (shrink)

Metformin hydrochloride is the first-line anti-diabetic drug used to treat type 2 diabetes mellites and helps to control blood sugar levels. Various brands of metformin are available in the Libyan market which makes it challenging to select, an effective and economical one. This study aimed to compare different brands of metformin available in the Misurata and evaluate the quality parameter according to the British Pharmacopoeia. Six brands of metformin tablets (850 mg) were taken from the market and assessed. (...) To achieve this purpose five tests were done on each brand, the uniformity of weight test shows the average weight and 5.0% deviation, the friability test gives how much the tablet can stand attrition, the disintegration time test shows the time taken by the tablet to disintegrate, dissolution test to confirm the rate of drug release, weight variation and friability test of all brands was within the specified limit. Disintegration time for all the brands was within 30 minutes. All six brands of metformin hydrochloride tablets fulfilled the in-vitro dissolution rate test specification not less than 80% of the drug is released within 45 minutes. Using Ultraviolet-visible (UV) spectroscopy, UV analysis of different samples shows that the percentage content of active ingredients of five brands of metformin hydrochloride tablets was within the monograph specification (95%-105%) of drug content but one brand failed this test. The study indicated that strict quality control of imported drugs should enforced to ensure effective and safe medicines in the Libyan market. (shrink)

Several theories propose that one of the core functions of inner speech (IS) is to support subjects in the completion of cognitively effortful tasks, especially those involving executive functions (EF). In this paper we focus on two populations who notoriously encounter difficulties in performing EF tasks, namely, people diagnosed with schizophrenia who experience auditory verbal hallucinations (Sz-AVH) and people within the Autism Spectrum Conditions (ASC). We focus on these two populations because they represent two different ways in which IS can (...) fail to help in EF tasks, which can be illustrative for other mental conditions. First, we review the main components of EF (Section 1). Then we explain the functions that IS is taken to perform in the domain of EF (Section 2) and review the evidence concerning problems about EF in the two populations of our study: Sz-AVH (Section 3) and ASC (Section 4). After this we further detail our account about what a properly functioning IS can do for both populations and how different IS profiles may impact EF performance: in the case of Sz-AVH, the uncontrolled and intrusive character of IS negatively affects EF performance, whereas in ASC, EF is not sufficiently supported by IS, given the tendency in this population to present a diminished use of IS (Section 5). We finally briefly discuss Attention Deficit/Hyperactivity Disorder (ADHD) and Developmental Language Disorders (DLD). (shrink)

Self-medication of antibiotics is an irrational use of drugs, contributing to microbial resistance, increasing healthcare costs and higher mortality and morbidity. This study aimed to assess self-medication with antibiotics without a medical prescription in the community of Libya. This is a cross-sectional study conducted from June to December 2022 and the total number of participants was 200. The design of the study and sample size were modified according to the proficiency of pharmacists and the medical and non-medical population (...) of Libya. The questionnaire was developed in English and Arabic language and was distributed through social media platforms. The questions were used after a thorough literature search and assessing the validity and reliability. The significant signs regarding reasons for the treatment by self-medication drugs of antibiotics, because of its various drugs of antibiotic by pharmacist (n=80, 40.0%) and family (n=90, 45.0%) compared with experience and physicians by used prescription was 13 (6.50%) and significant sings regarding by nasal congestion self-medication of various antibiotics (n=100, 50.0%). This sign must be practiced based on a previous physician’s prescription. The antibiotics are often self-administered as patients feel that they will save money and time but this can lead to substantial adverse drug reactions, antibiotic resistance, treatment failure and drug-related toxicity. This study respondent's medical and non-medical public of Libya who should be relatively informed and educated about the risk of treatment by self-medication of antibiotics with the development of resistance. (shrink)

A student's self-efficacy—defined as their belief in their capacity to succeed in particular circumstances—is a critical factor in their food decisions. Also a university’s overall environment, including the presence of fast-food outlets and the nature of food marketing on campus, can shape undergraduate students' eating habits and self-efficacy. The primary purpose of this cross-sectional correlational study was to investigate eating self-efficacy in Nigerian public university students. A sample of 400 undergraduate students were surveyed at a Nigerian public university (...) using validated instruments to assess their level of eating self-efficacy and identify the relationships between their eating self-efficacy and eating habits. The Eating Self-Efficacy Brief Scale (ESEBS)–8 items was used to assess students' level of difficulty in resisting the desire to eat. The researcher utilized the Eating Attitudes Test (EAT)–16 items to evaluate the students’ eating habits. Statistical analysis was conducted at a significance level of p<.05. The results revealed that mean eating self-efficacy score (ESEBS-8) of 2.21 (SD=0.68). Regression analysis showed that gender, school environment, peer factor, and parental factor significantly predicted eating self-efficacy, F(4,398)=9.17, p<.001. Eating self-efficacy (ESEBS-8) was strongly positively correlated with eating habits (EAT-16), r=.861, p<. 001. Regression analysis showed that ESEBS-8 significantly predicted EAT-16 scores, B=1.399, β=.861, t=33.68, p<.001. The findings highlight significant correlations between various factors and eating self-efficacy through the lenses of gender, school environment, peer influence, and parental factors, as well as the relationship between eating self-efficacy and eating habits. (shrink)

This study examined students’ perception of rape and sexual violence and methods of prevention in tertiary institutions in Lagos State. It was a cross-sectional study carried out among one thousand, two hundred and eleven (1,211) female undergraduates selected from two tertiary institutions in Lagos State. The sample size for the study was one hundred and twenty-one (121) representing 10% of the population. Inferential statistics was used for analysis. The results revealed that majority of the students are aware of (...) the different types of rape but did not consider forced sexual intercourse between spouses as rape. The students have a good knowledge of rape and sexual violence. The students perceive that rape can have detrimental effects on the victims’ mental, physical and reproductive health. Avoiding late nights, dressing decently, increasing the presence of security officers at strategic places on campus and the likes were identified ways of preventing rape in tertiary institutions. Among the recommendations proffered are that students should review their dressing styles to conform to the morals of the society to prevent the occurrence of rape. (shrink)

Due to the Coronavirus Disease-2019 (COVID-19) lockdown implemented by the government, we had to transform our classes into the online sphere. The most commonly used methods of online teaching in Government Medical College, Thrissur were, live online lectures, PowerPoint presentations with narrations, prerecorded videos and assignments. Aim: To assess the logistical aspects, merit and demerits of different online teaching-learning methods among phase-1 medical student in a tertiary care teaching hospital during COVID-19 lockdown Materials and Methods: This cross-sectional study (...) was conducted from July 2020 to September 2020, among phase-1 MBBS students of Government Medical College, Thrissur, Kerala, India. Data was collected from 161 students through a questionnaire consisting of two parts. The first part dealt with logistical aspects, like net connectivity, gadget, expenditure, financial burden, residence and eye strain with online teaching learning methods. The second part dealt with the merits and demerits of each type of teaching learning methods, according to the students. All statistical data was analysed using the Statistical Package for the Social Sciences (SPSS) software version 16. Qualitative data was expressed as a percentage. Results: A total of 97.5% population of students was able to frequently access the online classes. Online learning strained the eyes of 47.8% of students. Mobile phones were used by 92.5% of students for attending online classes internet connectivity was mainly through 4G (71.4%) followed by Wi-Fi (19.9%) connections. Their most preferred method of online learning was online live lectures (35.4%) followed by PowerPoint presentations with narrations (33.5%). Blended learning (online and traditional together) was best preferred method of learning (46.6%). Conclusion: Live online lectures and blended learning were preferred by the majority of students. Thus, the online classes can be continued along with the traditional teaching in future. (shrink)

Introduction: Universal health coverage (UHC) was introduced in Iran in 2014. The aim of this study was to evaluate the usage rate of health services by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients after UHC implementation. Material and methods: In 2018, in a cross-sectional study, we evaluated the outpatients’ needs (within its previous month) and inpatients’ needs (within its previous 6 months) of HIV/AIDS patients in Isfahan province (the center of Iran). Concurrently, we estimated the essential health (...) care services that HIV/AIDS patients have to receive regularly, including vaccination for hepatitis B, measurement of CD4, tuberculosis (TB) assessments and TB treatment, anti-retroviral therapy, examination of viral load, treatment approach, and drug side effects counseling. Two checklists were used for assessing the utilization of health services and essential health cares for HIV/AIDS patients, validated by the Ministry of Health and Medical Education of Iran. Data were analyzed by χ2 test, Pearson’s correlation coefficient, and Spearman’s correlation test. Results: Two hundred and thirteen HIV/AIDS patients completed the questionnaires. The mean age of participants was 41.14 ± 9.23. The outpatient service utilization rate was 31.94% in the previous month and the rate of hospitalization was 126 per 1,000 HIV/AIDS patients in the previous 6 months. The majority of HIV/AIDS patients received essential health services more often than the national standard goals estimation. Conclusions: After UHC implementation, the utilization rate of outpatients and inpatients services in HIV/AIDS patients was more than similar indices in the general population. In addition, HIV/AIDS patients received essential health services adequately. (shrink)

Type 2 diabetes mellites (T2DM) is a common complex disease with multiple factors contributing to its development and progression. Dyslipidemia refers to the abnormality of lipid metabolism, characterized by elevated levels of low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), and decreased levels of high-density lipoprotein (HDL). It is a major risk factor for cardiovascular disease in type 2 diabetic patients. This study aimed to evaluate the diagnostic value of glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) in (...) predicting the risk of developing diabetic dyslipidemia. 86 clinically diagnosed Libyan patients with type 2 diabetes mellitus (44 males: 42 females), 30 years and 70 years of age were engaged in this study. Levels of HbA1C, blood glucose, TC, TG, LDL, and HDL were performed using a Lntegra Cobas 400+ analyzer. The findings showed that HbA1c exhibits a significant positive correlation with TC and TG with no significant correlation with LDL and HDL levels. Thus, this study suggests that HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus. (shrink)

Background: Socio-epidemiological data of dental caries helps to plan effective community interventions. Objective: To estimate the prevalence and assess the experience of dental caries among school going adolescents in a rural area of Bangladesh. Methods: A cross-sectional study was donein Sylhet District in Bangladesh, between January and December of 2014. Students of class VIII, IX and X, aged 12-16 years were taken for the study. A total of 90 studentswere divided into 12-14 years and 15-16 years age groups (...) using simple random sampling technique. A pre-designed, self-administered questionnaire was used for demographic survey. Students were examined for dental caries. Assessment of Experience of dental caries was done by Decayed, Missing and Filled teeth (DMFT) index. Results: The mean age of the respondents was 14.37±0.50 years. Females were 68(75.6%) and males were 22(24.4%). 31(34.4%), 30 (33.3%) and 29(32.2%) were from VIII, IX and X respectively. The older age group (15-16 years) had more decayed teeth than that of 12-14 years group (2.28 vs. 1.46; p=0.04). The mean DMFT score was lower in male compared to female (1.43 vs. 2.30; p>0.05).There was significant difference in the total DMFT score among the classes (p=0.009). Mean DMFT score was 1.88. Caries prevalence was 42.2% in the maxillary arch and 58.9% in the mandibular arch. Among males, the mandibular arch showed a higher caries level (63.64%) than the maxillary arch (40%), while in females, in maxillary and mandibular archeswere 42.64% and 42.65% respectively (p>0.05). Conclusion: 64.4% of the study population had dental caries with male predominance; mandibular arch was more involved. (shrink)

The use of tobacco is a major cause of preventable mortality. The estimated number of smokers is 1.1 billion. Of these, 700 million men and 100 million women are in developing countries. The objective of this study was to find out attitude towards tobacco consumption among residents of Dhankuta Municipality. The cross sectional study was conducted among the residents of Dhankuta Municipality where 205 households were taken as subjects. Pretested semi structured questionnaire was administered to the study subjects (...) and face to face interview was conducted. The collected data was entered in MS Excel 2000. The quantitative data was analyzed using Statistical Package for the Social Sciences SPSS software package. The study subjects consist of 50.2 of male and 49.8 of female. Regarding respondent's education, study population showed high level of SLC and above 40.5 followed by below SLC 36.1 and very less was illiterate 14.1 . Majority of the respondents think that there should be ban of the advertising of tobacco products 87.3 and smoking in public places 79 . Almost 67 of respondents think that patient's chances of quitting smoking will be increased if health professionals will give advice to patients. Almost 72.6 of the study population feel cut down tobacco use and 80.3 feel guilty about this habit. Almost 65.8 have tried to discontinue tobacco consumption. We conclude that the residents of Dhankuta reflect good attitude towards cessation of tobacco but poor practice to prevent of tobacco consumption. Dr. Ram Bilakshan Sah | Jha N "Attitude towards tobacco consumption among residents of Dhankuta Municipality of Nepal" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-1 | Issue-4 , June 2017. (shrink)

Background: Leprosy is a chronic granulomatous infectious disease having major burden on humans over thousands of years. If untreated, it results in permanent damage to various systems and organs. So we designed this study to evaluate the neurological complications in early stage in adult leprosy patients. Objective: The aim of this study was to find out the pattern of neurological manifestations among adult leprosy patients. Materials and Methods: This cross-sectional hospital-based study on 85 adult tribal leprosy patients was (...) conducted in a district level health care facility from January to December 2014 using simple, direct, standardized questionnaire including history and neurological examinations. Results: The commonest age group affected was 18–30 years (62.4%). Male group was predominant (68.2%). Majority cases (66%) had multibacillary leprosy. At first visit 72.7% cases with neurological findings could not be diagnosed correctly by primary health care personnel. More than six months were required for correct diagnosis in 61.2% cases. Numbness was the commonest (74.5%) neurological symptom. In upper limb, motor findings were predominant with wasting in 50.9% cases. In lower limb, sensory findings were predominant with stock pattern sensory impairment being the commonest (56.4%). Ulnar nerve was the commonest peripheral nerve to enlarge with tenderness. Facial nerve was the commonest cranial nerve involved. All cases with multiple cranial nerves involvement were of multibacillary type. Due to physical disability 92.7% cases lost their jobs. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based (...) on the variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

The elderly face very challenging situations due to their mental and physical conditions. Like the other country in the world, Bangladesh Government has enacted laws to protect the elderly rights. However, the law does not seem to represent what the elderly actually needs. Therefore, 385 elderly people, aged between 60 and 90 years were surveyed to understand their expectations from family, society, and government. There were 57.1% men and 42.9% women. Most of the elderly (80%) were educated. Just over half (...) (53.5%) had ordinary mental and physical health, while a quarter (31.4%) had good status. More than half (53%) of the participants required 2000–5000 BDTK (Bangladeshi Taka) equivalent to $20-50 to cover monthly treatment expenditures. The majority (67.3%) felt government Old Age Allowance should be increased to BDT 5,000 ($50). Of 13.8% of individuals experienced harsh discourse from family because of the cost of therapy. However, 16.9% of people choose not to respond to this question. More than half (57.4%) of the respondents’ thought caregivers were insufficient. One-third felt that legislation should be changed to take care of parents (33.5%) and One-third felt that children should take care of more (33.5%). Some (3.6%) thought that children should act as they did in their childhood respectively. Almost half (44.2%) of respondents did not know that the elderly should receive a separate senior citizen card for preferential treatment, yet 51.9% thought this. Some (44.7%) felt the elderly should get priority in any queue and discounts in Bus/Uber/Rickshaw. Results also showed that expectation is more than the service provided. Further, a one-stop elderly care clinic is required to provide integrated care and support for the quality of life of the elderly. (shrink)

This study focuses on implementing electric vehicles (EVs) in developing countries where energy production is mainly based on fossil fuels. Although for these countries the environmental short-run benefits of the EVs cannot offset the short-run costs, it may still be the best option to implement the EVs as soon as possible. Hence, it is necessary to evaluate the alternatives to introducing EVs to the market due to the environmental concerns that created an opportunity for some developing countries to catch up (...) with the international competition. Therefore, we develop a case scenario to explore the decision-making process in implementing the EVs with three alter natives and twelve criteria. We solve the decision-making problem by using Type-2 neutrosophic numbers (T2NNs) based on the RAFSI (Ranking of Alternatives through Functional mapping of criterion sub-intervals into a Single Interval) method. The proposed model combines the advantages of the RAFSI technique, and it applies T2NNs to address the uncertainties. The results show that the alternatives that may suspend the implementation of the EVs are inferior. Direct implementation of EVs is prioritized. The policy implications of the results are discussed in the study. (shrink)

Prescription drug misuse has emerged as a significant problem over the past decade, particularly topical corticosteroids for skin lightening. This study aimed to assess the misuse of topical corticosteroids among the female population in southern Libya; to determine prevalence, awareness, attitude, and practice regarding this drug misuse. A descriptive, cross-sectional questionnaire was distributed on January 2022 to females aged between 16-45 years old in southern Libya. Out of 200 distributed questionnaires, 155 were returned with a response rate of (...) 77.5%. The majority of the participants were aged 16-25 years (n=138, 89.0%) and over two-thirds of participants, said they obtained lightening products containing cortisone from pharmacies (n=107, 69.0%) while 36 participants indicated they obtained these products from cosmetic shops (23.2%). More than three-quarters of the participants said they were aware that they should read product ingredients (n=120, 77.4%). Just over one-quarter of respondents indicated they used the product on their face almost daily (n=41, 26.5%) while 28 participants denied using it (18.1%). The most common source of information about topical corticosteroids among participants was the Internet (n=51, 32.9%), followed by dermatologists (n=41, 26.5%), and pharmacists (n=31, 20.0%). Almost half of respondents were aware that topical corticosteroids can cause harmful effects (n=75, 48.4%). The most common indications reported for using topical corticosteroids were whitening (23.3%), and acne treatment (54.2%). Over two-thirds of participants, declared they would not use topical lightening products if they contained corticosteroids (n=107, 69.0%). In a similar attitude, nearly a third of participants stated that they would never use corticosteroid medications again if they knew about the negative effects of whitening (n=51, 32.9%). The majority of females, (87.7%), concur that only pharmacies should be able to sell and prescribe topical corticosteroid medications. The study's findings indicate that topical corticosteroids are frequently misused and that to lessen contraindications, especially for prolonged use, it is imperative to provide basic care to females who continue using topical corticosteroids in public or unlicensed marketing settings. (shrink)

Background -/- Retraction is a correction process for the scientific literature that acts as a barrier to the dissemination of articles that have serious faults or misleading data. The purpose of this study was to investigate the characteristics of retracted papers from Kazakhstan. Methods -/- Utilizing data from Retraction Watch, this cross-sectional descriptive analysis documented all retracted papers from Kazakhstan without regard to publication dates. The following data were recorded: publication title, DOI number, number of authors, publication date, (...) retraction date, source, publication type, subject category of publication, collaborating country, and retraction reason. Source index status, Scopus citation value, and Altmetric Attention Score were obtained. Results -/- Following the search, a total of 92 retracted papers were discovered. One duplicate article was excluded, leaving 91 publications for analysis. Most articles were retracted in 2022 (n = 22) and 2018 (n = 19). Among the identified publications, 49 (53.9%) were research articles, 39 (42.9%) were conference papers, 2 (2.2%) were review articles, and 1 (1.1%) was a book chapter. Russia (n = 24) and China (n = 5) were the most collaborative countries in the retracted publications. Fake-biased peer review (n = 38), plagiarism (n = 25), and duplication (n = 14) were the leading causes of retraction. Conclusion -/- The vast majority of the publications were research articles and conference papers. Russia was the leading collaborative country. The most prominent retraction reasons were fake-biased peer review, plagiarism, and duplication. Efforts to raise researchers’ understanding of the grounds for retraction and ethical research techniques are required in Kazakhstan. (shrink)

This study investigated the prevalence, perceived risk factors and effects of enuresis among school-age children in Nsukka local government area. The study adopted a descriptive cross-sectional survey research design with a population of 7,794 Junior Secondary Students within the age range of 9-12years in the study area. Multi-stage sampling technique was employed to select a sample of 820 students from 10 selected schools. A structured questionnaire was the instrument for data collection. The reliability of the questionnaire was 0.86 (...) Cronbach’s alpha showing a good internal consistency of the test items. Data were analysed using frequencies, percentages means and standard deviations. Findings showed that prevalence of bedwetting among the respondents was 17.8%, 14.6% among males and 24.4% among females. The prevalence of primary bedwetting was 12.7%, 5.0% experienced secondary bedwetting, 15.0% experienced nocturnal enuresis and 2.6% experienced diurnal bedwetting. Dreaming of urinating, drinking a lot of fluid before bed and cold weather were some of the risk factors of bedwetting identified by the respondents. Some of the effects of bedwetting identified by the respondents were that bedwetting children often smell bad and bedwetting makes children feel sad. Preventive, curative, hygiene management and reinforcement strategies for enuresis were identified by the respondents. It was concluded that bedwetting negatively affects children in such ways as making them have an offensive smell, sad feelings, mockery and loss of respect from friends. School authorities should therefore make out time within the school year, to create awareness and teach school children about enuresis to reduce the stigma and embarrassment they face. (shrink)

This study aimed to assess the influence of peer relationships on the self-consciousness and social adaptation of school-aged children in the Enugu North Local Government Area of Enugu State. A descriptive cross-sectional survey design was used, with a population of 60,780 (29,968 males and 30,812 females). A multi-stage sampling method was employed to select 602 school-aged children from 58 schools in the Local Government Area, forming the sample for the study. For data collection, the study used questionnaires. Data (...) were analyzed with descriptive statistics and inferential statistics. The findings revealed that more than half of the respondents (62.6%) showed moderate social adaptation, particularly when they were with their families (mean score of 4.53±2.31). The majority (76.6%) had low peer relationships, while 80.6% had high self-consciousness. The mean scores for peer relationships, self-consciousness, and social adaptation differed between male and female respondents. Females had higher peer relationships and social adaptation. The mean score for peer relationships was higher among students in private schools compared to those in public schools. A moderate positive relationship was found between peer relationships and social adaptation at a significance level of p<0.05. It is recommended that governmental and non-governmental organizations organize programs to facilitate peer relationships and social adaptation among school-aged children. Furthermore, teachers and parents should be educated to provide support to children in these areas. (shrink)

Can music be considered a language of the emotions? The most common view today is that this is nothing but a Romantic cliché. Mainstream philosophy seems to view the claim that 'Music is the language of the emotions' as a slogan that was once vaguely defended by Rousseau, Goethe, or Kant, but that cannot be understood literally when one takes into consideration last century’s theories of language, such as Chomsky's on syntax or Tarski's on semantics (Scruton 1997: ch. 7, see (...) also Davies 2003: ch. 8, and Kania 2012). In this chapter, I will show why this common view is unwarranted, and thus go against nowadays philosophical mainstream by defending what I call the musicalanguage hypothesis. In Section 1, I will introduce the musicalanguage hypothesis and present, based on empirical evidence, some of the many similarities between language and music and explain why we should take them seriously. I will introduce a framework that aims to explain the communicative power of music using what we already know about linguistic communication (1.1). I will then outline several working hypotheses about musical grammar, musical meaning, and affective meaning (1.2), and thus defend that music is indeed very close to literally be a language of the emotions. In Section 2, I will detail some of the methodology, expectations, and preliminary results of a cross-cultural study on musical grammar that I am presently conducting between South India (Chennai) and Switzerland (Geneva and Lausanne)4. This empirical study focuses on two musical idioms and their grammatical features: Western classical music of the Common Period (ca. 1600-1900) and South Indian classical music (also know as Carnatic music). The main hypothesis of this study is that you need to master the grammar of a musical idiom in order to properly understand its musical meanings. (shrink)

Previous research has interlinked alcohol consumption (AC), mental stress (MS), psychotic experiences (PE), and academic performance (AP) of students and psychological behavior of the general population. The current study seems to be the first to consider the joint and partial mediation effects of MS and PE in linking AC to graduates’ job performance in specific areas such as teamwork (TW), communication competence (CC), customer service (CS), and job functions (JF). A virtual cross-section of 3,862 graduates with self-reported cases of (...) having taken alcohol in the past participated in the study. These participants responded to an electronic questionnaire that was mailed to them. The instrument used for data collection had acceptable psychometric properties. The study used the partial least squares structural equation modeling (PLS-SEM) to achieve its objectives. The inner and outer models were all evaluated for quality and goodness of fit. Results showed a significant negative effect of AC and MS on graduates’ job performance in terms of TW, CC, CS, and JF, respectively. AC had a significant positive effect on MS and PE. MS had a significant positive effect on PE. A significant joint mediation effect of MS and PE was found in linking AC to graduates’ TW, CC, and CS, excluding JF. MS partially mediated AC’s paths to all the graduates’ job performance indicators. PE was only a significant partial mediator of the connection between AC to JF, but not TW, CC, and CS. This study’s result can help improve graduates’ work effectiveness and has revealed some negative predictors. Therefore, it is recommended that graduates avoid alcohol or only consume mild quantities of it to enable them to discharge services effectively at the workplace. (shrink)

In “Normativity and Epistemic Intuitions”, Weinberg, Nichols and Stich famously argue from empirical data that East Asians and Westerners have different intuitions about Gettier -style cases. We attempted to replicate their study about the Car case, but failed to detect a cross - cultural difference. Our study used the same methods and case taken verbatim, but sampled an East Asian population 2.5 times greater than NEI’s 23 participants. We found no evidence supporting the existence of cross - cultural (...) difference about the intuition concerning the Gettier car case. Taken together with the failures of both of the existing replication studies, our results provide strong evidence that the purported cross - cultural difference in Gettier intuitions does not exist. (shrink)

Objective: Our study is a cross-sectional study that aims to evaluate the presence and levels of anti-phospholipase A2 receptor (PLA2R) antibodies in healthy volunteers and idiopathic membranous nephropathy (IMN) patients and to assess the relationship between these levels and clinical parameters. -/- Methods: Serum anti-PLA2R antibody levels, complete blood count, urea, creatinine (Kre), total protein,albumin, low-density lipoprotein (LDL)-cholesterol, triglycerides (TG), high-density lipoprotein (HDL)-cholesterol, total cholesterol, C-reactive protein (crp), sedimentation, proteinuria were measured from 71 IMN patients and 48 healthy (...) volunteers. -/- Results: Of the values compared between the two groups, the urea, creatinine, and modified diet renal disease (MDRD) were similar, total protein, albumin, LDL-cholesterol, TG, total cholesterol, HDL-cholesterol, and complete urinalysis protein values were statistically significantly high in the patient group, as expected in nephrotic syndrome (p<0.01). The anti-PLA2Rantibody levels measured using enzyme-linked immunosorbent assay (ELISA) in patient and control groups were found to be negative. The anti-PLA2R level was found to be 0.104 (0.093-0.129) ng/ml in the IMN group, while it was 0.141 (0.117-0.177) ng/ml in the control group (P=0,001). Although the P value was significant, the anti-PLA2R antibody level was found to be high in the control group and was outside the reference range of the kit. -/- Conclusion: There is a need to conduct more sensitive studies with a higher number of patients in order to distinguish between primary and secondary nature and to investigate the presence of anti-PLA2R in IMNpatients, which constitute the majority of nephrotic syndromes in adults. Antibody titer levels were observed to be low and it was revealed that the measurement range of the antibody kit used in the study should be more sensitive. (shrink)

A community based cross-sectional study was carried out by a self-structured questionnaire on 168 participants aged between 18 and 60 years at two arsenic prone area of Bangladesh to determine the association between extent of depression and socio-demographic as well as illness characteristics in arsenicosis population. The mean age ± SD was 42 ± 10.15 years. Female respondents were almost twice (63.1%) than the males (36.9%) in this study. Most of the respondents (94.0%) were shallow tube well water (...) user. Among them most (80.0%) of the respondents were detected as arsenic contaminated water consumer over more than six months. Study estimated that almost half (44.3%) of the participants had suffered from mild to moderate depression in the moderate arsenicosis group. Less than quarter (20.8%) participants suffered severe depression in severe arsenicosis group. Quarter (26.7%) had mild arsenicosis with no depression. This difference was not significant. Gender had significant influence on proportion of level of depression. Females significantly suffered more from depressive symptoms than males. More than two third of the female respondents suffered from some kind of depressive symptoms; where less than one third of the males were suffered from depressive symptoms. Age has no significant relation with depression. Respondents who were 48 years and above age group had highest percentages of severe depressive symptoms (35.8%). This age group also suffered from highest percentage of mild to moderate depression (37.1%). Though most of the respondent (85.1) had no diabetes and hypertension. Respondents with physical illness suffered more from some sorts of depression than those without illness, but the result is not statistically significant. We understood that depression has health challenges in adult arsenicosis patients. Therefore, physicians should take account depression in their treatment management when deal with arsenicosis patients. (shrink)

Philosophers who study the problem of biological function often begin their deliberations by reflecting on the functions of parts of animals, or the behavior of animals. Applying theories of biological function to unconventional or borderline cases can help us to better evaluate and refine those theories. This is the case when we consider whether parts of transposable elements —bits of “selfish” DNA that move about within a host genome—have functions of their own, that is, whether the parts of TEs have (...) the function of helping the TE move about within the genome. Here I argue that whether or not the parts of TEs have functions depends crucially on whether collections of TEs form “populations,” by which I mean, here, a group of individuals of the same type that impact one another’s chances of persistence or multiplication, by impacting one another’s access to a shared resource. I think there is suggestive, but not conclusive, evidence that some TEs have functions of their own. Considering the problem of TE functionality, then, has value both for philosophy and for biology. (shrink)

Loyalty is considered central to people’s moral life, yet little is known about how people think about what it means to be loyal. We used a prototype approach to understand how loyalty is represented in Colombia and the United States and how these representations mediate attributions of loyalty and moral judgments of loyalty violations. Across 7 studies (N = 1,984), we found cross-cultural similarities in the associative meaning of loyalty (Study 1) but found differences in the centrality of features (...) associated with loyalty (Study 2) and the latent structure of loyalty representations (Study 3). Colombians represent loyalty in terms of more general moral characteristics, while US participants represent loyalty in terms of interpersonal commitment, both in contrast with current approaches to loyalty. By comparing representations of loyalty and honesty, we establish that difference in loyalty conceptualizations reflect a different way of thinking about loyalty rather than morality more generally (Study 4). Further, Colombians attributed greater loyalty to individuals with general moral characteristics compared to participants from the United States sample (Study 5) and were more likely to classify non-loyal values as loyalty-related (Study 6). While the centrality of prototypical features predicts categorizing norm violations as loyalty-related, differences in prototypical structure account for differences in the severity of moral judgment for such violations (Study 7), which suggests that loyalty representations have similar functions even though these representations differ in structural characteristics. (shrink)

Clinical microbiology serves as a partner to clinicians in the diagnosis and treatment of infectious diseases. Antibiotics are prescribed empirically before the availability of antimicrobial susceptibility testing data, especially when the patient's medical status could deteriorate by suspending the treatment. To investigate the impact of antimicrobial susceptibility testing on the management of outpatients with suspected bacterial infection in Libyan patients, a cross-sectional prospective study concluded on microbial microdroplet culture by including outpatients with suspected bacterial infection, who have (...) done antimicrobial susceptibility testing. Thus, 53 Libyan patients with urinary tract infections and 14 Libyan patients with skin infections were included in this study. Before the availability of antimicrobial susceptibility testing data, 25 patients were appropriately treated while 42 patients were inappropriately treated. After the availability of antimicrobial susceptibility testing data, the number of appropriately treated patients increased to 57 patients. Thus, antimicrobial susceptibility testing improved the management of 41 patients by discontinuing an unnecessary antibiotic in four patients, starting necessary antibiotic therapy in 18 patients, and changing to more appropriate antibiotic in 19 patients. However, the antimicrobial susceptibility testing has no impact on the management of 24 patients and has led to the worsening of the management of two patients. The effect of antimicrobial susceptibility testing of antibiotic de-escalation was assessed in 35 patients; however, antibiotic de-escalation occurred in six patients. Thus, data of antimicrobial susceptibility testing has improved the management of Libyan outpatients with bacterial infection but their role in antibiotic de-escalation was slight. (shrink)

Clinical microbiology serves as a partner to clinicians in the diagnosis and treatment of infectious diseases. Antibiotics are prescribed empirically before the availability of antimicrobial susceptibility testing data, especially when the patient's medical status could deteriorate by suspending the treatment. To investigate the impact of antimicrobial susceptibility testing on the management of outpatients with suspected bacterial infection in Libyan patients, a cross-sectional prospective study concluded on microbial microdroplet culture by including outpatients with suspected bacterial infection, who have (...) done antimicrobial susceptibility testing. Thus, 53 Libyan patients with urinary tract infections and 14 Libyan patients with skin infections were included in this study. Before the availability of antimicrobial susceptibility testing data, 25 patients were appropriately treated while 42 patients were inappropriately treated. After the availability of antimicrobial susceptibility testing data, the number of appropriately treated patients increased to 57 patients. Thus, antimicrobial susceptibility testing improved the management of 41 patients by discontinuing an unnecessary antibiotic in four patients, starting necessary antibiotic therapy in 18 patients, and changing to more appropriate antibiotic in 19 patients. However, the antimicrobial susceptibility testing has no impact on the management of 24 patients and has led to the worsening of the management of two patients. The effect of antimicrobial susceptibility testing of antibiotic de-escalation was assessed in 35 patients; however, antibiotic de-escalation occurred in six patients. Thus, data of antimicrobial susceptibility testing has improved the management of Libyan outpatients with bacterial infection but their role in antibiotic de-escalation was slight. (shrink)

The researcher pursued the study in the common errors of language learners on subject-verb agreement because Filipino Students learning English have well-formed speech habits in the native language which are totally different in form, meaning and distribution. In the evident that language teaching in the Philippines has not been efficient and effective enough to meet the expectation that English is mastered by the students if it is to become functional for a lifetime. The actual respondents of the study were grouped (...) according to gender and section. The researcher used a descriptive research design to determine the students’ common errors in Subject-Verb Agreement. The items in the test were based on the descriptions of Subject-Verb Agreement errors found in the Harbrace College Handbook and in the Grammar Journal for Subject-Verb Agreement. The objective of the study is to determine the types of Subject-Verb Agreement errors frequently committed by the combined population of the students in Reading Clinique Center. (shrink)

This study aims to examine counseling services as determinants of senior secondary 2 students’ anti-social behaviour in Calabar Education Zone of Cross River State, Nigeria. The main independent variable of the study was counseling services which includes informative counseling services, rehabilitation while the dependent variable is anti-social behaviours. Two hypotheses were formulated to direct the study. Ex-post facto research design was adopted for the study. The population of the study consisted of 2686 senior secondary 2 students in 90 public (...) secondary schools in Calabar Education Zone of which a sample of 700 senior secondary 2 students were selected using stratified and proportionate random sampling procedures. A questionnaire titled Counseling services and antisocial behaviour was used for data collection. The instrument was face-validated by two experts in measurement and evaluation from the University of Calabar. The reliability estimate of the questionnaire was established through the Cronbach alpha which ranges from give .82 to .87. Simple Linear Regression was the statistical technique adopted to test the two hypotheses at .05 level of significance. The results of the analysis revealed that informative counseling services, rehabilitation counseling service are significantly determinant of senior secondary 2 students’ anti- Social behaviour in public secondary schools in Calabar Education zone. Based on these findings, it was recommended that regular counseling services should be given to students in order to inform them about the acceptable behaviours in the society and to curb anti-social behaviours among them. (shrink)

This study aims to identify various meanings of the expression (name) “dignity”, with particular emphasis on the meanings of this expression as it appears in the text of the Constitution of the Republic of Poland. The meaning of the name “dignity” is the concept of dignity; in turn, the different concepts of dignity encompass dignity of particular types. Twelve different meanings of the expression “dignity” are indicated – twelve different concepts of dignity, and thus twelve types of dignity. Half of (...) them are meanings (concepts) that recognize dignity as something belonging to a human being as a subject of law. They were considered in the essay Godność jako właściwość osoby. Typy godności – propozycja systematyzacji [Dignity as a Quality of Person – a Proposed Systematisation]. This group of meanings includes three concepts of dignity which recognize dignity as something constitutive of being a person: (1) inherent dignity of the person, (2) dignity established by qualities specific to a thinking being, and (3) dignity as a historically emergent social status of all human beings. The second group of meanings, treating dignity as something with which the human being (the person) is endowed, includes concepts which encompass (4) personal dignity (honour and good reputation), (5) dignity as moral excellence, and (6) dignity as appropriateness of attitude or behaviour. -/- Dignity as an attribute of collective entities and dignity as an institutionally grounded attribute are a subject of this paper. The Constitution of the Republic of Poland speaks of (1) the dignity of the Nation, (2) the dignity of office or function, and (3) public dignity. The expression “the dignity of the Nation” can be understood in four different ways: (i) analogously to the understanding of dignity of the person, (ii) of personal dignity, (iii) of dignity as moral excellence, and (iv) of dignity as appropriateness of attitude or behaviour. The expression “dignity” when designating something institutionally grounded can designate (4) the dignity of social roles, (5) the dignity of a profession, and – specifically to the Polish language – (6) dignity meaning a surname. -/- The author argues that it is unacceptable to ascribe different concepts of dignity to the expression “dignity” appearing in a specific legal provision. (shrink)

Talk of different types of cells is commonplace in the biological sciences. We know a great deal, for example, about human muscle cells by studying the same type of cells in mice. Information about cell type is apparently largely projectible across species boundaries. But what defines cell type? Do cells come pre-packaged into different natural kinds? Philosophical attention to these questions has been extremely limited [see e.g., Wilson (Species: New Interdisciplinary Essays, pp 187–207, 1999; Genes and the (...) Agents of Life, 2005; Wilson et al. Philos Top 35(1/2):189–215, 2007)]. On the face of it, the problems we face in individuating cellular kinds resemble those biologists and philosophers of biology encountered in thinking about species: there are apparently many different (and interconnected) bases on which we might legitimately classify cells. We could, for example, focus on their developmental history (a sort of analogue to a species’ evolutionary history); or we might divide on the basis of certain structural features, functional role, location within larger systems, and so on. In this paper, I sketch an approach to cellular kinds inspired by Boyd’s Homeostatic Property Cluster Theory, applying some lessons from this application back to general questions about the nature of natural kinds. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of patients, the (...) age range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

Higher education institutions are expected to produce quality and competitive graduates for the job market and nation-building. In realizing this role, Bukidnon State University needs to ensure that graduates may land a job-relevant and align with their education and training. With this, a tracer study was conducted to verify whether the three batches of graduates are employed and are employable. It ascertained their employability based on their work experience from graduation to the present job. It employed a cross-sectional (...) method and data mining for the information of 326 graduates. The results revealed that the majority of graduates had jobs relevant to their education and training; yet, there was a significant difference in the employability of graduates across batches, except in terms of gender. Biological Science, Social Studies, and Math graduates were employable within the first six and twelve months compared to graduates from other curricula. It was claimed that the BukSU had prepared BSE graduates for employment. However, these results have implications for strategic options in improving the programs. The study made some recommendations for future tracer initiatives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 25.2 (2001) 215-232 [Access article in PDF] Eighteenth-Century Print Culture and the "Truth" of Fictional Narrative Lisa Zunshine As a session entitled "Truth" at a recent Modern Language Association of America annual convention has demonstrated, the obsession with the epistemologies of truth is alive and well. Our "familiar ways of thinking and talking about truth," as one of the speakers, Barbara Herrnstein Smith, observed, remain "theoretically (...) elusive, discursively slippery, and hard or perhaps impossible to articulate clearly in relation to other current concepts and ideas" 1 --an irresistible invitation to further thinking and talking on the subject. My essay enters this conversation by attempting to contemplate truth not as a stable attribute but as a ongoing attribution, that is, not as an inherent property but rather as a dynamic process predicated upon functional idiosyncrasies of our evolved cognitive architecture. The broad question posed here is this: What if our never-ending quest for truth is itself cognitively constructed and the various forms that this quest takes manifest the (not necessarily harmonious) interaction between our evolved cognitive capacities and the ever-changing specifics of our cultural environment?Consider just one of the forms of such an interaction, namely, our age-long preoccupation with the "truth" of literary narrative. In many respects, this preoccupation is counterproductive: the most "fantastic" story contains a number of contingently useful "truths" about the world, whereas the most "factual" narrative manipulates facts by virtue of being a narrative or a subjective arrangementof information. Still, we persevere in wanting to put the label "fiction" or "nonfiction" onto any story that comes our way. As I will argue, the bookstore's organization of its sections satisfies this species of "cognitive" craving as well as [End Page 215] reinforces it, making it seem culturally inevitable. Viewed from this perspective, our culture appears to be a multifaceted feedback mechanism engaged in the process of satisfying, reinforcing, struggling with, and manipulating our cognitive predispositions.The cultural manipulation of our cognitive predispositions is the topic of the present essay, which discusses several examples of such manipulation that respond to our desire to assign a certain "truth-value" to a given narrative, i.e., to attach a label to it announcing its "factuality" or "fictionality." "Truth-value" is a loaded term, resisting definition, and liable to lead me into trouble. Imperfect as it is, however, I need it in order to shuffle between two scholarly discourses that do not (yet) have much vocabulary in common: literary criticism and cognitive science. The reason for turning to cognitive science in my discussion of literary narrative is that cognitive anthropologists and psychologists frequently engage the same problems that we do when we ask, What is "Fiction"? How is it different from "History"? How do we decide whether what we are reading is "true?" The key difference between the two approaches is, however, that whereas the literary critic focuses on specific texts produced and read in specific cultural circumstances, the cognitive anthropologist pays attention to the cross-cultural insistence with which people wish to and often claim to distinguish "truth" from "fiction" and inquires into the possible evolutionary history of the cognitive architecture implicated in our never-ending quest for "truth." The latter perspective can thus be useful for literary studies because, by suggesting that our evolved cognitive architecture often "encourages" us to construe the world as a negotiation of "truths" and "nontruths," this perspective begins to account--at least on some level--for the fact that people may approach a complex cultural artifact, such as a novel, with a "truth"/"non-truth" binary in mind that is ultimately not very productive. 2 Evolutionary psychologists and anthropologists frequently point to disjunctions between the tasks that our brain evolved to solve and the tasks that we have to deal with in the modern environment; our vexed insistence on determining the truth-value of the 500-page printed narrative--not an object one would come across in the Pleistocene--can be seen as yet another instance of such a disjunction.Thus, I suggest that, on the... (shrink)

Our society is undergoing digital change. Dealing with digital technologies has become a daily practice. Many healthcare facilities are implementing digital technologies. Nurses are placed in a strategic position to be the leader of the digital healthcare workforce. Nursing students are more exposed to this technological advancement as they are future professional nurses. This study aimed to examine how information-processing and exchanging skills in digital spaces affect digital problem-solving skills among nursing students. The Bayesian mindsponge framework (BMF) was used as (...) a conceptual framework. This quantitative study utilized a cross-sectional design. The population was all nursing students in two private nursing institutions located in Bangkok, Thailand (n=476) and Surabaya, Indonesia (n=179). Samples were the total population. Self-developed instrument was used in data collection. Data analysis used BMF analytics. The majority were females aged 20-22 years old who use smartphones and tablets daily. The information-processing and information-exchanging skills in digital spaces were positively associated with digital problem-solving skills among nursing students (MInformationProcess=0.30 and SDInformationProcess=0.05; MInformationExchange=0.37, and SDInformationExchange=0.05). More efforts are needed to improve nursing students’ problem-solving skills by using digital content, for instance, by modifying the information-processing and information-exchanging skills in digital spaces. Collaborative learning methods should be promoted in order to support the creation of conducive environment for supporting knowledge or information-exchanging behavior among nursing students by using digital technology. (shrink)

This study analyzed the utilization of social media platforms and university students' attitudes towards academic activities in Cross River State. A descriptive survey research design was adopted for the study. The population of this study comprised all the private and public university students in Cross River State. A sample of 1,600 students, which cuts across the three universities in the area of study, was selected using the convenience sampling technique. A questionnaire (r=.849) and a rating scale (r=.786) were (...) used as the instruments for data collection. Findings emerged amongst others that the utilization status of social media platforms by university students is generally high; the utilization of Facebook, WhatsApp, Instagram, Twitter, WeChat, Skype, Snapchat, Eskimi, Telegram and YouTube social media platforms has a significant composite influence (F=52.453, p<.05) on university students' attitudes towards academic activities. Relatively, utilization of Facebook was the highest predictor (t=11.222, β=.232, p<.05), followed by the utilization of WhatsApp (t=11.068, β=.229, p<.05), utilization of Twitter (t=5.977, β=.118, p<.05), and the utilization of Instagram (t=2.772, β=.056, p<.05), in that order. It was recommended that secondary school students should develop positive attitudes towards their academic activities and abhor activities that will lead to a decline in the learning outcomes. (shrink)

In this paper, we aim to trace the origin of the systematic cross-cultural variations in referential intuitions by investigating the effects of perspective taking on people’s responses in the Gödel-style probes through two novel experiments. Here is how we will proceed. In section 2, we first briefly introduce the MMNS (2004) study, and then critically review the two relevant studies conducted by Sytsma and colleagues (i.e., Sytsma and Livengood 2011; Sytsma et al. 2015). In section 3, we introduce the (...) literature on cross-cultural variation in perspective taking in cultural psychology, which together with the conjecture of perspectival ambiguity leads to the hypothesis of our current study. In sections 4 and 5, two new experiments on how perspective taking affects people’s responses in hypothetical stories modelled on the Gödel thought experiment will be reported. Based on the empirical findings, in section 6 we argue that the robust cross-cultural variations thus far observed in people’s responses to the Gödel cases are largely attributable to culturally specific perspective-taking strategies, which provides new support for the proposal previously made by Sytsma and Livengood (2011). The implications of the experimental results for the ongoing work of testing the theories of refence of names and for the current metaphilosophical debate on the robustness of philosopher’s intuitions are also drawn in this section. Finally, the major conclusions and contributions of the current study are highlighted in section 7. (shrink)

GAMETOGÊNESE -/- Emanuel Isaque Cordeiro da Silva Instituto Agronômico de Pernambuco Departamento de Zootecnia – UFRPE Embrapa Semiárido -/- • _____OBJETIVO -/- Os estudantes bem informados, estão a buscando conhecimento a todo momento. O estudante de Veterinária e Zootecnia, sabe que a Reprodução é uma área de primordial importância para sua carreira. Logo, o conhecimento da mesma torna-se indispensável. No primeiro trabalho da série fisiologia reprodutiva dos animais domésticos, foi abordado de forma clara, didática e objetiva os mecanismos de diferenciação (...) sexual dos embriões em desenvolvimento, quais os genes envolvidos nesse processo e tudo mais. Nesse segundo trabalho, a abordagem será teórica, mas também clara, sobre a formação primordial dos gametas femininos e masculinos, através da ovogênese nas fêmeas e a espermatogênese nos machos. Esse trabalho visa levar a importância do processo de formação dos gametas e a produção hormonal das gônadas, bem como o entendimento sobre as interações com o eixo hipotálamo-hipofisário. -/- •____INTRODUÇÃO -/- A reprodução sexual é um processo mediante a qual dois organismos da mesma espécie unem seu material genético para dar lugar a um organismo fixo com combinação única de genes; para isso, cada organismo produz células que contém a metade do material genético característico da espécie. Essas células haploides (1n) são denominadas gametas; ao combinar-se um gameta masculino com um feminino produz-se uma célula diploide (2n) (zigoto ou ovo) a partir da qual se forma o embrião. A grande maioria das espécies com reprodução sexual são anisogâmicas, o que significa que produzem dois tipos de gametas diferentes: os gametas masculinos são microscópios, móveis e produzem-se em grande quantidade, enquanto que os femininos são grandes, imóveis e produzem-se em menor quantidade. O tipo de gameta que um indivíduo produz é o que define seu sexo; sobre os animais o macho é o indivíduo que produz grandes quantidades de espermatozoides e a fêmea produz uma menor quantidade de óvulos, enquanto que nas plantas as gônadas masculinas são as produtoras pólen e as femininas produzem oosferas. Os gametas são diferentes do resto das células do organismo, as quais se chamam células somáticas; essas últimas são diploides porque contém dois pares de cromossomos, um par herdado do pai do indivíduo e o outro da mãe. As células somáticas, ademais, se dividem por mitose, ao qual os cromossomos se duplicam antes de cada divisão celular e cada uma das células filhas recebe um complemento diploide idêntico dos cromossomos, logo todas as células somáticas de um indivíduo possuem o mesmo material genético, embora cada tipo celular expresse diferentes combinações de genes. Em contraponto, os gametas são células haploides porque possuem somente um par de cromossomos e a metade do material genético característico da espécie. Cada um dos cromossomos em um gameta é resultado da recombinação dos genes contidos nos cromossomos paterno e materno do indivíduo que originam o gameta, e cada um destes possuem uma combinação única de genes. Os gametas se formam a partir das células germinais, que são células que em sua origem são diploides e elas de “comprometem” a manter-se como uma linha celular especial que em determinado momento sofrerá o processo de meiose para dar origem aos gametas haploides, sejam óvulos ou espermatozoides segundo o sexo do animal. Como descrito no trabalho sobre a diferenciação sexual, as células germinativas primordiais originam-se no epiblasto do embrião, e migram desde o saco vitelino até colonizar as cristas gonodais, onde, por sua vez, proliferam-se e se organizam junto com as células somáticas da gônada primitiva para formar o testículo ou o ovário. As células germinais masculinas e femininas tem a mesma origem embrionária. As gônadas indiferenciadas em um embrião possuem três tipos celulares: as células que dão origem aos gametas (ovogonia ou espermatogonia), as precursoras de células que nutrem os gametas em desenvolvimento (células da granulosa no ovário; células de Sertoli no testículo) e as precursoras de células que secretam hormônios sexuais (células da teca no ovário; células de Leydig no testículo). As células germinais são as únicas estruturas do organismo que têm a capacidade de dividir-se por meiose sofrendo uma redução no número de seus cromossomos, sendo responsável pela transmissão da carga genética aos descendentes. Em contraste, as células somáticas somente se dividem por mitose. A formação dos gametas compreende fases sequenciais de mitose, meiose e pós-meiose. Esses processos são altamente organizados e necessitam de um preciso e bem coordenado programa de expressão genética. Uma das características importantes da gametogênese é a redução cromossômica, que através da meiose, reduz pela metade o número de cromossomos e produz células distintas entre si, devido a trocas de material genético entre os pares de cromossomos provenientes do pai e da mãe, o que ocorre no processo de “crossing over” durante a primeira fase da meiose. A gametogênese é o processo mediante o qual as células germinais de cada sexo se multiplicam, dividem e diferenciam até formar os gametas. No caso da formação dos gametas masculinos o processo recebe o nome específico de espermatogênese, e para os gametas femininos é denominado como ovogênese. Embora os dois processos alcancem o objetivo comum de produção das células haploides, por onde compartilham algumas características, existem diferenças marcadas entre eles devido a necessidade de produzir um número muito distinto de gametas, de tamanho diferente, e com características de motilidade também distintas. -/- •___ESPERMATOGÊNESE -/- A espermatogênese é o processo mediante o qual se produz os gametas masculinos denominados espermatozoides. Durante a vida fetal as células germinais e as células somáticas do testículo em formação organizam-se em túbulos seminíferos que se derivam dos cordões sexuais primários e conformam a maior parte da medula do testículo. Na etapa fetal cada tubo seminífero é delimitado por uma membrana basal, recoberta na parte interior pelas células precursoras das células de Sertoli (um tipo de células somáticas). No exterior do túbulo localizam-se as células precursoras das células de Leydig ou intersticiais (figura 1), que também são células somáticas. Entre a membrana basal e as células de Sertoli encontram-se algumas células germinais denominadas espermatogonias de reserva A0 (denominadas gonócitos) que serão o único tipo de células germinais presentes no testículo enquanto o animal não alcançar a puberdade. As células de Sertoli estabelecem na região basal uniões oclusoras entre si, formando parte da barreira hemato-testicular. As espermatogonias A0 localizam-se por dentro da membrana basal do túbulo seminífero, embora fora da barreira hemato-testicular. Figura 1: fase neonatal. Nota-se a grande infiltração de tecido intersticial em quase 50% da seção originando que os túbulos sejam pequenos e redondos em sua maioria. O citoplasma e núcleo das células pré-Leydig são notadas claramente por essa ser uma espécie suína onde o tecido intersticial está claramente diferenciado. Hematoxilina-eosina (X 220.5). Fonte: Embrapa. -/- O número de células de Sertoli no testículo depende da influência do hormônio folículo estimulante (FSH) presente durante a vida fetal e as primeiras etapas de vida pós-natal. A população de células de Sertoli ao chegar a puberdade se manterá fixa durante o resto da vida do animal; existe uma relação positiva entre o tamanho e a população de células de Sertoli e a capacidade de produção de espermatozoides do testículo. As células de Sertoli são as únicas células somáticas que estão no epitélio seminífero, e sua função é a nutrição, sustentação e controle endócrino das células germinais. As células de Sertoli participam ativamente no processo de liberação dos espermatozoides para a luz do túbulo. Nesse momento, as células de Sertoli realizam a fagocitose de parte do citoplasma do espermatozoide dos chamados corpos residuais. As células de Sertoli também fagocitam as células germinais que se degeneram no curso normal da espermatogênese. Essas células ainda sintetizam grande quantidade de proteínas, como por exemplo as proteínas ABP (androgen hinding protein), que transportam andrógenos para todo o aparelho reprodutivo, transferrinas, que transportam ferro para a respiração celular das células germinais e também às inibinas, que regulam a liberação de FSH pela hipófise, através de um sistema de retroalimentação (feedback) negativa (figura 2). Figura 2: epitélio seminífero, células de Sertoli (flecha) (400 X). Fonte: Embrapa. -/- Antes da puberdade dos túbulos seminíferos observam-se ao corte como estruturas de diâmetro pequeno, sem luz, e conformados unicamente pelas células de Sertoli e espermatogonias de reserva e rodeados por abundante tecido intersticial, ao que estão presentes as células precursoras das células de Leydig. Ainda antes da puberdade, a diferenciação celular manifesta-se primeiro pela presença de espermatócitos primários, os quais se degeneram em geral na fase de paquíteno, por falta de estimulação hormonal. A partir de que o animal chega a puberdade inicia-se o processo de espermatogênese, que se manterá durante toda a vida do animal, exceto em espécies de animais silvestres muito estacionais, ao qual pode se suspender durante a época não reprodutiva para voltar e ser retomada na época ou estação reprodutiva. Depois da puberdade, os túbulos seminíferos possuem um diâmetro muito maior; em seu interior observa-se um grande número de células germinais de todos os tipos, diferentes estádios de divisão, e em seu lúmen contém líquido e espermatozoides. Ainda sobre o alcancei da puberdade, as espermatogonias começam a dividir-se aceleradamente por mitose, enquanto que no espaço intersticial as células mesenquimais também começam a se diferenciar e a dar origem as células de Leydig (figura 3). A partir dessa etapa as células de Leydig (totalmente diferenciadas) são também evidentes no exterior do túbulo, junto com as células mioides ou peritubulares que o rodeiam o que ao contrair-se são responsáveis por controlar o avanço dos fluidos e as células presentes no lúmen do túbulo. As células mioides estão situadas ao redor do túbulo, e é creditado a elas a promoção da contração e da integridade estrutural do túbulo. Esse tipo celular apenas se diferencia na puberdade pela ação dos andrógenos (figura 4). As interações entre as células de Sertoli e as mioides parecem ter um papel importante na manutenção das funções do testículo. Durante o processo de espermatogênese, as espermatogonias de reserva dividem-se periodicamente e enquanto algumas células fixas permanecem como espermatogonias de reserva, outras proliferam e sofrem uma seção de divisões mitóticas durante as quais se vão diferenciando até formarem espermatócitos primários (espermatocitogênese ou fase de mitose), logo sofrem divisões especiais mediante as quais reduzem seu número de cromossomos (fase de meiose), e ao final trocam de forma para converter-se em espermatozoides (espermatocitogênese) (figura 5). Cada uma dessas etapas da espermato- gênese será descrito detalhadamente adiante, antes é necessário a explicação de algumas características das células de Sertoli e de Leydig que ajudarão a entender seu papel durante a espermatogênese. Figura 3: células de Leydig no espaço intersticial do testículo bovino adulto PAS (400 X). Fonte: Embrapa. -/- Figura 4: o estabelecimento da puberdade pela presença de espermatozoides no túbulo. Hematoxilina-eosina (400 X). Fonte: Embrapa. Figura 5: fases mitóticas das espermatogonias (A0 e B) para formação de um espermatócito primário e as duas fases de meiose que se sucedem antes da espermatogênese. Fonte: ZARCO, 2018. -/- Ao início da espermatocitogênese as uniões oclusoras entre as células de Sertoli se abrem por etapas (como as comportas de um submarino) para permitir a passagem das espermatogonias em direção ao centro do túbulo seminífero sem que se estabeleça uma continuidade entre o exterior e o interior da barreira hemato-testicular. Uma vez ultrapassada essa barreira, as sucessivas gerações de espermatogonias, espermatócitos, espermátides e espermatozoides irão se localizar em direção ao interior do túbulo seminífero, em estreita associação com as células de Sertoli. Em consequência, as células de Sertoli dividem o túbulo seminífero em dois compartimentos; o compartimento basal (debaixo das uniões oclusoras das células de Sertoli), ao qual residem as espermatogonias de reserva, e o compartimento adluminal (em direção ao centro do túbulo), cujos espaços entre as células de Sertoli desenvolvem o resto do processo de espermatogênese (meiose e espermatocitogênese). Esse feito é importante porque durante a vida fetal as únicas células germinais existentes eram as espermatogonias de reserva, pelo que os antígenos expressados por gerações mais avançadas (espermatogonias intermediárias, secundárias, espermátides e espermatozoides) não são reconhecidos como próprios do corpo pelo sistema imunológico. Logo, o anterior implica que deve existir uma barreira entre eles e o sangue para evitar um ataque imunológico. Em todas as etapas da espermatogênese, as células de Sertoli atuam como células de suporte para as células germinais, que sempre permanecem recoberta pela membrana das células de Sertoli. Também atuam como células nutricionais já que proporcionam o meio em que as células germinais se desenvolvem e maturam, assim como as substâncias que regulam e sincronizam as sucessivas divisões e transformações das células germinais. As células de Sertoli produzem hormônios, como estrógenos e inibina que atuam sobre a hipófise para regular a secreção das gonadotropinas que controlam a espermatogênese. As células de Leydig que residem no exterior do túbulo seminífero também são importantes para a espermatogênese: produzem a testosterona que estimula e mantém a espermatogênese, bem como serve como substrato sobre o qual atua como aromatizador das células de Sertoli para transformá-las em estrógenos. Como supracitado, para seu estudo podemos dividir a espermatogênese em três fase: espermatocitogênese, meiose e espermiogênese (figura 6). Agora, serão descritas cada uma dessas etapas. Em algumas espécies, incluindo no homem, os macrófagos representam o segundo tipo celular intersticial mais numeroso no testículo, depois das células de Leydig. Os macrófagos e vários subtipos de linfócitos são identificados nós testículos de ovinos e ratos. Eles estão intimamente associados com as células de Leydig e atuam juntamente na regulação da esteroidogênese. Figura 6: fluxograma da espermatogênese. -/- Espermatocitogênese -/- A espermatocitogênese, também chamada de etapa proliferativa ou de mitose, consiste numa série de divisões mitóticas sofridas pelas células descendentes de uma espermatogonia de reserva. Uma vez que a célula se divide, abandona o estado de reserva e começa um processo de diferenciação. As espermatogonias de reserva (denominadas espermatogonias A0 na rata ou As nos humanos) são células que existem desde a vida fetal e que permanecem mitoticamente inativas durante a infância. Uma vez que alcançam a puberdade começam a dividir-se em intervalos regulares, e as células filhas podem permanecer como espermatogonias de reserva ou abandonar a reserva e ingressar na dita espermatocitogênese. Uma vez abandonada a reserva, as células filhas que vão se formando em cada divisão permanecem unidas por pontes citoplasmáticas, constituindo um clone que se divide sincronicamente. As células que se formam depois de cada divisão continuam sendo espermatogonias, porém cada geração é ligeiramente diferente da anterior. Na rata, por exemplo, as espermatogonias tipo A0 ao dividir-se originam espermatogonias do tipo A1, que em sucessivas divisões formam espermatogonias dos tipos A2, A3 e A4, as quais, por sua vez, sofrem outra mitose para formar espermatogonias intermediárias e uma mais para formar espermatogonias do tipo B. Essas últimas se diferenciam (sem se dividir) em espermatócitos primários, processo em que termina a fase de espermatocitogênese, que literalmente significa processo de geração de espermatócitos. As espermatogonias tipo A0 são a fonte para a contínua produção de gametas. A metade delas se dividem e formam células iguais (as chamadas células tronco) e a outra metade forma as espermatogonias A1, que sofre novas divisões mitóticas e formam os tipos 2, 3 e 4. O tipo A4 sofre mitose para formar a intermediária (A In), que por mitose, forma a tipo B (figura 6). Esses tipos de espermatogonias podem ser identificadas em evoluções histológicas de acordo com sua organização topográfica na membrana basal dos túbulos seminíferos ou mediante seu conteúdo de heterocromatina. Outra maneira de diferenciação se baseia em marcadores moleculares específicos que distinguem as espermatogonias tronco (A0) das demais, com os fins de isolamento, desenvolvimento in vitro e transplante. As tipo B passam por mitose para formarem os espermatócitos primários; estes iniciam a primeira etapa da meiose formando os espermatócitos secundários; na segunda etapa da divisão meiótica, cada espermatócito secundário se divide e formam as chamadas espermátides. Quando o testículo alcança seu desenvolvimento total, a meiose completa-se e as espermátides originadas se convertem em espermatozoides. Um dos maiores sinais característicos desse fenômeno é o alargamento das espermátides e sua migração em direção ao lúmen do túbulo seminífero (figuras 4, 7 e 8). Figura 7: espermatogonias marcadas por imuno-histoquímica, anticorpo monoclonal TGFa (400 x). Figura 8: fases de divisões meióticas (M), espermatócitos em paquíteno (PA) e espermatócitos secundários (ES). -/- Figura 9: estádio posterior a liberação dos espermatozoides na luz do túbulo. Hematoxilina-eosina (400 x). Mediante as seis divisões mitóticas que ocorrem durante a espermatocitogênese se forma potencialmente um clone de 64 espermatócitos primários a partir de cada espermatogonia A que ingressa sobre o processo. Não obstante, algumas células sofrem apoptose em cada uma das etapas do processo, ao qual o número real formado é menor. Em outras espécies produzem-se um transcurso similar de divisões mitóticas sucessivas durante a espermatocitogênese, embora a nomenclatura utilizada possa ser distinta, por exemplo nos bovinos as duas últimas divisões mitóticas dão origem as espermatogonias de tipo B1 e B2. -/- Meiose -/- Uma vez que as espermatogonias B se diferenciam em espermatócitos primários, esses iniciam a etapa de meiose, com uma nova divisão; desta vez a divisão é do tipo meiótica. Ao completar-se a primeira divisão meiótica (meiose I) se obtém os espermató-citos secundários, que ao sofrer a segunda divisão meiótica (meiose II) dão origem as espermátides. Vale salientar que a meiose é o processo mediante o qual reduz-se a metade do número de cromossomos, pelo que as espermátides que se obtém são células haploides (1n). Os espermatócitos secundários que se formam depois da primeira divisão meiótica contém a metade do número normal de cromossomos, porém a mesma quantidade de DNA já que cada cromossomo é duplo. As espermátides formadas na conclusão da segunda divisão meiótica (figura 7), por sua vez, contém a metade dos cromossomos, e esse já não são duplos, já que se trata de células 1n. Também deve-se enfatizar que durante a meiose é relevante o entrecruzamento dos cromossomos homólogos, pelo que cada espermátide possui uma combinação única e diferente de genes paternos e maternos. Outro ponto que deve ser levado em consideração é que cada espermátide somente possui um cromossomo sexual; a metade das espermátides contém o cromossomo X herdado da mãe do macho que está levando a cabo a espermatogênese e a outra metade contém o cromossomo Y herdado de seu pai. Para cada espermatócito primário que entra no processo de meiose obtém-se cerca de quatro espermátides, pelo qual ao ser completada a meiose potencialmente se poderiam formar até 256 espermátides por cada espermatogonia que abandona a reserva e ingressa na espermatocitogênese. -/- Espermiogênese -/- Durante a espermiogênese, também chamada de fase de diferenciação, as esper-mátides sofrem, sem se dividir, uma metamorfose que as transforma em espermatozoides, os quais finalmente são liberados das células de Sertoli em direção ao lúmen do túbulo seminífero. A espermiogênese é um processo complicado e longo já que a espermátide deve sofrer complexas trocas nucleares, citoplasmáticas e morfológicas que resultam na forma-ção dos espermatozoides. Algumas dessas mudanças incluem a condensação do material nuclear para formação de um núcleo plano e denso, a eliminação do citoplasma para a constituição de uma célula pequena, a formação de uma estrutura especializada denomi-nada acrossomo ou tampa cefálica, e a formação do pescoço e da cauda (flagelo) do esper-matozoide, do que depende a sua motilidade. Durante a maior parte da espermiogênese, as espermátides se mantém com uma estreita associação com as células de Sertoli; logo, chega-se a observar, então, flagelos que se projetam em direção a luz do túbulo que pare-cem sair das células de Sertoli, sendo na realidade os flagelos dos espermatozoides que ainda não tinham sido liberados pelo lúmen. Ao liberar os espermatozoides em direção a luz do túbulo, as células de Sertoli realizam a fagocitose de parte do citoplasma dos espermatozoides (corpos residuais). Também fagocitam os restos de todas as células germinais que sofrem apoptose ou degeneram-se durante a espermatogênese. Credita-se que ao realizar essas funções as células de Sertoli podem fazer uma monitoração eficiente da espermatogênese, o que lhes permitiria emitir sinais para colaborar na regulação desse processo em nível gonodal e a nível sistêmico através da secreção de hormônios como a inibina e o estradiol. Além da inibina e activina, as células de Sertoli sintetizam outras proteínas, como a ABP (proteína ligadora de andrógenos) que serve como uma molécula de transporte de andrógenos dentro dos túbulos seminíferos, ductos deferentes e epidídimo, ou a transfer-rina, que transporta o ferro necessário para a respiração celular. -/- Resultados da espermatogênese -/- O resultado da espermatogênese não significa apenas uma simples multiplicação das células germinais (até 256 espermatozoides a partir de cada espermatogonia A1), senão que através dela são produzidos gametas haploides pequenos, móveis e com grande diversidade genética entre eles, ao mesmo tempo que se mantêm uma reversa de células mãe (espermatogonias A0) a partir das quais se poderiam originar novos ciclos de esper-matogênese durante o resto da vida do animal. -/- Controle hormonal da espermatogênese -/- Como mencionado, o FSH reproduz um importante papel para o estabelecimento das células de Sertoli durante a vida fetal e início da vida pós-natal. O começo da esper-matogênese também é estimulado pelo FSH, que atua sobre as células de Sertoli para estimular sua função e a ativação de sinais dessas células em direção as células germinais, incluindo-as a abandonar a reserva e ingressar na espermatogênese. O FSH, assim mesmo, estimula a mitose durante o resto da espermatogênese e aumenta a eficiência do processo, já que reduz a apoptose e a degeneração de espermatogonias intermediárias e do tipo B. O FSH também estimula as células de Sertoli para produzirem inibina e ABP. Uma vez iniciada a espermatogênese somente requerem níveis baixos de FSH para se mantê-la. As células de Sertoli também devem ser estimuladas pela testosterona para funcio-nar de maneira adequada; se requer também do LH hipofisário: hormônio que estimula as células de Leydig para produzir testosterona. Por sua vez, a secreção de LH e FSH é regulada pelo GnRH hipotalâmico: esse neurohormônio também faz parte do mecanismo de regulação da espermatogênese. A espermatogênese também é modulada em nível local mediante a produção de determinados fatores e interações entre as células. Dentro dos fatores locais podemos mencionar o fator de crescimento parecido com a insulina 1 (IGF-1), o fator de crescimen-to transformante beta (TGF- β), activina, ocitocina e diversas citocinas. Entre as intera-ções celulares existem tanto uniões de comunicação entre as células de Sertoli e as células germinais, como pontes citoplasmáticas entre todas as células germinais que formam o clone de células descendentes de uma espermatogonia A1. Uma vez que as células de Sertoli iniciam sua função na puberdade é possível manter experimentalmente a espermatogênese somente com testosterona, sem ser requeri-dos nenhum outro hormônio. A quantidade de espermatozoides produzidos, no entanto, é maior quando há presença do FSH. Abaixo do estímulo do FSH as células de Sertoli produzem estradiol e inibina, hormônios que geram uma retroalimentação sobre o eixo hipotálamo-hipofisário para a regulação da secreção de gonadotropinas. Em particular, a inibina reduz a secreção de FSH, pelo qual é factível que sirva como um sinal que evite uma excessiva estimulação as células de Sertoli. -/- Ciclo do epitélio seminífero -/- Em cada espécie as espermatogonias de reserva iniciam um novo processo de divi-sões celulares em intervalos fixos: a casa 14 dias no touro; 12 dias no garanhão e a cada 9 dias no cachaço (reprodutor suíno). A nova geração de células que começam a proliferar sobre a base do tubo deslocam-se em direção ao centro do túbulo a geração anterior, que por sua vez deslocam-se as gerações anteriores. Devido as mudanças que vão sofrendo cada geração celular se ajustam a tempos característicos de cada etapa, já que rodas as células em uma determinada seção do túbulo estão sincronizadas entre si pelas células de Sertoli; em cada espécie somente é possível encontrar um certo número de combinações celulares: 14 diferentes combinações no caso da rata, 8 no touro e 6 no ser humano. A sucessão de possíveis combinações até regressar a primeira combinação se conhece como o ciclo do epitélio seminífero. Na maioria das espécies os espermatozoides que são libera-dos em direção a luz do túbulo provém das células que entraram no processo de esperma-togênese quatro gerações antes que a geração que está ingressando nesse momento, pelo que a espermatogênese no touro dura ao redor de 60 dias e um pouco menos em outras espécies domésticas. Significa que os efeitos negativos das alterações na espermatogêne-se podem estar presentes até dois meses depois de que se produziram essas alterações. Como supracitado, geralmente se observa a mesma combinação celular em toda a área de uma determinada secção transversal do túbulo seminífero. No entanto, se fizermos uma série de secções, observa-se que ao longo do túbulo há uma sucessão ordenada de combinações (a primeira em uma determinada secção; a segunda combinação na seguinte secção, e assim sucessivamente em secções subsequentes até regressar a primeira combi-nação. Teremos, então, que ao início da divisão das espermatogonias A1 se produz de forma sincronizada em uma secção do túbulo, e vai-se transmitindo como uma onda peristáltica as secções adjacentes. Esse processo é denominado como onda do epitélio seminífero e graças à esse túbulo seminífero sempre tem secções em todas as etapas da espermatogênese, com o que se alcança uma produção constante de espermatozoides. -/- Alterações da espermatogênese -/- Nas espécies estacionais a espermatogênese, como já mencionado, pode reduzir-se ou inclusive suspender sua atividade fisiológica durante a época não reprodutiva dessas espécimes, porém esse processo fisiológico não pode ser considerado como uma altera-ção. No entanto, a espermatogênese só pode ser alterada pelas enfermidades ou por fatores externos. A principal causa de alterações na espermatogênese é o aumento da temperatura testicular. Por isso, os testículos são localizados na saco escrotal e são “caídos” para fora do corpo como pode-se observar nos bovinos, caprinos, ovinos, caninos e no próprio homem. A temperatura testicular deve estar cerca de 2 a 6 °C abaixo da temperatura corporal normal. As células germinais masculinas são sensíveis ao calor, pelo qual na maioria dos mamíferos os testículos se encontram fora da cavidade abdominal e existe um sofisticado sistema de termorregulação para mantê-los a uma temperatura menor que a corporal. Se a temperatura corporal for elevada ou se os testículos permanecerem na cavidade abdominal, ou ainda se os sistemas termorreguladores do testículo sejam afetados por fatores inflamatórios como edema ou falta de mobilidade testicular dentro do escroto, a temperatura do tecido testicular aumentará e a espermatogênese sofrerá alterações proporcionais ao excesso de temperatura e a duração da elevação. A espermatogênese também pode ser afetada pela exposição a hormônios ou a outras substâncias. É possível que a causa mais comum (sobretudo no homem) seja o uso de esteroides anabólicos, que elevam a concentração de andrógenos na circulação, provo-cando um feedback negativo sobre a secreção de gonadotropinas. Ao deixar de estimular-se o testículo pelas gonadotropinas, este deixará de produzir testosterona, e as concentra-ções de andrógeno exógeno nunca alcançará as altíssimas concentrações de testosterona que normalmente estão presentes a nível do tecido testicular por ser o local onde se produz o hormônio. Também se supõe que diversas substâncias com propriedades estrogênicas derivadas de processos industriais (indústria dos plásticos, hidrocarbonetos etc.) e presentes no ambiente (fatores xenobióticos) podem ser responsáveis pelas alterações na espermatogênese em diversas espécies, entre as quais se inclui o ser humano. -/- • OVOGÊNESE E FOLICULOGÊNESE -/- A ovogênese é o processo seguido pelas células germinais da fêmea para a forma-ção dos óvulos, que são células haploides. Durante a vida fetal as células germinais proliferam-se no ovário por mitose, formando um grande número de ovogonias, algumas das quais se diferenciam em ovócitos primários que iniciam sua primeira divisão meiótica para deter-se na prófase da divisão. Somente alguns desses ovócitos primários retornarão e concluirão a primeira divisão meiótica em algum momento da vida adulta do animal, dando origem a um ovócito secundário e a um corpo polar. O ovócito secundário inicia a sua segunda divisão meiótica, a qual volta a ficar suspensa até receber um estímulo apropriado, já que somente os ovócitos secundários que são ovulados e penetrados por um espermatozoide retornam e concluem a segunda divisão meiótica, dando origem a um óvulo (figura 10). O processo de ovogênese é realizado dentro dos folículos ovarianos, que também tem que sofrer um longo transcurso de desenvolvimento e diferenciação denominado foliculogênese pelo que a ovogênese como tal realiza-se dentro do marco desse último processo. Por essa razão, na seguinte seção descreverei tanto a ovogênese como a folicu-logênese, e a relação que existe entre ambos. Figura 10: representação da ovogênese. Na etapa de proliferação, as células germinais se diferen-ciam por mitose. A meiose I se caracteriza por uma prófase prolongada, ocorrendo a duplicação do DNA. Nas duas divisões, que ocorrem antes da ovulação e depois da fertilização, a quantidade de DNA é reduzida a 1n, com o fim de que a fusão dos pronúcles (singamia) pós-fertilização, seja gerado um zigoto com um número de cromossomos de 2n (diploide). -/- Geração de ovócitos primários e folículos primordiais Tanto a ovogênese como a foliculogênese iniciam-se durante a vida fetal, quando as células germinais primordiais provenientes do saco vitelino colonizam a gônada primitiva e, junto com as células somáticas z organizam-se para a formação dos cordões sexuais secundários, que se desenvolvem principalmente no córtex do ovário. Nesse período, as células germinais que colonizaram o ovário sofrem até 30 divisões mitóticas, proliferando-se até formar milhares ou milhões de ovogonias, que inicialmente formam “ninhos” constituídos cada um deles por um clone de várias ovogonias que descendem da mesma célula precursora e que se mantêm unidas por pontes citoplasmáticas, sincronizan-do suas divisões mitóticas. Nessa etapa alcança-se a máxima população de células germinais no ovário, que antes de nascer se reduzirá drasticamente por apoptose. No ovário do feto humano chegam a haver até sete milhões de células germinais que ao nascimento se reduzem a dois milhões. Os ovários fetais do bovino, de maneira análoga, chegam a ter até 2.100.000 células germinais, que ao nascimento reduzem para 130.000 aproximadamente. A redução no número de ovogonias produz-se ao mesmo tempo que essas células, que vêm dividindo-se por mitose e estão agrupadas em ninhos, iniciam sua primeira divisão meiótica para se transformarem em ovócitos primários: células germinais que se encontram em uma etapa de suspensão (diplóteno) da prófase da primeira divisão meiótica. Nesse período produz-se uma grande proporção de células germinais; as células somáticas dos cordões sexuais, por sua vez, emitem projeções citoplasmáticas que separam a isolam os ovócitos primários sobreviventes, ficando cada um deles rodeados por uma capa de células aplanadas da (pré) granulosa. Ao mesmo tempo em que se forma uma membrana basal entre as células da granulosa e o tecido intersticial do ovário. Ao ovócito primário rodeado de uma capa de células da (pré) granulosa aplanadas e delimita-das por uma membrana basal denomina-se de folículo primordial (figura 11). Nas vacas os folículos primordiais bem formados já estão presentes nos ovários a partir do dia 90 da gestação. A maioria dos folículos primordiais com os que nasce uma fêmea se manterão inativos durante um longo tempo; muitos deles durante toda a vida do animal. Nos folículos primordiais inativos tanto os ovócitos primários como as células da granulosa conservam sua forma original e mantém um metabolismo reduzido estritamente ao mínimo necessário para manter-se viáveis. Por essa razão, ao realizar um corte histológico de qualquer ovário as estruturas mais numerosas que se observam serão os folículos primordiais. No entanto, cada dia da vida de um animal, inclusive desde a vida fetal, um certo número de folículos primordiais reiniciam seu desenvolvimento, e a partir desse momento um folículo exclusivamente pode ter dois destinos: o primeiro, prosseguir seu desenvolvi-mento até chegar a ovular, e o segundo (que é muito mais frequente) encontrar em algum momento condições inadequadas que fazem fronteira com ele para parar seu desenvolvi-mento, levando-o a sofrer atresia e degenerar até desaparecer do ovário. Figura 11: sequência da foliculogênese apresentando as diferentes estruturas que podemos encontrar em cada fase. Fonte: ZARCO, 2018. Culminação da ovogênese A ovogênese somente se completará quando um ovócito primário reinicia a meio-se; completa sua primeira divisão meiótica para formar um ovócito secundário e um primeiro corpo polar e, quando, finalmente sofrer uma segunda divisão meiótica para formar um óvulo e um segundo corpo polar. Os óvulos são as células 1n que constituem os gametas femininos, pouco numerosos, grandes e imóveis. A grande maioria dos ovóci-tos primários, como veremos mais adiante, nunca retomam a meiose e, em consequência, não chegam a formar ovócitos secundários, e muitos dos ovócitos secundários tampouco sofrem uma segunda divisão meiótica, pelo que não chegam a formar os óvulos. Ao longo da vida de uma fêmea, na maioria das espécies, menos de 0,1% dos ovócitos primários (um a cada mil) chega a terminar a ovogênese, dando origem a um óvulo. O supracitado deve-se a que a ovogênese somente pode retomar-se e ser completa-da em ovócitos primários que se encontram dentro dos folículos primordiais que (uma vez ativados) vão alcançando diversas etapas de seu desenvolvimento em momentos precisos aos que encontram as condições ideais de oxigenação, nutrição, vascularização e exposição a fatores parácrinos e a exposição a concentrações de hormônios que se requerem para que o folículo continue em cada etapa de seu desenvolvimento com o processo de foliculogênese até chegar a ovular. Qualquer folículo que não esteja nessas condições ao longo do desenvolvimento sofrerá degeneração e atresia, pelo que o ovócito primário em seu interior nunca chegará ao ponto em que pode retomar a primeira divisão meiótica. No que resta da presente seção revisaremos o processo de foliculogênese em cujo marco se desenvolve a ovogênese; havemos que tomar de conta que essa última se limita ao que ocorre nas células germinais (ovogonia, ovócito primário, secundário e óvulo), pelo qual depende intimamente do desenvolvimento do folículo de que essas células formam parte. Em um princípio a ativação do folículo primordial e o desenvolvimento folicular são independentes das gonadotropinas: não se conhecem os mecanismos precisos median-te os quais um folículo primordial se ativa e reinicia seu desenvolvimento, nem como se decide quais folículos, dentre as dezenas de milhares de ou centenas de milhares presentes em um ovário se reativarão em um dia em particular. A reativação trata-se de uma liberação de influência de fatores inibidores, já que os folículos primordiais se reativam espontaneamente quando cultivados in vitro, isolados do resto do tecido ovariano. Uma vez que um folículo primordial se ativa, inicia-se um longo processo de desenvolvimento que somente depois de vários meses (ao redor de cinco meses no caso dos bovinos) o levará a um estádio em que seu desenvolvimento posterior requer a presença das gonado-tropinas; daí que se diz que as primeiras etapas do desenvolvimento são independentes das gonadotropinas. Durante a fase independente de gonadotropinas, um folículo primordial que tenha sido ativado e tenha começado a crescer; passará primeiro para a etapa de folículo primá-rio, caracterizada por conter um ovócito primário que está rodeado, por sua vez, por uma capa de células da granulosa, que não são planas, e sim cúbicas. Depois, se o folículo continuar crescendo se transformará em um folículo secundário, ao qual as células da granulosa começam a proliferar (aumentando em número) e se organizam em duas ou mais capas que rodeiam o ovócito primário. Entre o ovócito e as células da granulosa que o rodeiam se forma nesta uma zona pelúcida; ainda assim o ovócito mantém contato direto com essas células, mediante o estabelecimento de pontes citoplasmáticas que atravessam a zona pelúcida. Através dessas pontes citoplasmáticas as células da granulosa podem passar nutrientes e informação ao ovócito primário. O volume e o diâmetro do ovócito primário aumentam ao mesmo tempo que as células da granulosa proliferam-se, para incrementar as capas ao redor do ovócito. De maneira gradual o citoplasma do ovócito primário aumenta até 50 vezes seu volume e a proliferação das células continua. Esses folículos que possuem cada vez mais células e portanto mais capas de células da granulosa se denominam folículos secundários. Para evitar confusões, há a necessidade de nomen-clatura ao qual o folículo vá mudando de nome de primordial a primário e logo, de secun-dário, a terciário, por sua vez, o ovócito que encontra-se em seu interior, a todo momento, segue sendo um ovócito primário. Durante a etapa dependente de gonadotropinas, os folículos secundários começam a formar um espaço cheio de líquido, o antro folicular, desse modo se convertem em folí-culos terciários. Com a utilização de outra nomenclatura, a formação do antro marca a transição entre folículos pré-antrais (sem antro) e folículos antrais (com antro). Em algum momento dessa transição entre folículo secundário e terciário, também aparece a depen-dência de folículos em direção as gonadotropinas, pelo qual somente podem seguir crescendo na presença do hormônio luteinizante (LH) e do hormônio folículo estimulante (FSH). Nos bovinos e em outras espécies (para seu estudo), os folículos antrais são dividi-dos em pequenos, médios e grandes. Embora todos eles possuam um antro folicular, dependendo do seu grau de desenvolvimento requerem diferentes concentrações de gona-dotropinas para continuar o crescimento. Os folículos antrais mais pequenos somente re-querem concentrações baixas de LH e FSH, pelo qual podem continuar crescendo em qualquer momento do ciclo estral inclusive em animais que não estão ciclando (fêmeas em anestro pré-puberal, gestacional, lactacional, estacional). Nas etapas posteriores os folículos antrais requerem primeiro concentrações elevadas de FSH, e nas etapas finais somente podem continuar crescendo na presença de pulsos frequentes de LH, pelo qual somente os folículos que encontram-se sob concentrações apropriadas desses hormônios podem seguir crescendo. Por essa razão, nos animais que se encontram em anestro de qualquer tipo somente é possível encontrar folículos antrais pequenos ou médios, segundo a espécie, e nos animais que se encontram ciclando (estro) o maior tamanho folicular encontrado em um determinado dia do ciclo dependerá das concentrações de FSH e LH presentes nesse momento e nos dias anteriores. Um folículo que chega ao estado máximo de desenvolvimento, conhecido como folículo pré-ovulatório, ao final, somente chegará a ovular se for exposto a um pico pré-ovulatório de LH. Como supracitado, cada dia na vida de uma fêmea inicia seu desenvolvimento um certo número de folículos; a grande maioria sofrem atresia, mas depois da puberdade em cada dia do ciclo estral um ou vários folículos vão encontrando ao longo do seu desenvol-vimento concentrações hormonais que lhes permite chegar na etapa de folículo pré-ovula-tório. Somente nestes folículos, e como consequência de um pico pré-ovulatório de LH, se reinicia e completa-se a primeira divisão meiótica do ovócito primário, produzindo duas células distintas. Uma delas é o ovócito secundário, que retém praticamente todo o citoplasma. Contém, assim mesmo, em seu núcleo um par de cromossomos duplos, a outra é o primeiro corpo polar, que é exclusivamente um núcleo com uma quantidade mínima de citoplasma. Na maioria das espécies ovula-se um ovócito secundário que se encontra, então, suspendido na segunda divisão meiótica. Esta segunda divisão meiótica somente reinicia-rá e completarar-se uma vez que o espermatozoide começa a penetrar sob o ovócito secundário. Ao concluir-se a divisão se forma o segundo corpo polar e completa-se a ovogênese com o qual se obtém o óvulo, célula 1n que constitui o gameta feminino. No entanto, o óvulo existe pouco tempo como tal, já que em poucos minutos/horas (depen-dendo da espécie) se produzirá a fusão do núcleo do mesmo (pró-núcleo feminino) com o do espermatozoide (pró-núcleo masculino), com o qual se completa a fertilização e se forma um novo indivíduo (o ovo ou zigoto). -/- Ondas foliculares -/- Como mencionado supra, todos os dias um determinado número de folículos pri-mordiais se ativam e começam a crescer, os quais crescem em um ritmo característico em cada espécie. Isso provoca que em qualquer momento existam nos ovários folículos pri-mordiais (que começam a crescer em alguns dias ou semanas), assim como folículos secundários em diversas etapas do desenvolvimento, os quais iniciaram seu desenvolvi-mento em semanas ou inclusive meses (segundo o grau de desenvolvimento atual). Também em qualquer momento poderá haver folículos antrais nas etapas iniciais de seu desenvolvimento (com antros que já se podem detectar em cortes histológicos mas não são visíveis macroscopicamente). Todos esses folículos chegaram até seu estado de de-senvolvimento atual (primário, secundário ou antral pequeno), independente da etapa do ciclo estral em que sejam observados ou encontrados. Nos bovinos, os folículos que chegam ao início da etapa antral iniciaram seu desenvolvimento cinco meses antes, e todavia requerem ao redor de 42 dias para chegar ao estado pré-ovulatório. Para continuar seu desenvolvimento, os folículos antrais pequenos devem encon-trar concentrações altas de FSH, que os estimulam para prosseguir o crescimento. Cada vez que se produz uma elevação nas concentrações de FSH, esse hormônio estimula o desenvolvimento de um grupo de folículos antrais pequenos, que começaram a crescer muito tempo antes e que o dia da elevação de FSH tenha alcançado o grau de desenvolvi-mento preciso para responder com eficiência a este hormônio, o qual atuará através de seus receptores nas células da granulosa para estimular a produção de estradiol, a secreção de inibina, a produção de líquido folicular e a proliferação das células da granulosa. Um grupo de folículos antrais pequenos é assim recrutado pelo FSH para acelerar seu cresci-mento e aumentar sua produção de estradiol e inibina (figura 12). Mediante um seguimento ultrassonográfico dos ovários é possível identificar pou-cos dias depois um certo número de folículos, que por haver sido recrutados começam um período de crescimento acelerado. Durante alguns dias vários folículos crescem juntos, porém depois um deles é selecionado para continuar crescendo, enquanto que o restante do grupo deixam de fazê-lo e terminam sofrendo atresia. Através da ultrassom é possível identificar o folículo selecionado, agora chamado folículo domi-nante, já que sua trajetória de crescimento sofre um desvio com respeito a seguida pelo restante do grupo. Os folículos que não foram selecionados deixam de crescer e sofrem atresia já que deixam de possuir o suporte gonadotrópico de FSH, uma vez que as concentrações desse hormônio são suprimidos pela inibina e o estradiol produzidos pelo conjunto de folículos que conformam a onda folicular (figura 12), porém o folículo mais desenvolvido do grupo se converterá em dominante. A inibina atua diretamente a nível hipofisário para reduzir a secreção de FSH. Figura 12: onda folicular e relação dos níveis de FSH, estradiol e LH. Fonte: ZARCO, 2018. -/- Figura 13: Recrutamento, seleção e dominação folicular na espécie ovina e influência do FSH e LH nas fases. Fonte: SILVA, E. I. C. da, 2019. -/- A razão pela qual o folículo dominante é capaz de continuar seu desenvolvimento apesar da baixa nas concentrações de FSH é que o folículo é o único que alcançou o grau de progresso necessário para que apareçam os receptores para LH em suas células da granulosa. Esse processo permite ao folículo dominante ser estimulado pela LH, e que requeira baixas concentrações de FSH para manter seu desenvolvimento. A secreção de LH em forma de pulsos de baixa frequência (um pulso a cada quatro a seis horas), característica da fase lútea do ciclo estral; é suficiente para permitir que um folículo dominante continue crescendo por mais dias depois da sua seleção e que mais tarde mantenha-se viável durante alguns dias embora não aumentem de tamanho. Contu-do, se durante o período viável desse folículo não seja finalizada a fase lútea e não diminuam as concentrações de progesterona, o folículo terminará sofrendo atresia devido a exigência de um padrão de secreção acelerada de LH (aproximadamente um pulso por hora) durante o desenvolvimento pré-ovulatório, que somente pode ser produzido com a ausência da progesterona. Uma vez que um folículo dominante sofre atresia deixa de produzir inibina, pelo qual as concentrações de FSH podem elevar-se novamente para iniciar o recrutamento de outro grupo de folículos a partir da qual se origina uma nova onda folicular. Durante o ciclo estral de uma vaca podem gerar-se dois ou três ondas foliculares; somente em raros casos quatro. A etapa de dominância folicular da primeira onda na grande maioria dos casos não coincide com a regressão do corpo lúteo, pelo qual o primei-ro folículo dominante quase invariavelmente termina em atresia. Em algumas vacas o fo-lículo dominante da segunda onda ainda está viável quando se produz a regressão do corpo lúteo e acelera-se a secreção de LH, pelo qual esse segundo folículo dominante se converte em folículo pré-ovulatório e, ao final ovula. Em outros animais o segundo folícu-lo dominante também perde a sua viabilidade antes da regressão do corpo lúteo, por onde nesses animais se inicia uma terceira onda folicular, da qual surge o folículo que finalmen-te ovulará depois de produzir-se a regressão do corpo lúteo. Sem importar a onda em que se origine, uma vez que um folículo dominante é ex-posto a alta frequência de secreção de LH que se produz depois da regressão do corpo lúteo, aumenta ainda mais sua secreção de estradiol até que as altas concentrações desse hormônio comecem a exercer um feedback positivo para a secreção do LH. Isso provoca-rá a aceleração da frequência de secreção do LH até que os pulsos são tão frequentes que começam a ficar por cima e produzir-se o pico pré-ovulatório de LH, que é responsável pela realização da ovulação e a maturação final do ovócito. -/- •___DIFERENÇAS ENTRE ESPERMATOGÊNESE E OVOGÊNESE -/- Enquanto que na fêmea a ovogênese inicia-se durante a vida fetal, no macho a es-permatogênese começa na puberdade. Na fêmea, a partir de um ovócito primário se origi-na um óvulo; no macho, de um espermatócito primário se produzem, teoricamente, quatro espermatozoides. Outra característica interessante é que enquanto a fêmea já conta desde o nasci-mento com todos os ovócitos que necessitará na vida adulta, o macho necessitará chegar a puberdade para iniciar o desenvolvimento das células sexuais, já que ao nascer somente possui gonócitos precursores das células germinais, células de Sertoli e intersticiais. Na vida adulta de uma fêmea, o número de células germinais desaparece paulati-namente. Uma vez iniciada a espermatogênese no macho, a cada ciclo do epitélio seminí-fero as células germinais são renovadas mantendo a provisão para toda a vida reprodutiva. Na fêmea, a meiose sofre duas interrupções em seu transcurso, e no macho é ininterrupta. Figura 14: representação em diagramação comparativa do desenvolvimento da gametogênese. -/- Principais pontos abordados sobre as diferenças entre a gametogênese masculina e feminina: ❙ Na ovogênese a meiose contêm-se em duas ocasiões esperando acontecimentos externos para prosseguir. Já na espermatogênese não existe a suspensão da meiose. ❙ A espermatogênese é um processo contínuo, enquanto que a ovogênese pode completar exclusivamente um óvulo em cada ciclo estral; já que só pode ser completada por mais de um nas espécies que ovulam vários ovócitos no caso das porcas, cadelas, gatas etc. ❙ Na espermatogênese existem células de reserva que permitem a continuação du-rante toda a vida, enquanto que na ovogênese o número de ovócitos primários é limitado. A fêmea somente conta com os que nasceu, e eles não se dividem. ❙ Na espermatogênese obtém-se até 256 espermatozoides para cada espermatogo-nia que inicia o processo, enquanto que na ovogênese somente se obtém um óvulo a partir de cada ovócito primário. ❙ Durante a espermatogênese se produz uma metamorfose que transforma as es-permátides em espermatozoides. Na ovogênese não ocorre um processo análogo. ❙ Na espermatogênese, durante a meiose produzem-se quatro espermátides a partir de cada espermatócito primário. Na ovogênese se produz somente um óvulo a partir de cada ovócito primário; produz, ademais, dois corpos polares. ❙ Todos os óvulos que se produzem durante a ovogênese contém um cromossomo X, enquanto que a metade dos espermatozoides possuem um cromossomo Y e a outra metade um cromossomo X. ❙ Na espermatogênese produzem-se centenas ou dezenas de milhões de esperma-tozoides por dia, enquanto que na ovogênese se produz um ou alguns óvulos a cada ciclo estral. ❙ A espermatogênese produz gametas macroscópicos e com motilidade própria, enquanto que a ovogênese produz gametas grandes e imóveis. -/- REFERÊNCIAS BIBLIOGRÁFICAS -/- ABDEL-RAOUF, Mohammed et al. The postnatal development of the reproductive organs in bullswith special reference to puberty.(Including growth of the hypophysis and the adrenals). Acta endocrinologica, n. Suppl No. 49, 1960. ADONA, Paulo Roberto et al. Ovogênese e foliculogênese em mamíferos. Journal of Health Sciences, v. 15, n. 3, 2013. AERTS, J. M. J.; BOLS, P. E. 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Gametogénese. In. PORTA, L. R.; MEDRANO, J. H. H. Fisiología reproductiva de los animales domésticos. Cidade do México: FMVZ-UNAM, 2018. ZIRKIN, Barry R. et al. Endocrine and Paracrine Regulation of Mammalian Spermatogenesis. In: Hormones and Reproduction of Vertebrates. Academic Press, 2011. p. 45-57. -/- REALIZAÇÃO -/- . (shrink)

Authoritarian parenting has long been associated with Western individualism and improved child development. This study examined the relationship between cultural values, parenting styles, and children’s perceived competence in Hong Kong. A total of 48 parents from local Chinese families, 49 parents from South Asian families, and 105 children (24 local Chinese and 81 South Asian) aged 5–6 years participated in the study. Self-report questionnaires on adherence to Asian cultural values and parenting style were administered to parents. The Pictorial Survey on (...) Children’s Perceived Competence was administered to children by trained research assistants. The results contradicted two long-standing assumptions on Asian cultural values and parenting styles. (shrink)

ABSTRACT For learning any language, motivation plays a vital role. This study aims to investigate collegiate students’ predictive motivational factors toward students’ attitude toward learning English as secondary language. This is a cross-sectional study in which questionnaire was adapted from the existing literature for data collection. For this quantitative study data were collected from two government degree colleges of Larkana. Total 400 questionnaires were randomly distributed among intermediate students both boys and girls, out of that 247 were returned. (...) Data were analyzed using statistical packages for social sciences (SPSS) version 24. Initially, data were cleaned by identifying missing values and outliers. Study hypotheses were examined using Multiple Regression Analysis (MRA). The findings of this study revealed that instrumental motivation and parental encouragement (independent variables) have positive and significant relationship with attitude toward learning English. However, one variable i.e. integrative motivation was not found as a significant and positive predictor of the dependent variable. Like any study, this study also possesses few limitations, such as sample size, time horizon, and context of the study. In the end, future directions are given for further exploration. (shrink)

The present work posits that social motives, particularly status seeking in the form of moral grandstanding, are likely at least partially to blame for elevated levels of affective polarization and ideological extremism in the U.S. In Study 1, results from both undergraduates (N = 981; Mean age = 19.4; SD = 2.1; 69.7% women) and a cross-section of U.S. adults matched to 2010 census norms (N = 1,063; Mean age = 48.20, SD = 16.38; 49.8% women) indicated that prestige-motived (...) grandstanding was consistently and robustly related to more extreme ideological views on a variety of issues. In Study 2, results from a weighted, nationally-representative cross-section of U.S. adults (N = 2,519; Mean age = 47.5, SD = 17.8; 51.4% women) found that prestige motivated grandstanding was reliably related to both ideological extremism and affective polarization. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with (...) asthma visiting, for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

The total early-stage entrepreneurial activity (TEA) in South Africa is said to be extremely low compared to those of other sub-Saharan countries. This is despite the concerted efforts of the government to establish, develop and nurture entrepreneurship at all levels, especially among the youths. This calls for concern given the current state of the economy and the challenges faced by South Africa’s future generation. This paper is anchored on two theoretical frameworks to substantiate our argument for the inclusion of entrepreneurship (...) education in the curricula of non-business programmes at universities of technology. The theoretical frameworks are the contingency organizational theory and the magnet versus radiant model. The study adopted an exploratory cross-sectional research design which allowed us to collect data from a cross-section of a population: the universities of technology in South Africa. The findings suggest that only fifteen (out of the 46) of the programmes showed visible evidence of entrepreneurship/business studies in their content. Such finding implies that there is a need for entrepreneurship to be integrated into the curricula of all non-business departments if not for the sake of its perceived employment generation attributes, but for its other attributes such as innovation, and more importantly employability. (shrink)

Objectives: To explore individuals’ perception of the personal, family and societal educational needs following a spinal cord injury. Methods: Sixty-one patients who sustained a traumatic SCI between March 2015 and June 2016 referred to Brain and Spinal Cord Injury Research Center were included in a cross sectional study and completed an online survey containing open-and closed-ended questions, in Iran. Participants’ responses were analyzed i using a qualitative approach with a thematic analysis. Results: Following a thematic analysis of the (...) patient’s perceived educational needs, 3 themes and 14 subthemes were identified. The 3 themes included personal, family, and societal educational perceived needs. Within personal educational needs, there were 7 subthemes which included personal independence and transportation, financial independence, life skills modification, knowledge about SCI, prevention of SCI complications, relationships and sexual function, and psychological adjustments. Among family educational needs, the 3 subthemes were caregiver skills and communication, first aid and emergency skills, and emotional and psychological support. For societal educational needs, the 4 subthemes described were social integration, interpersonal communication skills, SCI awareness and injury prevention, sympathize while avoiding pity. Conclusion: According to our findings, people with SCI have various needs that need to be addressed. Educational support should be a part of a comprehensive rehabilitation program and geared towards addressing the patients’ personal and family needs, while educating the community about SCI in order to allow for reintegration into society. (shrink)