17β-hydroxysteroid dehydrogenase 3 deficiency (17β-HSD3) consists of a defect in the last phase of steroidogenesis, in which androstenedione is converted into testosterone and estrone into estradiol. Patients present female-like or with ambiguous genitalia at birth and most affected males are raised as females. Virilization in subjects with 17β-HSD3 deficiency occurs at the time of puberty and almost half change to be males. Maintenance of the testes in patients raised male is safe and recommended, except when the testes cannot be positioned inside the scrotum. The phenotype of 46,XY disorders of sex development (DSD) owing to 17β-HSD3 deficiency is extremely variable and is clinically indistinguishable from other causes of 46,XY DSD such as partial androgen insensitivity syndrome and 5α-reductase 2 deficiency. Laboratory diagnosis is based on elevated serum levels of androstenedione and estrone and low levels of testosterone and estradiol, resulting in elevated androstenedione:testosterone and estrone:estradiol ratios, indicating an impairment of the conversion of 17-keto into 17-hydroxysteroids. The disorder is due to homozygous or compound heterozygous mutations in the HSD17B3 gene that encodes the 17β-HSD3 isoenzyme. Molecular genetic testing confirms the diagnosis and provides the orientation for genetic counseling. Our proposal in this article is to review the reported and our own cases of 17β-HSD3 deficiency.
Using a question-and-answer format, this book provides practical pearls of wisdom and tricks of the trade to enhance your oncology nursing skills and aid in effective decision-making when caring for your patients. Written by experts in the field, this reference provides insightful answers, bulleted lists, and tables so you get the best information in an easy-to-read format. Keep it on hand every day in the clinical setting, use it to review for certification, or add it to your professional library at home! The 75 Top Secrets, listed in the front of the book, highlight the key points you should know about oncology nursing.Key Points boxes in each chapter outline important points to remember.Internet Resources boxes direct you to more information on a variety of topics via the web.Versatile question-and-answer format, written by experts in the field, makes this book great for both the experienced and new nurse. A chapter on sleep-wake disturbances enables you to help patients get the rest they need.Expanded content in chapters on carcinogenesis and genetics, biologic and targeted therapy, leukemia and myeloidyplastic syndrome, and disseminated intravascular coagulation provides a deeper look into these important aspects of oncology nursing.
Thomas Walter Scott was a newspaper owner and successful businessman before being elected to the House of Commons in 1905 as member for Assiniboia West. He became leader of the Saskatchewan Liberal Party by 1905 and premier of the new province. This biography covers the life of this respected political leader from birth through his political career to his retirement years, giving a picture of his labours in the fields of education, female suffrage, agriculture, and public policy whose fruits continue to be of influence in the province.
The Affordable Care Act, landmark health legislation passed in 2010, called for the development of the National Prevention Strategy to realize the benefits of prevention for all Americans¿ health. This Strategy builds on the law¿s efforts to lower health care costs, improve the quality of care, and provide coverage options for the uninsured. Contents: Nat. Leadership; Partners in Prevention; Healthy and Safe Community Environ.; Clinical and Community Preventive Services; Elimination of Health Disparities; Priorities: Tobacco Free Living; Preventing Drug Abuse and Excessive Alcohol Use; Healthy Eating; Active Living; Injury and Violence Free Living; Reproductive and Sexual Health; Mental and Emotional Well-being. Illus. A print on demand report.
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