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Introduction: Evidence shows that sexual dysfunctions (SDs) are very prevalent in both sexes and that they share risk factors with many other conditions. It is known that only a minority of people experiencing sexual problems seek treatment, but the role of the general practitioner (GP) in SD diagnosis and treatment is relatively unexplored. No study has been conducted in Portugal in order to identify GPs' knowledge, attitudes, beliefs, and practices regarding SD and only a small amount of similar studies from other countries have been published., Aim: To characterize GPs' knowledge, attitudes, and beliefs concerning SD; practices of SD management in daily practice; self-perceived competence in discussing and treating SD; and need for training., Methods: Cross-sectional study using confidential self-administered questionnaires applied to GPs working in Primary Health Care Units in the Lisbon region., Main Outcome Measures: The questionnaire collected information concerning GPs' knowledge and perceptions regarding SD, training and practice in sexual health, criteria for initiating discussion and treatment, and the adoption of guidelines., Results: A total of 50 questionnaires (30 females) were obtained (73.5% response rate). On average, the 50 participants were 52±8.6 years old, had 21±8.2 years of family practice, and followed 1,613±364 patients. The degree in medicine was never considered as an extremely adequate source of information both for male and female SD. Lack of time to obtain relevant information for clinical practice and to deal with sexual health issues were perceived as important barriers in initiating a discussion with the patient, as well as lack of academic training and experience in this area., Conclusions: GPs expressed a high need for continuous training in this area and more than half considered that their degree was not an adequate source of training. These results indicate that there is a need for both pregraduate and postgraduate training in this area., (© 2012 International Society for Sexual Medicine.)

The author refers to the changes occurred in thyroid dimensions during pregnancy, evaluated clinically and echographically. He also describes the changes in thyroid normal function on pregnant women and the different stages of the fetal thyroid maturation. Some complementary tests must be carried out, when there is a presence of a goitre nodule, which opportunity and relevance the need are discussed. The possibility of thyroid carcinoma is referred as its most adequate treatment.

Introduction: In recent years, there have been many reports about a possible association between Stressful Life Events (SLE) and the onset of Graves' Disease (GD). Nevertheless, most papers have been criticised and no such association has yet been proven., Aim of the Study: To assess the possible associations between SLE and the onset of GD., Methods: Retrospective study of 62 subjects, divided into 2 groups of 31 each, GD (Gp1) and controls (Gp2). The patients in Gp1 had thyroid disease diagnosed within the last 12 months, with clinical and biochemical confirmation. In Gp2, psychopathological and endocrine disturbances had been ruled out. Each 2 group consisted of 9 males (29%) and 22 females (71%). The mean age was 38.48 + 10.9 in Gp1 and 41.1 + 11.8 in Gp2. SLE evaluation (number and impact) was reported for the 12 months preceding the onset of symptoms of thyroid disease. To assess SLE, we used the Life Experiences Survey-LES from Saranson, Johnson and Siegel (1978; 1985). Statistical analysis was done using Mann-Whitney and Kruskal-Wallis tests., Results: Patients with GD had a significantly greater number of SLEs compared to Controls (p < .001). The number and impact of negative SLEs was significantly higher in Gp1 compared to Gp2 (p < .001). There were no significant differences between the groups in terms of the number and impact of both positive and neutral SLEs., Discussion: The findings of this study support that SLEs may contribute to the precipitation of GD. We observed that patients with GD had significantly more negative events and experienced a greater negative impact from them prior to the onset of GD. The association of SLEs with GD is probably related to the association of stress with changes in the immune system, which can play an important role in the aetiology of thyrotoxicosis.

Propylthiouracil (PTU) is widely used to treat patients with hyperthyroidism. In rare cases this drug has been found to have toxic effects on the liver. We describe the second assymptomatic case, reported in the literature, of PTU induced hepatotoxicity. Sixteen cases have been published so far, all with clinical manifestations. A 20-year-old female patient developed an elevation of AST, ALT and GGT levels after 5 months of PTU (50 mg tid) therapy for Graves disease with hyperthyroidism. The patient showed normal levels of liver aminotransferases before starting PTU. She had no risk factors for or clinical evidence of pre-existing liver disease. She didn't take any regular medication. After stopping PTU, the plasma levels of hepatic enzymes normalised within 6 weeks. Thirteen days after the reinstitution of PTU (150 mg tid), because of the recurrence of hyperthyroidism, another episode of assymptomatic hepatotoxicity was documented. AST, ALT, GGT and AP levels rose again, but bilirrubin levels remained normal, which represents a very unusual laboratory constellation in this kind of patient. The serology for hepatitis A, B, C and for EBV and CMV was negative. After stopping PTU, methimazole (MMI) was started and the liver enzymes normalised within two weeks. After 12 months of MMI therapy, the patient is assymptomatic, with normal liver enzyme levels and normal thyroid function tests. This case is the second to be described where the diagnosis was confirmed by the rechallenge of PTU, being this a major diagnostic criteria. Despite its rarity the disease should be suspected in any patient receiving PTU in whom clinical or laboratorial evidence of hepatocellular injury develops. The drug should be discontinued immediately when the hepatic injury is detected. Recovery is usually complete after the withdrawal of the drug, but there were al least, three fatalities among the 17 cases described.

Objective: To examine the secular trend of weight, height and obesity among young Portuguese males at the time of military inspection for national conscription purposes in the region of Lisbon, during the last thirty years., Design: Cross-sectional study, based on the review of military census files., Setting: Military selection centre of Lisbon., Subjects and Methods: In Portugal, military service is obligatory and medical inspections are carried out every year on males at the age of twenty. For study purposes, representative samples were taken from the young male population undergoing inspection for the Armed Forces on a five year basis, between 1960 and 1990 in the region of Lisbon. Weight and height were evaluated by a trained team, using standard measurement instruments and procedures., Results: A progressive and significant increase in weight, height and BMI of the young male population was found between 1960 and 1990. For certain variables the increase was also statistically significant within a five-year period, as it was the case for height between 1965-1980 and for weight between 1985-1990. The increase in BMI experienced some minor fluctuation along the reference period, however, it was statistically significant between 1985-1990. The increase in weight and in BMI was greater in the highest percentiles and particularly noticeable between 1985 and 1990. The percentage of young males with BMI over 25 kg/m2 was of 8.1% in 1960 and of 18.0% in 1990, while those having a BMI over 27 kg/m2 varied between 3.6% and 6.4% in the same period, respectively. The percentage of young adult males with BMI higher than 25 kg/m2 doubled between 1960 and 1990.

Obesity is commonly associated with hyperlipidemia on the basis of clinical and epidemiological studies, but the mechanisms of that relationship are not well understood. To evaluate the contribution of obesity to fasting levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG), we retrospectively analyzed data of 209 patients (175 women and 34 men) attending our outpatient clinic to lose weight. Hyperlipidemia, namely hypertriglyceridemia and low levels of HDL-C, was more frequent in more advanced grades of obesity. Fifty per cent of men with moderate obesity were found to have hypertriglyceridemia and 41.6% showed low levels of HDL-C. However, the relationship between obesity and hyperlipidemia is confounded by age and is not significant when body mass index (BMI) is correct for age. After this correction, we only found a significant correlation (r = 0.93, p = 0.01) between BMI and hypertriglyceridemia in female patients. We conclude that hyperlipidemia and obesity are associate but their relationship is weak and influenced by age. Also important in this relationship seems to be the distribution of body fat.