Role of chemerin in the control of glucose homeostasis.

Chemerin is an adipokine produced by the white adipose tissue and other tissues, which plays various roles in the pathogenesis of inflammatory and metabolic diseases in multiple organs. The present review aims at gathering scientific evidence reported in the last ten years, concerning the relationship of chemerin with alterations of glycaemic control, such as insulin resistance, type 2 diabetes and gestational diabetes in humans. Although the vast majority of the studies have shown a positive correlation between the chemerin level and a bad glycaemic control, a general consensus has not been reached. The reported results come from case-control and observational longitudinal studies, thereby limiting their interpretation. In fact, it cannot be stated whether insulin resistance and diabetes lead to an increase in chemerin levels or, on the contrary, if high levels of chemerin contribute to an impaired glycaemic control. Elevated levels of circulating chemerin are also associated with gestational diabetes mellitus. Chemerin gene polymorphisms could be proposed as mediators of glucose-related diseases. Nevertheless, to date very little is known about their implication in glucose metabolism. With regard to the mechanisms of action, chemerin impairs insulin cascade signaling by acting on several proteins of this cascade and by inducing inflammation.

Electrocardiographic alterations during treatment of mucocutaneous leishmaniasis with meglumine antimoniate and allopurinol.

The electrocardiographic (ECG) changes in Bolivian patients with mucocutaneous leishmaniasis, treated with meglumine antimoniate and allopurinol, were evaluated. Electric changes due to the antimonial compound appeared in 45% of the patients, and consisted of repolarization alteration, principally affecting the T wave and the S-T segment. The changes disappeared within 2 months following the end of the antimonial treatment. In patients with associated Chagas disease and leishmaniasis, antimonial therapy did not aggravate the ECG changes characteristic of Chagasic cardiopathy.

[Characteristics and impact of sedation, analgesia, and neuromuscular blockage in critical patients undergoing prolonged mechanical ventilation]. / Características e impacto de la sedación, la analgesia y el bloqueo neuromuscular en los pacientes críticos que recibieron ventilación mecánica prolongada.

AIM: To describe use of sedatives, analgesics, and neuromuscular blockers (NMB) in patients undergoing long-term mechanical ventilation and to assess factors associated with their use and their association with mortality at 28 days. DESIGN: Prospective observational multicenter cohort study. SETTING: Thirteen intensive care units (ICU) in Chile. PATIENTS: Patients undergoing mechanical ventilation for more than 48h. We excluded patients with neurological disorders, cirrhosis of the liver, chronic renal failure, suspected drug addiction, and early no resuscitation orders. INTERVENTION: None. MAIN MEASUREMENTS: Proportion of use and dosage of sedatives, analgesics, and NMB. Level of sedation observed (SAS). Variables associated with the Sedation Agitation Scale (SAS), use of sedatives, analgesics, and NMB. Multivariate logistic regression of variables associated to mortality at 28 days. RESULTS: A total of 155 patients participated (60+/-18 years, 57% male, SOFA 7 [6-10], APACHE II 18 [15-22], 63% with sepsis, and 47% with acute lung injury/adult respiratory distress syndrome. The drugs most frequently used were midazolam (85%, 4 [1.9-6.8]mg/hr) and fentanyl (81%, 76 [39-140]microg/hr). NMB were administered at least 1 day in 30% of patients. SAS score was 1 or 2 in 55% of patients. There was an association between NMB use and mortality at 28 days, but it was not consistent in all the models of NMB evaluated. CONCLUSIONS: Sedatives were frequently employed and deep sedation was common. Midazolam and fentanyl were the most frequently administered drugs. The use of NMB might be independently associated to greater mortality.

Spurious sulfamethoxazole-trimethoprim resistance of Salmonella typhi.

Several studies have identified thymidine excess in susceptibility test media as the cause of spurious resistance of various bacteria to sulfamethoxazole-trimethoprim. We document the phenomenon in Salmonella typhi and Salmonella paratyphi-A and demonstrate its occurrence in 3 of 17 (18%) lots of Mueller-Hinton agars now in use in major medical laboratories in Lima, Peru. The findings are particularly significant because sulfamethoxazole-trimethoprim is an important alternative to chloramphenicol or ampicillin for the treatment of typhoid and paratyphoid fevers.

Procalcitonin used as a marker of infection in the intensive care unit.

OBJECTIVE: To determine the value of procalcitonin (ProCT) as a marker of infection in critically ill patients. DESIGN: Prospective, observational study. SETTING: Medicosurgical department of intensive care (31 beds). PATIENTS: One hundred eleven infected and 79 noninfected patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: ProCT and C-reactive protein (CRP) concentrations were monitored daily. The best cutoff values for ProCT and CRP were 0.6 ng/mL and 7.9 mg/dL, respectively. Compared with CRP, ProCT had a lower sensitivity (67.6 vs. 71.8), specificity (61.3 vs. 66.6), and area under the receiver operating characteristic curve (0.66 vs. 0.78, p < .05). The combination of ProCT and CRP increased the specificity for infection to 82.3%. In the infected patients, plasma ProCT, but not CRP, values were higher in nonsurvivors than in survivors. Infected patients with bacteremia had higher ProCT concentrations than those without bacteremia, but similar CRP concentrations. ProCT levels were particularly high in septic shock patients. CONCLUSIONS: ProCT is not a better marker of infection than CRP in critically ill patients, but it can represent a useful adjunctive parameter to identify infection and is a useful marker of the severity of infection.

Evaluation of blood clot cultures for isolation of Salmonella typhi, Salmonella paratyphi-A, and Brucella melitensis.

Two types of clot culture, one with taurocholate-streptokinase and the other with bile as a culture medium, and two conventional cultures of whole blood were evaluated in parallel in an area where typhoid fever and brucellosis are endemic. Each of the four systems contained 5 ml of blood or the clot derived from 5 ml of blood and sufficient broth to yield a 1:11 dilution of the specimen. Of 542 patients studied, Salmonella paratyphi-A was isolated from 61, S. typhi from 46, and Brucella melitensis from 30. The two clot cultures yielded the salmonellae equally well; both were superior to whole blood cultured in Trypticase soy broth (P less than 0.02) but not to whole blood cultured in bile (P greater than 0.05). Only two systems were successful for isolation of B. melitensis. Blood-Trypticase soy broth identified 28 (93%), and clot-streptokinase cultures identified 21 (70%) (P greater than 0.05). The data indicate that use of clots per se offers no advantage in sensitivity over procedures which use whole blood. Nonetheless, they are excellent for isolation of enteric fever salmonellae and can be performed with clots left over after serum is removed for serological, biochemical, or other tests.

Sistema adrenérgico en los residentes de grandes alturas / Adrenergic system at high altitude population

Heart rate (FC) response to perfusion with isoprenaline is decreased in sealevel natives on expuser to high altitude hypoxia. Since noredraline concentration in plasma is elevated under these condition as phenomenon of downregulation of the betareceptors (BAR) cuold be evoked. For the fisrt time, this aspect was explored in a population native from and residing at 3600 m consisting of normocythemics (HAN) and polycythemics (HAP). the results were compared to those obtained from a sealevel population, exmined in normoxia (SLN) at 4800 m (J. Appl. Physiol. 65:1975-61, 1988). The dose necessary to increase FC by 25 beats per min (125) was identical for HAN and HAP as well as SLN. This iondicates that the chronotropic responses is igual in the two populations when they are studied in their habitual environment; to the contrary, this response is diminished in SLH, thus correlating to the phenomenon of downregulation.