Cognitive dysfunction and serum levels of brain-derived neurotrophic factor (BDNF) in primary anti-phospholipid syndrome (PAPS).

OBJECTIVES: Cognitive dysfunction (CD) is a poorly understood non-stroke central neurological manifestation in anti-phospholipid syndrome (APS). Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays an important role in neural plasticity and could potentially be a biomarker of CD in primary APS (PAPS). The aim of the study is to assess CD in PAPS patients and to evaluate its association with clinical data, anti-phospholipid antibodies and serum BDNF levels. METHODS: This cross-sectional study compared 44 PAPS patients and 20 healthy controls matched for age, gender and education. PAPS patients and controls underwent a standardized cognitive examination. The demographic, clinical and laboratory characteristics of patients were recorded. Serum BDNF was measured by Enzyme Linked Immunosorbent. RESULTS: Fourteen (31.8%) of the 44 patients with PAPS had CD compared with only one (5%) healthy control (P =0.019). PAPS patients presented lower serum BDNF levels when compared with controls (P =0.007). Lower levels of BDNF were associated with CD in PAPS patients (P =0.032). In the univariate analysis, a positive association was found between CD and livedo reticularis, deep vein thrombosis, stroke, seizure, smoking as well as a negative association with Mini Mental State Examination and serum BDNF. According to multivariate analysis, the only independent predictor of CD in PAPS was stroke (OR 137.06; 95% CI: 4.73, 3974.32; P =0.004). CONCLUSIONS: CD is commonly reported in PAPS patients; however, its assessment lacks in standards and objective screening tests. The association between CD and low serum BDNF suggests that this neurotrophin can be a promising biomarker for PAPS cognitive impairment.

Alcaptonúria (ocronose): relato de dois casos / Alkaptonuria (ochronosis): report of two cases

A alcaptonúria (ocronose) é um erro inato do metabolismo da fenilalanina e tirosina, transmitido de forma autossômica recessiva. Resulta da deficiência completa da enzima ácido homogentísico oxidase (HGO), causada por mutação no gene 3q (3q21 - q23), levando ao acúmulo do ácido em diversos órgãos e tecidos, com aumento de sua excreção urinária. Os achados clínicos característicos incluem artropatia ocronótica, pigmentação anormal da cartilagem de outros tecidos conjuntivos e urina enegrecida. A incidência é rara, estimada em 1-4: 1.000.000 indivíduos, tendo maior prevalência em populações com alto grau de consangüinidade. A seguir, relataremos o caso de dois irmãos (um homem e uma mulher) com ocronose, discutindo sua patogênese, manifestações clínicas, diagnóstico e tratamento(1, 2).

Alkaptonuria (ochronosis) is an autossomal recessive disorder which results from an innate error of phenylalanine and tyrosine's metabolism. This defect causes accumulation of homogentisic acid on the tissue and usually is excreted in the urine. This disorder results from a complete deficiency of the homogentisate 1,2 - dioxygenase (HGO) caused by chromosome 3q(3q21-q23) mutation. The clinical features include: ochronotic artropathy, black-gray pigmentation of the cartilage and the urine turns black. This is a rare disorder and incidence is about 1-4 in 1.000.000 of people and the prevalence is higher in consanguineous groups. The author will describe two affected brothers and discuss the pathophysiology, clinical features, diagnosis and treatment of ochronosis.

Osteonecrose e síndrome da imunodeficiência adquirida / Osteonecrosis and AIDS

A osteonecrose é uma terminologia que se refere à morte celular de dois componentes do osso: a medula hematopoiética e os osteócitos. É mais freqüente em homens do que em mulheres (8:1) e a maioria dos casos acontece em pacientes abaixo dos 50 anos de idade. Pacientes infectados pelo vírus HIV encontram-se em maior risco de desenvolver osteonecrose, estando implicados como fatores predisponentes a terapêutica antiviral, ao uso de corticosteróides e outros fatores associados, comuns à população em geral. Os autores fazem uma revisão dos aspectos etiológicos, clínicos, patogênicos e diagnóstico, além de aspectos relacionados a esta entidade nos enfermos infectados pelo HIV.