الملخص
Lipodystrophy is a pathological condition associated with an abnormal body adipose tissue redistribution. Facial lipoatrophy can be a consequence of congenital, acquired, or involutional. The lipograft is an autologous fat transplant, which constitutes a treatment option that provides volume, tissue regeneration, and advantages in relation to other fillers in autoimmune diseases. The aim is to highlight the filling action and the metabolic effect of facial lipotransfer, due to the grafted adipocytes survival, and the adipose tissue derived stem cells regenerative activity obtained by nano-fat in patients with facial lipoatrophy. Lipoinjection improves the architecture of the new dermis and increases its functional capacity. It is a treatment with autologous tissue (fatty graft) with great efficacy in relation to other alloplastic filler materials capable of exacerbating an inflammatory response mediated by antibody production.
La lipodistrofia es una condición patológica asociada a una redistribución anómala del tejido adiposo en el cuerpo. La lipoatrofia facial puede ser consecuencia de defectos congénitos, adquiridos o involutivos. El lipoinjerto es el trasplante de grasa autógena y constituye una opción de tratamiento que aporta volumen, regeneración tisular y ventajas en relación con otros materiales de relleno en enfermedades autoinmunes. Se busca resaltar la acción de relleno y el efecto metabólico de la lipotransferencia facial, por la supervivencia de los adipocitos injertados y la actividad regenerativa de las células madre provenientes del tejido adiposo obtenidas por nanofat en pacientes con lipoatrofia facial. La lipoinyección mejora la arquitectura de la nueva dermis y aumenta su capacidad funcional, es un tratamiento con tejido autógeno (injerto graso) con gran eficacia en relación con otros materiales de relleno aloplásticos capaces de exacerbar una respuesta inflamatoria mediada por la producción de anticuerpos.
الموضوعات
Humans , Female , Adult , Scleroderma, Localized , Therapeutics , Lupus Erythematosus, Cutaneous , Skin Transplantation , Skin and Connective Tissue Diseases , Connective Tissue Diseases , Cell- and Tissue-Based Therapy , Lipodystrophyالملخص
RESUMEN La obesidad y el sobrepeso se definen como una acumulación anormal o excesiva de grasa que puede ser perjudicial para la salud. Es una enfermedad crónica de origen multifactorial, que como consecuencia ocasiona problemas higiénicos, discapacidad funcional y alteración de la calidad de vida. La dermolipectomía abdominal es una técnica quirúrgica que constituye la única opción para el tratamiento de pacientes con panículo adiposo prominente; de esa forma se logra disminuir las complicaciones y se reintegra socialmente al paciente que, a causa del enorme faldón abdominal, estuvo limitado por muchos años. Presentamos el caso de una paciente de 53 años con lipodistrofia abdominal grave, que llegaba a ambos tobillos con afectación cutánea, y discapacidad para realizar actividades diarias, resuelta con dermolipectomía abdominal y resección de 29 kg de tejido dermograso. Se realizará, además, una revisión bibliográfica del tema.
ABSTRACT Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. It is a chronic disease caused by multiple factors, which results in hygienic issues, functional disability and impaired quality of life. Abdominal dermolipectomy is the only surgical option for the treatment of patients with prominent panniculus morbidus, thus reducing complications and providing social reintegration for the patient who has been limited for many years due to the enormous abdominal panniculus. We report the case of a 53-year-old female patient with severe abdominal lipodystrophy with coverage of both ankles, skin involvement, and disability to perform daily activities, that was managed with abdominal dermolipectomy and resection of 29 kg of dermo-adipose tissue. Bibliographic research is also presented.
الموضوعات
Female , Middle Aged , Obesity, Morbid/surgery , Lipodystrophy/surgery , Obesity, Morbid/complications , Abdominal Wall/surgery , Infections , Lipodystrophy/diagnosisالملخص
Introduction: People living with the human immunodeficiency virus (HIV) are generally overweight or have an altered body composition as compared to healthy individuals, showing a change in nutritional profile over time. Objective: The aim of the study was to characterize the nutritional status, estimate the prevalence of lipodystrophy, and examine the association between lipohypertrophy and lipid profile alterations, and other clinical data of HIV-infected individuals. Methods: This was a cross-sectional study on male and female subjects living with HIV, treated at a specialized outpatient clinic, aged 18 years old and over, whether using the antiretroviral therapy or not. Results: The sample consisted of 420 people with a mean age of 43.8 years (standard deviation 11.7). The length of time of the HIV infection averaged 74.6 months, and 91% of the respondents were on antiretroviral therapy. Lipodystrophy prevalence was 35.7%. Of these, 82 (54.7%) presented lipohypertrophy, 61 (40.7%) had lipoatrophy and 7 (4.6%) had a mixed syndrome. Female gender, body mass index, fat percentage, waist circumference and waist-hip ratio were positively associated with the presence of lipohypertrophy (p<0.001). High mean total cholesterol (p=0.015) and LDL fraction (p=0.028) also showed a statistically significant association with lipohypertrophy. The sampled participants had a nutritional profile compatible with overweight or obesity. No association was found between lipohypertrophy and ART and the therapy duration. Conclusion: Considering the consequences of overweight as a cause of various pathological conditions, preventive measures and interventions are highly recommended for this population.
As pessoas que vivem com o HIV geralmente têm excesso de peso ou composição corporal alterada em relação aos indivíduos saudáveis, apresentando uma mudança no perfil nutricional ao longo do tempo. Objetivo: O objetivo do estudo foi caracterizar o estado nutricional, estimar a prevalência de lipodistrofia e examinar a associação entre lipohipertrofia e alterações no perfil lipídico e outros dados clínicos de indivíduos infectados pelo HIV. Métodos: Estudo transversal com indivíduos dos sexos masculino e feminino vivendo com HIV, atendidos em ambulatório especializado, com idade igual ou superior a 18 anos, em uso ou não de terapia antirretroviral. Resultados: A amostra foi composta de 420 pessoas com média de idade de 43,8 anos (desvio padrão 11,7). O tempo de infecção pelo HIV foi em média de 74,6 meses e 91% dos entrevistados estavam em terapia antirretroviral. A prevalência de lipodistrofia foi de 35,7%. Destes, 82 (54,7%) apresentavam lipohipertrofia, 61 (40,7%) lipoatrofia e 7 (4,6%) síndrome mista. Sexo feminino, índice de massa corporal, percentual de gordura, circunferência da cintura e relação cintura-quadril foram positivamente associados à presença de lipohipertrofia (p<0,001). As médias elevadas de colesterol total (p=0,015) e fração LDL (p=0,028) também mostraram associação estatisticamente significante com lipohipertrofia. Os participantes da amostra apresentavam perfil nutricional compatível com sobrepeso ou obesidade. Não foi encontrada associação entre lipohipertrofia e terapia antirretroviral e duração da terapia. Conclusão: Considerando as consequências do excesso de peso como causa de diversas patologias, medidas e intervenções preventivas são altamente recomendadas para essa população.
الموضوعات
Humans , Nutritional Status , HIV , Lipodystrophy , Body Mass Index , Waist-Hip Ratio , Obesityالملخص
Objetivo Exponer los factores que han sido asociados al desarrollo de disfunción eréctil (DE) en las personas con virus de la inmunodeficiencia humana (VIH) y cuál es la prevalencia de la disfunción eréctil en esta población. Métodos Se realizó una revisión de alcance utilizando las siguientes bases de datos: MEDLINE, CENTRAL, Embase, Scopus, Lilacs, y Psycinfo. Los artículos incluidos debían tener cualquier información relacionada con la DE en personas con VIH, su prevalencia, y posibles factores asociados. Se filtraron un total de 2.726 artículos por título y resumen, y, de estos, se seleccionaron 22 referencias para revisión de texto completo y análisis. Resultados Se encontró que las personas con VIH tienen una mayor probabilidad de presentar DE en comparación con las personas sin VIH. Algunos estudios han establecido una asociación entre la DE y trastornos psicológicos o factores orgánicos, como la lipodistrofia, la hipertensión arterial, la hipercolesterolemia, la diabetes mellitus, la depresión, la ansiedad, y el hipogonadismo. La ingesta de terapia antirretroviral (TARV), más específicamente los inhibidores de la proteasa, sigue siendo cuestionada como causante de DE en pacientes con VIH. Conclusiones Ante un paciente con diagnóstico de VIH, se debe ahondar sobre DE con el fin de recomendar e iniciar conductas terapéuticas que aseguren un mejoramiento en su calidad de vida.
Aim To present factors that have been associated with the development of erectile dysfunction (ED) in people with human immunodeficiency virus (HIV) and the frequency of erectile dysfunction among this population. Methods We performed a scoping review on the following databases: MEDLINE, CENTRAL, Embase, Scopus, Lilacs, and Psycinfo. The articles included information related to ED in people with HIV, its frequency, and possible associated factors. A total of 2,726 articles were filtered by title and abstract, and, from these, 22 references were selected for full-text review and analysis. Results People with HIV were found to be more likely to have ED compared to people without HIV. Some studies have established an association between ED and psychological disorders or organic factors, such as lipodystrophy, high blood pressure, hypercholesterolemia, diabetes mellitus, depression, anxiety, and hypogonadism. The intake of antiretroviral therapy (ART), more specifically protease inhibitors, continues to be questioned as a cause of ED in patients with HIV. Conclusions In HIV-positive men, we recommend to actively seek ED in order to initiate therapeutic conducts that can ensure an improvement in their quality of life.
الموضوعات
Humans , Male , Quality of Life , HIV , Erectile Dysfunction , Anxiety , Peptide Hydrolases , Protease Inhibitors , Homeopathic Therapeutic Approaches , Alkalies , Hypercholesterolemia , Lipodystrophyالملخص
Introducción: La paniculitis mesentérica es una afección infrecuente. Aparece en la adultez tardía, con manifestaciones clínicas inespecíficas, puede cursar asintomática o caracterizarse por dolor, hinchazón y distensión abdominal, masa palpable a nivel del abdomen. Esto puede ser un hallazgo casual al realizar exploraciones radiológicas. Objetivo: Describir las características clínico-imagenológicas, así como terapéutica empleada en el tratamiento de un paciente con paniculitis mesentérica. Presentación de caso: Se presenta el caso de un paciente blanco, masculino de 59 años. Con antecedentes de hiperlipidemia, con cuadros doloroso abdominal inespecífico, de 6 meses de evolución. Se le realiza tomografía axial computarizada de abdomen simple y E/V donde se observó engrosamiento de la grasa mesentérica y múltiples imágenes nodulares a nivel del mesenterio compatible con paniculitis mesentérica. Desarrollo: La paniculitis mesentérica es una enfermedad de baja prevalencia, con mayor predominio en la sexta década de la vida, es habitualmente un hallazgo incidental en laparotomía exploratoria o tomografía computarizada de abdomen. Conclusiones: Deben conocerse las manifestaciones clínicas y hallazgos imagenológicos de la paniculitis mesentérica, así como las variantes terapéuticas en su tratamiento para evitar las intervenciones quirúrgicas innecesarias(AU)
Introduction: Mesenteric panniculitis is a rare condition. It appears in late adulthood, with nonspecific clinical manifestations, it can be asymptomatic or characterized by pain, swelling and abdominal distension, a palpable mass in the abdomen. This can be a chance finding when performing radiological examinations. Objective: To describe the clinical-imaging characteristics, as well as the therapy used in the treatment of a patient with mesenteric panniculitis. Case report: We report the case of a 59-year-old white male patient, with history of hyperlipidemia, nonspecific abdominal pain and 6 months of evolution. A simple abdominal computed tomography and E / V were performed, showing thickening of the mesenteric fat and multiple nodular images at the level of the mesentery compatible with mesenteric panniculitis. Findings: Mesenteric panniculitis is a low prevalence disease, with greater prevalence in the sixth decade of life, which is usually found incidentally in exploratory laparotomy or abdominal computed tomography. Conclusions: The clinical manifestations and imaging findings of mesenteric panniculitis must be known, as well as the therapeutic variants in its treatment to avoid unnecessary surgical interventions(AU)
الموضوعات
Humans , Male , Middle Aged , Panniculitis, Peritoneal/epidemiology , Tomography, X-Ray Computed/methods , Lipodystrophy/diagnostic imagingالملخص
A lipodistrofia localizada é o aumento na densidade e espessura do tecido adiposo da hipoderme. O gel crioterápico ativa o metabolismo causando resfriamento da pele, estimulando a termogênese para que aconteça a lipólise. Objetivo: Comparar o resultado do gel crioterápico na gordura localizada abdominal antes e após o tratamento. Métodos: O estudo foi composto por 30 mulheres entre 20 e 40 anos, sedentárias e com lipodistrofia abdominal, submetidas a 10 sessões de tratamento. Foi comparado o IMC, perimetria, adipometria, e bioimpedância, análise do perfil sociodemográfico e o grau de satisfação, por meio de frequências e percentuais, antes e após o tratamento. Resultados: Houve diferença significativa na satisfação corporal das pacientes entre o início e o final do tratamento (p < 0,05). Para as variáveis de bioimpedância, adipometria, IMC e perimetria não houve significância estatística (p > 0,05). Todavia, foi observado resultado positivo através de fotos comparativas ao final do tratamento. Conclusão: Foi identificada, através do perfil sociodemográfico, a prevalência da faixa etária de 20 a 30 anos, de cor parda, estudantes e residentes da cidade de Vitória e Serra. Para o IMC, perimetria, adipometria e bioimpedância não houve resultados satisfatórios. Contudo, para o questionário de satisfação, constatou-se melhora da satisfação corporal das participantes. (AU)
الموضوعات
Female , Adult , Lipodystrophy , Lipolysis , Women's Health , Cryotherapyالملخص
Introducción. El objetivo de este artículo es dar a conocer el caso de un paciente con diagnóstico de mesenteritis esclerosante quien cursó con cuadro de obstrucción intestinal. Descripción del caso. Paciente masculino de 28 años de edad, quien se presenta con cuadro clínico sugestivo de obstrucción intestinal, por lo que se decide resolución quirúrgica. Durante la cirugía se observa una zona fibrótica y adherente del intestino delgado, asociada a un mesenterio engrosado. El examen histopatológico de la pieza quirúrgica confirmó el diagnóstico de mesenteritis esclerosante. Discusión. La mesenteritis esclerosante es una patología de baja incidencia, y su forma de presentación es inespecífica, por lo que el diagnóstico definitivo es histopatológico. La tomografía es útil para el diagnóstico cuando se tiene la sospecha clínica. Puede optarse por el tratamiento quirúrgico para los casos que se presenten con clínica de obstrucción intestinal, o en caso contrario, el tratamiento médico a base de fármacos inmunosupresores e inmunomoduladores ha demostrado ser efectivo. De acuerdo con los diferentes estudios publicados hasta el momento, se observa una adecuada respuesta, independientemente del tratamiento empleado
Introduction. The objective of this article is to present the case of a patient diagnosed with sclerosing mesenteritis who presented with intestinal obstruction.Case description. A 28-year-old male patient, who presented with a clinical picture suggestive of intestinal obstruction, for which a surgical resolution was decided. During surgery, a fibrotic and adherent area of the small intestine is observed, associated with a thickened mesentery. The histopathological examination of the surgical specimen confirmed the diagnosis of sclerosing mesenteritis. Discussion. Sclerosing mesenteritis is a low incidence pathology, and its presentation is nonspecific, so the definitive diagnosis is histopathological. Tomography is useful for diagnosis when there is clinical suspicion. Surgical treatment can be chosen for cases that present with symptoms of intestinal obstruction, or otherwise medical treatment based on immunosuppressive and immunomodulatory drugs has proven to be effective. According to the different studies published so far, an adequate response is observed, regardless of the treatment used
الموضوعات
Humans , Panniculitis, Peritoneal , Intestinal Diseases , Intestinal Obstruction , Lipodystrophyالملخص
Resumen Introducción. La lipodistrofia congénita generalizada (LCG) es un síndrome genético autosómico recesivo extremadamente raro que se caracteriza por ausencia generalizada de tejido adiposo, deficiencia en la producción de hormonas como la leptina y complicaciones metabólicas potencialmente serias como diabetes mellitus tipo 2 (DM2), esteatohepatitis e hipertrigliceridemia. Presentación del caso. Paciente femenina de 17 años con un diagnóstico tardío de LCG y con diabetes mellitus (erróneamente clasificada como tipo I), hipertrigliceridemia severa e infecciones a repetición. Luego de introducir metformina y un inhibidor del SGLT2 en el manejo de la paciente, se logró un adecuado control metabólico. Conclusión. Con frecuencia, el desconocimiento de algunas enfermedades huérfanas lleva a diagnósticos erróneos y, por tanto, a tratamientos inadecuados que en algunos casos pueden empeorar la condición clínica de los pacientes. Por lo anterior, en el caso de la LCG, es necesario que la comunidad médica tenga una mejor comprensión de sus aspectos diagnósticos y terapéuticos para brindar un diagnóstico y tratamiento oportunos.
Abstract Introduction: Generalized congenital lipodystrophy (GDL) is an extremely rare autosomal recessive genetic syndrome characterized by generalized absence of adipose tissue, deficient production of hormones such as leptin, and potentially serious metabolic complications such as type 2 diabetes mellitus (DM2), steatohepatitis and hypertriglyceridemia. Case presentation: This is the case of a 17-year-old female patient with a late diagnosis of GDL and with diabetes mellitus (erroneously classified as type 1), severe hypertriglyceridemia and recurrent infections. Adequate metabolic control was achieved after the introduction of metformin and an SGLT2 inhibitor. Conclusion: Lack of knowledge about some orphan diseases usually leads to misdiagnosis and, therefore, to inadequate treatments that may worsen the clinical condition of patients. Therefore, in the case of GDL, the medical community should have a better understanding of its diagnostic and therapeutic aspects in order to provide timely diagnosis and treatment.
الموضوعات
Humans , Insulin Resistance , Diabetes Mellitus , Lipodystrophy, Congenital Generalized , Fatty Liver , Lipodystrophyالملخص
ABSTRACT Objective: Our aim is to establish genetic diagnosis of congenital generalized lipodystrophy (CGL) using targeted massively parallel sequencing (MPS), also known as next-generation sequencing (NGS). Subjects and methods: Nine unrelated individuals with a clinical diagnosis of CGL were recruited. We used a customized panel to capture genes related to genetic lipodystrophies. DNA libraries were generated, sequenced using the Illumina MiSeq, and bioinformatics analysis was performed. Results: An accurate genetic diagnosis was stated for all nine patients. Four had pathogenic variants in AGPAT2 and three in BSCL2. Three large homozygous deletions in AGPAT2 were identified by copy-number variant analysis. Conclusions: Although we have found allelic variants in only 2 genes related to CGL, the panel was able to identify different variants including deletions that would have been missed by Sanger sequencing. We believe that MPS is a valuable tool for the genetic diagnosis of multi-genes related diseases, including CGL.
الموضوعات
Humans , GTP-Binding Protein gamma Subunits/genetics , Lipodystrophy, Congenital Generalized/diagnosis , Lipodystrophy, Congenital Generalized/genetics , Lipodystrophy/diagnosis , Lipodystrophy/genetics , Alleles , High-Throughput Nucleotide Sequencing , Mutation/geneticsالملخص
Introdução: Atualmente com o aumento das gastroplastias redutoras (cirurgia bariátrica) e grande perda ponderal, há também um aumento na procura destes pacientes pela cirurgia plástica. Uma das características destes pacientes é o excesso de tecido dermogorduroso que causa deformidades, principalmente nos membros inferiores, acometendo a região trocantérica. Objetivo: Relatar um caso de dermolipectomia trocantérica em paciente pós-cirurgia bariátrica, onde a lipoaspiração por si só não resolveria a correção da deformidade. Relato de caso: IPMS, sexo feminino, 55 anos, histórico de gastroplastia redutora (cirurgia bariátrica) com grande perda ponderal. Relata desconforto importante com a lipodistrofia e extensa flacidez em região trocantérica bilateral. Após avaliação pela equipe, foi optado por realizar dermolipectomia trocantérica bilateral, em janeiro de 2019, no Serviço de Cirurgia Plástica Osvaldo Saldanha. Discussão: Nos casos de lipodistrofia trocantérica com deformidades graves, a cicatriz da dermolipectomia em relação à deformidade é favorável quanto a escolha desta técnica, pois a lipoaspiração poderá agravar ainda mais a deformidade, sendo mandatório utilizar a técnica de dermolipectomia trocantérica para corrigila. Quanto à lipodistrofia com deformidade moderada há dúvida entre a relação do benefício e a deformidade resultante, sendo aplicada a técnica de acordo com a necessidade do paciente e, por fim, nos casos de lipodistrofia com deformidade leve, opta-se pela lipoaspiração devido à correção ser realizada sem grandes cicatrizes aparentes. Conclusão: Portanto, a lipoaspiração tem benefício nos casos de adiposidade localizada, limitando as indicações da técnica de dermolipectomia, em especial na região trocantérica, sem invalidá-la para casos selecionados, como o descrito neste relato de caso.
Introduction: Currently, with the increase in reducing gastroplasty (bariatric surgery) and the great weight loss, there is also an increase in the demand of these patients for plastic surgery. One of the characteristics of these patients is the excess of dermal adipose tissue that causes deformities, especially in the lower limbs, affecting the trochanteric region. Objective: To report a case of trochanteric dermolipectomy in a patient after bariatric surgery, where liposuction alone would not solve the correction of the deformity. Case report: IPMS, female, 55 years old, history of reducing gastroplasty (bariatric surgery) with great weight loss. She reports significant discomfort with lipodystrophy and extensive flacidity in the bilateral trochanteric region. After the team's evaluation, it was decided to perform bilateral trochanteric dermolipectomy, in January 2019, at the Plastic Surgery Service Osvaldo Saldanha Discussion: In cases of trochanteric lipodystrophy with severe deformities, the scar of dermolipectomy in relation to the deformity is favorable in terms of the choice of this technique, since liposuction may further aggravate the deformity, and it is mandatory to use the trochanteric dermolipectomy technique to correct it. Conclusion: Therefore, liposuction is beneficial in cases of localized adiposity, limiting the indications for the dermolipectomy technique, especially in the trochanteric region, without invalidating it for selected cases, as described in this case report.
الموضوعات
Humans , Female , Middle Aged , History, 21st Century , Postoperative Complications , Surgery, Plastic , Obesity, Morbid , Case Reports , Cicatrix , Evaluation Study , Lower Extremity , Bariatric Surgery , Lipodystrophy/pathology , Postoperative Complications/surgery , Surgery, Plastic/adverse effects , Surgery, Plastic/methods , Obesity, Morbid/surgery , Obesity, Morbid/complications , Obesity, Morbid/pathology , Cicatrix/surgery , Lower Extremity/surgery , Bariatric Surgery/adverse effects , Bariatric Surgery/methods , Lipodystrophy , Lipodystrophy/surgery , Lipodystrophy/complicationsالملخص
Objetivo: Analisar a percepção dos diabéticos tipo 1 sobre a insulinoterapia. Métodos: Trata-se de estudo epidemiológico analítico de percepção, tendo sido realizado com pacientes de um Serviço de Apoio e Assistência aos Diabéticos e seus Familiares, no período de abril a agosto de 2018. Resultados: Os 33 diabéticos tipo 1 avaliados eram predominantemente do sexo feminino (60,6%) e a média de idade foi de 21±9 anos. A maioria afirmou portar o Cartão de Identificação do Diabético (78,8%). Mais de dois terços dos pacientes afirmaram saber quando aplicar a insulina de correção. A aferição da glicemia capilar foi relatada por 78,8%. Das insulinas utilizadas no esquema basal, a glargina e a NPH foram citadas como as mais utilizadas. Do total de pacientes, 97% referiram fazer autoaplicação, e 90,9% disseram posicionar a agulha corretamente sobre a pele. Quanto aos locais de aplicação, 84,8% realizavam rodízio. A maioria dos pacientes (78,8%) que aplicavam a insulina não referiu desconforto durante ou após a aplicação, e 69,7% mostraram conhecimento sobre o significado de distrofia. Conclusão: O serviço de educação continuada desenvolvido pelo Serviço de Apoio e Assistência aos Diabéticos e seus Familiares é efetivo na aquisição de bons hábitos e dos devidos cuidados para esses pacientes. A educação do indivíduo com diabetes tipo 1 e de sua família, bem como o acompanhamento por uma equipe multidisciplinar, é essencial para o bom controle da doença,
Objective: To analyze the perception of type 1 diabetes (DM 1) patients of insulin therapy. Methods: This is an epidemiological study of analysis of perception and was performed at the service for care and support of diabetes patients and their families from April to August 2018. Results: The 33 type 1 diabetes mellitus patients evaluated were predominantly female (60.6%) and the mean age was 21 years ± 9 years. Most reported having the diabetes medical ID card (78.8%). More than two thirds of the patients reported knowing when to apply the correction insulin. The capillary glycemia measurement was reported by 78.8%. Of the insulins used in the baseline regimen, Glargine and NPH were cited as the most used. Of the total patients, 97% reported self-application and 90.9% reported positioning the needle correctly on the skin. As for the application sites, 84.8% reported rotating sites. Most patients (78.8%) who applied insulin did not report discomfort during or after application, and 69.7% showed knowledge about the meaning of dystrophy. Conclusion: The continuing education service developed by the Service for Care and Support of Diabetics and their Families is effective in promoting good habits and the proper care of these patients for their disease.The education of the individual with type 1 diabetes and of his/her family, as well as follow-up by a multidisciplinary team, is essential for good disease control.
الموضوعات
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Patient Participation , Social Work Department, Hospital , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Blood Glucose/analysis , Attitude to Health , Surveys and Questionnaires , Sex Distribution , Age Distribution , Insulin/administration & dosage , Lipodystrophy/prevention & controlالملخص
A boy, aged 66 days, was admitted to the hospital due to subcutaneous nodules for 46 days and abdominal distension for 10 days. The main clinical manifestations were loss of adipose tissue, subcutaneous nodules, insulin-resistant diabetes, hypertriglyceridemia, and hepatic steatosis. The boy was diagnosed with congenital generalized lipodystrophy type 1 (CGL1). His condition was improved after administration of middle-chain fatty acid formula milk and insulin injection or oral metformin. Gene testing revealed a homozygous mutation, c.646A>T, in the AGPAT2 gene, and both his parents were carriers of this mutation. This case of CGL1 has the youngest age of onset ever reported in China and multiple subcutaneous nodules as the initial symptom.
الموضوعات
Humans , Infant , Male , Adipose Tissue , China , Fatty Liver , Insulin Resistance , Lipodystrophy , Lipodystrophy, Congenital Generalizedالملخص
Abstract Purpose To collect data capable of pointing out the effects of the ultracavitation treatment on the liver of rabbits after adipose tissue application, by means of histological analyses of the liver and hematological and biochemical exams. Methods This is an experimental study with 12 albino rabbits as sample, which were divided into 3 groups and submitted to a hypercaloric diet for one month. Subsequently, subjects underwent UCV treatment: 3 minutes, 30 W, continuous mode at 100%, every 2 ERAS = 441.02 J/cm2, intensity of 10w/cm2. They were then euthanized and underwent biopsy after 24 hours. Results After 48 hours from the ultracavitation treatment, the animals' livers presented greater amount of fat infiltration if compared to the amount presented 96 hours after the treatment. However, laboratory tests showed no alterations. Values were maintained within normal parameters of cholesterol, triglycerides, liver enzymes, hemoglobin and hematocrit levels. Conclusions This study has identified that infiltrates may appear on livers after the treatment, despite high hematological and biochemical tests results. The fat infiltrates reduction 96 h after treatment suggests lower risks to animal health, if the period between applications is respected.
الموضوعات
Adipose Tissue/pathology , High-Intensity Focused Ultrasound Ablation/methods , Lipodystrophy/pathology , Lipodystrophy/therapy , Liver/pathology , Rabbits , Aspartate Aminotransferases/blood , Reference Values , Triglycerides/blood , Hemoglobins/analysis , Cholesterol/blood , Reproducibility of Results , Risk Factors , Treatment Outcome , Alanine Transaminase/blood , High-Intensity Focused Ultrasound Ablation/adverse effects , Hematocrit , Lipodystrophy/bloodالملخص
Introdução: A lipoaspiração tem sido submetida à evolução constante desde a sua consolidação e emprego sistemático. O auxílio de tecnologia ultrassônica de terceira geração, VASER® (Vibration Amplification of Sound Energy at Resonance), se destina a facilitar a execução da lipoaspiração e trazer maior segurança e resultados satisfatórios, especialmente na busca por maior definição e lipoaspiração superficial. Métodos: No período de 2015 a 2017, 76 pacientes foram submetidas à lipoaspiração para melhora de contorno corporal no Centro Hospitalar Santa Mônica em Erechim. Foram avaliados os resultados obtidos, as possíveis complicações e a segurança do emprego do VASER®. Resultados: A utilização rotineira do VASER® gera aperfeiçoamento de resultados em contorno corporal. A emulsificação gerada pelo dispositivo associada à lipoaspiração em diversos níveis permite uma maior definição e evidenciação dos marcos anatômicos. Conclusão: Lipoaspiração associada ao VASER® permite ao cirurgião plástico o refinamento de seus resultados com a preservação da segurança do paciente.
Introduction: Liposuction has been improved continuously since it was first introduced. The third-generation ultrasound technology VASERTM (Vibration Amplification of Sound Energy at Resonance) facilitates liposuction, providing improved safety and satisfactory results, especially in the search for greater definition and superficial liposuction. Methods: From 2015 to 2017, 76 patients underwent liposuction to improve their body contour at the Santa Monica Hospital Center in Erechim, Rio Grande do Sul, Brazil. The results, complications, and the safety of VASERTM were evaluated. Results: The routine use of VASERTM improves body contour. The emulsification generated by the device, along with liposuction, resulted in greater definition and revelation of the anatomical landmarks. Conclusion: Liposuction associated with VASERTM allows plastic surgeons to refine the results better while ensuring patient safety is maintained.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , History, 21st Century , Postoperative Complications/surgery , Surgical Procedures, Operative , Lipectomy , Adipose Tissue , Subcutaneous Fat/surgery , Patient Safety/standards , Body Contouring , Lipodystrophy , Postoperative Complications , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methods , Lipectomy/methods , Adipose Tissue/surgery , Subcutaneous Fat , Patient Safety , Body Contouring/adverse effects , Body Contouring/methods , Lipodystrophy/surgery , Lipodystrophy/complicationsالملخص
Lipodystrophies are a heterogeneous group of syndromes defined by a severe reduction of the adipose tissue. These can be congenital or acquired. Anatomically, they can be partial or generalized. The etiology of several lipodystrophies is well known. However, the cause of many others remains unknown. The commonest lipodystrophy worldwide is secondary to highly active anti-retroviral therapy in HIV-infected patients. By contrast, primary lipodystrophies (those not associated to any known disease or condition) are much less common and represent a diagnostic challenge. The major complications of lipodystrophies are metabolic, often resulting in severe insulin resistance, diabetes and dyslipidemia. No cure is available for lipodystrophies but the supplementation with recombinant leptin potently controls the metabolic abnormalities when there is a leptin deficiency. Herein, we review the clinical presentation, diagnostic process and therapeutic principles of the main primary lipodystrophy syndromes.
الموضوعات
Humans , Lipodystrophy/classification , Lipodystrophy/diagnosis , Lipodystrophy/genetics , Lipodystrophy/drug therapy , Diagnosis, Differentialالملخص
Introdução: Abdominoplastia é um dos procedimentos cirúrgicos estéticos mais realizados. Seroma é a complicação local mais comum associada com abdominoplastia, com uma incidência média de 10%. A maior incidência de seroma pós-operatório (PO) ocorre no décimo primeiro dia PO. Ecografia abdominal é o método de escolha para o diagnóstico de seroma após abdominoplastia. Novas técnicas surgiram ao longo dos anos na tentativa de trazer melhores resultados estéticos com menos complicações, como lipoabdominoplastia descrita por Saldanha. Porém, estudos anatômicos recentes questionam a necessidade da manutenção da fáscia de Scarpa descrita na técnica de lipoabdominoplastia, descrevendo que em torno de 90% do sistema linfático abdominal está no plano subdérmico e 10% em um sistema linfático profundo justa-aponeurose abdominal. O objetivo é comparar a incidência de seroma na lipoabdominoplastia sem preservação da fáscia de Scarpa com a abdominoplastia clássica. Métodos: Coorte prospectiva, cega na qual serão analisados 40 pacientes consecutivos que realizaram abdominoplastia sem lipoaspiração associada (n = 20) ou lipoabdominoplastia (n = 20) no Hospital de Clínicas de Porto Alegre entre abril de 2016 e maio de 2017. Todos foram submetidos à ecografia de parede abdominal no 10o dia PO. Resultados: A incidência de seroma foi de 5% (n = 1) no grupo de abdominoplastia clássica e de 10% (n = 2) no grupo de lipoabdominoplastia, sem diferença estatística. Conclusão: Estes resultados, neste grupo de pacientes, mostram que não houve diferença estatística entre os dois grupos.
Introduction: Abdominoplasty is among the most commonly performed surgical procedures. Seroma is the most common local complication associated with abdominoplasty, with an average incidence of 10%. The highest incidence of postoperative (PO) seroma occurs on the eleventh postoperative day (POD). Abdominal ultrasound is the method of choice for diagnosing seroma after abdominoplasty. New techniques have emerged aiming to improve aesthetic results with fewer complications, such as lipoabdominoplasty described by Saldanha. However, recent anatomical studies have questioned the need for Scarpa fascia preservation recommended in the lipoabdominoplasty technique, describing that around 90% of the abdominal lymphatic system is in the subdermal plane, while the other 10% is in a deep lymphatic system near the abdominal aponeurosis. The objective is to compare the incidence of seroma in lipoabdominoplasty without Scarpa fascia preservation to that in classic abdominoplasty. Methods: Prospective blinded cohort in which 40 consecutive patients who underwent abdominoplasty without associated liposuction (n = 20) or lipoabdominoplasty (n = 20) at the Hospital de Clínicas of Porto Alegre between April 2016 and May 2017 were analyzed. All patients underwent abdominal wall ultrasonography on the tenth POD. Results: The incidence of seroma was 5% (n = 1) in the classic abdominoplasty group and 10% (n = 2) in the lipoabdominoplasty group, with no statistical difference. Conclusion: These results showed no statistically significant intergroup difference in seroma development.
الموضوعات
Humans , Adult , Middle Aged , Lipectomy/adverse effects , Lipectomy/methods , Ultrasonography/adverse effects , Ultrasonography/methods , Seroma/surgery , Seroma/complications , Abdominoplasty/adverse effects , Abdominoplasty/methods , Body Contouring/adverse effects , Body Contouring/methods , Lipodystrophy/complications , Lipodystrophy/metabolismالملخص
Antecedentes: la diastasis de rectos constituye la separación de la línea media o línea alba, originada en una laxitud de las fibras entrecruzadas de la aponeurosis de ambos músculos rectos. En la actualidad se discute su corrección quirúrgica, existiendo una multiplicidad de factores que lo justifican. Objetivo: analizar la factibilidad y la seguridad del abordaje endoscópico subcutáneo para efectuar la plicatura de músculos rectos, y la corrección de otros defectos de la línea media, en pacientes sin lipodistrofia abdominal. Material y métodos: entre marzo de 2014 y febrero de 2017 fueron abordados por esta vía 42 pacientes con diastasis asociada a otros defectos de línea media. Se analizaron datos demográficos, características de la diastasis, tamaño de los defectos, tiempo operatorio, estadía hospitalaria y complicaciones. El dolor posoperatorio se midió mediante una escala visual análoga, y se valoró la morbilidad y recurrencia mediante ultrasonografía. Resultados: 42 pacientes fueron intervenidos por vía endoscópica. Un 76% fueron de sexo femenino, con una edad promedio de 39 años. En el 93% de los casos, la diastasis fue supraumbilical e infraumbilical, y su tamaño promedio fue de 5,5 cm. Los defectos asociados en su mayoría fueron hernia umbilicales. No se registraron complicaciones intraoperatorias, con un tiempo quirúrgico promedio de 80 minutos. La intensidad de dolor posoperatorio fue de 4,1 puntos. La morbilidad más asociada fue el seroma. Conclusiones: la reparación endoscópica subcutánea de la diastasis de rectos, asociada a otros defectos de la línea media, es factible y segura de realizar. Aporta ventajas estéticas considerables, permitiendo su corrección con complicaciones mínimas.
Background: Diastasis recti is the separation of the midline or linea alba due to laxity of the intercrossed fibers of both aponeurosis of the rectus abdominis muscles. Although the surgical correction of this condition is still under debate, many factors justify it. Objective: The aim of this study was to analyze the feasibility and safety of the endoscopic subcutaneous approach for plication of the rectus muscles associated with other midline defects repair in patients without abdominal lipodystrophy. Material and methods: Between March 2014 and February 2017, 42 patients underwent subcutaneous endoscopic repair of diastasis recti and other midline defects. The demographic data, the characteristics and size of the defects, the surgical time, hospital stay and complications were analyzed. Postoperative pain was measured using a visual analogue scale. Ultrasound was used to evaluate morbidity and recurrence. Results: A total of 42 patients underwent the endoscopic approach; 76% were women and mean age was 39 years. In 93% of the cases, diastasis was supraumbilical and infraumbilical, with a mean size of 5.5 cm. Umbilical hernias were the most common associated defects. No intraoperative complications were reported. Mean surgical time was 80 minutes; the intensity of posoperative pain was 4.1 points and seroma was the most common complications. Conclusions: Subcutaneous endoscopic repair of diastasis recti and other midline defects is a feasible and safe procedure that allows the simultaneous correction of both conditions with minimal complications and esthetic benefits.
الموضوعات
Humans , Female , Adult , Diastasis, Muscle , Pain , Pain, Postoperative , Patients , Therapeutics , Women , Morbidity , Ultrasonography , Rectus Abdominis , Aponeurosis , Hernia , Hernia, Umbilical , Intraoperative Complications , Lipodystrophy , Methods , Musclesالملخص
SHORT syndrome is an extremely rare congenital condition due to a chromosomal mutation of the PIK3R1 gene found at 5q13.1. SHORT is a mnemonic representing six manifestations of the syndrome: (S) short stature, (H) hyperextensibility of joints and/or inguinal hernia, (O) ocular depression, (R) Rieger anomaly, and (T) teething delay. Other key aspects of this syndrome not found in the mnemonic include lipodystrophy, triangular face with dimpled chin (progeroid facies, commonly referred to as facial gestalt), hearing loss, vision loss, insulin resistance, and intrauterine growth restriction (IUGR). 3q duplication syndrome is rare syndrome that occurs due to a gain of function mutation found at 3q25.31-33 that presents with a wide array of manifestations including internal organ defects, genitourinary malformations, hand and foot deformities, and mental disability. We present a case of a 2 year and 3 month old male with SHORT syndrome and concurrent 3q duplication syndrome. The patient presented at birth with many of the common manifestations of SHORT syndrome such as bossing of frontal bone of skull, triangular shaped face, lipodystrophy, micrognathia, sunken eyes, and thin, wrinkled skin (progeroid appearance). Additionally, he presented with findings associated with 3q duplication syndrome such as cleft palate and cryptorchidism. Although there is no specific treatment for these conditions, pediatricians should focus on referring patients to various specialists in order to treat each individual manifestation.
الموضوعات
Humans , Male , Chin , Cleft Palate , Cryptorchidism , Depression , Facies , Fetal Growth Retardation , Foot Deformities , Frontal Bone , Hand , Hearing Loss , Hernia, Inguinal , Insulin Resistance , Joints , Lipodystrophy , Micrognathism , Parturition , Skin , Skull , Specialization , Tooth , Tooth Eruptionالملخص
Objective: The present study evaluated the influence of the duration of antiretroviral therapy on insulin resistance among people living with HIV with lipodystrophic syndrome. Methods: The study assessed 36 subjects of both sexes between 22 and 60 years old split into three groups: 1) HIV-positive using antiretroviral with lipodystrophy syndrome (HIV+LIPO+); 2) HIV-positive using antiretroviral therapy with no lipodystrophy syndrome (HIV+LIPO-); and 3) HIV-negative and healthy (Control). The data were collected at the Special Unit for the Treatment of Infectious Diseases (Unidade Especial de Tratamento para Doenças Infecciosas - UETDI) of the Dyslipidemia Outpatient Clinic (Ambulatório de Dislipidemia - ADIS) of the General Hospital of the Medical School of Ribeirão Preto (HC-FMRP). The biochemical assessment used laboratory kits when the results were not available in the volunteer's records. Results: Higher HOMA-IR values were observed for the group 1: HIV+LIPO+ (1,61 ± 1,17 ) compared to group 2: HIV+LIPO- (0,79 ± 0,87) and group 3: Control (0,46 ± 0,72 ) and such values were positively correlated with the time of antiretroviral medication use (r=0,41). Conclusions: The time of infection by HIV and the use of antiretrovirals impact the glucose metabolism with changes in serum insulin levels and consequent insulin resistance and increased risk for the development of diabetes and diseases related to carbohydrate metabolism. (AU)
Métodos: Foram avaliados 36 indivíduos de ambos os sexos, com idade entre 22 e 60 anos, divididos em três grupos: 1) Soropositivo para HIV em uso de TARV com síndrome de lipodistrofia (VIH + LIPO +); 2) Soropositivo para HIV em uso de TARV sem síndrome de lipodistrofia (VIH + LIPO-); 3) Soronegativo para HIV (Controle). Os dados foram coletados na Unidade Especial de Tratamento para Doenças Infecciosas (UETDI), no Ambulatório de Dislipidemia (ADIS) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HC-FMRP). Para a análise bioquímica foram utilizados kits de laboratório, quando os mesmos não estavam disponíveis nos prontuário eletrônico. Resultados: Foram observados maiores valores de HOMA-IR para o grupo GRUPO 1: HIV+LIPO+ (1,61 ± 1,17), comparado aos grupos GRUPO 2: HIV+LIPO- (0,79 ± 0,87) e GRUPO 3: Controle (0,46 ± 0,72), sendo que o HOMA-IR apresentou correlação positiva com o tempo de uso dos antirretrovirais (r=0,41). Conclusão: O tempo de infecção por HIV e o uso de antirretrovirais influenciam o metabolismo glicídico, com modificações nos níveis séricos de insulina e consequentemente resistência à insulina e maior risco para desenvolver diabetes e enfermidades relacionadas ao metabolismo de carboidratos. (AU)
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Insulin Resistance , HIV , Anti-Retroviral Agents , Lipodystrophyالملخص
Introduction: Since the earliest reported cases in the United States, Acquired Immunodeficiency Syndrome (AIDS) remains one of the major challenges to global health. Objective: To evaluate the metabolic parameters and clinical manifestations of lipodystrophy in patients with lipodystrophy syndrome associated with the use of antiretroviral therapy. Methods: A cross-analytical study carried out from December 2015 to June 2016, in a public reference hospital for the care of HIV patients, in the city of Belém, state of Pará, Brazil. The sample consisted of HIV positive serology patients in treatment with antiretrovirals and lipodystrophy. Interviews were conducted and a research protocol plus laboratory analysis applied. Results: A total of 54 patients was included, 68.5% male and 31.5% female, aged 2672 years, average of 53.07 years (standard deviation SD±10.41). Among the clinical forms of lipodystrophy, the mixed one was the most prevalent (72.2%). As for dyslipidemia, 30.8% of the patients presented isolated hypertriglyceridemia, 26.9% mixed dyslipidemia, 19.2% low high-density lipoprotein (HDL-c) and 17.3% without dyslipidemia. Regarding the glycemic profile, 28.3% of the patients were diabetic, 28.3% had altered fasting glycaemia and 5.6% had altered fasting glycaemia and glucose intolerance. Conclusion: The clinical form of mixed lipodystrophy was the most prevalent. In this study, there was no association between the lipid profile and the clinical forms of lipodystrophy. However, follow-up of these patients is necessary to avoid possible complications and risks of cardiovascular events
Introdução: Desde os primeiros casos relatados nos Estados Unidos, a Acquired Immunodeficiency Syndrome (AIDS) ainda continua sendo um dos grandes desafios para a saúde global. Objetivo: Avaliar os parâmetros metabólicos e as manifestações clínicas da lipodistrofia em pacientes com síndrome lipodistrófica do HIV, associada ao uso de terapia antirretroviral. Métodos: Estudo transversal analítico realizado de dezembro de 2015 a junho de 2016 em hospital público de referência no atendimento de pacientes HIV, em Belém, Pará, Brasil. A amostra foi composta de pacientes com sorologia positiva para o HIV em tratamento com antirretrovirais e lipodistrofia. Foram realizadas entrevistas e foi aplicado um protocolo de pesquisa mais análise laboratorial. Resultados: Foram incluídos 54 pacientes, 68,5% masculinos e 31,5% femininos, com idade entre 26 e 72 anos e média de 53,07 anos (desvio padrão DP±10,41). Entre as formas clínicas da lipodistrofia, a mista foi a de maior prevalência (72,2%). Quanto à dislipidemia, verificou-se que 30,8% dos pacientes apresentaram hipertrigliceridemia isolada, 26,9% dislipidemia mista, 19,2% lipoproteína de alta densidade (HDL-c) baixo e 17,3% sem dislipidemia. Quanto ao perfil glicêmico, 28,3% dos pacientes são diabéticos, 28,3% apresentaram glicemia de jejum alterada e 5,6% glicemia de jejum alterada e intolerância à glicose. Conclusão: A forma clínica da lipodistrofia mista foi a mais prevalente. Nesta pesquisa, não houve associação entre o perfil lipídico e as formas clínicas de lipodistrofia, contudo faz-se necessário o seguimento desses pacientes, para evitar possíveis complicações e riscos de eventos cardiovasculares.