Effects of the Consumption of Milk Biofortified with Selenium, Vitamin E, and Different Fatty Acid Profile on Immune Response in the Elderly.

SCOPE: Nutrition is a major contributing factor for immunocompetence. The aim was to assess the immune status of older people after consuming milk produced by lactating cows fed with one of the following diets: control diet (C), C + vitamin E + selenium (C + A), C + sunflower oil (C + O), and C + sunflower oil + vitamin E + selenium (A + O). METHODS AND RESULTS: Sixty elderly people received one of these biofortified milks for 12 weeks. Immune response was assessed by measurement of the expression of COX-1, COX-2, MCP-1, PPAR (δ, α, and ß/δ) genes, neutrophil production of oxygen reactive species induced by immune complexes, neutrophil phagocytosis and lytic activity of the alternative pathway of the complement system, and cytokine levels. Variables were assessed before and after treatment. Our findings showed stability of some inflammatory mediators (complement activity and neutrophils burst) in treatment groups, except complement activity in C + A, and an increase of these markers in C, especially reactive oxygen species production and phagocytic activity. TNF-α was significantly increased in all groups. In C + A, IL-4 and IL-2 increased after treatment, and in the group that received the milk produced by cows fed with "O" diet, CCL20 and IL-27 increased. CONCLUSION: Overall, as compared to C, milk biofortification was associated with stabilization of the activity of alternative complement pathway and the neutrophils burst, and modulated different cytokines levels.

Abordagem clínica do paciente reumático / Clinical approach to the rheumatic diseases

Uma proporçäo significativa de pacientes em ambulatórios gerais apresentam problemas músculo-esqueléticos, a maioria deles reumatismos de partes moles auto-limitados. O primeiro objetivo do médico é diferenciar estes problemas simples de doenças reumáticas mais graves e complexas e assim evitar exames laboratoriais desnecessários. A primeira parte desta revisäo apresenta uma abordagem orientada-por-problemas do diagnóstico diferencial das doenças reumáticas. Nesta abordagem, as informaçöes obtidas da história clínica e do exame físico permitem a classificaçäo dos problemas do paciente em mono, óligo ou poliartrite, aguda ou crônica e restringem-se as possibilidades diagnósticas a umas poucas em uma destas categorias. Limitar as possibilidades diagnósticas permite uma melhor utilizaçäo dos recursos laboratoriais e radiológicos. Säo também apresentadas a sensibilidade, especificidade e o fundamento destes métodos subsidiários de diagnóstico. Na segunda parte, säo discutidas a imunopatogênese, manifestaçöes clínico-laboratoriais e critérios diagnósticos das principais doenças reumáticas. Com este conhecimento, o clínico näo-especialista poderá diagnosticar a grande maioria dos problemas reumáticos e encaminhar ao especialista apenas aqueles doentes portadores de doenças mais críticas ou mais agressivas