Serum levels of Th17 associated cytokines in chronic hepatitis C virus infection.

The Th17-mediated immune response was investigated in patients chronically infected with hepatitis C virus (HCV) by determining the serum levels of the cytokines involved in the induction of the Th17 response (TGF-ß and IL-6), the cytokines produced by Th17 cells (IL-17A, IL-17F and IL-22) and the cytokines whose production is stimulated by Th17 lymphocytes (IL-8 and GM-CSF). We investigated the relationships among the levels of these cytokines by assessing clinical findings, liver histology and viremia. Sixty untreated patients and 28 healthy individuals were included in the study. Cytokine levels were determined using ELISA. Differences between HCV and control groups were identified in the median levels of IL-17F (controls=172.4 pg/mL; HCV=96.8 pg/mL, p<0.001) and IL-8 (controls=30.1 pg/mL; HCV=18.1 pg/mL, p<0.05). IL-6 levels were higher in patients presenting moderate liver necroinflammation than in patients with mild or no liver necroinflammation (p<0.05). IL-17F levels were increased in patients that had increased ALT levels. Additionally, a strong positive correlation was observed between IL-17F and IL-22 levels in the two groups investigated, and the IL-17F/IL-22 ratio was lower in the patients infected with HCV (p<0.0001). Patients with low HCV viral loads had higher median levels of IL-8 (32.5 pg/mL) than did patients with high HCV loads (16.7 pg/mL, p<0.05). These results suggest that in chronic hepatitis C infection, IL-17F and IL-8 could be associated with the control of liver injury and infection, respectively.

Detecção do hipotireoidismo subclínico em gestantes com diferentes idades gestacionais / Detection of subclinical hypothyroidism in pregnant women with different gestational ages

OBJETIVO: Detectar hipotireoidismo subclínico em gestantes. MATERIAL E MÉTODO: Foram estudadas 75 gestantes, voluntárias, residentes na cidade de Itabuna, Bahia. O protocolo constou de: critérios de inclusão: gestante com faixa etária < 40 anos, sem história prévia de doença tireoidiana ou auto-imunes e diabetes mellitus em qualquer idade gestacional; avaliação clínica com entrevista sob a forma de questionário; avaliação laboratorial com dosagem de T4 livre, TSH, anticorpos anti-TPO, perfil lipídico (colesterol total, HDL-colesterol e triglicérides); avaliação ultra-sonográfica da tireóide. RESULTADOS: A idade média foi de 21,6 ± 5,1 anos (14-40); a idade gestacional média foi de 24,2 ± 8,2 semanas (5-39); foi encontrado TSH elevado com T4 livre normal em 3 gestantes (4,0 por cento). A positividade de anticorpos anti-TPO foi de 8,0 por cento. Foram encontradas 5,4 por cento de alterações ultra-sonográficas tireoidianas. CONCLUSÃO: Encontramos uma prevalência de 4,0 por cento de hipotireoidismo subclínico na amostra, e com base neste resultado os autores consideram de grande importância a inclusão da avaliação tireoidiana na rotina do exame pré-natal. Estudos ulteriores se fazem necessários para estabelecer em que momento a avaliação tireoidiana de mulheres grávidas deve ser iniciada e com que freqüência deve ser repetida durante o curso da gestação.

[Detection of subclinical hypothyroidism in pregnant women with different gestational ages]. / Detecção do hipotireoidismo subclínico em gestantes com diferentes idades gestacionais.

AIM: To detect subclinical hypothyroidism in pregnant women. SUBJECTS AND METHODS: Seventy-five pregnant women who resided in the town of Itabuna, state of Bahia, were voluntarily studied. Inclusion criteria were age < 40 years, no history of previous thyroid disease, autoimmunopathy or diabetes mellitus, and any gestational age; a clinical evaluation (an interview obeying to a questionnaire); laboratory evaluation (free T4, TSH, anti-TPO antibody, total and HDL cholesterol, triglyceride determinations); thyroid ultrasonography. RESULTS: Average age was 21.6 +/- 5.1 (14-40 years); gestation age was 24.2 +/- 8.2 (5-39 weeks); an elevated TSH with normal free T4 was found in 3 cases (4.0%). Anti-TPO antibodies were positive in 8.0% on the pregnant women. In 5.4% of them, thyroid ultrasonographic changes were documented. CONCLUSION: Based on finding of a 4% prevalence of elevated TSH during pregnancy, the authors consider important the inclusion of thyroid function laboratory evaluation in the routine prenatal examination. Further studies appear necessary to establish at what gestational age thyroid function evaluation should be started in pregnant women and how frequently it should be repeated during the course of gestation.

Cintilografia de perfusão miocárdica em pacientes diabeticos tipo 2 com dor torácica atípica / Myocardial perfusion scintigraphy in type 2 diabetic patients with atypical chest pain

Foram avaliados através de cintilografia miocárdica de perfusão, 67 pacientes com diabetes tipo 2 (DM2) com dor torácica atípica e com eletrocardiograma de repouso normal ou com alterações inespecíficas da repolarização ventricular, com o objetivo de se verificar a prevalência de alterações miocárdicas isquêmicas. A idade média ± DP dos pacientes foi de 63,5 ± 9 anos. Vinte e um (31,3 por cento) homens e 46 (68,7 por cento) mulheres. Grande parte da amostra (62,7 por cento) apresentou exame normal, enquanto em 37,3 por cento a cintilografia apresentou-se positiva para isquemia. O teste ergométrico foi realizado em 91 por cento (n = 61) e em 31,1 por cento foi positivo para isquemia. A concordância entre a cintilografia miocárdica e o teste ergométrico mostrou baixa correlação entre os dois testes (Kappa = 0,49; P = 0,0001). Concluímos que a cintilografia de perfusão miocárdica comprovou-se de elevado valor clínico na avaliação e diagnóstico da doença coronariana em pacientes com DM2 com dor precordial atípica.

[Myocardial perfusion scintigraphy in type 2 diabetic patients with atypical chest pain]. / Cintilografia de perfusão miocárdica em pacientes diabeticos tipo 2 com dor torácica atípica.

To verify the prevalence of ischemic myocardial abnormalities, 67 patients with type 2 diabetes mellitus (DM2) with normal basal electrocardiogram (EKG) or with ventricular repolarization abnormalities were evaluated by a perfusional myocardial scintigraphy. The average age was 63.5 +/- 9 years. Twenty-one (31.3%) were male and 46 (68.7%) female. A significant part of the sample (62.7%) had a normal myocardial scan, 37.3% were positive for ischemia. The majority of the sample (91%; n = 61) was submitted to an EKG during exercise which was positive for ischemia in 31.1%. The concordance between myocardial scintigraphy and the EKG during exercise demonstrated a low correlation between the two procedures (Kappa = 0.49; P = 0.0001). We conclude that perfusional myocardial scan is a highly valuable tool for evaluation and diagnosis of coronary artery disease in DM2 patients with atypical angina.