A Web-based Fuzzy Inference System Based Tool for Cardiovascular Disease Risk Assessment / Herramienta Fuzzy de Inferencia basada en Web para la evaluación del riesgo vascular

Objective: a Web-based Fuzzy Inference Tool for cardiovascular risk assessment has been developed. The tool makes use of inference rules from evidence-based medicine for membership classification. Methods: the system framework allows adding variables such as gender, age, weight, height, medication intake, and blood pressure, with various types of membership functions based on classification rules. Results: the tool allows health professional to enter patient clinical data and obtain a prediction of cardiovascular risk. The tool can also be later used to predict other types of risks including cognitive and physical disease conditions.

Objetivo: desarrollar una herramienta Fuzzy de Inferencia basada en Web para la evaluación del riesgo cardiovascular. La herramienta hace uso de reglas de inferencia de medicina basada en evidencia para la clasificación de membresía. Métodos: el marco del sistema permite la adición de variables como el género, la edad, el peso, la altura, la ingesta de medicamentos, y la tensión arterial, con varios tipos de funciones de pertenencia basada en reglas de clasificación. Resultados: la herramienta permite a los profesionales de la salud ingresar los datos clínicos del paciente y obtener una predicción del riesgo cardiovascular. La herramienta también puede ser utilizada más adelante para predecir otros tipos de riesgos, incluyendo condiciones de la enfermedad cognitivas y físicas.

Muscle free amino acid profiles are related to differences in skeletal muscle growth between single and twin ovine fetuses near term.

Twin sheep fetuses have reduced skeletal muscle weight near birth relative to singles as a result of restricted muscle hypertrophy. Intracellular free amino acids (FAA) are reported to regulate metabolic pathways which control muscle protein accretion, whereby reduced intracellular content of specific FAA may reduce their activation and therefore, muscle hypertrophy. The aim of this study was to determine whether differences in muscle weight between singleton and twin fetuses, under different maternal conditions is associated with reduced concentration of specific FAA. The FAA content in the semitendinosus muscle (ST) in singleton and twin fetuses (rank) at 140 days of gestation from heavy (H) or light (L) ewes fed ad libitum (A) or maintenance (M) level of nutrition was measured. Muscle weight was reduced in twin fetuses compared to singletons in all groups. Reduced concentrations of leucine, threonine and valine, but higher concentrations of methionine, ornithine, lysine and serine were found in twin fetuses compared to singletons. Maternal size and nutrition interaction with rank resulted in reduced glutamine in twins from HM-ewes (H-ewes under M nutrition) compared to their singleton counterparts. Maternal weight interaction with pregnancy rank reduced the concentration of arginine in twins, with a larger effect on H-ewes compared with L-ewes. Maternal size interaction with pregnancy rank resulted in twins from M-ewes to have lower alanine, while twins from A-ewes had lower aspartic acid concentration compared to singletons. The ST muscle weight was positively correlated only with arginine concentration after taking into account rank, size and nutrition. The present results indicate that reduced concentrations of specific intracellular FAA, such as arginine, leucine, valine, glutamine, which are known to play a role in muscle growth, could be acting as limiting factors for muscle hypertrophy in twin fetuses during late gestation. Ewe size and nutrition can influence the concentration of specific FAA in muscle and should be considered in any intervention plan to improve twin fetal muscle growth.

Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis.

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

Autoimmune thyroiditis presenting as interstitial granulomatous dermatitis / Dermatite intersticial granulomatosa como apresentação de tireoidite autoimune

A 54-year-old female presented with recurrent, widespread, erythematous, painful plaques, over a 3-month period. Skin biopsy was compatible with interstitial granulomatous dermatitis. Additional investigation revealed hypothyroidism and positive anti-thyroid antibodies. Normalization of thyroid function and high-potency topical corticosteroids provided only transitory improvement of the dermatosis. Interstitial granulomatous dermatitis is a histologic inflammatory reaction, with variable cutaneous expression. It has been reported in association with several drugs, lymphoproliferative diseases and autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus and vasculitis, but association with autoimmune thyroiditis is rare. Optimal therapy for this condition is yet to be established, but topical corticosteroids have been a mainstay of treatment. In most cases, this disease is characterized by flares and remissions.

Uma doente de 54 anos foi avaliada por placas eritematosas, dolorosas, disseminadas, recorrentes, com 3 meses de evolução. A biopsia cutânea foi compatível com dermatite intersticial granulomatosa. Os restantes exames laboratoriais revelaram hipotiroidismo e anticorpos anti-tiroideus positivos. Apesar da normalização da função tiroideia e de tratamento com corticóide tópico de alta potência, a dermatose melhorou apenas parcialmente. Dermatite intersticial inflamatória é um diagnóstico histopatológico, com expressão clínica variável. Tem sido associada a vários fármacos, doenças linfoproliferativas e autoimunes, nomeadamente artrite reumatóide, lupus eritematoso sistémico e vasculites, mas a associação com tireoidite autoimune é rara. Até ao momento, não foi definido nenhum tratamento específico, mas os corticóides tópicos são dos fármacos mais utilizados. A doença caracteriza-se por períodos de agravamento e remissão.

Detección de hiperplasia de paratiroides por ultrasonografía y correlación con signos clínicos y de laboratorio en pacientes con enfermedad renal crónica / Ultrasound detection of parathyroid hyperplasia and correlation with clinical and laboratory findings in patients with chronic kidney disease

Objetivo: Determinar la correlación entre la hiperplasia de paratiroides detectada por ecografía de alta resolución y variables clínicas y de laboratorio en pacientes con hiperparatiroidismo secundario a enfermedad renal crónica (ERC) estadio 5 en terapiadialítica en RTS Ltda, sucursal Caldas, Hospital Santa Sofía, Hospital Infantil. Métodos: A lospacientes detectados se les practicó ultrasonografía de tiroides y paratiroides con un equipo de alta resolución. Se analizaron variables como etiología, duración de la ERC, tiempo en terapia dialítica, tipo de diálisis, presencia de síntomas relacionados con hiperparatiroidismo (dolor óseo, fracturas, prurito) y las variables de laboratorio PTH intacta, calcio, fósforo,producto calcio por fósforo y fosfatasa alcalina. Resultados: De 403 pacientes evaluados, 92 cumplieron con los criterios de inclusión y se realizó ultrasonografía en 86. En este grupo de pacientes la causa más común de ERC fue nefroesclerosis hipertensiva, con un tiempo promedio en diálisis de 61,4 ± 36,6 meses. De los pacientes, 37 se encontraron en diálisis peritoneal y 49 en hemodiálisis. La correlación entre las variables de laboratorio y la presencia de hiperplasia de paratiroides no demostró significancia estadística cuando se comparó contra el grupo sin documentación ecográfica de crecimiento glandular paratiroideo.Conclusión: La hiperplasia de paratiroides puede estar presente en cualquier paciente con ERC estadio 5 y valores de PTH intacta mayores a 400 pg/ml, independientemente de sus variables clínicas y de laboratorio. Es necesario practicarle ultrasonografía a todos los pacientes con cifras altas de PTH, con el fin de asignarles una terapia eficiente.

The importance of patch tests in the differential diagnosis of adverse drug reactions.

Exudative erythema multiforme is an acute self-limited skin disease often associated with infections (usually viral), and also with systemic diseases and drugs. We report the case of a 39-year-old woman diagnosed with systemic lupus erythematosus, who presented at the emergency clinic with exudative erythema multiforme which started 10 days after taking amoxicillin and clavulanic acid for tonsillitis together (almost simultaneously) with the pneumococcal vaccine. Rowell's syndrome was also considered to be a possibility. Skin patch tests were carried with the standard battery of patches (GPEDC) and the active ingredients of the suspected drugs (Chemotechnique ®), with readings at D2 and D3. The tests were positive for amoxicillin 10% pet (++), ampicillin 10% pet (+ +) and penicillin G potassium 10% pet (+). We accepted the diagnosis of erythema multiforme due to amoxicillin, confirmed by patch testing.

A importância das provas epicutâneas de contacto no diagnóstico diferencial de reações a medicamentos / The importance of patch tests in the differential diagnosis of adverse drug reactions

O eritema exsudativo multiforme é uma erupção aguda, autolimitada, frequentemente associada a infecções (geralmente virais), doenças sistêmicas e fármacos. Apresenta-se o caso de uma mulher de 39 anos, com o diagnóstico de lúpus eritematoso sistêmico, que recorreu à Urgência com quadro de eritema exsudativo multiforme, com início 10 dias após tomar amoxicilina e ácido clavulânico por amigdalite e, quase simultaneamente, receber a vacina antipneumocócica. Colocou-se também a hipótese de síndrome de Rowell. Efetuaram-se testes epicutâneos de contacto com bateria básica (portuguesa) e princípios ativos dos fármacos suspeitos (Chemotechnique®). Encontrou-se hipersensibilidade à amoxicilina 10 por cento vas (++), à ampicilina 10 por cento vas (++) e à penicilina G potássica 10 por cento vas (+), atribuindo-se à amoxicilina a causa mais provável do eritema exsudativo multiforme.

Exudative erythema multiforme is an acute self-limited skin disease often associated with infections (usually viral), and also with systemic diseases and drugs. We report the case of a 39-year-old woman diagnosed with systemic lupus erythematosus, who presented at the emergency clinic with exudative erythema multiforme which started 10 days after taking amoxicillin and clavulanic acid for tonsillitis together (almost simultaneously) with the pneumococcal vaccine. Rowell's syndrome was also considered to be a possibility. Skin patch tests were carried with the standard battery of patches (GPEDC) and the active ingredients of the suspected drugs (Chemotechnique ®), with readings at D2 and D3. The tests were positive for amoxicillin 10 percent pet (++), ampicillin 10 percent pet (+ +) and penicillin G potassium 10 percent pet (+). We accepted the diagnosis of erythema multiforme due to amoxicillin, confirmed by patch testing.

Relation of osteocalcin with insulin resistance and histopathological changes of non alcoholic fatty liver disease.

BACKGROUND: Osteocalcin is a hormone with a complex cross-talk between adipose tissue and the skeleton. The aim of the present study was to explore the relation of osteocalcin with histopathological changes of NALFD patients. SUBJECTS: A population of 69 NAFLD patients was analyzed. A liver biopsy was realized. Weight, fat mass, body mass index, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDLcholesterol, HDL-cholesterol, triglycerides and osteocalcin levels were measured. RESULTS: Patients were divided in two groups by median osteocalcin value (11.34 ng/mL), group I (patients with the low values) and group II (patients with the high values). Only liver fibrosis frequencies were different between groups (group I: 22.9% vs group II: 9.4%; p < 0.05). Patients in group I had higher levels of glucose (115.6 ± 28.1 mg/dL vs. 103.7 ± 24.3 mg/dL; p < 0.04), HOMA (4.6 ± 3.1 units vs. 3.6 ± 1.8 units; p < 0.04), weight (102.9 ± 32.4 kg vs. 85.9 ± 16.8 kg; p = 0.002) and body mass index (38.3 ± 11.4 kg/m(2) vs. 30.1 ± 5.7 kg/m(2); p = 0.001)) than patients in group II. Osteocalcin was inverse correlated with glucose (r =-0.4; p = 0.002) and HOMA (r = -0.3:p = 0.01). CONCLUSION: Osteocalcin is associated with liver fibrosis. However, this association disappeared in a multivariate analysis, and HOMA remained as an independent factor.

G308A polymorphism of TNF-alpha gene is associated with insulin resistance and histological changes in non alcoholic fatty liver disease patients.

Some studies have pointed to a role of TNF-alpha in pathogenesis of non alcoholic fatty liver disease (NAFLD). The aim of our study was to investigate the influence of G308A polymorphism TNF alpha gene on the histological changes, insulin resistance and TNF-alpha levels in overweight patients. A population of 66 patients with NAFLD was recruited in a cross sectional study. A biochemical analysis of serum was measured. Genotype of TNF alpha gene G308A was studied. Fifteen patients (22.7%) had the genotype G308A (mutant type group) and 51 patients (77.3%) G308G (wild type group). Patients with mutant type group presented more moderate-severe portal inflammation (86.7%) in liver biopsy compared to patient with wild genotype (19.7%). Mutant type group had more moderate-severe fibrosis (73.3%) than wild type group (51.3%). The multivariate analysis adjusted by age, sex, BMI and genotype with the dependent variable (fibrosis) showed that HOMA remained in the model, with an increase of the probability to develop fibrosis of 1.78 (CI95%:1.06-3.2) and develop moderate-severe inflammation of 1.45 (CI95%:1.02-2.1) with each increase of one unit on HOMA levels. In conclusion, Patients with mutant genotype have more frequently moderate-severe portal inflammation and fibrosis than wild type genotype.