Waist circumference is an effect modifier of the association between bone mineral density and glucose metabolism

ABSTRACT Objective: The role of bone markers on insulin resistance (IR) remains controversial. The objective of this study is to evaluate the association between bone mineral density (BMD) and glucose metabolism and investigate if visceral hyperadiposity, evaluated by waist circumference (WC), is an effect modifier of this association. Subjects and methods: Cross-sectional analysis with 468 young adults from the fourth follow-up of the 1978/79 Ribeirão Preto prospective birth cohort, Brazil. BMD, total osteocalcin (OC), fasting plasma glucose and insulin concentrations were assessed. IR, sensitivity (S) and secretion (β) were estimated by homeostasis model assessment (HOMA) indexes. Multiple linear regression models were constructed to estimate the association between BMD and glucose metabolism. Beta coefficient, R2 and p-values were provided. WC was tested as an effect modifier and OC as a confounder. The covariates were selected based on Direct Acyclic Graph. Results: Significant interaction between BMD (femoral neck and proximal femur areas) and WC on glucose metabolism was observed in the adjusted models. Subjects with increased WC presented a positive association between BMD and log HOMA1-IR while an inverse association was found in those with normal WC (femoral neck R2 = 0.17, p = 0.036; proximal femur R2 = 0.16, p = 0.086). BMD was negatively associated with log HOMA2-S in individuals with increased WC and positively in those with normal WC (femoral neck R2 = 0.16, p = 0.042; proximal femur R2 = 0.15, p = 0.097). No significant associations between BMD, log HOMA2-β and OC and glucose metabolism markers were observed. Conclusions: BMD was associated with glucose metabolism, independently of OC, and WC modifies this association.

Leptin: molecular mechanisms, systemic pro-inflammatory effects, and clinical implications / Leptina: mecanismos moleculares, efeitos pró-inflamatórios sistêmicos e implicações clínicas

Leptin, the adipokine produced mainly by the white adipose tissue, plays important roles not only in the regulation of food intake, but also in controlling immunity and inflammation. It has been widely demonstrated that the absence of leptin leads to immune defects in animal and human models, ultimately increasing mortality. Leptin also regulates inflammation by means of actions on its receptor, that is widely spread across different immune cell populations. The molecular mechanisms by which leptin determines its biological actions have also been recently elucidated, and three intracellular pathways have been implicated in leptin actions: JAK-STAT, PI3K, and ERK 1/2. These pathways are closely regulated by intracellular proteins that decrease leptin biological activity. In this review, we discuss the molecular mechanisms by which leptin regulates immunity and inflammation, and associate those mechanisms with chronic inflammatory disorders. Arq Bras Endocrinol Metab. 2012;56(9):597-607.

A leptina, uma adipocina produzida principalmente pelo tecido adiposo branco, tem um papel importante não somente na regulação da ingestão alimentar, mas também no controle da imunidade e da inflamação. Já foi amplamente demonstrado que a ausência de leptina causa deficiências imunológicas em modelos animais e em humanos, levando ao aumento da mortalidade. A leptina também regula a inflamação por meio da ação em seu receptor, amplamente distribuído em diversos tipos de células do sistema imunológico. Os mecanismos moleculares pelos quais a leptina determina suas ações biológicas foram recentemente elucidados, e três cascatas intracelulares são ativadas pela leptina: JAK-STAT, PI3K e ERK 1/2. Essas cascatas são reguladas por proteínas intracelulares, reduzindo as ações da leptina. Nesta revisão, são discutidos os mecanismos moleculares pelos quais a leptina regula a imunidade e a inflamação, associando-os a enfermidades inflamatórias crônicas. Arq Bras Endocrinol Metab. 2012;56(9):597-607.

Manejo del drenaje recuperador y autotransfusor de sangre tipo Bellovac ABT / Handling of a Bellovac ABT drainage recuperation-blood auto transfusion device

Se exponen las características del drenaje recuperador-autotransfusor de sangre tipo Bellovac ABT, así como su manejo adecuado y los cuidados de enfermería requeridos con el fin de minimizar los riesgos y proporcionar una óptima seguridad al paciente. También se exponen las complicaciones potenciales y se discuten las principales ventajas e incovenientes de este tipo de drenaje(AU)

The authors describe the characteristics of the Bellovac ABT drainage recuperation - blod auto transfusion device along with its proper handling and the required nurses´ care in order to minimize the risks and to provide optimun safety for patients. The authors also explain the potential complications and they discuss the main advantages this type of drainage has(AU)

Pancreatitis crónica / Chronic pancreatitis

La pancreatitis crónica es una enfermedad multifactorial.Las mutaciones en el gen de la quimotripsina C pueden favorecerel desarrollo de pancreatitis crónica. El hábito defumar es un importante factor asociado al desarrollo y evoluciónde la pancreatitis crónica. Es necesario categorizarlos signos identificados en la ecoendoscopia a la hora dediagnosticar una pancreatitis crónica, ya que no todos tienenel mismo valor diagnóstico. La pancreatitis autoinmunitariatiene manifestaciones clínicas más variadas que lasdescritas inicialmente y varían según la población estudiada.Los criterios utilizados para el diagnóstico de la pancreatitisautoinmunitaria no son del todo precisos y su tratamientopuede requerir del uso de inmunomoduladores. El tratamientocon antioxidantes tiene efectos beneficiosos a largoplazo en pacientes con pancreatitis crónica. Algunas manifestacionesclínicas en pacientes con síndrome del intestinoirritable pueden tener su origen en una insuficiencia pancreáticano identificada. Un estudio con cápsula endoscópicamuestra que la fibrosis quística presenta signos de enteropatíaen el intestino delgado(AU)

Chronic pancreatitis is a multifactorial disease. Mutations inthe chymotrypsin C gene may encourage the development ofchronic pancreatitis. Smoking is an important factor in thedevelopment and progression of chronic pancreatitis. Thesigns identified in endoscopic ultrasound should be categorizedwhen diagnosing chronic pancreatitis, since not all havethe same diagnostic value. The clinical manifestations of autoimmunepancreatitis are more varied than initially describedand depend on the population studied. The criteria usedfor the diagnosis of autoimmune pancreatitis have not beenwell defined and treatment may require the use of immunomodulators.Antioxidant therapy has beneficial effects in thelong term in patients with chronic pancreatitis. Some clinicalmanifestations found in patients with irritable bowelsyndrome may be caused by unidentified pancreatic insufficiency.Capsule endoscopy shows that cystic fibrosis presentssigns of small bowel enteropathy(AU)

Prevención de la isoinmunización materna al RhD, con gamma-globulina anti-D / Prevention of maternal RhD isoimmunization with anti-D gamma globulin

Objetivo. Presentar la experiencia institucional en la prevención de la isoinmunización al RhD, mediante el empleo de 150 µg de g-globulina anti-D en las mujeres Rh negativo. Material y métodos. Se registraron los antecedentes inmunohematológicos de los casos consecutivos de todas las mujeres Rh negativo que acudieron, para su atención médica, al Instituto Nacional de Perinatología entre 1982 y 1995. A las mujeres con riesgo de isoinmunización se les aplicó 150 µg de g-globulina anti-D, con fines preventivos. Resultados. En el periodo de estudio ingresaron 4 857 mujeres Rh ne-gativo (4.85 por ciento del total de mujeres), de las cuales 629 (13.0 por ciento), presentaron isoinmunización al RhD. De estas últimas, 542 (86.2 por ciento) ya se encontraron isoinmu-nizadas desde antes de su ingreso al Instituto. En 22 casos (3.5 por ciento), la isoinmunización ocurrió a pesar de que recibie-ron la dosis adecuada de g-globulina anti D. De las 2 605 pacientes (53.6 por ciento) sometidas a prevención, a 2 039 se les aplicó una sola dosis, y a 475, hasta dos dosis. En 22 casos se documentó la falla de la prevención; sin embargo, en cua-tro de ellos, se registraron embarazos múltiples, y los restantes 18 presentaron patología obstétrica asociada. Conclusiones. Mediante este programa de prevención, consistente en administrar 150 µg de g-globulina anti-D por dosis, es posible reducir la iso-inmunización a menos de un caso por cada 1 000 mujeres. Los fracasos en la prevención de la isoinmunización se asociaron a condiciones obstétricas agregadas y al incumplimiento de las guías o lineamientos del programa. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html