Evidence for a Pro-Inflammatory State of Macrophages from Non-Obese Type-2 Diabetic Goto-Kakizaki Rats.

Obesity causes insulin resistance (IR) through systemic low-grade inflammation and can lead to type 2 diabetes mellitus (T2DM). However, the mechanisms that cause IR and T2DM in non-obese individuals are unclear. The Goto-Kakizaki (GK) rat develops IR spontaneously and is a model of non-obese T2DM. These rats exhibit hyperglycemia beginning at weaning and exhibit lower body mass than control Wistar rats. Herein, we tested the hypothesis that macrophages of GK rats are permanently in a pro-inflammatory state, which may be associated with a systemic inflammation condition that mimics the pathogenesis of obesity-induced T2DM. Using eighteen-week-old GK and control Wistar rats, we investigated the proportions of M1 (pro-inflammatory) and M2 (anti-inflammatory) macrophages isolated from the peritoneal cavity. Additionally, the production of inflammatory cytokines and reactive oxygen species (ROS) in cultured macrophages under basal and stimulated conditions was assessed. It was found that phorbol myristate acetate (PMA) stimulation increased GK rat macrophage ROS production 90-fold compared to basal levels. This response was also three times more pronounced than in control cells (36-fold). The production of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), tended to be upregulated in cultured macrophages from GK rats under basal conditions. Macrophages from GK rats produced 1.6 times more granulocyte-macrophage colony-stimulating factor (GM-CSF), 1.5 times more monocyte chemoattractant protein-1 (MCP-1) and 3.3 times more TNF-α than control cells when stimulated with lipopolysaccharide (LPS) (p = 0.0033; p = 0.049; p = 0.002, respectively). Moreover, compared to control cells, GK rats had 60% more M1 (p = 0.0008) and 23% less M2 (p = 0.038) macrophages. This study is the first to report macrophage inflammatory reprogramming towards a pro-inflammatory state in GK rats.

Insulin resistance in nonobese type 2 diabetic Goto Kakizaki rats is associated with a proinflammatory T lymphocyte profile.

Goto-Kakizaki (GK) rats develop a well-defined insulin resistance (IR) and type 2 diabetes mellitus (T2DM) without presenting obesity. The lymphocyte profile in nonobese diabetic conditions is not yet characterized. Therefore, GK rats were chosen to explore T lymphocyte (TL) dynamics at various stages (21, 60, and 120 days) compared to Wistar rats. GK rats exhibit progressive disruption of glucose regulation, with early glucose intolerance at 21 days and reduced insulin sensitivity at 60 days, confirming IR. Glucose transporter 1 (GLUT1) expression was consistently elevated in GK rats, suggesting heightened TL activation. T-regulatory lymphocyte markers diminished at 21 days. However, GK rats showed increased Th1 markers and reduced Gata-3 expression (crucial for Th2 cell differentiation) at 120 days. These findings underscore an early breakdown of anti-inflammatory mechanisms in GK rats, indicating a proinflammatory TL profile that may worsen chronic inflammation in T2DM.

Factors associated with the absence of postpartum consultations in a high-risk population.

Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

Insulin resistance in nonobese type 2 diabetic GotoKakizaki rats is associated with a proinflammatoryT lymphocyte profile

Goto-Kakizaki (GK) rats develop a well-defined insulin resistance (IR) andtype 2 diabetes mellitus (T2DM) without presenting obesity. The lymphocyteprofile in nonobese diabetic conditions is not yet characterized. Therefore,GK rats were chosen to explore T lymphocyte (TL) dynamics at variousstages (21, 60, and 120 days) compared to Wistar rats. GK rats exhibit progressive disruption of glucose regulation, with early glucose intolerance at21 days and reduced insulin sensitivity at 60 days, confirming IR. Glucosetransporter 1 (GLUT1) expression was consistently elevated in GK rats, sug-gesting heightened TL activation. T-regulatory lymphocyte markers dimin-ished at 21 days. However, GK rats showed increased Th1 markers andreduced Gata-3 expression (crucial for Th2 cell differentiation) at 120 days.These findings underscore an early breakdown of anti-inflammatory mecha-nisms in GK rats, indicating a proinflammatory TL profile that may worsenchronic inflammation in T2DM.

Factors associated with the absence of postpartum consultations in a high-risk population

Abstract Objective: To assess the rate of missed postpartum appointments at a referral center for high-risk pregnancy and compare puerperal women who did and did not attend these appointments to identify related factors. Methods: This was a retrospective cross-sectional study with all women scheduled for postpartum consultations at a high-risk obstetrics service in 2018. The variables selected to compare women were personal, obstetric, and perinatal. The variables of interest were obtained from the hospital's electronic medical records. Statistical analyses were performed using the Chi-square, Fisher's exact, or Mann-Whitney tests. For the variable of the interbirth interval, a receiver operating characteristic curve (ROC) was used to best discriminate whether or not patients attended the postpartum consultation. The significance level for the statistical tests was 5%. Results: A total of 1,629 women scheduled for postpartum consultations in 2018 were included. The rate of missing the postpartum consultation was 34.8%. A shorter interbirth interval (p = 0.039), previous use of psychoactive substances (p = 0.027), current or former smoking (p = 0.003), and multiparity (p < 0.001) were associated with non-attendance. Conclusion: This study showed a high rate of postpartum appointment non-attendance. This is particularly relevant because it was demonstrated in a high-risk obstetric service linked to clinical severity or social vulnerability cases. This highlights the need for new approaches to puerperal women before hospital discharge and new tools to increase adherence to postpartum consultations, especially for multiparous women.

Cutaneous infection by Mycobacterium lentiflavum after subcutaneous injection of lipolytic formula

Abstract The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. Mycobacterium lentiflavum is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by M. lentiflavum is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.

Cutaneous infection by Mycobacterium lentiflavum after subcutaneous injection of lipolytic formula.

The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. Mycobacterium lentiflavum is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by M. lentiflavum is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.

Efetividade do tratamento antirretroviral nas primeiras 48 semanas após seu início, Belo Horizonte, Minas Gerais - 2010 a 2013 / Effectiveness of antiretroviral treatment in the first 48 weeks after its beginning, Belo Horizonte, Minas Gerais - 2010 to 2013

Introdução: Após mais de 30 anos da epidemia e apesar de grandes conquistas, o impacto da infecção HIV/Aids representa ainda grande problema em todo o mundo, permanecendo como um desafio a ser vencido. Método: Trata-se estudo de coorte que avalia a efetividade da terapia antirretroviral (TARV) no primeiro ano de sua introdução. Analisou-se apenas efetividade através da quantificação da carga viral (CV) 48 semanas após o início. Trocas relacionadas à intolerância e evento adverso não foram consideradas falha terapêutica. O estudo foi conduzido no Serviço de Referência em Doenças Infecto-parasitárias (CTR/DIP) Orestes Diniz, em Belo Horizonte, MG, entre outubro de 2010 e janeiro de 2013. Foram incluídos 182 pacientes que preencheram os critérios inclusão. Resultados: Houve predomínio do sexo masculino, maioria abaixo 50 anos. Encontrou-se elevada prevalência de grupos de maior vulnerabilidade para exposição ao HIV, como homens que fazem sexo com homens, que representavam 43,4% da amostra do estudo. A efetividade geral, avaliada através da proporção de CV < limite de detecção, foi 91% (166/182). Análises univariada e multivariada não encontraram associação entre variáveis estudadas e a efetividade do tratamento. Conclusão: Observou-se alta taxa sucesso terapêutico avaliado através da CV, entretanto o grande desafio é a manutenção dos indivíduos no cuidado e adesão ao tratamento. Destaca-se também menor percentual de início tardio da TARV em relação outros estudos brasileiros, entretanto, ainda elevado em relação aos países desenvolvidos. Apesar disso, as respostas imunovirológicas foram superiores às descritas pelo Ministério da Saúde e alguns estudos de eficácia. (AU)

Introduction: After more than 30 years of epidemic and despite all achievements, HIV infection represents healthy problem that still has to be faced. Methods: It is cohort study that analyzes the efficacy of TARV after a year of use. It has studied the effectiveness through the quantification of viral load (VL) change after 48 weeks of use. The changes related to intolerance or adverse effects were not considered as therapeutic failure. The study was conduced in outpatient clinic in Belo Horizonte, MG. It was include 182 patients with HIV that fulfilled the inclusion criteria. Results: There were found 91% of efficacy. There were more male patients, and the majority was younger than 50 years. The vulnerable group, like men who have sex with men, was the majority (43.4%). Conclusion: There was a high rate of therapeutic success assessed by VL. However, the biggest challenge is the maintenance of the patients in the treatment. This study also highlights the lower percentage of late onset of TARV compared with other Brazilian studies. Unfortunately, our percentage is s higher compared with develop countries. Despite of that, immune and viral response in this study was higher than the values described by Ministry of Health. It is important to remember that our study did not considered the change of initial antiretroviral treatment due intolerance or toxicity as a failed and that could had increased the success rate of this cohort. (AU)

Emergência do vírus Influenza A-H1N1 2009 no Brasil: a propósito do primeiro caso humano de doença respiratória aguda grave em Minas Gerais / Emergency in influenza A-H1N1 in 2009 in Brazil: about the first human case of severe acute respiratory disease in Minas General

Este relato apresenta as características clínico-epidemiológicas do primeiro caso de doença respiratória aguda grave pelo vírus Influenza A-H1N1 2009 registrado em Minas Gerais, com melhora após 68 dias de internação hospitalar. O paciente era do gênero masculino, Terceira década de vida, com índice de massa corpórea entre 30 e 40, sem outras comorbidades. A internação hospitalar foi necessária devido ao desenvolvimento, em uma semana desde o início de sua sintomatologia, de dispneia de rápida progressão para insuficiência respiratória e necessidade de suporte de ventilação mecânica (VM) devido à síndrome de angústia respiratória do adulto. Houve também o surgimento de rabdomiólise e insuficiência renal aguda. O início da sintomatologia ocorreu por volta da 24a semana epidemiológica, em Belo Horizonte (Minas Gerais), sem contato aparente com caso suspeito ou comprovado. A característica sintomatológica inicial foi de aumento da temperatura corpórea, tosse, mialgia, e rinorreia. A telerradiografia de tórax revelou inicialmente consolidação na base direita, com progressão rápida para múltiplas consolidações em vários lobos, sem aumentoda área cardíaca. Os parâmetros necessários para a VM, que perdurou por 40 dias, foram de pressão expiratória final positiva de 20 cmH2O, fração inspirada de oxigênio de 100 por cento, pressão inspiratória de 37 cmH2O, relação inspiração/expiração de 1:1,5 e saturimetria de pulso de 75 por cento. Surgiu hipotensão após a sedação para a intubação, revertida pela infusão de 1.000 mL de NaCl 0,9 por cento e norepinefrina. A terapia de substituição da função renal foi necessária durante 27 dias e realizada por intermédio da hemodiálise. O oseltamivir foi administrado por sete dias. Houve o desenvolvimento de infecções hospitalares associadas aos seguintes agentes: Enterococcus faecalis, Acinetobacter baumannii meticilina-resistente e Candida albicans. Os antibióticos e antifúngicos usados, em algum momento de sua evolução, foram...

Emergência do vírus influenza A-H1N1 no Brasil: a propósito do primeiro caso humano em Minas Gerais / Emergence of influenza A-H1N1 virus in Brazil: the purpose of the first human case in Minas Gerais

Este relato apresenta as características clínico-epidemiológicas do primeiro caso de infecção pelo vírus influenza A-H1N1 registrado em Minas Gerais. A internação hospitalar foi realizada com todos os cuidados de controle respiratório, em quarto com pressão negativa e de contacto. A paciente esteve em Cancun (México) em viagem de lazer, retornando a Belo Horizonte com sintomatologia caracterizada por tosse, rinorreia, mal-estar, permanecendo 36 horas em contacto com seus familiares até procurar atenção médica, quando foi internada. Evoluiu com melhora progressiva, permanecendo internada por 10 dias. Ao final desse período, estava restabelecida, sem queixas ou anormalidades. Não houve sintomatologia em seus familiares em Belo Horizonte. Seu marido, que esteve sempre ao seu lado, também apresentou sintomatologia semelhante, sem ter sido isolado o vírus influenza A H1N1.

This report presents the clinical and epidemiological characteristics of the first case of infection with influenza A virus H1N1-registered in Minas Gerais. The hospital has carefully conducted the respiratory control in room with negative pressure and contact. The patient has been in Cancun (Mexico) on a leisure trip, returning to Belo Horizonte with symptoms characterized by cough, rhinorrhea, malaise, staying for 36 hours in contact with relatives to seek medical attention when she was hospitalized. Evolved with progressive improvement and remained in hospital for 10 days. At the end of this period she was recovered, without complaints or abnormalities. There was no report of symptoms in the relatives in Belo Horizonte. Her husband who has always been at her side has also presented similar symptoms and has been isolated with the virus influenza A H1N1.