Abdominal Obesity and Type 2 Diabetes Mellitus are Associated With Higher Seric Levels of IL 4 in Adults.

AIMS: Study of IL4 in relation to the anthropometric, biochemical and immunological parameters in patients with obesity and/or diabetes. METHODS: The relationship between IL4 and clinical and biological parameters was studied in 76 patients divided into 4 groups: obese diabetics (OD), n = 25; obese without diabetes (O), n = 25; non obese diabetics (NOD), n = 11; controls (M), n = 15. IL4 was determined using the ELISA method. Statistical analysis was done using the MedCalc statistical software, version 16.1. RESULTS: Serum IL4 was 0.38 ±0,40 pg / mL in the Control group, 0.366 (0,100-2,35) pg / ml in group O, 4.66±3.73 pg / ml in group OD, 0.30 (0.10-1.35) pg / ml in NOD. When IL4 levels were compared between the four groups, statistical significance was reached for the comparison between groups OD and M. Statistically significant correlations were detected between IL4 and age, waist circumference and hip circumference, blood glucose, glycated hemoglobin (HbA1c), VLDL, triglycerides and serum protein fraction ß1. In univariate regression, the IL4 level predictors were age, height, BMI, abdominal circumference, hip circumference, beta 1% glucose, HbA1c, total lipids, total cholesterol, VLDL triglycerides, CRP. In multivariate regression, waist circumference and glycemia were significant predictors of levels of IL4 (p = 0.0001).

Correlation between Tgf-Β1 and Fsp-1 Expression in Chronic Viral Hepatitis - an Immunohistochemical Study.

Infection with hepatitis C virus (HCV) is the most important stimulus for chronic hepatitis and subsequent progression to cirrhosis and hepatocellular carcinoma. Fibrosis that follows inflammation represents the main complication. One of the mechanisms that could be associated with development of liver fibrosis is epithelial-mesenchymal transition (EMT). Transforming Growth Factor ß1 (TGF-ß1) is an important mediator of fibrosis and also able to trigger phenotypic changes in EMT. Fibroblast-specific protein 1 (FSP-1), a marker of fibroblasts in organs undergoing tissue remodeling, is used to identify cells that derive from EMT. In this study, we assessed the expression of TGF-ß1 and FSP-1 in liver biopsies obtained from HCV-infected patients using immunohistochemistry and correlated them in order to evaluate the relation between fibrosis and EMT in liver disease progression. Staining of liver sections revealed increased amount of type III collagen and clusters of inflammatory cells invading portal spaces. The number of TGF-ß1-positive cells was directly proportional to the incidence of liver injury. In cases of mild fibrosis, FSP-1 positive cells were observed in cells lining sinusoids. As fibrosis progressed, increased number of FSP-1 positive fibroblasts, isolated cholangiocytes and hepatocytes was observed. Even EMT via the activation of TGF-ß signaling pathway is recognized as a pathogenic mechanism of HCV-induced liver disease, FSP-1 alone couldn't be used as a valuable marker for cells that undergo EMT.

Teamwork behaviours and errors during neonatal resuscitation.

OBJECTIVE: To describe relationships between teamwork behaviours and errors during neonatal resuscitation. METHODS: Trained observers viewed video recordings of neonatal resuscitations (n = 12) for the occurrence of teamwork behaviours and errors. Teamwork state behaviours (such as vigilance and workload management, which extend for some duration) were assessed as the percentage of each resuscitation that the behaviour was observed and correlated with the percentage of observed errors. Teamwork event behaviours (such as information sharing, inquiry and assertion, which occur at specific times) were counted in 20-s intervals before and after resuscitation steps, and a generalised linear mixed model was calculated to evaluate relationships between these behaviours and errors. RESULTS: Resuscitation teams who were more vigilant committed fewer errors (Spearman's rho for vigilance and errors = -0.62, 95% CI -0.07 to -0.87, p = 0.031). Assertions were more likely to occur before errors than correct steps (OR = 1.44, 95% CI 1.10 to 1.89, p = 0.008) and teaching/advising occurred less frequently after errors (OR = 0.59, 95% CI 0.37 to 0.94, p = 0.028). Though not statistically significant, there was less information sharing before errors (OR = 0.90, 95% CI 0.77 to 1.05, p = 0.172). CONCLUSIONS: Vigilance is an important behaviour for error management. Assertion may have caused errors, or perhaps was an indicator for some other factor that caused errors. Teams may have preferred to resolve errors directly, rather than using errors as opportunities to teach their teammates. These observations raise important questions about the appropriate use of some teamwork behaviours and how to include them in team training programmes.

Tromboembolismo pulmonar: anticoagulação ou trombólise? / Pulmonary thromboembolism: anticoagulation or thrombolysis?

A terapia trombolítica é freqüentemente indicada nos pacientes com tromboembolismo pulmonar grave, principalmente naqueles que se apresentam com instabilidade hemodinâmica, hipoxemia grave e sinais de falência do ventrículo direito ao ecocardiograma. Nas últimas três décadas, vários estudos demonstraram a superioridade da terapia trombolítica, seja com a estreptoquinase, a uroquinase, ou a rt-PA, na restauração precoce da perfusão pulmonar. A rápida lise do trombo é acompanhada pela redução da hipertensão pulmonar e dos achados ecocardiográficos compatíveis com elevação da pós-carga do ventrículo direito. Entretanto, o impacto da terapia trombolítica em relação à heparina na sobrevida dos pacientes sem sinais de instabilidade hemodinâmica, especialmente na mortalidade hospitalar, recorrência e riscos de sangramento, não está esclarecido e tem sido motivo de recentes estudos multicêntricos. Os pacientes com sinais de instabilidade clínica também deverão ser considerados para tratamento trombolítico, respeitando-se as contra-indicaçöes de seu uso geral.

Hypomagnesemia is a frequent finding in the emergency department in patients with chest pain.

STUDY OBJECTIVE: To evaluate the frequency of low blood levels of total and ultrafilterable magnesium (total and ultrafilterable hypomagnesemia) in patients with chest pain in the emergency department, and to determine if hypomagnesemia is associated with other clinically important diagnostic and outcome variables in cardiac care. SETTING: An emergency department of a university teaching hospital. DESIGN: Prospective study of extracellular magnesium homeostasis in patients with chest pain in the emergency department and a cohort of patients without chest pain with a clinical indication for blood sampling. PATIENTS: During a 4-month period, 147 patients presenting to the emergency department were studied: 67 patients (mean +/- SD age, 61.4 +/- 13 years) with a chief complaint of chest pain (study group) and 80 patients (55.6 +/- 19 years) with other diagnoses (control group). RESULTS: Total and ultrafilterable hypomagnesemia occurred more frequently in patients with chest pain (20/67 [30%] and 9/67 [13%]) than in the control group (12/80 [15%] and 3/80 [4%]). Patients with a chief complaint of chest pain who were receiving diuretic medications were hypomagnesemic more frequently (9/16 [56%]) than patients not receiving diuretics (12/51 [23%]). In patients with chest pain admitted to the hospital with a diagnosis of "rule out" myocardial infarction, the frequency of hypokalemia was greater among hypomagnesemic patients (6/14 [43%]) than normomagnesemic patients (3/31 [10%]). A similar frequency of hypomagnesemia was noted in patients with a final diagnosis of myocardial infarction (4/15 [27%]) when compared with other patients admitted with chest pain (10/31 [32%]) in whom myocardial infarction was excluded. No association was noted among hypomagnesemia and length of hospital stay or the occurrence of hypotension or dysrhythmias. CONCLUSIONS: Total and ultrafilterable hypomagnesemia are frequent occurrences in patients with and without chest pain in the emergency department. Diuretic use is associated with hypomagnesemia in patients presenting with chest pain in the emergency department. These results support the concept that hypomagnesemia is common in patients with chest pain in the emergency department and is associated with hypokalemia but is not predictive of whether the patient with chest pain has had an acute myocardial infarction.

Reliability of right atrial pressure monitoring to assess left ventricular preload in critically ill septic patients.

Right atrial pressure (RAP) can be used as a guide to fluid therapy in critical care settings. RAP and pulmonary capillary wedge pressure (WP) were measured in 27 septic patients without cardiac disease and on mechanical ventilation. An r of .61 was obtained with a regression line defined by the equation WP = 7.38 + (0.53 x RAP) +/- 3.15. However, a large SD of data points can invalidate the clinical usefulness of this equation. The reliability of various RAP interval values in predicting optimal WP was then studied in these patients. We concluded that RAP values less than or equal to 5 mm Hg were highly specific (97%) in predicting low or normal WP (less than or equal to 12 mm Hg).