Tissue-specific adaptive levels of glucocorticoid receptor alpha mRNA and their relationship with insulin resistance.

Insulin resistance is an underlying cause of metabolic changes associated with cardiovascular diseases. Glucocorticoids are known determinant factors of insulin resistance. We quantified glucocorticoid receptor alpha (GRα) mRNA and 11 beta-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) mRNA in various tissues of 35 patients with previously established cardiovascular disease. This was a prospective study in a cardiac surgery patient setting. Samples of subcutaneous adipose tissue, epicardial fat, muscle, and peripheral blood mononuclear cells were examined. GRα and 11ß-HSD1 mRNA were determined by real-time PCR. Mean age was 54.4 years. A significantly higher level of GRα mRNA was observed in muscle, with mean = 43.6 arbitrary units, median (p25-p75) = 39.4, compared to epicardial adipose tissue, with mean = 34.2, median (p25-p75) = 27.6, and to subcutaneous adipose tissue, with mean = 29.0, median (p25-p75) = 19.0, and lymphocytes, with mean = 17.5, median (p25-p75) = 14.02. When patients with diabetes mellitus were compared to patients without insulin resistance, significantly lower levels of GRα mRNA were observed in epicardial fat. Lymphocytes had the lowest 11ß-HSD1 mRNA concentration. We also observed significantly reduced 11ß-HSD1 mRNA levels in visceral fat when compared with muscle tissue. GRα and 11ß-HSD1 mRNA levels differed among tissues involved in the pathophysiology of metabolic syndrome. We conclude that epicardial adipose tissue has lower GRαmRNA levels in insulin-resistant patients; this seems to be an adaptive and protective mechanism.

Quantitation of glucocorticoid receptor alpha and NF-κB pathway mRNA and its correlation with disease activity in rheumatoid arthritis patients.

We measured NF-κB, IKK, c-Fos, and GRα mRNA expression and in vivo glucocorticoid sensitivity in patients with rheumatoid arthritis. A very low dose intravenous dexamethasone suppression test and real-time PCR quantitation of mRNA of these genes were performed on blood samples from 21 rheumatoid arthritis patients who were not on glucocorticoids during the previous four months and on blood samples from 20 healthy individuals. Mean rheumatoid arthritis duration was 8.8 years, and mean disease activity, as assessed by Disease Activity Score 28 (DAS28), was 4.45. Basal cortisol and the percentage of cortisol reduction after the very low dose intravenous dexamethasone suppression test, as well as NF-κB, IKK, c-Fos, and GRα mRNA expression, were similar among groups. We did not observe significant correlations between glucocorticoid in vivo sensitivity and DAS28. There was a positive correlation between DAS28 and NF-κB, IKK, and GRα, but not c-Fos. In the multivariate analysis, only NF-κB mRNA remained as an independent variable for predicting DAS28.

[Non-verbal communication in nurse-user interactions in mental health care]. / A comunicação não-verbal nas interações enfermeiro-usuário em atendimentos de saúde mental.

On this exploratory-description study, we analyzed the nurse's nonverbal communication during 11 interactions in mental illness attendance. We came to the conclusion that among nonverbal sins observed, a greater number used to the feelings demonstration, the codified especially, as interest, attention, quietness/relaxing, tension/fear, indifference, anxiety and irritation. We identified also the nonverbal contradicting the verbal, alerting us that the contradictory of sending messages can give a double or distorted understanding of the message sent. In our perception, most of the nurses researched are not enough attentive to realize consciously how much the nonverbal way of communicating can influence on assistance and humanization of attendance.

[Risk stratification in acute myocardial infarction survivors. Exercise stress test versus coronary angiography]. / Estratificação prognóstica em sobreviventes ao infarto agudo do miocárdio. Teste ergométrico versus cinecoronariografia.

PURPOSE: To compare the predictive accuracy for future ischemic events of heart rate limited treadmill exercise test (HET) and coronary angiography (CA) applied to survivors of an uncomplicated myocardial infarction. METHODS: 142 consecutive patients (55 +/- 11 years, 80% males), presenting a non complicated acute myocardial infarction (AMI) were included. HET was performed 10 +/- 3 days after AMI, and CA during hospital stay or within 4-6 weeks. HET positivity criteria were: 1) horizontal or down-sloping ST segment displacement > or = 1 mm; 2) angina; 3) arterial pressure drop during exercise; 4) low workload (< 6 METS); 5) complex ventricular arrhythmia. At CA lesions causing > or = 50% of luminal reduction were considered significant. HET and CA results were correlated to ischemic events occurring during the follow-up (unstable angina in 20%, cardiac death 6%, and reinfarction 6%). RESULTS: HET was positive in 69 (49%) patients, exhibiting a positive predictive value for ischemic events (PV+) of 26% and a negative predictive value (PV-) of 77%. The mean event-free time was 43 +/- 3 months for positive HET and 46 +/- 3 months for a negative one (p = 0.48). CA showed 0-1 vessel involvement in 93 (66%) patients and > or = 2 vessels in 49 (34%) patients. The presence of multivascular disease at CA presented a PV+ of 37% and PV- of 82%; the mean event-free time was 37 +/- 4 months for patients with multivascular involvement and 48 +/- 2 months for patients without this pattern (p = 0.007). CONCLUSION: The predictive accuracy of HET for future ischemic events in the thrombolytic era is markedly reduced. This population of AMI survivors presents an overall good prognosis that seems to justify the poor predictive accuracy of this test.

Esclerose lateral amiotrófica: variante distal dos membros inferiores; apresentaçäo de três casos / Amyotrophic lateral sclerosis: distal variant of the lower extremities; report of 3 cases

Os autores apresentam três casos de pacientes com esclerose lateral amiotrófica, variante de patrikios, chamando a atençäo para a importância do diagnóstico diferencial desta com as neuropatias periféricas

Anestesia com quetamina para cateterismo cardíaco em pacientes pediátricos / Ketamine for cardiac catheterization in pediatric patients

É apresentada uma série de 22 pacientes pediátricos, com idade média de 30,9 ñ 8,9 meses, submetidos a cateterismo cardíaco para estudo de defeitos congênitos, sob anestesia geral com quetamina. O anestésico foi administrado segundo um de três regimes: A) dose única (8 mg.Kg-1) por via muscular; b) dose inicial 2 mg.Kg-1 venosa e doses suplementares venosas 1-2 mg.Kg-1; c) dose inicial por via muscular 8 mg.Kg-1 e doses suplementares venosas 1-3 mg.Kg-1. A estabilidade cardiovascular, a ausência de depressäo respiratóriia e a facilidade de administraçäo tornam o método efetivo para a anestesia de crianças encaminhadas a cateterismo cardíaco