Riesgos y complicaciones asociados al embarazo en la adolescencia / Risks and complications associated with pregnancy in adolescent ages

RESUMEN Introducción: el embarazo en la adolescencia constituye un problema de salud en el mundo, repercute en la sociedad y compromete la salud de la madre y del feto. Objetivo: describir los factores de riesgos y complicaciones asociados al embarazo en la adolescencia. Métodos: se realizó una revisión bibliográfica sobre el embarazo en la adolescencia. Se expresó criterios de autores y resultados de investigaciones disponibles en las bases de datos SciELO, Medline, PubMED. Se empleó un total de 30 referencias bibliográficas, más del 75 % de la literatura consultada corresponde a los últimos cinco años. Desarrollo: el embarazo en la adolescencia no tiene causa específica. En su desarrollo inciden factores de riesgos individuales, familiares y socioeconómicos. Las complicaciones del embarazo en edades tempranas son frecuentes, constituyen un alto riesgo obstétrico pues compromete la vida de la madre y el feto. Las complicaciones se asocian fundamentalmente a las características biológicas de la madre y a la edad gestacional que presenta. Conclusiones: los principales factores de riesgos asociados con el embarazo adolescente están relacionados con el inicio precoz de las relaciones sexuales, la deficiente educación sexual y los conflictos con la familia. Las complicaciones más significativas asociadas a gestantes adolescentes son la enfermedad hipertensiva gestacional, los traumas obstétricos del parto, el recién nacido pretérmino y el bajo peso. La prevención de los factores de riesgos, desarrollar una correcta educación sexual por la familia, la sociedad y los profesionales de la salud, favorecerá a la disminución de los embarazos en edades tempranas.

ABSTRACT Introduction: pregnancy in adolescent age constitutes a health problem all over the world, having repercussion throughout the society and affecting the health of the mother and the fetus. Objective: to describe the risk factors and complications associated with pregnancy in adolescent age. Methods: a bibliographic review with reference to pregnancy in adolescent age was carried out. The criteria of the authors and the results of the available researches in SciELO, Medline, PubMED databases were expressed; using a total of 30 bibliographic references, more than 75 % of the consulted literature corresponded to the last 5 years. Development: pregnancy in adolescent ages has not a specific cause. In its increase individual, familial and socioeconomic risk factors influence. Complications in pregnancy at early ages are frequent, and constitute a high obstetric risk affecting the life of the mother and the fetus. Complications are mainly associated with the biological characteristics of the mother and her gestational age. Conclusions: the main risk factors associated with pregnancy in adolescent ages are related to early initiation of sexual relations, poor sexual education and conflicts with the family. The most significant complications associated with pregnancy in adolescent ages are gestational hypertensive disease, obstetric trauma of delivery, preterm newborn and low birth weight (LBW). The prevention of risk factors, to develop a correct sexual education by the family, the society and the healthcare professionals will favor to decrease the rates of pregnancy in early ages.

Growth Failure Prevalence in Neonates with Gastroschisis : A Statewide Cohort Study.

OBJECTIVES: To perform a multicenter study to assess growth failure in hospitalized infants with gastroschisis. STUDY DESIGN: This study included neonates with gastroschisis within sites in the University of California Fetal Consortium. The study's primary outcome was growth failure at hospital discharge, defined as a weight or length z score decrease >0.8 from birth. Regression analysis was performed to assess changes in z scores over time. RESULTS: Among 125 infants with gastroschisis, the median gestational age was 37 weeks (IQR 35-37). Length of stay was 32 days (23-60); 55% developed weight or length growth failure at discharge (28% had weight growth failure, 42% had length growth failure, and 15% had both weight and length growth failure). Weight and length z scores at 14 days, 30 days, and discharge were less than birth (P < .01 for all). Weight and length z scores declined from birth to 30 days (-0.10 and -0.11 z score units/week, respectively, P < .001). Length growth failure at discharge was associated with weight and length z score changes over time (P < .05 for both). Lower gestational age was associated with weight growth failure (OR 0.70 for each gestational age week, 95% CI 0.55-0.89, P = .004). CONCLUSIONS: Growth failure, in particular linear growth failure, is common in infants with gastroschisis. These data suggest the need to improve nutritional management in these infants.

Prolonged Tracheal Intubation and the Association Between Patent Ductus Arteriosus and Bronchopulmonary Dysplasia: A Secondary Analysis of the PDA-TOLERATE trial.

In the PDA-TOLERATE trial, persistent (even for several weeks) moderate to large patent ductus arteriosus (PDA) was not associated with an increased risk of BPD when the infant required <10 days of intubation. However, in infants requiring intubation for ≥10 days, prolonged PDA exposure (≥11 days) was associated with an increased risk of moderate/severe BPD.

Second Language Learners' Listener Impressions of Foreigner-Directed Speech.

Background According to sociolinguistic frameworks such as Communication Accommodation Theory, English native speakers modify their speech to meet the communicative needs of non-native speakers (Beebe & Giles, 1984). However, when foreigner-directed speech is used inappropriately, it may lead to overaccommodation, which in turn can act counterproductively toward communicative goals. Purpose To date, much of the research on foreigner-directed speech toward non-native speakers has focused on its acoustic parameters, but few studies have examined how second language learners interpret it emotionally and pragmatically. Method This study asked 36 English second language learners to listen to four types of speech accommodation styles (casual, clear, infant-directed, and foreigner-directed) spoken by four different speakers. Their task was to evaluate the extent to which the speaker was easy to understand, competent, condescending, friendly, and respectful. Results Acoustic analyses of the speech stimuli showed that speakers used distinct acoustic cues for each speech accommodation style, for example, slower speech rate for foreigner-directed speech. The rating results show that second language learners of English judged casual speech as least intelligible, least competent, and least friendly compared to all other speech types. Respectfulness ratings show that participants perceived casual speech as less respectful compared to clear speech and infant-directed speech, but not foreigner-directed speech. However, no effects were found for condescension. Conclusion The results suggest second language learners in the current experiment generally perceived speech accommodation positively.

Lack of Equipoise in the PDA-TOLERATE Trial: A Comparison of Eligible Infants Enrolled in the Trial and Those Treated Outside the Trial.

The PDA: TO LEave it alone or Respond And Treat Early trial compared the effects of 2 strategies for treatment of patent ductus arteriosus (PDA) in infants <280/7 weeks of gestation; however 137 potentially eligible infants were not recruited and received treatment of their PDA outside the PDA-TOLERATE trial due to "lack-of-physician-equipoise" (LPE). Despite being less mature and needing more respiratory support, infants with LPE had lower rates of mortality than enrolled infants. Infants with LPE treated before day 6 had lower rates of late respiratory morbidity than infants with LPE treated ≥day 6. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.

PDA-TOLERATE Trial: An Exploratory Randomized Controlled Trial of Treatment of Moderate-to-Large Patent Ductus Arteriosus at 1 Week of Age.

OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial. RESULTS: At enrollment, 49% of the patients were intubated and 48% required nasal ventilation or continuous positive airway pressure. There were no differences between the groups in either our primary outcome of ligation or presence of a PDA at discharge (early routine treatment [ERT], 32%; conservative treatment [CT], 39%) or any of our prespecified secondary outcomes of necrotizing enterocolitis (ERT, 16%; CT, 19%), bronchopulmonary dysplasia (BPD) (ERT, 49%; CT, 53%), BPD/death (ERT, 58%; CT, 57%), death (ERT,19%; CT, 10%), and weekly need for respiratory support. Fewer infants in the ERT group met the rescue criteria (ERT, 31%; CT, 62%). In secondary exploratory analyses, infants receiving ERT had significantly less need for inotropic support (ERT, 13%; CT, 25%). However, among infants who were ≥26 weeks gestational age, those receiving ERT took significantly longer to achieve enteral feeding of 120 mL/kg/day (median: ERT, 14 days [range, 4.5-19 days]; CT, 6 days [range, 3-14 days]), and had significantly higher incidences of late-onset non-coagulase-negative Staphylococcus bacteremia (ERT, 24%; CT,6%) and death (ERT, 16%; CT, 2%). CONCLUSIONS: In preterm infants age <28 weeks with moderate-to-large PDAs who were receiving respiratory support after the first week, ERT did not reduce PDA ligations or the presence of a PDA at discharge and did not improve any of the prespecified secondary outcomes, but delayed full feeding and was associated with higher rates of late-onset sepsis and death in infants born at ≥26 weeks of gestation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.

Análise do perfil das internações hospitalares por drogadição em Santa Catarina entre 1998-2015 / Analysis of the hospital drug interventions profile in Santa Catarina between 1998 and 2015

Introdução: O uso abusivo de substâncias psicoativas é um dos maiores problemas de saúde pública da atualidade. Apesar da sua proibição e combate, a forma contraditória como a sociedade aceita algumas delas, as tensões existenciais e a busca pelo prazer a qualquer custo, apanágios da sociedade moderna, podem explicar o crescimento acelerado e contínuo do uso de substâncias psicoativas, com impactos sobre a saúde individual e coletiva. Por conta disto, as estatísticas hospitalares são fontes úteis para avaliar este problema, auxiliando na formulação de políticas públicas de prevenção e recuperação. Objetivo: Analisar os padrões de internação hospitalar por drogadição em Santa Catarina entre 1998 ­ 2015. Métodos: Estudo observacional ecológico, com análise do perfil populacional e tendência temporal. Foram analisadas 108.721 internações hospitalares por ''Transtornos mentais e comportamentais devido ao uso de substâncias psicoativas'' em SC entre 1998 e 2015 segundo o Sistema de Informações Hospitalares - SIH. A análise estática foi realizada por regressão linear. O nível de significância estabelecido foi valor p<0,05. O projeto foi aprovado pelo CEP-UNISUL. Resultados: As maiores taxas médias de internação anual para cada 100.000 habitantes foram associadas ao uso de álcool (87), múltiplas drogas (16,72) e cocaína (8,57). Houve uma taxa média muito maior de internações no sexo masculino (198,42) do que no sexo feminino (22,98). A taxa de mortalidade média foi de 21,5 pacientes hospitalizados a cada 100.000 habitantes. Conclusão: Os homens, a dependência do álcool e a faixa etária entre 35 e 44 anos compõe o perfil predominante das internações estudadas.

Introduction: The abuse of psychoactive substances is one of the most significant public health problems. With the popularity of drugs in the XIX century, several countries took measures relating to the field of security and justice about illicit drugs. Given the relative youth of the new drugs combat policy, there is a rapid and continued growth of the use of psychoactive substances. Hospital statistics are useful sources of data for future socio-economic assessments to formulate effective treatment and prevention policies. Objective: To assess hospital standards for drug addiction in Santa Catarina between 1998 - 2015. Methods: ecological observational study, analyzing the population profile and temporal trend. 108,721 hospital admissions were analyzed by ''mental and behavioral disorders due to use of psychoactive substances'' in SC between 1998 and 2015 for access to the Hospital Information System. The static analysis was performed by linear regression. The significance level was p <0.05. Approved by CEP-UNISUL. Results: The highest average annual hospitalization per 100,000 inhabitants were due to alcohol (87), multidrug (16.72) and cocaine (8.57). Notes a higher average admissions in males (198.42) compared to females (22.98). The average mortality rate was 21.5 per 100,000 inhabitants. Conclusion: The highest hospitalization rates were due to alcohol dependence, profiles found most of the hospitalized patients were men between 35 and 44 years.

Clozapine-induced myocarditis in observational cross-sectional and follow-up evaluations: comparison with other antipsychotics in naturalistic settings / Miocarditis inducida por clozapina durante la evaluación observacional, transversal y longitudinal: comparación con otros antipsicóticos en ambientes naturalísticos

Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.

El desarrollo de miocarditis ocurre con más frecuencia durante el tratamiento con clozapina (CLZ) que durante el uso de otros antipsicóticos (APs). En el presente estudio observacional evaluamos la presencia de miocarditis mediante un protocolo transversal comparando 132 sujetos tratados con CLZ con 371 pacientes tratados con otro AP, y en 21 sujetos tratados con CLZ y 18 pacientes tratados con otro AP en un protocolo longitudinal mayor 1 año de duración. La evaluación incluyó: a) detección de síntomas como disnea, taquicardia, malestar torácico, fiebre, tos y edema; b) presión arterial y auscultación cardiaca; c) electrocardiograma estándar luego de un reposo de 5 minutos; d) contaje de glóbulos blancos y determinación cualitativa de troponina I, creatin-kinasa-MB y mioglobina, y e) evaluación por un cardiólogo en sujetos sospechosos para miocarditis. Detectamos un solo caso de miocarditis, lo que permite una aproximación sobre la frecuencia de miocarditis de 1,6 % durante el primer mes de tratamiento. Se trató de un sujeto masculino con esquizofrenia que desarrolló síntomas durante el día 6 después de haber iniciado el tratamiento con CLZ a la dosis de 200 mg por día sin titulación. No se detectaron sujetos sospechosos de miocarditis durante el tratamiento prolongado con CLZ u otro AP. Estos resultados sustentan la recomendación de comenzar el tratamiento con clozapina a dosis bajas, y la factibilidad de utilizar un protocolo sencillo para detectar miocarditis en la atención psiquiátrica primaria.

Highly Efficient Luminescent Metal-Organic Framework for the Simultaneous Detection and Removal of Heavy Metals from Water.

We have designed and synthesized an isoreticular series of luminescent metal-organic frameworks (LMOFs) by incorporating a strongly emissive molecular fluorophore and functionally diverse colinkers into Zn-based structures. The three-dimensional porous networks of LMOF-261, -262, and -263 represent a unique/new type of nets, classified as a 2-nodal, (4,4)-c net (mot-e type) with 4-fold, class IIIa interpenetration. All compounds crystallize in a body-centered tetragonal crystal system (space group I41/a). A systematic study has been implemented to analyze their interactions with heavy metals. LMOF-263 exhibits impressive water stability, high porosity, and strong luminescence, making it an excellent candidate as a fluorescent chemical sensor and adsorbent for aqueous contaminants. It is extremely responsive to toxic heavy metals at a parts per billion level (3.3 ppb Hg2+, 19.7 ppb Pb2+) and demonstrates high selectivity for heavy metals over light metals, with detection ratios of 167.4 and 209.5 for Hg2+/Ca2+ and Hg2+/Mg2+, respectively. Mixed-metal adsorption experiments also show that LMOF-263 selectively adsorbs Hg2+ over other heavy metal ions in addition to light metals. The Pb2+ KSV value for LMOF-263 (55,017 M-1) is the highest among LMOFs reported to date, and the Hg2+ KSV value is the second highest (459,446 M-1). LMOF-263 exhibits a maximum adsorption capacity of 380 mg Hg2+/g. The Hg2+ adsorption process follows pseudo-second-order kinetics, removing 99.1% of the metal within 30 min. An in situ XPS study provides insight to help understand the interaction mechanism between Hg2+ and LMOF-263. No other MOFs have demonstrated such a high performance in both the detection and the capture of Hg2+ from aqueous solution.

Miocarditis inducida por clozapina durante la evaluación observacional, transversal y ongitudinal: comparación con otros antipsicóticos en ambientes naturalísticos.

Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.

Increased C-reactive protein and decreased Interleukin-2 content in serum from obese individuals with or without insulin resistance: Associations with leukocyte count and insulin and adiponectin content.

AIMS: Chronic inflammation in obesity is associated with co-morbidities such as, hyperglycemia, hypertension and hyperlipidemia. Leukocytes play an important role in this inflammation and C-reactive protein (CRP) and Interleukin-2 (IL-2) can be important effectors during the immune response in obesity; however, the initial inflammatory events in obesity remain unclear. The aim of this study was to determine the circulating levels of CRP, IL-2, insulin and adiponectin, their association and the association with leukocyte count in obese individuals without co-morbidities and with or without insulin resistance (IR). MATERIALS AND METHODS: Nineteen obese non-diabetic and 9 lean subjects were studied for serum levels of CRP, IL-2, insulin, adiponectin, lipids, glycated hemoglobin, glycemia, for homeostasis model assessment of insulin resistance (HOMA-IR), arterial pressure and anthropometric parameters, and for leukocyte counts. Neutrophil/lymphocyte ratio (N/L) was calculated using the loge of leukocyte counts. Associations were determined by Pearson's correlation. RESULTS: None of the studied groups presented co-morbidities and two groups of obese individuals with normal or high levels of insulin (IR) were found. Increased CRP concentration and decreased IL-2 and adiponectin concentrations in obese were observed. Positive correlation between leukocyte type counts with CRP in obese with IR was found; however, no correlations with IL-2 in obese were observed. Insulin in obese were positively correlated with CRP and negatively correlated with IL-2 in IR obese individuals. Adiponectin in obese was negatively correlated with CRP. CONCLUSION: CRP and IL-2 may represent two important effectors in the early inflammatory events in obese individuals without co-morbidities. Adiponectin and insulin may be involved in anti-inflammatory events.

Metabolic syndrome and related variables, insulin resistance, leptin levels, and PPAR-γ2 and leptin gene polymorphisms in a pedigree of subjects with bipolar disorder.

OBJECTIVE: Evidence points to a high prevalence of metabolic dysfunction in bipolar disorder (BD), but few studies have evaluated the relatives of subjects with BD. We conducted a cross-sectional study in an extended family of patients with BD type I. METHODS: The available relatives of the same family were interviewed (DSM-IV-R) and assessed in fasting conditions for body mass index, constituent variables of the metabolic syndrome (MS), leptin levels, insulin resistance index, and single nucleotide polymorphisms (SNPs) for the leptin receptor and promoter and PPAR-γ2 genes. The frequency of MS was compared with that recorded in the local general population. RESULTS: Ninety-three relatives of three adults with BD were evaluated (30 aged < 18 years, 63 aged > 18 years). The frequency of MS was similar to that of the general population. Significantly higher frequencies of abnormal glucose, total and low density cholesterol (LDL-c) levels (all p < 0.05), waist circumference (p = 0.057), and leptin and insulin resistance values (in adults only) were observed in the family. Adults with the QQ genotype of the leptin receptor displayed higher LDL-c levels than carriers of the R allele. CONCLUSIONS: The associations among BD consanguinity, familial hypercholesterolemia, and leptin receptor SNPs reported herein should be replicated and extended in other pedigrees.

Colonic transit diagnostic test shows significant gastrointestinal hypomotility in clozapine-treated patients in comparison with subjects treated with other antipsychotics.

BACKGROUND: Constipation occurs in 25-60% of the subjects during administration of the antipsychotic drug (AP) clozapine (CLZ). METHODS: We used a colonic transit diagnostic test that quantifies in a single abdominal X-ray the number of silver O-ring markers out of 25 units ingested five days before. The quantity of markers is directly proportional to the degree of gastrointestinal hypomotility, and elimination of over 80% of the markers is considered normal. The test was applied to three groups of AP-treated subjects for at least three consecutive months: CLZ alone (n=45), CLZ+Other APs (n=28), and Other APs (n=64). RESULTS: The number of remaining markers at day 5 (mean±S.D.) was significantly higher in the CLZ alone (10.8±10.6) and in the CLZ+Other APs (9.7±9.7) groups than in the Other AP group (4.5±6.7), Kruskal-Wallis test: p=0.004. No significant associations were found between the number of markers, age, AP dose and treatment duration. All subjects who passed <80% of markers - which approximately corresponds to the 60th percentile of marker elimination - showed a scattered marker distribution along the colon, thus suggesting colon inertia. In subjects with hypomotility, 38.5% of the CLZ group, 25% of the CLZ+Other APs group, and 25% of the Other APs group were negative for the Rome III clinical criteria of constipation, thus showing objective, not subjective, hypomotility. CONCLUSIONS: This study objectively confirms significant gastrointestinal hypomotility associated with CLZ administration.

Metabolic syndrome and related variables, insulin resistance, leptin levels, and PPAR-γ2 and leptin gene polymorphisms in a pedigree of subjects with bipolar disorder

Objective: Evidence points to a high prevalence of metabolic dysfunction in bipolar disorder (BD), but few studies have evaluated the relatives of subjects with BD. We conducted a cross-sectional study in an extended family of patients with BD type I. Methods: The available relatives of the same family were interviewed (DSM-IV-R) and assessed in fasting conditions for body mass index, constituent variables of the metabolic syndrome (MS), leptin levels, insulin resistance index, and single nucleotide polymorphisms (SNPs) for the leptin receptor and promoter and PPAR-γ2 genes. The frequency of MS was compared with that recorded in the local general population. Results: Ninety-three relatives of three adults with BD were evaluated (30 aged < 18 years, 63 aged > 18 years). The frequency of MS was similar to that of the general population. Significantly higher frequencies of abnormal glucose, total and low density cholesterol (LDL-c) levels (all p < 0.05), waist circumference (p = 0.057), and leptin and insulin resistance values (in adults only) were observed in the family. Adults with the QQ genotype of the leptin receptor displayed higher LDL-c levels than carriers of the R allele. Conclusions: The associations among BD consanguinity, familial hypercholesterolemia, and leptin receptor SNPs reported herein should be replicated and extended in other pedigrees. .

Definitions of cardiovascular insufficiency and relation to outcomes in critically ill newborn infants.

BACKGROUND: We previously reported on the overall incidence, management, and outcomes in infants with cardiovascular insufficiency (CVI). However, there are limited data on the relationship of the specific different definitions of CVI to short-term outcomes in term and late preterm newborn infants. OBJECTIVE: This study aims to evaluate how four definitions of CVI relate to short-term outcomes and death. STUDY DESIGN: The previously reported study was a multicenter, prospective cohort study of 647 infants ≥ 34 weeks gestation admitted to a Neonatal Research Network (NRN) newborn intensive care unit (NICU) and mechanically ventilated (MV) during their first 72 hours. The relationship of five short-term outcomes at discharge and four different definitions of CVI were further analyzed. RESULTS: All the four definitions were associated with greater number of days on MV and days on O2. The definition using a threshold blood pressure (BP) measurement alone was not associated with days of full feeding, days in the NICU or death. The definition based on the treatment of CVI was associated with all the outcomes including death. CONCLUSIONS: The definition using a threshold BP alone was not consistently associated with adverse short-term outcomes. Using only a threshold BP to determine therapy may not improve outcomes.

Increased proinflammatory markers and lipoperoxidation in obese individuals: Inicial inflammatory events?

BACKGROUND: Chronic inflammation associated to obesity increases the risk for developing insulin resistance (IR), hyperglycemia, hypertension and hyperlipidemia. The initial factors involved in generating the inflammatory events in the obesity remain unclear. Therefore, this study was aimed to determine inflammatory and oxidative markers in the blood of obese individuals with normal clinical and biochemical parameters and with or without IR. METHODS: Nineteen obese non-diabetic and nine lean subjects were studied for serum levels of TNF-α, IL-1ß, adiponectin, angiotensin II, insulin, malondialdehyde (MDA) and the expressions of RAGE (advanced glycation end product receptor), AT1 (Ang II receptor), s100A12 protein (RAGE ligand) and nuclear factor-κB (NF-κB) in circulating mononuclear cells (CMC) by available antibodies and commercial kits. CMC were also cultured to determine pro-inflammatory mediators. RESULTS: Insulin was increased in obese subjects with IR. Decreased serum adiponectin in obese individuals and increased TNF-α, IL-1ß and CMC bearing RAGE, AT1 and s100A12 in obese individuals without IR were found. High values of serum MDA in obese subjects were observed. Similar TNF-content in cultures from obese and controls, increased cellular IL-1ß content in cultures from obese individuals without IR and high content of MDA in supernatants from obese individual cultures were observed. CONCLUSIONS: The inflammatory events were mainly observed in obese individuals without IR. The absent of inflammatory events and high levels of insulin in obese subjects with IR, suggest a protector role of insulin for developing inflammatory events. These data can represent initial aspects of the chronic inflammation observed in the obesity.

Efecto del filtrado crudo de Purpureocillium sp. (Cepa UdeA0106), sobre la eclosión de huevos y movilidad de juveniles de Meloidogyne incognita-javanica / Effect of the raw filtrate of Purpureocillium sp. (UdeA0106 strain) on the eclosion of eggs and the motility of Meloidogyne incognitajavanica juveniles

Meloidogyne incognita-javanica representa una limitación de los cultivos agrícolas y es necesario buscar alternativas para su manejo. El presente trabajo tuvo como objetivo evaluar el efecto in vitro del filtrado crudo de Purpureocillium sp. (Cepa UdeA0106) sobre laeclosión de huevos y los estadios juveniles de Meloidogyne spp. Adicionalmente, se evaluaron los medios: caldo extracto de malta (CEM), caldo extracto de levadura (CEL) y caldo papa glucosa (CPG), escogiéndose aquel que no ejerciera daño sobre la morfología de los huevos y permitiera la eclosión de los estadios juveniles. El hongo se multiplicó durante 7 días y fue filtrado. Para establecer su efecto sobre los huevos y estadios J2 de Meloidogyne spp., se probaron concentraciones del filtrado al 100 %, 90 %, 70 %, 50 %, 25 % y 10 %; comparándolas con un control compuesto de estadios J2 en agua destilada estéril (ADE) y CPG. Las variables a evaluar fueron el porcentaje de eclosión e inmovilidad en los J2. La unidad experimental fue la caja de Petri, cada una con 200 huevos/J2, con 5 réplicas de cada tratamiento. Se utilizó un diseño experimental completamente aleatorizado con ANOVA (P = 0,05) y análisis de comparación múltiple de Tukey. Se encontraron diferencias significativas entre todos los tratamientos (P < 0,05) pero el tratamiento correspondiente al filtrado puro (100 %) logró mantener el porcentaje más bajo de eclosión y mayor porcentaje de inmovilidad de los J2 (96,8 %). Las concentraciones al 90 % y 70 % igualmente lograron efectos en los J2, con porcentajes altos de inmovilidad.

Meloidogyne incognita-javanica represents an important threat to the agricultural crops, and it is necessary to seek alternatives for its control. The aim of this research it was to evaluate a crude filtrate from the strain Purpureocillium sp. UdeA0106 in order to establish the in vitro effect on the egg hatching and the immobility of juvenile stages of Meloidogyne spp. The mediums evaluated were malt extract broth (MEB), yeast extract broth (YEB), and potato dextrose broth (PDB), after which it was chosen the one that didn't produce any damages on nematode eggs and allowed the emergence of the larval stages. The fungus was multiplied for 7 days, and then it was filtrated. To evaluate its effect on the eggs and the J2 of Meloidogyne spp., filtrate concentrations were made at 100 %, 90 %, 70 %, 50 %, 25 % and 10 %, contrasting them with a control composed of the J2 stages in sterile distilled water and PDB. The variables evaluated were the percentage of altered eggs and the immobility observed in J2 stages. The experimental unit was the Petri dish, each one containing 200 eggs /J2. Each treatment was replicated 5 times. It was used a completely randomized design, and an ANOVA was performed (P = 0,05) as well as a multiple comparison test (Tukey). Significant differences were found between all treatments (P < 0,05), although the most effective in inhibiting both egg hatching and J2 mobility (96,8 %) were the full strength filtering (100 %). The dilutions at 90 % and 70 %, were able to produce effects with high percentages in the immobility.

Association of obesity with leukocyte count in obese individuals without metabolic syndrome.

AIMS: Inflammation in obesity is associated to insulin resistance (IR), hyperglycemia, hypertension and hyperlipidemia. Leukocytes play an important role in obesity associated inflammation. The initial factors that generate the inflammatory events in the obesity remain unclear. Therefore, the aim of this study was to determine the association of circulating leukocytes with clinical and biochemical parameters in obese individuals with clinical and biochemical parameters in normal range and with or without IR. METHODS: Nineteen obese non-diabetic and 9 lean subjects were studied for serum levels of insulin, lipids, glycated hemoglobin, glycemia, for clinical parameters as HOMA-IR, arterial pressure and anthropometric parameters, and for leukocyte counts. Neutrophil/lymphocyte ratio (N/L) was calculated using the loge of leukocyte counts. Association between leukocytes and studied parameters was determined by Pearson's correlation. RESULTS: Two groups of obese individuals were observed: with high levels of insulin (with IR) and with normal levels (without IR). Positive correlations were observed between leukocyte and lymphocyte counts with body mass index and HOMA-IR and negative correlation with decreased HDL levels. Lymphocytes correlated with increased levels of insulin. Leukocytes and neutrophils correlated positively with increased visceral fat and liver steatosis. These associations were absent in the obese group without IR. N/L ratio did not show correlations with studied parameters. The leukocyte associations were mainly observed in obese individuals with IR. CONCLUSIONS: These data may represent initial leukocyte associations with morbidity features and define two different obese individuals that may evolve to the chronic inflammation observed in the obesity.

[Hepatic steatosis, visceral fat and metabolic alterations in apparently healthy overweight/obese individuals]. / Esteatosis hepática, grasa visceral y alteraciones metabólicas, en individuos con sobrepeso/obesidad aparentemente sanos.

Clinical observation indicates that many obese individuals do not display important metabolic alterations. Consequently, the objective of this study was to establish whether simple obesity, non concurrent with other important risk factors, was associated with metabolic alterations; or if the phenomenon known as "obesity paradox" was present. A clinical history, measurements of anthropometric and metabolic parameters and estimation of hepatic steatosis and visceral fat, were determined in 30, apparently healthy, individuals from Maracaibo, Venezuela, between 20 and 59 years of age and a body mass index (BMI) above 25 kg/m2, and compared to a lean control group of 11 individuals with BMI less than 25 kg/m2. The study demonstrated that only one third of overweight/obese individuals (OW/OB), with high body mass index (BMI) and waist circumference (WC), presented elevated values of insulin, HOMA-IR and triglycerides. Nevertheless, the presence of hepatic steatosis was elevated in the OW/OB group (91%) vs. 9% in the control group. The visceral fat in the lean control group was associated with both, WC and glycemia; however, it was not related to the BMI or insulin, HOMA-IR and HDLc. The visceral fat in the OW/OB group, although elevated in relation to the lean group, revealed a loss of these associations. In the OW/OB it was the BMI that was associated with insulin and HOMA-IR. The results emphasize the importance of investigating for the presence of hepatic steatosis, rather than visceral fat, in individuals with OW/OB, to identify subjects with high cardiometabolic risk.

Hypotension following patent ductus arteriosus ligation: the role of adrenal hormones.

OBJECTIVE: To test the hypothesis that an impaired adrenal response to stress might play a role in the hypotension that follows patent ductus arteriosus (PDA) ligation. STUDY DESIGN: We performed a multicenter study of infants born at <32 weeks' gestation who were about to undergo PDA ligation. Serum adrenal steroids were measured 3 times: before and after a cosyntropin (1.0 µg/kg) stimulation test (performed before the ligation), and at 10-12 hours after the ligation. A standardized approach for diagnosis and treatment of postoperative hypotension was followed at each site. A modified inotrope score (1 × dopamine [µg/kg/min] + 1 × dobutamine) was used to monitor the catecholamine support an infant received. Infants were considered to have catecholamine-resistant hypotension if their greatest inotrope score was >15. RESULTS: Of 95 infants enrolled, 43 (45%) developed hypotension and 14 (15%) developed catecholamine-resistant hypotension. Low postoperative cortisol levels were not associated with the overall incidence of hypotension after ligation. However, low cortisol levels were associated with the refractoriness of the hypotension to catecholamine treatment. In a multivariate analysis: the OR for developing catecholamine-resistant hypotension was OR 36.6, 95% CI 2.8-476, P = .006. Low cortisol levels (in infants with catecholamine-resistant hypotension) were not attributable to adrenal immaturity or impairment; their cortisol precursor concentrations were either low or unchanged, and their response to cosyntropin was similar to infants without catecholamine-resistant hypotension. CONCLUSION: Infants with low cortisol concentrations after PDA ligation are likely to develop postoperative catecholamine-resistant hypotension. We speculate that decreased adrenal stimulation, rather than an impaired adrenal response to stimulation, may account for the decreased production.