Intergenerational inheritance induced by a high-fat diet causes hyperphagia and reduced hypothalamic sensitivity to insulin and leptin in the second-generation of rats.

OBJECTIVE: The aim was to investigate the intergenerational inheritance induced by a high-fat diet on sensitivity to insulin and leptin in the hypothalamic control of satiety in second-generation offspring, which were fed a control diet. METHODS: Progenitor rats were fed a high-fat or a control diet for 59 d until weaning. The first-generation and second-generation offspring were fed the control diet until 90 d of age. Body mass and adiposity index of the progenitors fed the high-fat diet and the second-generation offspring from progenitors fed the high-fat diet were evaluated as were the gene expression of DNA methyltransferase 3a, angiotensin-converting enzyme type 2, angiotensin II type 2 receptor, insulin and leptin signaling pathway (insulin receptor, leptin receptor, insulin receptor substrate 2, protein kinase B, signal transducer and transcriptional activator 3, pro-opiomelanocortin, and neuropeptide Agouti-related protein), superoxide dismutase activity, and the concentration of carbonyl protein and satiety-regulating neuropeptides, pro-opiomelanocortin and neuropeptide Agouti-related protein, in the hypothalamus. RESULTS: The progenitor group fed a high-fat diet showed increased insulin resistance and reduced insulin-secreting beta-cell function and reduced food intake, without changes in caloric intake. The second-generation offspring from progenitors fed a high-fat diet, compared with second-generation offspring from progenitors fed a control diet group, had decreased insulin-secreting beta-cell function and increased food and caloric intake, insulin resistance, body mass, and adiposity index. Furthermore, second-generation offspring from progenitors fed a high-fat diet had increased DNA methyltransferase 3a, neuropeptide Agouti-related protein, angiotensin II type 1 receptor, and nicotinamide adenine dinucleotide phosphate oxidase p47phox gene expression, superoxide dismutase activity, and neuropeptide Agouti-related protein concentration in the hypothalamus. In addition, there were reduced in gene expression of the insulin receptor, leptin receptor, insulin receptor substrate 2, pro-opiomelanocortin, angiotensin II type 2 receptor, angiotensin-converting enzyme type 2, and angiotensin-(1-7) receptor and pro-opiomelanocortin concentration in the second-generation offspring from progenitors fed the high-fat diet. CONCLUSIONS: Overall, progenitors fed a high-fat diet induced changes in the hypothalamic control of satiety of the second-generation offspring from progenitors fed the high-fat diet through intergenerational inheritance. These changes led to hyperphagia, alterations in the hypothalamic pathways of insulin, and leptin and adiposity index increase, favoring the occurrence of different cardiometabolic disorders in the second-generation offspring from progenitors fed the high-fat diet fed only with the control diet.

Unicentric Castleman Disease and Pheochromocytoma.

Castleman disease is an uncommon and heterogenous lymphoproliferative disorder which is classified as unicentric or multicentric depending on the number of lymph nodes involved. Each type has a different clinical presentation, aetiology, treatment and prognosis. We report the case of a young woman who presented with cervical lymphadenopathy and a retroperitoneal mass, and was diagnosed with unicentric Castleman disease and pheochromocytoma. We describe the diagnostic steps, the complications that developed, and the importance of the differential diagnosis in the evaluation of these patients. LEARNING POINTS: Castleman disease in an uncommon disease and should be considered in all patients with adenomegalies and systemic symptoms.Pheochromocytoma should not be overlooked in the differential diagnosis of a retroperitoneal mass.It is important that doctors consider these two diagnoses in patients with adenomegalies and a retroperitoneal mass due to the potential harmful impact of a missed diagnosis.

A Hematologic Disease Disguised as Cutaneous Candidiasis.

Langerhans cell histiocytosis is a rare hematologic neoplasm with a myeloid origin, which can affect numerous organs, the skin being the second most frequently affected by this disease. In this report, a case of a 44-year-old female, who was intermittently followed due to a suspected persistent cutaneous candidiasis in which a skin biopsy revealed Langerhans cell histiocytosis with immunohistochemistry positive for CD1a and S100 protein, is described. The management of Langerhans cell histiocytosis is difficult because these disorders respond inconsistently to immunosuppressive and chemotherapeutic strategies. The authors present this case to highlight a differential diagnosis of refractory cutaneous candidiasis and raise awareness of the importance of skin biopsy in these cases.

Ancianos: relación entre residencia y estado de salud / Elderly: relationship between residence and health status

Introduction: The European population is aging, for every 100 young people there are 128 elderly. There is a decrease in the number of elderly people living in their family environment. The main objective of this study is to identify the differences in the general health status of the elderly according to their residence: in families or in others types of centres (nursing home, host family or national integrated network of integrated care (NINIC)). Material and Methods: This is an observational study, using a sample of 254 elderly patients admitted to the Internal Medicine Service. Results: Of the patients studied, 78,7% lived at home/with relatives, 15,4% in nursing homes, 3,15% in host families and 2,75% in NINIC. Age ranged from 65 to 99 years, with a median of 80 years (SD=7,97). Patients from their homes were more independent/mild dependence (X(3)=59.8, p<0.001), although there were no significant differences in the number of comorbidities (t(252)=0.029, p=0.999). However, patients from others centres had more neurological pathology (X(1)=12.39, p<0.001). There were no statistically significant differences in the number of medications usually taken, although patients from others centres had more potentially inappropriate medications (t(252)=5.85, p<0.001) and potential prescribing omissions (t(252)=3.71,p<0.001). Patients at home had fewer rehosts (X(1)=5.14, p=0.039). There were more intercurrences (X(1)=19.0, p<0.001) and more deaths at 6months after discharge (X(1)=16.3, p<0.001) from others centres. Conclusion: In a population less attended by families, these differences in relation to their dwelling places are paramount. (AU)

Relapsing Candida parapsilosis Endocarditis With Septic Embolization: A Case Report.

Candida endocarditis is a rare infection that is becoming an emerging and growing health concern, especially among risk groups such as the elderly and the immunosuppressed. It is associated with high morbidity and mortality. Dilemmas about Candida endocarditis treatment are still around, particularly about the treatment options and their duration. We report a case of Candida parapsilosis prosthetic valve endocarditis with septic embolisms. An elderly male patient with a biological prosthetic valve presented with fever and constitutional symptoms. Abdominal computed tomography (CT) showed an area suggestive of splenic emboli. Transesophageal echocardiography showed a vegetation attaching to the prosthetic valve. Due to several comorbidities, he was not considered a candidate for surgical treatment. He was treated with antifungal drugs (liposomal amphotericin B and caspofungin) and was discharged with per os fluconazole. Later he presented with evidence of lumbar spondylodiscitis due to septic embolization and relapsing fungemia with multidrug-resistant isolates was documented. Unfortunately, the patient outcome was ill-fated and he died in hospital due to sepsis-related to the candidemia and also nosocomial urinary sepsis. Here, we illustrate the complexity of diagnosing and managing fungal endocarditis due to its complications and poor prognosis.

Potentially inappropriate medications and potential prescribing omissions. Identification and relevance

INTRODUCTION: Europe presents 19% of the population aged 65 or over (elderly), who are especially susceptible to inadequate prescriptions (potentially inappropriate medications (PIM) and potential prescribing omissions (PPO)), identified by the STOPP and START criteria. This study has as main objectives the identification of PIM and PPO and associated factors. MATERIAL AND METHODS: This is a cross sectional study, using a sample of 254 elderly individuals from the Internal Medicine Service. RESULTS: 81.9% of patients are polymedicated, 72.4% have at least one PIM and 57.5% have at least one PPO. The most frequently identified PIM was benzodiazepine and PPO was the anti-pneumococcal vaccine. There was a direct correlation between the number of PIM and chronic medication (r(254)=0.348, p < 0.001) and inverse with the Katz scale (dependence) (r(254)=-0.324, p < 0.001). In the cases of the domicile it was verified association between PIM and the days of internment (U=3653, p = 0.025). PIM were associated with death in less than 6 months after discharge (U=3396, p = 0.007) and the presence of intercurrences at admission (U=5766, p = 0.005). There is a relationship between the number of co-morbidities and having at least one PIM (U=5378, p = 0.041) or at least one PPO (U=6271, p = 0.005). Diabetes mellitus (DM) type 2, neurological and psychiatric disease are associated with PIM, while obesity, DM type 2, arterial hypertension, dyslipidemia and cardiac pathology with PPO. Discussion and CONCLUSION: In a population that is older each year, with more comorbidities and more polymedicated, PIM and PPO are increasingly relevant

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Pneumothorax as a Presentation of Tuberous Sclerosis-Associated Lymphangioleiomyomatosis.

Tuberous sclerosis complex (TSC) is a rare, autosomal dominant disorder with a recognized phenotypic variability with clinical manifestations developing continuously throughout life. The follow-up of TSC patients is challenging. The authors present a case with a definite diagnosis of TSC with known skin, renal, hepatic and neuropsychiatric involvement, whose diagnosis of TSC-associated lymphangioleiomyomatosis was establish at a late stage after the patient had presented with recurrent pneumothorax. Notwithstanding, mammalian target of rapamycin inhibition therapy was initiated. LEARNING POINTS: Tuberous sclerosis complex (TSC) is a systemic and progressive disorder leading to significant morbidity, highlighting the need to closely monitor such patients.TSC-associated lymphangioleiomyomatosis is the major pulmonary manifestation and screening at an early stage is imperative.Managing TSC requires a multidisciplinary approach and the introduction of mammalian target of rapamycin (mTOR) inhibition therapy reinforces the need for collaboration between well-prepared health professionals.

Venous and Lung Thromboembolism in the Context of Lung Cancer: Clinical Manifestations, Risk Factors and Prognosis.

INTRODUCTION: The relationship between cancer and thromboembolic events has been known for a long time. Lung and venous thromboembolism are frequent complications of lung cancer and its treatment, being a great cause of morbidity and mortality. We pretend to establish the relationship between lung and venous thromboembolism and lung cancer, describe patient characteristics and analyze the impact in the survival and prognosis. MATERIAL AND METHODS: It was a retrospective study. All research subjects were selected from lung cancer patients with a newly diagnosed lung and venous thromboembolism event admitted to Hospital S. João, between January 2008 and December 2013 and were followed until December 2014. Statistical analysis was performed with SPSS. RESULTS: From the search, we obtained 113 patients. The majority was male, smokers or ex-smokers, and adenocarcinoma was the most frequent histologic type, being diagnosed mostly in advanced stages. We noticed that the median time between lung cancer diagnosis and lung venous thromboembolism was 2.9 months. In 24 patients (21.4%), the lung cancer diagnosis occurred after the lung and venous thromboembolism event and in 86 patients (76.8%), it occurred before the event. After a median follow up of 1.4 months, 107 (94.7%) patients died, 1 (0.9%) was lost to follow-up and 5 (4.4%) were still alive. The median survival rate was 1.5 months. DISCUSSION: The diagnosis of lung and venous thromboembolism in patients with lung cancer is associated with bad prognosis. It occurs most frequently in patients with advanced disease, in the first months after lung cancer diagnosis and after beginning chemotherapy. CONCLUSION: Disease progression is an independent predictor with negative impact in overall survival.

Introdução: A relação entre as neoplasias e os eventos tromboembólicos é uma realidade já conhecida. O tromboembolismo pulmonar e venoso são complicações frequentes das neoplasias e do seu tratamento. Pretende-se estabelecer a relação entre o tromboembolismo pulmonar e venoso e a neoplasia pulmonar, descrever as suas características clínicas e analisar o seu impacto na sobrevida e prognóstico. Material e Métodos: Este estudo é retrospetivo. Foram selecionados doentes com neoplasia pulmonar, diagnosticados com tromboembolismo pulmonar e venoso no Hospital de S. João entre janeiro de 2008 e dezembro de 2013, e acompanhados até dezembro de 2014. A análise estatística foi realizada utilizando o SPSS. Resultados: Da pesquisa efetuada, foram obtidos 113 doentes. A maioria eram homens, fumadores ou ex-fumadores, e o adenocarcinoma foi o tipo histológico mais frequentemente encontrado, diagnosticado maioritariamente em estádios avançados. A mediana de tempo entre o diagnóstico de neoplasia pulmonar e tromboembolismo pulmonar e venoso foi de 2,9 meses. Em 24 doentes (21,4%), o diagnóstico de neoplasia pulmonar ocorreu depois do tromboembolismo pulmonar e venoso e em 86 doentes (76,8%) antes do evento. Após uma mediana de follow-up de 1,4 meses, 107 (94,7%) dos doentes faleceram, 1 (0,9%) deixou de ser seguido e 5 (4,4%) permaneceram vivos no fim do estudo. A mediana da taxa de sobrevivência foi de 1,5 meses. Discussão: O diagnóstico de tromboembolismo pulmonar e venoso nos doentes com neoplasia pulmonar está associado a mau prognóstico. Ocorre mais frequentemente em doentes com doença avançada, nos primeiros meses depois do diagnóstico e do início da quimioterapia. Conclusão: A progressão da doença demonstrarou ser preditor independente com impacto negativo na sobrevida global.

Health-related physical fitness among undergraduate students in physical education / Aptidão física relacionada à saúde de alunos de gradução em educação física

ABSTRACT The aim of this study was to describe and analyze physical fitness of undergraduate students in Physical Education. The sample consisted of 110 women and 115 men. We evaluated weight, height, body mass index, percentage of body fat (BF), heart rate, systolic blood pressure (SBP), diastolic blood pressure, flexibility, strength and muscular endurance (ME). As main results we observed a higher percentage of women with body fat and ME above the ideal values ​​for age when compared to men (BF: 37% vs 4%, p = 0.001; ME: 32% vs 13%, p = 0.001), while there were more men with changes in SBP when compared with women (22% vs 6%, p = 0.001). In conclusion, male students had higher levels of physical fitness than women, and a significant portion of undergraduate students in Physical Education showed results different than normal for anthropometric, hemodynamic and performance variables.

RESUMO O objetivo desse estudo foi descrever e analisar o condicionamento físico de alunos de graduação do curso de Educação Física. A amostra foi composta por 110 mulheres e 115 homens. Foram avaliados peso, altura, índice de massa corpórea, percentual de gordura corporal (GC), frequência cardíaca em repouso (FCR), pressão arterial sistólica (PAS) e diastólica, flexibilidade, força e resistência muscular localizada (RML). Como principais resultados observou-se maior porcentagem de mulheres com gordura corporal e RML acima dos valores ideais para a idade quando comparados aos homens (GC: 37% vs 4%, p= 0,001; RML: 32% vs 13%, p= 0,001), enquanto houveram mais homens com alteração na PAS quando confrontado com mulheres (22% vs 6%, p= 0,001). Em conclusão, estudantes do sexo masculino apresentaram maiores níveis de aptidão física em relação às mulheres, e parcela expressiva de alunos de Educação Física apresentam alterações nos valores de referência à normalidade para variáveis antropométricas, hemodinâmicas e de desempenho motor.

Estimation of optimal ratios of digestible phenylalanine + tyrosine, histidine, and leucine to digestible lysine for performance and breast yield in broilers.

Three experiments were carried out to estimate the optimal ratios of digestible phenylalanine + tyrosine (Phe + Tyr), histidine (His), and leucine (Leu) relative to digestible lysine (Lys) for performance and carcass criteria of Cobb-500 broilers from 8 to 17 d of age. In each experiment, 160 male chicks were allocated to a completely randomized experimental design with eight replicate pens, each receiving five dietary treatments. A common, semi-purified basal diet was formulated to meet all dietary recommendations except for those of the tested amino acids (i.e., Phe + Tyr, His, and Leu). Growth performance and carcass characteristics data were analyzed using various requirement-estimation models, including 95% of the quadratic regression, linear response plateau (LRP; i.e., stepwise regression), LRP-to-quadratic regression ratio; and quadratic broken line (QBL). Graded digestible Phe + Tyr ratios elicited a quadratic response (P < 0.05) in body weight gain and linear responses (P < 0.05) in breast and breast fillet weights. Linear effects (P < 0.05) were also observed when graded ratios of digestible His were fed for feed intake and weight gain, and quadratic responses (P < 0.05) were noted for feed conversion ratio and breast and breast fillet weights and yields. Graded Leu ratios elicited quadratic responses (P < 0.05) in feed intake, weight gain, and breast and breast fillet weight and yield. Based on growth and carcass parameters, the estimated ideal digestible ratios of Phe + Tyr, His, and Leu relative to digestible Lys were 112, 38, and 104%, respectively, for broiler chicks raised from 8 to 17 d of age.

Sunflower meal and supplementation of an enzyme complex in diets for growing and finishing pigs / Farelo de girassol e suplementação de complexo enzimático em dietas para suínos em crescimento e terminação

This study aimed to evaluate the inclusion of sunflower meal and an enzyme complex supplement on the performance and carcass parameters in swine from 30 to 100 kg live weight. A total of 96 pigs with average live weight of 32.19 ± 3.27 kg were distributed in a randomized blocks design with a 4 × 2 factorial arrangement of treatments (four levels of sunflower meal-SM: 0, 8, 16 and 24%, with or without inclusion of an enzyme complex-EC), factorial arrangement with six replicates and two animals per experimental unit. The analyzed variables were feed intake (kg), weight gain (kg), feed conversion (kg/kg), backfat thickness (mm), carcass muscularity (kg), hot carcass weight (%), lean meat carcass percentage (%), and lean meat carcass weight (kg). There was no interaction between factors for any of the studied variables. Feed conversion of animals from 30 to 70 kg live weight was improved by the inclusion of EC. This enzyme complex inclusion did not affect carcass characteristics. Increasing levels of SM in the test subject feed diet rations presented a quadratic effect on weight gain and on backfat thickness that reached maximum values in parameters of 7.26% and 8.16%, respectively.

Este estudo teve como objetivo avaliar a inclusão de farelo de girassol e a suplementação de complexo enzimático sobre os parâmetros de desempenho e características de carcaça de suínos, dos 30 aos 100 kg de peso vivo. Foram utilizados 96 suínos com peso vivo médio de 32,19 ± 3,27 kg distribuídos em um delineamento experimental de blocos casualiza- dos, em esquema fatorial 4 x 2 (quatro níveis de farelo de girassol-FG: 0, 8, 16 e 24% com ou sem inclusão do complexo enzimático-CE), com seis repetições e dois animais por unidade experimental. As variáveis analisadas foram: o consumo de ração (kg), o gancho de peso (kg), a conversão alimentar (kg/kg), a espessura de toucinhos (mm), a musculosidade (kg), o peso da carcaça quente (%), a porcentagem de carne magra na carcaça (%), a quantidade de carne magra na carcaça (kg). Na houve interação entre os fatores para nenhuma de variáveis estudadas. A conversão alimentar dos animais dos 30 aos 70 kg de peso foi diminuida pela inclusão do CE, porém não afetou os parâmetros de carcaça. Níveis crescentes de FG na ração apresentaram efeito quadrático sobre o ganho de peso dos animais e sobre a espessura de toucinho, com valores máximos destas variáveis em 7,26% e 8,16% de inclusão do FG, respectivamente