RESUMO
No disponible
Assuntos
Idoso , Feminino , Humanos , Abdome Agudo/fisiopatologia , Abdome Agudo , Dor Lombar/etiologia , Dor Lombar , Leucocitose/complicações , Leucocitose , Aneurisma/complicações , Aneurisma/cirurgia , Aneurisma , Abdome Agudo/cirurgia , Hipertensão/complicações , Hipertensão/diagnóstico , Sarcoidose/complicações , Ultrassonografia/instrumentação , Ultrassonografia/métodos , UltrassonografiaRESUMO
OBJECTIVE: Insulin resistance (IR) and white adipose tissue (WAT) dysfunction frequently are associated with nonalcoholic fatty liver disease (NAFLD); however, the pathogenic mechanisms contributing to their clustering are not well defined. The aim of this study was to define some nutritional, anthropometric, metabolic, and genetic mechanisms contributing to their clustering. METHODS: Forty-five (20 men, 25 women) patients (age 45.7 ± 11.1 y) with recent diagnosis of NAFLD were grouped according to IR state. Energy balance was assessed using a food questionnaire and indirect calorimetry, and body composition with anthropometry and dual-energy x-ray absorptiometry. Biochemical and hormonal parameters combined with adipose tissue gene expression were determined. Microarray analysis of gene expression was performed in a subset of WAT samples from IR patients (n = 9), in the fasted state, after specific test meals (monounsaturated fatty acid [MUFA], saturated fat [SAT], and carbohydrate-rich) and after being challenged with insulin. RESULTS: IR patients exhibited higher trunk fat to leg fat ratio (P < 0.05) and had a higher ratio of SAT/MUFA fat intake (P < 0.05) than insulin-sensitive (IS) individuals. Deposition of fat in the trunk but not in the leg was directly related to liver enzyme levels (P < 0.05). IR patients also had lower adiponectin serum levels and leptin (LEP) mRNA expression in WAT compared with IS patients (P < 0.01 and P < 0.05, respectively). Microarray analysis after insulin challenge confirmed that insulin treatment induces the expression of PPARG gene and LEP and decreases GCGR gene (P < 0.05 for all) in WAT. No changes in these genes were observed in the postprandial state induced after the acute effect of specific diets. CONCLUSIONS: Patients exhibiting NAFLD and IR had preferential central fat deposition directly related to their serum alanine aminotransferase levels. These patients showed peripheral adipose tissue dysfunction and exhibited inappropriately low LEP biosynthesis that could be partially restored after anabolic conditions induced by insulin signaling.
Assuntos
Tecido Adiposo Branco/metabolismo , Fígado Gorduroso/genética , Comportamento Alimentar , Expressão Gênica , Resistência à Insulina/genética , Obesidade Abdominal/genética , Absorciometria de Fóton , Adiponectina/sangue , Adulto , Composição Corporal , Índice de Massa Corporal , Estudos Cross-Over , Carboidratos da Dieta/administração & dosagem , Metabolismo Energético , Ácidos Graxos/administração & dosagem , Ácidos Graxos Monoinsaturados/administração & dosagem , Fígado Gorduroso/dietoterapia , Feminino , Humanos , Insulina/sangue , Interleucina-6/sangue , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica , Estado Nutricional , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários , Fator de Necrose Tumoral alfa/sangueAssuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Agregação Plaquetária , Agregação Plaquetária/fisiologia , Escleroterapia/métodos , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório , Tomografia Computadorizada de Emissão/métodos , Hemodinâmica , Testes de Função Plaquetária , Inibidores da Agregação Plaquetária , Diagnóstico Diferencial , Doenças do Esôfago , Esôfago/patologia , EsôfagoRESUMO
Malignant syphilis is an infrequent manifestation of syphilis in HIV infected patients. Only 21 cases have been published in medical literature. Most frequent in men, 62%, the mean age of presentation is 34 years. The most frequent symptoms are: 100% ulcerative cutaneous lesions, 47% fever and 33% ocular affectation. About 80% of the patients have a CD4 count >200. Lues serological test was 100% positive and 81% responded to penicillin. We report a 18 year old woman diagnosed of HIV infection, admitted to our service because of fever, painful oral sores, over-elevated eritematous lesions and cratered ulcers all over the body, with the initial suspicion of chickenpox. Lues serology turned out to be positive, as well as the Warthin Starry stain. After penicillin treatment was initiated, skin lesions improved, although residual lesions currently persist. Malignant syphilis should be considered in infected HIV patients with fever and ulcerated skin injuries as a possible diagnosis. Eventhough serological tests allow diagnosis confirmation, Warthin Starry stain can be useful when serology is negative. The first choice of treatment is penicillin and in case of penicillin allergy, a third generation cefalosporine should be used.
Assuntos
Infecções por HIV/complicações , HIV-1 , Sífilis Cutânea/complicações , Adolescente , Feminino , Humanos , Penicilina G Benzatina/uso terapêutico , Penicilinas/uso terapêutico , Sorodiagnóstico da Sífilis , Sífilis Cutânea/sangue , Sífilis Cutânea/tratamento farmacológico , Resultado do TratamentoAssuntos
Eosinófilos/patologia , Gastroenterite/patologia , Adulto , Ascite/patologia , Feminino , HumanosRESUMO
La sífilis maligna es una manifestación infrecuente de la sífilis en personas infectadas por el VIH. Sólo existen 21 casos publicados en la literatura. Con un 62 por ciento de predominio en hombres, la edad media de presentación es de 34 años. Los síntomas predominantes son lesiones cutáneas ulceradas en el 100 por ciento de los casos, fiebre en el 47 por ciento y afectación ocular en el 33 por ciento. El 80 por ciento tienen CD4 >200. La serología luética resultó positiva en todos los casos y el 81 por ciento respondieron a penicilina.Presentamos el caso de una mujer de 18 años, diagnosticada de infección VIH, que ingresa por fiebre, úlceras orales dolorosas, lesiones eritematosas sobreelevadas y úlceras con crater por todo el cuerpo, con la sospecha inicial de varicela. La serología luética resultó positiva, así como la tinción de Warthin Starry. Tras la instauración de tratamiento con penicilina mejoraron las lesiones, aunque persisten lesiones residuales cutáneas en la actualidad. En pacientes infectados por el VIH con fiebre y lesiones cutáneas ulceradas hay que considerar la sífilis maligna entre las posibilidades diagnósticas. Aunque los test serologicos permiten confirmar el diagnóstico, la tinción de Warthin Starry puede ser de utilidad cuando la serología es negativa. El tratamiento de primera elección es la penicilina y en caso de alergia una cefalosporina de tercera generación (AU)
Malignant syphilis is an infrequent manifestation of syphilis in HIV infected patients. Only 21 cases have been published in medical literatu re. Most frequent in men, 62%, the mean age of presentation is 34 years. The most frequent symptoms are: 100% ulcerative cutaneous lesions, 47% fever and 33% ocular affectation. About 80% of the patients have a CD4 count >200. Lues serological test was 100% positive and 81% responded to penicillin. We report a 18 year old woman diagnosed of HIV infection, admitted to our service because of fever, painful oral sores, over-elevated eritematous lesions and cratered ulcers all over the body, with the initial suspicion of chikenpox. Lues serology turned out to be positive, as well as the Warthin Starry stain. After penicillin treatment was initiated, skin lesions improved, although residual lesions currently persist. Malignant syphilis should be considered in infected HIV patients with fever and ulcerated skin injuries as a possible diagnosis. Even though serological tests allow diagnosis confirmation, Warthin Starry stain can be useful when serology is negative. The first choice of treatment is penicillin and in case of penicillin allergy, a third generation cefalosporine should be used (AU)
