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1.
Clin Nutr ; 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30948220

RESUMO

BACKGROUND & AIMS: Peripheral white blood cells (PWBC) may allow for the development of obesity biomarkers. We aimed to investigate the existence of gene expression and DNA methylation changes in PWBC after a very low calorie diet (VLCD) followed by a laparoscopic sleeve gastrectomy (LSG), and its correlation with surgical outcomes. METHODS: From July 2013 to June 2014, 35 consecutive bariatric patients and 33 healthy lean volunteers were recruited. Molecular data was obtained once on the control group and at 3 different times on the LSG group: 1) at baseline; 2) after 2 weeks of VLCD, right before LSG; and 3) 6 months after LSG. The expression of 12 genes in PWBC was analyzed by quantitative real-time polymerase chain reaction: ghrelin (GHRL), visfatin (NAMPT), insulin receptor substrate 1 (IRS1), fat mass and obesity-related gene (FTO), leptin (LEP), peroxisome proliferator-activated receptor gamma (PPARG), adiponectin (ADIPOQ), fatty acid synthase (FASN), melanocortin 4 receptor (MC4R), fas cell surface death receptor (FAS), tumor necrosis factor alpha (TNF) and chemokine (C-C motif) ligand 2 (CCL2). Moreover, DNA methylation of GHRL, NAMPT and FAS promoters was analyzed in PWBC by bisulfite pyrosequencing. RESULTS: Seven genes (GHRL, NAMPT, IRS1, FTO, FAS, TNF and CCL2) had detectable expression in PWBC. FTO expression at baseline was lower in patients than in controls (p = 0.042), equalizing after LSG. In patients, FAS expression decreased after VLCD (p = 0.01) and stayed low after LSG (p = 0.015). Also, CCL2 expression decreased 50% after LSG compared to pre-surgical levels (p = 0.016). All studied CpG sites in the GHRL gene promoter followed a consistent pattern of DNA methylation/demethylation. No direct correlation between these molecular changes and surgical outcomes was found at 1-year follow-up. CONCLUSIONS: FTO expression increased and FAS and CCL2 expression decreased in PWBC after LSG. Molecular changes did not correlate with surgical outcomes.

2.
Minerva Endocrinol ; 44(2): 143-158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30311754

RESUMO

Acromegaly is a rare disease caused by excess growth hormone (GH) secretion leading to an insulin-like growth factor-1 (IGF-I) which is the major mediator of GH action. Biochemical diagnosis of GH excess is accomplished by the combined measurement of baseline serum IGF-I concentration and the response of GH on an oral glucose tolerance test (OGTT). Several drawbacks regarding the interpretation of biochemical tests that include measurement of GH have been widely described in the literature, including different protocols for obtaining serum samples, great differences in the results obtained by different immunoassays, different cut-off points used to differentiate the normal status of the hypersecretion of GH. Clinical guidelines related to the diagnosis and management of patients with acromegaly state that "normal" IGF-I concentrations, (within an established age- and sex- reference range), excludes the diagnosis of active acromegaly, and mean disease control in patients who have received treatment. But many factors may exert influence over IGF-I measurement or interpretation and limit its value as a biological marker of disease activity. Major drawbacks of IGF-I measurements derive both from its own physiology, to the divergences in results obtained from different biochemical methods used for their quantification, to the heterogeneous ways of expressing the results obtained and to the lack of uniformity of the cut-offs to define treatment effectiveness. All these issues make it difficult to compare the results obtained by different authors. We will focus on the issues regarding the measurement and interpretation of IGF-I concentrations in the management of acromegaly patients.


Assuntos
Acromegalia/tratamento farmacológico , Acromegalia/metabolismo , Fator de Crescimento Insulin-Like I/análise , Acromegalia/diagnóstico , Biomarcadores/análise , Humanos , Fator de Crescimento Insulin-Like I/genética
3.
Clin Biochem ; 61: 23-27, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30130523

RESUMO

BACKGROUND: vitamin D deficiency in children is still a global health problem. Measuring free 25-hydroxyvitamin D concentrations could provide a better estimate of the vitamin D status than total 25-hydroxyvitamin D (25(OH)D) levels. OBJECTIVE: To assess the relationship between measured free vitamin D (m-f25(OH)D) and calculated free 25(OH)D (c-f25(OH)D), total 25(OH)D, intact parathyroid hormone (iPTH) and other markers of phosphocalcic metabolism. To establish serum m-f25(OH)D concentrations corresponding to a total 25(OH)D > 50 nmol/L which is accepted as vitamin D-sufficiency status in children. DESIGN: Prospective cohort study. SETTING: January and February 2017 in a Mediterranean population. PATIENTS: healthy children. MEASUREMENTS: m-f25(OH)D and vitamin D binding protein (VDBP) by ELISA. Free 25(OH)D was calculated using the formula described by Bikle. RESULTS: m-f25(OH)D directly correlated with total 25(OH)D (r:0.804,p < .001), serum calcium (r:0.26,p:0.035), and c-f25(OH)D (r:0.553,p:0.016); and inversely with iPTH (r:-0.374, p:0.002), alkaline phosphatase (r:-0.28, p:0.026), and age (r:-0.289, p:0.018). Total 25(OH)D correlated with the same parameters as m-f25(OH)D except for serum calcium. However, c-f25(OH)D correlated only with total 25(OH)D and VDBP, both included in the calculation formula. Multiple regression analysis showed that m-f25(OH)D variations were independently explained by calcium (ß:0.156, p:0.026) and total 25(OH)D (ß:0.043, p < .001). The optimal m-f25(OH)D cut-off for discriminating between insufficient and sufficient total 25(OH)D was >9.8 pmol/L (Area Under Curve (AUC): 0.897 (95% confidence interval (CI): (0.798-0.958); p < .001; sensitivity:72.7% (95%CI: 49.8-89.3); specificity: 95.5% (95%CI: 84.5-99.4)). CONCLUSIONS: Directly measured free vitamin D correlated better with markers of phosphocalcic metabolism than total 25(OH)D and c-f25(OH)D in a population of healthy children.


Assuntos
Doenças Assintomáticas , Calcifediol/sangue , Fenômenos Fisiológicos da Nutrição Infantil , Estado Nutricional , Deficiência de Vitamina D/sangue , Proteína de Ligação a Vitamina D/sangue , Adolescente , Biomarcadores/sangue , Calcifediol/química , Calcifediol/deficiência , Calcifediol/metabolismo , Cálcio/sangue , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Masculino , Ambulatório Hospitalar , Hormônio Paratireóideo/sangue , Estudos Prospectivos , Valores de Referência , Sensibilidade e Especificidade , Solubilidade , Deficiência de Vitamina D/diagnóstico , Proteína de Ligação a Vitamina D/metabolismo
5.
Obes Surg ; 27(7): 1674-1682, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28161887

RESUMO

BACKGROUND: Nutritional deficiencies are common after bariatric surgery, but data are scarce after sleeve gastrectomy (SG) at long term. METHODS: We performed a prospective nutritional status evaluation before and at 2 and 5 years after SG in morbid obese patients receiving mulvitamin and mineral supplementation at a Spanish university hospital. One hundred seventy-six patients (49.3 ± 9.1 years and 46.7 ± 7.4 kg/m2) were evaluated; 51 of them were followed during 5 years. Anthropometric, compliance supplementation intake, and micronutrient evaluation were performed. RESULTS: Baseline concentrations were below normal values for 25(OH) vitamin D (73%), folic acid (16.5%), cobalamin (6.9%), pyridoxine (12%), thiamine (3.4%), and copper (0.5%). Anemia was found in 23%. In 49% of the subjects, at least one micronutrient deficiency was found at 2 years after SG. Vitamin D deficiency persisted at 2 and 5 years higher than 30% of patients. Frequencies of deficiencies for folic acid, B12, B6, and B1 vitamins decreased significantly after 2 years with normalization at 5 years. Copper deficiency increased between 1 and 2 years and it persisted at 5 years after SG. Vitamin supplementation compliance decreased progressively from the first year after surgery (94.8 to 81% at 2 years and to 53% 5 years after surgery). CONCLUSIONS: Vitamin D deficiency is the most prevalent long-term nutritional deficiency after SG. About half of patients show some micronutrient deficiency at medium long term, despite supplementation. A proactive follow-up is required to ensure a personalized and adequate supplementation in all surgically treated obese patients including those in which SG has been performed.


Assuntos
Gastrectomia/efeitos adversos , Desnutrição/diagnóstico , Obesidade Mórbida/cirurgia , Oligoelementos/sangue , Oligoelementos/deficiência , Vitaminas/sangue , Adulto , Anemia/sangue , Anemia/diagnóstico , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/etiologia , Micronutrientes/sangue , Micronutrientes/deficiência , Pessoa de Meia-Idade , Estado Nutricional , Obesidade Mórbida/sangue , Estudos Prospectivos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/etiologia
6.
Clin Biochem ; 50(9): 481-484, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28109748

RESUMO

BACKGROUND: Chronic use of proton pump inhibitors (PPIs) leads to increases in gastrin and pepsinogen-I serum concentrations. AIM: To asses if chronic treatment with PPIs has an effect on serum gastrin and pepsinogen-I concentrations for the diagnosis of pernicious anaemia (PA). MATERIALS AND METHODS: Serum gastrin and pepsinogen-I were measured in 38 patients with PA and 74 without PA (controls); 17/38 PA patients and 36/74 controls were treated with PPIs. Receiver Operating Curves (ROC) were used to compare diagnostic accuracy of gastrin and pepsinogen-I for PA in patients under chronic treatment with PPIs and in untreated patients. RESULTS: PPI treatment increased pepsinogen-I in patients and in controls, while gastrin increased only in controls. In untreated patients, a pepsinogen-I <8.3ng/mL had 95.2% sensitivity and 100% specificity, whereas a gastrin >115pg/mL had 100% sensitivity and 92.11% specificity for PA diagnosis. In PPI-treated patients, a pepsinogen I<24.1ng/mL had a lower sensitivity (82.4%) but retained 100% specificity, however the best cut-off point for gastrin, 610pg/mL, had a very low sensitivity (58%). CONCLUSIONS: PPI chronic treatment decreased the diagnostic accuracy for the studied biomarkers, particularly of gastrin. In PPI-treated patients, serum pepsinogen-I concentrations >24.1ng/mL allowed rejecting a PA diagnosis with 100% specificity.


Assuntos
Anemia Perniciosa/sangue , Gastrinas/sangue , Pepsinogênio A/sangue , Inibidores da Bomba de Prótons/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/farmacocinética , Estudos Retrospectivos
7.
Growth Horm IGF Res ; 26: 32-5, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26774403

RESUMO

BACKGROUND: In children with growth disorders, mean final height is associated to poor adherence to Growth Hormone therapy. The primary goal of this study is to identify patients who do not adhere to GH therapy and determine the influence of adherence in response to the treatment. The role of serum IGF-I and influence of socio-economic factors on the therapeutic adherence will also be evaluated. METHODS: 158 children under treatment with rhGH were included in the study. Age, gender, etiology, Tanner stage, duration of treatment, growth rate, IGF-I serum values, daily dose, and annual rhGH dose data were collected. Adherence to therapy was defined as moderate-to-poor when the patient had taken less than 92% of the prescribed medication. A subgroup of 106 patients completed a questionnaire to assess social and environmental effects. RESULTS: Moderate-to-poor adherence to rhGH treatment was determined in 33.5% of study patients. A decrease in adherence was associated to treatment duration (p=0.001). A significant correlation was determined between adherence and height velocity (p=0.002) and IGF-I (p<0.0001) levels. Adherence rates were associated to the mother's educational level (p=0.007). CONCLUSION: Poor adherence to GH therapy was observed in one-third of study patients, resulting in suboptimal growth. IGF-I levels can be helpful to identify patients with poor adherence to GH medication. Physicians should pay special attention to certain characteristics of the patient and their environment, and encourage desirable therapeutic compliance.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Transtornos do Crescimento/tratamento farmacológico , Transtornos do Crescimento/epidemiologia , Hormônio do Crescimento Humano/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Terapia de Reposição Hormonal/estatística & dados numéricos , Hormônio do Crescimento Humano/deficiência , Humanos , Estudos Longitudinais , Masculino , Proteínas Recombinantes/uso terapêutico , Fatores Socioeconômicos
8.
Clin Biochem ; 49(3): 295-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26562029

RESUMO

OBJECTIVES: Primary hyperaldosteronism (PHA) is one of the most common endocrine forms of secondary hypertension. Among the most used confirmatory tests for PHA is urinary aldosterone determination after oral sodium loading test. The primary aim of our study was to investigate if sodium concentrations interfere with urinary aldosterone in an automated competitive immunoassay (Liaison®) as well as to verify the manufacturer's specifications. DESIGN AND METHODS: 24-hr urine samples were collected and stored frozen until assayed. Two pools at low and high aldosterone concentrations were prepared. Verification of performance for precision was tested according to Clinical and Laboratory Standards Institute (CLSI) document EP15-A2 and interference with increasing concentrations of NaCl according to CLSI EP7-A2. RESULTS: The assay met the quality specifications according to optimal biological variation. Our results show that sodium concentrations up to 200mmol/L do not interfere on urinary aldosterone quantification, but sodium concentrations above 486mmol/L negatively interfere with the test. CONCLUSIONS: The Liaison® automated method is useful for aldosterone determination in the PHA confirmatory test, but interferences with NaCl may occur. It is therefore recommended to determine urinary NaCl before measuring urinary aldosterone to avoid falsely low results.


Assuntos
Aldosterona/urina , Imunoensaio/métodos , Sódio/urina , Aldosterona/química , Humanos , Hiperaldosteronismo/urina , Hipertensão , Reprodutibilidade dos Testes , Sódio/química , Cloreto de Sódio/metabolismo
9.
Med. clín (Ed. impr.) ; 145(10): 433-435, nov. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-145253

RESUMO

Fundamento y objetivo: La causa o causas de la anemia que acompaña a la anorexia nerviosa (AN) no ha sido establecida, pero no parece relacionarse con deficiencias nutricionales ni cambios medulares. El objetivo de este trabajo fue evaluar la producción de eritropoyetina (EPO) en respuesta a la anemia en un pequeño grupo de pacientes con AN y anemia. Pacientes y métodos: Los niveles de EPO en muestras de suero de 41 mujeres con AN (11 con anemia y 30 sin alteraciones en los parámetros de la serie eritroide) se compararon con la respuesta observada en un grupo de pacientes de peso normal con anemia. Resultados: Las concentraciones de EPO en pacientes con AN anémicas fueron mayores que en las no anémicas: 20,63 mU/ml (4,04 a 28,46) frente a 8,7 mU/ml (3,9 a 20,93), p = 0,0088, pero el aumento de EPO fue menor de lo esperado (27,85 mU/ml [17,7 a 118,9]), p = 0,014. La correlación entre el IMC y la diferencia entre la EPO y la EPO esperada es inversa. Conclusiones: Una producción inadecuada de EPO puede explicar en parte la anemia en la AN. Son necesarios más estudios para investigar la causa de esta respuesta (AU)


Background and objective: The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients. Patients and methods: EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia. Results: EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63 mU/mL (4.04-28.46) vs 8.7 mU/mL (3.9-20.93), P = .0088, but the increase in EPO was lower than expected (27.85 mU/mL [17.7-118.9]), P = .014. BMI and the difference between actual and expected EPO were inversely correlated. Conclusions: Inadequate EPO response may partly explain anemia in AN, but further studies are necessary (AU)


Assuntos
Feminino , Humanos , Anorexia Nervosa/metabolismo , Anorexia Nervosa/patologia , Anemia/sangue , Anemia/metabolismo , Porfiria Eritropoética/patologia , Transtornos de Alimentação na Infância/diagnóstico , Hematologia/métodos , Anorexia Nervosa/complicações , Anorexia Nervosa/diagnóstico , Anemia/complicações , Anemia/patologia , Porfiria Eritropoética/genética , Transtornos de Alimentação na Infância/complicações , Hematologia/normas
10.
J Stroke Cerebrovasc Dis ; 24(11): 2605-12, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26363707

RESUMO

BACKGROUND: Metabolic syndrome (MetS) has been associated with higher resistance to clot lysis at 24 hours after tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke. We aimed to test this hypothesis at earlier time points, when neurointerventional rescue procedures may still be indicated to achieve arterial recanalization. METHODS: This is a prospective and observational study in consecutive stroke patients with MCA occlusion treated with IV tPA. MetS was diagnosed following the unified criteria of the last Joint Interim Statement 2009 participating several major organizations. The primary outcome variable was resistance to thrombolysis, defined as the absence of complete middle cerebral artery recanalization 2 hours after tPA bolus assessed by transcranial color-coded duplex or when rescue mechanical thrombectomy after IV tPA was required. Secondary outcome variables were dramatic neurological improvement (decrease in ≥10 points, or a National Institutes of Health Stroke Scale [NIHSS] score of 0-1 at 24 hours), symptomatic intracerebral hemorrhage following European-Australasian Acute Stroke Study II criteria, infarct volume at 24 hours (calculated by using the formula for irregular volumes, ABC/2), and good outcome (modified Rankin Scale score < 3) at 3 months. RESULTS: A total of 234 patients (median baseline NIHSS score 16 [10-20]) were included and 146 (62.4%) fulfilled MetS criteria. After multivariate analysis, MetS emerged as an independent predictor of resistance to thrombolysis (odds ratio = 2.2 [1.3-4.2], P = .01) and absence of dramatic neurological improvement (odds ratio = .5 [.28-.97], P = .04). In addition, MetS conferred poorer functional outcome, higher symptomatic intracerebral hemorrhage rate, and increased infarct volume, although these associations disappeared after adjustment for covariates. CONCLUSIONS: MetS predicts patients with middle cerebral artery occlusion refractory to early clot dissolution after IV tPA. This finding may help in acute clinical decision-making.


Assuntos
Fibrinolíticos/efeitos adversos , Doenças Metabólicas/etiologia , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/efeitos adversos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tomógrafos Computadorizados , Ultrassonografia Doppler Transcraniana
11.
Int J Endocrinol ; 2015: 381415, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26089883

RESUMO

Type 2 diabetes (T2D) exists in 25-40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittance HbA1c was 7.7 ± 1.5%; 47% (189) had HbA1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA1c. Ninety-four of the 189 SCGC patients were evaluated 3-6 months later. Their HbA1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P < 0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.

12.
Med Clin (Barc) ; 145(10): 433-5, 2015 Nov 20.
Artigo em Espanhol | MEDLINE | ID: mdl-26049959

RESUMO

BACKGROUND AND OBJECTIVE: The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients. PATIENTS AND METHODS: EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia. RESULTS: EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63mU/mL (4.04-28.46) vs 8.7mU/mL (3.9-20.93), P=.0088, but the increase in EPO was lower than expected (27.85mU/mL [17.7-118.9]), P=.014. BMI and the difference between actual and expected EPO were inversely correlated. CONCLUSIONS: Inadequate EPO response may partly explain anemia in AN, but further studies are necessary.


Assuntos
Anemia/etiologia , Anorexia Nervosa/complicações , Eritropoetina/deficiência , Adolescente , Adulto , Anemia/sangue , Anorexia Nervosa/sangue , Biomarcadores/sangue , Eritropoetina/sangue , Feminino , Humanos , Adulto Jovem
13.
Clin Lab ; 60(11): 1859-64, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25648027

RESUMO

BACKGROUND: IGF-I is a clinically relevant protein in the diagnosis and monitoring of treatment of growth disor- ders. The Growth Hormone Research Society and the International IGF Research Society have encouraged the adoption of a universal calibration for immunoassays to improve standardization of IGF-I measurements, but currently commercial assays are calibrated either against the old WHO IRR 87/518 or the new WHO 02/254. We compared two IGF-I immunochemiluminescent assays: IMMULITE® 2000 (Siemens) and LIAISON® (DiaSorin), which differ in their standardization, and verified their precision according to quality specifications based on biological variation and their linear range. METHODS: 62 patient serum samples were analyzed for both assays and compared according to standards of the Clinical and Laboratory Standards Institute (CLSI), EP9-A2-IR. Precision was verified according to CLSI EP15- A2. Optimal coefficient of variation (CVo) and desirable coefficient of variation (CVd) for IGF-I assays were calculated as quality specifications based on the biological variability, in order to assess if the interassay analytical CV (CVa1) in the two methods were appropriate. Two dilution series using the 1st WHO International Standard (WHO IS) for IGF-I 02/254 were used to verify and compare the linearity range. RESULTS: The regression analysis showed constant and proportional differences for serum samples (slope b = 0.8115 (CI 95% CI; 0.7575-0.8556); intercept a = 33.6873 (95% CI: 23.3613-44.0133) between assays and similar pro- portional differences for WHO IS 02/254 standard dilutions series (slope b = 0.8024 (CI 95% CI; 0.7560-0.8616); intercept a = 6.9623 (95% CI: -2.0819-18.4383) between assays. Within-laboratory coefficients of variation for low and high levels were 2.82% and 3.80% for IMMULITE® 2000 and 3.58% and 2.14% for LIAISON®, respecttively. CONCLUSIONS: IGF-I concentrations measured by both assays are not transferable. The results emphasize the need to express IGF-I concentrations in standard deviation score (SDS) according to a matched normal population of the same age and gender. Within-laboratory precision in both methods met quality specifications derived from biological variation.


Assuntos
Imunoensaio/métodos , Fator de Crescimento Insulin-Like I/análise , Adolescente , Adulto , Automação Laboratorial , Biomarcadores/sangue , Criança , Feminino , Humanos , Imunoensaio/normas , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Controle de Qualidade , Padrões de Referência , Reprodutibilidade dos Testes , Adulto Jovem
14.
Eur J Endocrinol ; 169(5): 695-703, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23946276

RESUMO

OBJECTIVES: IGF1 is decreased in morbidly obese (MO) patients and its changes after bariatric surgery weight loss (WL) are not well known. The aim of this study was to analyse IGF1 modifications in MO patients after WL and its relationship to ghrelin and to different types of surgeries. DESIGN: Retrospective follow-up study at the University Medical Center. METHODS: One hundred and nine MO patients (age 44.19.3, BMI 51.748.75KG/M(2)) were evaluated at baseline and 1 year after surgery: 28 sleeve gastrectomy (SG), 31 distal modified (m), and 50 ringed (r) Roux-en-Y gastric bypass (RYGBP) surgery. Changes in IGF1, IGFBP3, ratio IGF1:IGFBP3, and ghrelin were evaluated 1 year after surgery. RESULTS: Baseline prevalence of low IGF1 (defined by s.d. IGF1<-2) was 22%, and %WL 1 year after surgery was 34.9±8.9%. There was a significant decrease in IGFBP3 in all the procedures, an increase in IGF1:IGFBP3 ratio in rRYGBP and SG, but total IGF1 only increased significantly in SG. Albumin concentrations decreased in mRYGBP, did not change in rRYGBP, but increased in SG after surgery. Total ghrelin concentrations increased after both RYGBPs and decreased after SG (P<0.05 in all cases). The prevalence of low IGF1 decreased in SG (28.6 vs 10.1%, P=0.03) and did not change in RYGPBP techniques. The %albumin change was the only dependent variable associated with the % total IGF1 change. CONCLUSIONS: Recovery of low IGF1 after bariatric surgery was specifically related to the albumin modifications induced by surgery and was not related to ghrelin modifications.


Assuntos
Cirurgia Bariátrica/métodos , Fator de Crescimento Insulin-Like I/metabolismo , Estado Nutricional , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Grelina/sangue , Homeostase , Humanos , Hipertensão/sangue , Hipertensão/complicações , Insulina/sangue , Resistência à Insulina , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Análise de Regressão , Albumina Sérica/metabolismo
15.
Am J Surg ; 206(5): 783-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23835208

RESUMO

BACKGROUND: There is no consensus about the usefulness of postoperative intact parathyroid hormone (iPTH) determination to predict permanent hypoparathyroidism (pHPP). We evaluated the value of calcium (Ca2+) and iPTH concentration at 24 hours after total thyroidectomy (TT) for predicting pHPP. METHODS: Ca2+ and iPTH levels from 70 consecutive patients who underwent TT were measured at 24 hours and 6 months after TT. RESULTS: Five patients (7.1%) developed pHPP. An iPTH concentration ≤5.8 pg/mL at 24 hours after TT identified patients at risk for pHPP (sensitivity, 100%; specificity, 81.5%), but it was not accurate enough to predict its development (positive predictive value, 30%). Conversely, an iPTH level >5.8 pg/mL predicted normal parathyroid function at 6 months (negative predictive value, 100%). Compared with iPTH, a postoperative Ca2+ level ≤1.95 mmol/L was 60% sensitive and 78.5% specific to predict pHPP. CONCLUSIONS: An iPTH concentration >5.8 pg/mL on the first postoperative day rules out pHPP with much better diagnostic accuracy than Ca2+. Postoperative iPTH could be helpful in identifying patients at risk for developing pHPP.


Assuntos
Cálcio/sangue , Hipoparatireoidismo/diagnóstico , Hormônio Paratireóideo/sangue , Tireoidectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Fatores de Tempo
16.
Age (Dordr) ; 35(6): 2515-23, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23604919

RESUMO

Obestatin has been proposed to have anorexigenic and anti-ghrelin actions. The objective was to study obestatin concentrations in relation to handgrip strength, functional capacity and cognitive state in old women. The prospective study included 110 women (age, 76.93 ± 6.32) from the Mataró Ageing Study. Individuals were characterized by anthropometric variables, grip strength, Barthel and assessment of cognitive impairment [Mini Cognoscitive Examination (MCE) Spanish version], depressive status by the Geriatric Depression Scale (GDS) and frailty by the Fried criteria. Obestatin was measured by IRMA. Obestatin showed negative correlation to handgrip at basal time point (r = -0.220, p = 0.023) and at 2-year follow-up (r = -0.344, p = 0.002). Obestatin, divided into quartiles, showed a negative lineal association with handgrip: 11.03 ± 4.88 kg in first, 8.75 ± 4.08 kg in second, 8.11 ± 3.66 kg in third and 7.61 ± 4.08 kg in fourth quartile (p = 0.018). Higher obestatin levels were associated to increased weakness (categorized by handgrip of frailty criteria): 2.24 ± 0.42 ng/ml in weak vs. 1.87 ± 0.57 ng/ml in non-weak (p = 0.01). The decrease of either MCE or Barthel scores at 2-year follow-up was significantly higher in individuals in the fourth quartile of obestatin in comparison with individuals in the first quartile (p = 0.046 and p = 0.019, respectively). No association was found between obestatin and GDS score and neither with frailty as a condition. Obestatin is associated to low muscle strength, and impaired functional and cognitive capacity in old women participating in the Mataró Ageing Study.


Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/metabolismo , Cognição/fisiologia , Idoso Fragilizado , Avaliação Geriátrica/métodos , Grelina/metabolismo , Força Muscular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo
17.
Thyroid ; 23(8): 964-70, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23528137

RESUMO

BACKGROUND: The relationship between thyrotropin (TSH) concentrations and body mass index (BMI) in euthyroid subjects has been demonstrated only in some studies. Leptin regulates TSH secretion and TSH stimulates leptin secretion. The main aims of our study were to assess the relationship between leptin, the thyroid axis, and thyroid autoimmunity in a representative sample of a nonhospitalized euthyroid adult population of Catalonia and to determine whether smoking status could influence this relationship. METHODS: This cross-sectional population-based study includes 894 euthyroid iodine-sufficient adults (390 men, 44.87±15.03 years old) with BMI 26.19±4.61 kg/m(2), representative of people living in Catalonia. The study analyzes the relationship between TSH, free thyroxine (FT4), leptin, thyroperoxidase and/or thyroglobulin antibodies (thyroid autoimmunity), smoking status, and BMI. Measurements also include glycemia and insulinemia to calculate homeostasis model assessment of insulin resistance (HOMA-IR) index as a measure of insulin sensitivity. RESULTS: In the univariate analysis and in the overall group, TSH correlated directly with BMI, leptin, and HOMA-IR (p=0.039, p<0.001, and p=0.010, respectively). In all men, TSH correlated directly with leptin (p=0.004), and in all women, directly with leptin (p=0.002) and HOMA-IR (p=0.031) and inversely with FT4 (p=0.024). Only in men who smoke, TSH correlated directly with leptin (p=0.010) and HOMA-IR (p=0.024). In women, TSH correlated directly with leptin (p=0.004) and in nonsmoking women, inversely with FT4 (p=0.047). In the multiple regression analysis, age (ß=-0.00310, p=0.0265), smoking status (ß=-0.24085, p=0.0202), and thyroid autoimmunity (ß=0.20652, p=0.0075) were independent predictors of TSH variations. Leptin was a significant independent predictor of TSH variations only in smokers (ß=0.16451, p=0.047). CONCLUSIONS: Leptin is an independent predictor of TSH concentration variations only in euthyroid smoker subjects of both sexes at all ranges of BMI, but not in nonsmokers. Age, smoking status, and positive thyroid autoimmunity also influenced TSH variability.


Assuntos
Leptina/sangue , Fumar/fisiopatologia , Glândula Tireoide/fisiologia , Tireotropina/sangue , Adolescente , Adulto , Idoso , Autoanticorpos/sangue , Glicemia/metabolismo , Índice de Massa Corporal , Estudos Transversais , Feminino , Homeostase , Humanos , Resistência à Insulina/fisiologia , Iodeto Peroxidase/sangue , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/imunologia , Tiroxina/sangue
18.
BMC Neurol ; 12: 103, 2012 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-23006125

RESUMO

BACKGROUND: Low levels of plasma 25-hydroxyvitaminD (25(OH)D) are associated with a higher incidence of multiple sclerosis (MS) due to the immune suppressive properties of vitamin D.The aim of this study was to determine the correlation between plasma 25(OH)D concentrations and clinical and immunological variables in a cohort of multiple sclerosis patients. METHODS: Plasma 25(OH)D concentrations were evaluated in summer and winter in 15 primary progressive MS (PPMS) patients, 40 relapsing- remitting MS (RRMS) patients and 40 controls (HC). Protocol variables included demographic and clinical data, radiological findings and immunological variables (oligoclonal bands, HLADR15 and T-lymphocyte proliferation to a definite mix of 7 myelin peptides). RESULTS: During the winter, plasma concentrations were significantly lower in RRMS patients compared to HC, whereas no differences were found in summer. No relationships were found between plasma 25(OH)D concentrations and clinical or radiological variables. RRMS patients with a positive T-cell proliferation to a mix of myelin peptides (n = 31) had lower 25(OH)D concentrations. CONCLUSIONS: 25(OH)D is an immunomodulatory molecule that might have a regulatory role in T-cell proliferation to myelin peptides in RRMS patients.


Assuntos
Esclerose Múltipla Recidivante-Remitente/sangue , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Proteínas da Mielina/sangue , Estações do Ano , Linfócitos T/metabolismo , Vitamina D/sangue , Adulto , Feminino , Humanos , Masculino
19.
Obes Surg ; 22(12): 1835-42, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22923309

RESUMO

BACKGROUND: The effect of weight loss by bariatric surgery on gonadal hormones in morbidly obese males is not entirely known. The main objective of the study was to analyze gonadal hormonal changes after weight loss. METHODS: An observational study was conducted before and after 12 months of weight loss at a clinical research center. Thirty-three men [age 40.5 ± 9.9, body mass index (BMI) 50.3 ± 6.1 kg/m(2)] undergoing bariatric surgery were included. The main outcome measures were as follows: changes in total (TT) and free testosterone (FT), estradiol (E2), sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), inhibin B, and prolactin (PRL). RESULTS: Baseline prevalence of hypogonadism (defined by TT < 300 ng/dl or FT < 65 pg/ml) was 78.8 and 51.5%, respectively. Hypogonadal patients were older and showed inhibin B and AMH significantly lower than those with normal TT. BMI correlated negatively with TT, LH, and SHBG. Regression analyses showed a significant and independent association of hypogonadism with age (OR = 1.2, p = 0.01), BMI (OR = 1.3, p = 0.03), and AMH (OR = 0.4, p = 0.03) after adjustments. After 1 year, percentage of weight loss (%WL) was 18.8 ± 5.2%, and there was a significant increase of TT, FT, SHBG, and FSH and a decrease of E2 and PRL. Prevalence of persistent hypogonadism after surgery was 6% (low TT) and 15% (low FT). %WL was significantly associated with percent changes in SHBG (r = -0.4, p = 0.04), inhibin B (r = -0.4, p = 0.03), and AMH (r = -0.4, p = 0.01). Age and %WL were the only significant and independent parameters associated with %TT change. CONCLUSIONS: Obesity-associated hypogonadism is very prevalent in males with morbid obesity and is mostly reversed after sustained weight loss by bariatric surgery.


Assuntos
Cirurgia Bariátrica , Hipogonadismo/sangue , Obesidade Mórbida/sangue , Obesidade Mórbida/cirurgia , Perda de Peso , Adulto , Hormônio Antimülleriano/sangue , Biomarcadores/sangue , Índice de Massa Corporal , Estradiol/sangue , Hormônio Foliculoestimulante/sangue , Humanos , Inibinas/sangue , Hormônio Luteinizante/sangue , Masculino , Obesidade Mórbida/complicações , Prolactina/sangue , Valores de Referência , Indução de Remissão , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Resultado do Tratamento
20.
Endocrine ; 38(3): 391-6, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20972723

RESUMO

The prevalence of thyroid dysfunction varies in different populations. The aim of this cross-sectional study was to analyze the prevalence of undiagnosed thyroid dysfunction and thyroid antibodies and their relationship with urine iodine excretion in a representative sample of 1,124 (55.5% women; mean age: 44.8 ± 15.2 years) non-hospitalized Mediterranean adults, in Catalonia (Spain). Free thyroxine, thyroid-stimulating hormone, thyroperoxidase and thyroglobulin antibodies, and urine iodine were measured. Undiagnosed thyroid dysfunction was 5.3% (hypothyroidism 3.8%; 56.66% of these subjects were women). The total (diagnosed + undiagnosed) thyroid dysfunction was 8.9% (71.15% women). Thyroperoxidase antibodies were positive in 2.4% of men and 9.4% of women and thyroglobulin antibodies, in 1.3% of men and 3.8% of women. No differences were observed in urine iodine between groups with thyroid dysfunction and euthyroidism, or between subjects with positive or negative antibodies. In subjects over 60, undiagnosed thyroid dysfunction was 9.8% (hypothyroidism 6.9%, hyperthyroidism 3.3%; 36.36% women) and total thyroid dysfunction 13.61% (53.12% women). Women and men over 60 had similar thyroid dysfunction prevalence. Thus, aggressive case-finding should be recommended in both, over 60.


Assuntos
Anticorpos/sangue , Iodo/urina , Doenças da Glândula Tireoide/epidemiologia , Glândula Tireoide/imunologia , Adulto , Doenças Assintomáticas/epidemiologia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Iodo/metabolismo , Masculino , Região do Mediterrâneo/epidemiologia , Pessoa de Meia-Idade , População , Prevalência , Espanha/epidemiologia , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/urina , Testes de Função Tireóidea
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