Self-reported adverse reactions to subcutaneous airborne allergen immunotherapy: a real-life, single center study.

Summary: Background. To estimate the prevalence of self-reported adverse reactions (AdR) to subcutaneous airborne allergen immunotherapy (SCIT) and to describe factors associated with its occurrence. Methods. Real-life, observational, descriptive study of all patients treated with SCIT at a Portuguese allergy unit between 03/2017 and 06/2019, and who answered ≥ 1 time to a pre-SCIT evaluation questionnaire assessing the occurrence of local and/or systemic AdR in the previous administration. Results. 939 questionnaires from 231 patients (42% female, 35% with asthma) were included. Most (60%) SCIT preparations had multiple allergens with concentration adjusted to prevent dilution (MA-NoDil), 26% were single allergen with standard concentration (SA-SC), 10% single allergen with higher than standard concentration (SA-HC), and 4% mixtures without concentration adjustment (MA-Dil). SCIT-related AdR were self-reported in 313 (33%) administrations, 97% at the injection site and 11% grade 1 systemic symptoms. In a multivariable model, being a female and having asthma were associated with higher risk of AdR. MA-NoDil SCIT presented a lower risk of AdR compared to SA-SC SCIT. Conclusions. SCIT-related AdR were self-reported in 1/3 of the administrations, most at the injection site. The risk of AdR was higher in females and in patients with asthma. The lower risk of adverse reactions observed in SCIT preparations with multiple allergens with no dilutional effect should be further explored in future, targeted studies.

Double blind randomized clinical trial comparing minimally- invasive envelope flap and conventional envelope flap on impacted lower third molar surgery.

BACKGROUND: The latest trend in surgery is to look for minimally invasive procedures, with fewer complications and a shorter recovery time. This study aims to compare the minimally- invasive envelope flap, with smaller incision and fewer dissection and the conventional envelope flap, with a 20mm incision, on impacted mandibular third molar surgery, focusing on the hypothesis that there were no differences in postoperative outcomes. MATERIAL AND METHODS: A double-blind randomized clinical trial was designed to compare both incisions, focused on determining the approach with minor postoperative side-effects and minor impact on quality-of-life. A total of 60 patients were enrolled for the study if their presented impacted mandibular third molar and was 18-years-old or more. Both groups were evaluated from time elapsed on the surgery, maximum mouth opening, swelling and quality of life assessment. RESULTS: The flap choice influenced facial swelling (p=0,03), pain on the first three days (p=0,037), interference with oral hygiene (p=0,019) and discomfort on speech (p=0,07). Chewing, swallowing, trismus, pain after seven days, postoperative complications and other quality-of-life arrangements were no different between groups. CONCLUSIONS: The minimally- invasive envelope flap could lead to a less painful experience for the patient, with fewer impact on the oral hygiene and speech discomfort.

Molecular-based diagnosis of respiratory allergic diseases in children from Curitiba, a city in Southern Brazil.

BACKGROUND: Prevalence of respiratory allergic diseases has increased worldwide. Identification of the aeroallergens involved in allergenic sensitisation is important for diagnosis, treatment and prevention. OBJECTIVE: To verify the molecular pattern of sensitisation to aeroallergens in patients with allergic respiratory diseases using microarray technique for specific IgE antibody detection. METHODS: Cross-sectional study of 101 children with allergic rhinitis was followed in an outpatient clinic. All patients had positive skin prick tests (SPT) to at least one of the following antigens: Dermatophagoides pteronyssinus, Blomia tropicalis, Blattella germanica, Lolium multiflorum, and dog and cat epithelium. Serum specific IgE antibodies (sIgE) to mites, animal epithelia, fungi, cockroach and pollens components were determined by ImmunoCAP ISAC. RESULTS: sIgE to group 1 and 2 mite allergens showed higher positive rates: Der p 1 (74.2%), Der p 2 (73.3%), Der f 1 (74.2%), Der f 2 (72.3%). sIgE to animal epithelia were less frequent, Can f 1, Can f 2, Can f 3 in 4.9%, 2.9%, 1.9% respectively and Fel d 1, Fel d 2, Fel d 4 in 16.8%, 0.9% and 1.9%. respectively. Sensitisation to fungi and cockroach were rare, except for Bla g 7, to which 16.8% were positive. There was no significant recognition for tree pollens group. For grass, sIgE were detected to Cyn d 1 in 16.8%, Phl p 1 and Phl p 4 in 14.8% and 12.9%, respectively. CONCLUSION: Knowing that the pattern of allergic sensitisation varies according to environment and population, our results reinforce the need for local studies, using molecular-based diagnosis.

Effects of a low-dose IL-2 treatment in HLA-B27 transgenic rat model of spondyloarthritis.

INTRODUCTION/AIM: HLA-B27/human ß2m transgenic rats (B27-rats) develop an inflammatory disorder resembling spondyloarthritis (SpA) with dysregulated IL-10/IL-17 production by regulatory T cells (Treg). Treg plays a major role in controlling pathogenic inflammatory processes. Interleukin 2 (IL-2), a cytokine which promotes Treg cell survival and function, may thus have therapeutic efficacy in SpA. Here, we tested this hypothesis using a low dose of IL-2 treatment in B27-rat. MATERIAL AND METHODS: B27-rats aged 4 weeks (before disease onset) and nontransgenic (NTG) littermates were administered intraperitoneally recombinant human IL-2 (Sanofi®; 2,000IU/injection) or PBS, 3 days per week during 6 weeks. Assessment of treatment effect was performed, based on clinical (weight, diarrhea, arthritis), histological (proximal and distal colon, caecum, ileum and tarsal/ankle joint) scores, and frequency of Treg in the spleen and lymph nodes (LN). RESULTS: IL-2 administration had no effect on weight gain, either in B27- or NTG-rats. Over the 6 weeks of treatment, the clinical disease score worsened similarly in both IL-2-treated and control groups of B27-rats. The macroscopic and histological evaluation of gut and joints showed marked inflammation in B27-rats; however, no change related to IL-2 treatment was observed. In the B27-rats, the percentage of Treg was moderately increased after IL-2 treatment in the spleen, but neither in mesenteric nor peripheral LN in those rats. CONCLUSION: Our data demonstrate that a low dose of IL-2 administered before disease onset was moderately effective for boosting Treg but failed to prevent SpA development in B27-rat.

Epidemiological aspects of scorpionic accidents in a municipality in Brazil's northeastern.

Scorpionic accidents are a major public health problem due to the high occurrence with potential seriousness. In this manner, the research aimed to analyze the occurrence of scorpionic accidents in a municipality in the northeastern of Brazil. An exploratory, descriptive study was made, with a quantitative approach, using secondary data which was gotten from the Notifiable Diseases Information System (SINAN), from 2008 to 2018. Data such as neighborhood, presence of street markets were also used, and the existence of sanitation and climatic data such as temperature and season. Geoprocessing was used to identify possible changes in the environment. In the analyzed period, 9,330 cases of scorpion accidents were recorded, with an average of 848 annual notifications. Scorpionic accidents occurred more frequently in women (5,686; 60.94%). Individuals aged 20 to 29 years (1.727; 18.51%) were more frequent to scorpion stings. Regarding the body parts where the stings were made, the highlights were on the foot (3.515; 37.67%) followed by the hand (2.818; 30.20%). No statistically significant relation was observed between climatic factors and scorpionic accidents. However, the high number of cases of scorpionic accidents was observed in the last 11 years studied. It was evident that during the study period there was no statistical relationship when climatic factors were correlated to scorpionic accidents. On its turn, when it was verified the results of the geoprocessing analysis, it was seen that anthropic factors have been motivating the potentiation of the occurrence of these accidents.

Association of lipase lipoprotein polymorphisms with high-density lipoprotein and triglycerides in elderly men.

Lipoprotein lipase is essential for triglyceride hydrolysis. The polymorphisms S447X in exon 9 and HindIII in intron 8 have been associated with lower triglyceride levels and lower cardiovascular risk in adult men. We examined the association of these lipoprotein lipase polymorphisms with high-density lipoprotein (HDL) and triglyceride levels in elderly men. Blood samples were obtained from 87 elderly men, 48 of whom had cardiovascular disease and 39 (controls) had no history of cardiovascular events. The lipoprotein lipase polymorphisms were analyzed by PCR-RFLP. Allele frequencies were H- = 27.9% and X = 21.5%. There were no significant differences in allele frequencies or blood lipid levels between cardiovascular disease and control groups. However, the X allele was associated with a lower triglyceride/HDL ratio, 2.30 vs 3.02 for X allele absent (P = 0.03); the H-X haplotype was associated with lower triglyceride levels compared to the H+S haplotype (1.22 vs 1.58 mM, respectively) and a lower triglyceride/HDL ratio (2.29 vs 3.26, respectively). The X allele and H-X haplotype were associated with lower triglyceride/HDL ratios in these elderly men, independent of the history of cardiovascular events.

Association of lipase lipoprotein polymorphisms with high-density lipoprotein and triglycerides in elderly men.

Lipoprotein lipase is essential for triglyceride hydrolysis. The polymorphisms S447X in exon 9 and HindIII in intron 8 have been associated with lower triglyceride levels and lower cardiovascular risk in adult men. We examined the association of these lipoprotein lipase polymorphisms with high-density lipoprotein (HDL) and triglyceride levels in elderly men. Blood samples were obtained from 87 elderly men, 48 of whom had cardiovascular disease and 39 (controls) had no history of cardiovascular events. The lipoprotein lipase polymorphisms were analyzed by PCR-RFLP. Allele frequencies were H- = 27.9% and X = 21.5%. There were no significant differences in allele frequencies or blood lipid levels between cardiovascular disease and control groups. However, the X allele was associated with a lower triglyceride/HDL ratio, 2.30 vs 3.02 for X allele absent (P = 0.03); the H-X haplotype was associated with lower triglyceride levels compared to the H+S haplotype (1.22 vs 1.58 mM, respectively) and a lower triglyceride/HDL ratio (2.29 vs 3.26, respectively). The X allele and H-X haplotype were associated with lower triglyceride/HDL ratios in these elderly men, independent of the history of cardiovascular events.

The influence of porosity on the integration histology of two polypropylene meshes for the treatment of abdominal wall defects in dogs.

Two types of monofilament polypropylene mesh with different pore sizes, mass densities and burst strengths were used to repair two identical paired full-thickness abdominal wall defects in ten dogs, in order to compare their integration histology 90 days after implantation. On one side a standard mesh, Prolene (Ethicon), was sutured to the borders of the defect, while on the other a new ultralightweight macroporous mesh, Mpathy mesh, was used. There was a significantly greater densitometric proportion of mature (type I) collagen (58.38%) for Mpathy mesh compared to Prolene (34.05%, P=0.01). Although Prolene has 3.6 times the burst strength of Mpathy mesh, the implanted tissue strength was marginally greater for Mpathy mesh. We conclude that Mpathy mesh gives a surgical repair that is at least as strong as that provided by Prolene, along with a higher concentration of mature collagen and less fibrosis (P=0.07), in this canine histology model.

Epidemiological aspects of scorpionic accidents in a municipality in Brazil's northeastern / Aspectos epidemiológicos dos acidentes escorpiônicos em um munícipio do nordeste brasileiro

Scorpionic accidents are a major public health problem due to the high occurrence with potential seriousness. In this manner, the research aimed to analyze the occurrence of scorpionic accidents in a municipality in the northeastern of Brazil. An exploratory, descriptive study was made, with a quantitative approach, using secondary data which was gotten from the Notifiable Diseases Information System (SINAN), from 2008 to 2018. Data such as neighborhood, presence of street markets were also used, and the existence of sanitation and climatic data such as temperature and season. Geoprocessing was used to identify possible changes in the environment. In the analyzed period, 9,330 cases of scorpion accidents were recorded, with an average of 848 annual notifications. Scorpionic accidents occurred more frequently in women (5,686; 60.94%). Individuals aged 20 to 29 years (1.727; 18.51%) were more frequent to scorpion stings. Regarding the body parts where the stings were made, the highlights were on the foot (3.515; 37.67%) followed by the hand (2.818; 30.20%). No statistically significant relation was observed between climatic factors and scorpionic accidents. However, the high number of cases of scorpionic accidents was observed in the last 11 years studied. It was evident that during the study period there was no statistical relationship when climatic factors were correlated to scorpionic accidents. On its turn, when it was verified the results of the geoprocessing analysis, it was seen that anthropic factors have been motivating the potentiation of the occurrence of these accidents.

Os acidentes escorpiônicos apresentam-se como um grande problema de saúde pública em virtude da grande ocorrência com potencial gravidade. Nesse sentido, o trabalho teve como objetivo analisar a ocorrência de acidentes escorpiônicos em um município do nordeste brasileiro. Foi realizado um estudo descritivo, de caráter exploratório, com abordagem quantitativa em que foram utilizados dados secundários obtidos no Sistema de Informação de Agravos de Notificação (SINAN), no período de 2008 a 2018. Também foram utilizados dados como bairro, presença de feiras livres e a existência de saneamento básico e dados climáticos como temperatura e estação do ano. O geoprocessamento foi utilizado para identificar as possíveis alterações no ambiente. No período analisado, foram registrados 9,330 casos de acidentes com escorpião, com média de 848 notificações anuais. Os acidentes escorpiônicos ocorreram com mais frequência em mulheres (5,686; 60,94%). Em indivíduos na faixa etária de 20 a 29 anos (1,727; 18,51%) foram mais frequentes a picada de escorpião. Com relação ao local das picadas destacaram-se o pé (3,515; 37,67%), seguido da mão (2,818; 30,20%). Não foi observada relação estatisticamente significativa entre os fatores clímáticos e os acidentes escorpiônicos. Foi observado elevado número de casos de acidentes escorpiônicos nos últimos 11 anos estudados. Ficou evidente que durante o período de estudo não existiu relação estatística quando se correlacionou fatores climáticos aos acidentes escorpiônicos. Por sua vez, ao verificar os resultados da análise de geoprocessamento foi visto que fatores antrópicos têm sido motivadores da potencialização da ocorrência desses acidentes.

Epidemiological aspects of scorpionic accidents in a municipality in Brazil's northeastern / Aspectos epidemiológicos dos acidentes escorpiônicos em um munícipio do nordeste brasileiro

Scorpionic accidents are a major public health problem due to the high occurrence with potential seriousness. In this manner, the research aimed to analyze the occurrence of scorpionic accidents in a municipality in the northeastern of Brazil. An exploratory, descriptive study was made, with a quantitative approach, using secondary data which was gotten from the Notifiable Diseases Information System (SINAN), from 2008 to 2018. Data such as neighborhood, presence of street markets were also used, and the existence of sanitation and climatic data such as temperature and season. Geoprocessing was used to identify possible changes in the environment. In the analyzed period, 9,330 cases of scorpion accidents were recorded, with an average of 848 annual notifications. Scorpionic accidents occurred more frequently in women (5,686; 60.94%). Individuals aged 20 to 29 years (1.727; 18.51%) were more frequent to scorpion stings. Regarding the body parts where the stings were made, the highlights were on the foot (3.515; 37.67%) followed by the hand (2.818; 30.20%). No statistically significant relation was observed between climatic factors and scorpionic accidents. However, the high number of cases of scorpionic accidents was observed in the last 11 years studied. It was evident that during the study period there was no statistical relationship when climatic factors were correlated to scorpionic accidents. On its turn, when it was verified the results of the geoprocessing analysis, it was seen that anthropic factors have been motivating the potentiation of the occurrence of these accidents.

Os acidentes escorpiônicos apresentam-se como um grande problema de saúde pública em virtude da grande ocorrência com potencial gravidade. Nesse sentido, o trabalho teve como objetivo analisar a ocorrência de acidentes escorpiônicos em um município do nordeste brasileiro. Foi realizado um estudo descritivo, de caráter exploratório, com abordagem quantitativa em que foram utilizados dados secundários obtidos no Sistema de Informação de Agravos de Notificação (SINAN), no período de 2008 a 2018. Também foram utilizados dados como bairro, presença de feiras livres e a existência de saneamento básico e dados climáticos como temperatura e estação do ano. O geoprocessamento foi utilizado para identificar as possíveis alterações no ambiente. No período analisado, foram registrados 9,330 casos de acidentes com escorpião, com média de 848 notificações anuais. Os acidentes escorpiônicos ocorreram com mais frequência em mulheres (5,686; 60,94%). Em indivíduos na faixa etária de 20 a 29 anos (1,727; 18,51%) foram mais frequentes a picada de escorpião. Com relação ao local das picadas destacaram-se o pé (3,515; 37,67%), seguido da mão (2,818; 30,20%). Não foi observada relação estatisticamente significativa entre os fatores climáticos e os acidentes escorpiônicos. Foi observado elevado número de casos de acidentes escorpiônicos nos últimos 11 anos estudados. Ficou evidente que durante o período de estudo não existiu relação estatística quando se correlacionou fatores climáticos aos acidentes escorpiônicos. Por sua vez, ao verificar os resultados da análise de geoprocessamento foi visto que fatores antrópicos têm sido motivadores da potencialização da ocorrência desses acidentes.

Epidemiological aspects of scorpionic accidents in a municipality in Brazils northeastern

Abstract Scorpionic accidents are a major public health problem due to the high occurrence with potential seriousness. In this manner, the research aimed to analyze the occurrence of scorpionic accidents in a municipality in the northeastern of Brazil. An exploratory, descriptive study was made, with a quantitative approach, using secondary data which was gotten from the Notifiable Diseases Information System (SINAN), from 2008 to 2018. Data such as neighborhood, presence of street markets were also used, and the existence of sanitation and climatic data such as temperature and season. Geoprocessing was used to identify possible changes in the environment. In the analyzed period, 9,330 cases of scorpion accidents were recorded, with an average of 848 annual notifications. Scorpionic accidents occurred more frequently in women (5,686; 60.94%). Individuals aged 20 to 29 years (1.727; 18.51%) were more frequent to scorpion stings. Regarding the body parts where the stings were made, the highlights were on the foot (3.515; 37.67%) followed by the hand (2.818; 30.20%). No statistically significant relation was observed between climatic factors and scorpionic accidents. However, the high number of cases of scorpionic accidents was observed in the last 11 years studied. It was evident that during the study period there was no statistical relationship when climatic factors were correlated to scorpionic accidents. On its turn, when it was verified the results of the geoprocessing analysis, it was seen that anthropic factors have been motivating the potentiation of the occurrence of these accidents.

Resumo Os acidentes escorpiônicos apresentam-se como um grande problema de saúde pública em virtude da grande ocorrência com potencial gravidade. Nesse sentido, o trabalho teve como objetivo analisar a ocorrência de acidentes escorpiônicos em um município do nordeste brasileiro. Foi realizado um estudo descritivo, de caráter exploratório, com abordagem quantitativa em que foram utilizados dados secundários obtidos no Sistema de Informação de Agravos de Notificação (SINAN), no período de 2008 a 2018. Também foram utilizados dados como bairro, presença de feiras livres e a existência de saneamento básico e dados climáticos como temperatura e estação do ano. O geoprocessamento foi utilizado para identificar as possíveis alterações no ambiente. No período analisado, foram registrados 9,330 casos de acidentes com escorpião, com média de 848 notificações anuais. Os acidentes escorpiônicos ocorreram com mais frequência em mulheres (5,686; 60,94%). Em indivíduos na faixa etária de 20 a 29 anos (1,727; 18,51%) foram mais frequentes a picada de escorpião. Com relação ao local das picadas destacaram-se o pé (3,515; 37,67%), seguido da mão (2,818; 30,20%). Não foi observada relação estatisticamente significativa entre os fatores clímáticos e os acidentes escorpiônicos. Foi observado elevado número de casos de acidentes escorpiônicos nos últimos 11 anos estudados. Ficou evidente que durante o período de estudo não existiu relação estatística quando se correlacionou fatores climáticos aos acidentes escorpiônicos. Por sua vez, ao verificar os resultados da análise de geoprocessamento foi visto que fatores antrópicos têm sido motivadores da potencialização da ocorrência desses acidentes.

Approaches that use software to support the prevention of pressure ulcer: A systematic review.

CONTEXT: The incidence and costs for pressure ulcer (PU) treatment remain high even though preventive methods are applied. Approaches that use software to support the prevention of PU are presented in the literature to make it more effective. OBJECTIVES: Identify the state of art of the approaches that use software to support the prevention of PUs. METHODS: A systematic literature review was performed to analyze approaches that use software to support the prevention of PU. ACM, IEEE, PubMed, Scopus, CINAHL and Embase databases have been searched with a predetermined search string to identify primary studies. We selected the ones that met the established inclusion criteria. RESULTS: Thirty-six articles met the inclusion criteria. To support prevention, most approaches monitor the patient to provide information about exposure to pressure, temperature level, humidity level and estimated body position in bed providing risk factor intensity charts and intensity maps. The main method to perform patient's monitoring is using sensors installed on the mattress, but recently, alternative methods have been proposed such as electronic sensors and tactile sensory coils. Part of the approaches performs automated management of the risk factors using ventilation tubes and mattresses with porous cells to decrease body's temperature and movable cells to automatically redistribute the pressure over the body. Matters as cost of the approach, patient comfort and hygiene of the monitoring equipment is only briefly discussed in the selected articles. No experiments have been conducted to evidence the approached may reduce PU incidence. DISCUSSION AND CONCLUSION: Currently, approaches that use software to support the prevention of PU provide relevant information to health professionals such as risk factor intensity charts and intensity maps. Some of them can even automatically manage risk factors in a limited way. Yet, the approaches are based on risk factor monitoring methods that require patient's contact with the monitoring equipment. Therefore, some matters need to be considered such as patient's comfort and the hygiene or replacement of the equipment due to the risk of infection. With the emergence of new alternative methods of monitoring, new technologies that do not require contact could be explored by new researches. Randomized Control Trials could also be conducted to verify which approaches are really effective to reduce PU incidence.

Activating mutation of the stimulatory G protein (gsp) as a putative cause of ovarian and testicular human stromal Leydig cell tumors.

Activating mutations of the G protein genes have been associated with the development of several endocrine neoplasms. Such activating mutations, gip2, affecting the alpha-subunit of the G alpha i2 protein were previously described by a single group in 30% of ovarian sex cord stromal tumors. Other activating mutations of the alpha-subunit of the Gs (gsp) have been identified in GH-secreting and nonfunctioning pituitary tumors, autonomous thyroid adenomas, and all affected McCune-Albright tissues, but not in sex cord stromal tumors. In the present study, we investigated the presence of gip2 and gsp mutations in 14 human sex cord stromal tumors. Six Leydig cell tumors (4 ovaries and 2 testes), 2 thecomas, 2 granulosa cell tumors, 3 androblastomas, and 1 gonadoblastoma (sex cord and germ cell) were included in this study. Genomic DNA was obtained from either fresh-frozen tumor tissues or paraffin-embedded sections and in some cases from blood samples. Using PCR, denaturing gradient gel electrophoresis, and direct sequencing, we detected 4 tumors (66.6%) with the gsp mutation (R201C) in our series of ovarian and testicular Leydig cell tumors. In contrast, no gip2 mutations were found in any of the sex cord stromal tumors studied. In conclusion, our findings suggest that the putative oncogene gsp may play a significant role in the molecular mechanism of these tumors.

Effect of genetic modifications by selection for immunological tolerance on fungus infection in mice.

Two strains of mice genetically selected for extreme phenotypes of immunological tolerance to ovalbumin, susceptible (TS) and resistant (TR), were experimentally infected with Sporothrix schenckii. The objective was to observe whether the genetic modifications produced by the selection might be associated with interstrain differences in adaptive immune and innate responses to infection. Therefore, we evaluated the LD(50), CFU, phagocytic index, fungicidal activity, pro-inflammatory cytokines, specific antibody titres, and the delayed-type hypersensitivity reactivity. TR mice were tenfold more susceptible to infection than TS mice, as shown by LD(50) (5 x 10(6) conidia i.v.). In TS mice, the resistance was a consequence of the tissue fungal load reduction, consistent specific T-cell-mediated immunity, and tumour necrosis factor (TNF)-alpha activity at onset of infection. In TR mice, these responses were not precociously detected. Therefore, the absence of CD4(+) T-cell response in the first week of infection might explain the non-clearance of pathogen in TR mice. However, TR mice did show an increase in TNF level and delayed-type hypersensitivity response after the first week post-infection; there was also expansion and increase in granulomatous foci and CFU in the spleen. The expansion of granulomatous foci and the increase in TNF-alpha and tissue fungal load to damaging levels induced severe tissue destruction, general failure of the organs, cachexy and death in TR mice. The results show that genetic selection for extreme phenotypes of immunological tolerance also modified the responses to S. schenckii infection.

Comparison of left ventricular mass and function in obese versus nonobese women <40 years of age.

We evaluated, through Doppler echocardiography, left ventricular (LV) mass and function in 82 obese young women (aged <40 years) who were asymptomatic, without any cardiovascular or pulmonary disease compared with a lean control group matched by age and height. LV mass, LV mass/height, and LV mass/volume were increased in obese women, and a lower LV E- and A-wave velocity ratio was noted, suggesting early cardiac involvement.

AREDYLD: a syndrome combining an acrorenal field defect, ectodermal dysplasia, lipoatrophic diabetes, and other manifestations.

A daughter of second cousins is described as having lipoatrophic diabetes, unusual facial appearance, generalized hypotrichosis, two natal teeth with enamel dysplasia, eruption of four dysplastic deciduous teeth, absence of permanent dentition, low birth weight, short stature, lumbar scoliosis, renal alterations, aplasia of a breast and hypoplasia of the other, hypoplastic and hypopigmented areolae with diffuse limits, hyperostosis of the cranial vault, metacarpal hypoplasias, difficulty of grasping with the left hand, exertional dyspnea, absence of DIP extension and flexion creases, dermatoglyphic alterations, and other anomalies. Her sister, dead at 1 1/2 years, had had some manifestations of the condition; seven sibs are normal. It is more likely that the whole clinical picture represents a single syndrome rather than homozygosity of different autosomal-recessive genes.

Liver and biliary ultrasonography in diabetic and non-diabetic obese women.

Liver and biliary ultrasonographic findings were studied in 217 asymptomatic obese women [mean age 35.0 +/- 8.3 years, range 15 to 57; mean body mass index (BMI, weight/height2) 40.7 +/- 6.9 kg/m2, range 30.3-71.9] from the Obesity Outpatient Clinic of the Professor Edgard Santos University Hospital. The women underwent an oral glucose tolerance test and were divided into two groups: 21 diabetic obese women plus 25 glucose intolerant (group I); and 171 non-diabetic obese women (group II). Ultrasonography (US) was performed on a Siemens Sonoline SL2 apparatus with a 3.5 MHz transducer. Plasma glucose levels and biochemical tests were determined by the enzymatic method. The frequency of liver US abnormalities was similar in both groups (52.2% of group I and 47.8% of group II). Steatosis was found in 34.8% of group I and 32.2% of group II; steatosis associated with hepatomegaly in 17.4% of group I and 10.5% of group II; and hepatomegaly in 4.1% of group I and absent in group II. Serum cholesterol, HDL-cholesterol, triglycerides, and liver function tests, including aspartate aminotransferase, alanine aminotransferase and gama-glutamiltranspeptidase levels, were similar in both groups. However, triglycerides, uric acid and gamaglutamyl transpeptidase levels were higher in the diabetic and glucose-intolerant group. The frequency of asymptomatic gallstones was higher in group II than group I (24.4% vs 11.7%, p < 0.04). It is suggested that liver and biliary US should be included in the evaluation of all obese women, even when asymptomatic.

Association of acanthosis nigricans with race and metabolic disturbances in obese women.

Acanthosis nigricans (AN) has been recognized as a marker of insulin resistance and diabetes mellitus. We have compared frequency of race and metabolic disturbances in obese women with several degrees of AN (AN group, N = 190) to a group without AN (non-AN group, N = 61) from a mixed racial population. The groups were similar regarding age and body mass index. All patients (except the diabetic patients) underwent an oral glucose tolerance test (75 g). The racial distribution of this population was 35.1% white, 37.8% mulatto and 27.1% black and the frequency of AN was 62.5, 82.1 and 83.8%, respectively, higher in black versus white (P = 0.003) and mulatto versus white (P = 0.002) women. The frequencies of diabetes mellitus and impaired glucose tolerance were 5.8 and 12.6% in the AN group and 1.6 and 8.2% in the non-AN group, respectively (P>0.05). Fasting glucose, beta cell function determined by the homeostasis model of assessment (HOMA), fasting insulin and insulin area under the curve were similar for the AN and non-AN groups. A higher HOMA insulin resistance was observed in the AN group compared to the non-AN group (P = 0.02) and in the subgroup of highest degree of AN compared to those with other degrees. The mean lipid levels and the frequency of dyslipidemia were similar for the two groups. AN was strongly associated with the black or mulatto rather than the white race, even after taking into account the effect of age, body mass index and HOMA insulin resistance.

The effects of glibenclamide treatment on insulin secretion and on insulin binding to erythrocytes in type II diabetes mellitus.

1. Eleven patients with type II diabetes mellitus were studied prior to, and after short- (10 days) and long-term (6 months) glibenclamide treatment. 2. A marked decrease in glucose level was observed after short- and long-term therapy using the oral glucose tolerance test (OGTT) and diet test (DT). 3. After short-term therapy, insulin level increased by 52.5% with the OGTT and by 37.6% with the DT; after long-term therapy, the increases were 78.6% and 69.5%, respectively. 4. Insulin binding to erythrocytes was unchanged by short- or long-term glibenclamide therapy. 5. These data suggest that the hypoglycemic effect of glibenclamide results from an increase in insulin secretion and that extrapancreatic actions at the receptor or post-receptor level are not necessarily involved.

Induction versus noninduction therapy in kidney transplantation: considering different PRA levels and different induction therapies.

To evaluate the rate of acute cellular rejection (ACR) and long-term results in different levels of anti-HLA sensitization, using noninduction or different induction therapies, 763 patients who underwent transplantation from January 1995 to December 2001 were evaluated: 213 patients received induction therapy, 71 received Thymoglobulin (Thymo), 66 Simulect, and 44 OKT3. Follow-up time was at least 1 year for all groups. The Simulect group included older recipients and the OKT3 group had more female patients. Simulect and OKT3 groups had more black patients; Thymo and OKT3 groups had more retransplantations. PRA was low in the noninduction group (mean, 7%) and about the same in the Simulect and Thymo groups (mean, 30%). OKT3 was the most sensitized group (mean = 59%). Dialysis during the first posttransplantation week was more frequent among the induction groups (43% vs 65%; P <.005). Fewer patients experienced rejection episodes in the Thymo group (20% vs 50%; P =.02). Patients were classified according to their level of sensitization, and the Thymo group showed the lower rejection rates in all levels (mean, 20%; P =.001). When analyzing PRA >50%, the Thymo group showed lower rejection rates (12% vs 50%; P =.02). At this level of sensitization, there was no significant difference on graft loss and death with a functioning graft. There was a trend to more cytomegalovirus (CMV) disease in the Thymo group (33% vs 23%; P =.08). Two PTLD were diagnosed, both in the noninduction group. Renal function was better in the Thymo group (1.3 mg/dL). In conclusion, Thymo showed lower ACR rates in all PRA groups. No significant differences in CMV infection, tumors, and patient survival were observed.