Níveis de grelina circulante e a suscetibilidade ao câncer colorretal / Circulating ghrelin levels and susceptibility to colorectal câncer

ABSTRACT BACKGROUND AND OBJECTIVE: Considering the association between colorectal cancer (CRC) and both insulin resistance and obesity, and the prominent role of ghrelin in these metabolic disorders, we explored whether plasma levels of ghrelin were associated with CRC. Moreover, in the patients with CRC the possible correlations between ghrelin and insulin, insulin resistance, and body mass index (BMI) as an indicator of obesity were examined. METHODS: A total of 170 subjects, including 82 cases with CRC and 88 controls were enrolled in this study. Plasma levels of ghrelin, insulin, and glucose were measured in all the subjects using ELISA and glucose oxidase methods. Furthermore, insulin resistance was assessed by calculating HOMA-IR index. RESULTS: The cases with CRC had decreased ghrelin levels (P<0.001) and a higher HOMA-IR index (P<0.001) than controls. Interestingly, when CRC patients were stratified based on tumor site, lower ghrelin levels and a higher HOMA-IR index were observed in the patients with either colon or rectal cancer vs. controls too. Additionally, there were an age and BMI-independent negative correlation between ghrelin levels and HOMA-IR (r=-0.365, P<0.05), and an age-independent negative correlation between ghrelin levels and BMI (r=-0.335, P<0.05) in the rectal subgroup. CONCLUSION: Our findings support a role for ghrelin in connection with insulin resistance and obesity in CRC susceptibility; however, it needs to be corroborated by further studies.

RESUMO CONTEXTO E OBJETIVO: Considerando a associação entre câncer colorretal (CCR), a resistência à insulina, à obesidade e o papel proeminente da grelina nessas doenças metabólicas, foi explorado se os níveis plasmáticos de grelina estavam associados ao CCR. Além disso, nos pacientes com CCR foram pesquisadas as possíveis correlações entre a grelina, insulina, resistência insulínica e índice de massa corporal (IMC) como indicadores de obesidade. MÉTODOS: Foram incluídos neste estudo 170 indivíduos, sendo 82 com CRC e 88 controles. Os níveis plasmáticos de grelina, insulina e glicose foram medidos em todos os sujeitos utilizando métodos ELISA e glicose oxidase. Além disso, a resistência à insulina foi avaliada pelo cálculo do índice HOMA-IR. RESULTADOS: Os pacientes com CRC apresentaram redução dos níveis de grelina (P<0,001) e maior índice HOMA-IR (P<0.001) do que os controles. Curiosamente, quando os pacientes com CRC foram estratificados com base no local do tumor, níveis mais baixos de grelina e maior índice de HOMA-IR foram observados nos indivíduos com câncer de cólon ou retal versus controles também. Além disso, houve uma correlação negativa entre idade e IMC independente entre os níveis de grelina e HOMA-IR (r=-0,365, P<0,05) e uma correlação negativa independente da idade entre os níveis de grelina e IMC (r=-0,335, P<0,05) no subgrupo retal. CONCLUSÃO: Nossos achados apoiam o papel da grelina em relação à resistência à insulina e à obesidade na suscetibilidade do CRC; no entanto, ela precisa ser corroborada por estudos posteriores.

Concomitant neurogenic and vascular thoracic outlet syndrome due to multiple exostoses

We report a rare case of multiple hereditary exostosis where patient presented with bilateral base of neck exostoses with concurrent compression of brachial plexus and subclavian artery and vein. The patient was a young 26-year-old woman with chief complaints of pain in the left upper extremity, paresthesia in the left ring and little finger, and weakness in hand movement and grip. On referral, history, physical examination, radiological imaging, and electrodiagnostic tests evaluated the patient. Due to severe pain and disability in performing routine activities, surgical intervention was necessary. In the current case, the patient had thoracic outlet syndrome with concomitant venous, arterial, and neurogenic sub types. Radial pulse returned and pain associated with brachial plexus compression was resolved after the surgery.

Premedication effect of dexmedetomidine and alfentanil on seizure time, recovery duration, and hemodynamic responses in electroconvulsive therapy.

Introduction: Electroconvulsive therapy (ECT) is an effective treatment for many mental disorders, especially severe and persistent depression, bipolar disorder, and schizophrenia. The aim of this study is to compare the effect of dexmedetomidine and alfentanil on agitation, satisfaction, seizure duration, and patients hemodynamic after ECT. Materials and Methods: In a three phase crossover randomized clinical trial, 75 patients aged between 18 and 50 years and candidate for ECT were enrolled and assigned into three groups (25 patients in each group). All patients, respectively, took premedication of dexmedetomidine, alfentanil, or saline in three consecutive phases. Patients received 0.5 μg/kg dexmedetomidine, 10 μg/kg alfentanil or normal saline intravenously, 10 min before induction. Finally, seizure and recovery duration, satisfaction and agitation score, and hemodynamic parameters were evaluated. Results: There was no significant difference about seizure duration, agitation score, and hemodynamic parameters between groups but recovery duration was significantly lower in the control group than dexmedetomidine (P = 0.016) and alfentanil group (P = 0.0001). Patients’ satisfaction was significantly higher in intervention groups (alfentanil and dexmedetomidine groups) (P = 0.0001). Conclusion: Given the equal effects of alfentanil and dexmedetomidine, it seems that choosing one of these two drugs for premedication of patients undergoing ECT is appropriate. Drug choice is influenced by numerous factors such as accessibility of each drug and the dominance of anesthesiologist and psychiatrist.

Comparative survey of work related musculoskeletal disorders [WRMDs] prevalence and related factors in Iranian welders

To determine the prevalence and risk factors for work related musculoskeletal disorders among welders. All 160 welders who work at a petrochemical complex in south of Iran were included in this study. The Nordic musculoskeletal questionnaire [NMQ] was used to study prevalence of work related musculoskeletal disorders [WMSDs]. Most welders [88.3%] suffered from some kind of MSDs symptoms. Arc welders had significantly more musculoskeletal problems in the neck and wrists/hands regions than gas welders. Analysis showed that duration of employment as a welder was significantly associated with a work related musculoskeletal disorder of the shoulder [OR 3.2, 95% CM .1 to 8.9], lower back, neck [OR 3.1, 95% Cl 1.1 to 8.4], and knee [OR 3.5, 95% Cl 1.3 to 9.2]. WMSDs had occurred with a high rate among Iranian welders. This study supports the need for vigilant ergonomic intervention at welding

Gestational diabetes and its association with unpleasant outcomes of pregnancy

Diabetes Mellitus account for over 8% of all pregnancies and is associated with increased risk of complications of pregnancy, and prenatal mortality. This study was conducted to determine the disadvantages of gestational diabetes on mother and her baby, in order to prevent neonatal and marital unpleasant outcomes. The present historical cohort study includes 420 mothers referred to Shiraz hospitals in 2006. Seventy cases with diabetes and 350 were controls. Data was collected by questionnaire and analyzed by t-test and fisher exact tests in SPSS v.13 software. The recurrence rate of gestational diabetes was 72.4%. There was a significant difference between the two groups in still birth [RR= 8.87], macrosommia [RR= 7.38], respiratory distress [RR= 5.16], hypoglycemia [RR= 13.38], neonatal jaundice [RR= 3.28], need for respiratory support [RR= 3.17], congenital anomalies [RR= 7.28] and cesarean delivery [RR= 1.96] [p<0.05]. However it did not show any significant difference in intra uterine growth retardation [IUGR], shoulder dystocia, breech labor, need for insulin, meconium problems, induction of labor, episiotomy and placenta disorders [P>0.05]. Stillbirth, macrosomia, respiratory distress, hypoglycemia and neonatal jaundice are more common in women with gestational diabetes. Hence in view of the unfavourable outcome, preventive measures and control of diabetes are essential