Falciparum malaria is associated with risk markers of type 2 diabetes mellitus in individuals with or without COVID-19 exposure

Background: Scientific information on the impact of malaria on the risk of developing type 2 diabetes mellitus (T2DM) after recovery from the coronavirus disease 2019 (COVID-19) is limited in the Ghanaian context. The purpose of this study was to examine the association between selected risk markers of T2DM in falciparum malaria patients post-COVID-19 or not at a tertiary hospital in Ghana. Methodology: This was a descriptive cross-sectional comparative study of 38-recovered COVID-19 adult participants with malaria and 40 unexposed COVID-19 adults with malaria at the Tamale Teaching Hospital, Ghana. Demographic, anthropometric and levels of glucose, insulin, C-reactive protein and lipid profiles were measured in the two groups of participants under fasting conditions. Parasitaemia was assessed microscopically but insulin resistance and beta-cell function were assessed by the homeostatic model. Results: The COVID-19 exposed participants were older (p=0.035) with lower parasitaemia (p=0.025) but higher mean levels of insulin, insulin resistance, and beta-cell function compared with their unexposed counterparts (p<0.05). Parasitaemia correlated positively with a number of the measured indices of diabetogenic risk markers in the COVID-19 exposed group only, and predicted (Adjusted R2=0.751; p=0.031) by beta-cell function, C-reactive protein and triglycerides with the model explaining about 75% of the observed variation. Parasitaemia could only be predicted (Adjusted R2=0.245; p=0.002) by C-reactive protein with the model explaining just about a quarter of the observed variation in the COVID-19 unexposed group. Insulin resistance and sub-optimal beta-cell function were detected in both groups of participants. Conclusion: Falciparum malaria is associated with risk markers for development of T2DM irrespective of COVID-19 exposure. Insulin resistance, inflammation and sub-optimal beta-cell secretory function may drive the risk. The observed diabetogenic risk is higher in the recovered COVID-19 participants.

Tratamiento farmacológico del estrabismo / Pharmacological treatment of strabismus

La cirugía de la musculatura extraocular ha sido el estándar de atención para tratamiento quirúrgico del estrabismo por más de un siglo. A pesar del gran desarrollo técnico de la cirugía de estrabismo en la actualidad, la utilización de microscopio quirúrgico, el diseño novedoso del instrumental quirúrgico, la calidad de la sutura no reabsorbible; los avances en equipamiento y fármacos anestésicos, la misma no está exenta de complicaciones quirúrgicas, además del tiempo de recuperación que necesita el paciente para reincorporarse a sus actividades sociales, han propiciado una búsqueda permanente del tratamiento farmacológico para el estrabismo. El objetivo de esta revisión bibliográfica es analizar las distintas alternativas farmacológicas disponibles como tratamiento del estrabismo. Para su confección se consultó textos completos y artículos en idiomas español e inglés, disponible en algunas bases de datos. Concluimos que aunque se han estudiado numerosos fármacos, la toxina botulínica que es la más conocida y utilizada mundialmente, seguida de la bupivacaína. Encontramos otros como la IGF I y II (Insuline Growing Factor), capaces de generar un efecto de reforzamiento de la actividad muscular. Y otros que "debilitan" la musculatura extraocular, incluyen la mAb35-Rubicina, BMP4 (Proteína morfogénica ósea). Se continúa su investigación en la actualidad(AU)

Extraocular musculature surgery has been the standard of care for surgical treatment of strabismus for more than a century. Despite the great technical development of strabismus surgery today, the use of a surgical microscope, the novel design of surgical instruments, the quality of the non-absorbable suture; Advances in anesthetic equipment and drugs, it is not exempt from surgical complications, in addition to the recovery time that the patient needs to return to their social activities, have led to a permanent search for pharmacological treatment for strabismus. The objective of this bibliographic review is to analyze the different pharmacological alternatives available as a treatment for strabismus. For its preparation, full texts and articles in Spanish and English languages were consulted, available in some databases. We conclude that although numerous drugs have been studied, botulinum toxin, which is the best known and used worldwide, followed by bupivacaine. We find others such as IGF I and II (Insuline Growing Factor), capable of generating an effect of reinforcing muscle activity. And others that "weaken" MOE include mAb35-Rubicin, BMP4 (Bone Morphogenic Protein). His research is continuing today(AU)

Effect of Huazhi Rougan Granules on insulin resistance in patients with non-alcoholic steatohepatitis / 中成药

AIM To observe the clinical efficacy of Huazhi Rougan Granules (Artemisiae scopariae Herba,Cassiae Semen,Rhei Radix et Rhizoma,etc.) in the treatment of damp-heat accumulation type non-alcoholic steatohepatitis (NASH) and its influence on insulin resistance.METHODS During January 2014-January 2016,a total of one hundred and twenty patients with damp-heat accumulation type NASH,given diet and exercise guidance,were randomly and equally divided into control group (polyene phosphatidylcholine) and treatment group (Huazhi Rougan Granules),administrated for twelve weeks.The levels of serum alanine aminotransferase (ALT),aspartate aminotranferase (AST),gamma-glutamyltransferase (GGT),total cholesterol (TC),triglyceride (TG),γ-glutamyl transpeptadase (GGT),fasting plasma glucose (FPG),fasting insulin (FINS),HOMA-IR index,adiponectin (ADPN) and leptin,body mass index (BMI) and uhrasound examination were detected before and after the treatment,respectively.These data were compared in two groups.RESULTS Compared with the control group,the serum ALT,AST,GGT,TC,TG,FPG,FINS and HOMA-IR of the patients in the treatment group decreased significantly,and liver fat were effectively reduced,while serum adiponectin increased markedly (P ＜ 0.05).After the treatment,remarkable reductions in the levels of BMI,leptin were observed in both groups (P ＜ 0.05).CONCLUSION Huazhi Rougan Granules combined with lifestyle modulation can effectively improve the syndrome of damp-heat accumulation type NASH by lowing insulin resistance.

Índice, carga glicémica y fibra dietética de los alimentos y su asociación con resistencia a la insulina en adultos chilenos / Glycemic index, glycemic load and dietary fiber of foods and its association with insulin resistance in Chilean adults

El Índice y Carga Glicémica (IG y CG) categorizan los alimentos según su capacidad de incrementar la glicemia, considerando cantidad y calidad de hidratos de carbono consumidos. Diferentes estudios han postulado que una dieta con IG y CG altos y bajo consumo de fibra incrementan la glicemia e insulinemia, aunque con resultados heterogéneos.El objetivo de este estudio fue analizar la asociación entre IG, CG e ingesta de fibra y valores HOMA-IR en adultos jóvenes. En una muestra representativa de 738 personas que tenían entre 32 y 38 años, nacidos en el Hospital de Limache, Región de Valparaíso, Chile, se recogió información socioeconómica, de salud, se determinó estado nutricional, glicemia, insulina basal y HOMA, y con la encuesta de frecuencia de consumo se estimó IG, CG e ingesta de fibra. Se construyeron modelos de regresión múltiple, controlando efectos de confusión e interacción. En modelos ajustados, se observó que por cada 10 unidades que aumenta el IG y CG de la dieta en individuos con exceso de peso, aumenta el HOMA-IR en 0,31 (p=0,042) y 0,03 (p=0,012), respectivamente y por cada 10 gramos que aumenta la fibra total y soluble, disminuye el HOMA-IR en 0,10 (p=0,04) y 0,62 (p=0,034) respectivamente. En personas sin exceso de peso no hubo estos efectos. Existe una asociación directa entre el aumento de IG y CG de los alimentos y el incremento de HOMA-IR sólo en individuos con exceso de peso y una asociación inversa entre ingesta de fibra dietética total y soluble y HOMA-IR(AU)

Glycemic index, glycemic load and dietary fiber of foods and its association with insulin resistance in Chilean adults. Glycemic index and glycemic load (GI and GL) categorize foods according to their ability to increase blood sugar levels, considering quantity and quality of carbohydrates consumed. Different studies have postulated that a high GI and GL diet and low fiber intake increased glycemia and insulinemia, although with heterogeneous results. The aim of this study was to analyze the association between GI, GL and fiber intake and HOMA-IR values in young adults. In a representative sample of 738 people aged between 32 and 38 years old, born in the Limache’s Hospital, Valparaiso, Chile, socioeconomic and health information, nutritional status, basal glycemia, insulin and HOMA were collected. With a food frequency questionnaire, GI, GL and fiber intake were estimated. Multiple regression models were constructed, controlling confounding and interaction effects. In adjusted models, it was found that for every 10 units that increases diet GI and GL in overweight individuals, HOMA- IR increases in 0.31 (p = 0.042) and 0.03 (p = 0.012) respectively, and for every 10 grams that increases total and soluble fiber intake, HOMA-IR reduces in 0.10 (p = 0.04) and 0.62 (p = 0.034) respectively. In people without overweight such effects were not observed. There was a direct association bet- ween increased GI and GL foods and increased HOMA-IR only in individuals with overweight and an inverse association between total and soluble fiber intake and HOMA-IR(AU)

El polimorfismo (CAG)n del gen ATXN2, nuevo marcador de susceptibilidad para diabetes mellitus tipo 2 / (CAG)n polymorphism of the ATXN2 gene, a new marker of susceptibility for type 2 diabetes mellitus

RESUMEN Objetivo Estimar si hay asociación del repetido (CAG)n del gen ATXN2 en población mexicana con diabetes mellitus (DM) tipo 2. Métodos Estudio epidemiológico de casos y controles. Se incluyeron personas sanas y personas diabéticas. La detección de la expansión (CAG)n se realizó por reacción en cadena de la polimerasa (PCR)-punto final. Los productos de PCR se analizaron mediante electroforesis (PAGE al 8%) y tinción con nitrato de plata. Resultados La distribución de alelos del trinucleótido (CAG)n en la población analizada resultó similar a la reportada en el centro del país. El alelo más frecuente es el de 22 repetidos; sin embargo, hay asociación con los portadores de los repetidos largos dentro del rango normal con diabetes. Conclusiones Los resultados sugieren que el repetido (CAG)n del gen de ATXN2 podría ser un factor causal de DM tipo 2.

ABSTRACT Objective Estimate whether there is an association between the (CAG)n repeat in the ATXN2 gene in the Mexican population and type 2 diabetes mellitus (DM). Methods Epidemiological case-control study, including healthy people and diabetics. (CAG)n expansion was detected by end-point polymerase chain reaction (PCR). PCR outputs were analyzed by electrophoresis (PAGE 8%) and silver nitrate staining. Results (CAG)n nucleotide allele distribution in the study population was similar to that reported in central Mexico. The 22-repeat allele is the most frequent; however, there is an association with carriers of long repeats in the normal range with diabetes. Conclusions The results suggest that the (CAG)n repeat of the ATXN2 gene could be a causal factor for type 2 DM.

Sindrome metabólico en niños y adolescentes: qué hay de nuevo? / Metabolic syndrome in children and adolescents: what is new?

El Síndrome Metabólico (SM) comprende alteraciones antropométricas, clínicas y metabólicas predisponentes del desarrollo de diabetes tipo 2 y enfermedades cardiovasculares; resulta de la interacción de factores genéticos y ambientales mediados por regulación epigenética; algunos loci pueden tener mayor efecto en los fenotipos metabólicos modificados por la dieta u otros factores ambientales. Una vez caracterizados los componentes del SM, diversos estudios se enfocan en identificar los mejores predictores de riesgo cardio-metabólico en adultos: obesidad central (CCi) y resistencia a la insulina (RI). La obesidad gestacional y RI en tejidos fetales se asocian a riesgo alto de SM en niños y adolescentes. En adultos jóvenes: mayor prevalencia de HTA y RI en nacidos pretérmino (peso al nacer < 1500 g) vs nacidos a término, sin diferencias significativas en perfil lipídico entre ambos. Estudios recientes reportan asociación entre suministro bajo de ácidos grasos ώ-3 y elevado de ώ-6 en < 2 años con características posteriores del SM: dislipidemia, RI e hiperfagia. Adolescentes obesos no diabéticos con SM tenían menores habilidades aritméticas, de deletreo, atención y flexibilidad mental y más probabilidades de desempeño inadecuado en las evaluaciones cognitivas que sus pares saludables. Se encontraron reducciones de la integridad microestructural en la materia blanca y menores volúmenes del hipocampo, capaces de ocasionar complicaciones cerebrales a corto plazo. Se ha descrito adelanto fisiológico de indicadores de maduración sexual y ósea (MO) en obesos, pero se carece de información en SM; el análisis individual en obesos de 9-16 años con SM evidenció alto porcentaje de MO adelantada(AU)

Metabolic Syndrome (MS) includes anthropometric, clinic and metabolic changes that predispose to the development of diabetes type 2 and cardiovascular diseases. MS results from the interaction of genetic and environmental factors mediated by epigenetic regulation; some loci have greater effect on metabolic phenotypes modified by diet and other environmental factors. Once MS components are characterized, several studies focus on the best predictors to identify cardiometabolic risk in adults: Waist circumference (WC) and insulin resistance (IR). Obesity during pregnancy and IR in fetal tissues is associated to high risk of MS in children and adolescents. In young adults there is a higher prevalence of high blood pressure and IR in children born preterm (weight < 1500 g) vs. children born at term, without significant differences in lipidic profile between both groups. Recent studies have proposed the association between low intake of ώ-3 and high intake of ώ-6 fatty acids in infants with latter appearance of MS characteristics: dyslipidemia, IR and hyperphagia. Non-diabetic obese adolescents with MS were found to have lower arithmetic skills, spelling and mental flexibility and inappropriate performance in cognitive evaluations when compared with their healthy peers. Decreased microstructural integrity of the white matter and smaller hippocampus volume that may cause cerebral complications at short time was found. Early physiological puberty and skeletal development have been described in obesity, but no information is available in obese patients with MS. In obese 9-16 years old, we found high percentage of advanced bone age in those with MS criteria(AU)

Glicemia e concentrações séricas de insulina, triglicérides e cortisol em equinos da raça Quarto de Milha e mestiços usados em provas de laço em dupla / Glycemy and serum concentrations of insuline, triglycerides and cortisol in Quarter horses and crossbred submitted to team ropping

O objetivo do presente estudo foi avaliar a influência de uma prova de laço em dupla, caracterizado por ser um eresultados permitiu sugerir que os equinos usados estavam aptos ao nível de atividade física imposta.

The aim of the present study was to evaluate the effects of a ropping team competition (high intensity and short duration exercise) on glycemy and serum concentrations of cortisol, insuline and triglycerides in horses during competition at Espírito Santo state, Brazil. Blood samples were obtained from 10 Quarter Horses, or cross-bred, in three moments: (1) at rest, one week before the competition, with the animals being trained, (2) just before the competition, and (3) immediately after the exercise. Results showed that the imposed exercise did not influence plasmatic glucose, with mean values of 96.1±12.9mg/dL, 101.3±11.9mg/dL e 100.2±13.9mg/dL, and serum insuline, with mean values of 1.95±1.47μUI/mL, 2.36±1.21μUI/mL e 1.54±1.08μUI/mL, respectively on the moments T0, T1 and T2. Differently, it was possible to observe a positive influence of the exercise over serum triglycerides, with mean values of 17.9±4.7mg/ dL, 23.7±11.8mg/dL e 42.3±20.6mg/dL, and serum cortisol, with mean values of 7.49±3.46mg/dL, 6.86±2.76mg/dL e 10.89±3.99mg/dL, respectively on the moments T0, T1 and T2. It was possible to suggest that horses were adapted to the imposed level of exercise.

The association between insulin resistance and prostatic hyperplasia / 中华老年医学杂志

Objective To evaluate the relationship between insulin resistance and benign prostatic hyperplasia (BPH).Methods Totally 150 male patient from the Department of Geriatrics in Peking University Hospital were included in this study.Blood pressure,body weight,body height,body mass index (BMI) were measured and calculated.Biochemical analyses including serum fasting levels of insulin(FINS),glucose,total cholesterol,triglycerides,low-density lipoprotein cholesterol,high density lipoprotein cholesterol,and prostate-specific antigen (PSA) were performed.Total prostate volume (PV) were measured by ultrasound.Results PV and annual prostate growth rate were more increased in insulin resistance group(40 cases) compared with insulin sensitivity group(110 cases) (t=2.91,3.71 respectively,both P＜0.01).Along with the levels of FINS,HOMA-IR and PSA were increased,the prostate volume was enhanced (t=-3.02,-2.88,-2.84 respectively;all P ＜0.05).PV was positively correlated with insulin resistance,serum fasting insulin and PSA (r=0.16,0.16,0.35;all P＜0.05),while annual prostate growth rate was positively related with insulin resistance,serum fasting insulin,PSA and BMI (r =0.22,0.21,0.24,0.19 ; all P ＜ 0.05).Conclusions Insulin resistance and fasting insulin plays roles in the pathogenesis of prostatic hyperplasia.

Glicemia e concentrações séricas de insulina, triglicérides e cortisol em equinos da raça Mangalarga Marchador após exercício físico / Glycemia and serum concentrations of insuline, triglycerides and cortisol in Mangalarga Marchador horses after physical exercise

O presente estudo teve por objetivo avaliar a influência do exercício físico de intensidade submáxima (provas de marcha) sobre as variáveis bioquímicas sanguíneas usadas na avaliação do metabolismo energético em equinos da raça Mangalarga Marchador criados no Estado do Espírito Santo. Para tal foram obtidas amostras de soro e plasma de 15 equinos, da raça Mangalarga Marchador, em quatro momentos assim definidos: antes (T0) e com 5 minutos (T1), 30 minutos (T2) e 2 horas (T3) após o término do exercício. A análise dos resultados demonstrou a não influência do exercício físico imposto sobre a glicose plasmática, com valores médios de 117,1±35,8mg/dL, 122,6±59,6mg/dL, 124,8± 48,6mg/dL e 112,9±49,1mg/dL, e sobre a insulina sérica, com valores de mediana de 6,50mUI/mL, 2,00mUI/mL, 5,85mUI/mL e 11,60mUI/mL, respectivamente, nos tempos T0, T1, T2 e T3. De forma oposta, foi possível observar uma influência significativa sobre triglicérides séricos, com valores médios de 25,4±14,9mg/dL, 42,3±17,8mg/dL, 31,4±17,7mg/dL e 25,1±15,1mg/dL, e sobre o cortisol sérico, com valores médios de 7,46±4,37mg/dL, 12,45±3,08mg/dL, 11,40±2,52mg/dL e 6,89±1,78mg/dL, respectivamente nos tempos T0, T1, T2 e T3. A interpretação destes resultados permitiu concluir que a marcha elevou as concentrações séricas de triglicérides e cortisol. Também foi possível destacar que, por tais valores encontrarem-se dentro de intervalos fisiológicos, os equinos usados estavam aptos ao nível de exercício físico imposto na ocasião.

The aim of this study was evaluate the influence of physical exercise of submaximal intensity (marcha gait) on biochemical variables used for the evaluation of energetic metabolism in Mangalarga Marchador horses trained in Espirito Santo, Brazil. Serum and plasma samples were obtained from 15 horses in four different moments: before (T0), 5 minutes (T1), 30 minutes (T2) and 2 hours (T3) after the exercise. Results showed that the imposed exercise did not influence plasmatic glucose, with mean values of 117.1±5.8g/dL, 122.6±59.6mg/dL, 124.8±48.6mg/dL and 112.9±49.1mg/dL, and serum insuline, with median values of 6.50mUI/mL, 2.00mUI/mL, 5.85mUI/mL and 11.60mUI/mL, respectively on the moments T0, T1, T2 and T3. Differently, it was possible to observe a positive influence of the exercise over serum triglycerides, with mean values of 25.4±14.9mg/dL, 42.3±17.8mg/dL, 31.4±17.7mg/dL and 25.1±15.1mg/dL, and serum cortisol, with mean values of 7.46±4.37mg/dL, 12.45±3.08mg/dL, 11.40±2.52mg/dL and 6.89±1.78mg/dL, respectively on the moments T0, T1, T2 and T3. It was possible to conclude that the marcha gait leaded to an elevation of serum triglycerides and cortisol levels. Also, as the values found were within reference levels, it was possible to conclude that the horses were used to this physical activity imposed on the occasion.

The association of fasting insuline and insuline resistance with benign prostatic hyperplasia / 中国综合临床

Objective To reveal the effect of fasting insuline(FINS) and insuline resistance(IR) in the process of benign prostatic hyperplasia(BPH). Methods One hundred and seventeen outpatients( ≥60 ys)with BPH from geriatric department were enrolled into the study. The patients were divided into groups according to their FINS and insulin resistance index (HOMA-IR). The indices of BPH, including volume of prostate ( PV ),prostate specific antigen( PSA ), international prostate symptom score (IPSS), course of BPH were analyzed in both groups. Results The PV ( [ 56. 46 ± 26. 88 ] ml vs [ 44. 84 ± 17.66 ] ml, P = 0. 017 ) and the course ( [ 18. 00 ± 6. 91 ] years vs [ 13.93 ± 7. 74 ] years, P = 0. 031 ) were significantly greater in BPH combined hyperinsulinemias(HINS) group than the BPH with normal FINS group;but we found no significant differences in the comparisons of serum PSA level or IPSS between two groups. The PV( [54. 17 ± 25.38 ] ml vs [42. 26 ±14. 15]ml,P =0. 004)and the course([ 16.58 ±7. 65] years vs [13.49 ±7. 59] years,P = 0. 036) were also significantly greater in BPH combined insuline resistance gruop than the insulin sensitivity group, again we found no significant differences in the comparisons of serum PSA level or IPSS between two groups. Conclusion FINS and IR are risk factors of progressed BPH and can promote the progress of BPH.

Progress on human acid-labile subunit deficiency / 国际儿科学杂志

Acid-lable subunit (ALS)plays an important role in stablizing the insulin-like growth factor ( IGF),which has an great impact on the process of human growth and develepment.Mutations of the human IGF ALS gene result in ALS deficiency.Some degree of insulin insensitivity,as well as high level of insulin,low serum concentrations of IGF- Ⅰ and IGF binding protein ( IGFBP)-3,short stature,growth retardation,was generally found in patients with human ALS deficiency.Meanwhile,bone mineral desity reduction only occures in some cases.However,the exact mechanisms of insulin insensitivity and bone mineral density reduction have still remained unclear.

The effect of metabolic syndrome on pathogenesis of benign prostate hyperplasia / 中华老年医学杂志

ObjectiveTo explore the effect of metabolic syndrome (MS) on the occurrence and development of benign prostate hyperplasia (BPH).Methods 101 elderly BPH patients were divided into two groups:BPH (n = 45) and BPH with MS (n= 56)group.The effects of metabolic indexes,including body mass index (BMI),waist,high density lipoprotein cholesterol (HDL-C),fasting blood glucose (FBS) and insuline resistance index (H()MA-IR),on prostate volume(PV),prostate-specific antigen (PSA),international prostate symptom score (IPSS) and lower urinary tract symptoms (LUTS) were surveyed in BPH patients.Results BPH with MS group showed significantly higher values of PV (t = 3.22,P= 0.003)and longer course of LUTS (t= 2.02,P =0.046) than BPH group.The BPH patients with overweight and obesity had significantly higher levels of PV(49.44±26.83 ml and 51.7±22.2 ml,P=0.021 and 0.043) than BPH patients with normal weight (38.10 ± 10.64 ml).Additionally,BPH patients with abdominal obesity had significantly higher levels of PV than BPH patients without abdominal obesity(50.26±26.51 ml vs.38.99± 11.25ml,P=0.005).BPH patients with low HDL-C had significantly higher PV than BPH patients with normal HDL-C[(54.23±28.92)ml vs.(40.40± 14.87) ml,P=0.009].The values of PV,PSA in the BPH patients with elevated FBS were significantly higher than in BPH patients with normal FBS (t=3.17 and 2.4I,P= 0.035 and 0.013).BPH patients with insuline resistance (IR) had higher values of PV and longer courses of LUTS than BPH patients without IR (t= 3.43 and 3.58,P-0.001).The PV was positively correlated with BMI(r= 0.459.P= O.OOO),FINS (r= 0.42,P=O.OOI),HOMA-IR (r= 0.49,P= 0.003) and gatively correlated with HDL-C (r= 0.38,P-0.000)- Multiple linear stepwise regression analysis showed that PV was closely correlated with HOMA-IR.ConclusionsMS has evident effects on the occurrence and development of BPH.

Ghrelin en la Amenorrea Hipotalámica Funcional relacionada con la desnutrición / Ghrelin in Functional Hypothalamic Amenorrohea related with undernourished

La amenorrea hipotalámica funcional (AHF)presenta un proceso de adaptación homeostática frente al disbalance energético (consumo/gasto calórico) . En este síndrome participan hormonas hipotalámicas y neuropéptidos periféricos provenientes del tejido graso (leptina, adiponectina y otras adipokinas), el tracto gastrointestinal superior Ghrelin y el páncreas (insulina). Este "circuito periférico” está funcionalmente interrelacionado con un "circuito central "o hipotalámico. El descenso de la leptina, (un péptido anorexígeno), potencia el efecto orexígeno del Ghrelin. Los niveles basales de esta citokina están elelevados en la AHF e inducen en el hipotálamo, un aumento de la actividad del CRH. Esta hormona, a su vez, inhibe la secreción pulsátil del GnRH. El Ghrelin, además de ser un potente GH secretagogo, influye en la secreción de insulina e interviene en la metabolización de los glúcidos y lípidos. Normalmente se puede observar un ascenso preprandial del Ghrelin, seguido por un descenso posprandial relacionado con la sensación de saciedad. En los obesos, este descenso es menos pronunciado y lento. En cambio, en las mujeres anoréxicas la caída de este orexígeno es más rápida. Ambos comportamientos resultan ser acciones desfavorables para sus respectivas patologías. La administración de Ghrelin induce un rápido incremento de la glucemia y reducción de los niveles de insulina. Este aumento de la glucemia precede al descenso de la insulina, sugiriendo que el Ghrelin podría estimular directamente la glucogenólisis en el hígado. La hiperghrelemia podría entonces ser considerada como un probable mecanismo defensivo tendiente a prevenir la hipoglucemia de estas pacientes amenorreicas y desnutridas. Por otro lado, la hiperghrelemia basal en la AHF sería un efecto secundario a la resistencia a la insulina, la cual a su vez, es inducida por los niveles elevados de los ácidos grasos provenientes de la lipólisis que se encuentra acentuada en estas pacientes. La correlación negativa entre la insulina y el Ghrelin probablemente es mediada por el sistema vagal, como lo sugiere el aumento del polipéptido pancreático, un marcador confiable de la actividad vagal. Adicionalmente, el hipercortisolismo de estas pacientes y posiblemente la somatostatina a través de sus receptores en el páncreas, podrían regular en forma negativa la actividad de los receptores de insulina, con el consiguiente incremento del Ghrelin. Conclusión: el ascenso del Ghrelin en la AHF y sus particulares interrelaciones con la insulina y el eje adrenal convergen para mantener el equilibrio homeostático, intentando facilitar así el aporte de metabolitos energéticos a estas pacientes desnutridas, frecuentemente osteosporóticas, inmunodeprimidas y con un alto riesgo cardiovascular.

Functional Hypothalamic Amenorrhoea (FHA) reflects a homeostatic adaptive process resulting from a negative energy balance (increased caloric output/expenditure with inadequate nutrient replenishment). Hypothalamic hormones and peripheral neuropeptides from the fat tissue (leptin, adiponectin and other adipokines), the upper gastrointestinal tract (Ghrelin) and pancreas (insulin) are involved in this syndrome. This "peripheral circuit” is functionally interrelated with the central hypothalamic circuit controlling appetite and satiety. The decrease in leptin, an anorexigenic signal, potentiates the orexigenic effect of Ghrelin (the basal levels of Ghrelin are elevated in FHA) and induces an increased CRH activity within the hypothalamus. This hormone, in turn, inhibits pulsatile GnRH secretion. Besides its potent GH secretagogue activity, Ghrelin is a peptide that influences insulin secretion and affects the metabolism of carbohydrates and lipids. Usually, a preprandial increase in Ghrelin levels is observed, followed by a postprandial decrease related to satiety. In obese subjects, this decrease is less marked and slower. Conversely, in anorexic women, the drop in this orexigenic peptide is faster. Both behaviours are unfavourable for the pathologies in which they occur. Ghrelin administration induces a rapid increase in blood glucose and a decrease in insulin levels. The fact that an increase in blood glucose precedes a decrease in insulin might suggest that Ghrelin could directly stimulate hepatic glucogenolysis activity. Thus, hyperghrelinemia might be considered as a potential defence mechanism to prevent hypoglycaemia in undernourished amenorrheic patients. Basal hyperghrelinemia in FHA is secondary to insulin resistance and it is induced by elevated free fatty acids resulting from lipolysis, a process that is increased in patients with FHA. The negative correlation between insulin and Ghrelin is probably mediated by the vagal system, as suggested by the increase in the pancreatic polypeptide, a reliable marker of vagal activity. Additionally, the hypercortisolism that typically occurs in patients with FHA, and possibly somastotatin through its pancreas receptors, could negatively regulate the activity of insulin receptors, with a consequent increase in Ghrelin. Conclusion: the increase in Ghrelin in FHA and its particular interrelations with insulin and the hypothalamic-pituitary-adrenal axis reflect an attempt to maintain the homeostatic balance, contributing to facilitate the supply of energy metabolites in these undernourished patients. These patients commonly develop osteoporosis, immunosuppression and a high risk of cardiovascular disease.

Síndrome metabólico: definición, historia, criterios / Metabolic syndrome: definition, history, criterion

El síndrome metabólico es un conjunto de factores de riesgo para diabetes mellitus tipo 2 (DM2) y enfermedad cardiovascular, caracterizado por la presencia de resistencia a la insulina e hiperinsulinismo compensador asociados con trastornos del metabolismo de los carbohidratos y lípidos, cifras elevadas de presión arterial, y obesidad. Se hizo una revisión en Medline que arrojó 6,366 entradas para síndrome metabólico. Desde principios del siglo XX se describieron asociaciones de factores de riesgo. En 1988, Reaven observó que varios factores de riesgo (dislipidemia, hipertensión, hiperglicemia) tendían a estar juntos. Este conjunto lo llamó síndrome X. El término síndrome metabólico como entidad diagnóstica con criterios definidos fue introducida por la OMS en 1998. La prevalencia del síndrome metabólico varía según factores como género, edad, etnia, pero se ubica entre 15% y 40%; es mayor en la población de origen hispano. Existen varios criterios para el diagnóstico de síndrome metabólico. El mes conocido es del ATP III, donde se deben cumplir 3 ó mßs de los siguientes: perímetro abdominal elevado (>102 cm en hombres y >88 cm en mujeres), TG >150 mg/dl, HDL bajo (hombres <40 mg/dl y mujeres HDL <50 mg/dl), TA >130/85 mm Hg, glicemia >110 mg/dl incluyendo diabetes mellitus. Se consideran otros factores como trombogénesis, inflamación, ácido úrico, estrés, cigarrillo, sedentarismo, edad, origen étnico, acantosis nigricans, síndrome de ovario poliquístico, microalbuminuria, hipotiroidismo primario, uso de inhibidores de proteasa para pacientes con VIH, exceso de glucocorticoides endógeno o exógeno.

The metabolic syndrome is a set of risk factors for diabetes mellitus type 2 and cardiovascular disease, characterized by the presence of resistance to the insulin and compensating hiperinsulinemia associate to alterations of the metabolism of carbohydrates and lipids, elevated arterial blood pressure, and obesity. A revision in Medline was made, and gave as a result 6366 entrances for ½metabolic syndrome¼. In the beginnings of the XX century, associations of risk factors were described. In 1988, Reaven observed that several risk factors (dislipidemia, hypertension, hyperglicemia) tended to be together. This set was named syndrome X. The name metabolic syndrome like diagnostic entity with defined criteria was introduced by the WHO in 1998. The prevalence of the metabolic syndrome varies according to some factors such as gender, age, ethnic group, but it is located between 15% to a 40%, being greater in the population of Hispanic origin. Several criteria for the metabolic syndrome diagnosis exist. The most known it is of ATP III, in this case, three factors must be present: high abdominal perimeter (>102 cm in men and >88 cm in women), TG >150 mg/dl, HDL under (men >40 mg/dl y women HDL >0 mg/dl), TA >130/85 mm Hg, glycemia >110 mg/dl including diabetes mellitus.Other factors also considered are: thrombogenesis, inflammation, uric acid, stress, cigarette, sedentariness, age, ethnic origin, acantosis nigricans, polycystic ovary syndrome, microalbuminuria, primary hypothyroidism, use of protease inhibitors for patients with HIV, endogenous or exogenous excess of glucocorticoids.

Influence of valsartan and amlodipine on the left ventricular diastolic function,endothelium function and serum insuline level in aged hyperpietic patients / 医学研究生学报

Objective: To observe the effect of valsartan and amlodipine on the reduction of blood pressure in aged hyperpietic patients,as well as on the improvement of left ventricular diastolic function,endothelium function and insuline resistence. Methods: We divided 40 cases of aged hypertension patients(1 to 2 grade) into Valsartan and Amlodipine groups at random,giving valsartan 80-160 mg or amlodipine 5-10 mg,respectively,for 12 weeks as a treating period.We measured the blood pressure twice a week,observed the differences of blood pressure and heart rate before and after the treatment,as well as the changes of insuline sensitivity,left ventricular diastolic function and endothelium vascular disatolic function. Results and Conclusion: Both valsartan and amlodipine can effectivly reduce the blood pressure of aged hypertension patients(l to 2 grade).They can also improve the diastolic function,insuline resistance and endothelium dependent vascular diastolic function.

Insulin resistance in essential hypertension patients and effect of imidapril on it / 第三军医大学学报

Objective To certify insuline resistance in nonobese patients with essential hypertension(EH) and observe effect of imidapril.Methods An oral glucose tolerance test(OGTT) and insulin releasing test(IRT) were performed on 40 nonobese EH patients before and after imidapril treatment,the plasma levels of glucose and insulin were tested and compared with those of 16 normal subjects.Results The insuline level of fasting or 30,60,120 min after OGTT were significantly higher than those in normal group(P

A case of generalized lipodystrophy / 대한피부과학회지

Generalized lipodyst,rophy is characterized by generalized loss of body fat, and is asociated vith metabolic ahnormalities, including insulin resistance, hyperglycemia., and hypertriglyceridemia. like acanthosis nigricans, generalized lipodystrophy is a cutaneous marker of insulin re.istant diabetes. We report. herein a twenty year old female witti both classic generalized lipodystripin and acanthosis nigricans, in association with insulin resistant diabetes.