Correlation analysis between body mass index and clinical characteristics of rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics.@*METHODS@#The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m2 referred to obese individuals, 25≤BMI < 30 kg/m2 referred to overweight individuals, 18.5≤BMI < 25 kg/m2 referred to normal individuals, BMI < 18.5 kg/m2 referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors.@*RESULTS@#A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m2.Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m2, 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m2, amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m2, 24.7%) and 22 obese individuals (BMI≥30 kg/m2, 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs. 39.1%, P < 0.001), diabetes (25.5% vs. 15.0%, P=0.006), hyperlipidemia (22.7% vs. 10.9%, P=0.001), fatty liver (28.4% vs. 7.4%, P < 0.001), osteoarthritis (39.0% vs. 29.4%, P=0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs. 70.9%, P=0.016) and anemia (36.2% vs. 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs. 7.6%, P=0.442), cerebrovascular disease (6.4% vs. 8.8%, P=0.372) and peripheral atherosclerosis (9.2% vs. 7.6%, P=0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs. 2.35 mg/dL, P=0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs. 50.0 mm/h, P=0.003), pain visual simulation score (VAS) (3.66±3.08 vs. 4.40±2.85, P=0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs. 5.45±1.52, P=0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia.@*CONCLUSION@#In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.

Triatriatum sinistrum em adulto assintomático: relato de caso / Cor triatriatum sinistrum in an asymptomatic adult: a case report

Cor triatriatum é um anomalia cardíaca congênita rara frequentemente diagnosticada na primeira infância. Este estudo de caso apresenta um adulto com um achado acidental de cor triatriatum sinistrum. Com base na apresentação clínica, o paciente foi tratado de forma conservadora. São apresentados achados de imagens ecocardiográficas de cor triatriatum sinistrum deste paciente juntamente de revisão narrativa da literatura sobre essa doença.(AU)

Cor triatriatum is a rare congenital heart anomaly often diagnosed in early childhood. This case study features an adult with an incidental finding of cor triatriatum sinistrum. Based on the clinical presentation, the patient was treated conservatively. Cor triatriatum sinistrum echocardiographic image findings of this patient are presented along with a narrative review of the literature about this disease. (AU)

Hígado agudo graso del embarazo: reporte de caso / Acute fatty liver of pregnancy: case report

El hígado graso del embarazo es una patología poco frecuente en la especialidad obstétrica, cuyo diagnóstico se realiza basado en los criterios de Swansea, muchas veces es un diagnóstico que se realiza por exclusión; usualmente se presenta entre las semanas 30 y 35 del embarazo, y la cura definitiva se realiza con la interrupción expedita del mismo; con una tasa de recuperación casi del 100% si se realiza la interrupción oportuna y una tasa de mortalidad materno fetal actual del 10%. Es importante estar atentos a la ganancia ponderal de la embarazada durante el control prenatal, la epigastralgia, y los signos clínicos asociados a hipoglicemia(AU)

Fatty liver of pregnancy is a rare pathology in obstetrics, whose diagnosis is made based on the Swansea criteria, many times it is a diagnosis that is made by exclusion; It usually occurs between weeks 30 and 35, and the definitive cure is carried out with the expeditious interruption of pregnancy; with a recovery rate of almost 100% if timely interruption is made and a current maternal-fetal mortality rate of 10%. It is important to be attentive to the weight gain of the pregnant woman during prenatal control, epigastric pain, and clinical signs associated with hypoglycemia

Hígado graso agudo del embarazo / Acute fatty liver of pregnancy

El hígado graso agudo del embarazo, descrito en 1934, es una complicación gestacional poco frecuente y potencialmente fatal. El daño hepático materno ocurre por depósito citoplasmático perinuclear de microvesículas de grasa en el hepatocito relacionada con deficiencia enzimática autosómica recesiva en la vía de la oxidación mitocondrial de los ácidos grasos del feto. El objetivo de este artículo es exponer un caso de hígado graso agudo del embarazo acontecido en nuestro medio con criterios clínicos compatibles así como estudio histopatológico confirmatorio. Se trata de una paciente de 43 años procedente y residente de la ciudad de El Alto, La Paz (Bolivia), presenta ictericia, coluria, se automedica con paracetamol, asociándose al cuadro clínico nauseas acompañadas con vómitos, ausencia de movimientos fetales de producto único de 35 semanas; durante su evolución en UTI presenta encefalopatía hepática grado II y hemorragia digestiva, fallece a los 3 días de internación en UTI, se realiza necropsia hepática compatible con hígado graso agudo del embarazo. Cabe destacar la realización de estudio histopatológico en el presente caso, la cual no se realiza de manera rutinaria en nuestro medio, el cual reporta esteatosis hepática macro y microvacuolar asociada a proceso inflamatorio crónico activo acentuado difuso compatible con hígado graso agudo del embarazo, lo cual apoya los criterios clínicos de Swansea.

Acute fatty liver of pregnancy, described in 1934, is a rare but potentially fatal gestational complication. The damage in mother's liver is produced by perinuclear cytoplasmic deposit of fat micro vesicles in hepatocyte related with autosomal recessive enzymatic deficiency in mitochondrial oxidative fatty acids pathway of fetus. The objective of this paper is present an acute fatty liver of pregnancy occurred with clinical criteria and confirmation histopathological study. The present case is about a 43-year old patient, resident of El Alto, La Paz (Bolivia), with jaundice, choluria, auto medicated with acetaminophen, curses also with nausea and vomiting, absence of fetal movements of 35-week fetus, during her evolution in ICU presents hepatic encephalopathy and digestive hemorrhage, dies at 3th day in ICU, hepatic necropsy confirms acute fatty liver of pregnancy. It's worth mentioning the histopathological study, scarcely performed in our country, which, in this case, reports macro and microvacuolar steatosis in liver, associated to an active diffuse chronic inflammatory process compatible with acute fatty liver of pregnancy, in concordance with clinical Swansea criteria.

What we need to know when performing and interpreting US elastography

According to the increasing need for accurate staging of hepatic fibrosis, the ultrasound (US) elastography techniques have evolved significantly over the past two decades. Currently, US elastography is increasingly used in clinical practice. Previously published studies have demonstrated the excellent diagnostic performance of US elastography for the detection and staging of liver fibrosis. Although US elastography may seem easy to perform and interpret, there are many technical and clinical factors which can affect the results of US elastography. Therefore, clinicians who are involved with US elastography should be aware of these factors. The purpose of this article is to present a brief overview of US techniques with the relevant technology, the clinical indications, diagnostic performance, and technical and biological factors which should be considered in order to avoid misinterpretation of US elastography results.

Alterações hepáticas da gravidez / Liver disorders in pregnancy

A gestação é um período de significativas modificações no organismo materno, que objetivam promover a homeostase do binômio materno-fetal. Sob o ponto de vista hepático, demais das alterações conspícuas à gravidez, deve o obstetra detectar precocemente anomalias envolvendo o fígado, que complicam até 3% das gestações e são responsáveis por elevada mortalidade materna e perinatal. Por outro lado, certas doenças hepáticas têm sua história natural modificada quando ocorrem durante a gestação, demandando cuidados especiais de uma equipe multidisciplinar que envolva o obstetra e o hepatologista. Este artigo revisa as modificações fisiológicas do sistema hepático na gravidez, assim como suas alterações hepáticas mais prevalentes no Brasil. O objetivo é auxiliar e fornecer orientações ao obstetra e guiar o melhor cuidado das pacientes a fim de prevenir e reduzir as complicações hepáticas na gravidez.(AU)

Pregnancy is a period of significant changes in the mother's organism aimed at promoting the mother-fetus homeostasis. From the hepatic standpoint, the obstetrician should detect early the abnormalities attacking the liver, which complicates up to 3% of pregnancies and are responsible for high rates of maternal and perinatal mortality. On the other hand, some liver diseases have their natural evolution changed when they occur during the pregnancy, requiring special care of a multidisciplinary team involving obstetrician and hepatologist specialists. This study presents the physiological changes of the hepatic system during pregnancy, as well as the most prevalent pregnancy hepatic disorders occurring in Brazil. It aims to help the obstetrician and guide the best patient care to prevent and reduce hepatic complications in pregnancy.(AU)

Lung-dominant connective tissue disease among patients with interstitial lung disease: prevalence, functional stability, and common extrathoracic features / Colagenose pulmão dominante em pacientes com doença pulmonar intersticial: prevalência, estabilidade funcional e manifestações extratorácicas comuns

OBJECTIVE: To describe the characteristics of a cohort of patients with lung-dominant connective tissue disease (LD-CTD). METHODS: This was a retrospective study of patients with interstitial lung disease (ILD), positive antinuclear antibody (ANA) results (≥ 1/320), with or without specific autoantibodies, and at least one clinical feature suggestive of connective tissue disease (CTD). RESULTS: Of the 1,998 patients screened, 52 initially met the criteria for a diagnosis of LD-CTD: 37% were male; the mean age at diagnosis was 56 years; and the median follow-up period was 48 months. During follow-up, 8 patients met the criteria for a definitive diagnosis of a CTD. The remaining 44 patients comprised the LD-CTD group, in which the most prevalent extrathoracic features were arthralgia, gastroesophageal reflux disease, and Raynaud's phenomenon. The most prevalent autoantibodies in this group were ANA (89%) and anti-SSA (anti-Ro, 27%). The mean baseline and final FVC was 69.5% and 74.0% of the predicted values, respectively (p > 0.05). Nonspecific interstitial pneumonia and usual interstitial pneumonia patterns were found in 45% and 9% of HRCT scans, respectively; 36% of the scans were unclassifiable. A similar prevalence was noted in histological samples. Diffuse esophageal dilatation was identified in 52% of HRCT scans. Nailfold capillaroscopy was performed in 22 patients; 17 showed a scleroderma pattern. CONCLUSIONS: In our LD-CTD group, there was predominance of females and the patients showed mild spirometric abnormalities at diagnosis, with differing underlying ILD patterns that were mostly unclassifiable on HRCT and by histology. We found functional stability on follow-up. Esophageal dilatation on HRCT and scleroderma pattern on nailfold capillaroscopy were frequent findings and might come to serve as diagnostic criteria. .

OBJETIVO: Descrever as características de uma coorte de pacientes com colagenose pulmão dominante (CPD). MÉTODOS: Estudo retrospectivo de pacientes com doença pulmonar intersticial (DPI), anticorpo antinuclear (ANA) positivo (≥ 1/320), com ou sem autoanticorpos específicos, e com a presença de ao menos uma manifestação clínica sugestiva de doença do tecido conjuntivo (DTC). RESULTADOS: Dos 1.998 avaliados, 52 preencheram inicialmente os critérios para o diagnóstico de CPD: 37% eram homens; a média de idade ao diagnóstico era de 56 anos e a mediana do tempo de seguimento era de 48 meses. Durante o seguimento, 8 pacientes preencheram os critérios para um diagnóstico definitivo de DTC. Os 44 pacientes restantes formaram o grupo CPD, no qual as manifestações extratorácicas mais prevalentes foram artralgia, doença do refluxo gastroesofágico e fenômeno de Raynaud. Os autoanticorpos mais prevalentes nesse grupo foram ANA (89%) e anti-SSA (anti-Ro, 27%). A média de CVF no início e na última avaliação foi de 69,5% e 74,0% do predito, respectivamente (p > 0,05). Pneumonia intersticial não específica e pneumonia intersticial usual foram identificadas em 45% e 9% das TCARs, respectivamente; 36% das TCARs eram não classificáveis. Uma prevalência semelhante foi identificada na histologia. Dilatação esofágica difusa foi identificada em 52% das TCARs. Capilaroscopia subungueal foi realizada em 22 pacientes; 17 apresentavam um padrão de esclerodermia. CONCLUSÕES: No grupo CPD, houve predominância feminina, e os pacientes apresentaram alterações espirométricas leves ao diagnóstico, com diferentes padrões de DPI, em sua maioria não classificáveis, tanto em TCAR como na histologia. Estabilidade funcional foi identificada no seguimento. A dilatação esofágica em TCAR e o padrão de esclerodermia na capilaroscopia subungueal foram achados frequentes que poderiam servir como critérios diagnósticos. .

Management and conduct of vascular diseases of the portal system / Manejo e conduta das doenças vasculares do sistema porta

Aneurysms and thromboses of the portal vein are rare pathologies of the portal system that commonly follow an asymptomatic course. The vast majority of cases are diagnosed as incidental findings during imaging studies. Symptoms of aneurysms are the result of mass effects, while thrombosis symptoms are a function of the liver's ability to form a collateral circulation network in the thrombosis. The scant experience with such cases poses a dilemma for patient management and so the vast majority of authors choose an expectant approach with rigorous patient surveillance and only intervene in symptomatic patients. We report one case of an aneurysm of the portal vein and one case of portal vein thrombosis and discuss management and observation of these patients...

O aneurisma e a trombose de veia porta são doenças raras do sistema porta, que comumente cursam sem sintomas. A grande maioria dos pacientes é diagnosticada com achados em exames de imagem. Os sintomas são atribuídos ao efeito de massa, no caso do aneurisma, e relativos à capacidade hepática de formar uma rede de circulação colateral, no caso da trombose. A escassa experiência nesses casos representa um dilema na abordagem desses pacientes e, portanto, a grande maioria dos autores opta por seguimento rigoroso e a intervenção é indicada apenas para os pacientes sintomáticos. Neste trabalho, relatamos um caso de aneurisma de veia porta e outro de trombose da veia porta, propondo o manejo e o acompanhamento desses pacientes...

Enfermedad de hígado graso no alcohólico: Un problema silente en la salud Costarricense / Non alcoholic fatty liver disease: A silent problem in Costa Rican health

La enfermedad de hígado graso no alcohólico es una condición que engloba el espectro de esteatosis hepática no alcohólica simple y esteatohepatitis no alcohólica. Esta entidad afecta de un 20 a 30% de la población adulta general en sociedades occidentales. Asimismo suele estar asociada a obesidad, síndrome metabólico, diabetes, entre otras patologías cada vez más frecuentes a nivel mundial. Recientemente se reporta una prevalencia alarmante de 72% en pacientes diabéticos tipo 2 en Costa Rica, los cuales representan un aproximado 10,5% de los costarricenses. Su alta prevalencia, clínica silente, asociación importante a riesgo cardiovascular y de complicaciones hepáticas serias, convierten esta entidad en un tema de suma relevancia para la salud pública...

Non-alcoholic fatty liver disease is a condition that encompasses the spectrum of simple hepatic steatosis and non-alcoholic steatohepatitis. This condition affects 20 to 30% of the general adult population in Western societies. Is often associated with obesity, metabolic syndrome, and diabetes among other frequent diseases nowadays. Recently it has been reported an alarming prevalence of 72% diabetic type 2 patients in Costa Rica, which are approximately 10,5% of the population in the country. Its high prevalence, silent clinical manifestations, important cardiovascular risk and serious liver complications association, turn this entity on a topic of great relevance to public health...

Cholelithiasis in obese adolescents treated at an outpatient clinic / Litíase biliar em adolescentes obesos atendidos em ambulatório

OBJECTIVE: to describe the frequency and the factors associated with cholelithiasis in obese adolescents. METHODS: this was a cross-sectional descriptive study performed with the adolescents between 10 and 19 years of age treated at the Child and Adolescent Obesity Outpatient Clinic from May to December of 2011. Obesity was defined as body mass index (BMI) > P97, and overweight as BMI > P85, for age and gender, according to the 2007 World Health Organization reference. A questionnaire concerning the presence of signs and symptoms, such as abdominal pain, nausea, vomiting, and intolerance to fat, was administered. Patients were asked about how many kilograms they had lost and in how much time. Laboratory parameters were: triglycerides, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels. Cholelithiasis and hepatic steatosis were diagnosed by ultrasonography. RESULTS: cholelithiasis was diagnosed in 6.1% (4/66) of the obese adolescents, most of whom were female (3/4); hepatic steatosis was identified in 21.2% (14/66). Intolerance to dietary fat was reported by all patients with cholelithiasis (4/4) and by 17.7% (11/62) of the group without cholelithiasis (p = 0.001). The average weight loss was 6.0 ± 2.9 kg in the patients with cholelithiasis and 3.2 ± 4.8 kg in the group without cholelithiasis (p = 0.04). However, there was no difference between the two groups regarding the time of weight loss (p = 0.11). CONCLUSIONS: cholelithiasis and hepatic steatosis are frequent among obese adolescents and should be investigated systematically in the presence or absence of symptoms. .

OBJETIVO: descrever a frequência e os fatores associados à litíase biliar em adolescentes obesos. MÉTODOS: estudo descritivo tipo corte transversal com adolescentes entre 10 e 19 anos atendidos em ambulatório de obesidade infanto-juvenil, no período de maio a dezembro de 2011. A obesidade foi definida como índice de massa corporal > P97 e o sobrepeso > P85, para idade e sexo, segundo o referencial OMS 2007. Foi aplicado um questionário com dados relacionados à presença de sinais e sintomas, como: dor abdominal, náusea, vômito e intolerância à gordura. Os pacientes foram questionados sobre quantos quilos perderam e em quanto tempo. As variáveis laboratoriais foram: triglicerídeos, colesterol total, lipoproteína de alta densidade (HDL) e lipoproteína de baixa densidade (LDL), aspartato aminotransferase (AST) e alanina aminotransferase (ALT). A litíase biliar e a esteatose hepática foram diagnosticadas por ultrassonografia. RESULTADOS: a litíase biliar foi diagnosticada em 6,1% (4/66) dos adolescentes obesos, a maioria do sexo feminino (3/4); a esteatose hepática foi identificada em 21,2% (14/66). Intolerância à gordura da dieta foi referida por todos os portadores de litíase biliar (4/4) e por 17,7% (11/62) do grupo sem litíase biliar (0,001). A média de perda de peso foi de 6,0 ± 2,9 kg nos pacientes com litíase biliar e 3,2 ± 4,8 kg no grupo sem litíase biliar (p = 0,04). Porém, em relação ao tempo de perda não houve diferença entre os dois grupos (p = 0,11). CONCLUSÕES: a litíase biliar e a esteatose hepática são frequentes entre adolescentes obesos e devem ser investigadas sistematicamente na presença ou ausência de sintomas. .

Avaliacao da Relacao entre a Doenca Hepatica Nao Gordurosa e CAD utilizando TCMF / Assessment of the Relationship between Non-Alcoholic Fatty Liver Disease and CAD using MSCT

Fundamento: Alguns fatores de risco para a aterosclerose são acompanhados pela doença hepática gordurosa não alcoólica (DHGNA). Desejamos usar a tomografia computadorizada multi-fatias (TCMF) como a técnica para encontrar relação entre a DHGNA e a doença arterial coronariana (DAC). Objetivo: A relação entre a DHGNA e a DAC foi investigada através de TCMF. Métodos: Um total de 372 indivíduos com ou sem sintomas cardíacos, que foram submetidos à angiografia por TCMF, foram incluídos no estudo. Os pacientes foram divididos em dois grupos, de acordo com a presença da DHGNA. Os segmentos arteriais coronarianos foram avaliados visualmente via angiografia por TCMF. Com base no grau de estenose arterial coronariana, aqueles com placas ausentes ou mínimas foram considerados como normais, enquanto aqueles que apresentavam estenose de menos do que 50% e no mínimo uma placa foram considerados como portadores da doença arterial coronariana não obstrutiva (não-obsDAC). Os pacientes que apresentaram no mínimo uma placa e estenose arterial coronariana de 50% ou mais foram considerados como portadores de doença arterial coronariana obstrutiva (obsDAC). A DHGNA foi determinada de acordo com o protocolo de TCMF, utilizando a densidade hepática. Resultados: De acordo com a densidade hepática, o número de pacientes com doença hepática gordurosa não alcoólica (grupo 1) foi de 204 (149 homens, 54,8%) e com fígado normal (grupos 2) foi de 168 (95 homens, 45.2%). Houve 50 (24,5%) não-obsDAC e 57 (27,9%) casos de obsDAC no Grupo 1, e 39 (23,2%) não-obsDAC e 23 (13,7%) casos de obsDAC no Grupo 2. Conclusões: O presente estudo utilizando TCMF demonstrou que a frequência da doença arterial coronariana em pacientes com NAFDL foi significativamente superior do ...

Background: Some risk factors for atherosclerosis are followed by non-alcoholic fatty liver disease (NAFLD). We wanted to use Multislice computed tomography (MSCT) as technique for searching relationship between NAFLD and coronary artery disease (CAD). Objective: The relationship between NAFLD and CAD was investigated using MSCT. Methods: A total of 372 individuals with or without cardiac symptoms who had undergone MSCT angiography were included in the study. The patients were divided into two groups according to the presence of NAFLD. Coronary artery segments were visually evaluated via MSCT angiography. Based on the coronary artery stenosis degree, those with no or minimal plaques were considered normal, whereas those who had stenosis of less than 50% and at least one plaque were considered to have non-obstructive coronary artery disease (non-obsCAD). The patients who had at least one plaque and coronary artery stenosis of 50% or more were considered to have obstructive coronary artery disease (obsCAD). NAFLD was determined according to the MSCT protocol, using the liver density. Results: According to the liver density, the number of patients with non-alcoholic fatty liver disease (group 1) was 204 (149 males, 54.8%) and with normal liver (group 2) was 168 (95 males, 45.2%). There were 50 (24.5%) non-obsCAD and 57 (27.9%) obsCAD cases in Group 1, and 39 (23.2%) non-obsCAD and 23 (13.7%) obsCAD cases in Group 2. Conclusions: The present study using MSCT demonstrated that the frequency of coronary artery disease in patients with NAFDL was significantly higher than that of patients without NAFDL. .

Geração de espécies reativas de oxigênio (ERO) mitocondriais: papel das Acil-CoA desidrogenases de cadeia muito longa / Generation of mitochondrial reactive oxygen species (ROS): role of very long chain acyl-coA dehydrogenases

Dietas hiperlipídicas e a esteatose hepática são condições extremamente prevalentes. Trabalhos anteriores mostraram que a esteatose está associada a um aumento na geração de espécies reativas de oxigênio (ERO), e que isso pode mediar danos no fígado. Neste trabalho nós investigamos os possíveis mecanismos que desencadeiam os aumentos nas taxas de geração de ERO por meio da administração de dietas hiperlipídicas. Nós descobrimos que mitocôndrias de animais sujeitos a dietas hiperlipídicas não apresentaram diferenças significativas quanto a capacidade respiratória máxima e acoplamento, mas eram capazes de gerar mais ERO especificamente quando usados substratos do metabolismo de ácidos graxos. Além disso, foi observado que muitas isoformas de acil-CoA desidrogenases estavam mais expressas nos fígados de animais alimentados pela dieta hiperlipídica. No entanto, quando realizados ensaios de atividade enzimática apenas a acil CoA desidrogenase de cadeia longa (VLCAD) foi mais ativa. Estudos conduzidos com mitocôndrias permeabilizadas e expostas a grupos acil-CoA de diferentes tamanhos sugerem que a VLCAD pode ser uma fonte da produção aumentada de ERO em animais submetidos a dietas hiperlipídicas. Esta produção foi estimulada pela ausência de NAD+. Concluindo, nossos estudos descobriram uma nova fonte importante na geração de ERO estimulada por dietas hiperlipídicas, a VLCAD

High fat diets and accompanying hepatic steatosis are highly prevalent conditions. Previous work has shown that steatosis occurs concomitantly with enhanced reactive oxygen species (ROS) generation, which may mediate further liver damage. Here we investigated mechanisms leading to enhanced ROS generation following high fat diets (HFD). We found that mitochondria from HFD livers present no differences in maximal respiratory rates and coupling, but generate more ROS specifically when fatty acids are used as substrates. Indeed, many acyl-CoA dehydrogenase isoforms were found to be more highly expressed in HFD livers, although only the very long chain acyl-CoA dehydrogenase (VLCAD) was more functionally active. Studies conducted with permeabilized mitochondria and different chain length acyl-CoA derivatives suggest that VLCAD is a source of enhanced ROS production in mitochondria from HFD animals. This production is stimulated by the lack of NAD+. Overall, our studies uncover VLCAD as a novel, diet-sensitive, source of mitochondrial ROS

Sonography of hepatic hemangioma accompanied by arterioportal shunt

No abstract available.

Relação entre ácido úrico e os componentes da síndrome metabólica e esteatose hepática não alcoólica em crianças e adolescentes com sobrepeso ou obesidade / Association of uric acid levels with components of metabolic syndrome and non-alcoholic fatty liver disease in overweight or obese children and adolescents

OBJETIVO: Verificar a relação entre a concentração de ácido úrico sérico de acordo com a presença ou não de esteatose hepática não alcoólica e/ou síndrome metabólica (SM) em crianças e adolescentes com sobrepeso ou obesidade. MÉTODOS: Estudo transversal desenvolvido no período de abril/2009 a março/2010, incluindo 129 crianças e adolescentes atendidos no Centro de Obesidade Infantil. Foi realizada antropometria, aferição da pressão arterial, dosagem dos exames laboratoriais e o diagnóstico de esteatose hepática por exame ultrassonográfico. Para o diagnóstico de SM, foram utilizados os critérios da National Cholesterol Education Program/Adult Treatment Panel III adaptados para faixa etária. Para avaliação da associação do ácido úrico com os grupos, foi realizado o teste do Qui-quadrado ou Fisher, adotando-se o intervalo de confiança de 95%. Para comparação de médias, utilizou-se o ANOVA One Way. Para o ajuste das variáveis foi utilizada a regressão logística múltipla. Os dados foram processados no SPSS versão 17. RESULTADOS: Níveis elevados de ácido úrico associaram-se significativamente à adolescência, SM e pressão arterial sistólica. O maior quartil de ácido úrico apresentou valores médios significativamente mais elevados de índice de massa corpórea, circunferência abdominal, pressão arterial sistólica, pressão arterial diastólica, triglicerídeos, colesterol total e HOMA-IR, e menor média do colesterol HDL. No modelo final só permaneceram associadas aos níveis de ácido úrico a faixa etária e a presença de síndrome metabólica. CONCLUSÕES: Níveis elevados de ácido úrico estiveram associados à síndrome metabólica e à adolescência, o que não foi observado com a esteatose hepática.

OBJECTIVE: To investigate the association between serum uric acid concentration according to the presence or absence of non-alcoholic fatty liver disease (NAFLD) and/or metabolic syndrome (MS) in overweight or obese children and adolescents. METHODS: This was a cross-sectional study conducted from April of 2009 to March of 2010, including 129 children and adolescents treated at the Center for Childhood Obesity. Anthropometric data, blood pressure measurements, and laboratory test results were obtained, and NAFLD diagnosis was made by ultrasound. The diagnosis of MS was made using the criteria of the National Cholesterol Education Program/Adult Treatment Panel III, adapted to age range. The chi-squared test or or Fisher's test were used to evaluate the association of uric acid with the groups, with a 95% confidence interval. One way analysis of variance (ANOVA) was used for comparison of means. Multiple logistic regression was used for adjustment of variables. The data were analyzed with the Statistical Package for Social Sciences (SPSS), release 17. RESULTS: High levels of uric acid were significantly associated with adolescence, MS, and systolic blood pressure. The highest quartile of uric acid showed significantly higher values of body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, and homeostatic model assessment index (HOMA-IR), and lower mean values of HDL cholesterol. In the final model, only age range and the presence of MS remained associated with uric acid levels. CONCLUSIONS: High levels of uric acid were associated with MS and adolescence, which was not observed with NAFLD.

Hematoma subdural agudo espontâneo e hemorragia intracerebral em paciente com microangiopatia trombótica gestacional / Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy

Pré-eclâmpsia, síndrome HELLP (hemólise, elevação de enzimas hepáticas e plaquetopenia) e fígado gorduroso agudo da gestação são as principais causas de microangiopatia trombótica e disfunção hepática grave durante a gestação, representando um spectrum do mesmo processo patológico. Relatou-se aqui o caso de uma gestante com 35 semanas internada em unidade de terapia intensiva no pós-operatório imediato de cesariana por morte fetal, com náuseas, vômitos e icterícia. Diagnosticaram-se pré-eclâmpsia pós-parto e fígado gorduroso agudo da gestação. Houve evolução tardia com hematoma subdural agudo e hemorragia intracerebral, sendo realizado tratamento neurocirúrgico. A paciente foi a óbito por anemia hemolítica refratária, com sangramento espontâneo em múltiplos órgãos. Pré-eclâmpsia, síndrome HELLP e fígado gorduroso agudo da gestação são processos patológicos que podem se sobrepor e se associar a complicações potencialmente fatais, como a hemorragia intracraniana aqui descrita. Sua detecção e diagnóstico precoces são fundamentais para a instituição de manejo adequado e sucesso do tratamento.

Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.

Doença hepática gordurosa não alcoólica e sua relação com a síndrome metabólica no pré-operatório de pacientes submetidos à cirurgia bariátrica / Nonalcoholic fatty liver disease and its association with metabolic syndrome in the preoperative period in patients undergoing bariatric surgery

OBJETIVO: Verificar a relação entre a doença hepática gordurosa não alcoólica (DHGNA) e síndrome metabólica (SM) no período pré-operatório de pacientes submetidos à cirurgia bariátrica. MÉTODOS: Foram revisados 68 prontuários de pacientes de um centro de tratamento avançado da obesidade da cidade de Caxias do Sul - RS. As variáveis estudadas foram gênero, idade, parâmetros bioquímicos (nível de glicose em jejum, colesterol HDL e triglicerídeos), ultrassonografia abdominal, pressão arterial e antropometria (peso, estatura, circunferência abdominal e Índice de Massa Corporal). O diagnóstico da DHGNA foi obtido pela ultrassonografia abdominal e o da SM através do protocolo descrito pelo National Cholesterol Education Program's Adult Treatment Panel III, atualizado pela American Heart Association; e a National Heart, Lung, and Blood Institute. RESULTADOS: 72,1% (n = 49) da amostra foi composta pelo gênero feminino e a média de idade encontrada na população foi de 37,57 ± 10,29 anos. A média de peso entre eles foi de 123,14 ± 25,40 kg, a altura de 1,67 ± 0,09 m e o valor médio de IMC de 56,24 ± 9,30 kg/m². Apresentaram diagnóstico de DHGNA 60% (n = 27) dos pacientes portadores de SM (p = 0,008), 63,4% (n = 26) dos pacientes portadores de hipertensão arterial (p = 0,013) e 66,7% (n = 18) dos pacientes que apresentaram níveis glicêmicos alterados (p = 0,028). CONCLUSÃO: Os resultados do presente estudo mostraram que o diagnóstico de SM, bem como a presença das desordens associadas a esta (obesidade, hipertensão arterial e elevação nos níveis glicêmicos) estão fortemente relacionadas à presença da DHGNA.

OBJECTIVE: To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in the preoperative period in patients undergoing bariatric surgery. METHODS: A total of 68 medical records of patients from a center for advanced treatment of obesity in the city of Caxias do Sul, state of Rio Grande do Sul, Brazil, were reviewed. The variables analyzed were gender, age, biochemical parameters (fasting glucose, HDLcholesterol and triglycerides), abdominal ultrasound, blood pressure, and anthropometric data (weight, height, waist circumference, and body mass index [BMI]). The diagnosis of NAFLD was obtained by abdominal ultrasonography; the diagnosis of of MS was obtained according to the protocol described by the National Cholesterol Education Program's Adult Treatment Panel III, updated by the American Heart Association; and the National Heart, Lung, and Blood Institute. RESULTS: 72.1% (n = 49) of the sample consisted of females, and the mean age for the sample was 37.57 ± 10.29 years. The mean weight was 123.14 ± 25.40 kg, mean height was 1.67 ± 0.09 m, and mean BMI was 56.24 ± 9.30 kg/m². A total of 60% (n = 27) of patients with MS (p = 0.008), 63.4% (n = 26) of patients with hypertension (p = 0.013), and 66.7% (n = 18) of patients with altered glucose levels (p = 0.028) were diagnosed with NAFLD. CONCLUSION: The results of this study showed that the diagnosis of MS, as well as the presence of disorders associated with this syndrome (obesity, hypertension, and high blood glucose levels) are strongly associated with the presence of NAFLD.

Hígado graso agudo del embarazo y síndrome HELLP: aspectos diagnósticos y terapéuticos / Acute fatty liver of pregnancy and HELLP syndrome: diagnostic and therapeutic aspects

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and acute fatty liver of pregnancy (AFLP), cause liver dysfunction in the third trimester of pregnancy and determine risk of maternal and fetal mortality. Many maternal complications can occur, including acute renal failure and coagulopathy. Early diagnosis, prompt delivery and adequate supportive care are the key to a good outcome in most of the patients. In some cases, despite an appropriate conventional management, the disease may progress to multiple organ dysfunction, progressive liver insufficiency or severe hepatic complications (subcapsular hematoma, liver rupture), requiring adjunctive medical therapy, such as plasma exchange, surgery or liver transplantation.

El síndrome HELLP (hemolysis, elevated liver enzymes, and low platelet count) y el hígado graso agudo del embarazo (acute fatty liver of pregnancy -AFLP), son causa de disfunción hepática en el tercer trimestre del embarazo y condicionan riesgo de mortalidad materna fetal. Se pueden presentar diversas complicaciones como insuficiencia renal aguda y coagulopatía, entre otras. El diagnóstico oportuno, la interrupción del embarazo y un manejo de sostén adecuado permiten sacar adelante a la mayoría de las pacientes. En algunos casos, a pesar de un manejo convencional adecuado, la enfermedad puede evolucionar con disfunción multiorgánica, insuficiencia hepática progresiva o complicaciones hepáticas graves (hematoma subcapsular, rotura hepática), requiriendo de terapia médica adyuvante, como la plasmaféresis, cirugía o incluso trasplante hepático.