Rehabilitación cardiaca en mujeres y hombres después de un infarto agudo del miocardio

Fundamento: la rehabilitación cardiovascular favorece la recuperación de los pacientes que sufren de infarto del agudo del miocardio. Objetivo caracterizar la rehabilitación cardiovascular en mujeres y hombres con un primer infarto agudo de miocardio no complicado con elevación del segmento ST. Métodos: se realizó un estudio descriptivo y transversal en el Centro de Atención Cardiovascular del Hospital Provincial Docente Clínico Quirúrgico Manuel Ascunce Domenech de Camagüey en el período comprendido entre septiembre de 2015 hasta septiembre del 2016. La muestra estuvo constituida por 65 pacientes a los que se realizó una prueba ergométrica y ecocardiograma pre-alta y 6 semanas después de rehabilitados. A los cinco años se evaluó supervivencia. Se realizó prueba de ergométrica máxima limitada por síntomas para determinar estratificación de riesgo, capacidad funcional, prescripción de la actividad y proporcionar información al paciente. Resultados: hubo mayor incidencia de infarto rehabilitado en el sexo masculino, el grupo de edad más afectado fue el de 50-59 años y la hipertensión arterial fue el factor de riesgo cardiovascular predominante. Hubo notable mejoría en los parámetros ergométricos y hemodinámicos después de las 6 semanas de la rehabilitación. La reacción hipertensiva y la disnea, disminuyeron en la mayoría de los casos al final del estudio. Los pacientes que comenzaron el estudio mejoraron su clase funcional a las 6 semanas de rehabilitados y hubo un incremento de la categoría riesgo bajo a expensas del riesgo moderado. La supervivencia a los cinco años fue del 89,9 %. Conclusiones: se obtuvo una significativa mejoría de parámetros clínicos y ergométricos, así como la reincorporación a las labores cotidianas en los pacientes que participaron en el programa. Las mujeres recibieron menos beneficios de este programa que los hombres.

Background: cardiovascular rehabilitation favors the recovery of patients suffering from acute myocardial infarction. Objective: to characterize cardiovascular rehabilitation in women and men with a first uncomplicated acute myocardial infarction with ST-segment elevation. Methods: a descriptive and cross-sectional study was carried out at the Cardiovascular Care Center of the Manuel Ascunce Domenech Teaching Clinical Surgical Provincial Hospital in Camagüey in the period from September 2015 to September 2016. The sample consisted of 65 patients. who underwent a stress test and echocardiogram before discharge and 6 weeks after rehabilitation. Survival was evaluated at five years. Symptom-limited maximal stress test was performed to determine risk stratification, functional capacity, activity prescription and provide information to the patient. Results: there was a higher incidence of rehabilitated infarction in males, the most affected age group was 50-59 years, and arterial hypertension was the predominant cardiovascular risk factor. There was notable improvement in the ergometric and hemodynamic parameters after 6 weeks of rehabilitation. The hypertensive reaction and dyspnea decreased in most cases at the end of the study. The patients who began the study improved their functional class 6 weeks after rehabilitation and there was an increase in the low risk category at the expense of moderate risk. Five-year survival was 89.9 %. Conclusions: a significant improvement of clinical and ergometric parameters was obtained, as well as the return to daily tasks in the patients who participated in the program. Women received fewer benefits from this program than men.

Riesgos y complicaciones asociados al embarazo en la adolescencia / Risks and complications associated with pregnancy in adolescent ages

RESUMEN Introducción: el embarazo en la adolescencia constituye un problema de salud en el mundo, repercute en la sociedad y compromete la salud de la madre y del feto. Objetivo: describir los factores de riesgos y complicaciones asociados al embarazo en la adolescencia. Métodos: se realizó una revisión bibliográfica sobre el embarazo en la adolescencia. Se expresó criterios de autores y resultados de investigaciones disponibles en las bases de datos SciELO, Medline, PubMED. Se empleó un total de 30 referencias bibliográficas, más del 75 % de la literatura consultada corresponde a los últimos cinco años. Desarrollo: el embarazo en la adolescencia no tiene causa específica. En su desarrollo inciden factores de riesgos individuales, familiares y socioeconómicos. Las complicaciones del embarazo en edades tempranas son frecuentes, constituyen un alto riesgo obstétrico pues compromete la vida de la madre y el feto. Las complicaciones se asocian fundamentalmente a las características biológicas de la madre y a la edad gestacional que presenta. Conclusiones: los principales factores de riesgos asociados con el embarazo adolescente están relacionados con el inicio precoz de las relaciones sexuales, la deficiente educación sexual y los conflictos con la familia. Las complicaciones más significativas asociadas a gestantes adolescentes son la enfermedad hipertensiva gestacional, los traumas obstétricos del parto, el recién nacido pretérmino y el bajo peso. La prevención de los factores de riesgos, desarrollar una correcta educación sexual por la familia, la sociedad y los profesionales de la salud, favorecerá a la disminución de los embarazos en edades tempranas.

ABSTRACT Introduction: pregnancy in adolescent age constitutes a health problem all over the world, having repercussion throughout the society and affecting the health of the mother and the fetus. Objective: to describe the risk factors and complications associated with pregnancy in adolescent age. Methods: a bibliographic review with reference to pregnancy in adolescent age was carried out. The criteria of the authors and the results of the available researches in SciELO, Medline, PubMED databases were expressed; using a total of 30 bibliographic references, more than 75 % of the consulted literature corresponded to the last 5 years. Development: pregnancy in adolescent ages has not a specific cause. In its increase individual, familial and socioeconomic risk factors influence. Complications in pregnancy at early ages are frequent, and constitute a high obstetric risk affecting the life of the mother and the fetus. Complications are mainly associated with the biological characteristics of the mother and her gestational age. Conclusions: the main risk factors associated with pregnancy in adolescent ages are related to early initiation of sexual relations, poor sexual education and conflicts with the family. The most significant complications associated with pregnancy in adolescent ages are gestational hypertensive disease, obstetric trauma of delivery, preterm newborn and low birth weight (LBW). The prevention of risk factors, to develop a correct sexual education by the family, the society and the healthcare professionals will favor to decrease the rates of pregnancy in early ages.

Cierre de túnel aorto-ventricular derecho mediante un dispositivo percutáneo / Closure of the right aorto-ventricular tunnel through a percutaneous device

Resumen El túnel aorto-ventricular derecho es una anomalía congénita que consiste en un canal que conecta la aorta ascendente a la cavidad del ventrículo derecho. El diagnóstico se corrobora, en la mayoría de los casos, por ecocardiografía. El cierre quirúrgico se considera el tratamiento de elección y solo se han reportado dos casos previos en los que se ha logrado el cierre mediante intervencionismo. Se presenta el caso de una lactante con diagnóstico de túnel aorto-ventricular derecho, tratada por intervención percutánea con dispositivo de cierre percutáneo, que tuvo buena evolución clínica. La paciente, además, presentó un ductus permeable, el cual fue tratado en una segunda oportunidad por intervencionismo. La factibilidad de la técnica de cierre por procedimiento percutáneo y su baja tasa de complicaciones en comparación con el cierre por cirugía abierta pueden hacer de este el procedimiento de elección en la mayoría de los casos para esta infrecuente condición.

Abstract The aorto-right ventricular tunnel is a congenital anomaly that consists of a channel that connects the ascending aorta to the right ventricular cavity. The diagnosis is usually made by transthoracic echocardiography. Surgical closure is usually considered the treatment of choice and only two previous cases have been reported in which closure has been achieved by percutaneous intervention. We report a case of an infant with a diagnosis of aorto-right ventricular tunnel treated using a percutaneous device with good clinical evolution. The patient had also a patent ductus which was later treated by interventionism. The feasibility of the technique and its low rate of complications compared to the closure by open surgery can make it the procedure of choice in most cases for this rare condition.

Health-promoting activities of edible seaweed extracts from Chilean coasts: assessment of antioxidant, anti-diabetic, anti-inflammatory and antimicrobial potential / Actividades promotoras de la salud de extractos de algas comestibles de las costas chilenas: evaluación del potencial antioxidante, antidiabético, antiinflamatorio y antimicrobiano

ABSTRACT The aim of this study was to evaluate the antioxidant, antidiabetic, anti-inflammatory and antimicrobial activities of three edible seaweed extracts from Chilean coasts: Pyropia orbicularis, Ulva spp, and Durvillaea antarctica. Seaweed extracts in methanol and 70% acetone were performed to evaluate antioxidant and antidiabetic activities, whereas 60% methanol was used to measure anti-inflammatory and antimicrobial activities. Acetone extracts from D. antarctica had the highest total phenolic content and consequently exhibited the strongest antioxidant activity, while methanol extract of this seaweed presented the highest α-glucosidase inhibition (IC50= 0.004 mg mL-1). In the tests against E. coli and Penicillium sp., the extracts obtained from Ulva spp. were the most effective and exhibited the maximum anti-inflammatory effect against phorbol 12-myristate 13-acetate irritant agent (61.8% inhibition) in mice. Results indicated that all evaluated Chilean seaweed extracts are promising candidates for application in functional foods and in the pharmaceutical industry.

RESUMEN El objetivo de este estudio fue evaluar las actividades antioxidantes, antidiabéticas, antiinflamatorias y antimicrobianas de los extractos de tres algas marinas comestibles de las costas Chilenas (Pyropia orbicularis, Ulva spp. y Durvillaea antarctica). Se realizaron extractos de algas marinas en metanol y acetona al 70% para evaluar las actividades antioxidantes y antidiabéticas, mientras que el metanol al 60% se usó para actividades antiinflamatorias y antimicrobianas. Los extractos de acetona de D. antarctica tuvieron el mayor contenido de fenoles totales (TPC) y, en consecuencia, exhibieron la mayor actividad antioxidante, mientras que el extracto metanólico de estas algas presentó la mayor inhibición de la α-glucosidasa (IC50= 0,004 mg mL-1). En las pruebas contra E. coli y Penicillium sp., los extractos obtenidos de Ulva spp., actuaron como los más efectivos y exhibieron el máximo efecto antiinflamatorio contra el agente irritante de forbol 12-miristato 13-acetato (TPA) (inhibición del 61,8%) en ratones. Por lo tanto, los resultados indican que todos los extractos de algas chilenas evaluados pueden ser candidatos prometedores para su aplicación en alimentos funcionales y en las industrias farmacéuticas.

Caracterización del cáncer gástrico en Guatemala / Characterization of gastric cancer in Guatemala

Tomando en cuenta que las estadísticas del cáncer gástrico en la población guatemalteca han demostrado un aumento en los últimos años y que la prevalencia de la infección por Helicobacter pylori reportada es del 65%, se consideró importante analizar sus características y la relación con la bacteria. Para ello se obtuvo información de un número estadísticamente representativo de expedientes de pacientes con diagnóstico de cáncer gástrico que fueron atendidos en el Instituto de Cancerología y Hospital "Bernardo del Valle S" del período 2004 al 2007. Se revisaron un total de 284 expedientes, encontrando que el rango de edad más afectado es de 41 a 80 años. Por el estadio avanzado del cáncer al momento de la consulta, 107 pacientes (37%) fueron considerados como "caso fuera de tratamiento oncológico". A 248 (87%) el diagnóstico se realizó por endoscopia y únicamente a 69 (27.8%) se les investigó para H. pylori, encontrando positividad en 22 (31.9%). Se encontró 85 casos de cáncer difuso (34.3%) y 134 de tipo intestinal (54%), en los pacientes H. pylori positivo el tipo histológico más frecuente fue el intestinal (10/22, 45.4%), mientras que el tipo difuso predominó en los negativo (26/47, 55.3%). El área del estómago más afectada fue antro (69/155, 44.5%), unión esófago y estómago (24/155, 15.5%) y cuerpo (19/155, 12.3%). Con relación al género se observó un predominio del masculino, encontrando 76 (56.7%) para el tipo intestinal y 47(55.3%) para el difuso, lo que permitió establecer una relación de 1.31 y 1.26, respectivamente. La tasa de riesgo es de 1.97 (IC = 0.8251 - 4.7290, p = 0.20), lo que indica que los pacientes guatemaltecos que presentan la infección por H. pylori tienen el doble de riesgo de sufrir un cáncer tipo intestinal que uno del tipo difuso, mientras que la probabilidad conjunta que un paciente H. pylori positivo desarrolle cáncer es de 0.0058 (IC: 0.0052 ­ 0.008), la que es mayor que la probabilidad mundial reportada por la OMS.

Taking into account that gastric cancer in the Guatemalan population have shown an increase in recent years and that the prevalence of H. pylori infection reported is 65%, it was considered important to analyze the characteristics of this type of cancer and its relation to the bacteria. We obtained information from medical records of patients diagnosed with gastric cancer, statistically representative, who were treated at the Cancer Institute and "Bernardo del Valle S" Hospital during the period 2004 to 2007. A total of 284 records were reviewed and it was found that the most affected age range is 41-80 years. For the advanced stage of cancer at the time of the consultation, 107 patients (37%) were considered "case out of cancer treatment." In 248 (87%) patients, diagnosis was made by endoscopy and of them only 69 (27.8%) were investigated for H. pylori, finding 22 (31.9%) with a positive result. It was established 85 cases of diffuse cancer (34.3%) and 134 of intestinal type (54%), the most frequent histological type in H. pylori positive patients was intestinal (10/22, 45.4%), while diffuse type prevailed in the negative (26/47, 55.3%). The most affected stomach area was antrum (69/155, 44.5%), union esophagus and stomach (24/155, 15.5%) and body (19/155, 12.3%). With regard to gender a male predominance was observed being 76 (56.7%) for the intestinal type and 47 (55.3%) for diffuse, allowing to establish a relationship of 1.31 and 1.26, respectively. The hazard rate ratio is 1.97 (IC = 0.8251 - 4.7290, p = 0.20), indicating that Guatemalans patients with H. pylori infection have twice the risk of intestinal cancer type one of the diffuse type, while the joint probability that an H. pylori positive patient develop cancer is 0.0058 (CI 0.0052 to 0008), greater than the global probability reported by WHO.

Identificación de las pruebas más sensibles y específicas para el diagnóstico de Helicobacter pylori pre y post-tratamiento en pacientes dispépticos / Identification of the most sensitive and specific tests for the diagnosis of Helicobacter pylori pre and post-treatment dyspeptic patients

Con el fin de determinar la prueba no invasiva más sensible y específica para el diagnóstico de la infección por Helicobacter pylori y confirmar su erradicación post-tratamiento, se estudiaron prospectivamente 178 pacientes con dispepsia que acudieron a la clínica de endoscopía del Instituto Nacional de Cancerología (INCAN). A todos se les realizó la detección de antígeno fecal a través de una prueba inmunocromatográfìca comercial (Anarapid®) y un panel de pruebas serológicas que incluyó anticuerpos IgM, IgA, IgG CagA anti-H. pylori por medio de método inmunoenzimático (ELISA). Dichas pruebas se evaluaron estadísticamente para determinar su sensibilidad, especificidad y concordancia (índice kappa) comparando con el resultado de la biopsia, el cual fue considerado el estándar de oro. Así mismo se realizaron pruebas enzimáticas (Pepsinógeno I y II) para evaluar la integridad de la mucosa gástrica y se determinó su asociación con la sintomatología, según la prueba de Ji cuadrado. La detección de anticuerpos IgA anti-H. pylori presentó la mayor sensibilidad (74.2%) y la prueba de antígeno fecal la mayor especificidad (69.9%), respecto a las demás pruebas. Sesenta y tres pacientes diagnosticados con infección por H. pylori en la etapa inicial recibieron tratamiento específico y se les dio seguimiento por 5 meses para evaluar los cambios en la sintomatología. Al finalizar los cinco meses se les realizó el mismo panel de pruebas, observándose que en la mayoría de los pacientes los valores de pepsinógeno I y II se encontraron dentro del rango normal. En la evaluación post-tratamiento el índice de pepsinógeno I/II se normalizó en 24.86% de los pacientes y se incrementó el número de pacientes asintomáticos de 1.6% a 34.9%, lo cual demostró la eficacia del tratamiento. El antígeno fecal y anticuerpos IgA contra H. pylori en conjunto son las pruebas recomendadas para hacer el diagnóstico de la infección pre-tratamiento, mientras que en la fase post- tratamiento la prueba que demostró el éxito terapéutico es el antígeno fecal. Para la mayoría de la población de este estudio los valores de pepsinógeno I y II se encontraron en el rango normal, lo cual es indicativo de que sufren de una dispepsia funcional u otra enfermedad que no afecta la mucosa gástrica. Se hace además necesario continuar con los estudios de la utilidad de la determinación de pepsinógeno I /II y su asociación con el riesgo a desarrollar cáncer gástrico.

With the objective to determine a non-invasive most sensible and specific test for the diagnosis of H. pylori infection and confirming eradication after treatment, 178 patients with dyspepsia were prospectively studied during treatment at the Endoscopy clinic of the National Cancer Institute (INCAN). They underwent fecal antigen detection using a commercial immunoassay (Anarapid ®) technique and a panel of serological tests that included IgM, IgA, IgG (CagA) anti-H. pylori by immunosorbent assay (ELISA). These tests were statistically evaluated through 2x2 contingency tables (Kappa index) comparing with the biopsy results, which is considered the gold standard. Likewise enzyme assays were performed (Pepsinogen I and II) to assess the integrity of the gastric mucosa and determined its correlation with symptoms according to chi-square test. Findings indicate that the detection of IgA anti-H. pylori had the highest sensitivity (74.2%) and the fecal antigen test had the highest specificity (69.9%) compared to the other tests. Sixty three patients diagnosed with initial stage H. pylori infection received specific treatment and were followed for 5 months to evaluate changes. At the end of five months of specific treatment, the same test panel was gathered. Results showed that in most patients values pepsinogen I and II were within normal range. In post-treatment evaluation the rate of pepsinogen I / II was normalized in 24.86% of patients and the number of asymptomatic patients increased from 1.1% to 30.99%, which demonstrated the efficacy of treatment. Results show that fecal antigen and IgA antibody against H. pylori tests are together the recommended tests for diagnosis of pre-treatment infection, whereas in the post-treatment phase, the fecal antigen test demonstrated therapeutic success. Values of pepsinogen I and II were in the normal range for the majority of the study population, which is indicative of suffering from functional dyspepsia or another disease that affects the gastric mucosa. It is further necessary to continue studies of the usefulness of the determination of pepsinogen I / II and its association with the risk of developing gastric cancer

Dietary Patterns and Metabolic Syndrome in Adults.

Aims: Considering that diet is a potential factor contributing to the development of Metabolic Syndrome (MetS) and it is increasingly prevalent among population worldwide, the aim of the present study was to correlate dietary patterns with MetS and its main risk factors in adults. Study Design: Cross-sectional. Place and Duration of Study: School of Public Health, University of São Paulo, between August 2007 and January 2010. Methodology: This study was conducted with 267 adults (189 women and 78 men) submitted to evaluation procedures which included body composition (waist circumference (WC), height and weight) and blood pressure measurements, biochemical analysis from a single blood sample after a 12-h fasting (serum triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and fasting glucose) and assessment of dietary intake using a 24-hour recall. Dietary patterns (DPs) were identified using principal components factor analysis with varimax orthogonal rotation. Results: Three distinct DPs were identified from the principal component factor analysis: “Traditional”, “Healthy” and “Western”. Among individuals with MetS, there was a positive correlation between Healthy pattern and HDL-c (P = .03), as well as between Western pattern and WC, TG and LDL-c (P = .001, P = .04 and P = .047). In people without MetS, the negative correlation was observed between Traditional pattern and LDL-c (P = .049), and positive correlation between Healthy pattern and age, TC and, LDL-c (P = .01, P = .03 and P = .03). Conclusion: Our assessment offers information concerning food combinations that may increase the risk and prevalence of MetS. However, more studies are required to confirm these findings and to assist in the prevention and development of specific nutritional recommendations for this syndrome.

Eficacia del la terapia neural en el tratamiento de pacientes con epicondilitis humeral / Efficacy of the neural therapy in the treatment of patients with humeral epicondylitis

La epicondilitis se asocia a profesiones que conllevan a una actividad física mantenida, sobre todo en la que se refiere a movimientos o esfuerzos de repetición; constituyen un motivo habitual de baja laboral. Esta enfermedad es una de las que se presenta con mayor frecuencia en consulta de los Servicios Integrales de Rehabilitación. Objetivo: demostrar la eficacia de la terapia neural en el tratamiento de pacientes con diagnóstico de epicondilitis humeral en el servicio de medicina bioenergética del hospital universitario Manuel Ascunce Domenech desde enero a diciembre de 2008. Método: se realizó un estudio experimental, tipo ensayo clínico fase II abierto, en 47 pacientes diagnosticados con epicondilitis humeral, atendidos en la Clínica de Medicina Bioenergética. Se les aplicó un tratamiento con terapia neural. Los datos fueron obtenidos mediante el formulario clínico realizado al efecto, los mismos fueron procesados, mediante el programa informático SPSS 11.5 para Windows, se utilizaron las técnicas estadísticas descriptivas y las estadísticas inferencial. Resultados: con la aplicación de la escala visual analógica del dolor (EVA) y la de BARTHEL (evaluación de la capacidad funcional) se obtuvieron valores altos de mejoría entre la quinta y la décima sesión del tratamiento. Existió la peculiaridad de una recuperación funcional más tardía en aparición con respecto al alivio del dolor, se logró una mejoría funcional excelente. El por ciento de reacciones adversas fue bajo. Conclusiones: la terapia neural constituye una terapéutica efectiva para erradicar el dolor y la impotencia funcional secundaria a una epicondilitis.

Epicondylitis is associate to professions that leads to maintained physical activity, above all in which it refers to movements or efforts of repetition; it constitutes a habitual cause of work-related leave. This disease is showed with greater frequency in the Rehabilitation Integral Services consultation. Objective: to demonstrate the efficacy of neural therapy in the treatment of patients with humeral epicondylitis diagnosis in the bioenergetics medicine service at the Teaching Hospital Manuel Ascunce Domenech from January to December 2008. Method: an experimental study, type open phase II clinical trial was performed in 47 patients diagnosed with humeral epicondylitis, treated at the Bioenergetics Medicine Clinic, who a treatment with neural therapy were applied. Data were obtained by means of the clinical form carried out for this purpose; they were processed through the SPSS 11.5 computer program for Windows, descriptive and inferential statistical techniques were used. Results: with the application of the analogical visual scale of pain and the one of Barthel (evaluation of the functional capacity) high values of improvement between the fifth and the tenth session of treatment were obtained. The peculiarity of a functional recovery later in appearing regarding the relief of pain existed; an excellent functional improvement was achieved. It was a low percent of adverse reactions. Conclusions: neural therapy constitutes an effective therapeutics to eradicate pain and functional impotence secondary to an epicondylitis.

Relação entre estado nutricional da vitamina D e pressão arterial em adultos residentes na cidade de São Paulo / Relationship between vitamin D status and blood pressure in adults living at Sao Paulo city

Introdução A baixa concentração sérica de vitamina D tem sido associadas com a hipertensão no mundo todo. A hipovitaminose D tem sido observada mesmo na nossa população. Objetivo Investigar as concentrações séricas de vitamina D e sua associação com a pressão arterial (PA) em indivíduos adultos residentes na cidade de São Paulo. Métodos Para esta dissertação foram desenvolvidos dois artigos. Na revisão (artigo 1), foram selecionados artigos indexados nas bases de dados Pubmed, Lilacs e Medline, incluindo estudos realizados no Brasil. O artigo original (artigo 2) descreve o estudo transversal realizado com 332 adultos, 65 por cento mulheres, onde foi avaliada a associação entre vitamina D, paratormônio intacto (PTHi) e PA. Foram feitas: aferição da PA e coleta de medidas antropométricas e amostras sanguíneas. A concentração sérica de 25(OH)D3 foi mensurada pela técnica de cromatografia líquida de alta eficiência (HPLC). O valor médio de 2 medidas de PA foi considerado para as análises. Os participantes foram divididos em 3 grupos: (1) PA normal; (2) PA elevada; (3) PA normal pelo uso de medicação. A insuficiência de vitamina D foi considerada quando 25(OH)D3 75 nmol/L e o PTHi elevado quando > 65 pg/mL. A relação entre vitamina D, PTHi e PA foi ajustada pelo índice de massa corpórea (IMC), circunferência da cintura (CC) e perfil lipídico. Resultados Na revisão foi enfatizada a relação da vitamina D com doenças cardiovasculares, considerando, inclusive, os diferentes mecanismos fisiológicos propostos. No artigo original, observou-se idade média e desvio padrão de 50 (15) anos, IMC 29 (6) kg/m² e CC 97 (13) cm. Entre os indivíduos avaliados, 75 por cento tinham sobrepeso ou obesidade. PA média foi 129/80 (18/11) mmHg. A concentração média de cálcio sérico foi 9,3 (0,5) mg/dL, PTHi 40,8 (18,7) pg/mL e vitamina D 55,8 (17,1) nmol/L. O PTHi elevado e a insuficiência de vitamina D estiveram presentes em 12 por cento e 86 por cento da amostra, respectivamente. Não foram observadas diferenças nas prevalências de insuficiência de vitamina D e PTHi elevado entre os grupos de PA.

Vitamina D e doenças endocrinometabólicas: [revisão] / Vitamin D and endocrine diseases: [review]

Atualmente, a insuficiência/deficiência de vitamina D tem sido considerada um problema de saúde pública no mundo todo, em razão de suas implicações no desenvolvimento de diversas doenças, entre elas, o diabetes melito tipo 2 (DMT2), a obesidade e a hipertensão arterial. A deficiência de vitamina D pode predispor à intolerância à glicose, a alterações na secreção de insulina e, assim, ao desenvolvimento do DMT2. Esse possível mecanismo ocorre em razão da presença do receptor de vitamina D em diversas células e tecidos, incluindo células-β do pâncreas, no adipócito e no tecido muscular. Em indivíduos obesos, as alterações do sistema endócrino da vitamina D, caracterizada por elevados níveis de PTH e da 1,25(OH)2D3 são responsáveis pelo feedback negativo da síntese hepática de 25-OHD3 e também pelo maior influxo de cálcio para o meio intracelular, que pode prejudicar a secreção e a sensibilidade à insulina. Na hipertensão, a vitamina D pode atuar via sistema renina-angiotensina e também na função vascular. Há evidências de que a 1,25(OH)2D3 inibe a expressão da renina e bloqueia a proliferação da célula vascular muscular lisa. Entretanto, estudos prospectivos e de intervenção em humanos que comprovem a efetividade da adequação do status da vitamina D sob o aspecto "prevenção e tratamento de doenças endocrinometabólicas" são ainda escassos. Mais pesquisas são necessárias para se garantir o benefício máximo da vitamina D nessas situações.

Vitamin D insufficiency/deficiency has been worldwide reported in all age groups in recent years. It has been considered a Public Health matter since decreased levels of vitamin D has been related to several chronic diseases, as type 2 diabetes mellitus (T2DM), obesity and hypertension. Glucose intolerance and insulin secretion has been observed during vitamin D deficiency, both in animals and humans resulting in T2DM. The supposed mechanism underlying these findings is presence of vitamin D receptor in several tissues and cells, including pancreatic β-cells, adipocyte and muscle cells. In obese individuals, the impaired vitamin D endocrine system, characterized by high levels of PTH and 1,25(OH)2D3 could induce a negative feedback for the hepatic synthesis of 25(OH)D and also contribute to a higher intracellular calcium, which in turn secrete less insulin and deteriorate insulin sensitivy. In hypertension, vitamin D could act on renin-angiotensin system and also in vascular function. Administration of 1,25(OH)2D3 could decreases renin gene expression and inhibit vascular smooth muscle cell proliferation. However, prospective and intervention human studies that clearly demonstrates the benefits of vitamin D status adequacy in the prevention and treatment of endocrine metabolic diseases are lacking. Further research still necessary to assure the maximum benefit of vitamin D in such situations.

CCR5 and beta-chemokines in HIV-1 infected children

The duration from initial infection with HIV-1 to CD4 lymphocyte depletion and progression to AIDS varies among infected individuals. Despite treatment with highly active antiretroviral therapy (HAART), patients still show different stages of disease progression. We examined the role of beta-chemokines and its receptor, CCR5 in HIV-1 infected children in order to define determinants of HIV progression among treated individuals. Population was divided in two groups: Group 1--Long Term Non Progressors (LTNP) includes 10 patients with B1-B2 CDC disease classification and with a less aggressive therapy (only 2 in HAART); Group 2--Rapid Progressors (RP) includes 9 patients with C3 disease classification. All the patients had a CCR5 wild type (wt) genotype indicating that they do not have the 32 base-pair deletion associated with slower progression. There was an increased production of MIP 1-beta in 8/10 LTNP but only in 4/9 Progressors (Paired t-test/Wilcoxon Sign test, p-value < 0.05). The change in the levels of MIP-1 beta after PHA stimulation was statistically significant in both groups. The levels of RANTES increased in LTNP and RP and the change of the levels after mitogen stimulation was statistically significant for both groups included. The production of RANTES and MIP-1 beta in response to stimulation between both groups was not statistically significant. The production of MIP-1 alpha was variable in both groups and the difference in the levels after mitogen stimulation between the groups was not statistically significant. These results suggest that beta-chemokines do not play an important role in HIV-1 progression in children undergoing HAART.

Estudio de la vida útil de la tromboplastina de placenta humana liofilizada / Study of the useful life of tromboplastin from lyophilized human placenta

Se realizó un estudio durante 2 años de las variaciones que experimentan la actividad biológica y algunos parámetros químicos como: niveles de proteínas, fosfolípidos y malonaldehído de la tromboplastina placentaria humana liofilizada, con la finalidad de determinar la temperatura óptima de almacenamiento. Se obtuvo como resultado que tanto el tiempo de protrombina como el de coagulación se mantenían estables cuando los lotes eran almacenados a temperatura de congelación (-20-C), que el tiempo de protrombina variaba dentro del rango permisible cuando los lotes se mantenían a temperatura de refrigeración (2-8-C), mientras que cuando se almacenaban a temperatura ambiente la actividad biológica ofrecía resultados muy variables. El estudio de los parámetros químicos tales como: proteínas, fosfolípidos y malonaldehídos reveló que la proteína variaba dentro de los grupos, el malonaldehído aumentaba la temperatura, mientras que el fosfolípido disminuía