Elevated levels of plasma osteoprotegerin are associated with all-cause mortality risk and atherosclerosis in patients with stages 3 to 5 chronic kidney disease

Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and plays a role in vascular calcification. We evaluated the relationship between osteoprotegerin levels and inflammatory markers, atherosclerosis, and mortality in patients with stages 3-5 chronic kidney disease. A total of 145 subjects (median age 61 years, 61% men; 36 patients on hemodialysis, 55 patients on peritoneal dialysis, and 54 patients with stages 3-5 chronic kidney disease) were studied. Clinical characteristics, markers of mineral metabolism (including fibroblast growth factor-23 [FGF-23]) and inflammation (high-sensitivity C-reactive protein [hsCRP] and interleukin-6 [IL-6]), and the intima-media thickness (IMT) in the common carotid arteries were measured at baseline. Cardiac function was assessed by color tissue Doppler echocardiography. After 36 months follow-up, the survival rate by Kaplan-Meier analysis was significantly different according to OPG levels (χ 2=14.33; P=0.002). Increased OPG levels were positively associated with IL-6 (r=0.38, P<0.001), FGF-23 (r=0.26, P<0.001) and hsCRP (r=0.0.24, P=0.003). In addition, OPG was positively associated with troponin I (r=0.54, P<0.001) and IMT (r=0.39, P<0.0001). Finally, in Cox analysis, only OPG (HR=1.07, 95%CI=1.02-1.13) and hsCRP (HR=1.02, 95%CI=1.01-1.04) were independently associated with increased risk of death. These results suggested that elevated levels of serum OPG might be associated with atherosclerosis and all-cause mortality in patients with chronic kidney disease.

Estudo anatômico de folha e caule de Pereskia aculeata Mill. (Cactaceae) / Anatomical study of the leaf and stem of Pereskia aculeata Mill. (Cactaceae)

Pereskia aculeata Mill. (Cactaceae) é uma trepadeira arbustiva conhecida comumente como ora-pro-nobis. Apresenta elevado teor de mucilagem e proteína, sendo empregada na indústria alimentícia e farmacêutica. Na medicina popular, é utilizada externamente como emoliente. Este trabalho teve por objetivo estudar a anatomia foliar e caulinar da planta, a fim de fornecer informações complementares à sua identificação e aplicáveis ao seu controle de qualidade. Folhas adultas e fragmentos de caules foram fixados, seccionados à mão livre e corados com azul de astra e fucsina básica ou com azul de toluidina. Testes histoquímicos e análise ultra-estrutural de superfície foram realizados. A folha é simples e elíptica. Possui epiderme uniestratificada, estômatos paracíticos em ambas as faces, mesofilo que tende a ser dorsiventral, contendo numerosas drusas de oxalato de cálcio e células isodiamétricas grandes com conteúdo mucilaginoso. A nervura central é percorrida por um feixe vascular colateral em arco aberto. O pecíolo tem secção plano-convexa e um feixe colateral em formato de arco fechado. O caule, em estrutura secundária incipiente, possui epiderme unisseriada, colênquima angular, parênquima cortical com muitos amiloplastos, calotas de fibras perivasculares e organização vascular colateral. No córtex e na medula, são observadas numerosas cavidades com conteúdo mucilaginoso e drusas de oxalato de cálcio, estas também presentes no floema.

Pereskia aculeata Mill. (Cactaceae) is a climbing shrub commonly known as Barbados gooseberry. It has high mucilage and protein content and it is employed in the food and pharmaceutical industry. In traditional medicine, P. aculeata is used externally as emollient. This work aimed to study the leaf and stem anatomy of this plant, in order to supply additional information for its identification and quality control. Mature leaves and stem fragments were fixed, freehand sectioned and stained either with astra blue and basic fuchsine or toluidine blue. Histochemical tests and ultrastructure analysis were carried out. The leaf is simple and elliptical, and has uniseriate epidermis, paracytic stomata on both surfaces, dorsiventral-like mesophyll, several druses of calcium oxalate and large isodiametric cells containing mucilage. In the midrib a collateral bundle in open arc is embedded. The petiole exhibits a plain-convex transection and a collateral bundle in closed arc shape. The stem, in incipient secondary growth, has uniseriate epidermis, angular collenchyma, cortical parenchyma with many amiloplasts, perivascular fibre caps and collateral vascular organization. In the cortex and pith, numerous cavities containing mucilage and druses of calcium oxalate are seen, the latter also in the phloem.

Effect of hepatitis C serology on C-reactive protein in a cohort of Brazilian hemodialysis patients

Hepatitis C (HCV) is not an uncommon feature in hemodialysis (HD) patients and may be a cause of systemic inflammation. Plasma cytokine interleukin-6 (IL-6) is mainly produced by circulating and peripheral cells and induces the hepatic synthesis of C-reactive protein (CRP), which is the main acute phase reactant. The aim of this study was to investigate the influence of HCV on two markers of systemic inflammation, serum CRP and IL-6, in HD patients. The study included 118 HD patients (47 percent males, age 47 ± 13 years, 9 percent diabetics) who had been treated by standard HD for at least 6 months. The patients were divided into two groups depending on the presence (HCV+) or absence (HCV-) of serum antibodies against HCV. Serum albumin (S-Alb), plasma high sensitivity CRP (hsCRP), IL-6, and alanine aminotransferase (ALT) were measured and the values were compared with those for 22 healthy controls. Median hsCRP and IL-6 values and hsCRP/IL-6 ratio were: 3.5 vs 2.1 mg/l, P < 0.05; 4.3 vs 0.9 pg/ml, P < 0.0001, and 0.8 vs 2.7, P < 0.0001, for patients and controls, respectively. Age, gender, S-Alb, IL-6 and hsCRP did not differ between the HCV+ and HCV- patients. However, HCV+ patients had higher ALT (29 ± 21 vs 21 ± 25 IU/l) and had been on HD for a longer time (6.1 ± 3.0 vs 4.0 ± 2.0 years, P < 0.0001). Moreover, HCV+ patients had a significantly lower median hsCRP/IL-6 ratio (0.7 vs 0.9, P < 0.05) compared to the HCV- group. The lower hsCRP/IL-6 ratio in HCV+ patients than in HCV- patients suggests that hsCRP may be a less useful marker of inflammation in HCV+ patients and that a different cut-off value for hsCRP for this population of patients on HD may be required to define inflammation.

Relacion madre-hijo en una población urbano marginal / Mother-child relationship in a slum area population

Se realizó un estudio observacional-descriptivo sobre la relación madre-hijo en el Distrito de Independencia de Lima, parcialmente calificable de urbano marginal. Se utilizaron el Cuestionario Madre-Hijo del Departamento para del Desarrollo de la Juventud del Japón y la Ficha Socio-económica del INSM. La mustra fueron 50 hijos y 50 hijas, con sus correspondientes 100 madres. Se analizan y discuten los resultados, algunos de los cuales identifican temas para futuras indagaciones: así, la menor identidad religiosa de los hijos varones; la existencia frecuenrte de manifestaciones sugestivas de un síndrome ansioso-depresivo inicial en los menores; las elevadas expectativas ocupacionales de las madres para con sus hijos varones; las discrepancias entre madres, hijos e hijas en cuanto a cionductas indeseables; la importancia del profesor y el desmedro del padre en la satisfación de ciertas necessidades filiales y, en fin, las importantes expectativas maternas de dependencia respecto a sus hijos en la vejez

Prevalencia de vida de trastornos mentales en Independencia (Lima-Perú) / Lifetime prevalence of mental disorders in Independencia, Peru

Se presenta la morbilidad psiquiátrica en el distrito de Independencia, localidad urbano-marginal de Lima, cuyas características se describen. En la primera fase del estudio la muestra fue de 808 adultos mayores de 18 años seleccionados probabilísticamente. Se utilizó el Diagnostic Interview Schedule (DIS), instrumento altamente estructurado, aplicable por no-psiquiatras, el cual con un programa de computación para diagnóstico automatizado proporciona diagnósticos específicos utilizando como referencia el DSM-III. La prevalencia de vida global de trastornos mentales fue de 41%, siendo las tasas más altas las de Abuso/dependencia del Alcohol, en hombres, seguida de fobia, predominante en mujeres. Los resultados considerados preliminares se presentan comparativamente con los hallados en 3 poblaciones norteamericanas (New Haven, Saint Louis y Baltimore), y se discuten las semejanzas y diferencias observadas