Sífilis maligna y erupción papular pruriginosa en un paciente VIH positivo / Malignant Syphilis and Pruritic Papular Eruption in an HIV-Positive Man

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El papel de la Fisioterapia en los trastornos de la conducta alimentaria, una revisión sistemática / The role of physiotherapy in eating disorders: A systematic review

Objetivo: El objetivo de este estudio es conocer el papel de la Fisioterapia y su efectividad en el tratamiento de pacientes con trastornos de la conducta alimentaria. Estrategia de búsqueda: Se llevó a cabo una búsqueda sistemática en febrero de 2016 en diferentes bases de datos utilizando los términos «Anorexia nervosa», «Exercise», «Eating disorders» y «Resistance training» y la palabra clave «Physiotherapy». Selección de estudios: Tras la aplicación de los criterios de inclusión y exclusión se obtuvieron 12 artículos que emplean diferentes métodos terapéuticos para abordar a estos pacientes. Síntesis de resultados: La mayoría de los estudios analizados muestran una baja calidad metodológica. Los autores utilizan gran variedad de escalas y cuestionarios como instrumentos de medida ya que, además de los aspectos propios de los trastornos alimentarios, también se valoran la calidad de vida, el ejercicio compulsivo y la imagen corporal entre otros. Las intervenciones llevadas a cabo son la terapia de conciencia corporal y el ejercicio terapéutico; la duración de estas intervenciones es variable, fluctuando desde 1 hasta 38 semanas. Se observan mejoras significativas en la mayoría de los estudios que analizan la psicopatología del trastorno de la conducta alimentaria, la imagen corporal, la variación de peso, la fuerza y la percepción sobre la calidad de vida. Conclusiones: La Fisioterapia parece desempeñar un importante papel en la recuperación de los pacientes con trastornos de la conducta alimentaria, por lo que se debería incluir la figura del fisioterapeuta como parte del equipo multidisciplinar en el tratamiento de los trastornos de la alimentación

Objective: The aim of this study is to determine the role of physiotherapy, as well as its effectiveness in the treatment of patients with eating disorders. Search strategy: A systematic search was conducted in February 2016 in different databases using the terms 'Anorexia Nervosa', 'Exercise', 'Eating Disorders' and 'Resistance Training' and the keyword 'Physiotherapy'. Selection of studies: Following the application of the inclusion and exclusion criteria, 12 articles were obtained that used different therapeutic methods to approach these patients. Synthesis of results: most of the studies showed a low methodological quality. The authors use a wide variety of scales and questionnaires as measurement tools. In addition to the specific aspects of eating disorders, quality of life, compulsive exercise, body image, and others are valued. The interventions carried out were body awareness therapy and therapeutic exercise, with the duration of these interventions ranging from 1 - 38 weeks. Significant improvements seen in the majority of studies that analysed the psychopathology of eating disorder, body image, weight variation, strength, and perception of quality of life. Conclusions: Physiotherapy plays an important role in the recovery of patients with eating disorders, and the figure of the physiotherapist should be included as part of the multidisciplinary team in the treatment of eating disorders

Persistent effects of pre-Columbian plant domestication on Amazonian forest composition.

The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.

[Social policy changes and the health of asylum seekers: 3 years after the introduction of the Asylum Law]. / Durcissement des lois sociales et santé des migrants forcés: trois ans après (a Loi sur l'asile (LAsi).

In the canton de Vaud, General Practioners (GPs) caring for asylum seekers under the "aide d'urgence" regime can ask for an adaptation of their housing conditions, by filling out a specific form and addressing it to the medical commission responsible for advising the EVAM (the housing institution for asylum seekers) on these issues. The forms addressed to the commission are indicative of a worrisome state of health in this population, especially for mental health. More than 70% report at least one psychiatric diagnosis. Most frequent are anxiety and depressive disorders, as well as many posttraumatic stress disorders, associated with traumatic events both in the country of origin and in Switzerland. Adapting the housing conditions, based on vulnerabilities that the GP has specifically documented, may contribute to improve the health of the most vulnerable asylum seekers.

Transcriptional activation of the human insulin receptor gene by 1,25-dihydroxyvitamin D(3).

Treatment with 10(-8) M 1,25-dihydroxyvitamin D(3) for 24 h causes transcriptional activation of the human insulin receptor gene in U-937 human promonocytic cells. The activation seems to potentiate the response to insulin in terms of glucose oxidation. Wortmannin, a phosphatidylinositol 3-kinase inhibitor, causes a greater inhibition of insulin-stimulated glucose oxidation in 1,25-dihydroxyvitamin D(3)-treated cells than in untreated cells. This suggests a stimulation of phosphatidylinositol 3-kinase activity by 1,25-dihydroxyvitamin D(3), which could mediate, at least in part, the potentiation of the insulin response.

Aldosterone impairs insulin responsiveness in U-937 human promonocytic cells via the downregulation of its own receptor.

In an earlier study, we have reported an inhibition of insulin receptor (IR) mRNA levels and insulin binding by aldosterone in U-937 human promonocytic cells. In the present extension of our studies, we demonstrate that this inhibition by aldosterone had no effects on basal glucose transport or on basal thymidine incorporation into DNA, while the cell responsiveness reflected by the maximal response to insulin was decreased by 23% for glucose transport and by 31% for DNA synthesis after the aldosterone treatment. We also prove that this inhibition of the insulin response by aldosterone is mediated by a downregulation of the levels of mineralocorticoid receptors (MRs) (50% decrease) and their mRNA (50% decrease). In addition, the mineralocorticoid antagonist spironolactone reversed the decrease in MR mRNA levels elicited by aldosterone, which suggests the involvement of this receptor in the process.

Gentamicin concentrations in urine, cortex and medulla in an acutely obstructed kidney animal model.

Gentamicin was administered intraperitoneally, three times in 12 h to Hartley type guinea-pigs which had undergone complete unilateral ureteral obstruction with normal contralateral ureteral function for either 24 hours, 7 days or 21 days. Two hours after the last drug dose urine samples were collected from urinary bladder and obstructed ureter. Healthy and obstructed kidneys were then surgically removed from all sacrificed animals. Gentamicin concentration in urine of healthy kidney was 112-266 microg/ml, and in obstructed kidney 18-53 microg/ml, with a tendency of linear decrease over a 3-week obstruction period. The gentamicin concentration in obstructed renal cortex never exceeded one-third of the gentamicin concentration in unobstructed renal cortex. The maximum gentamicin concentration in obstructed renal medulla was 75% of the gentamicin concentration in unobstructed renal medulla.

Stimulation by 1,25-dihydroxyvitamin D3 of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells.

In the present work, we demonstrate that treatment with 1,25-dihydroxyvitamin D3 for 24 hours increased in a dose-dependent manner the levels of the two major insulin receptor (IR) mRNAs (11 and 8.5 Kb) present in U-937 human promonocytic cells. These levels reached maximum values (1.8-fold 11 Kb; 1.4-fold 8.5 Kb) with the addition of 10(-8) M 1,25-dihydroxyvitamin D3. In these optimal conditions the stimulatory effect of 1,25-dihydroxyvitamin D3 was accompanied by increases in both IR capacity, and insulin responsiveness for glucose transport in these cells. Moreover, such increases appear to be mediated by an enhanced expression of the receptor for 1,25-dihydroxyvitamin D3, measured at the level of both RNA and protein. These results provide evidence of 1,25-dihydroxyvitamin D3 acting as genomic stimulator of the insulin response in the control of glucose transport.

Inhibition by aldosterone of insulin receptor mRNA levels and insulin binding in U-937 human promonocytic cells.

The effect of aldosterone on insulin receptor (IR) expression was investigated in U-937 human promonocytic cells. The putative involvement of the mineralocorticoid receptor (MR) was also analysed. Aldosterone binding assays indicated the presence of MRs with high affinity and limited capacity in these cells. RNA blot assays showed that aldosterone treatment decreased the levels of the two major IR mRNAs (11 and 8.5 kb) present in these cells in a dose- and time-dependent manner. The partial reversal of such a decrease by the mineralocorticoid antagonist spironolactone suggested that MR was involved in the process. Experiments with the RNA synthesis inhibitor actinomycin D indicated that the decrease in IR mRNA content in aldosterone-treated cells was not the result of transcript destabilisation. The inhibitory action of aldosterone was not prevented by the simultaneous presence of the protein synthesis inhibitor cycloheximide, suggesting that the reduction of IR gene expression occurs as a direct response to the action of aldosterone. Furthermore, insulin binding assays showed that aldosterone decreased IR capacity but did not alter receptor affinity. In addition, the IR turnover resulted unaltered. These results provide the first evidence for an in vitro modulation of human IR expression by aldosterone.

In vivo tissue specific modulation of rat insulin receptor gene expression in an experimental model of mineralocorticoid excess.

Insulin receptor (IR) gene expression at the mRNA level was investigated in hindlimb skeletal muscle, epididymal adipose tissue and in the liver of rats exposed to prolonged in vivo administration of deoxycorticosterone acetate (DOCA). Following treatment, plasma insulin levels were reduced while glucose levels increased compared to values in control rats. DOCA-treated animals showed an increase in blood pressure and a reduction in body weight. This treatment also induced hypokalemia and decreased plasma protein levels. Sodium levels were unaffected. Moreover, no differences in DNA and protein content or in the indicator of cell size (protein/DNA) were observed in the skeletal muscle or adipose tissue of animals. In contrast, there was a clear increase in the protein and DNA contents of the liver with no change in the indicator of cell size. Northern blot assays revealed 2 major IR mRNA species of approximately 9.5 and 7.5 Kb in the 3 tissues from control animals. DOCA treatment induced no change in the levels of either RNA species in skeletal muscle. However, a decrease of approximately 22% was detected in the levels of both species in adipose tissue whereas the liver showed an increase of 64%. These results provide the first evidence for an in vivo tissue-specific modulation of IR mRNA levels under experimental conditions of mineralocorticoid excess.

Tissue-specific modulation of insulin receptor mRNA levels in adrenaline-treated rats.

Insulin receptor (IR) gene expression at the mRNA level was investigated in liver, hindlimb skeletal muscle, and epididymal adipose tissue of rats exposed to prolonged in vivo administration of adrenaline in relation to control rats. In the liver of adrenaline-treated rats, there were no differences in relation to controls when DNA and protein content were measured. In skeletal muscle, only a slight decrease in protein concentration was detected. By contrast, a clear increase in both protein and DNA content was observed in the adipose tissue of treated animals. Northern blot assays revealed two IR mRNA species of approximately 9.5 and 7.5 Kb in the three tissues from controls. Adrenaline treatment induced an increase of approximately 60% in the levels of both RNAs in adipose tissue but not in liver or skeletal muscle. These results provide evidence for an in vivo tissue-specific regulation of IR gene expression at the mRNA level in rats under an experimental condition of excess of catecholamines.

Serum growth hormone-binding protein is decreased in prepubertal children with idiopathic short stature.

The causes for growth failure in children with idiopathic short stature (ISS) are not definitely established. Peripheral GH resistance due to changes at the level of the GH receptor has been suggested as one of the most probable explanation. In this study, we have selected a group of prepubertal children with ISS to evaluate the GHBP/receptor status by measuring the GH binding protein (GHBP) activity in plasma. Thirty prepubertal children with ISS (18 boys and 12 girls; age range: 4.79 to 11.33 yr) and twenty age-matched children with normal growth (11 boys and 9 girls) were studied. The ISS group presented growth retardation of -2.3 +/- 0.43 SD score (mean +/- SD) and normal GH secretion. Plasma IGF-I levels were below or in the low normal range (mean +/- SD: 136.3 +/- 62.3 micrograms/l, a concentration that was significantly different from IGF-I levels in the normal group (mean +/- SD: 187 +/- 57.5 micrograms/l p < 0.005). Plasma GHBP activity using a GH-binding/gel chromatography assay showed significantly lower values in ISS group (mean +/- SD: 7.17 +/- 1.5%) as compared with those of the control group (mean +/- SD: 12.02 +/- 2.04%; p < 0.001). There were no significant age- or sex-related differences in GHBP values in either group. The decreased GHBP levels observed in this group of children with ISS suggest that they may present a certain degree of GH insensitivity, probably due to a defect at the GH-receptor level.

Serum growth hormone-binding protein is unchanged in adult panhypopituitarism.

The role of GH in regulating GH-binding protein (GHBP) and GH receptor concentrations in humans is not clear. Studies performed mostly in children and on a minor scale in adults are somewhat controversial. The key question as to whether GHBP levels are altered in hypopituitarism before GH treatment is instituted remains unanswered. In this study, we have selected a severely GH-deficient group of adult patients with panhypopituitarism, acquired as a result of surgery and irradiation of hypothalamic-pituitary tumors, to evaluate the GHBP/receptor status by measuring GHBP activity in plasma. Twenty panhypopituitary patients (8 males and 12 females; age range, 20-74 yr) and 20 age (22-68 yr)- and sex-matched normal subjects were studied. GH deficiency was confirmed by insulin-induced hypoglycemia and arginine infusion tests; the peak GH response was less than 2 micrograms/L. Plasma insulin-like growth factor-I levels were below or in the low normal range (mean +/- SD, 88.3 +/- 53.6 micrograms/L) and were significantly different from insulin-like growth factor-I (IGF-I) levels in the normal group (mean +/- SD, 189 +/- 49.8 micrograms/L; P < 0.01). Plasma GHBP activity, measured using a GH-binding/gel chromatography assay, showed similar values in the GH-deficient group (mean +/- SD, 14.1 +/- 3.83%) and the control group (mean +/- SD, 13.7 +/- 3.79%), with no statistically significant difference. Neither the intra- nor intergroup comparison of GHBP levels according to age and sex showed statistically significant differences or age trends. In the light of these data and considering that GHBP activity in plasma probably reflects the GH receptor status in tissues, we may assume that the GH receptor was unaffected by chronic GH deficiency. These findings also support the previously reported concept that the GHBP/receptor level is a relatively fixed determinant of growth, established individually and independently of GH secretory status in early life, perhaps on a genetic basis.

Body changes in adolescent patients with growth hormone receptor deficiency receiving recombinant human insulin-like growth factor I and luteinizing hormone-releasing hormone analogue: preliminary results.

Auxological and body composition changes were studied in three adolescent patients (2 female, 1 male) with growth hormone receptor deficiency (GHRD) given insulin-like growth factor I (IGF-I), 120 micrograms/kg s.c. twice daily, plus a monthly intramuscular injection of 7.5 mg of a luteinizing hormone-releasing hormone (LHRH) analogue. Preliminary results from the first 12 months of the study show that height velocity was increased compared with the pretreatment values. This increase was probably due to the IGF-I therapy, as the LHRH analogue would have suppressed gonadotrophins and gonadal steroid production. There was a reduction in percentage body fat, and increases in lean mass and the lean:fat ratio, whole body mineral content and body calcium content, even when expressed per kg body weight. There was also a trend towards increased bone mineral density of the whole skeleton, lumbar spine and femoral structures, as well as a maturation of facial features. These preliminary results indicate that concomitant therapy with IGF-I and an LHRH analogue is safe and efficacious in inducing growth without advancing bone age in patients with GHRD.

Heterogeneity of circulating growth hormone.

Human growth hormone (GH) represents a family of related proteins arising from two genes, alternative mRNA splicing, and several post-translational modifications. In addition, post-secretory events occur when GH enters the circulation. The full scale of GH heterogeneity is only beginning to be appreciated, and new GH forms or related proteins may be discovered in the future. GH measurements are affected by GH heterogeneity. Immunoassays are influenced by the mixture of GH variants, but are not sensitive to GH binding proteins (GHBPs). In contrast, radioreceptor assays are sensitive to both GH variant mixtures and to the high affinity GHBP. It is hoped that in the future, these problems can be minimized by rigorous characterization of existing antibodies with respect to epitope recognition on various GH forms, and ultimately, by production of GH variant-specific antibodies that permit direct and individual assessment of the circulating members of the GH family.

Distribution of growth hormone receptor messenger ribonucleic acid containing and lacking exon 3 in human tissues.

The extent of expression of the GH receptor (GHR) in human tissues is largely unknown. In some cell lines and placenta, the GHR gene generates two different mRNAs by alternative splicing of exon 3, one coding for a full-length receptor (GHR + 3) and the other for a receptor isoform that lacks exon 3 (GHR-3), with deletion of amino acid residues 7-28. To determine the distribution of the GHR and the relative abundance of its two isoforms in man, we studied a variety of tissues obtained at autopsy by reverse transcription and polymerase chain reaction (PCR) amplification, using isoform-specific primers. The nature of the PCR products was verified by restriction analysis and DNA sequencing. The relative proportions of the two GHR isoforms were determined by competitive PCR using a 32P-labeled anti-sense primer and a mixture of both isoform-specific sense primers in equimolar amounts. Electrophoretic bands corresponding to the amplification products were excised and counted, or quantitated by laser densitometry. Restriction analysis and sequencing of the amplified products were consistent with their predicted sequence. Both GHR transcripts were found in all 19 tissues tested, but their relative proportions varied depending on the tissue and, to a lesser extent, between subjects. They ranged from a preponderance of GHR-3 (kidney, bladder, adrenal, and brain stem) to a predominance of GHR + 3 (skeletal muscle and liver). We conclude that the GHR gene is widely expressed in human tissues. Both GHR + 3 and GHR-3 transcripts are present, but their relative proportions depend on the tissue and, possibly, the metabolic status. The physiological significance of the existence of two human GHR forms remains to be elucidated.

Usefulness of thyrotropin-releasing hormone test, SMS 201-995, and bromocriptine in the diagnosis and treatment of gonadotropin-secreting pituitary adenomas.

Five patients with gonadotropin-secreting pituitary adenomas were studied. The utility of gonadotropin response to TRH stimulation in the diagnosis and follow-up of these tumors was evaluated, as well as the effects of somatostatin analogue SMS 201-995 and bromocriptine on gonadotropin release. Three patients had FSH and LH secreting adenomas while the other two tumors secreted FSH and alpha-subunit. Transsphenoidal resection of the pituitary adenomas were performed in all patients. Following preoperative TRH administration (400 micrograms i.v.), marked increases were observed in FSH levels in two cases, in LH levels in three and in alpha-subunit in one. The FSH and LH responses to t.his stimulus persisted in the same patients after surgery. Following acute bromocriptine administration (5 mg orally), FSH was reduced in all cases by 19% to 46%, LH in three cases by 50-67% and alpha-subunit in one by 33%. In patient no. 5, with persistent high FSH levels in the immediate postoperative period, long-term bromocriptine treatment was administered (15 mg/d orally), resulting in normalization of FSH levels 6 months later, although the size of the tumor was not reduced. After acute SMS 201-995 administration (100 micrograms sc) FSH decreased in two cases by 38% and 76%, LH in three by 30-56% and alpha-subunit in one by 20%. We conclude that gonadotropin response to TRH stimulation is useful in the diagnosis and follow-up of patients with gonadotroph adenoma. Bromocriptine and SMS 201-995 may be effective as coadjuvant treatment following surgery and radiotherapy in these patients, although long-term studies will be necessary to confirm these proposals.