ABSTRACT
OBJECTIVE:: In liver diseases, hyperferritinemia (HYF) is related to injured cells in acquired and genetic conditions with or without iron overload. It is frequent in patients with nonalcoholic fatty liver disease (NAFLD), in which it is necessary to define the mean of HYF to establish the better approach for them. The present study evaluated the significance of elevated ferritin in patients with NAFLD and steatohepatitis (NASH). METHOD:: The review was performed using search instruments of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS and LILACS, to identify articles published in Portuguese, English and Spanish, from 2005 to May, 2016. Studies eligible included place and year of publication, diagnose criteria to NAFLD, specifications of serum ferritin measurements and/or liver histopathologic study. Exclusion criteria included studies with patients with alcohol consumption ≥ 20 g/day and other liver diseases. RESULTS:: A total of 11 from 30 articles were selected. It included 3,564 patients and they were cross-sectional, retrospective, case series and case-control. The result's analyses showed in 10 of these studies a relationship between ferritin elevated serum levels and NAFLD/NASH with and without fibrosis and insulin resistance. CONCLUSION:: Hyperferritinemia in patients with NAFLD/NASH is associated more frequently with hepatocellular injury than hemochromatosis. These data suggest the relevance to evaluate carefully HYF in patients with NAFLD/NASH to establish appropriate clinical approach.
Subject(s)
Ferritins/blood , Iron Overload/blood , Iron Overload/etiology , Non-alcoholic Fatty Liver Disease/blood , Non-alcoholic Fatty Liver Disease/complications , Humans , Iron/blood , Iron Overload/pathology , Non-alcoholic Fatty Liver Disease/pathology , Risk FactorsABSTRACT
Summary Objective: In liver diseases, hyperferritinemia (HYF) is related to injured cells in acquired and genetic conditions with or without iron overload. It is frequent in patients with nonalcoholic fatty liver disease (NAFLD), in which it is necessary to define the mean of HYF to establish the better approach for them. The present study evaluated the significance of elevated ferritin in patients with NAFLD and steatohepatitis (NASH). Method: The review was performed using search instruments of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS and LILACS, to identify articles published in Portuguese, English and Spanish, from 2005 to May, 2016. Studies eligible included place and year of publication, diagnose criteria to NAFLD, specifications of serum ferritin measurements and/or liver histopathologic study. Exclusion criteria included studies with patients with alcohol consumption ≥ 20 g/day and other liver diseases. Results: A total of 11 from 30 articles were selected. It included 3,564 patients and they were cross-sectional, retrospective, case series and case-control. The result's analyses showed in 10 of these studies a relationship between ferritin elevated serum levels and NAFLD/NASH with and without fibrosis and insulin resistance. Conclusion: Hyperferritinemia in patients with NAFLD/NASH is associated more frequently with hepatocellular injury than hemochromatosis. These data suggest the relevance to evaluate carefully HYF in patients with NAFLD/NASH to establish appropriate clinical approach.
Resumo Objetivo: A hiperferritinemia (HPF) está associada à agressão hepatocelular nas doenças do fígado e à sobrecarga de ferro, em doenças genéticas e adquiridas. A HPF é frequente em pacientes com doença hepática gordurosa não alcoólica (DHGNA) e é necessário definir seu significado para estabelecer as melhores condutas para esses indivíduos. Esta revisão avaliou o significado da HPF em portadores de DHGNA e esteato-hepatite não alcoólica (EHNA). Método: A busca de artigos foi realizada através do PubMed (Medline), Web of Science e Lilacs, e foram selecionados aqueles publicados em português, inglês e espanhol de 2005 a maio de 2016. Os artigos foram elegíveis quando informavam data e local da publicação, critérios diagnósticos para DHGNA, especificações das dosagens de ferritina sérica e/ou estudo histopatológico. Foram excluídos os artigos cujos pacientes relataram ingestão alcoólica ≥ 20 g/dia ou eram portadores de outras doenças do fígado. Resultados: Foram selecionados 11 de 30 artigos, totalizando 3.564 pacientes. Os artigos eram de corte transversal, retrospectivos, série de casos e caso-controles. Em dez artigos, observou-se correlação entre alteração de ferritina e DHGNA/EHNA com e sem fibrose hepática e resistência à insulina. Conclusão: Hiperferritinemia em pacientes com DHGNA/EHNA se associa com maior frequência à agressão hepatocelular do que com sobrecarga de ferro hepático. Os resultados da revisão sugerem a necessidade de um maior cuidado na interpretação da elevação da ferritina sérica em pacientes com DHGNA/EHNA para o estabelecimento de condutas clínicas apropriadas.
Subject(s)
Humans , Iron Overload/etiology , Iron Overload/blood , Ferritins/blood , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/blood , Risk Factors , Iron Overload/pathology , Non-alcoholic Fatty Liver Disease/pathology , Iron/bloodABSTRACT
BACKGROUND: Previous studies have reported high rates of depression and anxiety in HTLV-1 infected individuals with the neurological disease and in the asymptomatic phase. No study has investigated the rates in individuals that already show bladder symptoms without severe neurological changes; that is, during the oligosymptomatic phase. The present study investigated patients in this intermediate form on the spectrum of the infection. METHODOLOGY/PRINCIPAL FINDINGS: Participants answered a sociodemographic questionnaire, the Mini International Neuropsychiatric Interview Brazilian Version 5.0.0 (MINI PLUS) and the Hospital Anxiety and Depression Scale (HADS). Data analysis was performed in STATA statistical software (version 12.0). Depressive disorder was the most frequent comorbidity. Current depressive disorder was higher in the group of overactive bladder subjects (11.9%), and lifelong depression was more frequent in the HAM/TSP group (35%). The three groups had similar frequencies of anxiety disorders. Increased frequency and severity of anxiety and depression symptoms were observed in the overactive bladder group. CONCLUSION/SIGNIFICANCE: The results suggest that individuals with overactive bladders need a more thorough assessment from the mental health perspective. These patients remain an understudied group regarding psychiatric comorbidities.
Subject(s)
Anxiety Disorders/etiology , Depressive Disorder/etiology , HTLV-I Infections/complications , HTLV-I Infections/psychology , Urinary Bladder, Overactive/complications , Urinary Bladder, Overactive/psychology , Anxiety Disorders/psychology , Anxiety Disorders/virology , Brazil , Cohort Studies , Cross-Sectional Studies , Depressive Disorder/psychology , Depressive Disorder/virology , Female , Human T-lymphotropic virus 1 , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Urinary Bladder/pathology , Urinary Bladder/virology , Urinary Bladder, Overactive/virologyABSTRACT
Data on the prevalence of pneumococcal nasopharyngeal carriage and its risk factors among adolescents are scarce. The aim of this study was to provide such information. A cross-sectional, population-based prospective study was conducted. Participants were 1013 adolescents (age range 10-19 years) randomly recruited in 22 public schools. Those schools were randomly chosen among 307 public schools from 11 Sanitary Districts of Salvador, Brazil. Nasopharyngeal samples were assessed by standard procedures to recover and identify Streptococcus pneumoniae. Data on potential risk factors were gathered by confidential interview based on a standardized questionnaire. Pneumococci were recovered from 8.2 % [83/1013, 95 % confidence interval (CI) 6.6-10.0]. By stepwise logistic regression, pneumococcal colonization was independently associated with younger age [odds ratio (OR) 0.85, 95 % CI 0.77-0.94, P=0.001], being male (OR 1.78, 95 % CI 1.11-2.85, P=0.02), exposure to passive smoke in the household (OR 1.76, 95 % CI 1.10-2.79, P=0.02), having an upper respiratory infection during recruitment (OR 2.67, 95 % CI 1.67-4.28, P<0.001) and having a history involving an episode of acute asthma during the last year (OR 2.89, 95 % CI 1.18-7.08, P=0.03). The estimated probability of pneumococcal colonization decreased with age (chi(2) for trend=8.52, P=0.003). These findings provide tools for increasing the use of prevention strategies for pneumococcal diseases, such as pneumococcal vaccination among asthmatic patients and public health measures to stop smoking.
Subject(s)
Carrier State/epidemiology , Pneumococcal Infections/epidemiology , Respiratory Tract Infections/epidemiology , Streptococcus pneumoniae/isolation & purification , Adolescent , Age Factors , Brazil/epidemiology , Carrier State/microbiology , Child , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Pharynx/microbiology , Pneumococcal Infections/microbiology , Prevalence , Prospective Studies , Respiratory Tract Infections/microbiology , Risk Factors , Sex Factors , Surveys and Questionnaires , Tobacco Smoke PollutionABSTRACT
UNLABELLED: This cross-sectional study analyzed bone mineral density (BMD) in children and adolescents with type 1 diabetes mellitus (DM1) and its relationship with metabolic control, duration of disease and bone markers. METHODS: Forty-four children and adolescents with DM1 (age 8.8+/-4.4 years, disease duration 6.6+/-3.9 years) and 22 healthy children were assessed for BMD of the lumbar spine (L1-L4) by dual energy X-ray absorptiometry; osteocalcin (OC) and carboxy-terminal telopeptide (CTX) were measured in the study group. RESULTS: The BMD was similar in subjects with (-1.15+/-1.2 S.D.) and without DM1 (-0.85+/-0.88 S.D., p=0.25). After adjustment for weight, height and pubertal development, the BMD was <-2.0 S.D. in only two diabetic patients (4.5%). Bone area (BA) was inversely correlated with the duration of diabetes (p=0.03) and HbA1c (p=0.02). In girls, who presented a worse HbA1c than boys (p<0.01), BMD was inversely correlated with HbA1c (p=0.05). OC and CTX levels were higher in boys (p<0.01) and both inversely correlated with pubertal development (p=0.01), but not with BMD. CONCLUSIONS: Children and adolescents with DM1 have normal bone mass in the lumbar spine. However, longer diabetes duration and poor metabolic control may have a negative impact on bone mass, requiring further investigation through longitudinal studies.
Subject(s)
Bone and Bones/physiopathology , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/physiopathology , Absorptiometry, Photon , Adolescent , Age of Onset , Bone Density , Child , Child, Preschool , Cross-Sectional Studies , Female , Glycated Hemoglobin/analysis , Humans , Male , Puberty , Reference Values , Time FactorsABSTRACT
Obstructive sleep apnea and hypopnea syndrome (OSAHS) has been the focus of extensive research because of its association with neurocognitive and cardiovascular complications. The aim of this study was to evaluate the frequency and association between OSAHS and the class of obesity, gender and age in outpatients referred to a sleep laboratory. We selected 1,595 patients, 71.7% male. Mean +/- SD age was 46.7 +/- 11.7 years, BMI was 28.1 +/- 5.1 kg/m2 and AIH was 13.9 +/- 15.5 events/ hour of sleep. The patients were considered apneic when the apnea-hypopnea index (AHI) was > 5 events/hour of sleep; OSAHS was present in: (1) 71.1% of men and 50.3% of women (p < 0.001); (2) in 45.3% of patients with normal BMI, in 64.3% of those overweighed and in 80% of obese (p < 0.001). According to age, 61.2% with age < 55 were apneic, as well as 78% of those with age > 55 years old (p < 0.001). We concluded that OSAHS was directly and strongly associated to the male gender, obesity class and to aging.
Subject(s)
Obesity/complications , Sleep Apnea Syndromes/etiology , Adult , Age Factors , Aged , Body Mass Index , Female , Humans , Male , Middle Aged , Polysomnography , Retrospective Studies , Risk Factors , Severity of Illness Index , Sex Factors , Sleep Apnea Syndromes/diagnosisABSTRACT
A síndrome da apnéia e hipopnéia obstrutiva do sono (SAHOS) tem grande importância devido às conseqüências neurocognitivas e cardiovasculares. O objetivo deste estudo foi avaliar a freqüência e associação da SAHOS com a classe de obesidade, gênero e idade, em pacientes ambulatoriais referidos a um laboratório de sono. Foram selecionados 1.595 pacientes (71,7 por cento masculinos) com idade média ± DP de 46,7 ± 11,7 anos e IMC de 28,1 ± 5,1 kg/m². Foi considerado ter apnéia quando o índice de apnéia e hipopnéia (IAH) foi > 5 eventos/hora de sono. A freqüência de SAHOS foi de 71,1 por cento nos homens e de 50,3 por cento nas mulheres (p< 0,001); SAHOS esteve presente em 45,3 por cento dos indivíduos com IMC normal, 64,3 por cento daqueles com sobrepeso, e 80 por cento dos obesos (p< 0,001). Quanto à idade, 61,2 por cento dos pacientes com idade < 55 anos e 78 por cento daqueles com idade > 55 anos tinham SAHOS (p< 0,001). Concluímos que a SAHOS esteve direta e fortemente associada ao gênero masculino, à classe de obesidade e ao envelhecimento.
