Inflammatory cytokines are associated to lower glomerular filtration rate in patients with hypertensive crisis.

Introduction: Hypertension and kidney function are closely related. However, there are few studies on renal function during acute elevation of blood pressure (BP), denominated hypertensive crisis (HC). Objectives: To evaluate the relationship between renal function and inflammatory cytokines in HC, subdivided into hypertensive urgency (HUrg) and emergency (HEmerg). Materials and methods: This cross-sectional study was carried out in 74 normotensive (NT) and 74 controlled hypertensive individuals (ContrHT) followed up in outpatient care. Additionally, 78 subjects with hypertensive emergency (HEmerg) and 50 in hypertensive urgency (HUrg), attended in emergency room, were also evaluated. Hypertensive crisis was classified into HEmerg, defined by systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg in presence of target-organ damage (TOD), and HypUrg, clinical situation with BP elevation without TOD. The glomerular filtration rate (eGFR) was estimated, and cytokine levels were measured. Statistical analysis was performed using the Kruskal-Wallis or Mann-Whitney test and Spearman's correlation, with significant differences p-value < 0.05. Results: The median age was 53.5 years in the NT group (52 female), 61 years in the ContrHT group (52 female), and 62.5 years in the HC group (63 female) (p-value < 0.0001). The median BP was 118.5/75 mmHg for NT, 113.5/71 for ContrHT, and 198.5/120 mmHg for HC, respectively (p-value < 0.0001 among groups). BP and heart rate levels were significantly higher in the HC group compared to the NT and ContrHT groups (P < 0.001 for all). The eGFR was significantly lower in HC group compared to the NT and ContrHT groups. The cytokine levels were higher in the HEmerg and HUrg groups compared to ContrHT group (P < 0.0001, except for IL-1ß in HUrg vs. ContrHT), without difference between the acute elevation of BP groups. Thus, all cytokines were significantly elevated in patients with HC compared to the control groups (NT and ContrHT). There was a negative correlation between eGFR and the cytokines (IL-1ß, IL-6, IL-8, IL-10, and TNF-α) in the HC group. Conclusion: Elevated inflammatory cytokines are associated with reduced eGFR in individuals with HC compared to control groups, suggesting that the inflammatory process participates in the pathogenesis of acute elevations of BP.

Genetic characterization of an X-STR decaplex system in the State of Mato Grosso, Brazil: distribution, forensic efficiency and population structure.

Studies with X-STR loci show population genetic substructure, which makes necessary the characterization of such markers in the different geographical and/or ethnic populations. Therefore, this study assessed the distribution and forensic efficiency of an X-STR decaplex system in the population of the State of Mato Grosso, as well as analysed the population structure of this State based on the aforementioned system. All X-STR markers were in Hardy-Weinberg equilibrium and linkage equilibrium, and the DXS6809 was the most informative marker. The power of discrimination value in females and males was 0.99999999995 and 0.9999994, respectively. Analysis of molecular variance indicated 1.10% (p < 0.00001) of heterogeneity among Europeans, Africans, Brazilians and other Latin Americans, and in relation to such groups, the population of the State of Mato Grosso showed lower genetic variation when compared with the Brazilian group (-0.10%, p = 0.67327). The genetic distance analysis showed lower values of F ST (0.0004 ≤ F ST ≤ 0.00331), with non-significant p value (p > 0.00024), between the populations of Mato Grosso and Mato Grosso do Sul, Paraná and the Southeast region of Brazil (except for one sample of Rio de Janeiro). F ST values with significant p values (p ≤ 0.00024) were obtained between the population of Mato Grosso and Iberian, African and some Latin American populations. The X-STR decaplex system proved to be extremely useful in the population of the State of Mato Grosso, and the data obtained does not show the need for a specific forensic database for this State in relation to the Brazilian populations compared in this study, except for population of Rio de Janeiro.

WEIGHT LOSS AND METABOLIC OUTCOMES 12 MONTHS AFTER ROUX-EN-Y GASTRIC BYPASS IN A POPULATION OF SOUTHEASTERN BRAZIL.

UNLABELLED: BACKGROUNGD: previous outcome research in bariatric surgery has to document positive changes in co-morbidities associated with obesity. OBJECTIVE: the study aimed report a description of the impact of bariatric surgery on weight loss and on the resolution of diseases associated with obesity in patients followed up for 12 months in the public health service of São Paulo/Brazil. METHODS: the study was conducted on the data for 598 selected patients with grade III obesity subjected to Rouxen- Y gastric bypass evaluated postoperatively and 6 and 12 months after surgery. Anthropometric, demographic and biochemical data and personal history were determined at each time point. Serum glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were determined in the biochemical evaluation. Data were analyzed statistically by the Chi-square test, by ANOVA followed by the Bonferroni post-test and by the Student t-test for independent data, significance set at p < 0.05. RESULTS: weight loss of 45.5 ± 13.7kg (33.5%) was observed during the first year after surgery. Serum glucose, total cholesterol and LDL cholesterol were reduced during the first six months after surgery and the values were maintained up to 12 months, whereas weight and triglycerides were reduced throughout the study period. A reduced prevalence of diabetes mellitus and dyslipidemia was observed after surgery (p < 0.001). CONCLUSIONS: Roux-en-Y gastric bypass is an important procedure for weight loss and control of comorbidities such as diabetes and dyslipidemia at least during the first postoperative year.

Introducción: la investigación de los resultados previa en cirugía bariátrica tiene que documentar los cambios positivos en las comorbilidades asociadas a la obesidad. Objetivo: el objetivo del estudio fue informar de una descripción de los efectos de la cirugía bariátrica sobre la pérdida de peso y en la resolución de enfermedades asociadas con la obesidad en pacientes seguidos durante 12 meses en el servicio de salud pública de São Paulo/Brasil. Métodos: el estudio se realizó con los datos de 598 pacientes seleccionados con obesidad grado III sometidos a bypass gástrico en Y de Roux evaluados antes y 6 y 12 meses después de la cirugía. En cada momento se determinaron la antropometría, los datos demográficos y bioquímicos y la historia personal. La glucosa sérica, el colesterol total, el colesterol LDL, el colesterol HDL y los triglicéridos fueron determinados en la evaluación bioquímica. Los datos fueron analizados estadísticamente por el test de Chi-cuadrado, por ANOVA seguido por el post-test de Bonferroni y por la prueba t de Student para datos independientes; significación fijada en p < 0,05. Resultados: se observó pérdida de peso de 45,5 ± 13,7 kg (33,5%) durante el primer año después de la cirugía. Glucosa sérica, colesterol total y colesterol LDL se redujeron durante los primeros seis meses después de la cirugía y los valores se mantuvieron hasta los 12 meses, mientras que el peso y los triglicéridos se redujeron en todo el período de estudio. Se observó una prevalencia reducida de diabetes mellitus y dislipidemia después de la cirugía (p < 0,001). Conclusiones: el bypass gástrico en Y de Roux es un procedimiento importante para la pérdida de peso y el control de las comorbilidades como la diabetes y la dislipidemia, al menos durante el primer año postoperatorio.

Alpha-synuclein A53T mutation is not frequent on a sample of Brazilian Parkinson's disease patients.

INTRODUCTION: The pathogenesis of Parkinson's disease (PD) involves both genetic susceptibility and environmental factors, with focus on the mutation in the alpha-synuclein gene (SNCA).Objective To analyse the polymorphism SNCA-A53T in patients with familial PD (FPD) and sporadic PD (SPD). METHOD: A total of 294 individuals were studied, regardless of sex and with mixed ethnicity. The study group with 154 patients with PD, and the control group included 140 individuals without PD. The genotyping of SNCA-A53T was performed by PCR/RFLP. Significance level was p < 0.05. RESULTS: Among all patients, 37 (24%) had FPD and 117 (75.9%) had SPD. The absence of SNCA-A53T mutation was observed in all individuals. CONCLUSION: SPD is notably observed in patients. However, the SNCA-A53T mutation was absent in all individuals, which does not differ controls from patients. This fact should be confirmed in a Brazilian study case with a more numerous and older population.

Alpha-synuclein A53T mutation is not frequent on a sample of Brazilian Parkinson’s disease patients / Mutação A53T da alfa-sinucleína não é frequente em amostra de população brasileira com doença de Parkinson

Introduction The pathogenesis of Parkinson’s disease (PD) involves both genetic susceptibility and environmental factors, with focus on the mutation in the alpha-synuclein gene (SNCA).Objective To analyse the polymorphism SNCA-A53T in patients with familial PD (FPD) and sporadic PD (SPD).Method A total of 294 individuals were studied, regardless of sex and with mixed ethnicity. The study group with 154 patients with PD, and the control group included 140 individuals without PD. The genotyping of SNCA-A53T was performed by PCR/RFLP. Significance level was p < 0.05.Results Among all patients, 37 (24%) had FPD and 117 (75.9%) had SPD. The absence of SNCA-A53T mutation was observed in all individuals.Conclusion SPD is notably observed in patients. However, the SNCA-A53T mutation was absent in all individuals, which does not differ controls from patients. This fact should be confirmed in a Brazilian study case with a more numerous and older population.

Introdução A patogênese da doença de Parkinson (DP) envolve fatores ambientais e suscetibilidade genética, destacando-se a mutação de alfa-sinucleína (SNCA.)Objetivos Analisar a variante genética SNCA-A53T em pacientes com DP familiar (DPF) e DP esporádica (DPE).Método Foram estudados 294 indivíduos, independente de sexo, com etnia miscigenada, sendo 154 com DP e 140 sem a doença (grupo controle). A genotipagem de SNCA-A53T foi realizada por PCR/RFLP. Nível de significância para p < 0,05.Resultados Entre os pacientes, 37(24%) tinham DPF e 117 (75,9%) DPE. A ausência da mutação SNCA-A53T em todos os indivíduos.Conclusão DPE é destacada entre os pacientes, no entanto a mutação SNCA-A53T ausente em todos os indivíduos, não diferenciando os grupo controle e pacientes, o que deve ser confirmado em população brasileira, considerando uma ampla casuística, além da ancestralidade.

Impact of genetic variants of apolipoprotein E on lipid profile in patients with Parkinson's disease.

The pathogenesis of Parkinson's disease (PD) seems to involve genetic susceptibility to neurodegeneration. APOE gene has been considered a risk factor for PD. This study aimed to evaluate the association of APOE polymorphism with PD and its influence on lipid profile. We studied 232 PD patients (PD) and 169 individuals without the disease. The studied polymorphism was analyzed by PCR/RFLP. The Fisher's exact test, chi-square, ANOVA, and t-test (P < 0.05) were applied. The APOE3/3 genotype was prevalent in PD patients and Controls (P = 0.713) followed by APOE3/4 (P = 0.772). Both groups showed recommended values for lipid profile, with increase in the values of total cholesterol and LDLc, as well as decreased values of triglycerides in PD patients compared with Controls (P < 0.05 for all of them). Increased levels of HDLc, in PD patients, were associated with the APOE3/3 versus APOE-/4 genotypes (P = 0.012). The APOE polymorphism does not distinguish PD patients from Controls, as opposed to the lipid profile alone or in association with APOE. Furthermore, a relationship between increase of HDLc levels and APOE3 in homozygous was found in PD patients only.

Exposure to pesticides and heterozygote genotype of GSTP1-Alw26I are associated to Parkinson's disease.

OBJECTIVE: This study aimed to analyze the frequency of GSTP1-Alw26I polymorphism and to estimate its association with toxic substances in Parkinson's disease (PD). METHODS: A study group with 154 patients - subdivided into familial and sporadic PD groups - and 158 elderly individuals without the disease (control group) were evaluated. GSTP1-Alw26I polymorphism was analyzed by polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP). RESULTS: Patients were significantly more exposed to pesticides compared with the control group (p=0.0004), and the heterozygote genotype associated to exposure to pesticides also prevailed in patients (p=0.0001). Wild homozygote genotype was related to tobacco use (p=0.043) and alcoholism (p=0.033) in familial PD patients. CONCLUSION: Exposure to pesticides is associated to PD, whose effect can be enhanced when combined with the heterozygote genotype of GSTP1-Alw26I. Also, large genetic and environmental studies considering tobacco use, alcoholism, GSTP1 and PD are necessary to confirm our findings.

Renin angiotensin system blockage associates with insertion/deletion polymorphism of angiotensin-converting enzyme in patients with hypertensive emergency.

Hypertensive crisis (HC) stands out as a form of acute elevation of blood pressure (BP). It can manifest itself as hypertensive emergency (HE) or hypertensive urgency (HU), which is usually accompanied with levels of diastolic BP ≥120 mmHg. Angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism may influence manifestations of HC. Thus, this study evaluated the influence of ACE I/D polymorphism in individuals with HC. A total of 187 patients admitted with HC (HU [n=69] and HE [n=118]) and 75 normotensive individuals were included in the study. Peripheral blood was drawn for a biochemical and genetic analysis of the ACE I/D polymorphism by Polymerase Chain Reaction. HC group showed higher systolic BP, body mass index (BMI), glycemia, creatinine, and lower high-density lipoprotein (HDL) cholesterol compared with normotensive individuals. The use of renin-angiotensin system (RAS) blockers was more frequent in the HU group than in the HE group (p=0.020). The II genotype was more predominant in normotensive and HU individuals than among HE individuals (18.7%, 11.6%, and 2.5%, respectively; p=0.004). Higher BMI and glycemia were associated with HC in the logistic regression model. ACE II genotype (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.51) and HDL cholesterol were protective for the development of HE. ACE II genotype was present in the HU group, compared with the HE group (OR 0.18; 95% CI 0.04-0.88). This study shows an association between the low prevalence of ACE I/D polymorphism II genotype and a greater occurrence of HE in Brazilian individuals. The lower blockage of RAS, which was detected in the HE group, may interact with the low frequency of II genotype, conferring an increased risk for HE.

Exposure to pesticides and heterozygote genotype of GSTP1-Alw26I are associated to Parkinson's disease / Exposição a pesticidas e genótipo heterozigoto de GSTP1-Alw26I associam-se à doença de Parkinson

Objective This study aimed to analyze the frequency of GSTP1-Alw26I polymorphism and to estimate its association with toxic substances in Parkinson's disease (PD). Methods A study group with 154 patients - subdivided into familial and sporadic PD groups - and 158 elderly individuals without the disease (control group) were evaluated. GSTP1-Alw26I polymorphism was analyzed by polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP). Results Patients were significantly more exposed to pesticides compared with the control group (p=0.0004), and the heterozygote genotype associated to exposure to pesticides also prevailed in patients (p=0.0001). Wild homozygote genotype was related to tobacco use (p=0.043) and alcoholism (p=0.033) in familial PD patients. Conclusion Exposure to pesticides is associated to PD, whose effect can be enhanced when combined with the heterozygote genotype of GSTP1-Alw26I. Also, large genetic and environmental studies considering tobacco use, alcoholism, GSTP1 and PD are necessary to confirm our findings. .

Objetivo Analisar a frequência do polimorfismo GSTP1-Alw26I, assim como estimar sua associação com substâncias tóxicas na doença de Parkinson (DP). Métodos A casuística avaliada foi composta por um grupo de estudo, com 154 pacientes, subdivididos em DP familial e esporádica, e outro com 158 idosos sem a doença (grupo controle). O polimorfismo GSTP1-Alw26I foi analisado por reação em cadeia da polimerase/polimorfismo de comprimento do fragmento de restrição (PCR/RFLP). Resultados Os pacientes foram significativamente mais expostos a pesticidas, comparados com o grupo controle (p=0,0004), e o genótipo heterozigoto associado a exposição a pesticidas também prevaleceu nos pacientes (p=0,0001). O genótipo homozigoto selvagem apresentou relação com tabagismo (p=0,043) e etilismo (p=0,033) em pacientes com DP familial. Desse modo, a exposição a pesticidas está associada à DP, cujo efeito pode ser potencializado quando combinado ao genótipo heterozigoto de GSTP1-Alw26I. Estudos genético-ambientais envolvendo tabagismo, etilismo, GSTP1 e DP devem ser realizados em casuísticas numerosas, confirmando essa associação. .

Effect of genetic variants related to lipid metabolism as risk factors for cholelithiasis after bariatric surgery in Brazilian population.

BACKGROUND: The manifestation of cholelithiasis after bariatric surgery may depend on genetic factors related to lipid metabolism, including apolipoprotein E (APOE) and cholesteryl ester transfer protein (CETP) gene polymorphisms. METHODS: We investigated the association between APOE HhaI and CETP TaqIB polymorphisms [PCR-RFLP] and occurrence of cholelithiasis over up to 8 months of follow-up after gastroplasty to Roux-en-Y gastric bypass in 220 patients distributed in Group 1 (G1) 114 with cholelithiasis postoperatively and Group 2 (G2) 106 without cholelithiasis, including biochemical and anthropometric profiles analyses. RESULTS: In our series, the allelic and genotypic distributions of CETP TaqIB and APOE HhaI polymorphisms were similar in both groups (P > 0.05). The subgroup analysis evidenced that 54% of the patients from G1, APOE*4 allele carriers compared with APOE*3/3 carriers, presented altered low-density lipoprotein cholesterol (LDL cholesterol) serum levels (P = 0.022) before bariatric surgery. The B1 allele for CETP was associated to more quickly elevation of HDL cholesterol levels just in individuals without cholelitiasis (P < 0.0001). The multivariate logistic regression analysis demonstrates correlation between APOE*4 allele, higher total cholesterol (TC) serum levels and prediposition to cholelitiasis in preoperative period. However, the presence of postoperative cholelithiasis was not associated with altered lipid profile. CONCLUSIONS: The CETP TaqIB and APOE HhaI polymorphisms do not seem to have association with gallstones in the late postoperative bariatric surgery, considering that these genetic variants do not differ subgroups of patients who are eligible to routine prophylactic cholecystectomy, at least in Brazilian population.

Prevalência de síndrome metabólica em indivíduos com acompanhamento cardiológico / Prevalence of metabolic syndrome in individuals with cardiologic medical assistance

Introdução: A síndrome metabólica (SM) é associada com risco aumentado para eventos cardiovasculares. Esse estudo teve como objetivo avaliar a prevalência de SM em indivíduos brasileiros com acompanhamento cardiológico, considerando antecedentes pessoais e uso de medicamentos. Métodos: Foram estudados 163 adultos (85 pacientes e 78 controles). SM foi caracterizada de acordo com os critérios da International Diabetes Federation. Analisou-se história prévia de diabetes mellitus (DM), dislipidemia, doença arterial coronária (DAC), acidente vascular encefálico (AVE), tabagismo, etilismo, sedentarismo, além de medicamentos utilizados. Admitiu-se nível de significância P<0,05. Resultados: Maior frequência de SM (59%) e de pressão arterial elevada (71%) foi observada entre os pacientes se comparado aos controles (3% e 13%, respectivamente, P<0,0001 para ambos). No grupo dos pacientes detectou-se maior prevalência de níveis reduzidos de fração de colesterol de lipoproteína de alta densidade (HDLc: 41%) e de níveis aumentados de triglicérides (TG: 39%) quando comparados aos controles (17%, P=0,0010 e 19%, P=0,0095; respectivamente). A incidência de obesidade visceral foi semelhante em pacientes (77%) e controles (64%, P=0,0890). O uso contínuo de drogas anti-hipertensivas (67%), hipoglicemiantes (18%) e hipolipemiantes (42%) foi mais prevalente em pacientes comparado aos controles (P<0,0001). Uma maior proporção de pacientes com DM,DAC e dislipidemia foi observada (P<0,0010) e história pessoal de AVE foi detectada apenas nesses indivíduos(6%, P=0,0598). Entretanto, maior frequência de tabagismo (P=0,0015), alcoolismo (P=0,0070) e sedentarismo(P=0,0236) foi observada nos controles. Conclusão: Neste estudo SM, assim como particularmente pressão arterial elevada, nível baixo de HDLc e elevado de TG destacam-se em casuística brasileira com acompanhamento cardiológico, confirmando a necessidade de combate agressivo aos fatores de risco já consagrados...

Background: The metabolic syndrome (MS) is associated with an increased risk of major cardiovascular events. This study aimed to evaluate the prevalence of MS in Brazilian individuals with cardiologic medical assistance, considering their personal history and use of drugs. Methods: One hundred sixty-three adults (85patients and 78 controls) were studied. MS was characterized using International Diabetes Federation definitions. History of diabetes mellitus (DM), dyslipidemia, coronary artery disease (CAD), stroke, smoking,alcohol consumption, sedentary lifestyle, and habitual therapy were analyzed. Significance level was definedas P<0.05. Results: Higher frequency of MS (59%) and elevated blood pressure levels (71%) were observed among patients compared to controls (3% and 13%, respectively, P<0.0001 for both). In the group of patients were detected higher prevalence of reduced levels of high-density lipoprotein cholesterol fractions (HDLc)(41%) and increased levels of triglycerides (TG: 39%) when compared to controls (17%, P=0.0010 and 19%,P=0.0095; respectively). The incidence of visceral obesity was similar in patients (77%) and controls (64%,P=0.0890). The habitual therapy with anti-hypertensive (67%), anti-hyperglycemic (18%) and lipid-lowering drugs (42%) was more prevalent in patients when compared to controls (P<0.0001). A higher rate of DM,CAD and dyslipidemia was observed in patients (P<0.0010) and personal history of stroke was detected only among these individuals (6%, p=0.0598). However, higher frequencies of smoking (P=0.0015), alcohol consumption (P=0.0070), and sedentary life style (P=0.0236) was observed among controls. Conclusions: In this study MS, particularly high blood pressure, low HDLc and high TG levels stand out in Brazilian subjects with cardiologic medical assistance, supporting the importance in order to combat the classic clustering of cardiovascular disease risk factors. In addition, the expressive rate of visceral obesity...

Effects of APOE, APOB and LDLR variants on serum lipids and lack of association with xanthelasma in individuals from Southeastern Brazil.

Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95% = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95% = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95% = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68%) with elevated serum triglyceride levels, compared to patients (48%, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors.

Effects of APOE, APOB and LDLR variants on serum lipids and lack of association with xanthelasma in individuals from Southeastern Brazil

Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95 percent = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95 percent = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95 percent = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68 percent) with elevated serum triglyceride levels, compared to patients (48 percent, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors.

Influência do exercício físico no perfil lipídico e estresse oxidativo / Influence of the physical exercise on the lipid profile and oxidative stress

O perfil lipídico e a formação de radicais livres são influenciados por vários fatores tais como sedentarismo, obesidade, tabagismo, diabetes e características genéticas, entre outros. Este estudo teve como objetivo discutir aspectos sobre o possível efeito preventivo do exercício físico no perfil lipídico e no estresse oxidativo. Nas últimas três, décadas inúmeros estudos foram realizados relacionando níveis de lipoproteínas plasmáticas, estresse oxidativo e exercícios na prevenção de doenças como aterosclerose, sendo controversas as opiniões sobre o tipo e a intensidade da atividade física.

Lipid profile and free radicals formation are influenced by many factors such as sedentary, obesity, smoking, diabetes, and genetic characteristics, among others. This paper aimed to discuss the aspects about the potential preventive effect of physical exercise in lipid profile and oxidative stress. In the last three decades a number of papers have been written reporting plasmatic lipoprotein levels, oxidative stress, and exercises to prevent diseases such as atherosclerosis. The opinions related to the type and the intensity of the physical activity is controversial.

Quantificação do desperdício de medicamentos na prática clínica / Quantifying the drug waste in clinical practice

Objetivo: Analisar medicamentos, incluindo forma de apresentação e preço, visando adequar o produto comercializado à prática de prescrição médica e, conseqüentemente, reduzir gastos governamentais e pessoais.Métodos: Foi realizado um levantamento de drogas prescritas clinicamente incluindo nimesulida, paracetamol+ fosfato de codeína, cefalexina, amoxicilina, ciprofloxacino, omeprazol, loratadina e haloperidol. Foram relacionados o princípio ativo, a apresentação, a indicação terapêutica, a posologia, o tratamento administradoe os desperdícios financeiro e medicamentoso. A análise de custo dos medicamentos foi realizada comparando-se medicamentos genéricos com os de referência. Resultados: Nimesulida 100mg mostrou variação de preço sem torno de 60% em relação ao Nisulid®. Para cefalexina 500mg o custo variou de 37,5 a 62,2% comparado aoKeflex®. Amoxicilina 500mg apresentou variação de 36,5 a 58% do custo do Amoxil®. Para ciprofloxacino500mg o custo foi de 31 a 58,3% do valor do Cipro®. As variações para omeprazol 20mg foram de 52,3 e 67,1%do valor do Peprazol®. Loratadina 10mg variou seu preço de 57,2 a 65% do Claritin®. A apresentação denimesulida, paracetamol + fosfato de codeína, omeprazol, loratadina e haloperidol mostrou-se em desajusteà prescrição médica para as doenças ora associadas, refletindo em desperdício de dois a oito comprimidos evariação do prejuízo de R$ 0,32 a R$ 13,76. Conclusões: A apresentação da maioria dos medicamentosindicados no tratamento de doenças freqüentes na população está em desajuste com a prescrição médica, refletindo em desperdícios medicamentoso e financeiro. Isso confirma a necessidade da elaboração de estratégia para conscientização de indústrias, instituições e profissionais de saúde também na economia terapêutica medicamentosa.

Effects of isotretinoin on the metabolism of triglyceride-rich lipoproteins and on the lipid profile in patients with acne.

Isotretinoin treatment alters the plasma lipid levels but the mechanisms and the effects on the metabolism of triglyceride-rich lipoproteins such as chylomicrons and very-low-density lipoproteins remain unclear. We investigated the effect of isotretinoin on the plasma kinetics of emulsion models of triglyceride-rich lipoproteins and the lipid profile. Ten patients with acne were treated with 0.8 mg/kg of isotretinoin over 4 weeks for comparison with non-treated acne patients. In both groups the plasma kinetic study of a triglyceride-rich emulsion double-labeled with 14C-cholesterol oleate and 3H-triolein was performed after intravenous injection of the emulsion and radioactive counting in plasma samples collected over 60 min. Patients using isotretinoin showed decreased removal from the plasma of the 3H-triglyceride (median 0.019 min-1 TG) compared with controls (median 0.044 min-1, P=0.007), and the removal of the emulsion 14C-cholesterol oleate also tended to be decreased (treatment: 0.011 min-1; controls: 0.024 min-1, P=0.06). The values of total and LDL cholesterol and triglycerides were increased post-treatment (P<0.03). In conclusion, while increasing the fasting plasma concentration of VLDL and LDL, which are traditional risk factors for atherosclerosis, isotretinoin treatment also slows down the metabolism of triglyceride-rich lipoproteins such as chylomicrons, as tested by the emulsion model, an effect that is also increasingly recognized as atherogenic.

Anticardiolipin antibodies as a risk factor of atherosclerosis in intermittent claudication.

Anticardiolipin antibodies have been associated as a risk factor of atherosclerosis. The aim of this study was to evaluate the association between anticardiolipin antibodies and intermittent claudication. Forty consecutive patients (33 men, 7 women; age range: 45-84 years, mean 65.5) who were seen in the angiology and vascular surgery department with intermittent claudication were evaluated. Exclusion criteria included prior revascularization, angioplasty, or a history of thrombosis of a lower limb. Forty individuals (23 men, 17 women; age range: 58-82 years, mean 67.1) who attended a support group for senior citizens and who were apparently healthy formed the control group. Anticardiolipin antibodies were evaluated by means of enzyme-linked immunosorbent assay (ELISA) for quantitative measurement of immunoglobulin G (IgG) and IgM antibodies against cardiolipins in serum. IgG levels were considered normal when < 7, borderline from 7 to 10, and elevated at > 10 GPL units/mL; IgM levels were normal when < 4, borderline from 4 to 7, and elevated at > 7 MPL, as recommended by the test manufacturers. Statistical analysis used the relative risk test with a confidence interval of 95%. Twenty-three patients from the study group and 6 individuals from the control group were found to have elevated levels of anticardiolipin antibodies giving a relative risk of 3.833 (ranging from 1.749 to 8.4; p value < 0.0001). In conclusion, patients who have elevated levels of anticardiolipin antibodies present a 3.8 times greater risk of developing intermittent claudication.

Polimorfismo genético do fibrinogênio na doença arterial periférica / Genetic polymorphisms of fibrinogen in peripheral artery disease

O objetivo do presente estudo foi analisar freqüências alélicas e genotípicas para o gene codificador da cadeia beta do fibrinogênio em pacientes com doença arterial periférica (DAP). Foram estudados 44 pacientes caucasóides do sexo masculino com sintomas clínicos e comprovação angiográfica de DAP, com idade entre 38 e 79 anos (62±8,6 anos). Entre eles, 22 apresentaram obstrução aterosclerótica nas artérias ilíacas, femorais e/ou carótidas e 22 tinham aneurisma de aorta torácica, abdominal ou tóraco-abdominal. O grupo controle foi constituído por 56 indivíduos, sem história clínica de DAP ou alterações ao exame clínico, com idades variando de 43 a 80 anos (59±9,2 anos). Foram excluídos os indivíduos com doença renal, doença hepática ou diabetes mellitus. A análise do polimorfismo genético da cadeia do fibrinogênio foi realizada por PCR (polimerase chain reaction) e RFLP (restriction fragment lenght polimorphism) com a endonuclease Bcl I, identificando-se três genótipos: B1/B1, B1/B2 e B2/B2. A análise estatística incluiu teste exato de Fisher, calculo do odds ratio, teste de Kruskal Wallis e análise de variância (ANOVA). Admitiu-se erro a igual a 5 por cento, com nível de significância para P<0,05. O alelo B1 foi o mais prevalente em pacientes e controles (0,819 e 0,857, respectivamente; P=0,5605), com prevalência do genótipo B1/B1 nos pacientes (65,9 por cento) e controles (71,4 por cento; P=0,6639), seguido de B1/B2 (31,8; 28,6 por cento, respectivamente; P=0,8268). Em conclusão, DAP, independente do tipo de lesão obstrutiva ou aneurismática, apresenta-se indiferente ao polimorfismo Bcl I do fibrinogênio, portanto, sem influência dos alelos B1 e B2 para fibrinogênio e seus respectivos genótipos na doença.

The objective of this study was to analyze the frequencies of thealleles and genotypes of the gene encoder of the fibrinogen bchainin patients suffering from peripheral artery disease. A totalof 62 male Caucasoid patients with ages varying from 38 to 79years old were studied. All the patients had clinical symptoms ofperipheral artery disease, which was later confirmed byangiography. Forty of the patients had atheroscleroticobstructions of the iliac, femoral or carotid arteries and 22 sufferedfrom aneurysms of the thoracic, abdominal or thoracoabdominalaortas. All the patients were submitted to surgery. A controlgroup was formed of 62 individuals, with ages ranging from 43to 80 years old, without clinical histories or alterations in theirclinical examinations of peripheral artery disease. Individualswith renal disease, liver disease or diabetes mellitus wereexcluded. Analysis of the fibrinogen b-chain was performed usingpolymerase chain reaction and restriction fragment lengthpolymorphism with Bcl I endonuclease. Three genotypes, B1/B1,B1/B2 and B2/B2 were identified. Statistical analysis was madeusing the Fisher Exact test, odds ratio, Kruskal-Wallis test andvariance analysis (ANOVA). A p-value = 0.05 was consideredsignificant. The B1 allele was the most prevalent in both patientsand the control group (0.819 and 0.857, respectively), withprevalence of the B1/B1 genotype in patients and controls (65.9%vs. 71.4% respectively), followed by B1/B2 (31.8% vs. 28.6%respectively). No significant difference was observed in relationto the Bcl I polymorphisms of the fibrinogen b-chain andobstructive and aneurysmal peripheral artery disease. Inconclusion, the B1 and B2 polymorphisms of the fibrinogen bchain and teir respective genotypes do not have any influence in peripheral artery disease.

Influence of the polymorphism of apolipoprotein E in cerebral vascular disease.

UNLABELLED: The genetic heterogeneity of apolipoprotein E (apo E) has been associated with lipid profile and atherothrombotic stroke, however this association remains inconclusive. OBJECTIVE: To evaluate the relationship between the isoforms of apo E and atherothrombotic stroke, by ascertaining the frequency of its alleles and genotypes associated with the lipid profile in patients with stroke. METHOD: A total of 207 individuals were divided into two groups, consisting of 107 patients with stroke and 100 individuals without clinical symptoms of the disease. Blood samples were taken from patients and controls for molecular investigation of the apo E (epsilon2, epsilon3 and epsilon4 alleles) for the analysis of the lipid profile. RESULTS: The epsilon3 allele was the most common and its prevalence was significantly higher in patients (0.93) compared to the controls (0.86; p=0.024). The epsilon2 allele was rarely seen specifically in patients (0.02 versus 0.05 in controls, p=0.191). The epsilon4 allele was not associated with stroke showing a reduced frequency in patients (0.05) when compared to controls (0.09; p=0.011). Although higher average levels of lipid profile were found in patients when compared to controls, with statistical significance for the values of total cholesterol (TC) (203.6 mg/dL +/- 57.98 and 181.9 mg/dL +/- 68.47 respectively; p=0.003) and low-density lipoprotein cholesterol (LDLc) (131.4mg/dL +/- 52.60 and 116 mg/dL +/- 56.38, respectively; p=0.014), these were independent of the presence of the epsilon4 allele. In control group the higher TC and LDLc values occurred in the absence of the epsilon4 allele, confirming the conflicting effect of the alleles of apo E on the plasmatic lipids and atherothrombotic stroke. CONCLUSION: The isoforms of apo E cannot be regarded as an isolated risk factor for stroke and do not show association with lipid profile in this study.

Influence of the polymorphism of apolipoprotein E in cerebral vascular disease

The genetic heterogeneity of apolipoprotein E (apo E) has been associated with lipid profile and atherothrombotic stroke, however this association remains inconclusive. OBJECTIVE: To evaluate the relationship between the isoforms of apo E and atherothrombotic stroke, by ascertaining the frequency of its alleles and genotypes associated with the lipid profile in patients with stroke. METHOD: A total of 207 individuals were divided into two groups, consisting of 107 patients with stroke and 100 individuals without clinical symptoms of the disease. Blood samples were taken from patients and controls for molecular investigation of the apo E (epsilon2, epsilon3 and epsilon4 alleles) for the analysis of the lipid profile. RESULTS: The epsilon3 allele was the most common and its prevalence was significantly higher in patients (0.93) compared to the controls (0.86; p=0.024). The epsilon2 allele was rarely seen specifically in patients (0.02 versus 0.05 in controls, p=0.191). The epsilon4 allele was not associated with stroke showing a reduced frequency in patients (0.05) when compared to controls (0.09; p=0.011). Although higher average levels of lipid profile were found in patients when compared to controls, with statistical significance for the values of total cholesterol (TC) (203.6mg/dL±57.98 and 181.9mg/dL±68.47 respectively; p=0.003) and low-density lipoprotein cholesterol (LDLc) (131.4mg/dL±52.60 and 116mg/dL±56.38, respectively; p=0.014), these were independent of the presence of the epsilon4 allele. In control group the higher TC and LDLc values occurred in the absence of the epsilon4 allele, confirming the conflicting effect of the alleles of apo E on the plasmatic lipids and atherothrombotic stroke. CONCLUSION: The isoforms of apo E cannot be regarded as an isolated risk factor for stroke and do not show association with lipid profile in this study