Long-term Pegvisomant Therapy of Acromegaly: Effects on Bone Density, Turnover and Microstructure Using HRpQCT.

Context: Fracture rate is increased in patients with active acromegaly and those in remission. Abnormalities of bone microstructure are present in patients with active disease and persist despite biochemical control after surgery. Effects of treatment with the GH receptor antagonist pegvisomant on bone microstructure were unknown. Methods: We studied 25 patients with acromegaly (15 men, 10 women). In 20, we evaluated areal bone mineral density (BMD) by dual-energy X-ray absorptiometry and bone turnover markers (BTMs) longitudinally, before and during pegvisomant treatment. After long-term pegvisomant in 17, we cross-sectionally assessed volumetric BMD, microarchitecture, stiffness, and failure load of the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HRpQCT) and compared these results to those of healthy controls and 2 comparison groups of nonpegvisomant-treated acromegaly patients, remission, and active disease, matched for other therapies and characteristics. Results: In the longitudinal study, areal BMD improved at the lumbar spine but decreased at the hip in men after a median ∼7 years of pegvisomant. In the cross-sectional study, patients on a median ∼9 years of pegvisomant had significantly larger bones, lower trabecular and cortical volumetric density, and disrupted trabecular microarchitecture compared to healthy controls. Microstructure was similar in the pegvisomant and acromegaly comparison groups. BTMs were lowered, then stable over time. Conclusion: In this, the first study to examine bone microstructure in pegvisomant-treated acromegaly, we found deficits in volumetric BMD and microarchitecture of the peripheral skeleton. BTM levels remained stable with long-term therapy. Deficits in bone quality identified by HRpQCT may play a role in the pathogenesis of fragility in treated acromegaly.

Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review.

Nicotinamide adenine dinucleotide (NAD+) is an essential pyridine nucleotide cofactor that is present in cells and in several important biological processes, including oxidative phosphorylation and production of adenosine triphosphate, DNA repair, calcium-dependent secondary messenger and gene expression. The purpose of this systematic review is to examine whether the coenzyme formulae NAD+ and NADH are safe and effective when acting as a supplement to humans. This systematic review of randomized clinical trials performed a search in six electronic databases: PubMed, MEDLINE (ovid), Embase, Cochrane CENTRAL (clinical trials), Web of Science, and Scopus. Secondary search included the databases (e.g., Clinical trials.gov, Rebec, Google Scholar - advance). Two reviewers assessed and extracted the studies independently. The risk of bias in studies was performed using version 2 of the Cochrane risk of bias tool for randomized trials. This review includes 10 studies, with a total of 489 participants. The studies included different clinical conditions, such as chronic fatigue syndrome (CFS), older adults, Parkinson's disease, overweight, postmenopausal prediabetes, and Alzheimer's disease. Based on studies, the supplementation with NADH and precursors was well tolerated and observed clinical results such as, a decrease in anxiety conditions and maximum heart rate was observed after a stress test, increased muscle insulin sensitivity, insulin signaling. Quality of life, fatigue intensity, and sleep quality among others were evaluated on patients with CFS. All studies showed some side effects, thus, the most common associated with NADs use are muscle pain, nervous disorders, fatigue, sleep disturbance, and headaches. All adverse events cataloged by the studies did not present a serious risk to the health of the participants. Overall, these findings support that the oral administration of NADH can be associated to an increase in general quality of life and improvement on health parameters (e.g., a decrease in anxiety, maximum heart rate, inflammatory cytokines in serum, and cerebrospinal fluid). NADH supplementation is safe and has a low incidence of side effects. Future investigations are needed to evidence the clinical benefits regarding specific diseases and doses administered.

Bacteriúria assintomática. Perfil clínico-epidemiológico / Asymptomatic bacteriúria - clínical-epidemiologic profile

Objetivo: Determinar a prevalência de bacteriúria assintomática(BA), o perfil; clínico epidemiológico, fatores complicantes associados e a conduta terapêutica, comparando os dados com a literatura especializada. Método:Inquérito transversal descritivo, com base em registro médico, em pacientes adultos, näo gestantes, internados no Hospital Universitário (HU-UFSC), em Florianópolis-SC, no período de março de 1996 a março de 2000, classificados conforme a Classificaçäo das Doenças em sua décima revisäo (CID-10), como " infecçäo do trato urinário de localizaçäo näo especificada" ou N39.Dos 521 pacientes com este diagnóstico, 59 preencheram o critério de BA. Resultados : Encontramos prevalência de 11,3 porcento de BA, idade média de 64,2 anos,predomínio do sexo feminino 57,6(porcento) (34/59),e diabetes mellitus 48,7 porcento (20/59) e o uso prévio de cateter vesical 46,3 porcento( 19/59) , como os mais frequentes fatores complicantes. Predominou a infecçäo comunitári(porcento)a 69,5(porcento)(41/59), Escheria coli foi o principal agente etiológico 59,3 porcento (35/39) e a maioria foi tratada com drogas antimicrobianas 88,1 porcento (52/59), com duraçäo média de 9,6 dias. Conclusöes: A literatura aponta uma prevalência discretamente superior a encontrada e o tratamento somente em grupos selecionados, sendo os demais aspectos semelhantes ao encontrado nesse estudo.au