Isolated IgE reactivity to native walnut vicilin-like protein (nJug r 2) on ISAC™ microarray is due to cross-reactive carbohydrate epitopes.

BACKGROUND: The last version of the microarray-based testing ImmunoCAP ISAC 112™ includes the native walnut (Junglans regia) molecules 2S albumin (nJug r 1), vicilin (nJug r 2) and lipid transfer protein (nJug r 3). In view of the many unexpected cases of isolated positivity to nJug r 2 occurring in daily practice, we evaluated the association of these reactivities with clinical symptoms, as well as the relationship between sIgE and nJug r 2 and cross-reactive carbohydrate determinants (CCDs). METHODS: Sera from 320 consecutive allergic outpatients tested by ImmuoCAP ISAC™ 112 were considered. The medical records of all nJug r 2 positive patients were reviewed to assess clinical symptoms related to walnut allergy. A linear regression analysis was performed to evaluate the correlation between nJug r 2 and CCDs (nMUXF3) sIgE values, and a CAP inhibition assay was carried out to confirm the possible cross-reactivity between CCDs and nJug r 2. RESULTS: Thirty-seven out of 320 sera tested (11.6%) were positive to nJug r 2. Among them three (8.1%) and eight (21.6%) scored positive for nJug r 1 and nJug r 3 as well, respectively. Twenty-seven (73%) sera showed isolated nJug r 2 positivity. Only nJug r 1 reactors had symptoms referred to walnut allergy. Twenty-five/37 nJug r 2-positive sera (67.6%) showed a simultaneous positivity to nMUXF3 and a significant correlation (p<0.0001) between the IgE levels to nJug r 2 and nMUXF3 (r²=0.787). After incubation with nMUXF3 a complete inhibition of sIgE reactivity to both nMUXF3 and nJug r 2 was shown. CONCLUSIONS: The unexpected isolated sIgE reactivity to nJug r 2 found by ImmunoCAP ISAC™ 112 is frequently related to reactivity to cross-reactive carbohydrate epitopes and it is lacking clinical significance.

[Solidarity in the responsibilities of machine manufacturers and shoemakers]. / Solidali nelle responsabilità costruttori di macchine e calzaturieri.

The purpose of this article is to give a general frame of the relationship existing between safety legislation for workplaces and the legislation connected to the CE marking and declaration of conformity for machinery, as provided by the new Directive 2006/42/EC and its Italian implementation (D.L. 17/2010). The main aim is to highlight the issues which, joining their efforts, the manufacturers of work tools and machinery should face in order to avoid disputes, seizures and/or legal procedures. The intersection between the two legal sources can sometimes become complex, although both the law and the controlling institutions intervene to offer possible answers. In such context the necessity for a careful re-examination of the relationship between machine builders and users becomes clear, especially as to the methods of designing and testing, the terms of contract, the conditions of manteinance, installation and updating.

Alterations in downstream mediators involved in central control of eating behavior in obese adolescents submitted to a multidisciplinary therapy.

OBJECTIVE: The aim of this study was to verify the effects of a multidisciplinary therapy (24 weeks) on neurohormonal control of food intake, specifically in orexigenic (total ghrelin, agouti-related protein [AgRP], neuropeptide Y [NPY], and melanin-concentrating hormone) and anorexigenic factors (leptin, insulin, and alpha-melanocyte stimulating hormone [α-MSH]), in obese adolescents. METHODS: A total of 88 adolescents (38 boys and 50 girls), including 62 obese and 26 normal-weight, aged 15-19 years were recruited. Obese adolescents were submitted to a 24-week multidisciplinary therapy. AgRP, NPY, melanin-concentrating hormone, leptin, insulin, glucose, α-MSH, total ghrelin, and food intake were measured at three stages (at baseline, after 12 weeks, and after 24 weeks). RESULTS: At baseline, obese adolescents showed hyperleptinemia (circulating leptin levels, which were, in boys and girls, 40 and 35 times higher than in normal-weight subjects, respectively). After 24 weeks, these values decreased in all obese patients. Our results showed no differences in ghrelin levels between obese and normal-weight adolescents, in both genders. However, obese boys reduced their plasma ghrelin concentration after 24 weeks of therapy (p < .05). The multidisciplinary therapy decreased NPY and AgRP values and increased α-MSH; simultaneously with these changes there was a decrease in total food intake after 24 weeks of therapy. CONCLUSIONS: We can conclude that the multidisciplinary therapy was efficient to modulate neurohormonal control of food intake in obese adolescents.

[APACHE II and ATN-ISS in acute renal failure (ARF) in intensive care unit (ICU) and non-ICU]. / Uso do escore prognóstico APACHE II e ATN-ISS em insuficiência renal aguda tratada dentro e fora da unidade de terapia intensiva.

INTRODUCTION: Acute renal failure (ARF) remains highly prevalent with a high rate of morbidity and mortality. OBJECTIVE: of this study was to compare use of the APACHE II scoring prognosis with that of the ATN-ISS to determine whether the APACHE II could be used for patients with ARF outside the ICU. METHODS: For this purpose, 205 patients with ARF were accompanied in a prospective cohort. Demographic data, preexisting conditions, organ failure and characteristics of ARF were analyzed. The prognostic scores were performed with the assessment of a nephrologist. RESULTS: The mean age was 52 +/- 18 years, 50% were male, 69% were white, 45% were treated in ICU and 55% in other units. Mortality in the ICU group was 85% and in the non-ICU group 18%. Factors that correlated with higher mortality were more prevalent in the ICU group: age, male, hospitalization with ARF, organ failure, sepsis, septic IRA, oliguria and need of dialysis. Overall, the prognostic markers were the same for both the ICU and non-ICU groups. The discrimination with the APACHE II was similar in both, ICU and non-ICU groups and calibration was better in the non-ICU group. The ATN-ISS achieved good discrimination in both the ICU and non-ICU groups, but, regarding calibration, there was a discreet over estimating of mortality in the non-ICU group. The ATN-ISS showed a greater capacity for discrimination than the APACHE II in both the ICU and non-ICU groups. CONCLUSION: It was concluded that the APACHE II and ATN-ISS scores could be used for stratification of risk in patients with ARF treated outside of the ICU in Brazil.

Relationship between bone mineral density, leptin and insulin concentration in Brazilian obese adolescents.

Despite the epidemic of adolescent obesity, the effect of obesity and hormones on bone mineral accrual during growth is poorly understood. Studies using dual-energy X-ray to examine the effect of obesity on bone mass in children and adolescents have yielded conflicting results. The aim of this study was to explore the combined and independent contributions of body mass index, body composition, leptin, insulin, glucose levels and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) to bone mineral density (BMD) and bone mineral content in a group of Brazilian obese adolescents. This study included 109 post-pubescent obese adolescents. A whole-body dual-energy X-ray absorptiometry scan was performed,using a HOLOGIC QDR4200, to determine whole-body BMD and body composition. Blood samples were collected in the outpatient clinic after an overnight fast, and evaluated for fasting blood glucose and immunoreactive insulin. Leptin levels were assessed with a radioimmunoassay kit. Insulin resistance was assessed by HOMA-IR and the quantitative insulin sensitivity check index. Our results showed that insulin levels and HOMA-IR correlated negatively with BMD and a linear regression analysis showed that serum leptin is inversely associated to BMD adjusted for body mass. In conclusion, our data support the hypothesis that leptin, insulin and HOMA-IR are inversely associated with BMD and play a significant direct role in bone metabolism.

Uso do escore prognóstico APACHE II e ATN-ISS em insuficiência renal aguda tratada dentro e fora da unidade de terapia intensiva / APACHE II and ATN-ISS in acute renal failure (ARF) in intensive care unit (ICU) and non-ICU

INTRODUÇÃO: A insuficiência renal aguda (IRA) mantém alta prevalência, morbidade e mortalidade. OBJETIVO: Comparar o uso do escore prognóstico APACHE II com o ATN-ISS e determinar se o APACHE II pode ser utilizado para pacientes com IRA, fora da UTI. MÉTODOS: Coorte prospectiva, 205 pacientes com IRA. Analisamos dados demográficos, condições pré-existentes, falência de órgãos e características da IRA. Os escores prognósticos foram realizados no dia da avaliação do nefrologista. RESULTADOS: A média de idade foi 52 ± 18 anos, 50 por cento eram do sexo masculino, 69 por cento eram brancos, 45 por cento foram tratados em UTI e 55 por cento em outras unidades. A mortalidade no grupo UTI foi 85 por cento e no grupo não-UTI foi 18 por cento. Os fatores que se correlacionaram com maior mortalidade foram mais prevalentes na UTI: idade, sexo masculino, IRA hospitalar, falência de órgãos, sepse, IRA séptica, oligúria e necessidade dialítica. No contexto geral, os marcadores prognósticos foram os mesmos para os grupos UTI e não-UTI. O APACHE II obteve discriminação similar nos grupos UTI e não-UTI e sua calibração foi melhor no grupo não-UTI. O ATN-ISS obteve boa discriminação tanto no grupo UTI quanto não-UTI, porém, com relação à calibração houve discreta superestimação da mortalidade no grupo não-UTI. O ATN-ISS apresentou melhor capacidade de discriminação do que o APACHE II nos grupos UTI e não-UTI. CONCLUSÃO: Concluímos que os escores APACHE II e ATN-ISS podem ser utilizados para a estratificação de risco em pacientes com IRA tratados fora da UTI em nosso meio.

INTRODUCTION: Acute renal failure (ARF) remains highly prevalent with a high rate of morbidity and mortality. OBJECTIVE: of this study was to compare use of the APACHE II scoring prognosis with that of the ATN-ISS to determine whether the APACHE II could be used for patients with ARF outside the ICU. METHODS: For this purpose,, 205 patients with ARF were accompanied in a prospective cohort. Demographic data, preexisting conditions, organ failure and characteristics of ARF were analyzed. The prognostic scores were performed with the assessment of a nephrologist. RESULTS: The mean age was 52 ± 18 years, 50 percent were male, 69 percent were white, 45 percent were treated in ICU and 55 percent in other units. Mortality in the ICU group was 85 percent and in the non-ICU group 18 percent. Factors that correlated with higher mortality were more prevalent in the ICU group: age, male, hospitalization with ARF, organ failure, sepsis, septic IRA, oliguria and need of dialysis. Overall, the prognostic markers were the same for both the ICU and non-ICU groups. The discrimination with the APACHE II was similar in both, ICU and non-ICU groups and calibration was better in the non-ICU group. The ATN-ISS achieved good discrimination in both the ICU and non-ICU groups, but, regarding calibration, there was a discreet over estimating of mortality in the non-ICU group. The ATN-ISS showed a greater capacity for discrimination than the APACHE II in both the ICU and non-ICU groups. CONCLUSION: It was concluded that the APACHE II and ATN-ISS scores could be used for stratification of risk in patients with ARF treated outside of the ICU in Brazil.

Testing for IgG class antibodies in celiac disease patients with selective IgA deficiency. A comparison of the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG anti-gliadin and 1 IgG anti-deaminated gliadin peptide antibody assays.

BACKGROUND: To evaluate the diagnostic characteristics of commercially available IgG anti-tTG assays in selective IgA deficiency (SIgAD), we tested different IgG anti-tTG methods and compared the results with those obtained from two other tests: one for IgG anti-gliadin (AGA) and one for IgG to deaminated gliadin peptides (DGP). METHODS: 20 CD patients with SIgAD and 113 controls (9 patients with SIgAD without CD; 54 patients with chronic liver disease; 50 healthy subjects) were tested with 9 IgG anti-tTG assays (2 of which are enriched with gliadin peptides), one IgG AGA assay and one IgG anti-DGP assay. RESULTS: Using optimal cutoffs as determined by ROC curves, the sensitivity of IgG anti-tTG methods ranged from 75% (1 kit) to 95% (7 kits) and the specificity from 94% (1 kit) to 100% (5 kits). Sensitivity and specificity were 40% and 87% for IgG AGA, and 80% and 98% for IgG anti-DGP, respectively. CONCLUSIONS: All IgG anti-tTG methods evaluated are reliable serologic assays for the diagnosis of CD in patients with SIgAD and perform better than the gliadin-based assays used in this study. The tests containing both tTG and gliadinic peptides are burdened by a lower specificity than the anti-tTG assays.

Metabolic and nutritional profile of obese adolescents with nonalcoholic fatty liver disease.

BACKGROUND: The incidence of nonalcoholic fatty liver disease (NAFLD) is increasing due to its prevalence in obesity, diabetes, and insulin-resistance syndrome. The best treatment protocol for NAFLD has not been determined. However, there is evidence that exercise and nutritional intervention can improve and prevent it. The aim of the present study was to evaluate the dietary and metabolic profiles of obese adolescents with NAFLD who participated in a multidisciplinary program. PATIENTS AND METHODS: We studied 43 adolescents ages 15 to 19 years (17.18 +/- 1.66 years) with a body mass index (BMI) > or = 30, consisting of 30 patients without NAFLD (BMI = 35.80 +/- 3.44 kg/m2) and 13 with NAFLD (BMI = 33.47 +/- 2.34 kg/m2). The NAFLD diagnosis was determined by ultrasonography. Blood samples were collected to analyze glycemia, hepatic aminotransferase levels, and lipid profiles. Insulin resistance was measured by homeostasis model assessment insulin-resistance index (HOMA-IR). The analyses of baseline and postintervention food intake were made by a 3-day inquiry. RESULTS: At baseline conditions, the patients with NAFLD showed significant differences in body mass, BMI, and visceral and subcutaneous fat. Glucose and visceral and subcutaneous fat presented a significant reduction after treatment in patients with NAFLD. Analyzing the food intake, at baseline we observed a positive correlation between the visceral obesity and lipid consumption only in patients with NAFLD. We also observed significant decrease in energy and cholesterol consumption in patients with NAFLD after the multidisciplinary therapy. CONCLUSIONS: The intervention promoted a decrease in the prevalence of NAFLD, a significant decrease in visceral obesity, and improved HOMA-IR, glycemia, and serum lipid levels that are risk factors for NAFLD. In summary, the multidisciplinary program is essential in the treatment and prevention of NAFLD.

Nonalcoholic fatty liver disease decrease in obese adolescents after multidisciplinary therapy.

BACKGROUND: Despite the increasing prevalence of nonalcoholic fatty liver disease, its pathogenesis and clinical significance remain poorly defined and there is no ideal treatment. OBJECTIVE: The aim of this study was to assess the short-term (12-week) multidisciplinary therapy on visceral adiposity and nonalcoholic fatty liver disease control. METHODS: We evaluated and compared the distribution of visceral adiposity and nonalcoholic fatty liver disease, by ultrasonography, in 73 post-puberty obese participants (17.01+/-1.6 years old; body mass index 36.54+/-2.86 kg/m), submitted to a multidisciplinary treatment without medications, at the beginning and after 12 weeks of intervention. Descriptive and one-way analysis of variance, and paired t-test were performed. RESULTS: The results indicated that after intervention the adolescents had a significant reduction in visceral adiposity (4.05+/-1.55 to 3.37+/-1.44) and nonalcoholic fatty liver disease prevalence (from 52 to 29% on the right side and from 48 to 29% on the left side). It is a positive result because nonalcoholic fatty liver disease can progress to cirrhosis, even in children and adolescents. CONCLUSIONS: The short-term treatment suggests a profound impact on the control of obesity-related co-morbidities in young people.

Tratamento multidisciplinar reduz o tecido adiposo visceral, leptina, grelina e a prevalência de esteatose hepática não alcoólica (NAFLD) em adolescentes obesos / Multidisciplinary treatment reduces visceral adiposity tissue, leptin, ghrelin and the prevalence of non-alcoholic fat liver disease (NAFLD) in obese adolescents

O objetivo do presente estudo foi avaliar as alterações promovidas, por intervenção multidisciplinar, nas concentrações plasmáticas de grelina e leptina, adiposidade visceral e prevalência de esteatose hepática não alcoólica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m²) e 12 meninos (IMC 37,08 ± 3,17kg/m²), com idade entre 15 e 19 anos, quanto à concentração de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnóstico de NAFLD pelo método de ultra-sonografia. Os resultados demonstraram redução significante na concentração circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda redução percentual na prevalência de NAFLD, sendo este um resultado relevante, visto que esta doença pode progredir para cirrose, tanto em crianças quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabólico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

The aim of this study was to assess the changes promoted by a multidisciplinary therapy in ghrelin and leptin concentrations, visceral adiposity and non-alcoholic fat liver disease-NAFLD, in obese adolescents. A total of 28 obese adolescents, 16 girls (BMI 34.58 ± 3,86 wt/ht²) and 12 boys (BMI 37.08 ± 3.17 wt/ht²), aged between 15 and 19 years old, was evaluated to leptin, ghrelin and insulin concentrations, visceral adiposity and NAFLD through ultrasonography. The results showed a significant decrease in ghrelin, leptin concentrations and visceral adiposity (p < 0.01). Moreover, a decrease in the NAFLD prevalence was observed. It is an important result, since this disease can progress to cirrhosis, not only in children but also in obese adolescents. This kind of treatment can be efficient to improve metabolic and hormonal profile, as well as, to control obesity and related co-morbidities in obese adolescents.

El objetivo del presente trabajo ha sido evaluar las alteraciones promovidas por la intervención multidisciplinar, en las concentra- ciones plasmáticas de grelina y leptina, adiposidad visceral y prevalencia de esteatosis hepática no alcohólica - NAFLD, en adolescentes obesos. 28 adolescentes obesos, 16 chicas (IMC 34,58 ± 3,86 kg/m²) y 12 chicos (IMC 37,08 ± 3,17 kg/m²), con edades entre 15 y 19 años, fueron evaluados respecto a la concentración de leptina, grelina, insulina, así como a la adiposidad visceral y el diagnóstico de NAFLD por el método de ultrasonografía. Los resultados demostraron una reducción significante en la concentra- ción circulante de grelina y leptina y en la adiposidad visceral (p < 0,01). Hubo aún una reducción porcentual en la prevalencia de NAFLD, siendo este un resultado relevante, ya que esta enfermedad puede progresar hasta la cirrosis, tanto en niños como en adolescentes obesos. Este tipo de tratamiento demostró ser eficiente en la mejora del perfil metabólico y hormonal, contribuyendo para el control de la obesidad y su comorbilidad en adolescentes obesos.

Efeito do exercício de força sobre a adiposidade periférica e visceral, perfil lipídico, glicídico e hormonal em adolescentes obesos / Effect of strenght exercise in periferic and visceral adiposity, lipidic, glicidic and hormonal profile in obese adolescents

Objetivo: Verificar as possíveis alterações provocadas pelos exercícios de força sobre a adiposidade periférica e visceral, perfil lipídico, glicídico e respostas hormonais, após f doze semanas de intervenção, em adolescentes obesos. Métodos: Foram selecionados 126 adolescentes, de ambos os gêneros, com idade entre 14 e 19 anos, sedentários, e índice de massa corporal (IMC)≥95th; distribuídas em quatro grupos: controle (sem exercício físico), recreação, exercícios aeróbios e exercícios de força. Realizaram exercícios físicos durante 12 semanas, três sessões semanais com duração de uma hora. O grupo recreação não controlou a intensidade do treinamento aeróbio treinou na intensidade do Limiar Ventilatório-I, o grupo força treinou a 70 por cento de uma repetição máxima (1 RM). A gordura corporal total, subcutânea e massa livre de gordura foram avaliadas por absorciometria de feixe duplo de raios-X (DEXA), a gordura visceral por ultrassonografia. O perfil lipídico pelo método de comparativo calorimétrico e o perfil hormonal por radioimunoinsaio. Resultados: Em relação à composição corporal, após doze semanas de tratamento, o treinamento de força promoveu uma redução significativa no IMC, massa corporal, gordura visceral e subcutânea nos meninos. No grupo aeróbio também observamos uma redução significativa na massa corporal, gordura corporal e subcutânea de meninos e somente gordura corporal em meninas. Houve preservação de massa magra em todos os grupos e gêneros. Quanto ao perfil lipídico, o treinamento aeróbio diminuiu o colesterol total e LDL-c em ambos os gêneros. A atividade de recreação reduziu os níveis plasmáticos de glicose e insulina, bem como o HOMA, somente nas meninas. Conclusões: Após 12 semanas de treinamento os exercícios de força foram mais eficientes em meninos, sobre a composição corporal, enquanto que para colesterol total e LDL-c o exercício aeróbio foi mais eficiente em ambos os gêneros.

Depression, anxiety and quality of life scores in seniors after an endurance exercise program.

OBJECTIVE: Mood disorders are a frequent problem in old age, and their symptoms constitute an important public health issue. These alterations affect the quality of life mainly by restricting social life. The participation in a regular exercise program is an effective way of reducing or preventing the functional decline associated with aging. The aim of the present study was to examine the effects of fitness-endurance activity (at the intensity of Ventilatory Threshold 1 (VT-1)) in depression, anxiety and quality of life scores in seniors. METHODS: The study involved 46 sedentary seniors aged 60-75 (66.97 +/- 4.80) who were randomly allocated to two groups: 1) Control group, which was neither asked to vary their everyday activities nor to join a regular physical fitness program; and 2) Experimental group, whose members took part in an aerobic fitness program consisting of ergometer cycle sessions 3 times a week on alternate days for six months working at a heart rate corresponding to ventilatory threshold (VT-1) intensity. Subjects were submitted to a basal evaluation using the geriatric depression screening scale--GDS, STAI trait/state (anxiety scale) and SF-36 (quality of life scale). RESULTS: Comparing the groups after the study period, we found a significant decrease in depressive and anxiety scores and an improvement in the quality of life in the experimental group, but no significant changes in the control group. CONCLUSION: The data suggest that an aerobic exercise program at VT-1 intensity suffices to promote favorable modifications in depressive and anxiety scores to improve the quality of life in seniors.

Escores de depressão, ansiedade e qualidade de vida em idosos após um programa de exercícios aeróbios / Depression, anxiety and quality of life scores in seniors after an endurance exercise program

OBJECTIVE: Mood disorders are a frequent problem in old age, and their symptoms constitute an important public health issue. These alterations affect the quality of life mainly by restricting social life. The participation in a regular exercise program is an effective way of reducing or preventing the functional decline associated with aging. The aim of the present study was to examine the effects of fitness-endurance activity (at the intensity of Ventilatory Threshold 1 (VT-1)) in depression, anxiety and quality of life scores in seniors. METHODS: The study involved 46 sedentary seniors aged 60-75 (66.97 ± 4.80) who were randomly allocated to two groups: 1) Control group, which was neither asked to vary their everyday activities nor to join a regular physical fitness program; and 2) Experimental group, whose members took part in an aerobic fitness program consisting of ergometer cycle sessions 3 times a week on alternate days for six months working at a heart rate corresponding to ventilatory threshold (VT-1) intensity. Subjects were submitted to a basal evaluation using the geriatric depression screening scale - GDS, STAI trait/state (anxiety scale) and SF-36 (quality of life scale). RESULTS: Comparing the groups after the study period, we found a significant decrease in depressive and anxiety scores and an improvement in the quality of life in the experimental group, but no significant changes in the control group. CONCLUSION: The data suggest that an aerobic exercise program at VT-1 intensity suffices to promote favorable modifications in depressive and anxiety scores to improve the quality of life in seniors.

OBJETIVO: Transtornos de humor são problemas freqüentes na população idosa. Seus sintomas representam uma importante questão de saúde pública e afetam substancialmente a qualidade de vida, principalmente por restringir atividades sociais. A participação em um programa de exercícios físicos regulares parece ser efetiva em reduzir e prevenir o declínio funcional decorrente do envelhecimento. O objetivo do presente trabalho foi examinar o efeito de um programa de exercício físico aeróbio na intensidade do limiar ventilatório 1 (VT-1) nos escores indicativos de depressão e ansiedade e na qualidade de vida de idosos saudáveis. MÉTODOS: O estudo envolveu 46 voluntários sedentários saudáveis com idades entre 60-75 (66,97 ± 4,80), que foram distribuídos aleatoriamente em dois grupos: 1) Controle, que foi orientado a não alterar suas atividades rotineiras e a não se engajar em um programa de exercício físicos e 2) Experimental, que participou de programa de exercício em bicicleta ergométrica, três vezes por semana, em dias alternados, na intensidade do VT-1, por seis meses. Os voluntários foram submetidos a uma avaliação utilizando-se um screening composto pelas escalas: GDS (depressão), STAI traço/estado (ansiedade) e SF-36 (qualidade de vida). RESULTADOS: A comparação dos grupos após o período de estudo revelou que o grupo experimental obteve redução dos escores de depressão e ansiedade e aumento da qualidade de vida, enquanto que no grupo controle não foram observadas alterações. CONCLUSÃO: Os dados sugerem que um programa de exercício em bicicleta ergométrica na intensidade do VT-1 é suficiente para promover modificações favoráveis nos escores indicativos de depressão e ansiedade e melhorar a qualidade de vida de idosos.

Avaliação da composição corporal em adolescentes obesos: o uso de dois diferentes métodos / Body composition evaluation in obese adolescents: the use of two different methods

A pletismografia é um método rápido e fácil para determinação da composição corporal que utiliza a relação inversa entre pressão e volume. O objetivo do presente estudo foi o de comparar os valores obtidos com o método pletismografia com os valores observados com o DEXA em uma população de adolescentes obesos. Participaram da amostra 88 adolescentes pós-púberes de ambos os sexos, com idades entre 15 e 19 anos (17,01 ± 1,6) ingressantes de um programa de atividade física multidisciplinar. Os voluntários foram submetidos a uma avaliação da composição corporal em dias distintos dentro da mesma semana, pelo método de pletismografia e outra avaliação pelo método DEXA. Quando os métodos foram comparados, não se observaram diferenças significativas entre eles; além disso, foram observadas correlações significativas entre os parâmetros comuns dos dois métodos (massa magra, massa gorda (kg) e massa gorda ( por cento), r = 0,88 p < 0,05; r = 0,92 p < 0,05; r = 0,75 p < 0,05, respectivamente). Nossos dados sugerem que, para esta população específica, a pletismografia pode ser utilizada como um método de avaliação da composição corporal.

False positive reactions for IgA and IgG anti-tissue transglutaminase antibodies in liver cirrhosis are common and method-dependent.

BACKGROUND: Conflicting results were obtained in the assay of anti-transglutaminase (anti-tTG) autoantibodies in patients with chronic liver disease. In order to establish whether this was attributable to methodological differences, anti-tTG antibodies were assayed in a large number of patients suffering from liver cirrhosis (LC). METHODS: 54 patients with LC and 29 patients suffering from celiac disease (CD), used as controls, were tested for IgA and IgG anti-tTG with 11 different commercial methods. RESULTS: In the patients with LC, positivity ranged from 0% to 33.3% for IgA anti-tTG and from 0% to 11.1% for anti-tTG of the IgG class. The largest number of false positives was found with methods that used tTG in association with gliadin peptides as antigen substrate. A significant association was found between IgA anti-tTG antibodies and serum immunoglobulin concentration. CONCLUSIONS: The results of the various methods of assaying anti-tTG antibodies in patients with LC are highly variable, and the positives found are generally false positives, partly due to the high immunoglobulin concentration.

Analytical and diagnostic accuracy of the EliA automated enzyme fluoroimmunoassay for antineutrophil cytoplasmic autoantibody detection.

Anti-proteinase 3 antineutrophil cytoplasmic antibodies (PR3-ANCA) and anti-myeloperoxidase antibodies (MPO-ANCA) are considered important serological markers for several forms of idiopathic systemic vasculitis. The aim of the study was to verify the analytical and clinical performance of a new automated enzyme fluoroimmunoassay, the EliA system, for PR3-ANCA and MPO-ANCA detection. For this purpose the sera of 52 consecutive well-defined patients with a clinical diagnosis of Wegener's granulomatosis (WG) (n=29) or microscopic polyangiitis (MPA) (n=23), and 70 controls suffering from connective tissue disease (25 systemic lupus erythematosus, 25 Sjögren's syndrome and 20 rheumatoid arthritis) were tested for PR3-ANCA and MPO-ANCA with the EliA assay (Pharmacia Diagnostics, Freiburg, Germany). For comparison purposes, the same sera were also tested by indirect immunofluorescence, another direct immunometric assay (Varelisa, Pharmacia Diagnostics) and a capture PR3-ANCA (Wieslab AB, Lund, Sweden) method. Both the EliA PR3-ANCA and MPO-ANCA assays showed between- and within-assay precision of <10%. The dilution test gave straight lines (r2=0.998) for both antibody assays. The recovery ranged from 97.9% to 102.7% for PR3-ANCA and from 84.9% to 91.4% for MPO-ANCA. There was a high positive correlation between the EliA and Varelisa methods for quantitative detection of MPO-ANCA levels (r2=0.949) and a lower correlation for PR3-ANCA (r2=0.771). Conversely, poor correlation was observed between EliA PR3-ANCA and capture PR3-ANCA (r2=0.537). The overall sensitivity and specificity of EliA PR3-ANCA and MPO-ANCA for the vasculitides considered in this study were 82.7% and 97.2%, respectively, with a positive predictive value of 96.6% and a negative predictive value of 84.9%. Comparison of the results obtained with the indirect immunofluorescence, Varelisa and capture PR3-ANCA methods showed that the indirect immunofluorescence assay is the most sensitive method for the diagnosis of vasculitis (88.5%), but the least specific (94.3%); the EliA method is slightly more specific (97.2%) than the Varelisa method (95.7%), and also slightly more sensitive (82.7% vs. 80.8%). Capture PR3-ANCA proved to be the most sensitive method for detection of anti-proteinase 3 antibodies in WG (89.7% vs. 86.2% EliA and 79.3% Varelisa). In conclusion, the EliA MPO-ANCA and PR3-ANCA methods provide good diagnostic accuracy and excellent analytical accuracy, which, in association with the practicality of the automated EliA system, make this method a useful tool for the diagnosis of ANCA-associated vasculitides.

Prognosis of ARF in hospitalized elderly patients.

BACKGROUND: Differentiation between hospital-acquired acute renal failure (ARF) and community-acquired ARF may have epidemiological implications that lead to different prognoses in hospitalized patients. Such a comparison has not yet been made among elderly individuals. METHODS: We performed a 3-year prospective study in a tertiary referral hospital of 325 patients aged 60 years or older who presented with ARF. Patients were divided into 2 groups; those with hospital-acquired ARF (n = 154) and community-acquired ARF (n = 171), and were followed up in relation to mortality. Multiple logistic regression was used in the analysis. RESULTS: The overall mortality rate in this elderly population was 54%; 59% for the group with hospital-acquired ARF and 41% for the group with community-acquired ARF (P < 0.001). Groups differed (P < 0.01) in relation to cause of ARF, preexisting diseases, organ failure, sepsis, and performance of dialysis, among other factors. The adjusted mortality risk for the group with hospital-acquired ARF was 2.23 times greater than for the group with community-acquired ARF (95% confidence interval [CI], 1.21 to 4.08). In the group with hospital-acquired ARF, factors associated with mortality were neurological failure (odds ratio [OR], 2.97; 95% CI, 1.17 to 7.60), hematologic failure (OR, 4.30; 95% CI, 1.63 to 11.34), and oliguria (OR, 12.14; 95% CI, 4.62 to 31.87). In the group with community-acquired ARF, significant factors were neoplasia, cardiac disease, hepatic disease, cardiovascular failure, oliguria, and sepsis. CONCLUSION: Differentiation between hospital-acquired ARF and community-acquired ARF is important in determining the prognosis of ARF in the elderly. Mortality risk factors are different in these 2 groups, and knowledge of their characteristics may allow better management of such patients.

Indexes of power and aerobic capacity obtained in cycle ergometry and treadmill running: comparisons between sedentary, runners, cyclists and triathletes

The objectives of this study were: a) to determine, in a cross-sectional manner, the effect of aerobic training on the peak oxygen uptake...

Metabolic and ventilatory parameters of four activities of daily living accomplished with arms in COPD patients.

STUDY OBJECTIVE: The upper limbs are involved in the activities of daily living (ADLs). Normal subjects usually perform such activities without noticing the energy cost, but patients with COPD report tiredness when performing them. This study was designed to assess the metabolic and ventilatory demands in patients with COPD during the performance of four ADLs involving the upper limbs. DESIGN: The patients were tested on two different days. Oxygen uptake (O(2)), carbon dioxide output (CO(2)), minute ventilation (E), and heart rate were measured while performing four ADLs for 5 min each: sweeping, erasing a blackboard, lifting pots, and replacing lamps. PARTICIPANTS: Ten normal, young, male subjects (mean age, 27.9 years) were selected for testing the reproducibility of the methods, and 9 male patients with COPD (FEV(1), 32.5%; mean age, 58.9 years) entered the study. MEASUREMENTS AND RESULTS: The tests were reproducible for both groups. Patients with COPD presented a significant increase (p < 0.05) in O(2) (mean, 50.2% of maximum O(2)) and in E (mean, 55.7% of maximum voluntary ventilation [MVV]) in relation to initial resting conditions for all four activities. CONCLUSIONS: We conclude that when performing these four activities, patients with moderate-to-severe COPD present a high O(2), which may explain the tiredness reported by them during simple activities involving the upper limbs; the high E/MVV may be associated to dyspnea.

Estudo comparativo das capacidades aeróbica e anaeróbica de adolescentes com obesidade severa da cidade de Säo Paulo / Comparative study of the aerobic and anaerobic capacities of adolescents with severe obesity in the Säo Paulo city

A obesidade, antes um problema de saúde nos países desenvolvidos, tem-se tornado, ultimamente, um problema de saúde pública também nos países em desenvolvimento, sendo mais preocupante em crianças e adolescentes,uma vez que, estabelecida nesta faixa etária, determina uma potencial piora das condiçöes de saúde associada à obesidade na vida adulta. O estudo comparou a capacidade aeróbica e anaeróbica de meninos e meninas, com obesidade severa da cidade de Säo Paulo-Brasil.Sessenta meninos e sessenta meninas com obesidade severa (índice de massa corpórea - IMC 30.0) com idade entre 14 e 19 anos realizaram densidometria óssea (DEXA), avaliaçåo da capacidade anaeróbia em bicicleta.Os meninos apresentam valores aumentados para consumo máximo de oxigênio (VO2 MÄX), limiar anaeróbio ventilatório (VO2 LV-I), frequência cardíaca do limiar aeróbio ventilatório (FC LV-I), potência máxima (PT máx) e potência média (PT med), embora apresentassem mesma gordura corporal total (MG total) e uma massa magra total (MM total) maior se comparados com as meninas: O dados apresentam valores semelhantes aos apresentados em outros trabalhos de normalidade para capacidade aeróbia e anaeróbia em adolescentes obesos e näo obesos, confirmando a existência de diferenças entre os sexos na performance física.Quando analisamos as diferenças de composiçåo corporal, embora haja uma igualdade se comparando o IMC e a quantidade de gordura corporal total de ambos os grupos, podemos constatar uma diferença significativa quanto a quantidade de massa muscular total, o que poderia explicar tal diferença na performance física entre os sexos