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Individuals with obesity are more likely to develop asthma, but the exact mechanism is still uncertain and several hypotheses have been raised, such as the release of inflammatory mediators secreted by adipose tissue.To assess the effects of weight loss in patients submitted to bariatric surgery on pulmonary and systemic inflammation.The study evaluated patients undergoing bariatric surgery (Roux-en-Y gastric bypass) with the diagnosis of asthma, except smokers. The patients were evaluated at the time of entry into a preoperative weight loss group (T1), just before bariatric surgery (T2), six months after surgery (T3), and 12 months after surgery (T4). The following were measured: anthropometric data, dosage of systemic inflammatory markers by means of blood collection, pulmonary inflammatory markers obtained by induced sputum collection, pulmonary function parameters, and asthma activity assessed by a Asthma Control Test (ACT) questionnaire.Nineteen patients participated in the study. There were significant reductions in the systemic levels of interleukin (IL)-8 (p = 0.002), C-reactive protein (CRP) (p = 0.003), leptin (p = 0.001) and tumor necrosis factor (TNF)-α (p = 0.007), and significant increase in the systemic levels of IL-6 (p = 0.004) over time and adiponectin in T2 (p = 0.025). In regards to pulmonary inflammation, there were significant reductions in the sputum levels of TNF-α (p 0.001). There was no significant improvement of the pulmonary function parameters (p 0.05) and significant improvement in asthma activity scores (p 0.0001).Weight loss was associated with significant changes in the systemic and pulmonary inflammatory profiles of individuals with asthma, leading to a better asthma control as a result of an increase in some anti-inflammatory mediators and a reduction of pro-inflammatory mediators.

Glucagon-like peptide-1 (GLP-1) is a hormone widely studied in the short-term postoperative follow-up of Roux-en-Y gastric bypass due to its elevation and association with improvement of the glucose metabolism, but there are few studies in 10 years after RYGB follow-up with the same patient. Twenty morbidity obesity patients were submitted to RYGB; these patients were divided into two groups: normal glucose-tolerant morbidly obese patients (NGT) 11 patients and abnormal glucose metabolism morbidly obese patients (AGM) 9 patients. Oral glucose tolerance test (OGTT) was done during four different periods: T1 (first evaluation), T2 (pre-surgery), T3 (9 months after surgery) and T4 (10 years after surgery). Groups were matched for age and gender, and as NGT and AGM had BMI of 46.31 ± 5.03 kg/m2 and 50.87 ± 10.31 kg/m2. After 10 years of RYGB, they were obesity grade I with BMI for NGT 32.45 ± 4.99 kg/m2 and AGM 34.85 ± 4.46 kg/m2. Plasma glucose levels decreased NGT group at T4 period had a significant reduction at 120 min after OGTT for NGT 55.49 ± 17.15 mg/dL (p˂0.001). Insulin levels changed from T1 to T4 for the NGT group. GLP-1 curves were statistically different between the NGT and AGM groups. The AGM group had a higher mean for GLP-1 secretion at T4 period and at 30 min of OGTT 63.85 ± 37.98 pmol/L when compared to NGT 50.73 ± 24.82 pmol/L with AGM > NGT with p˂0.001. Evaluation of the same patient during 4 different periods shows that, even with weight regain, after 10-years of RYGB high levels of GLP-1 remained which can be associated with metabolic improvement especially at the NGT group.

Resumo: A avaliação de um processo de ensino-aprendizagem é fundamental para rever objetivos, metodologia e conteúdo. Avaliações de competência clínica através de exames clínicos objetivos estruturados têm-se firmado como instrumentos válidos, fidedignos e efetivos de avaliação de habilidades, além de permitir apreciar as atitudes dos alunos de Medicina. A Faculdade de Ciências Médicas da Unicamp vem implementando extensa reforma curricular nos últimos anos, baseada em módulo de aprendizagem que incluem o ensino de técnicas de entrevista aos aluno do 2° ano de graduação. Descrevemos a implantação de um método baseado em pacientes-padrão, treinados para avaliar conhecimento adquirido, habilidades e as atitudes dos alunos. Os resultados do projeto-piloto aplicado a 10 voluntários no módulo de habilidades de entrevista mostram que o método é factível, relativamente simples e barato, permite um avaliação objetiva das habilidades adquiridas além de identificar precocemente indivíduos com possíveis problemas na relação médico-paciente. O método permitiu ainda identificar pontos que necessitam de reforço por parte do corpo docente assim como rever os objetivos propostos pelo módulo em questão. Abstract: Evaluation of the teaching and learning process is essential in order to review objetives, methods and contentes. The use of objective, structured clinical examination methods is well established as a valid, reliable and effective process for the assessment of clinical skills, besides allowing the perception ofmedical students’ atitudes. The Faculty of Medical Science of Unicamp has implementd na extensive curriculum restructuring process based on learning units that include the teaching of interview techniques to second grade students. We describe the implementation of na assessment method based on standart-pacients trained to evaluate students’ acquantance, skills and atitudes. The results of the pilot Project applied to 10 voluntees demosntrate that the method is feasible, relatively simple and inexpansive and allows na objective assessment of the students’ skills besides providing precocious indications of possible patient-doctor relationship problems. The method allowed us to identify points that need to be reinforced by the teachers during the course as well as to review our aims in the module evaluated.

The literature lacks data on the use of the gold-standard hyperinsulinemic-euglycemic clamp (HEC) technique for the evaluation of insulin resistance (IR) in depot-medroxyprogesterone acetate (DMPA) users. This study assessed carbohydrate metabolism in non-obese users of DMPA using the HEC technique.A prospective, non-randomized, comparative study conducted at the Family Planning Clinic/Metabolic Unit, University of Campinas, Brazil. Forty-eight women aged 18-39 years underwent HEC: 30 initiating use of DMPA and 18 initiating use of a copper intrauterine device (IUD). Data from 15 women in each group, who completed the follow-up and underwent HEC at12 months, were compared using repeated measures ANOVA. All women were advised to perform aerobic physical exercise for 150 min/week; body composition and total energy intake were evaluated. Main outcome measures were IR defined by M-value4 mg/kg/min, and blood levels of insulin. Additional outcomes were total cholesterol, HDL-cholesterol, triglycerides, LDL-cholesterol, adipokines and free fatty acids.At 12 months, two women in the DMPA group and none in the IUD group had developed IR. The groups were similar in in M-values and in blood levels of insulin, total cholesterol, HDL-cholesterol, LDL-cholesterol, adipokines or free fatty acids. Triglyceride levels increased in the DMPA group when compared to the IUD group, 80.0 (SD 47.8) versus 61.8 (SD 35.8) mg/dL respectively, (p=.033); and increased the total daily energy intake, 1828.3 (SD 518.9) versus 1300.8 (SD 403.4) kilocalories/24hs, respectively in the same groups, (p=.041). All the DMPA users showing higher insulin sensitivity at 12 months reported performing physical activity regularly.Changes occurred in carbohydrate metabolism in DMPA users in the first year of use of the method. It is possible that the regular aerobic exercise may exert a beneficial and protective effect against the factors that trigger these changes.Carbohydrate metabolism undergoes adverse changes in few young non-obese women during the first year of DMPA use and regular aerobic exercise may exert a beneficial and protective effect against these changes.

Several studies have shown the correlation between vitamin D [25(OH)D] deficiency and thyroid autoimmunity and reducing of thyroid autoantibodies in patients with normal levels of vitamin D combining with thyroid hormone replacement. However, other authors not agree with this association. It is still unclear whether the low 25(OH)D levels are the result of HT disease or a part of its cause. We studied 88 patients with HT regarding vitamin D status and thyroid autoimmunity markers as well as the relationship with cytokines produced by Th1, Th2, and Th17 cells compared with a control group of 71 euthyroid healthy subjects. The present study demonstrated that vitamin D concentrations were similar in patients HT and the control group. The reduction of free T4 levels was a predictor of vitamin D insufficiency for Hashimoto's thyroiditis, but not for the control group. Lower concentrations of TNF-α was a predictor of lower levels of vitamin D. Differences in the association between HT and vitamin D insufficiency remain unresolved in the literature. The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

AimsWe compare spectral analysis of photoplethysmography (PTG) with insulin resistance measured by the hyperinsulinemic euglycemic clamp (HEC) technique.Material and MethodA total of 100 nondiabetic subjects, 43 men and 57 women aged 20–63years, 30 lean, 42 overweight and 28 obese were enrolled in the study. These patients underwent an examination with HEC, and an examination with the PTG spectral analysis and calculation of the PTG Total Power (PTG-TP). Receiver-operating characteristic (ROC) curves were constructed to determine the specificity and sensitivity of PTG-TP in the assessment of insulin resistance.ResultsThere is a moderate correlation between insulin sensitivity (M-value) and PTG-TP (r=− 0.64, p406.2. This cut-off had a sensitivity=95.7%, specificity =84,4% and the area under the ROC curve (AUC)=0.929 for identifying insulin resistance. All AUC ROC curve analysis were significant (p

Decreased insulin sensitivity in patients with hypopituitarism without GH replacement (pHP-WGHR) remains conflicting in literature. It is known that these patients present a decrease in free fat mass and an increase in fat mass. Typically, these kinds of alterations in body composition are associated with a decrease in insulin sensitivity; however, there is no consensus if this association is found in pHP-WGHR. Thus, we investigated pHP-WGHR regarding insulin sensitivity by euglycemic hyperinsulinemic clamp, the gold standard method, and body composition. In a cross-sectional study, we evaluated 15 pHP-WGHR followed up in a Service of Neuroendocrinology and 15 individuals with normal pituitary function as a control group with similar age, gender and body mass index. Insulin sensitivity was evaluated by euglycemic hyperinsulinemic clamp and homeostatic model assessment insulin resistance (HOMA-IR). Kappa coefficient evaluated the agreement between these two methods. Percentage of fat mass, percentage of free fat mass, fat mass weight and free fat mass weight were assessed by electrical bioimpedance. The pHP-WGHR presented similar insulin sensitivity to control group by euglycemic hyperinsulinemic clamp, both by the M-value, (p = 0.0913) and by the area under the glucose infusion rate curve, (p = 0.0628). These patients showed lower levels of fasting glycemia (p = 0.0128), insulin (p = 0.0007), HOMA-IR (p = 0.009). HOMA-IR shows poor concordance with euglycemic hyperinsulinemic clamp (Kappa = 0.16) in pHP-WGHR, while in the control group the agreement was good (Kappa = 0.53). The pHP-WGHR presented higher values of percentage of fat mass (p = 0.0381) and lower values of percentage of free fat mass (p = 0.0464) and free fat mass weight (0.0421) than the control group. This study demonstrated that the insulin sensitivity evaluated by euglycemic hyperinsulinemic clamp in pHP-WGHR was similar to individuals with normal pituitary function, despite the pHP-WGHR presenting higher fat mass percentage. HOMA-IR was not a good method for assessing insulin sensitivity in pHP-WGHR.

Incretin effect—the potentiation of glucose-stimulated insulin release induced by the oral vs the i.v. route—is impaired in dysglycaemic states. Despite evidence from human islet studies that NEFA interfere with incretin function, little information is available about the effect in humans. We tested the impact of acute bidirectional NEFA manipulation on the incretin effect in humans. Thirteen individuals with type 2 diabetes and ten non-diabetic volunteers had a 3 h OGTT, and, a week later, an i.v. isoglycaemic glucose infusion (ISO; OGTT matched). Both pairs of studies were repeated during an exogenous lipid infusion in the non-diabetic volunteers, and following acipimox administration (to inhibit lipolysis) in people with diabetes. Mathematical modelling of insulin secretion dynamics assessed total insulin secretion (TIS), beta cell glucose sensitivity (β-GS), glucose-induced potentiation (PGLU) and incretin-induced potentiation (PINCR); the oral glucose sensitivity index was used to estimate insulin sensitivity. Lipid infusion increased TIS (from 61 [interquartile range 26] to 78 [31] nmol/m2 on OGTT and from 29 nmol/m2 [26] to 57 nmol/m2 [30] on ISO) and induced insulin resistance. PINCR decreased from 1.6 [1.1] to 1.3 [0.1] (p

TSH-suppression is a therapy for thyroid cancer management, but it may lead to adverse effects, which should be balanced with its benefits. Previous studies evaluating the consequences of TSH suppression on insulin sensitivity have only been done with indirect techniques, and results were controversial. Therefore, we aimed to assess insulin sensitivity in patients with thyroid cancer and suppressed thyroid-stimulating hormone (TSH) with the most appropriate direct method (hyperinsulinemic-euglycemic clamp) in order to get a more conclusive response about the topic.A group of 20 non-obese and non-diabetic thyroid cancer patients with suppressed TSH underwent a hyperinsulinemic-euglycemic clamp to evaluate insulin sensitivity. Their results were compared to the results of a sex and body mass index (BMI) -paired control group composed of 20 healthy volunteers.Patients were all female, aged 36.8 ± 10.2 years-old, with mean TSH 0.1 ± 0.1 μIU/mL and mean BMI 26.2 ± 3.3 kg/mThis study shows for the first time that subclinical thyrotoxicosis in patients with thyroid cancer is associated with insulin resistance, as measured by hyperinsulinemic-euglycemic clamp technique. Such finding may be taken into consideration by clinicians when balancing risks and benefits of TSH-suppression therapy in thyroid cancer patients.

Objective: To investigate the body composition and metabolic profile in individuals in terms of different concentrations of serum vitamin D, ranging from deficiency to sufficiency. Methods: A cross-sectional study of 106 adults of both genders, who were divided into three groups according to vitamin D levels: deficiency

Background Squamous cell carcinoma of the head and neck (SCCHN) usually emerges as a set of signs and symptoms that, either alone or in combination with standard treatment, may lead to malnutrition and weight loss. Methods This study evaluated patients with SCCHN before day 0 and 30 days after the end of treatment, with/without tumor resection. Each individual patient underwent analyses of body composition and resting metabolic rate, as well as assessment of serum glucose, insulin, leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), IL-1β, and insulin sensitivity. Results There was body mass loss during treatment and significant reduction in body fat and free fat mass. Early nutritional monitoring and tumor resection before treatment led to a better nutritional status and reduced inflammatory state. Conclusion Early nutritional monitoring and resection of the tumor by surgery may be important factors for patients to better tolerate treatment. © 2014 Wiley Periodicals, Inc. Head Neck 37: 97–102, 2015

Objective: The visceral fat is linked to insulin resistance, the metabolic syndrome, type 2 diabetes and an increased cardiovascular risk, but it is not clear whether it has a causative role. Design and Methods: Surgical resection of this fat depot is a research model to address this issue. Twenty premenopausal women with metabolic syndrome and grade III obesity were randomized to undergo Roux-en-Y gastric bypass (RYGBP) either alone or combined with omentectomy. Insulin sensitivity (IS; euglycemic-hyperinsulinemic clamp), acute insulin response to glucose (AIR; intravenous glucose tolerance test), disposition index (DI = AIR × IS measured by clamp), lipid profile, adipokine profile (leptin, adiponectin, resistin, visfatin, interleukin-6, TNF-α, MCP-1), ultra-sensitive C-reactive protein (CRP), body composition, and abdominal fat echography were assessed prior to surgery and 1, 6, and 12 months post-surgery. Results: Omentectomy was associated with greater weight loss at all time points. IS improved similarly in both groups. Omentectomy was associated to lower CRP after 12 months, but it did not influence adipokines and other metabolic parameters. Among non-diabetic subjects, omentectomy was associated with a preservation of baseline AIR after 12 months (as opposed to deterioration in the control group) and a greater DI after 6 and 12 months. Conclusion: Although omentectomy did not enhance the effect of RYGBP on insulin sensitivity and adipokines, it was associated with a preservation of insulin secretion, a greater weight loss, and lower CRP.

Previous reports highlight the role of systemic inflammation in the genesis of non-thyroidal illness syndrome and type 2 diabetes mellitus (T2DM). Our objective was to assess whether body mass index and the low-grade systemic inflammation would be associated with changes in thyroid hormone metabolism in patients with type 2 diabetes. This was a cross-sectional study of 104 subjects; 52 patients with type 2 diabetes and 52 in a control group, paired by age, gender and body mass index. We measured total (T) and free (F) thyroxine (T4) and triiodothyronine (T3), reverse T3 (rT3), the ratios FT3/rT3, FT3/FT4 and FT4/rT3, clinical parameters (age, gender, diabetes duration and complications, body mass index, waist circumference, hypertension, HbA1c), and high sensitivity C-reactive protein. Patients with DM presented lower levels of TT4 (p=0.006), TT3 (p

Objective The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. Subjects and methods Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI < 30 kg/m2, and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. Results After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group’s only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained < 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. Conclusion Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus.

Agradecimentos: The authors wish to thank the biologist Conceicao Aparecida da Silva for her inestimable help in collecting blood samples and laboratory analysis. This study was received financial support of FAPESP (Sao Paulo Research Support Foundation-Grants 2010/08854-0 and 2013/03295-1) Abstract: Thyroid hormone (TH) abnormalities are common in patients with diabetes mellitus (DM). These thyroid hormone abnormalities have been associated with inflammatory activity in several conditions but this link remains unclear in DM. We assessed the influence of subclinical inflammation in TH metabolism in euthyroid diabetic patients. Cross-sectional study involving 258 subjects divided in 4 groups: 70 patients with T2DM and 55 patients with T1DM and two control groups of 70 and 63 non-diabetic individuals, respectively. Groups were paired by age, sex, and body mass index (BMI). We evaluated the association between clinical and hormonal variables [thyrotropin, reverse T3 (rT3), total and free thyroxine (T4), and triiodothyronine (T3)] with the inflammation markers C-reactive protein (hs-CRP), serum amyloid A (SAA), and interleukin-6 (IL-6). Serum T3 and free T3 were lower in patients with diabetes (all P < 0.001) compared to the control groups. Interleukin-6 showed positive correlations with rT3 in both groups (P < 0.05). IL-6 was independently associated to FT3/rT3 (B = -0.193; 95 % CI -0.31; -0.076; P = 0.002) and FT4/rT3 (B = -0.107; 95 % CI -0.207; -0.006; P = 0.039) in the T1DM group. In the T2DM group, SAA (B = 0.18; 95 % CI 0.089; 0.271; P < 0.001) and hs-CRP (B = -0.069; 95 % CI -0.132; 0.007; P = 0.03) predicted FT3 levels. SAA (B = -0.16; 95 % CI -0.26; -0.061; P = 0.002) and IL6 (B = 0.123; 95 % CI 0.005; 0.241; P = 0.041) were related to FT4/FT3. In DM, differences in TH levels compared to non-diabetic individuals were related to increased subclinical inflammatory activity and BMI. Altered deiodinase activity was probably involved. These findings were independent of sex, age, BMI, and HbA1c levels FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP Fechado

La enfermedad de Chagas (EC) es una infeccion causada por Trypanosoma cruzi que aun hoy constituye un problema de salud en los paises en desarrollo de Sudamerica y causa trastornos de la conduccion e insuficiencia cardiaca cronica. En este trabajo, el Grupo de Estudios de Enfermedad de Chagas del Hospital de la Universidad Estatal de Campinas ha analizado a 136 individuos para investigar la relacion entre insuficiencia cardiaca cronica y concentracion serica de proteina C reactiva (PCR). La PCR estratificada segun diferentes apariciones clinicas de la EC revelo que los pacientes con cardiopatia grave y cardiopatia no chagasica tenian estadisticamente concentraciones de PCR mayores que los otros grupos de control y cardiopatia leve (p Estos datos refuerzan la asociacion entre inflamacion cronica y aparicion de insuficiencia cardiaca. Aunque la elevaciones de PCR no estan exclusivamente relacionadas con la EC, serian un marcador asequible de la evolucion de la EC hacia fases avanzadas.

Introduction Wounds are a common health problem. Coffee is widely consumed and its oil contains essential fatty acids. We evaluated the local (skin) and systemic effects associated with the topical use of coffee oils in rats. Methods Punch skin wounds (6 mm) incisions were generated on the backs of 75 rats. Saline (SS), mineral oil (MO), green coffee oil (GCO), roasted coffee oil (RCO), green coffee ground oil (GCGO) or roasted coffee ground oil (RCGO) were topically applied to the wounds. Healing was evaluated by visual and histological/morphometric optical microscopy examination; second harmonics generation (SHG) microscopy, wound tissue q-PCR (values in fold-change) and blood serum (ELISA, values in pg/mL). Results RCO treated animals presented faster wound healing (0.986 vs. 0.422), higher mRNA expression of IGF-1 (2.78 vs. 1.00, p = 0.01), IL-6 (10.72 vs. 1.00, p = 0.001) and IL-23 (4.10 vs. 1.2, p = 0.05) in early stages of wound healing; higher IL-12 (3.32 vs. 1.00, p = 0.05) in the later stages; and lower serum levels of IFN-γ (11.97 vs. 196.45, p = 0.01). GCO treatment led to higher mRNA expression of IL-6 (day 2: 7.94 vs. 1.00, p = 0.001 and day 4: 6.90 vs. 1.00, p = 0.01) and IL-23 (7.93 vs. 1.20, p = 0.001) in the early stages. The RCO treatment also produced higher serum IFN-α levels throughout the experiment (day 2: 52.53 vs. 21.20; day 4: 46.98 vs.21.56; day 10: 83.61 vs. 25.69, p = 0.05) and lower levels of IL-4 (day 4: 0.9 vs.13.36, p = 0.01), adiponectin (day 10: 8,367.47 vs. 16,526.38, p = 0.001) and IFN-γ (day 4: 43.03 vs.196.45, p = 0.05). The SHG analysis showed a higher collagen density in the RCO and GCO treatments (p = 0.05). Conclusion Topical treatment with coffee oils led to systemic actions and faster wound healing in rats. Further studies should be performed are necessary to assess the safety of topical vegetal oil use for skin lesions.

It has been proposed that there is improvement in glucose and insulin metabolism after weight loss in patients who underwent diet restriction and bariatric surgery. Eleven normal glucose tolerant (NGT) morbidly obese patients [body mass index (BMI), 46.1 ± 2.27 g/m2] and eight abnormal glucose metabolism (AGM) obese patients (BMI, 51.20 kg/m2) were submitted to diet-restriction and bariatric surgery. Prospective study on weight loss changes, over the glucose, insulin metabolism, glucagon-like peptide-1 (GLP-1), and adiponectin levels were evaluated by oral glucose tolerance test during three periods: T1 (first evaluation), T2 (pre-surgery), and T3 (9 months after surgery). Insulin levels improved after surgery. T1 was 131.1 ± 17.60 pmol/l in the NGT group and 197.57 ± 57.94 pmol/l in the AGM group, and T3 was 72.48 ± 3.67 pmol/l in the NGT group and 61.2 ± 9.33 pmol/l in the AGM group. The major reduction was at the first hour of the glucose load as well as fasting levels. At 9 months after surgery (T3), GLP-1 levels at 30 and 60 min had significantly increased in both groups. It was observed that the AGM group had higher levels of GLP-1 at 30 min (34.06 ± 6.18 pmol/l) when compared to the NGT group (22.69 ± 4.04 pmol/l). Homeostasis model assessment of insulin resistance from the NGT and AGM groups had a significant reduction at periods T3 in relation to T1 and T2. Adiponectin levels had increased concentration in both groups before and after surgical weight loss. However, it did not have any statistical difference between periods T1 vs. T2. Weight loss by surgery leads to improvement in the metabolism of carbohydrates in relation to sensitivity to the insulin, contributing to the reduction of type 2 diabetes incidence. This improvement also was expressed by the improvement of the levels of adiponectin and GLP-1.

To assess the prevalence of insulin resistance (IR) and associated factors in contraceptive users.A total of 47 women 18 to 40 years of age with a body mass index (kg/m(2))30, fasting glucose levels100 mg/dl and 2-hour glucose level140 mg/dl after a 75-g oral glucose load were submitted to a hyperinsulinemic-euglycemic clamp. The women were distributed in tertiles regarding M-values. The analysed variables were use of combined hormonal/non-hormonal contraception, duration of use, body composition, lipid profile, glucose levels and blood pressure.IR was detected in 19% of the participants. The women with low M-values presented significantly higher body fat mass, waist-to-hip ratio, fasting insulin, HOMA-IR and were nulligravida, showed1 year of contraceptive use and higher triglyceride levels. IR was more frequent among combined oral contraceptive users, however no association was observed after regression analysis.The prevalence of IR was high among healthy women attending a family planning clinic independent of the contraceptive method used with possible long-term negative consequences regarding their metabolic and cardiovascular health. Although an association between hormonal contraception and IR could not be found this needs further research. Family planning professionals should be proactive counselling healthy women about the importance of healthy habits.

Alterations in thyroid hormone levels are found associated with inflammation in patients with non-thyroidal illness (NTIS) and are common in patients with type 2 diabetes mellitus (T2DM). Inflammation has also been linked with development of cardiovascular events (CVE) in T2DM. Our objective was to assess whether thyroid hormone abnormalities typical of NTIS in patients with T2DM are related to inflammation and CVE. This was a cross-sectional study of 140 subjects; 70 with T2DM and 70 as a control group paired by age, sex and body mass index (BMI). We recorded age, sex, BMI, waist/hip ratio, diabetes duration, HbA1c, CVE history, serum amyloid A (SAA), TSH, total (T) and free (F) T4 and T3, reverse T3 (rT3) and TT3/rT3 ratio. Patients with T2DM had lower levels of TT4 (p = 0.012), TT3 (p

Squamous cell carcinoma of the head and neck (SCCHN) usually emerges as a set of signs and symptoms that, either alone or in combination with standard treatment, may lead to malnutrition and weight loss.This study evaluated patients with SCCHN before day 0 and 30 days after the end of treatment, with/without tumor resection. Each individual patient underwent analyses of body composition and resting metabolic rate, as well as assessment of serum glucose, insulin, leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), IL-1β, and insulin sensitivity.There was body mass loss during treatment and significant reduction in body fat and free fat mass. Early nutritional monitoring and tumor resection before treatment led to a better nutritional status and reduced inflammatory state.Early nutritional monitoring and resection of the tumor by surgery may be important factors for patients to better tolerate treatment.

Objective Infection with hepatitis C virus (HCV) is a serious public health problem worldwide. In clinical studies, weight loss has been reported in 11% to 29% of patients treated with pegylated interferon-α-2a/2b. Few reports have tried to explain such a weight loss. The aim of this study was to evaluate nutritional status, body composition, and resting energy expenditure (REE) in patients with chronic hepatitis C before and during treatment with pegylated interferon and ribavirin. Methods This was a prospective study with the evaluation of patients with hepatitis C virus before and after 12 wk of treatment with pegylated interferon and ribavirin. The evaluation consisted of anthropometry (weight, height, body mass index, and waist circumference), and body composition was determined by bioelectrical impedance analysis. The REE of each individual was obtained by indirect calorimetry. To compare the two phases of treatment, the Wilcoxon test was used. The significance level was 5%. Results Subjects had significant weight loss during treatment with a consequent decrease in body mass index. This weight decrease was accompanied by a significant decrease in body fat and no decrease in fat-free mass. There was a significant decrease in energy intake as assessed by 24-h recall. However, there was no change in REE and in REE corrected for fat-free mass. Conclusion Our study of patients with hepatitis C treatment showed that these patients had significant weight loss and this was not associated with changes in energy expenditure. However, we observed a significant decrease in energy intake, pointing to a possible need for intervention measures to decrease the damage.

Type 2 diabetes has a major impact on patients lives and the healthcare network. Given the growth in qualitative information on diabetes, it becomes important to systematize this knowledge. A meta-study on diabetes was conducted through analysis on 42 articles that were made in journals at the periodicals portal of the Coordination Office for Advancement of Higher-level Personnel (Capes). We found that the studies reviewed had a good theoretical basis, which included: care management, health-disease concepts, professional-patient relationships, professional practices and treatment compliance. The articles clearly described the methodological procedures used. The use of interviews and focal groups for data gathering predominated, and it was sought to explore different views of the individuals investigated. It was reaffirmed that it was important for health professionals and managers to implement healthcare policies, programs and models that are appropriate for the specific features of chronic illness, guided by comprehensive care and co-responsibility. O diabetes tipo 2 produz um grande impacto sobre a vida dos pacientes e a rede assistencial. Diante do crescimento de informações qualitativas sobre diabetes, torna-se importante a sistematização desse conhecimento. Foi realizado um metaestudo sobre diabetes, por meio da análise de 42 artigos disponibilizados em revistas do portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Identificamos bom grau de teorização nos estudos revisados, os quais abordaram: gerenciamento do cuidado, concepções saúde-doença, relação profissional-paciente, práticas profissionais e adesão ao tratamento. Os artigos descreveram claramente os procedimentos metodológicos adotados. Houve predomínio do uso de entrevistas e grupos focais para a coleta de dados, buscando explorar diferentes visões dos sujeitos investigados. Afirma-se a importância dos profissionais de saúde e gestores implementarem políticas, programas e modelos de atenção adequados às especificidades do adoecimento crônico, orientados pelo eixo da integralidade e corresponsabilização pelo cuidado. La diabetes tipo 2 produce un gran impacto sobre la vida de los pacientes y la red asistencial. Ante el crecimiento de informaciones cualitativas sobre diabetes, llega a ser importante la sistematización de este conocimiento. Se ha realizado un meta-estudio sobre diabetes por medio del análisis de 42 artículos disponibles en revistas del portal de periódicos de la Coordinación de Perfeccionamiento de Personal de Nivel Superior (Capes). Identificamos un buen grado de teorización en los estudios revisados que tratan de la dirección del cuidado, concepciones de salud-enfermedad, relación profesional-paciente, prácticas profesionales y adhesión al tratamiento. Los artículos describen claramente los procedimientos metodológicos adoptados. Ha predominado el uso de entrevistas y grupos focales para la colecta de datos buscando explorar diferentes visiones de los sujetos investigados. Se afirma la importancia de los profesionales de salud y gestores que implementan políticas, programas y modelos de atención adecuados a las especificidades del enfermo crónico orientados por el eje de la integralidad y co-responsabilización por el cuidado.

Insulin resistance ameliorates after bariatric surgery, yet there is still a need for data on the acute effect of Roux-en-Y gastric bypass (RYGBP) on insulin sensitivity.The objective of the study was to describe the acute effect of RYGBP on insulin sensitivity, measured by both the euglycemic-hyperinsulinemic clamp and homeostasis model assessment insulin resistance index (HOMA-IR).Evaluations were conducted before and 1 month after RYGBP at State University of Campinas (São Paulo, Brazil).Patients included 19 premenopausal women with metabolic syndrome aged 35.3 (6.7) yr, body mass index 45.50 (3.74) kg/m2 [mean (sd)]. Six had mild type 2 diabetes, seven impaired glucose tolerance, and six normal glucose tolerance.The volunteers underwent RYGBP either alone or combined with omentectomy. Euglycemic-hyperinsulinemic clamp, HOMA-IR, nonesterified fatty acids, leptin, ultrasensitive C-reactive protein, adiponectin, and IL-6 were assessed at baseline and 4.5 (0.9) wk postoperatively.Fasting glucose decreased [99.2 (13.1) to 83.6 (8.1) mg/dl, P0.01] along with a reduction in fasting insulin [30.4 (17.0) to 11.4 (6.3) mU/liter, P0.01]. M value did not improve postoperatively [25.82 (6.30) to 22.02 (6.05) micromol/kgFFM.min] despite of a decrease in body weight [114.8 (14.5) to 102.3 (14.5) kg, P0.001]. This finding was discordant to the observation of an improvement in HOMA-IR [3.85 (2.10) to 1.42 (0.76), P0.01]. Nonesterified fatty acids increased. Leptin and C-reactive protein decreased. IL-6 and adiponectin remained unchanged.A month after RYGBP, fasting glucose metabolism improves independent of a change in peripheral insulin sensitivity.

O aumento do uso de Medicinas Alternativas e Complementares (MAC) motivou o crescimento do número de estudos qualitativos sobre o tema, justificando a realização de sínteses sobre esse material. Este artigo apresenta uma revisão sistemática de pesquisas qualitativas sobre MAC publicadas em periódicos internacionais. Esta revisão se orientou pela metodologia dos metaestudos. Foi realizada busca em revistas do Portal Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e foram selecionados 32 artigos para análise. Os estudos revisados apresentam questões que têm como foco: o paciente, suas experiências terapêuticas e seus contextos sociais e culturais; o profissional, as relações profissionais e o processo de profissionalização das MAC; a MAC e sua relação com a biomedicina. Conclui-se que as pesquisas qualitativas sobre as MAC ensejam um olhar exploratório sobre o tema, procurando identificar as experiências de pacientes e profissionais com essas terapêuticas, assim como buscam discutir as conseqüências desse uso para a Medicina Convencional ou biomedicina. The growing use of Complementary and Alternative Medicines (CAM) has led to an increase in the number of qualitative studies on the subject, thus justifying a meta-synthesis of the resulting material. The current article presents a systematic review of qualitative studies on CAM published in international journals. The review was conducted according to the meta-synthesis methodology. A search was performed in journals through the Periodicals Periodical of CAPES, the National Agency for the Evaluation of Graduate Studies, and 32 articles were selected for analysis. The reviewed studies raise questions focusing on: patients, their therapeutic experiences, and their social and cultural contexts; professionals, professional relations, and the process of professionalization of CAM; and CAM and their relationship to biomedicine. The article concludes that qualitative studies on CAM call for an exploratory view of the theme, seeking to identify the experiences of patients and professionals with these therapies and discussing the impact of their use on conventional medicine or biomedicine.

The growing use of Complementary and Alternative Medicines (CAM) has led to an increase in the number of qualitative studies on the subject, thus justifying a meta-synthesis of the resulting material. The current article presents a systematic review of qualitative studies on CAM published in international journals. The review was conducted according to the meta-synthesis methodology. A search was performed in journals through the Periodicals Periodical of CAPES, the National Agency for the Evaluation of Graduate Studies, and 32 articles were selected for analysis. The reviewed studies raise questions focusing on: patients, their therapeutic experiences, and their social and cultural contexts; professionals, professional relations, and the process of professionalization of CAM; and CAM and their relationship to biomedicine. The article concludes that qualitative studies on CAM call for an exploratory view of the theme, seeking to identify the experiences of patients and professionals with these therapies and discussing the impact of their use on conventional medicine or biomedicine.

FUNDAMENTOS: A observação de lesões cutâneas é freqüente pelos indivíduos que as têm e por seus familiares. A demanda de pacientes que buscam atenção médica com queixas cutâneas é significante. OBJETIVO: Determinar a freqüência das alterações dermatológicas em usuários do Sistema Único de Saúde de Campinas, Estado de São Paulo, Brasil. MÉTODOS: Cinco unidades básicas de saúde foram selecionadas pela Secretaria de Saúde da Prefeitura Municipal para participar da pesquisa. Todos os pacientes atendidos por profissionais de saúde dessas unidades, no período de 20 dias úteis, deveriam ser avaliados quanto à presença ou ausência de sintomas/sinais dermatológicos. RESULTADOS: Dos 1.491 pacientes avaliados, 358 (24,01%) apresentavam queixas e/ou achados dermatológicos, com maior prevalência nos mais jovens. De todos os usuários atendidos pelos profissionais de saúde que participaram do estudo e que tiveram as fichas preenchidas adequadamente, 9,98% procuraram a Unidade Básica de Saúde primariamente pela queixa dermatológica. CONCLUSÃO: Esses resultados, condizentes com estudos semelhantes realizados em outros países, mostram a importância da especialidade para o desempenho do médico não dermatologista, especialmente dos pediatras, e dão elementos para a discussão curricular sobre a suficiência do tempo destinado ao ensino da especialidade no curso médico. BACKGROUND: Skin lesions are often noted by the individuals bearing them, as well as by their relatives. There is a significant number of patients with skin complaints who search for medical care. OBJECTIVES: To determine the frequency of dermatological complaints and/or findings in users of the primary health care system of the city of Campinas, Brazil. METHODS: Five units were chosen by the Municipal Health Department to participate in this research. All the patients assisted by health professionals of these units were evaluated regarding the presence or absence of dermatological symptoms/ signals in a time period of twenty working days. RESULTS: The acquired data demonstrated that 358 (24.01%) out of 1,491 assisted patients displayed dermatological complaints and/or findings, with a greater prevalence among the younger patients. Of all the users assisted by health professionals who participated in the study and had their records adequately filled out, 9.98% sought the primary care unit primarily because of a dermatological complaint. CONCLUSIONS: These results, in accordance to those of similar surveys carried out in other countries, show the importance of the specialty for the performance of non-dermatologist physicians, pediatricians in particular, and provide elements for the discussion surrounding the curricular reform, concerning the amount of time dedicated to the teaching of dermatology.

Orientador: Mario Jose Abdalla Saad Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: A deficiência de G-6-PD é um erro inato do metabolismo de carboidratos em que a atividade ou estabilidade da glicose-6-fosfato desidrogenase (enzima que cataliza a reação inicial da via das pentoses-fosfato) está reduzida. Uma variedade de alterações é esperada, pois a referida enzima está presente em diferentes células e tecidos, incluindo pâncreas e o córtex da adrenal. Em nosso estudo anterior demonstramos que os portadores dessa deficiência enzimática apresentavam redução na fase rápida de secreção de insulina. No presente trabalho de pesquisa, tivemos como objetivo avaliar de forma mais precisa a secreção de insulina através da quantificação do peptídeo C plasmático após estimulo glicidico, assim como, após a L-arginina, outro estimulante da secreção de insulina, além da sensibilidade periférica à insulina. Constou dos objetivos avaliar a secreção de cortisol após estímulo com ACTH. Para tanto, foram estudados 11 individuos com deficiência de G-6-PD e 11 indivíduos controle que formaram o grupo I e foram submetidos aos testes par avaliar a função secretória da célula ß pancreática (Teste Endovenoso de Tolerância à Glicose - TETG e Teste da Arginina) e a sensibilidade periférica à insulina (Teste de Tolerdncia à Insulina - TTl). E, o grupo II composto com 12 indivíduos com deficiência de G-6-PD e 16 individuos controle que foram submetidos à estimulação das adrenais com ACTH (Teste do Cortisol). Para os dois grupos de estudo os procedimentos experimentais foram realizados após jejum de 12 -14 h. As amostras de sangue para as determinações séricos de glicose, insulina e peptideo C foram coletadas nos tempos: 0 (jejum}, 1, 3, 5, 7, 10, 30 e 60min. após a infusão de 0,5g de glicose/ Kg de peso corporal para o TETG e, 2, 3, 4, 5, 7 e 10 min. após o término da infusão de 50ml de L-arginina a 10% para o teste da arginina. A sensibilidade à insulina foi calculada pelo decaimento dos niveis séricos de glicose nos primeiros 15 min. após a infusão de 0,1 U de insulina regular humana / Kg de Peso corporal. A secreção de cortisol foi avaliada através de amostras basais de cortisol e, 30, 60 e 120 min. após infusão de 0,25mg de ACTH. Os resultados demonstram que pacientes com deficiência de G-6-PD e individuos controle apresentaram valores semelhantes de glicose plasmática durante o TETG. Os niveis séricos de insulina nos primeiros 10 min. do TETG, bem como os índices de avaliação da fase rápida de insulina foram significativamente menores nos pacientes com deficiência de G-6-PD. A quantificação do peptideo C está em concordância com esses resultados, pois os pacientes com deficiência enzimática apresentaram valores de peptideo C significativamente menores nos tempos: 1 min. (C: 3,2 ± 0,5 ng/ml X G-6-PD: 1,2 ± 0,5 ng/ml, p < 0,01); 3 min. (C: 4,5 ± 0,9 ng/ml X G-6-PD: 1,9 ± 0,4 ng/ml, p < 0,02); 5 min. (C: 4,8 ± 0,9 ng/ml X G-6-PD: 1,8 ± 0,3 ng/ml, p < 0,01); 7 min. (C: 4,1 ± 0,7 ng/ml X G-6-PD: 1,4 ± 0,3 ng/ml, p < 0,01); aos 10min. (C: 4,7 ± 1,0 ng/ml X G-6-PD: 1,5 ± 0,4 ng/ml, p < 0,01) e aos 30 min. (C: 4,3 ± 0,5 ng/ml X G-6-PD: 1,9 ± 0,5 ng/ml, p < 0,01) do T. E. T.G. Também a determinação das áreas sob as curvas de peptideo C, nos 60 min. do teste, bem como os índices de avaliação da fase rápida de secreção de insulina demonstram valores menores, estatisticamente significativos para o grupo de pacientes com deficiência de G-6-PD. A extração hepática de insulina,. após estimulo com glicose endovenosa, foi estatisticamente menor para os pacientes com deficiência de G-6-PD (C: 58,4 ± 4,1% X G-6-PD: 38,6 ± 8,8%, p < 0,05). O índice utilizado para avaliar a secreção de insulina no teste da arginna, a média dos três maiores valores nos primeiros 5 min., foi semelhante para os dois grupos quanto aos niveis de insulina, mas significativamente menor no grupo de individuos com deficiência de G-6-PD em relação ao peptideo C. A extração hepática de insulina, durante o teste da arginina, foi menor para o grupo, de portadores de deficiência de G-6-PD, embora esse resultado não tenha sido significativo. A sensibilidade periférica à insulina avaliada pela velocidade de decaimento da glicose foi semelhante nos dois grupos (C: 6,6 ± 1,0%/min. X G-6-PD: 5,56 ± 0.5%/min.). Para o grupo II, onde a secreção de cortisol foi avaliada durante a estimulação com ACTH, os niveis de cortisol plasmático foram significativamente menores nos pacientes com deficiência de G-6-PD aos 30 min. (C: 26 ± 1,2 µg/dl X G-6-PD: 21,1 ± 1,8 µg/dl, p < 0.05). No periodo restante do teste essa diferença desapareceu. A análise das áreas sob as curvas de cortisol foi semelhante nos dois grupos. Esses resultados demonstram que pacientes com deficiência de G-6-PD apresentam diminuição na secreção de insulina (fase rápida) após estimulo com glicose e L-arginina, sensibilidade periférica à insulina semelhante a de indivíduos controle e secreção de cortisol diminuida durante a primeira hora após estimulação com ACTH. Abstract: Glucose - 6 - phosphate dehydrogenase deficiency ( G-6-PD ) is an inborn error of carbohydrate metabolism in which the activity and/or stability of G-6-PD ( enzyme that catalyses the initial reaction of the pentose phosphate pathway) is decreased. Recognition that deficiency of G-6-PD also occurs in other cells, tissues and biologic fluids raises the question that some specific functional alterations might happens in the affected persons. We demonstrated in our previous study that the patients with G-6-PD deficiency showed. Decreased first phase insulin release after glucose stimulation. The aim of the present study was to investigate the insulin secretory activity of pancreatic ß-cells through the determination of the C-peptide concentration after the intravenous glucose and L-arginine stimulation, and to evaluate the insulin sensitivity. It was also a purpose of this study to investigate the cortisol levels in response to stimulation with ACTH in those patients. The study included 11 male controls and 11 patients with G-6-PD deficiency ( group I ) that were studied with intravenous infusion of glucose, L-arginine and regular human insulin (0,1 UI/Kg B.W) to evaluate the secretion and action of insulin. The group II with 16 normal subjects and 12 G-6-PD deficient patients were submited to stimulation with ACTH ( 0,25 mg corticotropin). All the tests were performed in the morning after a 12-14h overnight fast. Blood samples for glucose, insulin, and C-peptide determination were collected before and 1,3,5,7,10,30 and 60 min. after intravenous glucose infusion (0,5 g/Kg body weight) (IVTT), before and 2,3,4,5,7 and 10 min. after L-arginine infusion ( 5g as a 10% solution ). The insulin sensitivity was calculated by the glucose disappearance rate during the first 15 min. after intravenous injusion of 0,1U of human insulin/Kg B.W. The cortisol secretion was evaluated before and at 30,60 and 120 min. after 0,25 mg of ACTH infusion. In the intravenous glucose tolerance test no significant differences were demonstrated between the mean plasma glucose levels of the G-6-PD deficient patients and those of the control group. The serum insulin levels during IVGTT from G-6-PD deficient patients were significantly lower when compared to insulin levels in the normal men in the first 10 min. as the index of first phase insulin release. The serum C - peptide levels were significantly lower in the G-6-PD deficient patients than the control group at: 1,3,5,7,10 and 30 min., and as the area under the curve of C - peptide levels in IVGTI. The hepatic extraction of insulin during IVGTT were significantly lower in the patients than in the control group. The index used to evaluate insulin secretory response after arginine infusion, mean of the highest values during the first 5 min. were similar between patients and controls for insulin levels, but signiflcantly lower in G-6-PD deficient patients when we analysed C-peptide, after arginine infusion. Patients and controls showed similar hepatic extraction of insulin in the arginine test. In the group II, after stimulation with ACTH, the cortisol levels were significantly lower in the G-6-PD deficient patients than the normal men at 30 min., but this differences between the groups decreased gradually and were no statistically significant, after the first hour. The areas under the cortisol levels for the two groups were similar. These results demonstrate that the G-6-PD deficient patients showed decresead insulin secretion ( first phase ) after glucose and L-arginine stimulation, decreased hepatic insulin extraction during IVGTI, no alteration in insulin peripheral sensitivity and decreased cortisol production in the first 30 min. after corticotropin stimulation. Doutorado Doutor em Medicina

The aim of the present study was to investigate cortisol levels under basal conditions and in response to ACTH stimulation in male patients with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. The study included 14 male controls and 12 patients with G-6-PD deficiency matched for age and race. Fasting blood samples were taken from all the subjects at rest, and 30, 60 and 120 min after the infusion of 0.25 mg of corticotropin for cortisol determination. The mean cortisol levels observed in the first hour after ACTH stimulation in the G-6-PD-deficient patients were significantly (p = 0.03) lower than in the control group. No significant differences were observed between patients and controls at rest, and in the second hour after stimulation. These data suggest that, in the adrenals, G-6-PD plays a role in the initial phase of cortisol production. However, 1 h after ACTH stimulation, G-6-PD probably is no longer rate limiting in the production of cortisol.

Orientador: Mario Jose Abdalla Saad Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas Resumo: A deficiência de Glicose 6 Fosfato Desidrogenase (G - 6 - PD) é um erro inato do metabolismo de carboidratos em que a atividade e/ou estabilidade da G -6 PD (enzima que cataliza a reação inicial da via das pentoses -fosfato) está reduzida. Uma variedade de alterações é esperada pois a referida enzima está presente em diferentes células e tecidos incluindo o pâncreas.Objetivando investigar o papel da via das pentoses na secreção de insulinar foram estudados 12 indivíduos com deficiência de G - 6 - PD e 11 indivíduos normais (grupo controle) que após jejum de 12 - 14 horas foram submetidos aos testes oral e venoso de tolerância à glicose ¿Observação: O resumo, na íntegra poderá ser visualizado no texto completo da tese digital. Abstract: Glucose - 6 - Phosphate Dehydrogenase Deficiency (G - 6 - PD) is an inborn error of carbohydrate metabolism in which the ativity and/or stability of G- 6 - PD (enzyme that catalyses the initial reation of the pentose phosphate pathway) is decresead. Recognition that deficiency of G - 6 - PD also occurs in other cells tissues and biologic fluids of affected persons raises the question of whether and under what circunstances impairment of glucose induce insulin secretion might occur in such persons. It was the aim of the present study to investigate insulin responses during intravenous tolerance test and oral glucose tolerance test in patients with G- 6 - PD deficiency ...Note: The complete abstract is available with the full electronic digital thesis or dissertations. Mestrado Mestre em Medicina

Background Obesity is associated with development of the cardiorenal metabolic syndrome, which is a constellation of risk factors, such as insulin resistance, inflammatory response, dyslipidemia, and high blood pressure that predispose affected individuals to well-characterized medical conditions such as diabetes, cardiovascular and kidney chronic disease. The study was designed to establish relationship between metabolic and inflammatory disorder, renal sodium retention and enhanced blood pressure in a group of obese subjects compared with age-matched, lean volunteers. Methods The study was performed after 14 h overnight fast after and before OGTT in 13 lean (BMI 22.92 ± 2.03 kg/m2) and, 27 obese (BMI 36.15 ± 3.84 kg/m2) volunteers. Assessment of HOMA-IR and QUICKI index were calculated and circulating concentrations of TNF-α, IL-6 and C-reactive protein, measured by immunoassay. Results The study shows that a hyperinsulinemic (HI: 10.85 ± 4.09 μg/ml) subgroup of well-characterized metabolic syndrome bearers-obese subjects show higher glycemic and elevated blood pressure levels when compared to lean and normoinsulinemic (NI: 5.51 ± 1.18 μg/ml, P