O balão intragástrico nas formas graves de obesidade

Introduction: In patients with morbid obesity the intragastric balloon (IGB) can be a “bridge” to surgery or a temporary treatment in patients who are not candidates for surgery. Objective: Evaluate IGB efficacy in morbidly obese patients. Patients and Methods: In 2003/2004 seventeen IGB Bioenterics ® filled with normal saline and methylene blue were placed in 17 patients [11 women, median age was 49.2 (27-69 years); median body mass index was 55.6 (40.2-74.2 Kg/m2)], followed by nutritionists and/or endocrinologists. They had previously tried dietetic and/or pharmacological measures with limited results. Co-morbidities were present in 13 (76.5%). Results: Eight (47%) patients presented nausea/vomiting in the first 24-72h that persisted in 4 (23.5%) leading to dehydration and pre-renal insufficiency and forcing premature removal of the balloon (0.5 to 4 months). In the other patients, the device was removed at 6 months treatment (in 1 patient at 10 months). All patients suffered weight loss (5-70 Kg); median loss-19.6 Kg (p<0.001). No cases of spontaneous deflation/displacement occurred. Six (35.3%) underwent bariatric surgery. Conclusions: The IGB is a useful method for weight loss in morbidly obese patients. Nausea and vomiting are the most common complications. Although desirable, subsequent surgery is not always performed

Comparing the cost-effectiveness of two screening strategies for latent tuberculosis infection in Portugal

Introduction and objectives: Screening for latent tuberculosis infection (LTBI) in close contacts of infectious TB cases might include Tuberculin Skin Test (TST) and Interferon-Gamma Release Assays (IGRA), in combination or as single-tests. In Portugal, the screening strategy changed from TST followed by IGRA to IGRA-only testing in 2016. Our objective was to compare the cost-effectiveness of two-step TST/IGRA with the current IGRA-only screening strategy in immunocompetent individuals exposed to individuals with respiratory TB. Materials and methods: We reviewed clinical records of individuals exposed to infectious TB cases diagnosed in 2015 and 2016, in two TB outpatient centers in the district of Porto. We estimated medical, non-medical and indirect costs for each screening strategy, taking into account costs of tests and health care personnel, travel distance from place of residence to screening site and employment status. We calculated the incremental cost-effectiveness ratio (ICER) as the cost difference between the two screening strategies with the difference number of LTBI diagnosis as a measure of cost-effectiveness, assuming that treating LTBI is a cost-effective intervention. We also calculated adjusted odds-ratios to test the association between diagnosis of LTBI and screening strategy and estimated the total cost for averting a potential TB case. Results: We compared 499 contacts TST/IGRA screened with 547 IGRA-only. IGRA-only strategy yielded a higher screening effectiveness for diagnosing latent tuberculosis infection (aOR 2.12, 95%CI: 1.53 - 2.94). ICER was €106 per LTBI diagnosis, representing increased effectiveness with a slightly increased cost of IGRA-only screening strategy. Conclusions: Our data suggests that in Portugal LTBI screening with IGRA-only is more cost-effective than the two-step TST/IGRA testing strategy, preventing a higher number of cases of TB cases

Irf4 is a positional and functional candidate gene for the control of serum IgM levels in the mouse

Natural IgM are involved in numerous immunological functions but the genetic factors that control the homeostasis of its secretion and upholding remain unknown. Prompted by the finding that C57BL/6 mice had significantly lower serum levels of IgM when compared with BALB/c mice, we performed a genome-wide screen and found that the level of serum IgM was controlled by a QTL on chromosome 13 reaching the highest level of association at marker D13Mit266 (LOD score¼3.54). This locus was named IgMSC1 and covered a region encompassing the interferon-regulatory factor 4 gene (Irf4). The number of splenic mature B cells in C57BL/6 did not differ from BALB/c mice but we found that low serum levels of IgM in C57BL/6 mice correlated with lower frequency of IgM-secreting cells in the spleen and in the peritoneal cavity. These results suggested that C57BL/6 mice have lower efficiency in late B-cell maturation, a process that is highly impaired in Irf4 knockout mice. In fact, we also found reduced Irf4 gene expression in B cells of C57BL/6 mice. Thus, we propose Irf4 as a candidate for the IgMSC1 locus, which controls IgM homeostatic levels at the level of B-cell terminal differentiation