Elevated osteoprotegerin is associated with abnormal ankle brachial indices in patients infected with HIV: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Patients infected with HIV have an increased risk for accelerated atherosclerosis. Elevated levels of osteoprotegerin, an inflammatory cytokine receptor, have been associated with a high incidence of cardiovascular disease (including peripheral arterial disease, or PAD), acute coronary syndrome, and cardiovascular mortality. The objective of this study was to determine whether PAD is prevalent in an HIV-infected population, and to identify an association with HIV-specific and traditional cardiovascular risk factors, as well as levels of osteoprotegerin.</p> <p>Methods</p> <p>One hundred and two patients infected with HIV were recruited in a cross-sectional study. To identify the prevalence of PAD, ankle-brachial indices (ABIs) were measured. Four standard ABI categories were utilized: ≤ 0.90 (definite PAD); 0.91-0.99 (borderline); 1.00-1.30 (normal); and >1.30 (high). Medical history and laboratory measurements were obtained to determine possible risk factors associated with PAD in HIV-infected patients.</p> <p>Results</p> <p>The prevalence of PAD (ABI ≤ 0.90) in a young HIV-infected population (mean age: 48 years) was 11%. Traditional cardiovascular risk factors, including advanced age and previous cardiovascular history, as well as elevated C-reactive protein levels, were associated with PAD. Compared with patients with normal ABIs, patients with high ABIs had significantly elevated levels of osteoprotegerin [1428.9 (713.1) pg/ml vs. 3088.6 (3565.9) pg/ml, respectively, p = 0.03].</p> <p>Conclusions</p> <p>There is a high prevalence of PAD in young HIV-infected patients. A number of traditional cardiovascular risk factors and increased osteoprotegerin concentrations are associated with abnormal ABIs. Thus, early screening and aggressive medical management for PAD may be warranted in HIV-infected patients.</p

Epoetin Alfa: A Cause of Coronary Artery Thrombosis

Introduction. Epoetin alfa is an erythrocyte-stimulating factor. We here present a case of an anemic patient, who was given epogen before a coronary artery bypass (CABG) surgery and developed periprocedural myocardial infarction. To our knowledge, there has been no previous case reported of epogen causing myocardial infarction. Case Presentation. 66-year-old female presented with substernal chest pain. EKG showed ST segment elevations in aVf and L-III. Patient underwent left heart catheterization (LHC) and had triple vessel disease. A bare metal stent was placed in RCA. Patient continued to have symptoms after discharge and presented to the ED again with these complaints. She underwent coronary artery bypass surgery (CABG). Before the procedure, patient’s hemoglobin was 11.1 grams/deciliter and was given epogen to raise hemoglobin level. Postoperative day (POD) #1 patient had ST elevations in inferior and anterolateral leads. She was diagnosed with periprocedural myocardial infarction. Patient underwent repeat LHC, which identified obstruction of saphenous vein graft (SVG). Hypercoagulable workup was negative for any disease and the patient was diagnosed with epogen induced early graft occlusion. Conclusion. Epogen administration can cause myocardial infarction and coronary artery thrombosis. We suggest that physicians use epogen very cautiously, especially in population who has underlying coronary artery disease

"A epopeia da decadência": um estudo sobre o Essai sur l'inégalité des races humaines (1853-1855), de Arthur de Gobineau

O presente artigo discute a concepção racial de Arthur de Gobineau a partir de sua mais famosa obra, o Essai sur l'inégalité des races humaines. Se comumente este tratado é associado à discussão racialista que toma corpo nas últimas décadas do século XIX, pretendo relacioná-lo a uma polêmica característica da virada do século XVII para o XVIII, a Querela das duas raças. Neste sentido, o objetivo do artigo é revelar, em primeiro lugar, como a reflexão de Gobineau é tributária de um conceito de linhagem tornado paulatinamente anacrônico no mundo pós-revolucionário. Em segundo, demonstrar a hipótese segundo a qual o Essai, menos do que um estudo sobre raças pretensamente "biológicas", representa fundamentalmente uma recusa à nova ordem igualitária que se impõe na era moderna.<br>The present article discusses the racial concepts of Arthur de Gobineau based on his most famous work, Essai sur l'inegalité des races humaines. Instead of associating these with the racialist debate of the last decades of the XIX the century, I relate them to a polemical text characteristic of the late XVII and early XVIII century: The Quarrel of the Two Races. In this sense, my main objective is to show that, in the first place, the Gobineau's work owes significant debts to the concept of the "bloodline", an idea which gradually became anachronistic after the French Revolution. In addition, I argue that, rather than being a study of supposedly "biological" races, Gobineau's "Essay" should be regarded as a refusal of the new egalitarian order of modern times

Obesity- and Neuroinflammation-Associated Mood and Cognitive Disorders

Over the past decades, obesity rates have continued to increase at alarming rates globally, fostering the rise in serious comorbidities, particularly cardiovascular diseases and type 2 diabetes, collectively known as metabolic syndrome (MetS). Obesity is also linked with brain disease and is often associated with a high prevalence of mood and cognitive disorders that emerge as additional risk factors for obesity-related systemic pathological complications. Understanding the etiology of these disorders therefore represents a major public health challenge. In the present chapter, we aim to provide a new perspective on the pathophysiological mechanisms contributing to the development of these disorders. On the basis of recent experimental data obtained by using animal models of obesity/MetS, we propose that these disorders may reflect the neural consequences of molecular and cellular events playing a pivotal role in obesity and more importantly that inflammation/neuroinflammation, which is one of the key components of obesity/MetS, may contribute to the development of these behavioral alterations. We indeed provide converging evidence showing that brain dysfunctions related with neuroinflammation, particularly when they occur in key brain areas for mood, learning, and memory such as the hippocampus contribute to impair mood and cognition in models of obesity/MetS. These findings may prove valuable for introducing new strategies to treat neuropsychiatric complications reported in chronically obese/MetS patients

Obesity and depression: shared pathophysiology and translational implications

There is mounting evidence for a close relationship between obesity and depression. Depression is frequent in obese subjects and, in turn, obesity is associated with a greater risk of depression. Moreover, recent data suggest a role for obesity in treatment-resistant depression. While the association is bidirectional, the paths and mechanisms by which obesity can lead to depression appear to be particularly relevant to biological psychiatry, as they can provide new information on the pathophysiology and treatment of mood disorders. This chapter will review those pathophysiological pathways and processes that are shared by obesity and depression and that are likely to underlie the intricate relationship between the two disorders. Their potential translational implications and relevance to the development of personalized strategies for the treatment and management of depression will be further discussed