Does autonomic neuropathy play a role in erythropoietin regulation in non-proteinuric Type 2 diabetic patients?

Aims Erythropoietin (EPO)-deficient anaemia has been described in Type 1 diabetic patients with both severe autonomic neuropathy (AN) and proteinuria. This study was aimed at distinguishing between the effects of AN and nephropathy on haemoglobin and EPO levels in Type 2 diabetic patients at an early stage of diabetic nephropathy. Methods In 64 Type 2 diabetic patients (age 52 +/- 10 years, duration 10 +/- 9 years) without overt nephropathy and other causes of anaemia or EPO deficit, we assessed cardiovascular tests of AN, 24-h blood pressure (BP) monitoring, urinary albumin excretion rate (UAE), a full blood count, and serum EPO. Results Although the Type 2 diabetic patients with AN did not show differences in haemoglobin and EPO when compared with patients without AN, the presence of haemoglobin < 13 g/dl was associated with the presence of AN (chi(2)= 3.9, P < 0.05) and of postural hypotension (chi(2)= 7.8, P < 0.05). In a multiple regression analysis including as independent variables gender, body mass index, duration of diabetes, smoking, creatinine, 24-h UAE, 24-h diastolic BP, ferritin, erythrocyte sedimentation rate, and autonomic score, we found that the only variables independently related to haematocrit were autonomic score, ferritin and erythrocyte sedimentation rate. Finally, the physiological inverse relationship between EPO and haemoglobin present in a control group of 42 non-diabetic non-anaemic subjects was completely lost in Type 2 diabetic patients. The slopes of the regression lines between EPO and haemoglobin of the control subjects and the Type 2 diabetic patients were significantly different (t = 14.4, P < 0.0001). Conclusion This study documents an early abnormality of EPO regulation in Type 2 diabetes before clinical nephropathy and points to a contributory role of AN in EPO dysregulation

Características hematológicas de bovinos (Bos taurus) sadios da raça Pantaneira.

O gado Pantaneiro é a raça brasileira local adaptada às condições extremas de temperatura, umidade e qualidade das pastagens naturais do Pantanal. Com o objetivo de conhecer seus aspectos fisiológicos, foi determinado o perfil hematológico utilizando indivíduos clinicamente sadios. Para isso foram examinadas 293 amostras de sangue colhidas em duas propriedades, no Mato Grosso e Mato Grosso do Sul. Estes animais foram divididos, de acordo com a faixa etária, em cinco grupos: G1, G2, G3, G4 e G5. Estudou-se o eritrograma e o leucograma, submetendo os resultados à estatística descritiva e comparativa para determinação da relação com a idade e sexo.bitstream/item/79836/1/BP104.pd

Enzimas séricas e parâmetros bioquímicos de bovinos (Bos taurus) sadios da raça pantaneira.

Os colonizadores trouxeram para o Brasil sua cultura, técnicas de produção agropecuária e animais domésticos. No Pantanal, esse processo evoluiu para a formação do bovino Pantaneiro, raça naturalizada local, exemplo de adaptabilidade ao meio ambiente. Porém esses animais vêm sendo gradativamente substituídos por zebuínos desde o final do século XIX, em cruzamentos absorventes que resultaram em risco de extinção dessa população. Para conservar e expandir esse patrimônio genético é necessário conhecer os parâmetros fisiológicos da raça, que podem auxiliar na interpretação de aspectos clínicos, sanitários e metabólicos desses animais. Este trabalho teve o objetivo de estabelecer os valores de referência para atividade sérica da aspartato aminotransferase (AST), fosfatase alcalina (ALP), gama glutamiltransferase (GGT) e creatino quinase (CK). Também foram quantificados os níveis de bilirrubina, proteína total, globulinas, albumina, uréia, creatinina, glicose, colesterol e fibrinogênio, além da sua correlação com as variáveis, idade e sexo. Para isso, foram colhidas amostras de sangue de 263 animais, em duas propriedades rurais do Pantanal de Mato Grosso e Mato Grosso do Sul. Esses indivíduos foram classificados em cinco grupos, de acordo com a faixa etária. Os dados obtidos foram submetidos à estatística descritiva e posteriormente utilizaram-se testes não paramétricos para comparação de medianas. Os resuiltados descritos levam a conclusão de que o aumento da idade cursa com elevação da AST e com a diminuição de ALP e GGT. Além disso, os maiores valores de CK são detectados no período entre 3 a 11 meses, para em seguida ocorrer diminuição. A idade tem relação com todos os parâmetros bioquímicos, exceto a bilirrubina indireta, sendo que o aumento da idade cursa com a elevação da proteína total, creatinina, uréia, colesterol e fibrinogênio e com a diminuição de bilirrubinas total e direta, albumina e glicose. As fêmeas apresentaram valores maiores de uréia e colesterol, enquanto os machos tiveram níveis maiores de glicose e fibrinogênio.bitstream/item/54532/1/BP106.pd

Multidisciplinary Experience In The Selection Of Patients For Tubal Sterilization.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.113171572

Nuchal Translucency: An Ultrasound Marker For Fetal Chromosomal Abnormalities.

CONTEXT: The literature shows an association between several ultrasound markers and chromosome abnormality. Among these, measurement of nuchal translucency has been indicated as a screening method for aneuploidy. The trisomy of chromosome 21 has been most evaluated. OBJECTIVE: To define the best fixed cutoff point for nuchal translucency, with the assistance of the ROC curve, and its accuracy in screening all fetal aneuploidy and trisomy 21 in a South American population. TYPE OF STUDY: Validation of a diagnostic test. SETTING: This study was carried out at the State University of Campinas, Campinas, Brazil. PARTICIPANTS: 230 patients examined by ultrasound at two tertiary-level private centers, at 10 to 14 weeks of gestation. DIAGNOSTIC TEST: The participants consisted of all those patients who had undergone ultrasound imaging at 10 to 14 weeks of gestation to measure nuchal translucency and who had had the fetal or neonatal karyotype identified. MAIN MEASUREMENTS: Maternal age, gestational age, nuchal translucency measurement, fetal or neonatal karyotype. RESULTS: Prevalence of chromosomal defects - 10 %; mean age - 35.8 years; mean gestational age - 12 weeks and 2 days; nuchal translucency (NT) thickness - 2.18 mm. The best balance between sensitivity and specificity were values that were equal to or higher than 2.5 mm for overall chromosomal abnormalities as well as for the isolated trisomy 21. The sensitivity for overall chromosomal abnormalities and trisomy 21 were 69.5 % and 75 %, respectively, and the positive likelihood ratios were 5.5 and 5.0, respectively. CONCLUSION: The measurement of nuchal translucency was found to be fairly accurate as an ultrasound marker for fetal abnormalities and measurements equal to or higher than 2.5 mm were the best fixed cutoff points.1191192

Anticardiolipin Antibody In Recurrent Spontaneous Aborting And Fertile Women.

OBJECTIVE: To determine the association between the presence of anticardiolipin antibody and a history of recurrent spontaneous abortion. STUDY DESIGN: Clinical controlled study. LOCATION: Department of Gynecology and Obstetrics-University of Campinas (UNICAMP). SUBJECTS: 52 individuals with recurrent spontaneous abortion were included in Group 1 and 104 individuals with at least one live born child in Group 2. Elapsed time from last delivery to blood sampling varied from six months to two years. METHOD: Between November 1993 and November 1994, patients' blood samples were screened for anticardiolipin antibody by ELISA, as described by Triplett, Barna and Unger (1993). ANALYSIS: Chi-square and Fisher's Exact tests were used for statistical analysis. Student's "t" test was used to compare the means. RESULTS: There was no statistical difference in the presence of the anticardiolipin antibody between Group 1 (zero and 2.9%) and Group 2 (7.7 and 5.8%). CONCLUSION: There was no association between the presence of anticardiolipin antibody and recurrent spontaneous abortion.11641760176

Hematologia e bioquímica sérica de bovinos curraleiro pé duro infectados por Babesia spp. e Leptospira spp.

A Babesia spp. e a Leptospira spp. são importantes enfermidades em sistemas de produção pecuária de países tropicais como o Brasil podendo causar alterações laboratoriais em animais clinicamente sadios. Esse trabalho teve por objetivo avaliar os títulos de anticorpos anti-Babesia bovis, anti-Babesia bigemina e anti-Leptospira interrogans, em bovinos da raça Curraleiro Pé Duro e correlacioná-los às características hematológicas e da bioquímica sérica em animais sadios submetidos à infecção natural. Em 2003 foram amostrados dois rebanhos, localizados no Estado de Goiás e Tocantins e avaliadas 282 amostras para detecção de anticorpos anti-B. bovis e anti- B. bigemina e 236 amostras para detecção de anticorpos anti-Leptospira spp. Foram realizados, hemograma, determinação da atividade sérica de Aspartato Amino Transferase (AST), Alanina Amino Transferase (ALP) e Gama Glutamil Transferase (GGT) e a quantificação no soro da proteína total (PT), albumina, colesterol, uréia, creatinina e bilirrubina, de todos os animais amostrados. Obteve-se 92,90% (n=262) de positividade para B. bovis, 85,46% (n=241) para B. bigemina e 33,05% (n=78) para L. interrogans. Não houve qualquer alteração nos valores médios hematológicos e da bioquímica sérica em relação aos valores de referência. Os resultados não mostraram nenhuma correlação entre títulos de anticorpos anti-Leptospiras e as variáveis laboratoriais avaliadas. O nível de anticorpos específicos para Babesia spp. apresentou correlação positiva com os valores de hemácias, hemoglobina, leucócitos totais e linfócitos, além de AST, ALP, bilirrubina direta (BD), colesterol e creatinina. Concluiu-se que as correlações observadas entre os anticorpos anti-Babesia sp. estão relacionados principalmente ao estímulo do sistema imunológico, funções hepática e renal. Porém, como todos os valores encontrados estão dentro do intervalo de referência, concluiu-se que não houve manifestação patológica decorrente da infecção ou de maiores títulos de imunoglobulinas.bitstream/item/171695/1/Juliano-BP-Curraleiro-final.pd

Role of Gas6 and TAM Receptors in the Identification of Cardiopulmonary Involvement in Systemic Sclerosis and Scleroderma Spectrum Disorders

Background: Few biomarkers are available for early identification of pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) in systemic sclerosis (SS) and scleroderma spectrum disorders (SSD). Aims: To evaluate Gas6, sAxl, and sMer as biomarkers for cardiopulmonary complications of SS and SSD. Methods: In a cross-sectional observational study, we recruited 125 consecutive patients, affected by SS and SSD and referred to a tertiary-level pulmonary hypertension outpatient clinic. All patients underwent a comprehensive evaluation for identification of PAH and ILD. Gas6, sMer, and sAxl concentrations were measured with ELISA protocols, and concentrations were compared according to PAH or ILD. Results: Nineteen subjects had pulmonary hypertension (PH) (14 PAH), and 39 had ILD (6 severe). Plasma sMer was increased in PAH (18.6 ng/ml IQR [11.7-20.3]) with respect to the absence (12.4 [8.0-15.8]) or other form of pulmonary hypertension (9.6 [7.4-12.5]; K-W variance p < 0.04). Conversely, Gas6 and sAxl levels were slightly increased in mild ILD (25.8 ng/ml [19.5-32.1] and 24.6 [20.1-32.5]) and reduced in severe ILD (16.6 [15.0-22.1] and 15.5 [14.9-22.4]) in comparison to no evidence of ILD (23.4 [18.8-28.1] and 21.6 [18.1-28.4]; K-W, p 64 0.05). Plasma sMer 65 19 ng/ml has 50% sensitivity and 92% specificity in PAH identification (area under the ROC curve (AUC) 0.697, p < 0.03). Values of Gas6 64 24.5 ng/ml and of sAxl 64 15.5 ng/ml have 100% and 67% sensitivity and 47% and 86% specificity, respectively, in identifying severe ILD (Gas6 AUC 0.787, p < 0.001; sAxl AUC 0.705, p < 0.05). Conclusions: The assay of Gas6 sAxl and sMer may be useful to help in the identification of PAH and ILD in SS and SSD patients. The Gas6/TAM system seems to be relevant in cardiopulmonary complications of SS and SSD and merits further investigations