Interferon-gamma and interleukin-10 production by mononuclear cells from patients with advanced head and neck cancer

OBJECTIVE: This study aims to evaluate the production of interferon-gamma and interleukin-10 by stimulated peripheral blood mononuclear cells isolated from patients with supraglottic laryngeal cancer before and after surgical treatment. METHODS: Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cultures of peripheral blood mononuclear cells isolated during the preoperative and late postoperative periods were stimulated with concanavalin A and Bacille Calmette-Guerin, and the supernatant concentrations of interferon-gamma and interleukin-10 were measured. RESULTS: For non-stimulated cultures, the interferon-gamma levels produced by the preoperative period and the late postoperative period cultures were lower than the levels produced by the control group cultures. The interferon-gamma levels after stimulation with concanavalin A were higher in the late postoperative period cultures than in the preoperative evaluation cultures. Stimulation with Bacille Calmette-Guerin led to the production of similar levels of interferon-gamma and interleukin-10 by all cultures; thus, stimulation increased the levels of interferon-gamma produced by both the preoperative and postoperative cultures relative to the levels produced by the corresponding unstimulated cultures. CONCLUSION: Patients with advanced supraglottic laryngeal cancer exhibit an in vitro deficiency in interferongamma secretion by mononuclear cells. Stimulated cells seem to recover this function during the postoperative period

Interferon-gamma and interleukin-10 production by mononuclear cells from patients with advanced head and neck cancer

OBJECTIVE: This study aims to evaluate the production of interferon-gamma and interleukin-10 by stimulated peripheral blood mononuclear cells isolated from patients with supraglottic laryngeal cancer before and after surgical treatment. METHODS: Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cultures of peripheral blood mononuclear cells isolated during the preoperative and late postoperative periods were stimulated with concanavalin A and Bacille Calmette-Guerin, and the supernatant concentrations of interferon-gamma and interleukin-10 were measured. RESULTS: For non-stimulated cultures, the interferon-gamma levels produced by the preoperative period and the late postoperative period cultures were lower than the levels produced by the control group cultures. The interferon-gamma levels after stimulation with concanavalin A were higher in the late postoperative period cultures than in the preoperative evaluation cultures. Stimulation with Bacille Calmette-Guerin led to the production of similar levels of interferon-gamma and interleukin-10 by all cultures; thus, stimulation increased the levels of interferon-gamma produced by both the preoperative and postoperative cultures relative to the levels produced by the corresponding unstimulated cultures. CONCLUSION: Patients with advanced supraglottic laryngeal cancer exhibit an in vitro deficiency in interferongamma secretion by mononuclear cells. Stimulated cells seem to recover this function during the postoperative period

Diabetic ketoacidosis and hyperosmolar hyperglycemic state

Diabetic ketoacidosis is acute hyperglycaemic complication of DM type 1 patients and this situation of metabolic disturbances develops in a milieu of severe insulin deficiency,usually associated to stress conditions that increase the counterregulatory hormones.Hyperosmolar Hypergycemic state is a specific complication of the DM type 2 patients with predominance of the effects of hyperosmolarity and dehydration, specially involving the central nervous system. Precipitating factors, clinical presentation, basic pathophysiology and treatment of these diabetic hyperglycaemic emergencies are analysed in this review.A cetoacidose diabética é uma complicação aguda, típica dos pacientes com DM tipo I ou insulinodependentes, um conjunto de distúrbios metabólicos, que se desenvolvem em uma situação de deficiência insulínica grave, comumente associada a condições estressantes, que levam a aumento dos hormônios contra-reguladores. O estado hiperglicêmico hiperosmolar é uma complicação aguda, característica do diabético tipo II ou não insulinodependente, quando predominam os efeitos da hiperosmolaridade e desidratação, principalmente envolvendo o sistema nervoso central. Fatores precipitantes, quadro clínico, fisiopatologia básica e tratamento dessas emergências médicas são analisados nesta revisão

DIABETES MELLITUS E INTOLERÂNCIA À GLICOSE EM PACIENTES COM ACROMEGALIA

Acromegaly is a disease caused by growth hormone (GH) overproduction. In this state, carbohydrate metabolism disturbance often occurs. Diabetes mellitus prevalence has been demonstrated between 19 and 56%, and impaired glucose tolerance prevalence between 5 and 46% in many groups of patients with acromegaly. The present study was designed to estimate diabetes mellitus and impaired glucose tolerance prevalence in a group of acromegalic patients assisted in the Endocrinology/Metabology Division of University Hospital of School of Medicine of Ribeirão Preto, São Paulo University (HCFMRP), attempting to also analyze their endocrine and metabolic characteristics. The patients were studied before any therapeutic intervention and were divided in three groups: diabetics, with impaired glucose tolerance and nondiabetics/non impaired glucose tolerance patients. We studied 55 acromegalic patients assisted in HCFMRP. We determined age, sex, weight, height, time of typical acromegalic symptoms upset, and blood GH and glucose during oral glucose tolerance test (oGTT): 0, 30, 60, 90 and 120 minutes. In 19 patients (39,5%) the basal insulin levels were determined in the first sample of the oGTT. Using this data, we calculated body mass index (BMI = weight (kg), divided by square height (meters)), and areas under curves of mean values of GH and glucose in blood during oGTT. Statistical analyzes were processed by Kruskal-Wallis, Mann Whitney and Spearman correlation tests.Among the 55 acromegalic patients studied, 15 (27,3%) were diabetics (DM), 9(16,4%) had impaired glucose tolerance (IG), and 31 (56,4%) did not have blood glucose disturbances (NL). Females were more frequent in DM and IG groups (66,7% in both groups), while women were minority in NL group (29%). DM and IG groups show similar age distribution (45,8+13,1 and 46,3+10,6 years, respectively), and significantly higher age than NL group (36,4+11,1 years; p<0,05). Between the 19 patients whose basal insulin level were obtained, 4 were of the DM group, 6 of the IG group and 9 of the NL group. Mean basal serum insulin level in acromegalic patients, even from the DM, IG or the NL group, was higher than that seen in normal adult population. There was no correlation between areas under GH and glucose curves during oGTT. We did not see statistical differences among the three groups in BMI, activity acromegaly time and area under GH curves during oGTT. In conclusion, we verified increased prevalence of glucose metabolism alterations among our acromegalic patients, associated with female gender, older age, and higher levels of basal serum insulin.A acromegalia é uma doença insidiosa, causada pela secreção excessiva de hormônio do crescimento (GH). Nela, destaca-se a ocorrência freqüente de alteração do metabolismo dos carboidratos, tendo-se verificado, anteriormente, prevalência de diabetes mellitus entre 19 e 56% e de intolerância à glicose entre 5 e 46% em vários grupos populacionais. Neste estudo, objetivamos definir a freqüência de diabetes mellitus e intolerância à glicose em um grupo de pacientes acromegálicos, atendidos na Divisão de Endocrinologia/Metabologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Universidade de São Paulo (HCFMRP), no início do atendimento de cada paciente, antes, portanto da aplicação de qualquer medida terapêutica, procurando também analisar as características endocrinometabólicas desses pacientes, que foram subdivididos em três categorias: diabéticos, intolerantes à glicose e não diabéticos/não intolerantes.Foram analisados os dados de 55 pacientes acromegálicos, atendidos no HCFMRP. Foram registrados os dados de idade, sexo, peso, estatura, tempo do surgimento de sintomas típicos da acromegalia, e níveis sanguíneos de GH e glicemia durante o teste oral de tolerância à glicose (oGTT): aos 0, 30, 60, 90 e 120 min. Em 19 pacientes (39,5%), foi dosado o nível de insulina plasmática na amostra basal do oGTT. A partir dos valores obtidos, calculamos o índice de massa corporal (IMC = peso, em quilogramas, dividido pelo quadrado da estatura, em metros), e as áreas sob as curvas das médias de GH e glicemia no oGTT. As análises estatísticas foram feitas pelos testes de Kruskal-Wallis, de Mann Whitney e de correlação de Spearman, fixando-se intervalo de confiança de 95%.Dos 55 pacientes acromegálicos, estudados, 15 (27,3%) eram diabéticos (DM), 9 (16,4%) apresentavam intolerância à glicose (IG), e 31 (56,4%) não apresentavam alterações dos níveis glicêmicos (NL). Nos grupos DM e IG, predominam indivíduos do sexo feminino (66,7% são mulheres em ambos os grupos), enquanto no grupo NL, as mulheres são minoria (29%). Os grupos DM e IG apresentam distribuição de idades semelhante (45,8±13,1 e 46,3±10,6 anos, respectivamente), e significativamente mais alta do que a do grupo NL (36,4±11,1 anos; p<0,05). Dos 19 pacientes em que foi dosada a insulinemia basal, 4 eram do grupo DM, 6 do grupo IG e 9 do grupo NL. O nível sérico médio de insulina nos pacientes acromegálicos, tanto nos grupos alterados (DM e IG) quanto no grupo NL, é mais elevada do que a encontrada na população adulta normal. Não há correlação entre áreas sob curvas de GH e de glicemia no oGTT. Com relação ao IMC, duração da acromegalia e área sob curvas de GH durante o oGTT, não foram encontradas diferenças estatísticas significativas entre os três grupos. Foi possível observar, portanto, prevalência aumentada dos distúrbios do metabolismo de glicose nos acromegálicos, assim como a associação desses distúrbios com o sexo feminino e com idade mais avançada, além de aumento dos níveis de insulinemia basal

Interferon-gamma and interleukin-10 production by mononuclear cells from patients with advanced head and neck cancer

OBJECTIVE: This study aims to evaluate the production of interferon-gamma and interleukin-10 by stimulated peripheral blood mononuclear cells isolated from patients with supraglottic laryngeal cancer before and after surgical treatment. METHODS: Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cultures of peripheral blood mononuclear cells isolated during the preoperative and late postoperative periods were stimulated with concanavalin A and Bacille Calmette-Guerin, and the supernatant concentrations of interferon-gamma and interleukin-10 were measured. RESULTS: For non-stimulated cultures, the interferon-gamma levels produced by the preoperative period and the late postoperative period cultures were lower than the levels produced by the control group cultures. The interferon-gamma levels after stimulation with concanavalin A were higher in the late postoperative period cultures than in the preoperative evaluation cultures. Stimulation with Bacille Calmette-Guerin led to the production of similar levels of interferon-gamma and interleukin-10 by all cultures; thus, stimulation increased the levels of interferon-gamma produced by both the preoperative and postoperative cultures relative to the levels produced by the corresponding unstimulated cultures. CONCLUSION: Patients with advanced supraglottic laryngeal cancer exhibit an in vitro deficiency in interferongamma secretion by mononuclear cells. Stimulated cells seem to recover this function during the postoperative period

Controle de hiperglicemia intra-hospitalar em pacientes críticos e não-críticos

Hiperglicemia é uma condição frequente encontrada no ambiente intra-hospitalar. Quando presente em pacientes críticos internados pode levar a maior morbi-mortalidade, comprometendo o tratamento da doença de base. Essa revisão tem por objetivo padronizar a conduta terapêutica na hiper e hipoglicemias nos pacientes internados em ambiente hospitalar, de forma a reduzir tempo de internação e mortalidadeHyperglycemia is a common condition found in-hospital environment. When present in critically ill patients admitted can lead to increased morbidity and mortality, affecting the treatment of the underlying disease. This protocol aims to standardize the therapeutic approach in hyper-and hypoglycemia in patients admited to hospital in order to reduce length of stay and mortality.

Obesity and its relationship with cardiovascular risk factors in a Japanese-Brazilian population

OBJETIVO: Descrever associações entre excesso de peso e obesidade abdominal com fatores de risco cardiovascular na população nipo-brasileira de Mombuca, Guatapará, SP. MÉTODOS: Participaram do estudo 131 indivíduos com descendência japonesa (69,2% da primeira e 30,8% da segunda geração), com idade > 20 anos, correspondendo a 66,8% da população residente dessa faixa etária. Os dados foram coletados por meio de questionários padronizados e foram realizados exames clínicos e laboratoriais. RESULTADOS: A prevalência de sobrepeso foi de 29,6% entre os homens e de 25,6% entre as mulheres e a de obesidade foi de 46,3% entre os homens e de 39,0% entre as mulheres. Entre os homens a prevalência de obesidade abdominal foi de 55,6% e entre as mulheres de 20,8%. O índice de massa corpórea foi associado independentemente com triglicérides, circunferência abdominal e idade; a pressão arterial sistólica com a circunferência abdominal. CONCLUSÃO: O presente estudo enfatiza a necessidade de medidas de intervenção para a prevenção da obesidade na população nipo-brasileira de Mombuca.OBJECTIVE: To describe associations of weight excess and abdominal obesity with cardiovascular risk factors in a Japanese-Brazilian population from Mombuca, Guatapará, SP. METHODS: Cross-sectional study with 131 individuals of Japanese ancestry (69.2% first and 30.8% second generation), aged 20 years or more, corresponding to 66.8% of the resident population from this age group. Data were collected through standardized questionnaires and laboratory and physical examinations were performed. RESULTS: Prevalence of overweight and obesity was 29.6% and 46.3% in men and 25.6% and 39.0% in women, respectively. The prevalence of abdominal obesity was 55.6% in men and 20.8% in women. Body mass index was independently associated with triglycerides, waist circumference and age; systolic blood pressure with waist circumference. CONCLUSIONS: Data from the present survey highlight the necessity of interventions to prevent obesity in the Japanese-Brazilian population from Mombuca

Prevalence of diabetes mellitus and impaired glucose tolerance in a rural community of Angola

<p>Abstract</p> <p>Background</p> <p>To determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a rural community (Bengo) of Angola.</p> <p>Methods</p> <p>A random sample of 421 subjects aged 30 to 69 years (30% men and 70% women) was selected from three villages of Bengo province. This cross-sectional home survey was conducted using a sampling design of stage conglomerates. First, clinical and anthropometric data were obtained and fasting capillary glucose level was determined. Subjects who screened positive (fasting capillary glucose ≥ 100 mg/dl and < 200 mg/dl) and each sixth consecutive subject who screened negative (fasting capillary glucose < 100 mg/dl) were submitted to the second phase of survey, consisting of the 75-g oral glucose tolerance test. Data was analyzed by the use of SAS statistical software.</p> <p>Results</p> <p>The prevalence rates of diabetes mellitus and IGT were 2.8% and 8.1%, respectively. The age group with the highest prevalence of diabetes was 60 to 69 years (42%). Impaired glucose tolerance prevalence was 38% in the 40 to 49 year age group and it increased with age, considering that the 50 to 59 and 60 to 69 year age groups as a whole represent 50% of all subjects with impaired glucose tolerance. The prevalence of diabetes mellitus did not differ significantly between men (3.2%) and women (2.7%) (p = 0.47). On the other hand, the prevalence of impaired glucose tolerance among women showed almost twice that found in men (9.1% vs. 5.6%, respectively). Overweight was present in 66.7% of the individuals with diabetes mellitus and 26.5% of individuals with impaired glucose tolerance showed overweight or obesity.</p> <p>Conclusions</p> <p>Although the prevalence of diabetes mellitus was low, the prevalence of impaired glucose tolerance is considered to be within an intermediary range, suggesting a future increase in the frequency of diabetes in this population.</p

Prevalence of the metabolic syndrome using two proposed definitions in a Japanese-Brazilians community

Metabolic Syndrome (MetS) is associated with increased risk of morbi-mortality, thus the characterization of the population magnitude of this syndrome is critical for allocating health care. However, prevalence estimates of MetS in the same population could differ depending on the definition used. Therefore, we compared the prevalence of the MetS using definitions proposed by: National Cholesterol Education Panel Revised (NCEP) and International Diabetes Federation (IDF) 2009 in a Japanese-Brazilians community (131 individuals, age 57 ± 16 years, 1st and 2nd generation). All individuals went through a clinical and laboratorial evaluation for assessment of weigh, height, waist circumference, blood pressure, triglycerides, HDL-cholesterol and fasting plasma glucose. The prevalence of MetS was 26.7% (n = 35) and 37.4% (n = 49) under the NCEP and IDF definitions, respectively. Despite higher blood pressure measurements, waist circumference and serum triglyceride levels and lower HDL cholesterol levels (p < 0.01), individuals identified with MetS did not show increased blood glucose levels. IDF definition classified 14 individuals (10.7%) with MetS that were not classified under the NCEP and 35 individuals were identified with MetS by both criteria. We observed, in this group, more severe lipid disorders, compared to individuals identified only under the IDF definition, and the BMI and waist circumference (p = 0.01; p = 0.006, respectively) were lower. In conclusion, the IDF revised criteria, probably because of the ethnic specific values of waist circumference, was able to identify a larger number of individuals with MetS. However, our data suggesting that additional studies are necessary to define best MetS diagnostic criteria in this population.We are grateful to patients participating in this study and to Sebastiao L. Brandao Filho for technical assistance.This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sector