Гојазност и хумана репродукција

The price of obesity is represented by a long list of co-morbidities and social, psychological and demographic problems . There is evidence that infertility is growing in parallel with the obesity epidemic, in both males and females . This phenomenon may be due to a spectrum of factors, including social and cultural ones, environmental pollution, globalization of food industries and eating behavior, and others . In adult women the risk of ovulatory infertility increases in women with increasing BMI values . The abdominal pattern of fat distribution has a specific impact on ovulation and fertility, which obviously implies the role of metabolic disturbances, chiefly insulin resistance and associated hyperinsulinemia . Chronic oligo-anovulation is likely more pronounced in obese women with PCOS . There is evidence for decreased live birth rates in obese patients with spontaneous pregnancies or following ART . In men, obesity can affect fertility by altering the hormonal milieu, favoring erectile dysfunction, and by altering sperm count and physiology .Цена гојазности је представљена дугачком листом коморбидитета и социјалних, психолошких и демографских проблема . Проблем инфертилитета расте паралелно са епидемијом гојазности међу мушкарцима и међу женама . Овај феномен је узрокован читавим спектрумом различитих фактора међу које спадају социјални и културолошки фактори, загађење спољашње средине, глобализација индустрије хране, понашање у исхрани и други . У одраслих жена ризик за овулаторни инфертилитет расте са порастом индекса телесне масе . Абдоминални тип распореда масне телесне масе има специфичан утицај на овулацију и фертилитет, што очигледно намеће улогу метаболичких поремећаја као што је инсулинска резистенција и придружена хиперинсулинемија . Хронична олиго-ановулација је много више изражена међу гојазним женама са PCOS-ом . Број живо рођене деце је снижен међу гојазним болесницама са спонтаним трудноћама или након АRT-а . Код мушкараца гојазност може да оштети фертилитет тако што доводи до оштећења хормонског миљеа, фаворизовања еректилне дисфункције и оштећења броја сперматозоида и њихове физиологије .Проблеми јавног здравља и система здравствене заштите / Српска академија наука и уметности ; књ.

Predictors of weight loss and maintenance in patients treated with antiobesity drugs

Federica Guaraldi1, Uberto Pagotto2, Renato Pasquali21Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Division of Endocrinology, Department of Clinical Medicine, S Orsola-Malpighi Hospital, Alma Mater Studiorum University, Bologna, ItalyBackground: The prevalence of obesity and related diseases has increased enormously in the last few decades, becoming a very important medical and social issue. Because of the increasing number of people who need weight loss therapies and the high costs associated with these, the search for reliable predictors of success for weight loss and weight maintenance treatments has become a priority.Objective: A literature review was undertaken to identify possible predictors of outcome of weight loss and weight maintenance in patients treated with antiobesity drugs.Results: For the majority of variables, published data are not sufficient to define their role on final outcomes. Among all considered factors, only early response to treatment appeared to be a reliable positive predictor, and diabetes a negative predictor of weight loss and maintenance.Conclusion: To date, no definitive results have been obtained. Due to the great benefits of reliable predictors of outcome associated to currently available antiobesity drugs and those under development, identifying these predictors has to be supported and encouraged.Keywords: obesity, weight loss predictors, pharmacological treatmen

A PERSPECTIVA DO SUPREMO TRIBUNAL FEDERAL SOBRE DISCURSO RACISTA: ANÁLISE CRÍTICA

Brasil, 1990. Um autor e editor de livros de conteúdo antissemita é processado pelo crime comumente chamado racismo. Com a condenação mantida no Tribunal do de Justiça do Estado do Rio Grande do Sul, o julgamento vai ao Supremo Tribunal Federal (STF). A defesa alegou que a Constituição declara imprescritível o crime de racismo, mas a condenação seria por antissemitismo, e, como judeus não são raça, não seria racismo e, pelo tempo transcorrido, o crime estaria prescrito. Assim, a questão “judeus são uma raça ou não” inaugurou o mais relevante julgamento sobre crime de racismo no Brasil; o debate acerca do conceito de raça só tardiamente foi seguido de questionamento sério sobre se a publicação de um livro pode ser crime, e quais são os limites entre a liberdade de expressão e o crime de racismo. “Quem está envolvido” nos atos, “onde” e “em quais circunstâncias foi praticado” foram questões debatidas antes da denegação do habeas corpus. Este trabalho enfoca nesse último ponto de debate. Se cometer um crime publicando um livro causou dúvida no seu reconhecimento, o que dizer do racismo na cultura trazida pela internet, onde expressão é regra mor, e um discurso, uma vez postado, ganha alcance imensurável? Análise do caso narrado, conhecido como “caso Ellwanger”, mostra que os elementos para o STF caracterizar crime de racismo influenciam as consequências dadas. Seriam eles suficientes para lidar com as novas dimensões de expressão trazidas pela internet

Effects of Metformin on Spontaneous and Clomiphene-Induced Ovulation in the Polycystic Ovary Syndrome

ABSTRACT Background Obese women with the polycystic ovary syndrome are relatively unresponsive to the induction of ovulation by clomiphene. We hypothesized that reducing insulin secretion by administering metformin would increase the ovulatory response to clomiphene. Methods We performed oral glucose-tolerance tests before and after the administration of 500 mg of metformin or placebo three times daily for 35 days in 61 obese women with the polycystic ovary syndrome. Women who did not ovulate spontaneously were then given 50 mg of clomiphene daily for five days while continuing to take metformin or placebo. Serum progesterone was measured on days 14, 28, 35, 44, and 53, and ovulation was presumed to have occurred if the concentration exceeded 8 ng per milliliter (26 nmol per liter) on any of these days. Results Twenty-one women in the metformin group and 25 women in the placebo group were given clomiphene because they did not ovulate spontaneously during the first phase of the study. Among the 21 women given metformin plus clomiphene, the mean (±SE) area under the serum insulin curve after oral glucose administration decreased from 6745±2021 to 3479±455 µU per milliliter per minute (40.5±12.1 to 20.9±2.7 nmol per liter per minute, P=0.03), but it did not change significantly in the 25 women given placebo plus clomiphene. Nineteen of the 21 women (90 percent) who received metformin plus clomiphene ovulated (mean peak serum progesterone concentration, 23.8±3.4 ng per milliliter [7.6±10.9 nmol per liter]). Two of the 25 women (8 percent) who received placebo plus clomiphene ovulated (P\u3c0.001). Overall, 31 of the 35 women (89 percent) treated with metformin ovulated spontaneously or in response to clomiphene, as compared with 3 of the 26 women (12 percent) treated with placebo. Conclusions The ovulatory response to clomiphene can be increased in obese women with the polycystic ovary syndrome by decreasing insulin secretion with metformin. (N Engl J Med 1998;338:1876-80.

Genetic Variation in 11β-Hydroxysteroid Dehydrogenase Type 1 Predicts Adrenal Hyperandrogenism among Lean Women with Polycystic Ovary Syndrome

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Osteochondroma as a cause of scapular winging in an adolescent: a case report and review of the literature

INTRODUCTION: Winged scapula is defined as the prominence of the medial border of the scapula. The classic etiopathology of scapular winging are injuries to the spinal accessory or long thoracic nerves resulting respectively in trapezius and serratus anterior palsy. To the best of our knowledge, there are only few reports of scapular lesions being mistaken for winging of the scapula. We report a rare case of a large scapular osteochondroma arising from the medial border and causing a pseudowinging of the scapula. CASE PRESENTATION: A 17-year-old Caucasian boy came to us complaining about a winged left scapula. The patient had a complete painless range of motion, but a large hard bony swelling was palpable along the medial border of his left scapula. A grating sensation was felt when his arm was passively abducted and/or elevated causing discomfort. A lesion revealed on X-rays was diagnosed as an osteochondroma of the medial border of his scapula. After preoperative examinations, he underwent open surgery in order to remove the lesion. A histological examination confirmed the clinical diagnosis of osteochondroma. A clinical examination 3 months later showed a full and painless range of motion, the absence of the grating sensation during passive abduction and elevation and the complete disappearance of his left shoulder deformity. After 2 years of follow-up, there were no clinical or radiological signs of recurrence. CONCLUSIONS: Despite its rarity osteochondroma should be considered in the differential diagnosis for any adolescent presenting with a winging of the scapula

Single center experience with laparoscopic adrenalectomy on a large clinical series

BACKGROUND: Laparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies. METHODS: Pre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn's disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies. RESULTS: One hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn's disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100-180) during the learning curve adrenalectomies and 96.5 min (range 75-110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60-280) and 90.5 ml (range 50-200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile. CONCLUSIONS: Laparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes

Reverse end-diastolic flow in a fetus with a rare liver malformation: a case report

<p>Abstract</p> <p>Introduction</p> <p>We describe a case of early and persistent reverse end-diastolic flow in the middle cerebral artery in a fetus with severe ascites. These features are associated with a rare liver malformation known as ductal plate malformation.</p> <p>Case presentation</p> <p>A 28-year-old Caucasian woman was referred to our high-risk obstetric unit at 24 weeks' gestation for fetal ascites detected during a routine ultrasound examination. During her hospitalization we performed medical investigations, including a fetal paracentesis, to detect the etiology of fetal ascites. The cause of fetal ascites (then considered non-immune or idiopathic) was not evident, but a subsequent ultrasound examination at 27 weeks' gestation showed a reverse end-diastolic flow in the middle cerebral artery without any other Doppler abnormalities. A cesarean section was performed at 28 weeks' gestation because of the compromised fetal condition. An autopsy revealed a rare malformation of intrahepatic bile ducts known as ductal plate malformation.</p> <p>Conclusion</p> <p>Persistent reverse flow in the middle cerebral artery should be considered a marker of adverse pregnancy outcome. We recommend careful ultrasound monitoring in the presence of this ultrasonographic sign to exclude any other cause of increased intracranial pressure. To better understand the nature of these ultrasonographic signs, additional reports are deemed necessary. In fact in our case, as confirmed by histopathological examination, the fetal condition was extremely compromised due to failure of the fetal liver. Ductal plate malformation altered the liver structures causing hypoproteinemia and probably portal hypertension. These two conditions therefore explain the severe hydrops that compromised the fetal situation.</p

Similaridade genética em casais, variáveis culturais e personalidade

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