Efeitos de diferentes graus de sensibilidade a insulina na função endotelial de pacientes obesos Efectos de diferentes grados de sensibilidad a la insulina en la función endotelial de pacientes obesos Effects of different degrees of insulin sensitivity on endothelial function in obese patients

FUNDAMENTO: A obesidade derivada da deposição de gordura intra-abdominal tende a aumentar a produção de hormônios e citoquinas, piorando a sensibilidade a insulina e levando a disfunção endotelial. A hiperinsulinemia é considerada um fator de risco independente para doença isquêmica cardíaca e é uma causa de disfunção endotelial em indivíduos saudáveis. OBJETIVO: Avaliar o impacto de diferentes graus de resistência a insulina, medida pelo HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), sobre a função endotelial de obesos, pacientes não diabéticos, sem história prévia de eventos cardiovasculares e diversos componentes da síndrome metabólica. MÉTODOS: Um total de 40 indivíduos obesos foi submetido a medidas antropométricas, pressão arterial de consultório, MAPA e exames laboratoriais, além de avaliação ultrassonográfica não invasiva da função endotelial. Os pacientes foram divididos em três grupos de acordo com o grau de resistência a insulina: pacientes com valores de HOMA-IR entre 0,590 e 1,082 foram incluídos no Grupo 1 (n = 13); entre 1,083 e 1,410 no Grupo 2 (n = 14); e entre 1,610 e 2,510 no Grupo 3 (n = 13). RESULTADOS: Encontramos uma diferença significativa na vasodilatação mediada por fluxo no Grupo 3 em relação ao Grupo 1 (9,2 ± 7,0 vs 18,0 ± 7,5 %, p = 0,006). Houve uma correlação negativa entre a função endotelial e insulina, HOMA-IR e triglicérides. CONCLUSÃO: Nosso estudo sugere que leves alterações nos níveis de resistência a insulina avaliada pelo HOMA-IR podem causar algum impacto sobre a função vasodilatadora do endotélio em indivíduos obesos não complicados com diferentes fatores de risco cardiovascular.<br>FUNDAMENTO: La obesidad derivada del depósito de grasa intraabdominal tiende a aumentar la producción de hormonas y citocinas, empeorando la sensibilidad a la insulina y llevando a disfunción endotelial. La hiperinsulinemia es considerada un factor de riesgo independiente para enfermedad isquémica cardíaca y es una causa de disfunción endotelial en individuos sanos. OBJETIVO: Evaluar el impacto de diferentes grados de resistencia a la insulina, medida por el HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), sobre la función endotelial de obesos, pacientes no diabéticos, sin historia previa de eventos cardiovasculares y diversos componentes del síndrome metabólico. MÉTODOS: Un total de 40 individuos obesos fue sometido a medidas antropométricas, presión arterial de consultorio, MAPA y exámenes de laboratorio, además de evaluación ultrasonográfica no invasiva de la función endotelial. Los pacientes fueron divididos en tres grupos de acuerdo con el grado de resistencia a insulina: pacientes con valores de HOMA-IR entre 0,590 y 1,082 fueron incluidos en el Grupo 1 (n = 13); entre 1,083 y 1,410 en el Grupo 2 (n = 14); y entre 1,610 y 2,510 en el Grupo 3 (n = 13). RESULTADOS: Encontramos una diferencia significativa en la vasodilatación mediada por flujo en el Grupo 3 en relación al Grupo 1 (9,2 ± 7,0 vs 18,0 ± 7,5 %, p = 0,006). Hubo una correlación negativa entre la función endotelial e insulina, HOMA-IR y triglicéridos. CONCLUSIÓN: Nuestro estudio sugiere que leves alteraciones en los niveles de resistencia a la insulina evaluada por el HOMA-IR pueden causar algún impacto sobre la función vasodilatadora del endotelio en individuos obesos no complicados con diferentes factores de riesgo cardiovascular.<br>BACKGROUND: Obesity derived from intra-abdominal fat deposition tends to increase hormonal and cytokine production, thus worsening insulin sensitivity and leading to endothelial dysfunction. Hyperinsulinemia is considered an independent risk factor for ischemic heart disease and cause of endothelial dysfunction in healthy individuals. OBJECTIVE: To assess the impact of different degrees of insulin resistance, measured by HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), on endothelial function in obese, non-diabetic patients without prior history of cardiovascular events and different metabolic syndrome components. METHODS: Forty obese individuals were submitted to anthropometric measurements, BP measurements at office and ABPM and laboratory tests, in addition to non-invasive ultrasound assessment of endothelial function. Patients were divided into 3 groups according to the level of insulin resistance: patients with HOMA-IR values from 0.590 to 1.082 were assigned to Group 1 (n=13), from 1.083 to 1.410 to Group 2 (n=14) and from 1.610 to 2.510 to Group 3 (n=13). RESULTS: We found a significant difference in flow-mediated dilation in group 3 compared to group 1 (9.2±7.0 vs 18.0±7.5 %, p=0.006). There was a negative correlation between endothelial function and insulin, HOMA-IR and triglycerides. CONCLUSION: Our data suggest that mild changes in insulin resistance levels assessed by HOMA-IR may have an impact on vasodilatatory endothelial function in uncomplicated obese individuals with different cardiovascular risk factors

Ultrasound Determination of Gestational Age Using Placental Thickness in Female Dogs: An Experimental Study

Objective. To verify if the placental thickness allows determining the gestational age, evaluating the correlation between the referred gestational age with the studied one, and the accuracy of the placental thickness measurement (biometry) with fetal morphologic parameters in bitches. Methods. The placental thickness of 336 bitches of diverse breeds was evaluated. Bitches were divided in three groups by body weight: small, medium, and big large size. The gestations pregnancies were evaluated by ultrasound from the third week of gestation. An analysis was performed between the mean values of the gestational age obtained of placental thickness by adjustment of curves and the reported gestational age. Student's t-test was applied to compare the mean of reported and placental thickness gestational age. Significance was defined as P<0.05. Results. A positive and statistically significant correlation exists between the placental thickness and gestational age. The expression that presents the best correlation coefficient and explanation was thickness of placenta = 0.021x gestational age −0.314. Conclusion. It is possible to determine the gestational age in relation to the placental thickness measured by ultrasound in bitches with a satisfactory accuracy in relation to fetal morphologic parameters as gestational vesicle, ribs, or kidneys

Comparative evaluation of digital mammography and film mammography: systematic review and meta-analysis

CONTEXT AND OBJECTIVE: Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography. DESIGN: Systematic review and meta-analysis. METHOD: The Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations. RESULTS: A total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95% confidence interval, CI = 1.06-1.29; I² = 19%). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected. CONCLUSION: The cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods