The pancreas in human type 1 diabetes

Type 1 diabetes (T1D) is considered a disorder whose pathogenesis is autoimmune in origin, a notion drawn in large part from studies of human pancreata performed as far back as the 1960s. While studies of the genetics, epidemiology, and peripheral immunity in T1D have been subject to widespread analysis over the ensuing decades, efforts to understand the disorder through analysis of human pancreata have been far more limited. We have reviewed the published literature pertaining to the pathology of the human pancreas throughout all stages in the natural history of T1D. This effort uncovered a series of findings that challenge many dogmas ascribed to T1D and revealed data suggesting the marked heterogeneity in terms of its pathology. An improved understanding and appreciation for pancreatic pathology in T1D could lead to improved disease classification, an understanding of why the disorder occurs, and better therapies for disease prevention and management

Orthopedic Basis for Occupationally Related Arm and Neck Pain

A prospective clinical study of 204 individuals with occupationally related upper limb or neck pain was initiated to determine the major symptom patterns, the physical findings, and changes in laboratory tests that are exhibited by these subjects. On the basis of this information it was possible to determine the proportion that was suffering from a recognizable, pathologically discrete, musculoskeletal disorder. The study shows that in the majority (58%) of these people, a discrete musculoskeletal disorder exists. The most common diagnoses were peripheral nerve entrapments (19%) and arthropathies (16%). In 42% a discrete diagnosis was not made and the nature of the disorder, in these, is discussed

Fecal Microbiota Composition Differs Between Children With beta-Cell Autoimmunity and Those Without

<p>The role of the intestinal microbiota as a regulator of autoimmune diabetes in animal models is well-established, but data on human type 1 diabetes are tentative and based on studies including only a few study subjects. To exclude secondary effects of diabetes and FILA risk genotype on gut microbiota, we compared the intestinal microbiota composition in children with at least two diabetes-associated autoantibodies (n = 18) with autoantibody-negative children matched for age, sex, early feeding history, and HLA risk genotype using pyrosequencing. Principal component analysis indicated that a low abundance of lactate-producing and butyrate-producing species was associated with beta-cell autoimmunity. In addition, a dearth of the two most dominant Bifidobacterium species, Bifidobacterium adolescentis and Bifidobacterium pseudocatenulatum, and an increased abundance of the Bacteroides genus were observed in the children with beta-cell autoimmunity. We did not find increased fecal calprotectin or IgA as marker of inflammation in children with beta-cell autoimmunity. Functional studies related to the observed alterations in the gut microbiome are warranted because the low abundance of bifidobacteria and butyrate-producing species could adversely affect the intestinal epithelial barrier function and inflammation, whereas the apparent importance of the Bacteroides genus in development of type 1 diabetes is insufficiently understood. Diabetes 62:1238-1244, 2013</p>

Algumas considerações metodológicas sobre os estudos epidemiológicos das Lesões por Esforços Repetitivos (LER) Methodological issues in epidemiological studies of Repetitive Strain Injuries (RSI)

As lesões por esforços repetitivos (LER) constituem-se um problema de saúde pública, com repercussões sociais e econômicas. Este artigo apresenta uma revisão crítica dos estudos epidemiológicos das últimas duas décadas. A grande maioria desses estudos foi de corte transversal e exploratório, e os resultados são difíceis de interpretar devido aos problemas metodológicos. Entre os principais problemas notados estão: falta de padronização e rigor na definição e identificação de casos, não diferenciação dos "casos" segundo a especificidade e gravidade clínica, inclusão de "casos" prevalentes e incidentes no mesmo estudo, imprecisão e precariedade na definição e mensuração dos fatores de exposição e de confusão relevantes, além das limitações intrínsecas dos estudos de prevalência para inferir causalidade. Essas limitações resultam em parte da insuficiência de conhecimento científico das lesões de tecidos moles de membros superiores e da falta de métodos diagnósticos confiáveis. Entretanto, tais dificuldades podem ser minimizadas com desenhos mais apropriados e que levem em consideração e estratifiquem casos segundo a especificidade do quadro clínico e grau de certeza do diagnóstico.<br>Repetitive strain injuries (RSI) are a major public health problem with social and economic repercussions. This article presents a critical review of the published literature on RSI. The vast majority of the studies conducted in the last two decades were cross-sectional and exploratory. Results are difficult to interpret due to such methodological problems as lack of standardization and accuracy in identification of cases, inclusion of cases with potentially different diseases, varying levels of severity in the same study, lack of distinction between prevalent and incident cases, lack of precision in the definition and measurement of exposure, and confounding, besides the built-in constraint of cross-sectional studies for inferring causality. Some of these problems result from our insufficient knowledge of upper-limb soft tissue disorders and the absence of reliable diagnostic tests. Such problems could be addressed by studies whose design considered and stratified cases according to certainty and specificity of diagnosis