Clarisse Mourão Melo Ponte

Gonadotrophic axis dysfunction in men with HIV-infection/AIDS.

Gonadotrophic axis dysfunction is commonly observed in HIV-infected patients. The pathogenesis is multifactorial and related to duration of HIV infection, direct cytopathic effects of viruses, use of drugs, opportunistic infections, malignancies, and malnutrition, among other factors. In men, reduced levels of testosterone is associated with loss of muscle mass and strength, decreased bone mineral density, lipodystrophy, depression, asthenia, fatigue and sexual dysfunction. In HIV-infected patients with hypogonadism, numerous studies have shown the beneficial effects of testosterone replacement on the metabolic profile and distribution of body fat, with increased body mass weight, and promote better quality of life, reduce the bone mass loss and the rates of depression. Thus, this review aimed to present a brief update of epidemiologic data, pathophysiology aspects and treatment strategies for the major abnormalities of male gonadotrophic axis associated with HIV infection and its treatment.

Early commitment of cardiovascular autonomic modulation in Brazilian patients with congenital generalized lipodystrophy

BackgroundMetabolic abnormalities in congenital generalized lipodystrophy (CGL) are associated with microvascular complications. However, the evaluation of different types of neuropathy in these patients, including the commitment of cardiovascular autonomic modulation, is scarce. The objective of the present study was to determine the prevalence of cardiovascular autonomic neuropathy (CAN) in patients with CGL compared with individuals with type 1 diabetes and healthy subjects.MethodsTen patients with CGL, 20 patients with type 1 diabetes and 20 healthy subjects were included in the study. Controls were paired 1:2 for age, gender, BMI and pubertal stage. Heart rate variability (HRV) was analyzed using cardiovascular autonomic reflex tests, including postural hypotension test, Valsalva (VAL), respiratory (E/I) and orthostatic (30/15) coefficients, and spectral analysis of the HRV, determining very low (VLF), low (LF) and high (HF) frequencies components. The diagnosis of CAN was defined as the presence of at least two altered tests.ResultsCAN was detected in 40% of the CGL patients, 5% in type 1 diabetes patients and was absent in healthy individuals (p < 0.05). We observed a significant reduction in the E/I, VLF, LF and HF in CGL cases vs. type 1 diabetes and healthy individuals and lower levels of 30/15 and VAL in CGL vs. healthy individuals. A significant positive correlation was observed between leptin and 30/15 coefficient (r = 0.396; p = 0.036) after adjusting for insulin resistance and triglycerides. Autonomic cardiovascular tests were associated with HbA1c, HOMA-IR, triglycerides and albumin/creatinine ratio in CGL cases.ConclusionsWe observed a high prevalence of CAN in young patients with CGL, suggesting that insulin resistance, hypertriglyceridemia and hypoleptinemia, may have been involved in early CAN development. Additional studies are needed to evaluate the role of leptinemia in the physiopathogenesis of the condition.

Ophthalmologic Findings in Congenital Generalized Lipodystrophy—A Possible Marker of Metabolic Disorders

Background and Aims: Metabolic disorders can present ophthalmologic changes. Congenital Generalized Lipodystrophy (CGL) is characterized by severe metabolic manifestations such as insulin resistance, diabetes and hypertriglyceridemia, but there are few data published about ophthalmologic findings in this condition. The purpose of this study is to describe ocular abnormalities in patients with CGL. Materials and Methods: It was a cross sectional study with 15 patients with CGL of both sex, aged between 2 and 29 years old. We evaluated the symptoms of surface eye disease and visual acuity. In the slit lamp, were evaluated the anterior segment of the eye, the break up time of the tear film with fluorescein and the corneal findings. Under mydriasis, the eye fundus examination was performed. Results: All subjects had dyslipidemia: 15/15 (100%) hypertriglyceridemia; 15/15 (100%) low HDL-c; 4/15 (26,7%) and high levels of LDL-c. Diabetes was presented in 7/15 (46,7%) cases. Symptoms of surface eye disease (blurred vision, pruritus, hyperemia or dry eye sensation) were presented in 9/15 (60%) patients and 8/15 (53%) had refractive errors: 5/8 (62,5%) astigmatism, 2/8 (25%) myopia and 1/8 (13%) myopia and astigmatism. In the slit lamp, 12/15 (80%) presented anterior blepharitis (seborrheic or meibomite), 13/15 (87%) decrease in the break up time of the tear (less than 8 seconds) and 5/15 (33,3%) keratitis. In the fundoscopy, 2/15 (13,3%) presented retinopathy (one with nonproliferative diabetic retinopathy and another presented proliferative diabetic retinopathy). Conclusion: These findings demonstrate high frequency of blepharites and its complications in patients with CGL, even in young subjects without diabetes. These data allow us to speculate that the presence of abnormalities in the anterior segment of the eye may be a marker of metabolic disorders as dyslipidemia and insulin resistance. Disclosure V.O. Fernandes: None. L.M.A. Gomes: None. A.D.R. Montenegro: None. C.M.M. Ponte: None. L.A.A. Batista: None. R.E.M. Aragao: None. J.V. Silva: None. R.M. Montenegro: None.

Precocious endothelial dysfunction in patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) evaluated by two different methods

Virginia Oliveira Fernandes, Ana Paula Dias Rangel Montenegro, Clarisse Mourao Melo Ponte, Lia Beatriz de Azevedo Souza Karbage, Manuela Montenegro Dias de Carvalho, Daniel Duarte Gadelha, Synara Cavalcante Lopes, Marivaldo Loyola Aragao, Ana Paula Abreu Martins Sales, Cristiane Bezerra Rocha Liberato, Ana Gardenia Liberato Ponte Farias, Catarina Brasil D’Alva, Francisco Herlânio Costa Carvalho, Izabella Tamira Galdino Farias Vasconcelos, Carla Antoniana Ferreira de Almeida Vieira, Ana Paula Germano Lopes Cavalcante, Mariella Zaiden Rezende Reis, Renan Magalhaes Montenegro Junior

Thoracic circumference as a predictor of metabolic syndrome and changes in its components in non-obese adults

Results There were evaluated 85 men and 191 women and mean age was 34.9 ±11.2 yrs. (33,7 yrs. men; 35,5 yrs. women). The group BMI average was 25.0±2.9 Kg/m2 (25.0±2,84 men; 24,9±2,86 women); waist circumference average was 86,9±8,2 cm (89,6±7,9cm men; 85,6±8,1cm women); TC average was 90.0±6,7 cm ( 85,8±6,1 men; 87,5±5,2cm women). The prevalence of metabolic syndrome in this group was 28%. TC was found to correlate with all components of MetS except glycaemia, being these correlations stronger with waist circumference. When using ROC curve TC was able to identifying MetS, with best Results in women. TC values of 95.8 cm and 87.3 cm respectively for men and women have presented the greater sensitivity for the prediction of MetS, with specificity ≥ 50%.

Cardiovascular risk factors in patients with premature myocardial infarction and in their first-degree relatives

Materials and methods Cross-sectional study conducted in a tertiary hospital (November/2010 – January/2015). We included 103 index cases and 166 first-degree relatives without suspicion of familial hypercholesterolemia, compared with 111 asymptomatic individuals without family history of CAD matched for sex and age. Clinical and laboratory parameters were evaluated. Associations were tested by statistical analysis.

Projeto sala de espera: uma proposta para a educação em diabetes - doi:10.5020/18061230.2006.p197

Education is an essential aspect of diabetic care. For this, many strategies have been searched. The objectives of the present study were to describe “The Waiting Room Project”, a proposal based on using the time in which the patient waits for individual attendance, to promote Diabetes Education; and to evaluate the clinical and epidemiological profile of diabetic participants of this project. Twenty meetings were conducted from March to October 2006, with 350 patients followed-up at the Diabetes Clinics of Walter Cantidio University Hospital-UFC, and their companions. Of these, 76 randomly assigned patients were interviewed. The meetings occurred on each Friday, in 2 sessions of approximately half hour, which were coordinated by a multidisciplinary team, and took into account 25 patients each. At the end, a breakfast was served and used for nutritional education. Among the interviewed participants, women prevailed (85.5%), with mean age of 60.4±9.1 years, and average time of diagnosis of 10.6±5.9 years. In relation to treatment, 40.7% used insulin, 63.1% used oral anti-diabetics and 9.2% only adopted life style changes. Drugs compliance was present in only 47.8% of the participants and the majority (67.1%) did not practice physical activities. Regarding to the diet, only 31.5% fully adhered to it. More than 75% of the participants could read and write, and earned a minimum wage or less. From the observations derived from practice, one may perceive: a greater motivation of the patients after each meeting, a more active participation in doctor’s appointments and an increasing interest on their disease and care. To provide the participation of diabetic patients in their treatments, stimulating self-care, is a challenge to be reached by all health units, and that can be favored by strategies like this described.