Lúcia Helena Coelho Nóbrega

Body Adiposity Index Indicates Only Total Adiposity, Not Risk

95.1 ± 16.1 94 ± 13.6 99.7 ± 13.3 106.5 ± 13.9 <0.0001 0.2786* 0.2919* 0.3737* 0.3613* Waist-hip ratio 0.865 ± 0.09 0.876 ± 0.08 0.909 ± 0.08 0.948 ± 0.08 <0.0001 0.2669* 0.3525* 0.3133* 0.2643* Waist-to-height ratio 0.587 ± 0.1 0.580 ± 0.08 0.617 ± 0.08 0.665 ± 0.09 <0.0001 0.2938* 0.3229* 0.3732* 0.3575* BMI (kg/m 2 ) 29.72 ± 6.7 29.68 ± 6.5 31.21 ± 6.7 33.85 ± 7.1 <0.0001 0.2471* 0.2451* 0.341* 0.348* BAI (%Fat) 35.21 ± 6.0 34.17 ± 5.8 35.62 ± 6.9 37.64 ± 8.1 0.26 0.1609* 0.1388* 0.2028* 0.2245* Fasting glycemia (mg/dl) 85.0 ± 7.6 105.1 ± 6.2 88.6 ± 7.4 116.9 ± 25.7 <0.0001 — — — —

Predicting malignant involvement in a thyroid nodule: role of ultrasonography.

OBJECTIVE To assess how ultrasonography can contribute during the evaluation of a thyroid nodule and whether this technique can have a role in predicting malignant involvement. METHODS In this retrospective study, data were analyzed on 220 consecutive patients (with 348 thyroid nodules) who underwent thyroidectomy and had previously undergone assessment by high-resolution thyroid ultrasonography. Nodule size, echogenicity, regularity of margins, halo sign, presence or absence of calcifications, and invasion of surrounding tissues were evaluated. The nodules were classified as low, medium, or high risk for malignant involvement on the basis of nodule characteristics found on ultrasonography. All nodules were submitted to cytologic examination by fine-needle aspiration (FNA) before thyroidectomy. Ultrasound, FNA, and pathologic postoperative results were compared. RESULTS Among the 348 thyroid nodules, 56 were ultrasonographically classified as low risk, 268 as medium risk, and 24 as high risk for malignant potential. Fifty of 56 (89.3%) low-risk nodules and 213 of 268 (79.5%) medium-risk nodules were diagnosed as benign at pathologic postoperative examination. In contrast, however, only 6 of 24 (25%) high-risk nodules were diagnosed as benign. Among the 18 high-risk nodules of 1-cm diameter or larger, FNA showed a 20% false-negative result. CONCLUSION High-risk classification of a thyroid nodule on ultrasonography had a positive predictive value for malignant involvement of 75%. Nodule characteristics analyzed by ultrasonography should be considered at the time of surgical intervention.

Dislipidemia pós-prandial como achado precoce em indivíduos com baixo risco cardiovascular

OBJECTIVE: to show a correlation between postprandial hypertriglyceridemia and cardiovascular risk factors to atherogenesis. RESEARCH DESIGN AND METHODS: 47 (30 women and 17 men, 40.5 ± 14.9years, body mass index: 26.1 ± 5.4kg/m2) non diabetic volunteers with normal (<200mg/dl) triglycerides were studied. Triglycerides, HDL-cholesterol and total cholesterol were measured before (basal), 3 and 5 hours after a 70g-lipid standardized test meal. RESULTS: patients with 3 hours postprandial hypertriglycerides higher than the 2nd Quartile (164.8mg/dl), in spite of normal fasting triglycerides, have higher BMI (28.1 ± 5.6 vs. 24.2 ± 4.5kg/m2; p= 0.008), abdominal circumference (95.7 vs. 84.1cm; p= 0.001), waist/hip ratio (0.92 vs. 0.86; p= 0.008) and diastolic pressure (83.1 vs. 77.2mmHg; p= 0.02) and lower HDL (39.1 vs. 48.3mg/dl; p= 0.008). CONCLUSIONS: Postprandial hypertriglyceridemia related well with others risk factors, even in patients with normal fasting triglycerides.

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

PURPOSE: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. METHODS: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. RESULTS: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. CONCLUSION: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies.

Influência da função tireoidiana nos níveis séricos de CPK

OBJECTIVE: To determine serum CPK variation based on TSH e free T4 (FT4), and to assess serum CPK in pathological states of the thyroid (hyperthyroidism and hypothyroidism), in relation to the euthyroidism. MATERIAL AND METHODS: We evaluated retrospectively 6,230 laboratory results of TSH and CPK from 2007 to 2011. From these, 3,369 had free T4 results. We evaluated the correlation between CPK and TSH and the pathological states of the thyroid. RESULTS: The correlation between TSH and CPK was positive (r = 0.065), while that between CPK and FT4 was negative (r = -0.091, p < 0.05). From the total of results analyzed, 586 (9.4%) were measures of hyperthyroidism, with a median (range) of CPK of 98 U/L (27 to 1,113), and 556 (8.9%) were of hypothyroidism, with CPK of 114 U/L (25-4,182). CONCLUSION: A positive correlation was found between serum CPK and TSH, and a negative correlation between CPK and FT4. CPK was lower in the group with hyperthyroidism, and greater in that with hypothyroidism.

Analysis of testosterone pulsatility in women with ovulatory menstrual cycles

OBJECTIVE To evaluate the pattern of the pulsatile secretion of testosterone in normal menstrual cycle. METHODS Eight healthy women with ovulatory menstrual cycles were enrolled. Blood samples were collected at ten-minute intervals for six hours, starting between 7 and 8 am, after a ten-hour fasting, in three phases: mid-follicular (Day 7), late follicular (Day 12) and mid-luteal phase (Day 21). Samples were assayed for testosterone, LH and the baseline also for SHBG. RESULTS Testosterone pulse frequency, mean amplitude pulse, percentage of increment in pulse amplitude, mean duration of pulses and pulse interval were similar in the three phases. LH pulsatility was statistically different among the three phases (p < 0.001) representing normal ovulatory cycles. CONCLUSIONS These data increase the knowledge about the testosterone secretion profile in the human menstrual cycle and can be used as a contribution to clinical investigation in both hyperandrogenism and androgen insufficiency syndrome.

Supressão Hipotálamo-Hipófise-Adrenal e Risco de Insuficiência Adrenal Secundária Devido ao Uso de Dexametasona Nasal

Corticosteroid use is an important cause of secondary adrenal insufficiency and some authors do not consider nasal use as able to cause it. Rhinitis is a usual disease and corticosteroid has been used with good results, with no association to its possible systemic effects. The authors report two cases of secondary adrenal insufficiency caused by nasal dexamethasone. Some aspects of this peculiar condition are discussed.

Bone Density in Patients With Berardinelli-Seip Congenital Lipodystrophy Is Higher in Trabecular Sites and in Type 2 Patients

Berardinelli-Seip congenital lipodystrophy (BSCL) is a rare autosomal recessive syndrome characterized by a difficulty storing lipid in adipocytes, low body fat, hypoleptinemia, and hyperinsulinemia. We report here laboratory, bone mineral density (BMD), and bone mineral content findings of 21 patients (24.1 ± 8.4 yr old, 14 females, 18 diabetics, 5.3% total body fat) with BSCL. The mean leptin was very low (0.91 ± 0.42 ng/mL), and the mean values of the Z-scores for all studied sites were positive, except for the 33% radius (Z-score -0.5 standard deviation [SD]). Twelve patients (57.1%) had a BMD Z-score higher than +2.5 SD in at least 1 site. There was no significant difference in the Z-scores between males and females. None of type 1 (AGPAT2) patients had Z-scores higher than +2.5 SD, and these patients had a smaller Z-score of BMD total body (0.26 SD vs 1.90 SD, p = 0.022) and of bone mineral content (1.59 SD vs 3.3 SD, p = 0.032) than type 2 (seipin) patients. Insulin, as well as HOMAIR (homeostasis model assessment), correlated positively with the BMD of all sites, except for the 33% radius. Z-Scores on this site (33% radius) were the smallest of all. More than half of our patients with BSCL have BMD Z-scores higher than +2.5 SD on at least 1 site, and this increase is more pronounced in the trabecular sites and in type 2 patients.

Conversations between insulin and bone: Potential mechanism of high bone density in patients with Berardinelli-Seip Congenital Lipodystrophy

Berardinelli-Seip Congenital Lipodystrophy (BSCL) is a rare autosomal recessive syndrome characterized by a difficulty storing lipid in adipocytes, low body fat, hypertriglyceridemia, and fat liver. The serum leptin is usually very low, and serum insulin, as well as HOMAIR (homeostasis model assessment), is very high and correlated positively with bone mineral density (BMD). Despite deficiency/insufficiency of vitamin D, low body mass index, low daily calcium intake, physical inactivity, and menarche at a later age, BSCL patients usually have normal or even high BMD. We hypothesize that low leptin and high insulin may play a role in this outcome. Understanding the potential pathophysiological mechanism of these bone abnormalities will help to clarify the effects of extreme insulin resistance in the bone.

Effectiveness of adding vildagliptin to the treatment of diabetic patients nonresponsive to the combination of metformin and a sulphonylurea

OBJECTIVE To evaluate the effectiveness of adding vildagliptin to the treatment of patients with inadequately controlled type 2 diabetes mellitus (T2DM) treated with a combination of metformin and a sulphonylurea. SUBJECTS AND METHODS 37 T2DM patients with HbA1c ranging from 7.7% to 12.4% (mean of 9.30 ± 1.38), despite the use of metformin in combination with a sulphonylurea, were additionally treated with vildagliptin (100 mg/day) for at least 6 months. RESULTS During triple oral therapy (TOT) HbA1c levels < 7% were achieved in 11 patients (29.7%), whereas levels of fasting plasma glucose (FPG) < 120 mg/dL were observed in 12 patients (32.4%). Both findings were observed in 10 patients (27.0%). Compared to nonresponsive subjects, lower mean baseline HbA1c and FPG levels were seen in responsive patients, but the difference was only statistically significant for fasting plasma glucose (FPG). Moreover, there was considerable overlap between the two groups. CONCLUSION Our preliminary results suggest that TOT with metformin, a sulphonylurea and vildagliptin may be useful for some T2DM patients nonresponsive to combination therapy with metformin and sulphonylurea.