Association of acanthosis nigricans and skin tags with insulin resistance

Insulin resistance is a metabolic disorder in which target cells fail to respond to normal levels of circulating insulin. Insulin resistance has been associated with presence of acanthosis nigricans and acrochordons. It is known that early diagnosis and early initial treatment are of paramount importance to prevent a series of future complications. These dermatoses may represent an easily identifiable sign of insulin resistance and non-insulin-dependent diabetes.

Changes in food intake, metabolic parameters and insulin resistance are induced by an isoenergetic, medium-chain fatty acid diet and are associated with modifications in insulin signalling in isolated rat pancreatic islets

LLong-chain fatty acids are capable of inducing alterations in the homoeostasis of glucose-stimulated insulin secretion (GSIS), but the effect of medium-chain fatty acids (MCFA) is poorly elucidated. In the present study, we fed a normoenergetic MCFA diet to male rats from the age of 1 month to the age of 4 months in order to analyse the effect of MCFA on body growth, insulin sensitivity and GSIS. The 45% MCFA substitution of whole fatty acids in the normoenergetic diet impaired whole body growth and resulted in increased body adiposity and hyperinsulinaemia, and reduced insulin-mediated glucose uptake in skeletal muscle. In addition, the isolated pancreatic islets from the MCFA-fed rats showed impaired GSIS and reduced protein kinase Ba (AKT1) protein expression and extracellular signal-related kinase isoforms 1 and 2 (ERK(1/2)) phosphorylation, which were accompanied by increased cellular death. Furthermore, there was a mildly increased cholinergic sensitivity to GSIS. We discuss these findings in further detail, and advocate that they might have a role in the mechanistic pathway leading to the compensatory hyperinsulinaemic status found in this animal model.

Efeito de um protocolo de exerc��cios f��sicos sobre o ��ndice de massa corporal e circunfer��ncia da cintura em adultos com s��ndrome metab��lica

A s��ndrome metab��lica �� caracterizada por um conjunto de fatores de riscos cardiovasculares, que usualmente est�� relacionada a deposi��ao central de gordura corporal e resistência �� insulina. Este estudo tem como objetivo investigar o efeito de um programa de exerc��cios f��sicos na redu��ao do Indice de Massa Corporal (IMC) e Circunfer��ncia da Cintura (CC) em pessoas com s��ndrome metab��lica. Participaram do estudo sete adultos volunt��rios, de ambos os sexos, com m��dia de idades de 49 anos, que apresentavam s��ndrome metab��lica segundo os crit��rios de NCEP-ATP III (2001). Foram coletados dados antropom��tricos de peso, altura e CC. Foi realizado o c��lculo do IMC (IMC=peso/altura2). As coletas foram realizadas no in��cio do estudo e ap��s 16 semanas de interven��ao. O grupo de estudos foi submetido a um programa de exerc��cios f��sicos durante 16 semanas, com frequ��ncia semanal de tr��s sessoes, com dura��ao de 60 minutos cada. As sessoes compreendiam em: exerc��cios aer��bicos, alongamento, exerc��cios resistidos e alongamento. A intensidade foi adaptada de acordo com as caracter��sticas individuais. Os resultados foram analisados estatisticamente por meio do teste "t" Student pareado. Como resultados tivemos uma m��dia inicial de IMC de 33Kg m2 e final de 32Kg/m2, e de CC 106 e 104cm respectivamente. Houve uma discreta redu��ao tanto nos valores de IMC como CC, por��m nao significativas. Desta maneira, o programa de exerc��cios f��sicos foi capaz de reduzir modestamente os valores de IMC e CC de pessoas com S��ndrome Metab��lica. Acredita-se que um tempo maior de interven��ao seja necess��rio para a obten��ao de resultados significativos

Efeito de um protocolo de exerc��cios f��sicos sobre o ��ndice de massa corporal e circunfer��ncia da cintura em adultos com s��ndrome metab��lica

A s��ndrome metab��lica �� caracterizada por um conjunto de fatores de riscos cardiovasculares, que usualmente est�� relacionada a deposi��ao central de gordura corporal e resistência �� insulina. Este estudo tem como objetivo investigar o efeito de um programa de exerc��cios f��sicos na redu��ao do Indice de Massa Corporal (IMC) e Circunfer��ncia da Cintura (CC) em pessoas com s��ndrome metab��lica. Participaram do estudo sete adultos volunt��rios, de ambos os sexos, com m��dia de idades de 49 anos, que apresentavam s��ndrome metab��lica segundo os crit��rios de NCEP-ATP III (2001). Foram coletados dados antropom��tricos de peso, altura e CC. Foi realizado o c��lculo do IMC (IMC=peso/altura2). As coletas foram realizadas no in��cio do estudo e ap��s 16 semanas de interven��ao. O grupo de estudos foi submetido a um programa de exerc��cios f��sicos durante 16 semanas, com frequ��ncia semanal de tr��s sessoes, com dura��ao de 60 minutos cada. As sessoes compreendiam em: exerc��cios aer��bicos, alongamento, exerc��cios resistidos e alongamento. A intensidade foi adaptada de acordo com as caracter��sticas individuais. Os resultados foram analisados estatisticamente por meio do teste "t" Student pareado. Como resultados tivemos uma m��dia inicial de IMC de 33Kg m2 e final de 32Kg/m2, e de CC 106 e 104cm respectivamente. Houve uma discreta redu��ao tanto nos valores de IMC como CC, por��m nao significativas. Desta maneira, o programa de exerc��cios f��sicos foi capaz de reduzir modestamente os valores de IMC e CC de pessoas com S��ndrome Metab��lica. Acredita-se que um tempo maior de interven��ao seja necess��rio para a obten��ao de resultados significativos

Efeito de um protocolo de exerc��cios f��sicos sobre o ��ndice de massa corporal e circunfer��ncia da cintura em adultos com s��ndrome metab��lica

A s��ndrome metab��lica �� caracterizada por um conjunto de fatores de riscos cardiovasculares, que usualmente est�� relacionada a deposi��ao central de gordura corporal e resistência �� insulina. Este estudo tem como objetivo investigar o efeito de um programa de exerc��cios f��sicos na redu��ao do Indice de Massa Corporal (IMC) e Circunfer��ncia da Cintura (CC) em pessoas com s��ndrome metab��lica. Participaram do estudo sete adultos volunt��rios, de ambos os sexos, com m��dia de idades de 49 anos, que apresentavam s��ndrome metab��lica segundo os crit��rios de NCEP-ATP III (2001). Foram coletados dados antropom��tricos de peso, altura e CC. Foi realizado o c��lculo do IMC (IMC=peso/altura2). As coletas foram realizadas no in��cio do estudo e ap��s 16 semanas de interven��ao. O grupo de estudos foi submetido a um programa de exerc��cios f��sicos durante 16 semanas, com frequ��ncia semanal de tr��s sessoes, com dura��ao de 60 minutos cada. As sessoes compreendiam em: exerc��cios aer��bicos, alongamento, exerc��cios resistidos e alongamento. A intensidade foi adaptada de acordo com as caracter��sticas individuais. Os resultados foram analisados estatisticamente por meio do teste "t" Student pareado. Como resultados tivemos uma m��dia inicial de IMC de 33Kg m2 e final de 32Kg/m2, e de CC 106 e 104cm respectivamente. Houve uma discreta redu��ao tanto nos valores de IMC como CC, por��m nao significativas. Desta maneira, o programa de exerc��cios f��sicos foi capaz de reduzir modestamente os valores de IMC e CC de pessoas com S��ndrome Metab��lica. Acredita-se que um tempo maior de interven��ao seja necess��rio para a obten��ao de resultados significativos

Desnerva����o simp��tica renal e sua utiliza����o no tratamento da hipertens��o resistente : caso cl��nico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Altera����es metab��licas e risco cardiovascular em crian��as infectadas verticalmente pelo VIH-1 na era do tratamento anti-retroviral combinado : um caso cl��nico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Tratamentos periodontais em diab��ticos

Disserta����o para obten����o do grau de Mestre no Instituto Superior de Ci��ncias da Sa��de Egas Moniz

Paciente odontopedi��trico portador de diabetes

Disserta����o para obten����o do grau de Mestre no Instituto Superior de Ci��ncias da Sa��de Egas Moniz

Par��metros bioqu��micos e n��veis de IgE total e espec��ficas para aeroal��rgenos em mulheres obesas com s��ndrome dos ov��rios polic��sticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ��� 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

A influ��ncia da perda de peso no perfil inflamat��rio de mulheres com s��ndrome dos ov��rios polic��sticos

The polycystic ovary syndrome (PCOS) is considered the most common endocrine disorder in reproductive age women, with a prevalence ranging from 15 to 20%. In addition to hormonal and reproductive changes, it is common in PCOS the presence of risk factors for developing cardiovascular disease (CVD) and diabetes mellitus, insulin resistance (IR), visceral obesity, chronic low-grade inflammation and dyslipidemia. Due to the high frequency of obesity associated with PCOS, weight loss is considered as the first-line treatment for the syndrome by improving metabolic and normalizes serum androgens, restoring reproductive function of these patients. Objectives: To evaluate the inflammatory markers and IR in women with PCOS and healthy ovulatory with different nutritional status and how these parameters are displayed after weight loss through caloric restriction in with Down syndrome. Methods: Tumor necrosis factor-alpha (TNF-��), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women of childbearing age. The volunteers were divided into four groups: Group I (not eutrophic with PCOS, n = 12); Group II (not eutrophic without PCOS, n = 10), Group III (eutrophic with PCOS, n = 08) and Group IV (eutrophic without PCOS, n = 10). The categorization of groups was performed by body mass index (BMI), according to the World Health Organization (WHO) does not eutrophic, overweight and obesity (BMI> 25 kg / m��) and normal weight (BMI <24.9 kg / m��). IR was determined by HOMA-IR index. In the second phase of the study a controlled dietary intervention was performed and inflammatory parameters were evaluated in 21 overweight and obese women with PCOS, before and after weight loss. All patients received a low-calorie diet with reduction of 500 kcal / day of regular consumption with standard concentrations of macronutrients. Results: Phase 1: PCOS patients showed increased levels of CRP (p <0.01) and HOMAIR (p <0.01). When divided by BMI, both not eutrophic group with PCOS (I) as eutrophic with PCOS (III) showed increased levels of CRP (I = 2.35 �� 0,55mg / L and 2.63 �� III = 0,65mg / L; p <0.01) and HOMA-IR (I = 2.16 �� 2.54 and III = 1.07 �� 0.55; p <0.01). There were no differences in TNF-�� and IL-6 between groups. Step 2: After the weight loss of 5% of the initial weight was reduced in all of the components of serum assessed inflammatory profile, PCR (154.75 �� 19:33) vs (78.06 �� 8.9) TNF �� (10.89 �� 5.09) vs (6:39 �� 1:41) and IL6 (154.75 �� 19:33) vs (78.06 �� 08.09) (p <0:00) in association with improvement some hormonal parameters evaluated. Conclusion: PCOS contributed to the development of chronic inflammation and changes in glucose metabolism by increasing CRP, insulin and HOMA-IR, independent of nutritional status. The weight loss, caloric restriction has improved the inflammatory condition and hormonal status of the evaluated patients.

Avalia����o da genotoxicidade em mulheres com s��ndrome dos ov��rios polic��sticos: impacto da dieta

Introduction: Polycystic Ovary Syndrome (PCOS), present in 6-12% of women of reproductive age, the criterion of Rotterdam, is characterized by hyperandrogenism, insulin resistance (IR) and its inflammatory state, exacerbated by obesity and factors associated with the increase in damage DNA. Weight loss, combined with healthy eating, acts restoring the reproductive and metabolic functions in the SOP, though its influence in reducing DNA damage in PCOS are unknown. Aim: To investigate whether there are differences between DNA damage markers and factors of cardiometabolic risk in women with PCOS and control, and evaluate the effectiveness of nutritional intervention in DNA damage markers and cardiometabolic risk markers in overweight and obese women with PCOS. Methods: the study was conducted in two studies and the participants were aged between 18 and 35 years. In the first study, a prospective case-control, were included 27 women diagnosed with PCOS and 20 controls. In the second study, clinical trial of nutritional intervention with 12-week calorie-restricted diet 500Kcal / day. The genotoxicity, DNA damage (intensity tail, tail moment and tail length) was evaluated by the comet assay. Anthropometric data, dietary intake, hormonal, biochemical and inflammatory were evaluated in different studies. Results: there was no significant difference between the DNA damage marker tail intensity (p = 0.18), tail moment (p = 0.76) and tail length (p = 0.109) in PCOS when compared to the control group. Data after nutritional intervention in PCOS women with overweight and obesity showed a decrease in DNA damage markers: tail intensity (24.35 �� 5.86 - pre-diet vs. 17.15 �� 5.04 -Post-diet) and tail moment (20.47 �� 7.85 - pre-diet vs. 14.13 �� 6.29 -post-diet) (p <0.001). Reduction of weight (3.5%) and decreased cardiometabolic markers IR and hyperandrogenism. Conclusion: women with PCOS have a worse cardiometabolic risk profile compared to control however similar genotoxicity identified by DNA damage. Nutritional intervention reduced the genotoxicity of overweight and obese women with PCOS, and reduce the factors of cardiometabolic risk.

S��ndrome dos Ov��rios Polic��sticos: diagn��stico, tratamento e repercuss��es ao longo da vida

A s��ndrome dos ov��rios polic��sticos (SOP) �� uma endocrinopatia comum em mulheres na idade reprodutiva. Caracteriza-se por hiperandrogenismo, disfun����o ovulat��ria e infertilidade. Est�� associada a reconhecidos fatores de risco cardiovascular: obesidade, resistência �� insulina, dislipidemias, hipertens��o arterial, s��ndrome metab��lica,risco aumentado para intoler��ncia �� glicose e diabetes mellitus tipo 2 em idade mais precoce que o habitual. Embora mulheres com SOP apresentem perfil de risco cardiovascular adverso, os estudos s��o limitados em confirmar a associa����o entre SOP e mortalidade por evento cardiovascular. Devido �� ampla variabilidade cl��nica, o diagn��stico de SOP nem sempre �� f��cil. De acordo com o Consenso de Rotterdam, os crit��rios para diagn��stico de SOP incluem pelo menos dois dos seguintes crit��rios: amenoreia e/ou oligomenorreia, sinais cl��nicos e/ou bioqu��micos de hiperandrogenismo e/ou ov��rio polic��stico �� ultrassonografia; com exclus��o de outras etiologias que apresentam manifesta����es cl��nicas semelhantes. O tratamento de SOP �� sintom��tico e direcionado de acordo com a manifesta����o cl��nica, o desejo de contracep����o ou gesta����o e a presen��a de dist��rbios metab��licos associados. As pacientes com SOP devem ser informadas que esta �� uma enfermidade cr��nica, com tratamento e seguimento por longo prazo.

��ndices de obesidade central e fatores de risco cardiovascular na s��ndrome dos ov��rios polic��sticos

Fundamento: A obesidade abdominal apresenta elevada preval��ncia em mulheres com s��ndrome dos ov��rios polic��sticos (SOP) e est�� associada a um aumento do risco cardiovascular. Objetivo: Verificar a acur��cia da circunfer��ncia da cintura (CC), da rela����o cintura-quadril (RCQ), da rela����o cinturaestatura (RCEST) e do ��ndice de conicidade (��ndice C), no que se refere �� detec����o de fatores de risco cardiovascular (FRCV) em mulheres com SOP. M��todos: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 �� 5 anos) com diagn��stico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicer��deos (TG), o LDL-colesterol (LDL-C), o HDLcolesterol (HDL-C), a glicemia de jejum, a glicemia ap��s teste oral de toler��ncia �� glicose (TOTG) e a press��o arterial (PA) foram avaliados em todas as pacientes, al��m das vari��veis antropom��tricas. Resultados: A rela����o cintura-estatura foi o marcador que apresentou correla����es positivas significativas com o maior n��mero de FRCV (PA, TG e glicemia ap��s TOTG), destacando-se ainda a correla����o negativa com HDL-C. Todos os marcadores antropom��tricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correla����o positiva tamb��m com TG. No tocante �� acur��cia para detec����o de FRCV, os indicadores antropom��tricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. Conclus��o: A RCEST demonstrou ser o indicador antropom��trico com a melhor acur��cia para a predi����o de FRCV. Nesse sentido, prop��e-se a inclus��o desse par��metro de f��cil mensura����o na avalia����o cl��nica para o rastreamento de mulheres com SOP e FRCV----------------------ABSTRACT Background: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. Objective: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. Methods: The present transversal study allocated 102 women (26.5 �� 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. Results: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. Conclusion: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF

��ndices de obesidade central e fatores de risco cardiovascular na s��ndrome dos ov��rios polic��sticos

Fundamento: A obesidade abdominal apresenta elevada preval��ncia em mulheres com s��ndrome dos ov��rios polic��sticos (SOP) e est�� associada a um aumento do risco cardiovascular. Objetivo: Verificar a acur��cia da circunfer��ncia da cintura (CC), da rela����o cintura-quadril (RCQ), da rela����o cinturaestatura (RCEST) e do ��ndice de conicidade (��ndice C), no que se refere �� detec����o de fatores de risco cardiovascular (FRCV) em mulheres com SOP. M��todos: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 �� 5 anos) com diagn��stico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicer��deos (TG), o LDL-colesterol (LDL-C), o HDLcolesterol (HDL-C), a glicemia de jejum, a glicemia ap��s teste oral de toler��ncia �� glicose (TOTG) e a press��o arterial (PA) foram avaliados em todas as pacientes, al��m das vari��veis antropom��tricas. Resultados: A rela����o cintura-estatura foi o marcador que apresentou correla����es positivas significativas com o maior n��mero de FRCV (PA, TG e glicemia ap��s TOTG), destacando-se ainda a correla����o negativa com HDL-C. Todos os marcadores antropom��tricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correla����o positiva tamb��m com TG. No tocante �� acur��cia para detec����o de FRCV, os indicadores antropom��tricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. Conclus��o: A RCEST demonstrou ser o indicador antropom��trico com a melhor acur��cia para a predi����o de FRCV. Nesse sentido, prop��e-se a inclus��o desse par��metro de f��cil mensura����o na avalia����o cl��nica para o rastreamento de mulheres com SOP e FRCV----------------------ABSTRACT Background: Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. Objective: To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. Methods: The present transversal study allocated 102 women (26.5 �� 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. Results: The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. Conclusion: The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF