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RESUMEN Se trata de una mujer de 57 años con antecedentes de linfoma MALT gástrico y nefritis intersticial atribuida a la quimioterapia. En el estudio de diarrea crónica encontramos un páncreas atrófico, con deficiencia de elastasa. Se sospecha pancreatitis autoinmune. Se comprueba una elevación importante de IgG4 sérica. Con estos datos se procede a la revisión de la biopsia renal realizada 10 meses antes. La inmunohistoquímica revela un número significativo de células plasmáticas productoras de IgG4. En los pulmones la paciente tiene nódulos, adenopatías e infiltrados. El diagnóstico al que llegamos es Enfermedad relacionada con IgG4. ABSTRACT This is a 57-year-old woman with a history of gastric MALT lymphoma and interstitial nephritis attributed to chemotherapy. In the study of chronic diarrhea, we found an atrophic pancreas, with elastase deficiency. Autoimmune pancreatitis is suspected. There is a significant elevation of serum IgG4. With these data we proceed to the review of the renal biopsy performed 10 months before. Immunohistochemistry reveals a significant number of IgG4-producing plasma cells. In the lungs the patient has nodules, lymphadenopathy and infiltrates. The diagnosis we reached is IgG4-related disease.

BackgroundCorticosteroids are the cornerstone of the treatment of patients with COVID-19 admitted to hospital. However, whether corticosteroids can prevent respiratory worsening in hospitalized COVID-19 patients without oxygen requirements is currently unknown.AimsTo assess the efficacy of methylprednisolone pulses (MPP) in hospitalized COVID-19 patients with increased levels of inflammatory markers not requiring oxygen at baseline.MethodsMulticenter, parallel, randomized, double-blind, placebo-controlled trial conducted in Spain. Patients admitted for confirmed SARS-CoV-2 pneumonia with raised inflammatory markers (C-reactive protein >60 mg/L, interleukin-6 >40 pg/ml, or ferritin >1,000 μg/L) but without respiratory failure after the first week of symptom onset were randomized to receive a 3-day course of intravenous MPP (120 mg/day) or placebo. The primary outcome was treatment failure at 14 days, a composite variable including mortality, the need for ICU admission or mechanical ventilation, and clinical worsening, this last parameter defined as a PaO2/FiO2 ratio below 300; or a 15% decrease in the PaO2 from baseline, together with an increase in inflammatory markers or radiological progression. If clinical worsening occurred, patients received tocilizumab and unmasked corticosteroids. The secondary outcomes were 28-day mortality, adverse events, need for ICU admission or high-flow oxygen, length of hospital stay, SARS-CoV-2 clearance, and changes in laboratory parameters.ResultsA total of 72 patients were randomized and 71 patients were analyzed (34 in the MPP group and 37 in the placebo group). Twenty patients presented with treatment failure (29.4 in the MPP group vs. 27.0% in the placebo group, p = 0.82), with no differences regarding the time to treatment failure between groups. There were no cases of death or mechanical ventilation requirements at 14 days post-randomization. The secondary outcomes were similar in MPP and placebo groups.ConclusionsA 3-day course of MPP after the first week of disease onset did not prevent respiratory deterioration in hospitalized COVID-19 patients with an inflammatory phenotype who did not require oxygen.

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Abstract Reduced muscle mass and/or strength are risk factors for metabolic and musculoskeletal impairment. The present study evaluated anthropometric, metabolic, and musculoskeletal outcomes in females with and without sarcopenic-obesity parameters who underwent bariatric surgery during a 1-year follow-up. A prospective, single-center cohort study was conducted in females with obesity undergoing preoperative evaluation for surgery. In the preoperative period, females were allocated into obesity with sarcopenic-obesity parameters (SOP group, n = 15) and without sarcopenic-obesity parameters (obesity group, n = 21). Sarcopenic obesity parameters were defined as lower appendicular skeletal mass adjusted for weight (ASM/wt) and/or low handgrip strength (HGS). Anthropometric, metabolic, and musculoskeletal parameters were assessed before surgery and at 3 months, 6 months, and a 1-year after bariatric surgery. Weight loss was similar between groups (p > 0.05). Weight, body mass index, fat mass, body fat percentage, skeletal muscle mass, fat-free mass, fat-free mass index, HGS were reduced in both groups during the 1-year follow-up (p

Abstract Background Polymorphisms in the gene encoding methylenetetrahydrofolate reductase (MTHFR) have been investigated as risk factors for microvascular complications of diabetes; however, simultaneous analysis of these polymorphisms and the methylation pattern of the gene has never been conducted. The objective of the present study was to evaluate the simultaneous relationship between MTHFR methylation and MTHFR C6TT7 and A1298C polymorphisms with metabolic, inflammatory and oxidative stress parameters related to microvascular complications, diabetic retinopathy (DR) and diabetic nephropathy (DN) in diabetic patients. Methods A total of 107 patients who were diagnosed in the previous 5 to 10 years were recruited and divided into groups with complications (DR and/or DN) or without complications. Methylation analysis of the gene promoter was conducted using the MSP technique, and analysis of the A1298C and C677T polymorphisms was conducted using the restriction fragment length polymorphism (RFLP) assay. Microalbuminuria was determined using urine samples, and other analytes of interest were determined in blood samples using commercial kits. The Mann–Whitney and Chi square statistical tests were used with significance considered at p

IntroductionMTHFR methylation status is associated with microvascular complications in diabetes, but the factors influencing this profile remain unknown.ObjectiveThe aim of this study was to evaluate the influence of physical activity level and nutritional status on the methylation profile of the MTHFR gene in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 111 patients, 43 men and 68 women diagnosed with DM (7.0 ± 2.3 years), answered the International Physical Activity Questionnaire (IPAQ) and underwent blood collection for biochemical analysis, DNA extraction, and MTHFR gene methylation profile determination.ResultThe comparison of the methylation pattern showed that the partially methylated profile predominates in the insufficiently active group (85%), which does not occur in the sufficiently active group (54%) (p = 0.012). No differences were found in the nutritional status comparison. Logistic regression including overweight, waist circumference, gender, age, time of DM, hypertension, dyslipidemia, smoking, alcoholism, and family DM revealed that the association of the level of physical activity with methylation profile proved to be independent of these confounding variables. Considering the partially methylated profile as a result, being physically inactive favors the partially methylated MTHFR pattern in patients with DM.ConclusionWe concluded that insufficient physical activity is associated with partially methylated pattern of MTHFR promoter.

The objective of this study was to verify the influence of the Pro12Ala polymorphism of the PPARγ2 gene in response of a training program on the body composition. Sixty-nine previously inactive men and women (32.8 ± 8.2 years) were genotyped and underwent a 12-week aerobic (running/walking) training program (3–5 sessions, 40 – 60 min per session, and intensity between the aerobic and anaerobic threshold) (experimental group n = 53) or were part of the control group (n = 16). They were tested for aerobic capacity (ergospirometry), body composition (DXA), abdomen, waist and hip circumferences and nutritional assessment before and 48 h after the experimental protocol. Two-way repeated measures ANOVA test was used to verify possible differences in variables between the experimental vs. control groups or Pro/Pro vs. Pro/Ala groups, and the Chi-squared test was used to verify the distribution of responders and non-responders according to genotype (p < 0.05). Frequencies of 75.5% Pro/Pro (n = 40) and 24.5% Pro/Ala (n = 13) were found, without any occurrence of the recessive homozygote. Body fat reduction was initially confirmed compared to a control group which did not exercise (n = 16; 29.1 ± 8.8 years), so that the exercise group obtained a reduction of −1.3 kg vs. −0.3 kg in the control group (p = 0.03). When they were divided by genotype, there were significant changes in fat mass (−1.3 ± 2.1 kg; p = 0.00), lean mass (0.6 ± 1.5 kg; p = 0.02), fat percentage (−1.3 ± 1.6; p = 0.00), waist circumference (−2.2 ± 2.9 cm; p = 0.00), abdomen circumference (−3.3 ± 3.6 cm; p = 0.00) and hip circumference (−2.7 ± 2.7 cm; p = 0.00) for Pro/Pro genotypes; and fat mass (−1.1 ± 1.7 kg; p = 0.04), fat percentage (−0.9 ± 1.5; p = 0.04), abdomen circumference (−3.9 ± 3.5 cm; p = 0.00) and hip circumference (−1.8 ± 1.8 cm; p = 0.00) for Pro/Ala genotypes, without any group interaction differences. The Chi squared test revealed no differences in the distribution of responders or non-responders according to genotype. It is concluded that an aerobic training program promotes weight loss, but the Pro12Ala polymorphism in the PPARγ2 gene does not influence the variability of aerobic-induced exercise weight loss.

Abstract Background DNA methylation is an epigenetic mechanism for regulating the transcription of many genes and has been linked to the development of various diseases. A promising gene to investigate is methylenetetrahydrofolate reductase (MTHFR), since the enzyme methylenetetrahydrofolate reductase (MTHFR) promotes methyl radical synthesis in the homocysteine cycle and can provide methyl groups for DNA methylation. In addition, several studies have correlated gene polymorphisms of this enzyme with a greater risk of diabetes, but little is known regarding the relationship between epigenetic changes in this gene and diabetes and its complications. The aim of this study was to investigate the relationship between methylation profile in the MTHFR gene promoter and biochemical, inflammatory and oxidative stress markers in individuals with type 2 diabetes (T2DM) who have been diagnosed for 5–10 years with or without diabetic retinopathy (DR) and nephropathy (DN). Methods Specific PCR for methylation (MSP) was used to analyze MTHFR methylation profile in leucocytes DNA. Biochemical markers (glycemia, glycated hemoglobin, total cholesterol, LDL, HDL, triglycerides, serum creatinine), inflammatory markers (C-reactive protein and alpha-1 acid glycoprotein) and oxidative stress (total antioxidant and malonaldehyde) were determined in peripheric blood samples and microalbuminuria in 24 h urine samples. The X2 and Mann–Whitney statistical tests were performed and p

Introdução: A inspeção industrial e sanitária dos produtos de origem animal brasileira é regulamentada por diversos dispositivos legais. Dentre as legislações mais importantes, encontrava-se o Decreto n° 30.691, de 29 de março de 1952, que foi substituído em 29 de março de 2017, pelo Decreto no 9.013. Objetivo: Assim, vista a relevante importância deste regulamento para o agronegócio nacional e saúde dos consumidores, o presente trabalho teve como objetivo avaliar as atualizações e mudanças do novo regulamento em comparação ao seu antecessor. Método: Para isso, foi realizada uma revisão da legislação sobre inspeção sanitária publicada pelo governo federal, através da busca em bases de dados presentes em portais de órgãos do governo federal para um melhor entendimento da temática e como forma comparativa. Resultados: O novo regulamento é menos robusto que o seu anterior e apresenta 542 artigos. As principais atualizações foram a aplicação de análise de risco na inspeção dos estabelecimentos, a simplificação de rótulos e carimbos, as análises laboratoriais mais modernas como a biologia molecular, a distinção das exigências de acordo com o tamanho da produção, a maior severidade nas penas para estabelecimentos infratores e a preocupação com bem-estar animal e com o ambiente. Conclusões: Dessa forma, a atualização do regulamento era necessária e trouxe atualizações importantes com conceitos modernos, novos processos tecnológicos e de segurança alimentar, adequando-se melhor à realidade atual do Brasil.