RESUMO
BACKGROUND: The body mass index (BMI) is the most commonly used anthropometric indicator. However, it does not discern among the different body components. The body fat content, expressed as fat mass index (FMI), is an accurate way to estimate adiposity. Since most metabolic diseases are associated with excess fat tissue, our aims were to comparatively analyze the frequency of associated metabolic abnormalities in patients with different obesity degrees based on BMI and FMI and to determine the best cut-off value of both indicators to predict metabolic abnormalities. METHODS: From a cohort of 2007 patients, BMI and FMI were calculated using DXA. Individuals were classified into the different obesity degrees according to the reference ranges from the World Health Organization (WHO) and the National Health and Nutrition Examination Survey (NHANES). A comparative analysis between BMI, FMI, and their correlation to the presence of metabolic alterations was performed. RESULTS: BMI underestimated the degree of obesity when compared with FMI. Spearman's rank-order correlation for both indexes resulted in very high coefficients (rho Spearman's = 0.857; p = 0.0001). The prevalence of metabolic alterations increased as BMI and FMI also increased. Despite the high positive statistical correlation between BMI and FMI, it was seen that some comorbidities were more specifically related to one particular index. CONCLUSIONS: There were no significant differences between the BMI and the FMI for predicting the degree of obesity. Likewise, there were no significant differences between them for the prediction of metabolic alterations.
Assuntos
Composição Corporal , Obesidade Mórbida , Índice de Massa Corporal , Humanos , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade Mórbida/cirurgiaRESUMO
BACKGROUND: Diabetes mellitus (DM) adversely affects the skeleton and the physiological mechanisms implicated have not been explained sufficiently. Thus, the objective was to identify inflammatory cytokines (IL-1, IL-6 and TNF-alpha) in patients with T1DM and their association with markers of bone formation (sPINP) and markers of bone resorption (sCTX). METHODS: We studied 62 patients of 18 years of age or more with T1DM. We determined the values of HbA1c, vitamin D, inflammatory cytokines, as well as those of markers of bone formation and of markers of bone resorption. RESULTS: 49 patients were female with a mean age of 33.5 years. We found values of HbA1c > 7.5 in 83 %, vitamin D of 16 ng/mL. In patients with HbA1c >7.5 we found a positive correlation between TNF-alpha and sCTX (r = 0.43, p = 0.05), IL-6 and sCTX (r = 0.48, p = 0.037). With a model of simple linear regression between IL-6 and sCTX, it was found a beta coefficient of 23.8 with a p = 0.030 (95 % CI = 2-45.6), ie.: for every unit increase in IL-6 there is a sCTX increase of 23.8 pg/mL. CONCLUSIONS: We found a positive association between TNF-alpha and IL-6 with the marker of bone resorption (sCTX) in the group of patients with HbA1c > 7.5. The loss of metabolic control was associated with TNF-alpha and IL-6.
Introducción: la diabetes mellitus afecta de una manera adversa al esqueleto y esos mecanismos fisiopatológicos continúan sin entenderse completamente. Por lo tanto, el objetivo de este estudio es identificar citocinas inflamatorias (IL-1, IL-6 y TNFα) en pacientes con DM1 y su asociación con marcadores de formación (sPINP) y resorción (sCTX) óseas. Métodos: Se estudiaron 62 pacientes con DM1, mayores de 18 años. Se determinaron los valores de la HbA1c, la vitamina D, las citocinas inflamatorias, así como los de los marcadores de formación y resorción óseas. Resultados: 49 pacientes fueron del sexo femenino con una edad media de 33.5 años, HbA1c > 7.5 en 83%, vitamina D 16 ng/mL. En los pacientes con HbA1c > 7.5 hubo correlación positiva entre el TNFa y sCTX (r = 0.43, p = 0.05), IL-6 y sCTX (r = 0.48, p = 0.037). Posterior a un modelo de regresión lineal simple entre el sCTX y la IL-6 se encontró un coeficiente beta de 23.8, p = 0.030 (IC 2-45.6), es decir, por cada unidad de elevación de IL-6 hay un incremento de sCTX de 23.8 pg/mL. Conclusiones: encontramos una asociación positiva entre TNF-alfa e IL-6 con el marcador de resorción ósea (sCTX) en pacientes con HbA1c > 7.5 %. El descontrol metabólico se asoció con la elevación de citocinas inflamatorias TNF-alfa e IL-6.
Assuntos
Remodelação Óssea , Colágeno Tipo I/sangue , Citocinas/sangue , Diabetes Mellitus Tipo 1/sangue , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue , Adulto , Biomarcadores/sangue , Diabetes Mellitus Tipo 1/fisiopatologia , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-IdadeRESUMO
Posaconazole (POS) is approved for prophylaxis of Aspergillus and Candida infections in immunocompromised patients and for the treatment of oropharyngeal candidiasis. Data is limited as step-down therapy after treatment with amphotericin B (AMB). Four cases with refractory mucormycosis who had a favorable response after a change in antifungal therapy to POS are presented. In these four patients, POS demonstrated to be an effective therapeutic option in the management of refractory mucormycosis. Further studies should be conducted to define its role, whether as a single agent or as adjuvant therapy in combination with AMB.