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Overall excess of fat, usually defined by the body mass index, is associated with metabolic (e.g. glucose intolerance, type 2 diabetes mellitus (T2DM), dyslipidemia) and non-metabolic disorders (e.g. neoplasias, polycystic ovary syndrome, non-alcoholic fat liver disease, glomerulopathy, bone fragility etc.). However, more than its total amount, the distribution of adipose tissue throughout the body is a better predictor of the risk to the development of those disorders. Fat accumulation in the abdominal area and in non-adipose tissue (ectopic fat), for example, is associated with increased risk to develop metabolic and non-metabolic derangements. On the other hand, observations suggest that individuals who present peripheral adiposity, characterized by large hip and thigh circumferences, have better glucose tolerance, reduced incidence of T2DM and of metabolic syndrome. Insulin resistance (IR) is one of the main culprits in the association between obesity, particularly visceral, and metabolic as well as non-metabolic diseases. In this review we will highlight the current pathophysiological and molecular mechanisms possibly involved in the link between increased VAT, ectopic fat, IR and comorbidities. We will also provide some insights in the identification of these abnormalities.

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Overall excess of fat, usually defined by the body mass index, is associated with metabolic (e.g. glucose intolerance, type 2 diabetes mellitus (T2DM), dyslipidemia) and non-metabolic disorders (e.g. neoplasias, polycystic ovary syndrome, non-alcoholic fat liver disease, glomerulopathy, bone fragility etc.). However, more than its total amount, the distribution of adipose tissue throughout the body is a better predictor of the risk to the development of those disorders. Fat accumulation in the abdominal area and in non-adipose tissue (ectopic fat), for example, is associated with increased risk to develop metabolic and non-metabolic derangements. On the other hand, observations suggest that individuals who present peripheral adiposity, characterized by large hip and thigh circumferences, have better glucose tolerance, reduced incidence of T2DM and of metabolic syndrome. Insulin resistance (IR) is one of the main culprits in the association between obesity, particularly visceral, and metabolic as well as non-metabolic diseases. In this review we will highlight the current pathophysiological and molecular mechanisms possibly involved in the link between increased VAT, ectopic fat, IR and comorbidities. We will also provide some insights in the identification of these abnormalities. Arq Bras Endocrinol Metab. 2014;58(6):600-9.

Excesso de gordura, geralmente definido pelo índice de massa corporal, está associado a distúrbios metabólicos (p. ex., intolerância à glicose, diabetes melito tipo 2 (DM2), dislipidemia) e não metabólicos (p. ex., neoplasias, síndrome dos ovários policísticos, esteatose hepática não alcoólica, glomerulopatia, fragilidade óssea etc.). No entanto, mais do que sua quantidade total, a forma da distribuição corporal de tecido adiposo constitui-se em um melhor indicador de risco para o desenvolvimento de tais doenças. O acúmulo de gordura na região abdominal e em tecido não adiposo (gordura ectópica), por exemplo, está associado ao aumento de risco para distúrbios metabólicos e não metabólicos. Por outro lado, observações sugerem que os indivíduos que apresentam adiposidade periférica, caracterizada por aumento das circunferências dos quadris e da coxas, têm melhor tolerância à glicose, redução das incidências de DM2 e da síndrome metabólica. Uma das alterações subjacentes na relação entre a obesidade, particularmente a visceral, e os distúrbios citados é a resistência à insulina. Nesta revisão, enfatizaremos os mecanismos fisiopatológicos e moleculares possivelmente implicados na ligação entre o aumento das gorduras visceral e ectópica, IR e comorbidades. Também mencionaremos os métodos diagnósticos mais frequentemente usados na identificação dessas anormalidades. Arq Bras Endocrinol Metab. 2014;58(6):600-9.

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Recently developed, the Acrobat SOAW (Stent-On-A-Wire) coronarysystem combines a very-thin (81 μ) balloon-expandable, Cro-Co (L605) stentmounted on a delivery system with a 0.012” integrated guidewire tip (distance fromthe tip of the wire to the stent is 22mm). We sought to determine the efficacyprofile of this novel device.Methods and results: SVELTE trial is a multicenter, international (Brazil,Netherlands and Colombia), prospective, non-randomised, single-arm study of theAcrobat SOAW for the treatment of de novo coronary lesions no longer than 18mmand located in native vessels of 2.5 to 3.5mm. DS was highly recommended andpost-dilatation was at operator’s discretion. Patients were oriented to stay on dualanti-platelet regimen for at least 1 month. Main exclusion criteria were PCI in thesetting of acute ST-elevation MI and bifurcation lesions. All patients werescheduled to undergo angiographic follow-up at 6 months. The primary endpoint ofthe study was the survival-free of combined MACE (cardiac death, myocardiuminfarction and target-lesion revascularisation) at 30 days. Secondary endpointsincluded 6-month in-stent late lumen loss and binary restenosis as well ascombined MACE rate.A total of 46 patients were enrolled with mean age of 63years old, 76.6% of male and 21.3% of diabetics. Mean RVD and lesion lengthwere 3.03mm and 12.67mm, respectively. The Acrobat stent was deployed in100% of the cases (89.6% of DS) achieving a procedure success rate of 97.8%.Up to 30 days there were no deaths, Q-Wave MIs or urgent TLR. Six-monthinvasive follow-up is ongoing and complete QCA assessment will be available atthe meeting.Conclusions: The Acrobat SOAW may potentially facilitate PCI by reducingtime/cost and minimising peri-procedural complications. The present trialrepresents the first-in-man assessment of this innovative concept.

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A maconha, droga bastante difundida no meio estudantil, foi estudada do ponto de vista do usuário, através da coleta de relatos sobre seus efeitos e o significado de seu uso. Foram realizadas entrevistas semidirigidas, com 26 estudantes de 16 a 23 anos de idade, de ambos os sexos, com os quais já se havia estabelecido rapport. Colheram-se informaçöes sobre: situaçäo familiar e individual; variáveis controladoras da primeira administraçäo e do uso atual; significado do uso no contexto de outras atividades; uso de outras drogas; efeitos nas esferas somática, cognitiva, percentual, emocional e sócio-sexual, e sua variaçäo intra-individual. Os resultados mais relevantes indicaram que: a) metade dos usuários nunca experimentou outra droga ilícita; b) a freqüência de uso tende a aumentar no início, atinge um pico e depois decresce; c) a maioria dos sujeitos pretende continuar a administraçäo da droga; d) os efeitos apontam para um aguçamento da sensibilidade perceptual, emocional e sexual, aumento no fluxo de idéias e perda da consolidaçäo de memória, modificaçäo na percepçäo de tempo e espaço; e) esses efeitos parecem interagir com a personalidade básica do sujeito e as circunstâncias em que a droga é consumida. Apesar de pequeno o número de sujeitos, os relatos säo consistentes com a literatura e justificam a exploraçäo mais pormenorizada das constataçöes a e b

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Foi investigada neste estudo, através de entrevistas com 47 estudantes brasileiros de classe média, de 18 a 24 anos, de ambos os sexos, a mudança nos padröes de consumo de maconha ao longo do tempo. A partir dos relatos, conclui-se que o curso de freqüência de consumo segue dois padröes predominantes. Em um deles, o "padräo estável", os sujeitos relatam aumento de consumo até uma freqüência de pico, em que permanecem por um período de tempo relativamente longo e estável. No outro, o "padräo descendente", os sujeitos relatam um aumento gradual até alcançar o pico, seguido de uma clara diminuiçäo de freqüência de uso. Dois outros padröes foram detectados em um pequeno número de sujeitos. A diversidade dos padröes identificados chama a atençäo para a dificuldade em se predizer o curso da freqüência de consumo da maconha por jovens. A relaçäo entre consumo de maconha e uso de outras drogas foi também investigada. As únicas drogas que a maioria dos sujeitos declarou consumir regularmente foram álcool e tabaco, ao passo que 90% dos sujeitos revelaram ter experimentado pelo menos uma vez alguma outra droga ilegal

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Foi investigada neste estudo, atraves de entrevistas com 47 estudantes brasileiros de classe media, de 18 a 24 anos, de ambos os sexos, a mudanca nos padroes de consumo de maconha ao longo do tempo. A partir dos relatos, concluiu-se que o curso de frequencia de consumo segue dois padroes predominantes. Em um deles, o 'padrao estavel', os sujeitos relatam aumento de consumo ate uma frequencia de pico, em que permancem por um periodo de tempo relativamente longo e estavel. No outro, o 'padrao descendente', os sujeitos relatam um aumento gradual ate alcancar o pico, seguido de uma clara diminuicao de frequencia de uso. Dois outros padroes foram detectados em um pequeno numero de sujeitos. A diversidade dos padroes identificados chama a atencao para a dificuldade em se predizer o curso da frequencia de consumo da maconha por jovens. A relacao entre consumo de maconha e uso de outras drogas foi tambem investigada. As unicas drogas que a maioria dos sujeitos declarou consumir regularmente foram alcool e tabaco, ao passo que 90 por cento dos sujeitos revelaram ter experimentado pelo menos uma vez alguma outra droga ilegal.

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Three patients of the 760 with symptomatic poststreptococcal acute glomerulonephritis in Trinidad who were chosen for follow-up in 1968 or 1970 apparently had not healed initially and consistently had hematuria, usually with proteinuria, in our studies. One of these patients died in renal failure between 1972 and 1976 (six to 10 years after her initial illness). The other two are now 19 and 25 years old, 12 and 15 years after their initial illnesses, with normal blood pressures and serum creatinine values. Another 14 of the 534 patients currently examined had persistent abnormalities: three of these 14 appeared to have had lipoid nephrosis in the beginning, with recurrent proteinria since then; two had urinary-tract infections when examined; one had probably had a third attack of poststreptococcal acute glomerulonephritis; and eight had acquired proteinuria, which may or may not have been related to poststreptococcal acute glomerulonephritis. Thus, our data continue to indicate a good long-term prognosis for most of the patients with this disease in Trinindad.(AU)

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Continued improvement was noted among 722 patients in Trinidad seven to 12 years after the onset of poststreptococcal glomerulonephritis. In the five years since earlier follow-up, two of 709 patients with previous symptomatic disease apparently had died from renal failure, and 10 patients had died from unrelated causes. Nineteen patients presently had proteinuria, three had hematurias, and three had proteinuria plus hematuria. Of these abnormalities, proteinurias in only three patients and proteinuria plus hematuria in three more patients were persistent. Thus, 0.8 per cent of the study group had persistent abnormalities. When one adds those dead with renal disease, the percentage with renal damage becomes 1.1 per cent. In addition, six patients had protein in the two urine samples obtained after assuming the lordotic position for 10 minutes and in only one of the two urine samples obtained upon rising in the morning, making 1.4 per cent with probable evidence of chronic renal disease including the dead patients. Hypertension was present in 16 (2.3 per cent) of the patients and was much more common in those more than 20 years old (18.4 per cent). However, this prevalence of hypertension did not exceed that found in normal Trinidadians. Only three patients had serum creatitine values greater than 1.2 mg/dl. None of 13 patients with previous asymptomatic glomerulonephritis presently showed any abnormality. Thus, very few cases of chronic poststreptococcal glomerulonephritis appear to have developed in the 722 patients studied (AU)

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We will present bacteriological evidence for an association of acute glomerulonephritis with several streptococcal strains isolated from skin lesions in Trinidad; Types 52 and 55 during the first wave and type 49 during the second wave of the 1964-65 epidemic; atypical "type 2" in a sub-epidemic rise in cases during an endemic year; type 57 during a subsequent epidemic period; and type 60 most recently. Immunological confirmation of association of these strains with acute glomerulonephritis was obtained only for type 55. Low incidence of serum type specific antibodies to types 49 and "type 2" may be attribued to their poor antigenicity. However, this is not the case with type 57. Emergence of at least five and perhaps six apparently new types of nephritogenic streptococci during a relatively short period suggests that each recurrent epidemic wave of acute nephritis is the result of a newly introduced or newly developed strain of nephritogenic streptococci. Several questions might be asked: From where do these different types come?. Are they brought into Trinidad from outside or do they represent local mutants? Does a skin infection represent a particularly suitable environment for development of new streptococcal antigens? (AU)

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