Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 4(4)2017 - 6 Articles


1 - Obesity and gut microbiota - what do we know so far?

Vicente Lopes da Silva-Junior; Fernanda de Azevedo Marques Lopes; Rodolpho Mattos Albano; Maria das Graças Coelho de Souza; Carolina Monteiro de Lemos Barbosa; Priscila Alves Maranhão; Eliete Bouskela; Luiz Guilherme Kraemer-Aguiar

MEDICALEXPRESS 2017;4(4):M170401

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In the history of medicine, only recently has obesity been recognized as a disease. We know now that it is a pandemic condition, partly explained by the so-called Western lifestyle and related to multiple other comorbidities in various systems. This lyfestyle includes eating large portions, rich in saturated fats and refined sugar, all coupled with sedentary habits. In recent years, the gut microbiota has been indited as a new culprit in pathophysiological aspects involved in obesity. From studies with animals free of bacteria in the digestive tract, known as "germ-free animals"; the relevance of intestinal microbiota in the regulation of body fat became evident and its importance has also been extended to the pathophysiology of diseases such as diabetes mellitus and coronary heart disease. Characterization of Toll-like receptors led to the discovery of mechanisms that link the immune system with some metabolic pathways and opened new avenues of a previously unknown world to biological sciences. Increased knowledge about interactions between gut microbiota and the host can certainly reveal, in a not too distant future, new therapeutic perspectives for obesity and its related diseases.

Keywords: obesity; gut; microbiota


2 - The expression of gene ANKRD1 correlates with hypoxia status in muscle biopsies of treatment-näive adult dermatomyositis

Samuel Katsuyuki Shinjo; Sueli Mieko Oba-Shinjo; Miyuki Uno; Suely Kazue Nagahashi Marie

MEDICALEXPRESS 2017;4(4):M170402

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OBJECTIVES. The ANKRD1 gene codes for the ankyrin repeat domain containing protein 1 and has an important role in myogenesis and possibly also in angiogenesis. Microvasculopathy is a cornerstone and an early pathological marker of change in dermatomyositis, leading to hypoxia and muscle perifascicular atrophy. These alterations could upregulate genes involved in myogenesis and angiogenesis such as ANKRD1. Therefore, we analyzed ANKRD1 expression in muscle biopsies of dermatomyositis and correlated with other hypoxia parameters and with histological changes.
METHODS. Total RNA was extracted from frozen muscle biopsies samples of 29 dermatomyositis patients. A control group consisted of 20 muscle biopsies from adult patients with non-inflammatory myopathy diseases. The gene coding for hypoxia-inducible factor 1, alpha subunit (HIF1A), was analyzed to estimate the degree of hypoxia. ANKRD1 and HIF1A transcript expression levels were determined by quantitative real time PCR.
RESULTS. Significantly higher ANKRD1 and HIF1A expression levels were observed in dermatomyositis relative to the control group (P<0.001, both genes). In addition, ANKRD1 and HIF1A were coexpressed (r=0.703, P=0.001) and their expression levels correlated positively to perifascicular atrophy (r=0.420, P=0.023 and r=0.404, P=0.030, respectively).
CONCLUSIONS. Our results demonstrate ANKRD1 overexpression in dermatomyositis correlated to HIF1A expression and perifascicular atrophy. ANKRD1 involvement in myogenesis and angiogenesis mechanisms indicates that further investigation is worthwhile.

Keywords: Dermatomyositis; hypoxia; myogenesis; perifascicular atrophy; RNA expression.

3 - Tuberculum sellae meningioma: Is there an ideal approach?

Iracema Araújo Estevão; Bruno Camporeze; Giovanna Matricardi; Pedro da Silva Júnior; Daniel A. Gripp; Natally M. Santiago; Paulo Henrique Pires de Aguiar

MEDICALEXPRESS 2017;4(4):M170403

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BACKGROUND: Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. It accounts for up to 10% of all intracranial meningiomas. The difficulty in surgically excising a Tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. The authors discuss the main approaches and the complications based on their experience in comparison to previously reported data.
METHODS: We report our personal case series of 38 patients with Tuberculum sellae meningiomas; 36 patients under went craniotomy for tumor resection (12 bifrontal, 12 pterional, 6 supraciliary, 4 unilateral frontals, and 2fronto-orbito-zygomatic); in two patients, the excision was performed through an endoscopic endonasal approach. The Simpson grade of meningioma resection as well as the non-visual morbidity and the mortality rates were analyzed.
RESULTS: Thirty-one patients had Simpson grades 1 and 2 excisions, while seven had Simpson grade 4 excisions. The overall rate of non-visual morbidity was 13.15% (5 of 38 patients) and mortality was 5.3% (2 of 38).
CONCLUSION: The primary symptom leading to the diagnosis of a Tuberculum sellae meningioma is visual compromise and the main goal of surgery is to achieve improvement of vision. Favorable outcomes were achieved with appropriate selection of surgical approach. More studies are necessary to define the prognostic factors for patients in this scenario.

Keywords: Tuberculum Sellae, Meningiomas, Skull Base, Clinoid Process, Optic Nerve.

4 - Analysis of acceleration time of ankle in long-distance runners and triathletes

Natália Mariana Silva Luna; Angélica Castilho Alonso; Danilo Bocalini; Gabriela Borin; Guilherme Carlos Brech; Júlia Maria D'Andréa Greve

MEDICALEXPRESS 2017;4(4):M170404

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INTRODUCTION: Adequate muscle reaction time is essential for protecting the joints against injuries during sports activities. This phenomenon of time of acceleration has been investigated through methodologies such as trapdoor experiments and electromyography. However, isokinetic analysis is an assessment method that is more dynamic and shows behavior closer to the functionality of the sport. Sports that involve running, such as long distance running and triathlon, have high lower-limb injury rates, particularly in relation to the ankle joint. The objective of this study was to evaluate and compare isokinetic acceleration and deceleration times of the dorsiflexor and plantar flexor musculature of the ankle in long-distance runners, triathletes and non-athletic individuals.
METHOD: The sample comprised 75 individuals (men aged 18-42 years), divided into three groups: triathlete group, long-distance runner group and control group. The individuals were tested bilaterally on an isokinetic dynamometer. The evaluation modes used were (i) concentric/eccentric for plantar flexion and dorsiflexion, and (ii) eccentric/concentric for plantar flexion and dorsiflexion. We used (a) analysis of variance and Tukey's post hoc test; (b) Kruskal-Wallis and Müller-Dunn post hoc tsts; (c) Chi-square tests.
RESULTS: The acceleration time during concentric contraction was statistically different only between the control group and the long-distance runner group, such that the controls presented faster acceleraton.
CONCLUSION: This may signify a deficiency in their motor sensory control during concentric activity of the dorsiflexors.

Keywords: Isokinetic, Running, Triathlon.

5 - Rotavirus and Triple Viral Vaccine Losses in Vaccination Rooms: a Cross-Sectional Study

Barbara F Dias; Renan MVR Almeida

MEDICALEXPRESS 2017;4(4):M170405

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OBJECTIVE: This study aimed to analyze Rotavirus (ROTA) and Measles, Mumps and Rubella (MMR) vaccine wastage in vaccination rooms of Juiz de Fora city, MG, Brazil, to identify factors related to this wastage.
METHODS: The study had a cross-sectional design, based on spreadsheets reporting monthly vaccine use in a year; and based on questionnaires applied to 45 urban vaccination rooms. A linear regression model was developed, endeavoring to predict vaccine loss rates using variables related to vaccination room infrastructure/operational conditions.
RESULTS: Statistical significance was detected for ROTA loss variables: vaccine knowledge, health unit type and number of personnel in the vaccination room (R2=0.33; p = 0.001). It was also found that 1,254 ROTA and 33,762 MMR doses were wasted during the period. Concerning ROTA, 331 (26.4%) were technical losses, and 923 (73.6%) miscellaneous losses; for the MMR vaccine, these numbers were 23,281 (68.96%) for technical losses and 10,481 (31.04%) for miscellaneous losses.
CONCLUSION: The percentage losses in the period were significant, which should induce the production of health protocols to facilitate the correction of weaknesses in the studied vaccine cold chain.

Keywords: Rotavirus vaccine; MMR vaccine; Vaccine wastage.

6 - Molecular Characterization of Group B Streptococcus Serotypes By Multiplex Polymerase Chain Reaction

Paula Durante Andrade; Joice de Souza Russo; Jéssica Baliero Gouveia; Cláudia Raquel Cantarelli Costa; Ketti Gleyzer Oliveira; Michelli Gianetti; Emanuel Borges Vítor Anjos; Tycha Bianca Sabaini Pavan; Mariana Furquim Da Silva Martins; Josiele Franco; Maria Laura Costa; Marcelo Luís Nomura; Carlos Emílio Levy; Renato Passini Júnior; Sandra Cecilia Botelho Costa

MEDICALEXPRESS 2017;4(4):M170406

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OBJECTIVE: Group B Streptococcus (GBS) serotypes (Ia, Ib and II to IX) are classified based on variations in their capsular polysaccharide; their prevalence differs between different geographic areas. We examined the prevalence of all GBS serotypes in rectal and vaginal swab samples obtained from 363 pregnant women followed at a Brazilian referral center (Hospital da Mulher Professor Doutor José Aristodemo Pinotti); bacterial susceptibility to antibiotics was further determined.
METHOD: Prevalence of positive GBS was evaluated by latex agglutination and by multiplex PCR analysis; bacterial susceptibility to antibiotics, such as clindamycin, erythromycin, levofloxacin, linezolid, penicillin and tetracycline was determined by the disk diffusion method.
RESULTS: (a) standard GBS culture and the multiplex PCR analysis tested positive for 83 swabs, collected from 72 women (prevalence of GBS colonization: 72/363; 20%); the most prevalent Serotype was Ia (n=43/83; 52%), followed by serotype V (n=14/83; 17%); according to anatomical origin, serotype Ia accounted for 27/59 (46%) and 16/24 (67%) of the vaginal and rectal samples, respectively; PCR also identified serotypes Ib, II, III and VI. Serotype VI is rarely described and had not been previously reported in Brazil or in Latin America. (b) The latex agglutination test only identified 44 positive samples, all of which were serotyped: 34 of these samples (77%) had serotypes matching those identified by multiplex PCR. (c) Only one sample (serotype Ia) showed resistance to erythromycin and clindamycin.
CONCLUSION: Regional studies on GBS serotypes prevalence are essential to guide immunoprophylactic interventions (vaccines) and the implementation of adequate antibiotic prophylaxis or treatment. In this study, the incidence of the serotype VI, a new and rare serotype of GBS was described for the first time in a Brazilian population.

Keywords: Capsular polysaccharides; Group B Streptococcus; Molecular serotyping; Multiplex PCR; Streptococcus agalactiae; serotype VI.