Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group

Objective

The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health.

Methodology

A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and β-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05).

Results

RYGB reduced the serum levels of retinol and β-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and β-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of β-carotene.

Conclusion

Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.

     

Prolactin secretion in hypothyroid endotoxemic rats: involvement of L-arginine and nitric oxide synthase

The identification of nitric oxide (NO) within the hypothalamus and pituitary gland has suggested its role as modulator of the activity on hypothalamic-pituitary axis. Hypothalamic NO synthase (NOS) is known to be regulated by thyroid hormones. We investigated the effects of previous injection of N-nitro-L-arginine methyl ester (L-NAME), a NOS inhibitor, and L-arginine (L-Arg), the substrate for NO synthesis, on prolactin (PRL) secretion, through the lipopolysaccharide (LPS)-induced inflammatory response in thyroidectomized (TX) rats. TX or sham-operated (N) rats were intraperitoneally (i.p.) injected with L-NAME (10 mg kg) or L-Arg (200 mg kg) or the same volume of vehicle (saline solution) 30 min before endotoxemia-induction with LPS at 250 mug (100 g body weight), i.p.. In N rats, NO increased PRL release in response to endotoxemia, whereas in hypothyroid rats, NO appeared to have the opposite effect. Our data support the hypothesis that NO exerts a modulatory influence on PRL secretion after LPS-induced inflammatory response.     

Long-term follow-up of patients with chronic hepatitis C with sustained virologic response to interferon

Background and aimThe durability of the sustained virologic response (SVR) in patients with chronic hepatitis C after treatment and the ideal follow-up time for these patients remains undefined. The objective of the study was to evaluate the durability of the virologic response in patients with chronic hepatitis C followed up for at least 12 months after SVR at HCFMRP-USP.Methods: The study was conducted on 174 patients with chronic hepatitis C treated with different antiviral regimens who had achieved SVR. Qualitative serum HCV-RNA was determined by the commercial kit (COBAS AMPLICOR HCV, v2.0).ResultsThere was predominance of male (73%) with a mean age of 45.6 ± 10 years. Liver cirrhosis was present in 16.1% of the study subjects. Mean follow-up time after SVR was 47 months (12-156 months). Twenty-two patients received monotherapy with interferon; 94 received interferon plus ribavirin, and 58 received pegylated interferon plus ribavirin. A total of 134 patients (77.0%) received one treatment course, 29 (16.7%) received two courses, and 11 (6.3%) received three courses. The distribution of HCV genotypes was: genotype 1 (40.2%), genotype 3 (40.8%) and genotype 2 (10.3%). Genotype was undetermined in 8.7% of cases. None of the 174 patients had recurrence of HCV infection. Two cirrhotic patients developed hepatocellular carcinoma (HCC) during follow-up.ConclusionsAmong patients with SVR there was no recurrence of HCV infection or evidence of liver disease progression in any patient followed up for a mean of 47 months after SVR, except for patients with advanced hepatic disease before treatment, who may develop HCC despite SVR. Therefore, one can assume that SVR is associated with long term good prognosis.     

Effect of the insect growth regulator diflubenzuron on the predator Podisus nigrispinus (Heteroptera: Pentatomidae)

Podisus nigrispinus (Dallas) (Heteroptera: Pentatomidae) is a common natural predator of defoliating caterpillars in agricultural and forest systems. Insecticides acting as growth regulators of insect pests can indirectly affect their predators through consumption of contaminated prey. We examined the reproductive performance of P. nigrispinus fed on caterpillars of Anticarsia gemmatalis Hübner (Lepidoptera: Noctuidae) reared on soybean leaves exposed to the chitin synthesis inhibitor, diflubenzuron. Caterpillars of A. gemmatalis were fed for 12 h with treated soybean leaves and offered to adults of the predator P. nigrispinus over five consecutive days. The fertility of P. nigrispinus was reduced when feeding on diflubenzuron treated caterpillars, especially at the beginning of the reproductive period, but recovered 3 weeks later. The effects of diflubenzuron ingestion on the life table parameters of P. nigrispinus included an increase in the period taken to double the population size, and reductions in the intrinsic rate of population increase, generation duration, and net reproductive rate. Diflubenzuron therefore had an indirect negative effect on the reproduction and the population dynamics of the non-target predator P. nigrispinus. Clearly, its use in integrated pest management requires further evaluation.     

NF-kB expression in IgA nephropathy outcome

Some studies have demonstrated the involvement of nuclear factor-kappa B (NF-kB) in the pathogenesis of glomerulonephritis. The aim of our study was twofold: (1) to analyze the prognostic value of NF-kB expression in primary IgA nephropathy (IgAN) and (2) to compare the results of NF-kB expression by immunohistochemistry (IHC) and southwestern histochemistry (SWH). We analyzed 62 patients diagnosed with IgAN from 1987 to 2003. We used monoclonal antibodies to CD68 and mast cell tryptase and polyclonal antibodies to TGF-β1, α-SMA and NF-kB p65. We used SWH for the in situ detection of activated NF-kB. The results showed that NF-kB expression (mainly by SWH) correlated with clinical and histological parameters. An unfavorable clinical course of IgAN was significantly related to tubular NF-kB expression by SWH, but not by IHC. The Kaplan-Meier curves demonstrated that increased NF-kB expression, which was measured by IHC and SWH, decreased renal survival. In conclusion, the increased expression of NF-kB in the tubular area may be a predictive factor for the poor prognosis of patients with IgAN. Compared with IHC, NF-kB expression determined by SWH was correlated with a larger number of parameters of poor disease outcome.     

Evidence of Renal Infection in Fatal Cases of 2009 Pandemic Influenza A (H1N1)

The 2009 pandemic influenza A (H1N1) caused significant morbidity and mortality. Acute lung injury is the hallmark of the disease, but multiple organ system dysfunction can develop and lead to death. Therefore, we sought to investigate whether there was postmortem evidence of H1N1 presence and virus-induced organ injury in autopsy specimens. Five cases in which patients died of influenza A (H1N1) virus infection were studied. The lungs of all patients showed macroscopic and microscopic findings already described for H1N1 (consolidation, edema, hemorrhage, alveolar damage, hyaline membrane, and inflammation), and H1N1 viruses were present in alveolar cells in immunochemical studies. Acute tubular necrosis was present in all cases, but there was no evidence of direct virus-induced kidney injury. Nevertheless, H1N1 viruses were found in the cytoplasm of glomerular macrophages in the kidneys of 4 patients. Therefore, our data provide strong evidence that H1N1 presence is not restricted to the lungs.     

A minimally invasive procedure for esthetic achievement: enamel microabrasion of fluorosis stains

Esthetic alterations (such as fluorosis) that result from intrinsic dental staining in enamel and dentin can be controlled or softened by noninvasive methods such as dental bleaching or enamel microabrasion. Part of the enamel is removed during microabrasion; however, this wear is clinically insignificant and does not harm the dental structure. This article presents a case in which the microabrasion technique was used to remove fluorosis staining. Based on the results of this case report, it can be concluded that this technique is efficient and can be considered a minimally invasive procedure.     

Non-alcoholic Fatty Liver Disease and Its Relationship with the Nutritional Status of Vitamin A in Individuals with Class III Obesity

Background The objective of the present study was to investigate vitamin A nutritional status in individuals with class III obesity through a biochemical indicator (retinol and β-carotene serum levels), correlating these findings with non-alcoholic fatty liver disease (NAFLD) presence and its risk factors. Methods The studied population was composed of 145 patients with morbid obesity [body mass index, BMI ≥ 40 kg/m²) of both sexes. Retinol and β-carotene serum levels were assessed by high performance liquid chromatography. The cutoff values used for serum retinol and β-carotene inadequacy were <1.05 μmol/l and ≤40 μg/dl, respectively. Insulin resistance (IR) was assessed through homeostasis model assessment index (HOMA) method. Biochemical parameters of liver enzymes, lipid profile, and glycemia were analyzed. Anthropometric measurements were conducted. NAFLD diagnosis was performed through magnetic resonance. Results NAFLD prevalence in the group was 71%. An inadequacy of 11.3 and 41.7% of retinol and β-carotene serum levels, respectively, was found when NAFLD was present. A significant correlation of serum retinol with albumin liver and total bilirubin was found. As regards β-carotene, a positive correlation for HDL-c variable and a negative correlation for the HOMA-IR, weight, and BMI variables were observed. There was a significant association between IR presence and retinol and β-carotene inadequacy. Conclusion The high inadequacy of retinol and β-carotene nutritional status in the sample, with a higher inadequacy in those with NAFLD, suggests an increase in the utilization of vitamin A in this group related to the fight against the oxidative stress to what they are exposed to. The significant association between retinol and β-carotene with IR supports the hypothesis that vitamin A may have a protector effect on IR pathogenesis. Financial support: FAPERJ and CNPq.