Hipertensão Arterial e Ácido Úrico Sérico em Idosos - Estudo SEPHAR III

Background:Hyperuricemia is a frequent finding in patients with arterial hypertension, and there is increasing evidence that this entity is also a risk factor for cardiovascular disease.Objective:In the context of an aging population, this study aims to evaluate serum uric acid levels and arterial hypertension prevalence and control in a subgroup of Romanian adults (>65 years), concerning the influence of age on these parameters.Method:The study sample consists of 1,920 adults included in SEPHAR III survey, of whom 447 were elderly patients (>65 years of age). During the two study visits, three blood pressure (BP) measurements were performed at 1-min intervals and serum uric acid levels, kidney function by estimated glomerular filtration rate, blood pressure, and intima media thickness measurements were conducted. Hypertension and controls were defined according to the current guidelines. Intima-media thickness evaluation was assessed by B-mode Doppler ultrasound evaluation. A significance level p < 0.05 was adopted for the statistical analysis.Results:Adult patients had a significant lower serum uric acid levels, compared to elderly patients, regardless of glomerular filtration rate levels. Adult patients showed a significantly lower intima-media thickness levels, when compared to elderly patients.Conclusion:Similar to previous studies, in the present study, age represented one of the factors contributing to the increased level of serum uric acid. An increasing prevalence of arterial hypertension with age, together with a poor control of blood pressure, was also obtained.     

Glucagon‐like peptide‐1 receptor activation stimulates hepatic lipid oxidation and restores hepatic signalling alteration induced by a high‐fat diet in nonalcoholic steatohepatitis

Background/Aims: High‐fat dietary intake and low physical activity lead to insulin resistance, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Recent studies have shown an effect of glucagon‐like peptide‐1 (GLP‐1) on hepatic glucose metabolism, although GLP‐1 receptors (GLP‐1r) have not been found in human livers. The aim of this study was to investigate the presence of hepatic GLP‐1r and the effect of exenatide, a GLP‐1 analogue, on hepatic signalling. Methods: The expression of GLP‐1r was evaluated in human liver biopsies and in the livers of high‐fat diet‐treated rats. The effect of exenatide (100 nM) was evaluated in hepatic cells of rats fed 3 months with the high‐fat diet. Results: GLP‐1r is expressed in human hepatocytes, although reduced in patients with NASH. Similarly, in rats with NASH resulted from 3 months of the high‐fat diet, we found a decreased expression of GLP‐1r and peroxisome proliferator‐activated receptor γ (PPARγ), and reduced peroxisome proliferator‐activated receptor α (PPARα) activity. Incubation of hepatocytes with exenatide increased PPARγ expression, which also exerted an insulin‐sensitizing action by reducing JNK phosphorylation. Moreover, exenatide increased protein kinase A (PKA) activity, Akt and AMPK phosphorylation and determined a PKA‐dependent increase of PPARα activity. Conclusions: GLP‐1 has a direct effect on hepatocytes, by activating genes involved in fatty acid β‐oxidation and insulin sensitivity. GLP‐1 analogues could be a promising treatment approach to improve hepatic insulin resistance in patients with NAFLD/NASH.     

Understanding criminal behavior: Empathic impairment in criminal offenders

Criminal offenders (CO) are characterized by antisocial and impulsive lifestyles and reduced empathy competence. According to Zaki and Ochsner, empathy is a process that can be divided into three components: mentalizing, emotional sharing and prosocial concern. The aim of our study was to evaluate these competences in 74 criminal subjects compared to 65 controls.

The CO group demonstrated a lower ability in measures of mentalizing and sharing, especially in recognizing the mental and emotional states of other people by observing their eyes and sharing other people’s emotions. Conversely, CO subjects showed better abilities in prosocial concern measures, such as judging and predicting the emotions and behavior of other people, but they were not able to evaluate the gravity of violations of social rules as well as the control group.

In addition, logistic regression results show that the higher the deficits in the mentalizing component are, the higher the probability of committing a crime against another person. Taken together, our results suggest that criminal subjects are able to judge and recognize other people’s behavior as right or wrong in a social context, but they are not able to recognize and share the suffering of other people.     

Metabolic Syndrome in Childhood from Impaired Carbohydrate Metabolism to Nonalcoholic Fatty Liver Disease

Compelling evidence supports the concept that nonalcoholic fatty liver disease (NAFLD) represents the hepatic component of metabolic syndrome (MetS). Intrahepatic fat seems to predict more strongly than does visceral adiposity an individual's cardiovascular risk and the likelihood that metabolic abnormalities are present in youth.

Key teaching points:

? Overweight and obese youth should be screened for fatty liver disease once after puberty by liver function tests and ultrasonography.

? Screening for fatty liver should be accurately performed in young patients with features of metabolic syndrome.

? Obese patients with fatty liver are at increased risk for altered glucose metabolism, thus they should undergo an oral glucose tolerance test.

? A nutritional and behavioral intervention aimed at achieving a permanent change of the lifestyle in patients and their parents is recommended.