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Search Results: 1 - 10 of 74870 matches for " Catarina Bertaso Andreatta;álvares-da-Silva "
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Avalia??o nutricional de pacientes com cirrose pelo vírus da hepatite C: a aplica??o da calorimetria indireta
Gottschall, Catarina Bertaso Andreattalvares-da-Silva, Mário Reis;Camargo, Ana Cristina Riehs;Burtett, Renata Medeiros;Silveira, Themis Reverbel da;
Arquivos de Gastroenterologia , 2004, DOI: 10.1590/S0004-28032004000400004
Abstract: background: malnutrition is frequent in cirrhotic patients, and its assessment is difficult. functional assessment through a dynamometer is a simple method and could minimize these drawbacks. harris-benedict prediction formulae estimates the resting energy expenditure but has not been validated for this population. one alternative is the use of indirect calorimetry. aim: to assess nutritional status in cirrhotic patients and estimates the resting energy expenditure through indirect calorimetry and compares it to harris-benedict. patients and methods: thirty four adult hepatitis c cirrhotic outpatients were studied, classified by child-pugh and model of end-stage liver disease score. the resting energy expenditure was predicted through harris-benedict and measured by indirect calorimetry. nutritional assessment was done through anthropometry, subjective global assessment, hand-grip strength and a 3-day recall. results: fifteen (44.2%) were child-pug a, 12 (35.3%) b and 7 (20.6%) c, and 33 (97.1%) had model of end-stage liver disease scores less than 20. the resting energy expenditure predicted was higher than the measured (harris-benedict 1404.5 ± 150.3 kcal; indirect calorimetry 1059.9 ± 309.6 kcal). the prevalence of malnutrition varied between methods (body mass index, muscle arm circumference, subjective global assessment, triceps skinfold thickness and hand-grip strength: 0; 5.9; 17.6; 35.3 and 79.4%, accordingly). calories and proteins intake were 80% and 85% of recommended amounts and there was inadequate intake of calcium, magnesium, iron and zinc. conclusion: malnutrition was frequent and hand-grip strength seemed to be the most sensitive method for its diagnosis. calories and protein intakes were inadequate. considering that the predicted resting energy expenditure was higher than the measured one and the need to offer higher caloric intake, the use of the predicting equation may replace indirect calorimetry.
O uso de nutri??o enteral precoce pós-transplante hepático adulto
álvares-da-Silva, Mário Reis;Gottschall, Catarina Bertaso Andreatta;Waechter, Fábio Luis;Hadlich, Everton;Sampaio, José Arthur;Francesconi, Carlos Fernando M.;
Arquivos de Gastroenterologia , 2004, DOI: 10.1590/S0004-28032004000300002
Abstract: background: orthotopic liver transplantation is the treatment of choice for end-stage liver disease. malnutrition is common in this population. early enteral nutrition is not routine in the transplant groups. aim: to report our experience with the use of early enteral nutrition in patients undergoing orthotopic liver transplantation and also evaluate its safety. patients/methods: we studied 41 adults submitted to orthotopic liver transplantation. pre- orthotopic liver transplantation nutritional assessment was accomplished by the subjective global assessment and grip strength. enteral nutrition was begun in 12 hours. oral feeding was initiate gradually as soon as possible. results: we studied 35 individuals, with an average of age of 45.5 years (8.93). the prevalence of malnutrition in orthotopic liver transplantation was of 77.1% determined by subjective global assessment, and 100% by grip strength. early enteral nutrition was begun in all of the individuals in up to 12 hours, mode 10.9 hours, and maintained exclusively by medium period of 2.6 days (2.2). oral feeding was obtained in the medium period of 9.5 days (9.7). early enteral nutrition provided total caloric intake in 97% of the cases. intolerance to the enteral feeding occurred in five individuals (14.2%), and in four of them it was resumed successfully after 12 hours. the prevalence of respiratory infection was of 28.6%. in only two patients (5.7%) there was aspirative bronchopneumonia. conclusions: early enteral nutrition is an effective method in the provision of calories and safe in application to patients undergoing orthotopic liver transplantation.
IRS1 Expression in Hepatic Tissue and Leukocytes in Chronic Hepatitis C Virus Infected Patients: A Comparative Study
Camila Ripoll Kappel,Nélson A. Kretzmann,Mário Reis álvares-da-Silva
International Journal of Hepatology , 2012, DOI: 10.1155/2012/698905
Abstract: Aims. To determine lymphocyte IRS (IRS1 cells) in HCV patients, correlating it to liver IRS (IRS 1liver) and HOMA-IR. This study tested the hypothesis that IRS1 cells expression can be used as insulin resistance (IR) marker in HCV-infected patients. IRS1 cells were not studied before in HCV infection. Materials and Methods. HCV chronically infected patients, naïve, nonobese, noncirrhotic, and nondiabetic were prospectively included and compared to controls (blood donors). Blood was taken, and leukocytes were separated. IRS1 was determined by real-time PCR. Liver tissue was obtained from transplant donors as controls. Results. 41 HCV-positive patients were included, 26 males (60.5%); mean age of 45 (±7.9); 33 (80.5%) from genotype 1. 6 out of 12 controls were males (50%); mean age was 26.7 (±3.2). There was expression of IRS1 in leukocytes. The median IRS1 cells (HCV) were 0.061 (0.004 to 0.469); the median IRS 1liver (HCV) was 0.0003 (0.00002 to 0.0186)—lower than in controls (resp., =0.005 and =0.018). HOMA-IR had an inverse correlation with IRS 1liver (=0.04). There was no correlation between IRS1 liver and IRS1 cells (=0.930). Conclusions. There was expression of IRS1 in leukocytes. IRS1 cells and IRS1 liver were lower in HCV patients than in controls.
Prevalence of diabetes mellitus and impaired glucose tolerance in patients with decompensated cirrhosis being evaluated for liver transplantation: the utility of oral glucose tolerance test
Bragan?a, Ana Carolina Costa;álvares-da-Silva, Mário Reis;
Arquivos de Gastroenterologia , 2010, DOI: 10.1590/S0004-28032010000100005
Abstract: context: cirrhosis, diabetes mellitus, impaired glucose tolerance, insulin resistance, and protein calorie malnutrition are important issues in cirrhotic patients because they can increase the progression of liver disease and worsen its prognosis. objective:to determine the prevalence of diabetes mellitus, impaired glucose tolerance and insulin resistance in cirrhotic patients being evaluated for liver transplantation and their impacts on a 3-month follow-up, and to compare fasting glycemia and oral glucose tolerance test. methods: a cross-sectional study was performed in consecutively included adult patients. diabetes mellitus was established through fasting glycemia and oral glucose tolerance test in diagnosing diabetes mellitus in this population. homa-ir and homa-β indexes were calculated, and nutritional assessment was performed by subjective global assessment, anthropometry and handgrip strength through dynamometry. results: diabetes mellitus was found in 40 patients (64.5%), 9 (22.5%) of them by fasting glycemia and 31 (77.5%) of them by oral glucose tolerance test. insulin resistance was found in 40 (69%) of the patients. there was no relationship between diabetes mellitus and the etiology of cirrhosis. protein calorie malnutrition was diagnosed in a range from 3.22% to 45.2% by anthropometry, 58.1% by subjective global assessment and 88.7% by handgrip strength. diabetes mellitus identified by oral glucose tolerance test was related significantly to a higher prevalence of infectious complications and deaths in a 3-month period (p = 0.017). conclusion: the prevalence of diabetes mellitus, impaired glucose tolerance, insulin resistance and protein calorie malnutrition is high in cirrhotic patients on the waiting list for liver transplantation. there were more infectious complications and/or deaths in a 3-month follow-up period in patients with diabetes mellitus diagnosed by oral glucose tolerance test. oral glucose tolerance test seems to be indicated as a rou
IRS1 Expression in Hepatic Tissue and Leukocytes in Chronic Hepatitis C Virus Infected Patients: A Comparative Study
Camila Ripoll Kappel,Nélson A. Kretzmann,Mário Reis álvares-da-Silva
International Journal of Hepatology , 2012, DOI: 10.1155/2012/698905
Abstract: Aims. To determine lymphocyte IRS (IRS1 cells) in HCV patients, correlating it to liver IRS (IRS 1liver) and HOMA-IR. This study tested the hypothesis that IRS1 cells expression can be used as insulin resistance (IR) marker in HCV-infected patients. IRS1 cells were not studied before in HCV infection. Materials and Methods. HCV chronically infected patients, na?ve, nonobese, noncirrhotic, and nondiabetic were prospectively included and compared to controls (blood donors). Blood was taken, and leukocytes were separated. IRS1 was determined by real-time PCR. Liver tissue was obtained from transplant donors as controls. Results. 41 HCV-positive patients were included, 26 males (60.5%); mean age of 45 ( ); 33 (80.5%) from genotype 1. 6 out of 12 controls were males (50%); mean age was 26.7 ( ). There was expression of IRS1 in leukocytes. The median IRS1 cells (HCV) were 0.061 (0.004 to 0.469); the median IRS 1liver (HCV) was 0.0003 (0.00002 to 0.0186)—lower than in controls (resp., and ). HOMA-IR had an inverse correlation with IRS 1liver ( ). There was no correlation between IRS1 liver and IRS1 cells ( ). Conclusions. There was expression of IRS1 in leukocytes. IRS1 cells and IRS1 liver were lower in HCV patients than in controls. 1. Introduction Chronic infection with hepatitis C virus (HCV) is an independent risk factor for developing type 2 diabetes mellitus (DM) [1–5]. There is a three- to ten-fold increased risk of HCV infection among diabetic patients in comparison with different control groups [4]; this appears to be linked to the development of insulin resistance (IR) [6]. The normal route of entry of glucose into the cell involves receptor autophosphorylation and subsequent tyrosine kinase phosphorylation of insulin receptor substrates (IRS1/2) (Figure 1) [7]. The IR may be secondary to alternative serine phosphorylation, as well as due to factors such as obesity, metabolic syndrome, systemic inflammation, and hepatic steatosis, which are sometimes present in patients with HCV [8]. Figure 1: Mechanisms of insulin resistance (adapted from Science Oxcan et al., 2004). The figure shows both normal and alternative route of entry of glucose into the cell. With the increase of nonoxidized fatty acids by the liver, there is a change in the mechanism of tyrosine phosphorylation, and the glucose route of entry into the cell is impaired. Thereafter, intracellular insulin resistance occurs because glucose cannot enter the cell. The insulin resistance is associated with reduced expression of IRS1 and IRS2. These receptors are proteins of a family of ligands
HOMA-AD in Assessing Insulin Resistance in Lean Noncirrhotic HCV Outpatients
Matheus Truccolo Michalczuk,Camila Rippol Kappel,Oscar Birkhan,Ana Carolina Bragan a,Mário Reis álvares-da-Silva
International Journal of Hepatology , 2012, DOI: 10.1155/2012/576584
Abstract: Introduction. There is an association between HCV and insulin resistance (IR), which is currently assessed by HOMA-IR. There is evidence that HOMA-adiponectin (HOMA-AD) is more accurate, but its role in HCV patients is unknown. The purpose of this study was to evaluate IR in an HCV sample and controls, in order to compare the accuracy of HOMA-IR and HOMA-AD. Methods. Ninety-four HCV outpatients aged <60 years who met the criteria of nondiabetic, nonobese, noncirrhotic, and nonalcohol abusers were included and compared to 29 controls. Fasting glucose, insulin, adiponectin, and lipid profiles were determined. IR was estimated by HOMA-IR and HOMA-AD. Results. The groups were similar regarding sex and BMI, but the HCV patients were older. The median insulin level was higher in the HCV group (8.6 mU/mL (6.5–13.7) versus 6.5 (4.3–10.7), =0.004), as was median HOMA-IR (1.94 (1.51 to 3.48) versus 1.40 (1.02 to 2.36), =0.002) and the prevalence of IR (38.3% versus 10.3% (=0.009)). No differences were found in adiponectin levels (=0.294) and HOMA-AD (=0.393). Conclusion. IR is highly prevalent even in low-risk HCV outpatients. Adiponectin is not influenced by the presence of HCV. HOMA-AD does not seem to be useful in assessing IR in HCV patients.
Aging and its impact onthe quality of grafts: an experimental study in rats livers
Mota, Stela Maria;Gasperin, Glauber;Cerski, Carlos Thadeu;Oliveira, Jarbas Rodrigues de;álvares-da-Silva, Mário Reis;
Arquivos de Gastroenterologia , 2010, DOI: 10.1590/S0004-28032010000300016
Abstract: context: there are consistent clues of worse results with grafts from older donors, especially in hepatitis c. university of wisconsin (uw) solution is adopted for liver preservation, but other solutions are being studied, as fructose-1,6-bisphosphate (fbp). objective: to determinate the impact of aging of the donor on the cold ischemia injury in rat livers and compare uw and fbp. methods: twenty male wistar rats were studied - 10, aging 20 weeks: 5 to preservation with uw (c-uw) and 5, fbp (c-fbp); and other 10, aging 50 weeks: 5 to uw (e-uw) and 5 to fbp (e-fbp). rats were anesthesized, submitted to hepatectomy, and graft was kept under 2-4oc for 8 hours. liquid samples were taken at 2, 4, 6, and 8 hours, to determine ast and ldh. at the end, in the liver tissue thiobarbituric acid reactive substances and catalase were determined. results: average liver weight was similar between controls and the others (12.5 g ± 1.8 and 13.4 g ± 2.0). ast and ldh levels were higher in c-uw group (p<0.05). in the older group, there was a difference between uw and fbp preserved livers related to ldh, but not to ast. thiobarbituric acid reactive substances were superior in control group than in the older one (p = 0.001). catalase activity was similar between these groups (p = 0.11), but it was superior in uw preserved animals (p = 0.02). conclusion: livers from older rats were similar to the controls regarding cold ischemia injury in fbp group. surprisingly, with uw solution there was less cold ischemia injury in the elderly group. when comparing both solutions, fbp provided significantly more protection than uw in the controls. there was a trend to fbp to being better than uw in the elderly group. further studies with liver from older donors and ischemia and reperfusion are needed.
Síndrome de cockayne: relato de caso
GUARDIOLA, ANA;áLVARES-DA-SILVA, CLéBER RIBEIRO;GRISOLIA, JOSé RENATO GUIMAR?ES;SILBERMANN, ROGéRIO;
Arquivos de Neuro-Psiquiatria , 1999, DOI: 10.1590/S0004-282X1999000100021
Abstract: we describe a girl with cockayne syndrome (cs), the diagnostic criteria and the complications of this syndrome. the required criteria for the diagnosis include: prenatal poor growth failure, congenital structural eye anomalies, cataracts, pigmentary retinopathy, severe neurologic dysfunction from birth, sensorineural hearing loss, cutaneous photosensitivity and dental caries. cs is a rare autosomal recessive and biochemical disorder.
Síndrome de cockayne: relato de caso
GUARDIOLA ANA,áLVARES-DA-SILVA CLéBER RIBEIRO,GRISOLIA JOSé RENATO GUIMAR?ES,SILBERMANN ROGéRIO
Arquivos de Neuro-Psiquiatria , 1999,
Abstract: Apresenta-se um caso de síndrome de Cockayne, definem-se os critérios diagnósticos e identificam-se as complica es desta síndrome. Os critérios para diagnóstico deste quadro s o: crescimento pobre, observado desde a vida intra-uterina, anormalidades neurológicas (desde o nascimento), perda auditiva neurossensorial, catarata (aparecimento nos primeiros 3 anos), anomalias estruturais congênitas do olho, retinopatia pigmentosa, fotossensibilidade cutanea, cáries dentárias, vida média de 12-13 anos (pode chegar aos 20 anos). O largo espectro de sintomas e sua severidade indicam distúrbio bioquímico e genético raro, de heran a autoss mica recessiva.
HOMA-AD in Assessing Insulin Resistance in Lean Noncirrhotic HCV Outpatients
Matheus Truccolo Michalczuk,Camila Rippol Kappel,Oscar Birkhan,Ana Carolina Bragan?a,Mário Reis álvares-da-Silva
International Journal of Hepatology , 2012, DOI: 10.1155/2012/576584
Abstract: Introduction. There is an association between HCV and insulin resistance (IR), which is currently assessed by HOMA-IR. There is evidence that HOMA-adiponectin (HOMA-AD) is more accurate, but its role in HCV patients is unknown. The purpose of this study was to evaluate IR in an HCV sample and controls, in order to compare the accuracy of HOMA-IR and HOMA-AD. Methods. Ninety-four HCV outpatients aged <60 years who met the criteria of nondiabetic, nonobese, noncirrhotic, and nonalcohol abusers were included and compared to 29 controls. Fasting glucose, insulin, adiponectin, and lipid profiles were determined. IR was estimated by HOMA-IR and HOMA-AD. Results. The groups were similar regarding sex and BMI, but the HCV patients were older. The median insulin level was higher in the HCV group (8.6?mU/mL (6.5–13.7) versus 6.5 (4.3–10.7), ), as was median HOMA-IR (1.94 (1.51 to 3.48) versus 1.40 (1.02 to 2.36), ) and the prevalence of IR (38.3% versus 10.3% ( )). No differences were found in adiponectin levels ( ) and HOMA-AD ( ). Conclusion. IR is highly prevalent even in low-risk HCV outpatients. Adiponectin is not influenced by the presence of HCV. HOMA-AD does not seem to be useful in assessing IR in HCV patients. 1. Introduction The hepatitis C virus (HCV) is one of the most prevalent causes of chronic liver disease worldwide and leads to cirrhosis and hepatocellular carcinoma in a high percentage of carriers [1, 2]. Insulin resistance (IR), impaired glucose tolerance, and type 2 diabetes mellitus (DM) are frequent extrahepatic manifestations [3, 4]. The mechanisms by which chronic HCV infection leads to IR remain uncertain, but it has been suggested that the blockade of IRS-1 and IRS-2 signaling via proinflammatory cytokines is involved [5, 6]. Conditions other than HCV are associated with IR, which include cirrhosis [4, 7], obesity [8], and advanced age [9]. These risk factors are often present in studies focusing on IR in HCV patients. The adipocytokines (adiponectin, leptin, and resistin) are a family of adipose tissue-derived serum proteins that influence the glucose and lipid metabolism [10]. Adiponectin (AD) modulates hepatic fat content and acts as an insulin sensitizer and an anti-inflammatory and antifibrotic cytokine [11–15]. Nonalcoholic fatty liver disease (NAFLD), a model of IR, is related to low AD levels [16–18]. Some studies have investigated the role of AD in chronic hepatitis C, but it remains controversial. Some authors suggest that HCV increases AD levels [19–22], whereas others have not corroborated these results [23–30]. IR is
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