Arquivos Brasileiros De Endocrinologia E Metabologia, Jun 1, 2011
Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathy... more Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathyroid hormone. We present a case of a seven-year-old girl who was admitted at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor episodes affecting the arms. Her calcium level was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium was 5.5 mg/dL; phosphorus, 8.3 mg/dL and serum parathyroid hormone was 1,318 pg/mL. Pseudohypoparathyroidism diagnosis was considered. This is the first description of a case of pseudohypoparathyroidism without Albright's stigma, with cerebral calcification, and no calcium abnormalities at the initial clinical manifestation.
A relevância e a abordagem consistente dos temas reunidos no Guia Prático em Osteometabolismo ass... more A relevância e a abordagem consistente dos temas reunidos no Guia Prático em Osteometabolismo asseguraram a publicação dessa nova edição. Preparada pelos membros do Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) e por seus colaboradores, oferece uma visão ainda mais detalhada sobre condições enfrentadas diariamente por clínicos e especialistas, como diabetes mellitus, osteoporose, hipertireoidismo e hipoparatireoidismo. Com isso, o guia mantém a sua condição como material de consulta e referência para profissionais da Endocrinologia e áreas relacionadas.
Arquivos Brasileiros De Endocrinologia E Metabologia, 2011
Pseudohypoparathyroidism (PHP) is a disease characterized by resistance to the peripheral action ... more Pseudohypoparathyroidism (PHP) is a disease characterized by resistance to the peripheral action of the parathyroid hormone. We present a case of a seven-year-old girl that was attended at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor crises of the arms. Calcium was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium, 5.5 mg/dl; phosphorus, 8.3 mg/dl and serum parathyroid hormone was 1318 pg/ml. Diagnostic of pseudohypoparathyroidism was considered. This report describes the first case of pseudohypoparathyroidism without Albright’s stigma, with cerebral calcification and no calcium abnormalities at the initial clinical manifestation.
A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of t... more A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age > 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older...
Antiretroviral therapy (ART) has been the most commonly associated factor for the redistribution ... more Antiretroviral therapy (ART) has been the most commonly associated factor for the redistribution of body fat within this group. 2,3 However, studies have not reached a common agreement as to whether any particular drug or group of
Background: The Framingham score is used in most studies on human immunodeficiency virus (HIV)-po... more Background: The Framingham score is used in most studies on human immunodeficiency virus (HIV)-positive patients to estimate the risk for coronary heart disease; however, it may have some limitations for detecting risk among these individuals. Objective: The aim of this study was to evaluate the agreement between the Framingham and Prospective Cardiovascular of Mü nster (PROCAM) scores among HIV-positive individuals and to investigate the factors associated with disagreement between the two scores. Method: A cross-sectional study was conducted in a population of HIV/acquired immunodeficiency syndrome (AIDS) patients attending the outpatient's clinics of two reference centers for HIV/AIDS in Pernambuco, Brazil. Agreement between the Framingham and PROCAM scores was evaluated using the kappa index. From this analysis, a variable called ''disagreement between scores'' was created, and univariate and multivariate analysis were performed to investigate the factors associated with this variable. Results: The prevalence of low, moderate, and high risk were, respectively, 78.7%, 13.5%, and 7.8% by Framingham score and 88.5%, 4.3%, and 7.2% by PROCAM (kappa ¼ 0.64, P 0.0001). Agreement in the subgroup with metabolic syndrome by the International Diabetes Federation (IDF) (kappa ¼ 0.51, P 0.0001) and the National Cholesterol Education Program (NCEP) (kappa ¼ 0.59, P 0.0001) criteria was moderate. The Framingham score identified greater proportion of women with moderate risk. Factors independently associated with disagreement were: smoking, sex, age, low-density lipoprotein cholesterol, diastolic blood pressure, and metabolic syndrome. Conclusion: There was a good agreement between the Framingham and PROCAM scores in HIV-positive patients, but a higher proportion of moderate-high risk was identified by the Framingham score. This disagreement should be evaluated in cohort studies to observe clinical outcomes over the course of time.
Background: Hypertriglyceridemia associated with low high-density lipoprotein (HDL) levels and hy... more Background: Hypertriglyceridemia associated with low high-density lipoprotein (HDL) levels and hypercholesterolemia is the most common metabolic disorder among human immunodeficiency virus (HIV)-infected patients using antiretroviral therapy. This atherogenic profile is associated with increased cardiovascular risk among these patients. Apolipoprotein B (apoB) is a better parameter than low-density lipoprotein (LDL) for evaluating lipids and cardiovascular risk among patients with diabetes and metabolic syndrome, but studies of apoB among HIV-infected patients are scarce. Methods: A cross-sectional study was conducted to estimate hyperapolipoprotein B (hyperapoB) prevalence and its association with other factors among HIV-infected patients attended in Recife, Pernambuco, Brazil. Results: The prevalence of hyperapoB was 32.4% among 256 patients (62.1% male), with 90 mg/dL as the cutoff point. It was associated with prolonged use (>3 years) of antiretroviral therapy [odds ratio (OR), 3.63; 95% confidence interval (CI), 1.24-10.6], hypertriglyceridemia (OR, 2.45; 95% CI, 1.22-4.91), insulin resistance according to homeostasis model assessment of insulin resistance (HOMA-IR) (OR, 2.12; 95% CI, 1.03-4.35), past history of diabetes (OR, 3.58; 95% CI, 1.0-12.7), and hypertension (OR, 1.98; 95% CI, 0.92-4.28). It was not associated with low HDL levels or self-report lipodystrophy. ApoB was higher in patients with metabolic syndrome according to the National Cholesterol Education Program (NCEP) criteria and in those with higher Framingham scores. Conclusions: ApoB is a good parameter for evaluating lipid levels in HIV-infected patients with hypertriglyceridemia, among whom LDL measurements may not be appropriate. ApoB might be useful for diagnosing and treating hypertriglyceridemia in this population. The association between hyperapoB and hypertriglyceridemia and diseases relating to insulin resistance among HIV-infected patients suggests that this group of patients presents higher cardiovascular risk.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2011
Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathy... more Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathyroid hormone. We present a case of a seven-year-old girl who was admitted at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor episodes affecting the arms. Her calcium level was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium was 5.5 mg/dL; phosphorus, 8.3 mg/dL and serum parathyroid hormone was 1,318 pg/mL. Pseudohypoparathyroidism diagnosis was considered. This is the first description of a case of pseudohypoparathyroidism without Albright's stigma, with cerebral calcification, and no calcium abnormalities at the initial clinical manifestation.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2010
There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIV-p... more There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIV-positive men, studies have also demonstrated a high prevalence of osteoporosis in HIV-infected women. It would appear that antiretroviral therapy (ART) plays an important role in the pathogenesis of osteoporosis in HIV-infected patients, although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women. The aim of this systematic review was to evaluate the frequency of bone loss, bone mineral density (BMD) and fractures in HIV-positive women taking ART or protease inhibitors (PI). After screening 597 citations from the databases of PubMed, EMBASE and Lilacs, five studies were selected for the review. A difference was demonstrated of over 3% in the BMD at the femoral neck of HIV-positive women taking PI/ART. No difference was registered in the BMD at the lumbar spine between users and non-users of PI/ART. The lack of studies has made it impossibl...
Arquivos Brasileiros De Endocrinologia E Metabologia, Jun 1, 2011
Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathy... more Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathyroid hormone. We present a case of a seven-year-old girl who was admitted at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor episodes affecting the arms. Her calcium level was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium was 5.5 mg/dL; phosphorus, 8.3 mg/dL and serum parathyroid hormone was 1,318 pg/mL. Pseudohypoparathyroidism diagnosis was considered. This is the first description of a case of pseudohypoparathyroidism without Albright's stigma, with cerebral calcification, and no calcium abnormalities at the initial clinical manifestation.
A relevância e a abordagem consistente dos temas reunidos no Guia Prático em Osteometabolismo ass... more A relevância e a abordagem consistente dos temas reunidos no Guia Prático em Osteometabolismo asseguraram a publicação dessa nova edição. Preparada pelos membros do Departamento de Metabolismo Ósseo e Mineral da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) e por seus colaboradores, oferece uma visão ainda mais detalhada sobre condições enfrentadas diariamente por clínicos e especialistas, como diabetes mellitus, osteoporose, hipertireoidismo e hipoparatireoidismo. Com isso, o guia mantém a sua condição como material de consulta e referência para profissionais da Endocrinologia e áreas relacionadas.
Arquivos Brasileiros De Endocrinologia E Metabologia, 2011
Pseudohypoparathyroidism (PHP) is a disease characterized by resistance to the peripheral action ... more Pseudohypoparathyroidism (PHP) is a disease characterized by resistance to the peripheral action of the parathyroid hormone. We present a case of a seven-year-old girl that was attended at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor crises of the arms. Calcium was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium, 5.5 mg/dl; phosphorus, 8.3 mg/dl and serum parathyroid hormone was 1318 pg/ml. Diagnostic of pseudohypoparathyroidism was considered. This report describes the first case of pseudohypoparathyroidism without Albright’s stigma, with cerebral calcification and no calcium abnormalities at the initial clinical manifestation.
A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of t... more A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age > 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older...
Antiretroviral therapy (ART) has been the most commonly associated factor for the redistribution ... more Antiretroviral therapy (ART) has been the most commonly associated factor for the redistribution of body fat within this group. 2,3 However, studies have not reached a common agreement as to whether any particular drug or group of
Background: The Framingham score is used in most studies on human immunodeficiency virus (HIV)-po... more Background: The Framingham score is used in most studies on human immunodeficiency virus (HIV)-positive patients to estimate the risk for coronary heart disease; however, it may have some limitations for detecting risk among these individuals. Objective: The aim of this study was to evaluate the agreement between the Framingham and Prospective Cardiovascular of Mü nster (PROCAM) scores among HIV-positive individuals and to investigate the factors associated with disagreement between the two scores. Method: A cross-sectional study was conducted in a population of HIV/acquired immunodeficiency syndrome (AIDS) patients attending the outpatient's clinics of two reference centers for HIV/AIDS in Pernambuco, Brazil. Agreement between the Framingham and PROCAM scores was evaluated using the kappa index. From this analysis, a variable called ''disagreement between scores'' was created, and univariate and multivariate analysis were performed to investigate the factors associated with this variable. Results: The prevalence of low, moderate, and high risk were, respectively, 78.7%, 13.5%, and 7.8% by Framingham score and 88.5%, 4.3%, and 7.2% by PROCAM (kappa ¼ 0.64, P 0.0001). Agreement in the subgroup with metabolic syndrome by the International Diabetes Federation (IDF) (kappa ¼ 0.51, P 0.0001) and the National Cholesterol Education Program (NCEP) (kappa ¼ 0.59, P 0.0001) criteria was moderate. The Framingham score identified greater proportion of women with moderate risk. Factors independently associated with disagreement were: smoking, sex, age, low-density lipoprotein cholesterol, diastolic blood pressure, and metabolic syndrome. Conclusion: There was a good agreement between the Framingham and PROCAM scores in HIV-positive patients, but a higher proportion of moderate-high risk was identified by the Framingham score. This disagreement should be evaluated in cohort studies to observe clinical outcomes over the course of time.
Background: Hypertriglyceridemia associated with low high-density lipoprotein (HDL) levels and hy... more Background: Hypertriglyceridemia associated with low high-density lipoprotein (HDL) levels and hypercholesterolemia is the most common metabolic disorder among human immunodeficiency virus (HIV)-infected patients using antiretroviral therapy. This atherogenic profile is associated with increased cardiovascular risk among these patients. Apolipoprotein B (apoB) is a better parameter than low-density lipoprotein (LDL) for evaluating lipids and cardiovascular risk among patients with diabetes and metabolic syndrome, but studies of apoB among HIV-infected patients are scarce. Methods: A cross-sectional study was conducted to estimate hyperapolipoprotein B (hyperapoB) prevalence and its association with other factors among HIV-infected patients attended in Recife, Pernambuco, Brazil. Results: The prevalence of hyperapoB was 32.4% among 256 patients (62.1% male), with 90 mg/dL as the cutoff point. It was associated with prolonged use (>3 years) of antiretroviral therapy [odds ratio (OR), 3.63; 95% confidence interval (CI), 1.24-10.6], hypertriglyceridemia (OR, 2.45; 95% CI, 1.22-4.91), insulin resistance according to homeostasis model assessment of insulin resistance (HOMA-IR) (OR, 2.12; 95% CI, 1.03-4.35), past history of diabetes (OR, 3.58; 95% CI, 1.0-12.7), and hypertension (OR, 1.98; 95% CI, 0.92-4.28). It was not associated with low HDL levels or self-report lipodystrophy. ApoB was higher in patients with metabolic syndrome according to the National Cholesterol Education Program (NCEP) criteria and in those with higher Framingham scores. Conclusions: ApoB is a good parameter for evaluating lipid levels in HIV-infected patients with hypertriglyceridemia, among whom LDL measurements may not be appropriate. ApoB might be useful for diagnosing and treating hypertriglyceridemia in this population. The association between hyperapoB and hypertriglyceridemia and diseases relating to insulin resistance among HIV-infected patients suggests that this group of patients presents higher cardiovascular risk.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2011
Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathy... more Pseudohypoparathyroidism (PHP) is characterized by resistance to the peripheral action of parathyroid hormone. We present a case of a seven-year-old girl who was admitted at the service of Instituto Materno Infantil de Pernambuco, IMIP, with motor episodes affecting the arms. Her calcium level was normal. Computed tomography showed calcifications in frontal lobes and basal ganglia. After six years: calcium was 5.5 mg/dL; phosphorus, 8.3 mg/dL and serum parathyroid hormone was 1,318 pg/mL. Pseudohypoparathyroidism diagnosis was considered. This is the first description of a case of pseudohypoparathyroidism without Albright's stigma, with cerebral calcification, and no calcium abnormalities at the initial clinical manifestation.
Arquivos Brasileiros de Endocrinologia & Metabologia, 2010
There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIV-p... more There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIV-positive men, studies have also demonstrated a high prevalence of osteoporosis in HIV-infected women. It would appear that antiretroviral therapy (ART) plays an important role in the pathogenesis of osteoporosis in HIV-infected patients, although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women. The aim of this systematic review was to evaluate the frequency of bone loss, bone mineral density (BMD) and fractures in HIV-positive women taking ART or protease inhibitors (PI). After screening 597 citations from the databases of PubMed, EMBASE and Lilacs, five studies were selected for the review. A difference was demonstrated of over 3% in the BMD at the femoral neck of HIV-positive women taking PI/ART. No difference was registered in the BMD at the lumbar spine between users and non-users of PI/ART. The lack of studies has made it impossibl...
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