Non-alcoholic fatty liver disease in women with polycystic ovary syndrome: systematic review and meta-analysis

PURPOSE

Non-alcoholic fatty liver disease (NAFLD) is an insidious pathologic condition that can manifest from simple steatosis to steatohepatitis (NASH) with potential progression to cirrhosis. Like the polycystic ovary syndrome (PCOS), NAFLD is associated with obesity, diabetes mellitus, insulin resistance and metabolic syndrome. PCOS women have an increased risk of NAFLD, but it is debatable which features of PCOS, either specific (androgen excess) or unspecific (metabolic derangements) affect the NAFLD risk.

METHODS

We performed a systematic review and meta-analysis of studies that addressed the association of PCOS and NAFLD. We selected 17 studies published between 2007 and 2017 that included 2734 PCOS patients and 2561 controls of similar age and body mass index (BMI).

RESULTS

PCOS patients have increased prevalence of NAFLD (odds ratio 2.54, 95% confidence interval 2.19-2.95). PCOS women with hyperandrogenism (classic phenotype) have a higher prevalence of NAFLD compared to women with PCOS without hyperandrogenism, even after correction for confounding variables. Among women with PCOS, those with NAFLD have higher serum total testosterone (mean difference 0.40 nmol/L, 95% CI 0.29-0.50 nmol/L) and free androgen index (mean difference 4.46, 95% CI 3.53-5.39) than those without NAFLD. The studies that used multivariate analysis controlling for age, BMI, triglycerides, and insulin resistance index confirmed that serum androgens are independent predictors of NAFLD in women with PCOS.

CONCLUSION

The prevalence of NAFLD is increased in women with PCOS and the presence of NAFLD is associated with high serum androgen levels, in addition to obesity and insulin resistance.

Genetic potential of black bean genotypes with predictable behaviors in multienvironment trials

The aim of this study was to evaluate the phenotypic stability and specific and broad adaptability of common black bean genotypes for the Central and Center-South regions of Brazil by using the Annicchiarico and AMMI (weighted average of absolute scores: WAAS, and weighted average of absolute scores and productivity: WAASP) methodologies. We carried out 69 trials, with 43 and 26 trials in the Central and Center-South regions, respectively. Thirteen genotypes were evaluated in a randomized block design with three replications, during the rainy, dry, and winter seasons in 2 years. To obtain estimates of specific adaptation, we analyzed the parameters for each method obtained in the two geographic regions separately. To estimate broad adaptation, we used the average of the parameters obtained from each region. The lines identified with high specific adaptation in each region were not the same based on the Annicchiarico and AMMI (WAAS) methodologies. It was not possible to identify the same genotypes with specific or broad stability by using these methods. By contrast, the Annicchiarico and AMMI (WAASP) methods presented very similar estimates of broad and specific adaptation. Based on these methods, the lines with more specific adaptation were CNFP 8000 and CNFP 7994, in the Central and Center-South regions, respectively, of which the CNFP 8000 line was more widely adapted.

Genetic parameters and breeding strategies for high levels of iron and zinc in Phaseolus vulgaris L

One of the current focus of common bean breeding programs in Brazil is to increase iron (FeC) and zinc content (ZnC) in grains. The objectives of this study were to estimate genetic parameters for FeC and ZnC in common bean, verify the need for conducting multi-site evaluation tests, identify elite lines that combine high FeC and ZnC with good adaptability, stability, and agronomic potential, and examine the genetic association between FeC and ZnC. Elite lines (140) were evaluated for important agronomic traits in multiple environments. In one trial, FeC and ZnC were evaluated and genetic parameters were estimated. Based on the high heritability estimates and significant selection gains obtained, the conditions for a successful selection was favorable. Of the 140 evaluated lines, 17 had higher FeC and ZnC, and were included in the validation test (2013, five environments), specifically for the evaluation of FeC and ZnC. The line by environment interaction for FeC and ZnC was detected, but it was predominantly simple. The environmental effect strongly influenced FeC and ZnC . The environment Brasília/rainy season was selected as the best evaluation site for preliminary tests for FeC and ZnC, because it resulted in similar conclusions as the mean of the five environments. The lines CNFP 15701 and CNFC 15865 had higher FeC and ZnC and were highly adaptable and stable, and are recommended for utilization in breeding programs. The lines CNFC 15833, CNFC 15703, and CNFP 15676 showed excellent combined agronomic and nutritional traits, and were selected for the development of biofortified cultivars. Additionally, the genetic association between FeC and ZnC was detected.

Occult hepatitis B virus infection in liver transplant patients in a Brazilian referral center

Estimates of occult hepatitis B virus (HBV) infection prevalence varies among different studies depending on the prevalence of HBV infection in the study population and on the sensitivity of the assay used to detect HBV DNA. We investigated the prevalence of occult HBV infection in cirrhotic patients undergoing liver transplantation in a Brazilian referral center. Frozen liver samples from 68 adults were analyzed using a nested polymerase chain reaction assay for HBV DNA. The specificity of the amplified HBV sequences was confirmed by direct sequencing of the amplicons. The patient population comprised 49 (72.1%) males and 19 (27.9%) females with a median age of 53 years (range=18-67 years). Occult HBV infection was diagnosed in three (4.4%) patients. The etiologies of the underlying chronic liver disease in these cases were alcohol abuse, HBV infection, and cryptogenic cirrhosis. Two of the patients with cryptic HBV infection also presented hepatocellular carcinoma. Markers of previous HBV infection were available in two patients with occult HBV infection and were negative in both. In conclusion, using a sensitive nested polymerase chain reaction assay to detect HBV DNA in frozen liver tissue, we found a low prevalence of occult HBV infection in cirrhotic patients undergoing liver transplant, probably due to the low prevalence of HBV infection in our population.

Genetic variability for iron and zinc content in common bean lines and interaction with water availability

The common bean is an important source of iron and zinc in humans. Increases in the contents of these minerals can combat mineral deficiencies, but these contents are influenced by environmental conditions. Thus, the objectives of this study were to investigate the interaction between common bean lines and water availability on iron and zinc contents (CFe and CZn, respectively), identify superior lines with stable CFe and CZn, and test for a genetic relationship between CFe and CZn. Six crop trials were performed using a randomized block design with three replications. The trials were performed during the winter sowing period for three different combinations of year and site in Brazil. For each combination, 53 lines were evaluated across two parallel trials; one trial was irrigated according to the crop requirements, and the other trial operated under a water deficit. Interaction was detected between lines and environments, and between lines and water availability for CFe and CZn. However, some lines exhibited high CFe and CZn in both conditions. Lines G 6492 and G 6490 exhibited high mean values, stability, and adaptability for both minerals. Other lines exhibited high CFe (Xamego) or CZn (Bambuí and Iapar 65). A moderate genetic correlation (0.62) between CFe and CZn was detected. Water availability during the common bean cycle had an effect on CFe and CZn; however, lines with high CFe and CZn in different conditions of water availability and environment were detected.

High prevalence of asymptomatic Leishmania spp. infection among liver transplant recipients and donors from an endemic area of Brazil

Visceral leishmaniasis is an uncommon disease in transplant recipients; however, if left untreated, the mortality can be high. If an organ donor or recipient is known to be an asymptomatic Leishmania spp. carrier,monitoring is advised. This study proposes to assess the prevalence of asymptomatic Leishmania spp.infection in liver transplant donors and recipients from an endemic area. A total of 50 liver recipients and 17 liver donors were evaluated by direct parasite search, indirect fluorescent antibody test (IFAT), anti-Leishmania rK39 rapid test and Leishmania spp.DNA detection by polymerase chain reaction (PCR).Leishmania spp. amastigotes were not observed in liver or spleen tissues. Of the 67 serum samples, IFAT was reactive in 1.5% and indeterminate for 17.9%, and the anti-Leishmania rK39 rapid test was negative for all samples. The PCR test was positive for 7.5%, 8.9%, and 5.9% of blood, liver and spleen samples, respectively(accounting for 23.5% of the donors and 8% of the recipients). Leishmania infantum-specific PCR confirmed all positive samples. In conclusion, a high prevalence of asymptomatic L. infantum was observed in donors and recipients from an endemic area, and PCR was the most sensitive method for screening these individuals.

Análise genética de características reprodutivas na raça brahman

Para fins de estabelecer critérios de seleção para a raça Brahman, no Brasil, este estudo objetivou estimar parâmetros genéticos e ambiental para peso ao nascer (PN), período de gestação (PG) e perímetro escrotal aos 365 (PE365), 455 (PE455) e 550 (PE550) dias de idade e eficiências relativas de seleção indireta versus a direta para essas características. Os dados referem-se a 15 851 animais de 16 rebanhos de seis estados, participantes de um programa de melhoramento genético. Componentes de (co)variância e coeficientes de herdabilidade e de correlações genéticas e ambientais entre características foram estimados pelo método da máxima verossimilhança restrita, sob modelo animal multi-característica. No modelo, foram incluídos como efeitos fixos, grupo de contemporâneos e idade da vaca ao parto como covariável (efeitos linear e quadrático) e, como efeitos aleatórios, genético aditivo direto, ambiente permanente da vaca e resíduo. Para PN e PG considerou-se ainda o efeito aleatório genético materno. As herdabilidades estimadas para PN, PG, PE365, PE455 e PE550 foram, respectivamente, 0,36; 0,29; 0,55; 0,43 e 0,40. As correlações genéticas entre PN e PG, PG e PE365, PG e PE455, PG e PE550, PE365 e PE455, PE365 e PE550 e PE455 e PE550 foram, respectivamente, 0,06; 0,13; 0,20; 0,13; 0,96; 0,98 e 0,99. Todas as características apresentaram variabilidade genética aditiva suficiente para responder favoravelmente à seleção. No que tange a precocidade sexual, a melhor opção seria PE365, devido à alta herdabilidade estimada, além de que a seleção indireta a esta idade seria mais eficiente que a direta para PE455.

MRSA outbreak at a transplantation unit

Methicillin-resistant Staphylococcus aureus (MRSA) infections frequently complicate the post-operative course of transplant recipients, and despite nasal carriage and endemic colonization, MRSA outbreaks are not commonly described. This study reports a case of MRSA outbreak and discusses infection control measures and recommendations for this situation.

Neurologic dengue manifestations associated with intrathecal specific immune response

BACKGROUND

Dengue infection is caused by a flavivirus, with 4 virus serotypes (types 1 to 4). The serotypes 2 and 3 represent the principal agents related to nervous system involvement. Neurologic involvement occurs in 4%-5% of dengue infection cases. The major mechanisms of the disease may be related to direct viral infection or postinfectious autoimmune process. The detection of intrathecal synthesis of specific antibodies has been used to support neurologic diagnosis as a proof of local reaction. It may be quantitatively calculated by the specific antibody index.

OBJECTIVES

To determine if patients with neurologic manifestations associated with dengue produce specific antibodies in the CNS and to determine the antibodies' clinical and pathophysiologic relevance.

METHODS

CSF and serum were evaluated for dengue immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by ELISA and for intrathecal synthesis of IgG antibodies to the dengue virus. Subjects included 10 patients IgM seropositive for dengue virus diagnosed with myelitis, encephalitis, optic neuromyelitis, or Guillain-Barré syndrome.

RESULTS

All patients had IgG and IgM antibodies to dengue virus in their sera; 7 were IgM positive and 9 were IgG positive for dengue virus in CSF. Only the 3 patients with myelitis had intrathecal synthesis of specific IgG antibodies.

CONCLUSIONS

Intrathecal synthesis of antibodies to dengue virus occurs in the CNS. It may be used as a marker of myelitis associated with dengue, and it seems to be related to the pathogenesis of spinal cord disease due to direct viral invasion.

Dengue infection: neurological manifestations and cerebrospinal fluid (CSF) analysis

Neurological manifestation is considered a rare complication of dengue infection. Neurological and cerebrospinal fluid (CSF) findings of 13 patients with dengue infection were studied. Seven patients had encephalitis, two had myelitis and four showed Guillain-Barré syndrome (GBS). No alteration in CSF was found from 57% of those with encephalitis. Patients with GBS and myelitis showed a CSF-blood barrier dysfunction. The differences in the CSF may be related to the location of the lesion and multiple mechanisms of the disease in the nervous system.

Succinate increases neuronal post-synaptic excitatory potentials in vitro and induces convulsive behavior through N-methyl-d-aspartate-mediated mechanisms

Succinate is a dicarboxylic acid that accumulates due to succinate dehydrogenase inhibition by malonate and methylmalonate exposure. These neurotoxins cause increased excitability and excitotoxic damage, which can be prevented by administering high amounts of succinate. In the present study we investigated whether succinate alters hippocampal field excitatory post-synaptic potentials. Bath application of succinate at intermediate concentrations (0.3-1 mM) increased the slope of field excitatory post-synaptic potentials in hippocampal slices, and at high concentrations (above 1 mM) did not alter or decrease field excitatory post-synaptic potentials slope. Succinate-induced enhancement of field excitatory post-synaptic potentials slope was abolished by the addition of d-2-amino-5-phosphonovaleric acid (50 microM) to the perfusate, supporting the involvement of N-methyl-d-aspartate receptors in the excitatory effect of this organic acid. Accordingly, succinate (0.8-7.5 micromol) i.c.v. administration caused dose-dependent convulsive behavior in mice. The i.c.v. co-administration of MK-801 (7 nmol) fully prevented succinate-induced convulsions, further suggesting the involvement of N-methyl-d-aspartate receptors in the convulsant action of succinate. Our data indicate that accumulation of moderate amounts of succinate may contribute to the excitotoxicity induced by succinate dehydrogenase inhibitors, through the activation of N-methyl-d-aspartate receptors.

Whipple's disease. Report of five cases with different clinical features

Whipple's disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.