PPAR-gamma agonists and their role in type 2 diabetes mellitus management

Type 2 diabetes mellitus and obesity are the most frequent endocrine-metabolic diseases in the world and their pathogenic basis are characterized by insulin resistance and insulin secretion defects that can be demonstrated through several alterations in carbohydrates, lipids, and protein metabolism. The peroxisome proliferator-activated receptors have been identified as key regulators of glucose and lipid metabolism, because they act as transcription factors that stimulate protein synthesis in a wide variety of processes (energetic metabolism, proliferation, and cellular differentiation), of which have been identified 3 types (alpha, beta/delta, gamma). The thiazolidenediones are compounds that act as agonists of the peroxisome proliferator-activated receptor-gamma increasing the tissues sensibility (muscle, adiposity tissue, and liver) to the insulin action; that is why they are used nowadays in treatment of type 2 diabetes mellitus. These drugs produce several of adverse effects, such as weight increased, edema, anemia, pulmonary edema, and congestive cardiac failure. Even their use have been related for some studies to an increased in the myocardium infarct risk; this correlation has not been a strong determinant to remove them from the market.

An elevated level of physical activity is associated with normal lipoprotein(a) levels in individuals from Maracaibo, Venezuela

Coronary artery disease is the main cause of death worldwide. Lipoprotein(a) [Lp(a)], is an independent risk factor for coronary artery disease in which concentrations are genetically regulated. Contradictory results have been published about physical activity influence on Lp(a) concentration. This research aimed to determine associations between different physical activity levels and Lp(a) concentration. A descriptive and cross-sectional study was made in 1340 randomly selected subjects (males = 598; females = 712) to whom a complete clinical history, the International Physical Activity Questionnaire, and Lp(a) level determination were made. Statistical analysis was carried out to assess qualitative variables relationship by chi2 and differences between means by one-way analysis of variance considering a P value <0.05 as statistically significant. Results are shown as absolute frequencies, percentages, and mean +/- standard deviation according to case. Physical activity levels were ordinal classified as follows: low activity with 24.3% (n = 318), moderate activity with 35.0% (n = 458), and high physical activity with 40.8% (n = 534). Lp(a) concentration in the studied sample was 26.28 +/- 12.64 (IC: 25.59-26.96) mg/dL. Lp(a) concentration according to low, moderate, and high physical activity levels were 29.22 +/- 13.74, 26.27 +/- 12.91, and 24.53 +/- 11.35 mg/dL, respectively, observing statistically significant differences between low and moderate level (P = 0.004) and low and high level (P < 0.001). A strong association (chi2 = 9.771; P = 0.002) was observed among a high physical activity level and a normal concentration of Lp(a) (less than 30 mg/dL). A lifestyle characterized by high physical activity is associated with normal Lp(a) levels.

[Granular cell tumor of the vulva]

Granular cell tumor is a relatively uncommon entity of unknown etiology and uncertain histogenesis. A case of granular cell tumor of the vulva is presented with a discussion of the clinical features, pathological characteristics and the histogenic theories of its origin.

[Single diverticulum of perforated cecum. Report of 5 cases]

Cecal diverticulitis is a relatively rare disease, which closely mimics the picture of acute appendicitis. At times it is difficult to differentiate from carcinoma. Five cases of cecal diverticulitis are reported, with a discussion of some salient features of this condition. Although two cases were treated with a right hemicolectomy, a plea for conservatism in the treatment of this disease is made.

[Seroprevalence of delta infection in a group of patients with HBsAg positive in the city of Maracaibo]

In order to establish a preliminary information about the penetration of delta infection in our population, 40 HBsAg positive sera were tested for antidelta. 20 were asymptomatic patients and 20 were symptomatics. In the group of asymptomatic patients 3 belong to a high risk population: 1 homosexual, 1 dialysis patient, 1 nurse of dialysis unit. None of the patients of this group were positive for antidelta. In the group of symptomatics one was positive for antidelta. It's represents a seroprevalence of 5%. This patient was an indian who lives in the city but was born in Perijá where severe epidemics have been reported. These results support that the infection seems to be restricted to this indigenous group but the spread must be considered because the patient was living in the city. In addition, the use of antidelta as the unique serologic marker should undervalue the real prevalence of infection in the cases of acute hepatitis, which represent the majority of symptomatics patients. In consequence the paper of delta agent must be considered in the genesis of hepatitis in our population as well as its further epidemiologic course.