Patients with hip fracture, had substantially higher mortality than comparable healthy people, and mortality was highest in the first six months after fracture. Age and prior comorbidities were associated with excess mortality.
HIV-1 viral encephalitis produced by antiretroviral-resistant strains in cerebrospinal fluid (CSF), despite suppression of plasma HIV-1 RNA, has been rarely described. We report two cases of symptomatic viral encephalitis demonstrated by clinical, magnetic resonance imaging (MRI), and an inflammatory CSF profile. Viral load in CSF was 24,000 and 6850 copies/ml, whereas plasma HIV RNA level was undetectable since the beginning of therapy. A resistance test in CSF showed genotypic mutations confering resistance to the drugs the patients received for more than 2 years. In the two cases, a high baseline HIV RNA level, a low nadir CD4(+) count, and suboptimal CSF levels of atazanavir were considered as the risk factors for developing encephalitis. The two cases did not resolve with a change to antiretroviral drugs with better CNS penetration, but they had complete clinical and MRI recovery after changing to therapy considering both CNS viral resistance and penetration.
The classical functions of bone are the maintenance of phosphorus-calcium homeostasis, damage repair, as well its structural function which allows locomotion and protects the vital organs. The recent discovery of new functions for bone in the regulation of energy metabolism suggest that bone may be an endocrine organ. In the last decade, different genetic and molecular studies carried out in mice have determined that osteocalcin increases the secretion of insulin, and sensitivity to it, by increasing the secretion of adiponectin, stimulates the proliferation and the better functioning of the beta cells, promotes the reduction of fatty mass and an increase in the consumption of energy. These findings demonstrate the existence of a reciprocal regulation between bone and energy metabolism, mediated by osteocalcin. The recognition of the metabolic role of osteocalcin is a significant discovery in the field of osteology and endocrinology, bringing the possibility of new therapies in the treatment and prevention of metabolic diseases such as diabetes mellitus, sarcopenia, obesity and osteoporosis.
Known bone functions include maintaining the homeostasis of the calcium-phosphate metabolism, repairing damage produced by daily exercise and maintaining the bone architecture according to mechanical requirements, meaning that bone remodeling is a true homeostatic function. Bone is a dynamic tissue that is constantly changing through bone remodeling, which requires a lot of energy. The sympathetic nervous system contributes to bone remodeling and is one form of interaction between the skeleton and the brain, through leptin, an adipocyte-derived hormone, which uses this route to induce expression of the gene for the receptor activator of nuclear factor kappa-b ligand, an osteoclast differentiation factor. This review summarizes basic research findings on the role of the sympathetic nervous system in bone metabolism.
Objective: To evaluate the relationship between cholesterol and triglycerides and bone mineral density in patients with vascular disease (hypertension and acute coronary syndrome).
Methods:The study included 217 patients (83 men and 134 women), aged between 36 and 76 (mean age 59 ± 10), with hypertension and acute coronary syndrome. Information obtained included anthropometric measurements, total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides; bone mineral density (BMD) was recorded at the lumbar spine.Results: BMD was signifi cantly lower in patients in the higher tertiles of cholesterol (p = 0.041). The effect was maintained after adjustment for age and Body Mass Index (BMI). However, there was no association between the range of triglycerides, LDL cholesterol, HDL cholesterol and bone mass.
Conclusions:A relationship was found between total cholesterol and bone mineral density in patients with vascular disease.
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