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Health 2017年第5期9卷 799-810页

作者： Karine Rucker Larissa bianca paiva cunha de sá Alberto Krayyem Arbex Endocrinology Division IPEMED Medical School S&#227 o Paulo Brazil Diabetology department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany

Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) have been suggested as “anti-aging” therapies, or for improving quality of life with aging. In this study, we focus on the actions of GH in the main organs and organ systems of the human body, like skeletal muscle, bones and brain, particularly in regard to data and research on the use of GH replacement therapy in adults without growth hormone deficiency, especially elderly patients. several different studies have been carried out to show what the effects and side effects of GH replacement in healthy people and what would be the impact in quality of life and life span. In this review, we demonstrate what answers we have so far about the effects of GH replacement in many organs and systems in healthy people.

关键词： Growth Hormone Insulin-Like Growth Factor 1 sarcopenia Growth Hormone Replacement Adult Growth Hormone deficiency

Polycystic Ovary syndrome (PCOs) and Fertility

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 58-65页

作者： Guilherme Barbosa Larissa bianca paiva cunha de sá denise Rosso Tenório Wanderley Rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Sao Paulo Brazil Harvard T. H. Chan school of Public Health Harvard University Boston USA

The polycystic ovary syndrome (PCOs) is defined as a combination of hyperandrogenism (hirsutism and acne) and anovulation (oligomenorrhea, infertility, and dysfunctional uterine bleeding), with or without the presence of polycystic ovaries on ultrasound. It represents the main endocrine disorder in the reproductive age, affecting 6% - 15% of women in menacme. It is the most common cause of infertility due to anovulation, and the main source of female infertility. When in the presence of a menstrual disorder, the diagnosis of PCOs is reached in 30% - 40% of patients with primary or secondary amenorrhoea and in 80% of patients with oligomenorrhea. PCOs should be diagnosed and treated early in adolescence due to reproductive, metabolic and oncological complications which may be associated with it. Treatment options include drugs, diet and lifestyle improvement.

关键词： Polycystic Ovary syndrome Infertility Anovulation Hyperandrogenism Insulin Resistance

Polycystic Ovary syndrome and the Role of Metformin in Ovulation Induction

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Health 2018年第5期10卷 565-576页

作者： Fabiana Fraga Gabriel Azeredo César salgado Romeiro Larissa bianca paiva cunha de sá Alberto Krayyem Arbex Endocrinology Division IPEMED Medical School S&#227 o Paulo Brazil Internal Medicine Division Itajub&#225 Brazil Diabetology department Malteser Krankenhaus St. Franziskus Hospital Flensburg Germany Harvard T. H. Chan school of Public Health Boston MA USA

The Polycystic Ovary syndrome (PCOs) is frequently associated with comorbidities such as obesity, reduced glucose tolerance, hypertension, macrovascular disease and dyslipidemia. The Metabolic syndrome occurs in 30% of women with PCOs. Metformin has increasingly been used in this therapy due to its effects in reducing insulin resistance. Treatment of PCOs aims to reduce the symptoms of hyperandrogenism, regularize the menstrual cycle, reduce metabolic abnormalities, and lower the risk of type 2 diabetes mellitus and of cardiovascular disease. Additionally it is important to prevent hyperplasia and endometrial cancer, and to offer contraception to those who do not wish pregnancy, and to help to induce ovulation to those who do. The effectiveness of metformin in this treatment is assessed in the light of the current best evidence.

关键词： Polycystic Ovary syndrome Metformin Oral Contraceptives Fertility Anovulation

The Role of states in Controlling the Obesity Epidemic, and a Personal Autonomy to decide

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 35-43页

作者： Priscila Rosa da Fonseca Ana Maria Anjo Toloi Larissa bianca paiva cunha de sá Alberto Krayyen Arbex Division of Endocrinology IPEMED Medical School S&atilde o Paulo Brazil Diabetology department MalteserKrankenhaus St. Franziskus-Hospital Flensburg Germany PPGBIOs Funda&ccedil &atilde o Oswaldo Cruz Rio de Janeiro Brazil

Obesity has reached pandemic proportions in the world. Who is to blame for this: the person or the state (or both?). An increase in diseases associated with excess weight is also worldwide reported, such as Diabetes, Hypertension and some types of cancers. Therefore, the economic impacts of these comorbidities are an important issue to be discussed by states and citizens. Although the World Health Organization (WHO) has set and classified obesity as a disease more than 30 years ago, the American Medical society was until recently (2010) not so sure about this definition. This article discusses the relevance of the implementation of public health policies for prevention and control of obesity, along with the possible ethical limitations to these actions, considering the autonomy of individuals regarding their health.

关键词： Obesity Comorbidities Public Health Policies Autonomy of the Citizen

Anti-Inflammatory Effects of Physical Exercise on Obesity

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 44-51页

作者： Lídia Figueiredo Ramiro Barcos Nunes Bruna Marmett Larissa bianca paiva cunha de sá Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School S&atilde o Paulo Brazil Laboratory of Experimental Physiology Universidade Federal de Ciências da Saúde de Porto Alegre Porto Alegre Brazil Research department Instituto Federal Sul-Rio-Grandense Gravataí Brazil Diabetology department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany Diabetology department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany

Obesity is a disease of epidemic proportions, associated with chronic inflammation in response to increased secretion of inflammatory cytokines originating in adipose tissue. Exercise has been shown to be effective in combating these changes. The aim of this study was to review the anti-inflammatory effect of physical exercise in the pathogenesis of obesity. We conducted a search of the terms “exercise”, “obesity” and “inflammation” on Medline and PubMed databases, restricting results to clinical trials published since 2011. The retrieved studies showed that physical exercise could, via different pathways, reduce levels of CRP, IL-6 and TNF-α, as well as other proinflammatory markers. Additionally, exercise was able to increase expression of genes related to the production of nitric oxide, positively modulating endothelial function and chronic inflammation in obese patients, with or without caloric restriction. In conclusion, aerobic exercise of moderate intensity is an effective intervention strategy for chronic inflammation associated with obesity.

关键词： Cardiovascular Disease Atherosclerosis Metabolic syndrome X Weight Loss

Vitamin D and Diabetes Mellitus: A Review

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Open Journal of Endocrine and Metabolic Diseases 2016年第1期6卷 1-7页

作者： Cintia Linhares e souza Larissa bianca paiva cunha de sá denise Rosso Tenório Wanderley Rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Sao Paulo Brazil Visiting scientist of the Harvard T. H. Chan school of Public Health Harvard University Boston USA

Vitamin D deficiency and Diabetes are both disorders of high prevalence in the world. Currently, evidences suggest a possible correlation of low levels of vitamin D with the diagnosis of Diabetes Mellitus. Hypovitaminosis D could be associated with insulin resistance and Diabetes Mellitus, which would in part explain mechanisms involved in the pathogenesis of Diabetes. The aim of this work is to discuss the association between Vitamin D and Diabetes, questioning if vitamin D can prevent the settlement of diabetes or slow down its clinical evolution, and improve the pancreatic function, thus providing a better glycaemic control.

关键词： Vitamin D Vitamin D deficiency Autoimmune Disease Diabetes Mellitus Insulin Resistance

Pathophysiology of Graves’ Ophthalmopathy: A Literature Review

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 77-87页

作者： Mariela Carolina santos Carballo bianca paiva cunha de sá denise Rosso Tenório Wanderley Rocha Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School S&atilde o Paulo Brazil Diabetology department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany

Graves’ ophthalmopathy (GO), an autoimmune condition associated with Graves’ disease (GD), occurs at a prevalence of nearly 40% in patients diagnosed with GD. Ocular involvement is probably due to the presence of autoantibodies in the orbital tissues, regardless of the control state of thyroid hormones in individuals with GD, even during euthyroid or hypothyroid states, which are associated with thyroid hormone treatment. In addition to the immunological role present in the pathophysiology of GO, the genetic component, proteins and cytokines, minerals (e.g., selenium), and environmental factors (e.g., smoking) also contribute to its development and occurrence of clinical manifestations in varying degrees. Until now, the interaction of causal, intermediary, and triggering factors of GO is still unclear, so the purpose of this article is to review literature on the theme.

关键词： Ophthalmopathy Graves Disease Pathophysiology

Populational description of Patients with Diabetes Mellitus Attended in a Family Health Center in Cuiabá, Mato Grosso

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 1-11页

作者： Erick Tiago de Jesus Assunç &atilde o Ana Paula Brianezi Danyelle Mariaca de Melo Paloma de Oliveira Luciana Graciela de Oliveira Boiç a Larissa bianca paiva cunha de sá Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School S&atilde o Paulo Brazil Family and Community Health Cuiabá Brazil Diabetology department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany

Diabetes mellitus (DM) represents one of the most serious current health problems nowadays, considering the number of people affected, its complications and morbidities. A broad analysis was performed among diabetic patients attended in the Family Health Center from the district of Baú, in Cuiabá, Mato Grosso state (Center-east Brazil), to examine the patterns of occurrence of overweight or obesity, values of glycated hemoglobin and the diagnostic of metabolic syndrome. The results show ahead a wide work that is necessary to prevent and early diagnose concerning DM, since only an intensive control will make it possible to alter the reality of the unfavorable prognosis documented.

关键词： Diabetes Mellitus Obesity Metabolic syndrome

Diabetes Mellitus, Leprosy: Intensive Education Protocol in Foot at Risk, santa Marcelina Hospital, Amazon, Brazil

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 52-58页

作者： Orlando Leite Vanderneide Oliveria Augiceli Rodrigues Ticiana Albuquerque Alexandre Carvalho Larissa Gaspar Alexandre Falqueti Larissa bianca paiva cunha de sá Alberto Krayyem Arbex Division of Endocrinology santa Marcelina Hospital Porto Velho Brazil Division of Endocrinology IPEMED Medical School (IPEMED) S&atilde o Paulo Brazil

Objective: To apply an intensive and multidisciplinary education protocol in order to decrease, improve, delay or cancel the beginning of neuropathy and the manifestation of lesions in diabetic patients. Methodology: This is a cross-sectional descriptive study carried out at the Diabetes Mellitus Outpatient Clinic and Ward of santa Marcelina Hospital in Porto Velho. This research was based on cases of patients with Diabetes and Diabetics with Leprosy. The criteria used to include the patients were: being treated with insulin therapy, not to be amputated, being on high medication of the leprosy at the moment of the evaluation and to present nutritional risk classification by the screening. The population was divided into two groups of fifteen patients: eight diabetic patients, four male and four female. seven diabetics associated with leprosy were 4 males and 3 females. The monofilament test (semmes-Weinstein 10 g) was used as the classification basis. Results and Discussion: Group A, called the intensive care group, began diabetes education work with medical, nutritional and rehabilitation guidelines by a multidisciplinary team for an average period of 15 days in the ward and after discharged with biweekly monitoring. Group B, called conventional care, received the same guidelines in outpatient care and the monitoring followed the quarterly protocol. Both groups were evaluated and reassessed for a period of 180 days in the outpatient clinic. Group A consisted of 8 (100%) patients, 4 (50%) diabetics and 4 (50%) diabetics and leprosy patients. Conclusion: Intensive education in diabetes showed an improvement in the sensitivity, healing and nutritional status of the patients, leading to an improvement in quality of life and disability level, reducing or delaying the beginning of neurological complications. The protocol intensive method demonstrated a 100% improvement in patients in group A.

关键词： Continuing Education Foot at Risk Healing

The Role of Fructose in Public Health and Obesity

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Health 2018年第4期10卷 434-441页

作者： Carla Torres Carvalho Maria Zélia de souza Nawal Arbex Diana sá Luciana Corrêa de souza Rodrigues de souza Rodrigues Diana Aristotelis Rocha de sá Larissa bianca paiva cunha de sá de sá Alberto Krayyem Arbex Endocrinology Division IPEMED Medical School Rio de Janeiro Brazil Gastronomy Faculty Centro de Ensino Superior Juiz de Fora Brazil Diabetology department Malteser Krankenhaus St. Franziskus Hospital Flensburg Germany Harvard T. H. Chan school of Public Health Boston MA USA

We are in the so-called nutritional transition, in which obesity and its comorbidities have emerged as an important research topic, and the information on food composition is fundamental to promote nutritional safety. Fructose is the sweetest carbohydrate, and this sweetness, along with its low cost, is the key factor for its use in commercial drinks and sweets. The global average consumption of fructose per capita has increased from 56 g/day in 1986 to 65 g/day in 2007. Experimental models associate high fructose intake with the development of obesity and induced insulin resistance. In recent studies, diabetic patients have been reported to use fructose more frequently than glucose. Fructose acts differently in the hypothalamus and generates less satiety than glucose;thus, fructose has a high lipogenic potential. Replacing fructose with another isocaloric carbohydrate is associated with better glycemic control.

关键词： Fructose Obesity Type 2 Diabetes Food Composition Carbohydrate