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Influence of Omega 3 Fatty Acid Supplementation on Phase Angle Values of People Living with HIV/AIDS with lipodystrophy Secondary to Antiretroviral Therapy: A Randomized Clinical Trial

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Food and Nutrition Sciences 2024年第1期15卷 58-70页

作者： Thalita Bandeira Dantas Alline Peralta Castro Fernando de Souza Flexa Ribeiro Filho Rosana Maria Feio Libonati Núcleo de Medicina Tropical do Pará Programa de Pós gradua&ccedil&atildeo em Patologia das Doen&ccedilas Tropicais Universidade Federal do Pará Pará Brasil Instituto de Ciências Biológicas e da Saúde Faculdade de Medicina Universidade Federal do Pará Pará Brasil Centro de Ciências Biológicas e da Saúde Universidade Estadual do Pará Pará Brasil

Objective: The measurement of phase angles is an important monitoring parameter and supplementation with omega-3 could promote benefits by modulating the electrical potential of membranes and increasing body cell mass. This study aimed to evaluate the effectiveness of omega-3 fatty acid supplementation on the phase angle of people living with HIV/AIDS. Methods: In this study, 63 individuals of all genders who were undergoing outpatient follow-up and showed lipodystrophy due to highly active antiretroviral therapy were analyzed. Our sample consisted of two groups, one that received supplementation containing 2550 mg of omega-3/day (1080 mg of eicosapentaenoic acid and 720 mg of docosahexaenoic acid) for three months (n = 32) and another that underwent nutrition guidance (n = 31). Phase angle and body cell mass were assessed for both groups and compared at the beginning of research (T0) and after our intervention (T1) for each group separately. Results: Phase angle averaged 6.45° ± 1.06 SD. The comparison between T0 and T1 showed a significant increase in phase angle and body cell mass, whereas the guidance group showed a decrease in body cell mass at T1 in relation to T0, with a significant p-value. Variance in phase angle between moments showed significant values between T0 and T1 in the supplementation group for all genders. Conclusion: Omega-3 positively modulated patients phase angle and body cell mass, but we emphasize the need for other studies that can solidify knowledge about supplementation dosage and intervention time.

关键词： HIV lipodystrophy Omega-3 Phase Angle

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Nursing a patient with latent autoimmune diabetes in adults with insulin-related lipodystrophy,allergy,and exogenous insulin autoimmune syndrome:A case report

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World Journal of Clinical Cases 2022年第20期10卷 7163-7170页

作者： Fang He Ling-Ling Xu Yu-Xiu Li Ya-Xiu Dong Department of Endocrinology Peking Union Medical College HospitalBeijing 100730China

BACKGROUND Latent autoimmune diabetes in adults(LADA)is a special type of type 1 diabetes mellitus.During the early stages,patients with LADA are treated with oral antidiabetics.However,insulin treatment is still required as islet function gradually declines.Once patients have developed insulin allergy,clinical treatment and nursing care become very challenging.CASE SUMMARY Here,we report a case of LADA with insulin-related lipodystrophy,allergy,and exogenous insulin autoimmune syndrome during insulin treatment,thus making it very difficult to effectively control glucose levels with insulin.We attempted subcutaneous injection and an insulin pump to desensitize the patient’s response to insulin,and finally assisted the doctor to select the appropriate insulin treatment for the patient.We describe the management of this patient from a nursing viewpoint.CONCLUSION We summarize the nursing experience of a case with complex insulin allergy requiring desensitization treatment.Our approach is very practical and can be applied to similar patients needing insulin desensitization.

关键词： Insulin allergy Desensitization lipodystrophy Exogenous insulin autoimmune syndrome Skin test Nursing Case report

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Self-Corporal Image among People Living with HIV/AIDS with lipodystrophy Syndrome in Brazil

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World Journal of AIDS 2022年第1期12卷 32-42页

作者： Patrícia Furtado Lismeia Raimundo Soares Alberto J. S. Duarte Jorge Casseb Department of Dermatology of Hospital das Clínicas School of Medical University of S&#227 o Paulo S&#227 o Paulo Brazil Department of Nutrition Federal University of Rio de Janeiro Rio de Janeiro Brazil

Currently, with the increase in life expectancy of people living with HIV (PLHIV), it is essential to analyze the biopsychosocial aspects involved in satisfaction with quality of life and its multidimensionality, because although HAART produces hope for the control of HIV, can have important emotional consequences. Thus, the aim of the present study was to evaluate the effects of lipodystrophy (LDS) on self-esteem and body image of PLHIV in Brazil. It is a psychoanalytic method by semi-structured interview, a body image scale and two drawings that represent the patients’ body image before and after. The diagnosis of LDS was by self-report. Sixteen patients 8 (eight men and 8 women), with a mean age of 43 years, were invited to the HIV-Out ADEE 3002 outpatient clinic of the Dermatology Clinic of the Central Institute of a University Hospital in São Paulo. It was noted that 50% of patients reported physical problems and 25% consequences in the family and social sphere. There were increased bodily changes, family problems and social prejudices after HAART and the self-esteem of 88% of patients were shown to be “little adjusted” to their condition. For 63%, physical appearance was a concern and 87% of them reported body dissatisfaction. Patients also reported impact on their sexuality (75% felt less attractive and 88% with reduced libido after starting LDS). The interviews, drawings and body image scale showed important changes in the lives of patients with lipodystrophy, where negative changes in appearance and effects on self-image were observed. This diagnosis seems to influence other aspects of social life, which can lead to prejudice in relation to illness and, therefore, isolation.

关键词： HIV Antiretroviral lipodystrophy Body Image Brazil

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Hereditary severe insulin resistance syndrome:Pathogenesis,pathophysiology,and clinical management

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Genes & Diseases 2023年第5期10卷 1846-1856页

作者： Junaid Iqbal Hong-Li Jiang Hui-Xuan Wu Long Li Ying-Hui Zhou Nan Hu Fen Xiao Ting Wang Shi-Na Xu Hou-De Zhou National Clinical Research Center for Metabolic Diseases Hunan Provincial Key Laboratory for Metabolic Bone Diseasesand Department of Endocrinology and MetabolismThe Second XiangYa Hospital of Central South UniversityChangshaHunan 410011China

Severe insulin resistance has been linked to some of the most globally prevalent disorders,such as diabetes mellitus,nonalcoholic fatty liver disease,polycystic ovarian syndrome,and hypertension.Hereditary severe insulin resistance syndrome(H-SIRS)is a rare disorder classified into four principal categories:primary insulin receptor defects,lipodystrophies,complex syndromes,and obesity-related H-SIRS.Genes such as INSR,AKT2,TBC1D4,AGPAT2,BSCL2,CAV1,PTRF,LMNA,PPARG,PLIN1,CIDEC,LIPE,PCYT1A,MC4R,LEP,POMC,SH2B1,RECQL2,RECQL3,ALMS1,PCNT,ZMPSTE24,PIK3R1,and POLD1 have been linked to H-SIRS.Its clinical features include insulin resistance,hyperglycemia,hyperandrogenism,severe dyslipidemia,fatty liver,abnormal topography of adipose tissue,and low serum leptin and adiponectin levels.Diagnosis of H-SIRS is based on the presence of typical clinical features associated with the various H-SIRS forms and the identification of mutations in H-SIRS-linked genes by genetic testing.Diet therapy,insulin sensitization,exogenous insulin therapy,and leptin replacement therapy have widely been adopted to manage H-SIRS.The rarity of H-SIRS,its highly variable clinical presentation,refusal to be tested for genetic mutations by patients’family members who are not severely sick,unavailability of genetic testing,and testing expenses contribute to the delayed or underdiagnoses of H-SIRS.Early diagnosis facilitates early management of the condition,which results in improved glycemic control and delayed onset of diabetes and other complications related to severe insulin resistance.The use of updated genetic sequencing technologies is recommended,and long-term studies are required for genotype–phenotype differentiation and formulation of diagnostic and treatment protocols.

关键词： Diabetes Genetics Insulin resistance lipodystrophy Pathophysiology Therapy

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lipodystrophy among Children Infected with Human Immunodeficiency Virus and on Antiretroviral Treatment in Ouagadougou

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Open Journal of Pediatrics 2015年第3期5卷 199-206页

作者： Caroline Yonaba Aissata Ouedraogo Sylvie Armelle Pingwende Ouedraogo Bourama Ouattara Angel Kalmogho Fla Koueta Diarra Ye Ludovic Kam Department of Pediatric Yalgado Ouedraogo University Teaching HospitalOuagadougouBurkina Faso Department of Pediatric Charles de Gaulle Pediatric University Teaching HospitalOuagadougouBurkina Faso

Management of Human Immunodeficiency Virus infection remains a major challenge in many sub-Saharan African countries. Antiretroviral drugs which have reduced significantly the mortality rate of this pandemic disease are a source of side effects. Among these side effects, adult lipodystrophy has already been described by several authors. The aim of this study is to determine the prevalence of lipodystrophy and associate factors in children on antiretroviral therapy, managed at Charles De Gaulle Children University Hospital and Yalgado Ouedrago University Hospital in Ouagadougou, Burkina Faso. This is a cross-sectional study conducted from June 2013 to January 2014. We included children aged 2 to 15 years who had been on antiretroviral treatment for at least six months with no severe acute malnutrition (wasting). lipodystrophy was diagnosed clinically after assessment of morphological changes. Overall, 323 children complying with the inclusion criteria were examined. The average duration of antiretroviral therapy was 5.3 years. Forty five children had lipodystrophy, i.e. 13.9% prevalence rate. One hundred and twenty seven different lipodystrophic lesions were noted, hence 82.7% lipoatrophy and 17.3% lipohypertrophy. The most common presentations were: face (32%), lower limbs (26%) and upper limbs (15.7%). Factors associated with lipoatrophy were: age above 10 years (P = 0.004);male gender (P = 0.0004);antiretroviral treatment duration of more than 60 months (P lipodystrophy is not exceptional in children on antiretroviral therapy in Ouagadougou. However, more researches on lipid profiles of these children are necessary to prevent other common complications related to fat accumulation.

关键词： HIV Children lipodystrophy Burkina-Faso

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Additional attention to combination antiretroviral therapy-related lipodystrophy

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World Journal of Virology 2017年第3期6卷 49-52页

作者： Norihiko Kobayashi Masako Nakahara Masako Oka Kumiko Saeki Department of Disease Control Research Institute National Center for Global Health and Medicine

The occurrence of lipodystrophy in patients taking antihuman immunodeficiency virus(HIV) medications is a serious problem as it is irreversible even after drug withdrawal. Although it was first recognized in patients taking proteinase inhibitors, other types of anti-HIV agents can also cause lipodystrophy. In a recent publication by Jones et al entitled "Highly active antiretroviral therapy dysregulates proliferation and differentiation of human pre-adipocytes" in World Journal of Virology, it was reported that simultaneous treatment of human subcutaneous adipocytes with anti-HIV drugs with different mechanisms of action synergistically exerted antiadipogenesis effects in vitro, warning us to take utmost care in every case receiving combination antiretroviral therapy(cART). For elucidation of the molecular basis for cART-related lipodystrophy, multi-faceted approaches should be taken, based on a deeper understanding of the development and organization of adipose tissues.

关键词： Combination antiretroviral therapy lipodystrophy Protease inhibitor Reverse transcriptase inhibitor Human immunodeficiency virus

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lipodystrophy of HIV (LDHIV) in the Head and Neck: Imaging and Clinical Features

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International Journal of Otolaryngology and Head & Neck Surgery 2012年第2期1卷 24-27页

作者： Saman Hazany Rafael Rojas Gul Moonis Department of Neuroradiology Beth Israel Deaconess Medical Center Boston USA

A subset of HIV-1 infected patients undergoing antiretroviral treatment with HIV-1 protease inhibitors (PI’s) develops a syndrome called lipodystrophy of HIV (LDHIV). LDHIV is characterized by loss of peripheral subcutaneous adipose tissue (face, limbs, buttocks), visceral fat accumulation, and in some cases, lipomatosis in the neck and dorsocervical area .We describe the clinical and imaging features of LDHIV in the head and neck in a series of 5 cases. There is a consistent pattern of fat accumulation in the dorsocervical region with paucity of fat in the face. This classic appearance should be recognized as potentially related to drug toxicity in the HIV infected population.

关键词： lipodystrophy of HIV LDHIV Protease Inhibitor

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Dunnigan-Type Familial Partial lipodystrophy: Understanding and Treating the Syndrome

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Open Journal of Endocrine and Metabolic Diseases 2017年第1期7卷 22-34页

作者： Ana Raisa Jatahy Santos Sabrina Pinto Ferreira Moacir Benazzi Mara Capra Helen Paula Apparicio Medeiros Ana Luísa de Jesus Mirella Hansen de Almeida Larissa Bianca Paiva Cunha de Sá Alberto Krayyem Arbex Division of Endocrinology IPEMED Medical School Rio de Janeiro Brazil Porto Velho Garrison Hospital—HGuPV Porto Velho Brazil Division of Endocrinology Central Air Force Hospital Rio de Janeiro Brazil Diabetology Department Malteser Krankenhaus St. Franziskus-Hospital Flensburg Germany

Dunnigan-type partial lipodystrophy, which is characterized by a number of metabolic alterations, change in body fat distribution, and autosomal dominant inheritance pattern, is rare in the general population. Objective: To report the case of an adolescent with clinical and laboratory findings suggestive of Dunnigan-type partial lipodystrophy. Methods: Case report and literature review. Results: A 15-year-old adolescent presented at the clinic complaining of darkening of skin folds on her trunk and back. During physical examination, the presence of serious acanthosis nigricans in her cervical region, axillae, and intergluteal space was noted. Hirsutism in androgen-dependent areas was also observed, as well as relevant reduction of subcutaneous adipose tissue in the limbs, gluteal region, abdomen, and trunk and fat accumulation in the face and chin. Discussion. Dunnigan-type familial partial lipodystrophy is a rare dominant autosomal disease resulting from a heterozygous missense mutation in the LMNA gene, known as LPF type 2 (Dunnigan variant), which encodes the nuclear protein A/C-type lamin. It is characterized by the progressive disappearance of the subcutaneous adipose tissue in the limbs, gluteal region, abdomen, and trunk, with onset in puberty, followed by fat accumulation in other areas such as the face, chin, labia majora, and intra-abdominal region, leading to hypertrophy that may mimic the Cushing’s syndrome phenotype. Affected patients display marked insulin resistance and may consequently develop diabetes mellitus, acanthosis nigricans, hirsutism, and polycystic ovary syndrome. Conclusion: This case report highlights the importance of suspecting Dunnigan-type familial partial lipodystrophy in clinical practice. Early clinical diagnosis allows for measures that minimize the severe metabolic disorders associated with this disease and, consequently, these adolescents’ self-esteem issues.

关键词： Dunnigan-Type Familial Partial lipodystrophy Insulin Resistance Heterozygous Mutation

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Congenital lipodystrophy: A Case Series Report from Cameroon

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Open Journal of Pediatrics 2020年第1期10卷 231-235页

作者： Suzanne Sap Ngo Um Jocelyn Tony Ritha Mbono Yannick Tekel Isabelle Mekone Mesmin Dehayem Koki Ndombo Department of Paediatrics University of Yaounde I Yaounde Cameroon Mother and Child Center of the Chantal Biya Foundation Yaounde Cameroon University of Douala Douala Cameroon Yaounde Central Hospital Yaounde Cameroon

Congenital lipodystrophy is a group of rare syndrome characterized by the absence of subcutaneous tissue. Affecting less per million live birth, this condition associate metabolic disturbance including severe insulin resistance and progeroid appearance. Diagnosis may be fortuitous or related to complications as presented in the present case series. lipodystrophy can be generalized or localized. Acquired lipodystrophy is associated with some drugs like antiretroviral. Thus, the condition is well described in African HIV patients but data on congenital forms from Sub Saharan Africa are sparse, justifying the present report. We present four cases, with peculiar appearance associated with increased blood triglycerides. Two on four of the patients presented diabetes mellitus. Genetic testing was not available, questioning the actual guidelines of diagnosis for our context.

关键词： lipodystrophy Diabetes Children

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An antiretroviral regimen containing 6 months of stavudine followed by long-term zidovudine for first-fine HIV therapy is optimal in resource-limited settings： a prospective, multicenter study in China

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Chinese Medical Journal 2014年第1期127卷 59-65页

作者： Li Taisheng Guo Fuping Li Yijia Zhang Chengda Han Yang Lye Wei He Yun Lu Hongzhou Xie Jing Huang Aiqiong Li Yanling Tang Xiaoping Wang Hui Zhang Tong Gao Guiju Lei Junkang Zhang Xiaoying Wu Xinhua Sun Yongtao Bai Jinsong Luo Ling Wang Huanlmg Department of Infectious Diseases Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730China The infectious Disease Hospital of Henan Province ZhengzhouHenan 450061 China Shanghai Public Health Clinical Center Fudan University Shanghai201508 China Fuzhou Infectious Diseases Hospital Fujian Medical UniversityFuzhou Fujian 350002 China Guangzhou No. 8 People's Hospital Guangzhou Guangdong 510060 China Shenzhen Third People's Hospital Shenzhen Guangdong 518112China Beijing You'an Hospital Capital Medical University Beijing 100054China Beijing Ditan Hospital Capital Medical University Beijing 100011China Yunnan AIDS Care Center Kunming Yunnan 650000 China The First People's Hospital of Honghe State Honghe Yunnan 650000 China Tangdu Hospital Affiliated to the Fourth Military Medical University Xi'an Shaanxi 710038 China Kunming Third People's Hospital Kunming Yunnan 650041 China

Background An zidovudine （AZT）-substitution regimen containing 24-week stavudine （d4T） followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associated with d4T in resourcelimited settings.However,evidence is scarce.This study aims to assess the efficacy and safety of AZT-substitution regimen,aiming to find a regimen with better efficacy,less adverse events,and more affordability in resource-limited settings.Methods This prospective,multicenter study enrolled 499 （190 on d4T regimen,172 on AZT regimen,and 137 on AZT-substitution regimen） HIV-1-infected subjects who initiated combined antiretroviral therapy and attended follow-up visits over 96 weeks from 2009 to 2011.Lamivudine （3TC） and either nevirapine （NVP） or efavirenz （EFV） were the other two drugs in the antiretroviral regimens.Virologic and immunologic responses and adverse events were monitored at baseline and at weeks 4,12,24,36,48,60,72,84,and 96.Results In terms of hematological adverse effects,AZT-substitution group had similar safety profiles to d4T group and was superior to AZT group.In comparison with AZT-substitution group,AZT group was associated with higher risk of developing anemia （adjusted hazard ratio （aHR）for anemia ≥ grade Ⅱ,8.44,95％ CI 1.81-39.46） and neutropenia （aHR for neutropenia ≥ grade Ⅱ,1.86,95％ CI 1.19-2.93）.The prevalence of lipodystrophy in d4T group was 19.5％,while that in AZT-substitution group was zero.As to antiretroviral efficacy,these three groups showed no differences.Conclusion AZT-substitution regimen provides a relatively safe and effective first-line antiretroviral strategy in resource-limited settings.

关键词： human immunodeficiency virus acquired immunodeficiency syndrome antiretroviral therapy zidovudine stavudine anemia lipodystrophy

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