Manoeuvring between anxiety and control : Patients experience of learning to live with diabetes: a lifeworld phenomenological study

Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices.

Effects of melatonin on hemolymph glucose and lactate concentrations in the fiddler crab, uca pugilator

Melatonin (N-acetyl-5-methoxytryptamine) is an indolamine hormone produced by the pineal gland that works to regulate sleep/wake cycles and activity rhythms. The effects of melatonin in metabolism are far from understood. Melatonin was injected into the fiddler crab, Uca pugilator, to investigate the effects of melatonin on hemolymph glucose and lactate levels. Following injection at t=O, hemolymph samples were collected at t=O.5, 1.0, 1.5 and 5.0 hours. Melatonin caused a decrease in the stress response to injection and also caused delayed hyperglycemia. Melatonin-injected crabs also retained the glucose and lactate rhythymicity when compared to saline-injected crabs. Glucose and lactate rhythms followed the same pattern indicating that the cycles are coupled. Also, melatonin was synthesized using tbe Fischer Indole synthesis and characterized using H?NMR. The synthetic melatonin demonstrated biological activity when injected into the crabs as when compared to pure melatonin on the effects on glucose and lactate concentrations. Overall, melatonin influences both glucose metabolism and the production of lactate.

Enzymatic inhibitory activity of hydroxycinnamates (HCs): in silico studies

Diabetes is a worldwide health issue that has been expanding mainly in developed countries. It is characterized by abnormal levels of blood sugar due to several factors. The most common are resistance to insulin and the production of defective insulin which exerts little or no effect. Its most common symptoms include tissue damage to several systems due to elevated levels of blood sugar. One of the key enzymes in hydrocarbon metabolism is α-glucosidase (EC 3.2.1.20). It catalyzes the breakdown of complex carbohydrates into their respective monomers (glucose) which allows them to be absorbed. In this work, caffeoyl quinic acids and their metabolites were analyzed as potential inhibitors for α-glucosidase. The search for the best inhibitor was conducted using molecular docking. The affinity of each compound was compared to the inhibitor present in the crystal structure of the protein. As no inhibitor with a similar affinity was´found, a new approach was used, in situ drug design. It was not possible to achieve an inhibitor capable of competing with the one present in the crystal structure of the enzyme, which is also its current commercial inhibitor. It is possible to draw some conclusions as to which functional groups interact best with certain residues of the active site. This work was divided into three main sections. The first section, Diabetes, serves as an introduction to what is Diabetes, its symptoms and/or side effects and how caffeoyl quinic acids could be used as a treatment. The second section, Caffeoylquinic acids and their metabolites as inhibitors for Alfa-glucosidase, corresponds to the search through molecular docking of caffeoyl quinic acids as inhibitors for α-glucosidase and what was possible to draw from this search. The last section, In situ design of an inhibitor for α-glucosidase (EC 3.2.1.20), corresponds to the in situ drug design study and what it achieved. The representation of each of the molecules used as a ligand can be found in the Annexes.

Effect of the consumption of a new symbiotic shake on glycemia and cholesterol levels in elderly people with type 2 diabetes mellitus

Background: The consumption of foods containing probiotic and prebiotic ingredients is growing consistently every year, and in view of the limited number of studies investigating their effect in the elderly.Objective: The objective of this study was to evaluate the effect of the consumption of a symbiotic shake containing Lactobacillus acidophilus, Bifidobacterium bifidum and fructooligosaccharides on glycemia and cholesterol levels in elderly people.Methods: A randomized, double-blind, placebo-controlled study was conducted on twenty volunteers (ten for placebo group and ten for symbiotic group), aged 50 to 60 years. The criteria for inclusion in the study were: total cholesterol > 200 mg/dL; triglycerides > 200 mg/dL and glycemia > 110 mg/dL. Over a total test period of 30 days, 10 individuals (the symbiotic group) consumed a daily dose of 200 mL of a symbiotic shake containing 10(8) UFC/mL Lactobacillus acidophilus, 10(8) UFC/mL Bifidobacterium bifidum and 2 g oligofructose, while 10 other volunteers (the placebo group) drank daily the same amount of a shake that did not contain any symbiotic bacteria. Blood samples were collected 15 days prior to the start of the experiment and at 10-day intervals after the beginning of the shake intake. The standard lipid profile (total cholesterol, triglycerides and HDL cholesterol) and glycemia, or blood sugar levels, were evaluated by an enzyme colorimetric assay.Results: The results of the symbiotic group showed a non-significant reduction (P > 0.05) in total cholesterol and triglycerides, a significant increase (P < 0.05) in HDL cholesterol and a significant reduction (P < 0.05) in fasting glycemia. No significant changes were observed in the placebo group.Conclusion: The consumption of symbiotic shake resulted in a significant increase in HDL and a significant decrease of glycemia.

Increase of gastric area and weight gain in rats submitted to the ingestion of gasified water

OBJETIVO: em virtude do aumento progressivo da utilização de bebidas gaseificadas e do ganho de peso na população brasileira, e sabendo-se que os refrigerantes têm no gás carbônico um fator em comum, planejou-se um estudo experimental em ratos para investigar os efeitos da água gaseificada na ingestão hídrica e alimentar, ganho de peso, área gástrica, glicemia, hematócrito e hemoglobina. MÉTODOS: Foram constituídos 4 grupos de 12 ratos acompanhados por 36 dias. Ao Grupo-1 foi oferecido 35 g/dia de ração ad libitum e 20 ml de água não gaseificada em 4 períodos diários, ao Grupo-2 foi oferecido 35 g/dia de ração ad libitum e 20 ml de água gaseificada em 4 períodos diários, ao Grupo-3 foi oferecido 10 g/dia de ração ad libitum e 20 ml de água não gaseificada em 4 períodos diários e ao Grupo-4 foi oferecido 10 g/dia de ração ad libitum e 20 ml de água gaseificada em 4 períodos diários. RESULTADOS: Os resultados identificaram que os animais que foram submetidos ao tratamento com água gaseificada (Grupo-2 e Grupo-4), apresentaram um maior volume de ingestão hídrica e aumento significativo da área gástrica (p<0,001), no Grupo-2 a ingestão alimentar assim como o ganho de peso foi significativo (p<0,01), os dados de glicemia, hematócrito e hemoglobina não tiveram alterações significativas entre os grupos estudados. CONCLUSÃO: Nas condições em que foi realizado este experimento, concluímos que a água gaseificada favoreceu a ingestão hídrica e alimentar, o ganho de peso e o aumento da área gástrica.

Pressão arterial e freqüência cardíaca avaliadas pela MAPA em primigestas durante o trabalho de parto e puerpério imediato

OBJETIVO: analisar os valores da pressão arterial e da freqüência cardíaca durante o trabalho de parto e puerpério imediato de primigestas normais. MÉTODOS: foram incluídas no estudo 60 parturientes, às quais foi aplicada a monitorização ambulatorial da pressão arterial (MAPA) com uso do aparelho modelo SpaceLabs 90207, durante o trabalho de parto e nas primeiras 12 horas após o mesmo. A pressão arterial e a freqüência cardíaca foram registradas a cada 15 minutos durante o trabalho de parto e na primeira hora após o parto, e a cada 30 minutos até a 12ª hora após o parto. Esses parâmetros foram avaliados em três momentos do trabalho de parto (com dilatação cervical até 7 cm, entre 8 cm e dilatação total e durante o período expulsivo) e em dois momentos do puerpério (na primeira e décima segunda hora). Primeiramente os resultados foram analisados sem levar em consideração o tipo de procedimento anestésico, e depois, dividindo-os em grupos conforme o tipo de procedimento realizado: anestesia local, analgesia peridural lombar e anestesia subaracnóidea. Para comparação dentro de cada grupo foram realizados análise de variância (ANOVA) e teste t de Student pareado e, entre os grupos, o teste t não-pareado. Foi considerado o limite de significância estatística de 5%. RESULTADOS: quando os resultados foram avaliados sem levar em consideração o procedimento anestésico, os valores médios da pressão arterial sistólica, registrados durante o trabalho de parto, foram significativamente mais elevados que no puerpério. Durante o trabalho de parto esses valores foram significativamente mais elevados nos períodos de dilatação final e expulsivo que no período de dilatação inicial e, na 12ª hora, inferiores ao da primeira hora após o parto. Os valores médios da pressão arterial diastólica registrados durante o trabalho de parto foram significativamente mais altos que no puerpério. Estes valores não apresentaram alteração durante os diferentes períodos do trabalho de parto ou durante as primeiras doze horas do puerpério. A freqüência cardíaca aumentou progressivamente durante o trabalho de parto, diminuindo nas primeiras 12 horas após o parto. Quando a pressão arterial e a freqüência cardíaca foram avaliadas conforme o tipo de procedimento anestésico empregado, ambas mostraram-se com mesmo comportamento na anestesia local e peridural, embora naquelas submetidas à anestesia subaracnóidea, tanto a pressão arterial sistólica como a diastólica não apresentaram alteração durante o trabalho de parto. CONCLUSÕES: o trabalho de parto determinou aumento da pressão arterial sistólica e da freqüência cardíaca. Durante o trabalho de parto os valores das pressões arteriais sistólica e diastólica foram mais altos que nas primeiras 12 horas do puerpério, havendo queda significativa entre a primeira e a décima segunda hora do mesmo. Diferentes procedimentos anestésicos não interferiram nos valores das pressões arteriais sistólica e diastólica ou da freqüência cardíaca, durante o trabalho de parto e nas primeiras doze horas após o parto.

Validação do monitor de medida de pressão arterial Omron HEM 742 em adolescentes

FUNDAMENTO: A medida precisa da pressão arterial é fundamental para a investigação científica ou decisão clínica. Nesse sentido, é importante verificar valores fornecidos por equipamentos eletrônicos. OBJETIVO: Validar o monitor Omron HEM 742 de medida de pressão arterial em adolescentes, segundo os critérios sugeridos pela British Hypertension Society. MÉTODOS: Participaram do estudo 150 adolescentes com idades entre 10 e 16 anos. O monitor automático Omron HEM 742 foi conectado em Y com equipamento auscultatório de coluna de mercúrio, e realizaram-se três avaliações simultâneas, calculando-se as diferenças entre os dois equipamentos. Para verificar a relação entre ambos, utilizaram-se o coeficiente de correlação intraclasse e a plotagem de Bland-Altman (concordância). A especificidade e a sensibilidade do aparelho foram determinadas pela curva ROC. RESULTADOS: A comparação entre as medidas acusou uma diferença menor ou igual a 5 mmHg em 67,3% dos valores sistólicos e 69,3% dos valores diastólicos; uma diferença menor ou igual a 10 mmHg ocorreu em 87,3% e 90,6% dos valores sistólicos e diastólicos, respectivamente; e uma diferença menor ou igual a 15 mmHg em 96,6% dos valores sistólicos e 97,3% dos diastólicos. Esses resultados indicam grau A segundo o protocolo da British Hypertension Society. Observou-se ainda elevada concordância nos valores obtidos por meio do monitor automático, e verificou-se que esse equipamento é capaz de identificar a presença ou a ausência da pressão arterial elevada. CONCLUSÃO: O monitor Omron HEM 742 mostrou-se válido para medidas de pressão arterial em adolescentes, conforme os critérios sugeridos pela British Hypertension Society.

Relevância de exames de rotina em pacientes de baixo risco submetidos a cirurgias de pequeno e médio porte

JUSTIFICATIVA E OBJETIVOS: A avaliação pré-operatória tem como objetivos diminuir a morbimortalidade do paciente cirúrgico, o custo do atendimento perioperatório e a ansiedade pré-operatória. A partir da avaliação clínica deve-se definir a necessidade de exames complementares e estratégias para reduzir o risco anestésico-cirúrgico. O objetivo deste trabalho foi avaliar o benefício de exames de rotina pré-operatório de pacientes de baixo risco em cirurgias de pequeno e médio porte. MÉTODOS: Trata-se de um estudo descritivo, transversal, com 800 pacientes atendidos no consultório de avaliação pré-anestésica do Hospital Santo Antonio, Salvador, BA. Foram incluídos pacientes de 1 a 45 anos, estado físico ASA I, que seriam submetidos a cirurgias eletivas de pequeno e médio porte. Avaliaram-se alterações no hemograma, coagulograma, eletrocardiograma, RX de tórax, glicemia, função renal e dosagem de sódio e potássio e as eventuais mudanças de conduta que ocorreram decorrentes dessas alterações. RESULTADOS: Dos 800 pacientes avaliados, 97,5% fizeram hemograma, 89% coagulograma, 74,1% eletrocardiograma, 62% RX de tórax, 68% glicemia de jejum, 55,7% dosagens séricas de ureia e creatinina e 10,1% dosagens de sódio e potássio séricos. Desses 700 pacientes, 68 (9,71%) apresentaram alteração nos exames pré-operatórios de rotina e apenas 10 (14,7%) dos considerados alterados tiveram conduta pré-operatória modificada, ou seja, solicitação de novos exames, interconsulta ou adiamento do procedimento. Nenhuma das cirurgias foi suspensa. CONCLUSÃO: Observou-se que excessivos exames complementares são solicitados no pré-operatório, mesmo em pacientes jovens, de baixo risco cirúrgico, com pouca ou nenhuma interferência na conduta perioperatória. Exames aboratoriais padronizados não são bons instrumentos de screening de doenças, além de gerar gastos elevados e desnecessários.

Hydrolyzed alpha-lactalbumin as a source of protein to the exercising

This work describes the effect of feeding enzymatically hydrolyzed a-lactalbumin on blood sugar, albumin and fatty acids, muscular and hepatic glycogen of rats subjected to physical exercise. Three normoenergetic/normoproteic diets, containing either casein (C), alpha-lactalbumin (L) or alpha-lactalbumin hydrolyzate (H) were fed to thirty male Wistar rats for five weeks. During this period, half of the rats swam for 1 hr daily (T category) while the other half remained sedentary (S category). At the end of training, all rats were required to swim to exhaustion. The results showed that those rats of the T-category consuming diet H reached exhaustion with significantly higher concentrations of serum glucose ([H] 56.0 and [L] 32.3 mg/100ml), serum albumin ([H] 3.8 and [L] 2.1 mg/dl) and muscle glycogen ([H] 2.1 and [L] 0.6 mg/g), while no differences were observed between diets regarding the time of arrival to exhaustion. Results from diets C and L differed minimally. It was concluded that feeding the hydrolyzed protein may result in nutritional advantage to the exercising rat. (C) 1998 Elsevier B.V.

Association between hypervolemia and ventricular hypertrophy in hemodialysis patients

Background: Left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular mortality in patients who have end-stage renal disease and are maintained on hemodialysis (HD), and LVH is not always correlated with the severity of hypertension in these patients. The purpose of this study was to investigate the role of other factors contributing to LVH.Methods: A total of 50 patients with HD were classified in three groups according to whether their LV mass index (LVMI) was higher than (n = 15), equal to (n = 20), or lower than (n = 15) that predicted by a formula based on their ambulatory blood pressure monitoring (ABPM).Results: Subjects with higher LVMI than predicted had significantly greater inter-HD weight gain (3.4 +/- 0.8 v 2.7 +/- 0.8 and 2.6 +/- 05 kg, respectively, in the other two groups, P < .05), and subjects with lower LVMI than predicted had a tendency toward a more pronounced nocturnal dipping pattern of BP (P = .07 v the other two groups), although daytime and night-time average BP levels did not differ between groups. All other clinical and laboratory parameters were similar among the three groups except higher cardiac output and various indices of LVH, which were more pronounced in the group with higher LVMI by ABPM. This group had also the lowest survival rate over the 2 to 3 years of follow-up, with five deaths versus two in each of the other two groups.Conclusions: the data suggest that correct management of inter-HD weight gain by nutritional counseling and shorter inter-HD intervals may prevent LVH and improve survival independently of BP control. (C) 2004 American Journal of Hypertension, Ltd.

Eficácia e segurança do uso inalatório da adrenalina-L na laringite pós-intubação utilizada em associação com a dexametasona

Objective: to assess the efficacy and safety of the use of nebulized L-epinephrine associated with dexamethasone in post-intubation laryngitis. Method: we carried out a prospective, randomized, double-blind, placebo controlled study with two cohorts of patients with postintubation laryngitis graded 3 to 6 by Downes and Raphaely score and during two years. Our population was divided into two groups: A and B; both groups received intravenous dexamethasone and nebulized saline with (group B) and without (group A) L-epinephrine. The efficacy was assessed by Downes and Raphaely's score. The side effects of epinephrine were evaluated according to occurrence of arrhythmia, to increased blood pressure, and to average heart rate of group B in comparison to group A. Results: twenty-two patients were included in group A (average score = 4.8) and 19 in group B (average score = 5.2). During treatment, 3 patients in group A presented a score of 8 and were reintubated. This group also showed higher clinical scores than group B during the first two hours of the protocol; these results were not statistically significant. No side effects were observed due to epinephrine. The gasometric parameters were adequate in both groups, but better in the control group. Conclusions: we did not observe increased efficacy for the treatment of post-intubation laryngitis when nebulized L-epinephrine was used simultaneously with intravenous dexamethasone. Some indicators, however, did present a favorable trend when combined therapy was used and should be submitted to further evaluation.

Efficacy and Tolerability of the Combination Valsartan/Hydrochlorothiazide Compared with Amlodipine in a Mild-to-moderately Hypertensive Brazilian Population

Most hypertensive patients need more than one drug to reach recommended blood-pressure targets. We investigated the effects on 24-h ambulatory blood pressure (ABP) of the angiotensin-receptor blocker, valsartan, in combination with hydrochlorothiazide (HCTZ), compared with the calcium-channel blocker amlodipine in a Brazilian population in a multicentre, double-blind, double-dummy, parallel group, controlled study in 373 patients with essential hypertension. After a 2-week washout period, patients with a mean sitting systolic blood pressure (SBP) of 160-190 mmHg were randomized to receive either valsartan 160 mg o.d., or amlodipine 5 mg o.d. for 2 weeks and subsequently force-titrated to valsartan 160 mg/HCTZ 25 mg o.d. or amlodipine 10 mg o.d. This regimen was continued until the end of the study at week 8. The primary efficacy parameter was the change from baseline to week 8 in mean 24-h SBP. Secondary endpoints were change in mean 24-h diastolic blood pressure (DBP), tolerability and safety of treatments. Valsartan/HCTZ achieved a mean reduction in systolic ABP of -19.1 ± 11.3 mmHg compared with -20.7 ± 12.0 mmHg with amlodipine (p = 0.324 for the comparison) and in diastolic ABP by -11.1 ± 7.4 mmHg vs -11.6 ± 7.2 mmHg by amlodipine (p = 0.853 for the comparison). The valsartan/HCTZ group exhibited markedly lower rates of adverse events and discontinuations than the amlodipine group. Peripheral oedemas were far more frequent with amlodipine than with valsartan/HCTZ (1.6% with valsartan/HCTZ; 16.8% with amlodipine). Thus, the valsartan 160 mg/HCTZ 25 mg combination appears to be as efficacious as amlodipine 10 mg in this patient population but better tolerated.

Effect of 6-months of physical exercise on the nitrate/nitrite levels in hypertensive postmenopausal women

Background: Evidences have showed that the incidence of arterial hypertension is greater in postmenopausal women as compared to premenopausal. Physical inactivity has been implicated as a major contributor to weight gain and abdominal obesity in postmenopausal women and the incidence of cardiovascular disease increases dramatically after menopause. Additionally, more women than men die each year of coronary heart disease and are twice as likely as men to die within the first year after a heart attack. A healthy lifestyle has been strongly associated with the regular physical activity and evidences have shown that physically active subjects have more longevity with reduction of morbidity and mortality. Nitric oxide (NO) produced by endothelial cells has been implicated in this beneficial effect with improvement of vascular relaxing and reduction in blood pressure in both laboratory animals and human. Although the effect of exercise training in the human cardiovascular system has been largely studied, the majority of these studies were predominantly conducted in men or young volunteers. Therefore, the aim of this work was to investigate the effects of 6 months of dynamic exercise training (ET) on blood pressure and plasma nitrate/nitrite concentration (NOx-) in hypertensive postmenopausal women. Methods: Eleven volunteers were submitted to the ET consisting in 3 days a week, each session of 60 minutes during 6 months at moderate intensity (50% of heart rate reserve). Anthropometric parameters, blood pressure, NOx- concentration were measured at initial time and after ET. Results: A significant reduction in both systolic and diastolic blood pressure values was seen after ET which was accompanied by markedly increase of NOx- levels (basal: 10 ± 0.9; ET: 16 ± 2 μM). Total cholesterol was significantly reduced (basal: 220 ± 38 and ET: 178 ± 22 mg/dl), whereas triglycerides levels were not modified after ET (basal: 141 ± 89 and ET: 147 ± 8 mg/dl). Conclusion: Our study shows that changing in lifestyle promotes reducftion of arterial pressure which was accompanied by increase in nitrite/nitrate concentration. Therefore, 6-months of exercise training are an important approach in management arterial hypertension and play a protective effect in postmenopausal women. © 2009 Zaros et al; licensee BioMed Central Ltd.

Perfil de cortisol, glicemia e de parâmetros sanguineos de girinos de rã-touro, Rana catesbeiana, em diferentes densidades e após exposição aérea

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)