Fatores associados ao controle metabólico em pacientes com diabetes melito tipo 2 não usuários de insulina

Introdução: a obtenção de um bom controle metabólico é essencial para a prevenção das complicações crônicas do Diabetes Melito (DM). O tratamento é complexo e depende da implementação efetiva das diferentes estratégias terapêuticas disponíveis. Para que isso seja possível, é necessário que o paciente entenda os princípios terapêuticos e consiga executá-los. A precária educação em diabetes é percebida como um dos obstáculos para o alcance das metas terapêuticas. Objetivo: analisar, os fatores associados ao controle metabólico, em pacientes com DM tipo 2 (DM2) não usuários de insulina. Métodos: foi realizado um estudo transversal em pacientes com DM2 não usuários de insulina, selecionados ao acaso entre aqueles que consultavam nos ambulatórios de Medicina Interna, Endocrinologia e Enfermagem do Hospital de Clínicas de Porto Alegre. Os pacientes foram submetidos à avaliação clínica, laboratorial e responderam um questionário que incluía o tipo de tratamento realizado para DM, outros medicamentos e co-morbidades, pesquisa de complicações em ano prévio e avaliação do conhecimento sobre DM. Os pacientes foram classificados em dois grupos, com bom ou mau controle glicêmico, de acordo com o valor da glico-hemoglobina de 1 ponto % acima do limite superior do método utilizado. As comparações entre variáveis contínuas, com distribuição normal, foram analisadas pelo teste t de Student para amostras não-pareadas e para as variáveis de distribuição assimétrica ou com variância heterogênea o teste U de Mann-Whitney. A comparação entre percentagem foi feita pelo teste de qui-quadrado ou exato de Fisher. Foi realizada uma análise logística múltipla para identificar os fatores mais relevantes associados ao controle metabólico (variável dependente). As variáveis independentes com um nível de significância de P < 0,1 na análise bivariada, foram incluídas no modelo. Resultados: foram avaliados 143 pacientes com DM2, idade de 59,3 ± 10,1 anos, duração conhecida do DM 7,5 ± 6,3 anos, índice de massa corporal (IMC) de 29,7 ± 5,2 kg/m².Destes, 94 pacientes (65,73%) apresentavam bom controle glicêmico. Os pacientes com mau controle glicêmico usavam mais anti-hiperglicemiantes orais como monoterapia (OR = 9,37; IC = 2,60-33,81; P=0,004) ou associados (OR = 31,08; IC = 7,42-130,15; P < 0,001). Da mesma maneira, não fizeram dieta em dias de festa (OR = 3,29; IC = 1,51-7,16; P = 0,012). A inclusão do conhecimento sobre diabetes não foi diferente entre os pacientes com bom ou mau controle glicêmico (OR = 1,08; IC = 0,97 - 1,21; P = 0,219). A análise multivariada demonstrou que a consulta com a enfermeira educadora (OR = 0,24; IC = 0,108-0,534; P = 0,003), com o endocrinologista (OR = 0,15 ; IC = 0,063-0,373; P = 0,001) e o uso de hipolipemiantes (OR = 0,10; IC = 0,016 - 0,72; P = 0,054) foram associados ao bom controle glicêmico, ajustados para a não realização de dieta em festas, uso de anti-hiperglicemiantes orais e conhecimento sobre diabetes. Conclusão: o controle metabólico em pacientes DM2 é influenciado pelas atividades de educação com enfermeira e endocrinologista. O tratamento do DM2 deve incluir atividades de educação de forma sistemática.

Registro da informação sobre nascidos vivos no nordeste: uma avaliação da evolução do SINASC entre 2000 e 2010

Os nascimentos ocorridos em uma população consistem em informação de grande valia para diversos estudos e planejamento de políticas públicas. O Sistema de informações sobre Nascidos Vivos (SINASC) representa uma promissora fonte de informação sobre o tema, uma vez que coleta continuamente e no âmbito municipal, dados sobre nascimentos. Tendo em vista a necessidade de avaliação contínua do SINASC e o panorama do declínio da fecundidade no Nordeste, objetivou-se avaliar a qualidade das informações provenientes do SINASC para o Nordeste, estados e microrregiões, nos anos 2000 e 2010, utilizando o Censo Demográfico como informação de referência, avaliando a cobertura do SINASC e identificando níveis e padrões de fecundidade. Pretendeu-se ainda verificar a relação entre os níveis de fecundidade, o grau de cobertura do SINASC e as condições socioeconômicas das microrregiões sintetizadas pelo Índice Social de Desenvolvimento Municipal (ISDM), utilizando-se a análise de cluster, associada à análise de variância (ANOVA) e o teste de Tukey. Por último, analisou-se a incompletude no preenchimento dos campos da Declaração de Nascido Vivo (DNV). De acordo com os resultados, observou-se que houve ampliação da qualidade das informações do SINASC no período estudado, resultando em uma maior aproximação das TFTs oriundas das duas fontes de dados consideradas no estudo. Maranhão e Paraíba foram os estados com maiores ganhos em cobertura das TFTs no período, e os estados do Rio Grande do Norte e Sergipe revelaram um grau de cobertura ligeiramente inferior em 2010 frente aos resultados de 2000, bem como ainda persistem várias microrregiões com TFTs oriundas do SINASC bem abaixo daquelas estimadas pelo Censo. Na verificação da associação entre o ISDM, TFTs e cobertura, a análise de cluster resultou em três agrupamentos, GrISDM A com melhores coberturas, ISDM e mais baixas TFT; GrISDM B , intermediário e GrISDM C com piores coberturas, ISDM e TFT mais altas. Notou-se a evolução das condições socioeconômicas no Nordeste, tendo o GrISDM A passado de 8% do total de microrregiões em 2000 para 37% em 2010. Reiterou-se ainda que quanto melhores as condições socioeconômicas de uma população, menores são as TFTs e melhores as coberturas do SINASC. A análise de variância apontou interações significativas entre o ano estudado versus ISDM (p-valor < 0,016) e o ano versus fonte de informação (p-valor < 0,020), e o teste Tukey apontou que não houve similaridade entre as médias das TFT das fontes Censo versus SINASC no período, fato que aponta para a captação ainda deficiente do SINASC nas microrregiões. O resultado da análise de variância da cobertura do SINASC em relação ao Censo apresentou uma interação significativa entre as variáveis UF versus Ano (p-valor < 0,0001), causada pelos estados que apresentaram queda de cobertura entre 2000 e 2010. Quanto à incompletude dos itens da DNV, evidenciou-se uma melhor coleta no período, embora alguns itens ainda careçam de atenção, como o apgar no 1º e 5º minuto e ocupação da mãe, sendo esta a que apresenta maiores percentuais de informações ignoradas. Destaca-se a possibilidade de preenchimento inconsistente nas variáveis referentes ao histórico de gestações anteriores, com o uso da informação zero inserida no lugar da informação ignorado . Concluiu-se que o SINASC é uma importante base de dados sobre nascimentos e que dispõe de dados confiáveis para o acompanhamento dos nascimentos e de seu panorama epidemiológico no Nordeste brasileiro, embora para alguns estados, assim como para algumas microrregiões, ainda faz-se necessária a ampliação da cobertura do Sistema. As informações constantes na DNV podem servir como embasamento para diversos estudos sobre as condições epidemiológicas dos nascituros e das suas mães, e dos indicadores baseados as informações dos nascimentos

Comparações entre os valores genéticos para características de crescimento de bovinos da raça Nelore preditos com modelos de dimensão finita ou infinita

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

DNA damage in cytologically normal urothelial cells of patients with a history of urothelial cell carcinoma

In order to determine if patients with a history of previous urothelial cell carcinoma (UCC) but with current normal urinary cytology have DNA damage in urothelial cells, the single-cell gel electrophoresis (comet) assay was conducted with cells obtained by urinary bladder washings from 44 patients (28 with a history of previous UCC). Increased DNA damage was observed in cytologically normal urothelial cells of patients with a history of UCC when compared with referents with no similar history and after correcting the data for smoking status and age (P < 0.018). Increased DNA damage also correlated with the highest tumor grade, irrespective of time or course of the disease after clinical intervention (Kendall tau correlation, 0.37, P = 0.016). Moreover, aneuploidy, as assessed by DNA content ratio (DCR; 75th/25th percentile of total DNA fluorescence of 50 comets/patient) was unaltered by smoking status, but increased with UCC grade: 1.39 +/- 0.12 (median +/- 95% confidence interval; referents); 1.43 +/- 0.11 (Grade I UCC; P = 0.264, against referents); 1.49 +/- 0.16 (Grade II UCC; P = 0.057); 1.57 +/- 0.16 (Grade III UCC; P = 0.003). Micronucleated urothelial cells (MNC) were also scored on Giemsa-stained routine cytological smears and were found not to correlate with DNA damage or DCR. MNC frequencies were higher for patients with a history of UCC and/or smoking than referents with neither history, but there was no statistical difference between groups. Taken together, these results suggest that the normal-appearing urothelium of patients resected for UCC still harbor genetically unstable cells. (C) 2002 Wiley-Liss, Inc.

Letinula edodes (Berk.) Pegler (Shiitake) modulates genotoxic and mutagenic effects induced by alkylating agents in vivo

We evaluated the antimutagenic effect of Letinula edodes (Berk.) Pegler (Shiitake) on the frequency of micronuclei in mice treated with N-ethyl-N-nitrosourea (ENU) or cyclophosphamide (Cl?). Mice were orally (gavage) pretreated for 15 consecutive days with solutions of Shiitake (0.6 ml per day, gavage) prepared at three different temperatures: 4, 21 (RT), and 60 degreesC. Then, the animals were intraperitoneally injected on day 15 with CP (25 or 50 mg/kg) or ENU (50 mg/kg) and killed 24 or 48 h after treatment for evaluation of micronucleated polychromatic erythrocytes (MNPCEs) in bone marrow and micronucleated reticulocytes (MNRETs). A mixture of L. edodes lineages (LE 95/016, 96/14, 96/17, 96/22, 96/23, 97/27, and 97/28) significantly decreased the frequencies of MNPCEs and MNRETs induced by CP (25 and 50 mg/kg). When a single lineage from the mixture (LE 96/17) was tested we also found a significant reduction in the frequencies of MNPCEs and MNRETs induced by both CP or ENU (50 mg/kg). The comet assay was also performed 3 h after ENU treatment using mice pretreated with the single lineage (LE 96/17) of L. edodes. The results showed a high degree of variability with some indications of an antigenotoxic effect. Taken together, our data show that solutions from Shiitake inhibit in vivo mutagenicity of CP and ENU. (C) 2001 Elsevier B.V. B.V. All rights reserved.

Avaliação da qualidade da atenção básica em 37 municípios do centro-oeste paulista: características da organização da assistência

No Estado de São Paulo, existe uma rede extensiva de serviços de Atenção Básica (AB) com perfil organizacional heterogêneo e pouco conhecido. Este estudo objetiva caracterizar a organização dos serviços de AB em 37 municípios do Centro-oeste paulista, como primeira etapa de um projeto de avaliação da qualidade desses serviços. Trata-se de um estudo transversal conduzido mediante questionário estruturado, autorrespondido pelos gerentes e equipes locais, com questões que abordam características institucionais e de organização e gerência do trabalho. Esses questionários foram enviados para 131 UBS, distribuídas em 37 municípios. Obteve-se resposta de 113 unidades (87%) localizadas em 32 municípios (86,4%). do total de unidades, 57 (50%) são UBS tradicionais, 26 (22,8%), Unidades de Saúde da Família, e 31, (27,2%) organizadas segundo formas mistas. A maioria dos serviços (62%, 70/113) não trabalha com área de abrangência delimitada de modo planejado. Os serviços se polarizam entre aqueles que realizam entre 70 e 100% de consultas médicas agendadas (37,6%, 41/109), e aqueles que realizam entre 70 e 100% de não agendadas (39,4%, 43/109). Não possuem conselhos locais organizados 65 unidades (63,7%, 65/102). Os dados coletados permitem discutir as características dos principais programas, procedimentos e ações realizados pelos serviços. Os perfis organizacionais predominantes apontam a presença de deficiências de estrutura e processo em relação às diretrizes do SUS. O desenvolvimento de instrumentos de autoavaliação permite que as equipes se apropriem, de forma crítica, de seu trabalho, e possam elaborar novos arranjos tecnológicos para melhoria da qualidade.

Characteristics of seminal plasma proteins and their correlation with canine semen analysis

The objectives were to separate canine seminal plasma proteins (with SDS-PAGE) and to determine the correlation between specific proteins and semen characteristics. Three ejaculates from 20 mixed-breed dogs, of unknown fertility, were collected by digital manipulation. Ejaculate volume and color, sperm motility, sperm vigor, percentage of morphologically normal spermatozoa, and membrane integrity (hypoosmotic swelling test and fluorescent staining) were assessed. For each dog, seminal plasma was pooled from all three ejaculates and proteins were separated with SDS-PAGE, using polyacrylamide concentrations of 13% and 22% in the separation gels. After staining, gel images were digitized to estimate molecular weights (MW) and integrated optical density (IOD) of each lane and of individual bands. Total seminal plasma protein concentration was 2.19 +/- 1.56 g/dL (mean +/- SD; range 1.12-5.19 g/dL). A total of 37 protein bands were identified (although no dog had all 37 bands). In the 13% gel, molecular weights ranged from 100.6 to 17.1 kDa, with four bands (49.7, 33.2, 26.4, and 19.5 kDa) present in samples from all dogs. In the 22% gel, molecular weights ranged from 15.6 to 3.6 kDa, with nine bands (15.6, 13.5, 12.7, 11.7, 10.5, 8.7, 7.8, 5.6, and 4.9 kDa) present in samples from all dogs. Combined for both gels, the majority of bands (85%) had molecular weights < 17 kDa, with B20 (15.6 kDa) in high concentrations in samples from all dogs. There were positive correlations (P <= 0.01) between two bands, 134 (67 kDa) and B5 (58.6 kDa), and sperm motility (r = 0.66 and r = 0.46), sperm vigor (r = 0.56 and r = 0.66), percentage of morphologically normal spermatozoa (r = 0.55 and r = 0.59), the hypoosmotic swelling test (r = 0.76 and r 0.68), and fluorescent staining (r = 0.56 and r = 0.59), respectively. In conclusion, 37 proteins were identified in seminal plasma; two were significantly correlated with semen characteristics. (c) 2007 Elsevier B.V. All rights reserved.

Radiography, computed tomography and magnetic resonance imaging at 0.5 Tesla of mechanically inducedosteoarthritis in rabbit knees

In the present experimental study we assessed induced osteoarthritis data in rabbits, compared three diagnostic methods, i.e., radiography (XR), computed tomography (CT) and magnetic resonance imaging (MRI), and correlated the imaging findings with those obtained by macroscopic evaluation. Ten young female rabbits of the Norfolk breed were used. Seven rabbits had the right knee immobilized in extension for a period of 12 weeks (immobilized group), and three others did not have a limb immobilized and were maintained under the same conditions (control group). Alterations observed by XR, CT and MRI after the period of immobilization were osteophytes, osteochondral lesions, increase and decrease of joint space, all of them present both in the immobilized and non-immobilized contralateral limbs. However, a significantly higher score was obtained for the immobilized limbs (XT: P = 0.016, CT: P = 0.031, MRI: P = 0.0156). All imaging methods were able to detect osteoarthritis changes after the 12 weeks of immobilization. Macroscopic evaluation identified increased thickening of joint capsule, proliferative and connective tissue in the femoropatellar joint, and irregularities of articular cartilage, especially in immobilized knees. The differences among XR, CT and MRI were not statistically significant for the immobilized knees. However, MRI using a 0.5 Tesla scanner was statistically different from CT and XR for the non-immobilized contralateral knees. We conclude that the three methods detected osteoarthritis lesions in rabbit knees, but MRI was less sensitive than XR and CT in detecting lesions compatible with initial osteoarthritis. Since none of the techniques revealed all the lesions, it is important to use all methods to establish an accurate diagnosis.

Maxillo-mandibular counter-clockwise rotation and mandibular advancement with TMJ Concepts (R) total joint prostheses Part III - Pain and dysfunction outcomes

47 end-stage TMJ patients with high occlusal plane angulation, treated with TMJ custom-fitted total joint prostheses and simultaneous maxillo-mandibular counter-clockwise rotation were evaluated for pain and dysfunction presurgery (T1) and at the longest follow-up (T2). Patients subjectively rated their facial pain/headache, TMJ pain, jaw function, diet and disability. Objective functional changes were determined by measuring maximum interincisal opening (MIO) and laterotrusive movements. Patients were divided according to the number of previous failed TMJ surgeries: Group 1 (0-1), Group 2 (2 or more). Significant subjective pain and dysfunction improvements (37-52%) were observed (<0.001). MIO increased 14% but lateral excursion decreased 60%. The groups presented similar absolute changes, but Group 2 showed more dysfunction at T1 and T2. For patients who did not receive fat grafts around the prostheses and had previous failure of proplast/teflon and or silastic TMJ implants, more than half required surgery for TMJ debridement and removal of foreign body giant cell reaction and heterotopic bone formation. End-stage TMJ patients can be treated in one operation with TMJ custom-made total joint prostheses and maxillo-mandibular counter-clockwise rotation, for correction of dentofacial deformity and improvement in pain and TMJ dysfunction; Group 1 patients had better results than Group 2 patients.

Prevalence and nonrandom distribution of exonic mutations in interferon regulatory factor 6 in 307 families with Van der Woude syndrome and 37 families with popliteal pterygium syndrome

Purpose: Interferon regulatory factor 6 encodes a member of the IRF family of transcription factors. Mutations in interferon regulatory factor 6 cause Van der Woude and popliteal pterygium syndrome, two related orofacial clefting disorders. Here, we compared and contrasted the frequency and distribution of exonic Mutations in interferon regulatory factor 6 between two large geographically distinct collections of families with Van der Woude and between one collection of families with popliteal pterygium syndrome. Methods: We performed direct sequence analysis of interferon regulatory factor 6 exons oil samples from three collections, two with Van der Woude and one with popliteal pterygium syndrome. Results: We identified mutations in interferon regulatory factor 6 exons in 68% of families in both Van der Woude collections and in 97% of families with popliteal pterygium syndrome. In sum, 106 novel disease-causing variants were found. The distribution of mutations in the interferon regulatory factor 6 exons in each collection was not random; exons 3, 4, 7, and 9 accounted for 80%. In the Van der Woude collections, the mutations were evenly divided between protein truncation and missense, whereas most mutations identified in the popliteal pterygium syndrome collection were missense. Further, the missense mutations associated with popliteal pterygium syndrome were localized significantly to exon 4, at residues that are predicted to bind directly to DNA. Conclusion: The nonrandom distribution of mutations in the interferon regulatory factor 6 exons suggests a two-tier approach for efficient mutation screens for interferon regulatory factor 6. The type and distribution of mutations are consistent with the hypothesis that Van der Woude is caused by haploinsufficiency of interferon regulatory factor 6. Oil the other hand, the distribution of popliteal pterygium syndrome-associated mutations suggests a different, though not mutually exclusive, effect oil interferon regulatory factor 6 function. Genet Med 2009:11(4):241-247.

Size at maturity and egg capsules of the softnose skates Bathyraja brachyurops (Fowler, 1910) and Bathyraja macloviana (Norman, 1937) (Elasmobranchii: Rajidae) in the SW Atlantic (37 degrees 00'-39 degrees 30'S)

P>The softnose skates Bathyraja brachyurops and Bathyraja macloviana represent an important portion of the skate catches of the Uruguayan trawling fleet in the southwestern Atlantic. From March to October 2004, specimens of these species were collected at 75-200 m depth range in the area situated between latitudes 37 degrees 00'-39 degrees 30'S. For B. brachyurops, total length at which 50% of the specimens were retained by the gear was 68.0 cm for both sexes; T(L50) was estimated at 65.4 cm for males and 67.0 cm for females. For B. macloviana, total length at which 50% of the specimens were retained was 56.0-57.0 cm for both sexes; T(L50) was estimated at 53.5 cm for males and 52.0 cm for females. Egg capsule length varied from 79-91 mm in B. brachyurops and 69-75.5 mm in B. macloviana. In both species, capsules displayed striated surfaces and similar gross morphology, although egg capsules of B. macloviana had more robust anterior horns and a smaller size than those of B. brachyurops. Egg capsules of the latter also exhibited microscopical prickles. Capsule edges were laterally keeled with a groove along the keel, and a straight and transverse velum was present in the egg capsules of both species.

Production of thermostable glucoamylase by newly isolated Aspergillus flavus A 1.1 and Thermomyces lanuginosus A 13.37

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

The Effectiveness of Low-Intensity Red Laser for Activating a Bleaching Gel and Its Effect in Temperature of the Bleaching Gel and the Dental Pulp

Statement of the Problem: The effectiveness of low-intensity red laser for activating a bleaching gel and its effect in pulp temperature was not investigated in dental literature. Purpose: The objective of this study was to assess the effectiveness of low-intensity red laser for activating a bleaching gel, as well as its effect in temperature of the bleaching gel and the dental pulp. Materials and Methods: Forty extracted bovine teeth were immersed in a solution of coffee 14 days for darkening. The initial colors were recorded by spectrophotometric analysis. The specimens were randomly distributed into two groups (N = 20): the control, which did not receive light and the experimental group that received light from an appliance fitted with three red light-emitting laser diodes (? = 660 nm). A green-colored, 35% H2O2based bleaching gel was applied for 30 minutes, and changed three times. After bleaching, the colors were again measured to obtain the L*a*b* values. Color variation was calculated (?E) and the data submitted to the non-paired t-test (5%). To assess temperature, 10 human incisors were prepared, in which one thermocouple was placed on the bleaching gel applied on the surface of the teeth and another inside the pulp chamber. Results: There was a significant difference between the groups (p = 0.016), and the experimental group presented a significantly higher mean variation (7.21 +/- 2.76) in comparison with the control group (5.37 +/- 1.76). There was an increase in pulp temperature, but it was not sufficient to cause damage to the pulp. Conclusion: Bleaching gel activation with low-intensity red laser was capable of increasing the effectiveness of bleaching treatment and did not increase pulp temperature to levels deleterious to the pulp. CLINICAL SIGNIFICANCE The application of a low-intensity red laser was effective for activating a bleaching gel with green dye, without any deleterious increases in pulpal temperature. (J Esthet Restor Dent 24:126134, 2012)

Kinetic parameters of polymer degradation by SAPO-37

High density poly(ethylene) has been submitted to thermal degradation alone, and in the presence of silicoaluminophosphate SAPO-37. The processes were carried out in a reactor connected on line to a gas chromatograph/mass spectrometer in order to analyze the evolved products. Polymer degradation was also evaluated by thermogravimetry, from room temperature until 800 degreesC, under nitrogen dynamic atmosphere, with multiple heating rates. From TG curves, the activation energy related to degradation process was calculated using the Flynn and Wall multiple heating rate kinetic model for pure polymer (PE) and for polymer in the presence of catalyst (PE/S37). SAPO-37 showed good selectivity for low molecular mass hydrocarbons in PE catalytic degradation.