Fatores litogênicos em pacientes com litíase urinária de Fortaleza, Ceará

Lithiasis is considered a public health issue due to its high prevalence and rates of recurrence. Objective: To identify risk factors for lithiasis in kidney stone patients from Fortaleza, Brazil. In the first stage of the study, the medical records of 197 patients with urinary lithiasis covering the period 1996 2006 were analyzed with regard to clinical and metabolic data. In the second stage, 340 kidney stones were submitted to morphological examination under 10x magnification. According to the external morphology and the cut surface, the stones were classified as pure or mixed, and major and minor components were identified. In addition, the stone fragments of 25 patients treated with lithotripsy were submitted to morphological analysis. In the third stage, a subsample of 50 stones was used in a double-blind comparison of morphological and chemical findings. Results were expressed as concordant, partly concordant (discordant for minor components) or discordant (discordant for major components). The average age of first symptoms was 35.8±13.3 years, with no significant difference between the genders. The male/female ratio was 1:1.7. Recurrence was reported in 53.3% of cases. The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), low urine volume (43.7%), hyperoxaluria (30.5%) and hyperuricosuria (17.3%). Pure stones represented 34.7% of the total sample of 340 stones. The most common route of elimination was spontaneous for pure stones (49.1%) and surgical for mixed stones (50.5%). Pure stones consisted most frequently of calcium oxalate (OxCa) (59.3%) and uric acid (UA) (23.7%), the former prevalent in women, the latter prevalent in men. The most frequently observed component in mixed stones was OxCa (67.1%), followed by carbapatite (11.2%) and struvite (7.9%). The main components were OxCa and UA for men, and carbapatite and struvite for women. Nearly half (48%) the 25 analyzed fragments were pure, consisting of calcium oxalate dihydrate (COD) (56%), calcium oxalate monohydrate (COM) (48%), phosphate (32%) and UA (20%). Four patients (16%) had infectious stones. In the chemical analysis of the subsample of 50 stones, the most 64 frequently observed major components were calcium (70%), oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the main components were calcium and magnesium phosphate (32%), COM (24%), UA (20%), COD (18%) and cystine (6%). Morphological and chemical findings were totally concordant for 38% of the stones, partly concordant in 52% and discordant in 10%. Conclusion: The risk factors for lithiasis in kidney stone patients from Fortaleza (Brazil) were hyperoxaluria, hypercalciuria with or without hypernatriuria, hyperuricosuria and low urine volume

Suplementação oral de zinco pode diminuir o perfil sérico de ferro em crianças saudáveis

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Ensaio clínico randomizado sobre a prática da atenção farmacêutica nas farmácias comunitárias

Introdução: A criação de programas de equipe multiprofissional de saúde desponta como uma alternativa eficiente para controlar a evolução dos pacientes portadores de diabetes, e a inserção do farmacêutico em tais programas tem contribuído para melhorar o acompanhamento desses pacientes. Objetivo: Avaliar o impacto da intervenção do farmacêutico no acompanhamento dos pacientes diabéticos tipo 2, em farmácias comunitárias. Métodos: Ensaio clínico randomizado, uni-cego envolvendo 100 pacientes diabéticos tipo 2 de ambos os gêneros, usuários de farmácia comunitária, com idade igual ou superior a 30 anos, em uso de hipoglicemiantes orais com adição ou não de insulina e foram acompanhados por 6 meses. Os pacientes do grupo controle receberam o tratamento habitual existente em qualquer farmácia, e os de intervenção receberam o acompanhamento do farmacêutico incluindo intervenções aos problemas relacionados aos medicamentos. Os desfechos primários avaliados foram os valores da hemoglobina glicada (HbA1c), glicose basal e um questionário de qualidade de vida validado denominado de Diabetes Quality of Life Measure (DQOL) - Brasil; e como desfechos secundários as dosagens dos triglicérides, colesterol total, (HDL) colesterol, (LDL) colesterol, tensão arterial e a satisfação do usuário com o serviço prestado. Essa pesquisa contou com a colaboração de vários profissionais das diferentes áreas do conhecimento a seguir nominados: médico, farmacêutico bioquímico, enfermeiro, nutricionista e estatístico. Resultados: Finalizaram o estudo 89 pacientes. Durante o acompanhamento 95,7% (45/47) dos pacientes no grupo intervenção apresentaram problemas relacionados aos medicamentos (PRM), perfazendo um total de 141, com uma média de 3 eventos por paciente, ocorrendo uma resolutividade de 61,7% (87/141). A categoria que mais apresentou PRM foi a de efetividade com 34,1% (48/141) e a classe farmacológica mais utilizada foi a dos hipoglicemiantes orais com 35% (49/141). As variáveis de desfechos primários como hemoglobina glicada (HbA1c) e a glicose basal não apresentaram valores estatisticamente significantes quando comparadas o final com o inicial do acompanhamento nos grupos intervenção e controle considerando um p<0,05, mas o questionário de qualidade de vida DQOL Brasil apresentou resultados estatisticamente significante com um p=0,000. Os desfechos secundários, com exceção da satisfação do usuário, não apresentaram valores xi estatisticamente significantes quando comparados o final com o início do acompanhamento nos grupos de intervenção e controle. Conclusão: Os resultados indicam que as modificações das variáveis clínicas não apresentaram valores significativos no controle da enfermidade e comorbidades, enquanto que na avaliação da qualidade de vida os pacientes afirmaram que melhoraram; portanto, pode-se postular que a intervenção farmacêutica é uma atividade necessária, mas que a prática do Pharmaceutical Care trará benefícios com sustentabilidade para os pacientes se houver uma efetiva integração do farmacêutico numa equipe multiprofissional de saúde, o que está indisponível nas Farmácias Comunitárias

Ação da cafeína sobre o rendimento esportivo de ciclistas em condições de calor e umidade

Objetivo: Verificar a ação da cafeína no tempo de rendimento, a taxa de esforço percebido (RPE), os níveis plasmáticos de glicose, sódio e potássio, a temperatura timpânica (Tt), o peso corporal (PC), freqüência cardíaca (FC) e concentração urinária da cafeína com a ingestão de doses de 5 e 9 mg/kg de cafeína e placebo, em provas ciclísticas sob condições de alto risco térmico. Métodos: Foram estudados 8 ciclistas treinados e aclimatizados em 3 provas de 45 km utilizando o modelo experimental e duplo-cego com randomização intra-sujeitos. Resultados: Não foram observadas diferenças significativas entre as variáveis avaliadas, entretanto o tempo de rendimento e a RPE foram menores com as doses de 5 e 9 mg/kg de cafeína que com a dose placebo. Conclusões: Estes dados indicam que as condições de calor e umidade podem ser suficientes para mascarar o benefício ergogênico da cafeína, entretanto deve-se considerar que a cafeína pode exercer influencia sobre a percepção subjetiva de esforço podendo levar à redução dos sinais de fadiga durante o exercício e conseqüente melhora do desempenho esportivo

Análise do vetor de impedância bioelétrico na avaliação da suplementação de zinco em crianças prepuberais e sadias

Conselho Nacional de Desenvolvimento Científico e Tecnológico

A influência do método pilates sobre a qualidade de vida em mulheres climatéricas

Objetivo: Avaliar a influência do método Pilates sobre a qualidade de vida em mulheres climatéricas atendidas pelo Sistema Único de Saúde. Métodos: Trata-se de um estudo prospectivo do tipo ensaio clínico randomizado, cego para avaliador, com amostra por conveniência, composta por 51 mulheres divididas em grupo controle (n=25) e experimental / Pilates (n=26), ao longo de 12 semanas. Os instrumentos usados para coleta foram: o Medical Outcome Study 36-item Short Form Health Survey (MOS SF-36 Health Survey) versão brasileira e o índice menopausal de Blatt e Kupperman. Os dados foram tratados com estatística descritiva e inferencial (teste t para amostra pareada e de Wilcoxon), com p≤0,05. Resultados: Observou-se que a amostra estudada apresentava idade média de 53,7±4,07 e 53,9±5,52 anos, IMC médio de 25,2Kg/m2±3,71 e 26,06 Kg/m2±2,56, no grupo controle e experimental, respectivamente. A maioria era casada, sem trabalho formal e com pelo menos o 2º grau completo. O grupo submetido ao método Pilates apresentou efeitos positivos sobre a diminuição dos sintomas climatéricos (19,6 para 12,2) com p= 0,001 (GE) e p=0,062 (GC), bem como apresentou significância estatística para comparação no parâmetro de capacidade funcional (p=0,001), limitação por aspectos físicos (p=0,05), dor (p=0,001), estado geral de saúde (p=0,001), vitalidade (p=0,001), aspectos sociais (p=0,027) e saúde mental (p=0,001) em mulheres na meia idade. Conclusões: Os resultados do estudo mostraram que 12 semanas de intervenção com o método Pilates apresentaram efeitos positivos sobre a diminuição dos sintomas climatéricos, bem como melhora nos domínios de qualidade de vida nestas mulheres, possibilitando efetivas propostas de intervenção profissional às especificidades deste público, com foco na promoção de saúde através de ações interdisciplinares

Avaliação da eficácia de um programa de "Escola de Coluna" para lombalgia crônica inespecífica

The Back School has been used to prevent and to treat back pain since 1969, however its effectiveness still is controversy in literature. The objective of this study was to evaluate the effectiveness of a program of "Back School" in patients with nonspecific chronic low back pain, directed by rheumatologists and orthopedic doctors to Physiotherapy School Clinic of Universidade Potiguar (UnP) Natal/RN- Brazil, in period of May/2002 to December/2003. Seventy patients, with age varying from 18 to 60 years, were randomized in two groups: Experimental group (group A) with 34 patients, which was subdivided in groups with 6 to 8 components. This group participated of a theoretician and practical program of Back School with 4 lessons, one day per week, with 60 minutes of duration; to the Control group (group B), with 36 patients, was explained that the group should stay four months in a waiting list . Both groups, had been carried through three evaluations, by a blind, to patient group, independent observer: initial evaluation, after four and sixteen weeks. The following variables were analyzed: pain intensity, measured by analog visual scale (AVS), functional disability, measured by disability questionnaire of Roland and Morris and the spinal mobility measured by Schöber s method. In statistical analysis it was used variance analysis ANOVA, the test of Newman-Keuls multiple comparations, and the Pearson correlation coefficient, with significance level p<0.05. Thirteen patients (18,6%) didn t complete the evaluations, (5 from experimental group and 8 from control group). At last, 57 patients were studied, (29 from Experimental group and 28 from Control group), it was observed a significant statistical improve just for Experimental group in variables pain intensity (p=0,0001), functional disability

Influência do tratamento com ácido lipoico sobre o metabolismo ósseo e perfil antioxidante de mulheres na perimenopausa

Bone is a dynamic tissue that is in constant process of remodeling in response to mechanical stress and hormonal changes. This study aimed to understand the relationship between the biochemical changes, which women in the menopausal transition are subject to, and how the use of an alternative therapy with lipoic acid (LA) could influence these changes. The study of double-blind, was carried out in perimenopausal women that underwent a three month treatment with 600 mg of AL compared with another group that received placebo during the same period. This study showed that women had a waist circunference and body mass index above the values recommended by WHO (WC ≥ 80 cm; BMI > 25kg/m2). Associated with this, these women had increased concentrations of total cholesterol and triglycerides, and borderline LDL (Total Cholesterol > 200mg/dL; Triglycerides > 150mg/dL; LDL >130mg/dL). These changes were not affected by treatment with AL. There were no shifts in liver profile (ALT, AST and GGT), kidney profile (urea, creatinine, total protein and albumin), mineral profile (Total Calcium, Ionized Calcium, Phosphorus and Magnesium) as well in bone markers (osteocalcin, Total Alkaline Phosphatase and Tartrate Resistant Acid Phosphatase) after treatment with LA. The results of the oxidative profile showed that treatment with LA decreased GPx activity (p < 0,01), while for the TBARS, GSH and SOD activity there were no differences. With regard to SOD, this enzyme will submit to be high in the placebo group after 3 months of study (p<0,05). The expression of RANKL mRNA was reduced (p < 0,05) and of RANK increased (p <0.001), after treatment with LA, while the expression of IL-6 and TNF-ɑ genes were no changed. We conclude that women already in the perimenopause stage have changes in lipid profile and body composition that could induce shifts in oxidative and bone metabolism. However, LA treatment has provided an effective effect in the oxidative and bone profile since the earliest markers such as GPx activity and mRNA expression of RANKL, respectively, were reduced associated with no change in SOD activity. These results suggest a beneficial and protective effect of LA, indicating it potential as an alternative treatment to help the to prevent the complications associated with estrogen deficiency

Efeito do ácido alfa-lipóico sobre biomarcadores de estresse oxidativo, inflamação e fatores de risco cardiovascular em hipertensos

Alpha-lipoic acid (ALA) is a potent antioxidant with favourable anti-inflammatory, metabolic and endothelial effects, and has been widely investigated due to its potential against cardiovascular risk factors. This study aimed to evaluate the effect of oral ALA supplementation on oxidative stress biomarkers, inflammation and cardiovascular risk factors in patients with hypertension. This is a double-blind placebo-controlled randomized clinical trial, where the intervention was evaluated prospectively comparing results in both groups. The sample consisted of 64 hypertensive patients who were randomly distributed into ALA group (n = 32), receiving 600 mg / day ALA for twelve weeks and control group (n = 32), receiving placebo for the same period. The following parameters were evaluated before and after intervention: lipid peroxidation, content of reduced glutathione (GSH), enzymatic activities of glutathione peroxidase (GPx) and superoxide dismustase, ultrasensitive C-reactive protein (hs-CRP), triglycerides, total cholesterol and fractions, fasting glucose and anthropometric indicators. There was a statistically significant reduction (p <0.05) in serum concentrations of total cholesterol, very low density lipoprotein (VLDL), high density lipoprotein (HDL), triglycerides and blood glucose. There was a reduction in body weight and waist, abdominal and hip circumferences in the group that received ALA. In addition, there was a statistically significant increase (p <0.05) in the contents of reduced glutathione (GSH) and glutathione peroxidase (GPx) in the group receiving ALA. Oral administration of ALA appears to be a valuable adjuvant therapy, which may contribute to decrease the damage caused by oxidative stress and other risk factors associated with the atherosclerotic process

A influência da estimulação transcrâniana por corrente contínua nos parâmetros de dano muscular induzido pelo exercício

A estimulação transcraniana por corrente contínua (ETCC) é uma técnica não invasiva que apresenta características anti-fadigante e analgésica. Com o objetivo de testar seus efeitos sobre a diminuição da força e do aparecimento da dor muscular de início tardio (DMIT), apresentados após um evento de dano muscular induzido pelo exercício (DMIE), foi utilizado um estudo clínico de caráter experimental, controlado, randomizado e duplo-cego. A amostra foi composta por 24 jovens do sexo masculino, aparentemente saudáveis (19,7±1,8 anos; 23,6±3,65 IMC), os quais foram alocada, de forma aleatória e estratificada, nos seguintes grupos: G1: grupo controle; G2: grupo de estimulação após o dano e G3: grupo com estimulação antes e após o dano muscular. Os dados foram submetidos à estatística descritiva e análise de variância ANOVA, adotando-se um nível de significância de 5%. O aumento nos níveis séricos de CK (56.18%) e LDH (24,15%) comprovou a ocorrência do DMIE. Em contrapartida, após a análise de variância para comparação dos tratamentos aplicados, pode-se observar que não houve diferenças significativas nos níveis de CK (p= 0,3514) e força muscular (p= 0,9702). A DMIT transcorreu como esperado, mas sem diferença significativa entre os grupos (p= 0,4861). Estes dados demonstraram que a ETCC não foi capaz de modular a DMIT e a diminuição da força muscular após o DMIE em jovens aparentemente saudáveis

Efeitos da laserterapia de baixa potência sobre a fadiga do músculo quadríceps de indivíduos jovens

The objective of this study was to evaluate the effect of low laser power on the performance of anaerobic endurance of the quadriceps muscle in young subjects. Low-level laser therapy (LLLT) appears to decrease some indices of muscle fatigue. Most of these effects may be due to the influence of the laser on the muscles predominantly aerobic. Animal studies and clinical trials have already shown that the laser can improve the efficiency of mitochondrial metabolism for the resynthesis of adenosine triphosphate and thus slow down - or minimize, the deleterious effects of muscle fatigue. This research was characterized as an experimental study of the controlled clinical trial, randomized, blinded, attended by 93 volunteers, military, with ages between 18 and 19 years. The subjects were randomly allocated into three groups: Control (G1), Placebo (G2) and Laser (G3). All volunteers underwent an anthropometric assessment and a protocol Fatigue. This protocol was applied to an initial assessment (AV-1) for the collection of baseline data, and a final evaluation (AV-2). As the study variables, we used the blood lactate concentrations and indices of muscle power, as average power and peak velocity. The fatigue protocol consisted of a test of speed with twenty repetitions, performed on an exercise machine leg press 45º . In conclusion, it was found that, in this study, LLLT caused a significant increase in the Average of the Averages Powers, phase eccentric exercise in leg press 45º performed by young individuals

Efeitos agudos da aplicação do laser de baixa potência sobre o desempenho neuromuscular do sóleo em sujeitos saudáveis

A laserterapia de baixa potência (LBP) tem demonstrado recentemente ser capaz de aumentar a resistência à fadiga, bem como potencializar o desempenho neuromuscular através de seus efeitos metabólicos e fotoquímicos. Estudos anteriores mostraram que o LBP reduziu o estresse oxidativo do exercício, promovendo um retardo da fadiga muscular e minimizando seus efeitos deletérios. O objetivo desse estudo foi avaliar se a aplicação do LBP antes de um protocolo de fadiga teria efeito sobre o desempenho neuromuscular nas variáveis eletromiográficas e dinamométricas do músculo sóleo em sujeitos saudáveis. Esta pesquisa caracterizou-se como um estudo experimental do tipo ensaio clínico controlado, randomizado e cego, no qual participaram 60 voluntários de ambos os sexos, com faixa etária entre 18 e 28 anos e fisicamente ativos, segundo o questionário internacional para a prática de atividade física (IPAQ). Os sujeitos foram alocados randomicamente em três grupos: Controle (G1), Placebo (G2) e Laser (G3) e todos os voluntários foram submetidos a uma avaliação inicial (AV-1), um Protocolo de Fadiga e uma avaliação final (AV-2), compostas por contrações isocinéticas para flexão plantar a uma velocidade de 90°/s. Os resultados encontrados nesse estudo mostraram que não houve diferença estatística entre os três grupos da pesquisa nas variáveis eletromiográficas de RMS e Frequência Mediana, contudo, em relação à dinamometria, o grupo que recebeu a aplicação do Laser obteve um índice de fadiga significativamente menor (p=0,04) quando comparado aos grupos Controle e Placebo. Além disso, a aplicação do laser pré-exercício também resultou em um aumento nas variáveis de desempenho potência e trabalho. Com isso, pode-se concluir que o LBP foi capaz de melhorar o desempenho do sóleo em sujeitos saudáveis, justificado pelo aumento da resistência à fadiga

Estudo do efeito de dipolos em arranjos de antenas adaptativas de sistemas de comunicação DS-CDMA

This master dissertation introduces a study about some aspects that determine the aplication of adaptative arrays in DS-CDMA cellular systems. Some basics concepts and your evolution in the time about celular systems was detailed here, meanly the CDMA tecnique, specialy about spread-codes and funtionaly principies. Since this, the mobile radio enviroment, with your own caracteristcs, and the basics concepts about adaptive arrays, as powerfull spacial filter was aborded. Some adaptative algorithms was introduced too, these are integrants of the signals processing, and are answerable for weights update that influency directly in the radiation pattern of array. This study is based in a numerical analysis of adaptative array system behaviors related to the used antenna and array geometry types. All the simulations was done by Mathematica 4.0 software. The results for weights convergency, square mean error, gain, array pattern and supression capacity based the analisis made here, using RLS (supervisioned) and LSDRMTA (blind) algorithms

Estudo do efeito de dipolos em arranjos de antenas adaptativas de sistemas de comunicação DS-CDMA

This master dissertation introduces a study about some aspects that determine the aplication of adaptative arrays in DS-CDMA cellular systems. Some basics concepts and your evolution in the time about celular systems was detailed here, meanly the CDMA tecnique, specialy about spread-codes and funtionaly principies. Since this, the mobile radio enviroment, with your own caracteristcs, and the basics concepts about adaptive arrays, as powerfull spacial filter was aborded. Some adaptative algorithms was introduced too, these are integrants of the signals processing, and are answerable for weights update that influency directly in the radiation pattern of array. This study is based in a numerical analysis of adaptative array system behaviors related to the used antenna and array geometry types. All the simulations was done by Mathematica 4.0 software. The results for weights convergency, square mean error, gain, array pattern and supression capacity based the analisis made here, using RLS (supervisioned) and LSDRMTA (blind) algorithms.

Laminados compósitos de PRFV: efeitos da descontinuidade geométrica e do envelhecimento ambiental acelerado

The growing demand in the use of composite materials necessitates a better understanding of its behavior related to many conditions of loading and service, as well as under several ways of connections involved in mechanisms of structural projects. Within these project conditions are highlighted the presence of geometrical discontinuities in the area of cross and longitudinal sections of structural elements and environmental conditions of work like UV radiation, moisture, heat, leading to a decrease in final mechanical response of the material. In this sense, this thesis aims to develop studies detailed (experimental and semi-empirical models) the effects caused by the presence of geometric discontinuity, more specifically, a central hole in the longitudinal section (with reduced cross section) and the influence of accelerated environmental aging on the mechanical properties and fracture mechanism of FGRP composite laminates under the action of uniaxial tensile loads. Studies on morphological behavior and structural degradation of composite laminates are performed by macroscopic and microscopic analysis of affected surfaces, in addition to evaluation by the Measurement technique for mass variation (TMVM). The accelerated environmental aging conditions are simulated by aging chamber. To study the simultaneous influence of aging/geometric discontinuity in the mechanical properties of composite laminates, a semiempirical model is proposed and called IE/FCPM Model. For the stress concentration due to the central hole, an analisys by failures criteria were performed by Average-Stress Criterion (ASC) and Point-Stress Criterion (PSC). Two polymeric composite laminates, manufactured industrially were studied: the first is only reinforced by short mats of fiberglass-E (LM) and the second where the reinforced by glass fiber/E comes in the form of bidirectional fabric (LT). In the conception configurations of laminates the anisotropy is crucial to the final mechanical response of the same. Finally, a comparative study of all parameters was performed for a better understanding of the results. How conclusive study, the characteristics of the final fracture of the laminate under all conditions that they were subjected, were analyzed. These analyzes were made at the macroscopic level (scanner) microscope (optical and scanning electron). At the end of the analyzes, it was observed that the degradation process occurs similarly for each composite researched, however, the LM composite compared to composite LT (configurations LT 0/90º and LT ±45º) proved to be more susceptible to loss of mechanical properties in both regarding with the central hole as well to accelerated environmental aging