Derivation and external validation of a simple prediction model for the diagnosis of type 2 Diabetes Mellitus in the Brazilian urban population

A risk score model was developed based in a population of 1,224 individuals from the general population without known diabetes aging 35 years or more from an urban Brazilian population sample in order to select individuals who should be screened in subsequent testing and improve the efficacy of public health assurance. External validation was performed in a second, independent, population from a different city ascertained through a similar epidemiological protocol. The risk score was developed by multiple logistic regression and model performance and cutoff values were derived from a receiver operating characteristic curve. Model`s capacity of predicting fasting blood glucose levels was tested analyzing data from a 5-year follow-up protocol conducted in the general population. Items independently and significantly associated with diabetes were age, BMI and known hypertension. Sensitivity, specificity and proportion of further testing necessary for the best cutoff value were 75.9, 66.9 and 37.2%, respectively. External validation confirmed the model`s adequacy (AUC equal to 0.72). Finally, model score was also capable of predicting fasting blood glucose progression in non-diabetic individuals in a 5-year follow-up period. In conclusion, this simple diabetes risk score was able to identify individuals with an increased likelihood of having diabetes and it can be used to stratify subpopulations in which performing of subsequent tests is necessary and probably cost-effective.

Conceções de amor desenhadas por crianças de 1.º e 2.º Ciclos de Ensino Básico: Análise de discurso

Tendo como intervenientes estudantes de ensino superior, realizou-se um estudo de carácter qualitativo (Amado & Ferreira, 2013), mais especificamente um estudo de caso (Yin, 2005), cujos objetivos foram definidos de acordo com orientações internacionais para a educação para a sexualidade (WHO, 2010a; UNESCO, 2009), nomeadamente: (1) perceber relacionamentos privilegiados; e (2) identificar conceções de futuros partilhados. Para a recolha de dados solicitou-se às crianças que representassem pares por meio de desenho e que dialogassem sobre a interação e o amor. A amostra foi constituída por 55 crianças com idades compreendidas entre os 5-12 anos, sendo 33 do género feminino e 22 do género masculino. Os dados recolhidos foram tratados com vista à análise de conteúdo e análise de discurso. Entre outros resultados, clarificou-se que os pares desenhados eram em menor número de membros da “família” (7 raparigas e 7 rapazes), nomeadamente, “casados”, “pai e filho”, “primo/as”, “avós” ou “sobrinha-tia”. Noutra categoria enquadraram-se as relações “não familiares” (23 raparigas e 13 rapazes), de “amizade”, “amor” e “paixão”, definidos os pares de “namorados”, exprimindo “carinho” ou estando “apaixonados”. Como conclusões verificaram-se os desejados finais felizes e foram debatidos os significados do amor, tendo as raparigas afirmado que o amor é “muito bom”, podendo ter como sentido “carinho”, “amizade”, “lealdade” ou “paixão”. Assim, quando uma pessoa gosta de outra, o amor “une-as”, é uma “coisa natural”, para duas meninas, mas vive-se o amor, segundo outra, «quando se anda juntos, dando passeios». Pode o amor ser para rapazes «tipo amigos a dar beijinhos na boca», mas são elas a desenhar o beijar. Um outro rapaz também valorizou o ser «mais do que amigo». Por acréscimo, depois dos 12 anos, foi aludido o “saber amar” quando se é “amigo”.

Associação entre otites bacterianas e infecção pelo circovírus suíno tipo 2 (PCV2) em suínos

Neste trabalho, foi estudada a ocorrência e a bacteriologia das otites purulentas em suínos apresentando três condições clínico-patológicas distintas: síndrome multissistêmica do definhamento dos suínos (SMDS), crescimento retardado (porém sem apresentação de sinais clínicos da SMDS) e crescimento normal. No total, foram examinados 385 animais com idade de 60-130 dias, sendo a confirmação do diagnóstico da SMDS obtida pelos sinais clínicos e achados patológicos e pela detecção de antígenos virais por imunoistoquímica. De 242 animais com a SMDS, 57 (23,5%) apresentaram lesões purulentas no ouvido médio. Entre os 119 animais de baixo desenvolvimento, apenas 1 (0,7%) apresentou a lesão. Não foram detectadas lesões macroscópicas no ouvido médio dos 24 animais com crescimento normal. Os agentes isolados com maior freqüência foram Arcanobacterium pyogenes (43%), Streptococcus α-hemolíticos (37,2%) e Pasteurella multocida (27,9%) dos 86 ouvidos submetidos à bacteriologia. A alta ocorrência de lesões purulentas no ouvido médio de animais com a SMDS sugere que a infecção pelo PCV2 pode tornar o suíno mais suscetível às otites bacterianas. A ocorrência reduzida dessas lesões em suínos de baixo desenvolvimento, sem a manifestação clínica da SMDS, sugere que a otite média não representa uma causa importante de mau desempenho em leitões nas fases de crescimento e terminação. O envolvimento de A. pyogenes, Streptococcus α-hemolíticos e P. multocida na maioria das lesões apontam a importância desses organismos como agentes causais de otite média em suínos.

Effect of metabolic syndrome and of its individual components on renal function of patients with type 2 diabetes mellitus

The objective of this study was to evaluate the effect of metabolic syndrome (MetS) and its individual components on the renal function of patients with type 2 diabetes mellitus (DM). A cross-sectional study was performed in 842 type 2 DM patients. A clinical and laboratory evaluation, including estimated glomerular filtration rate (eGFR) calculated by the modification of diet in renal disease formula, was performed. MetS was defined according to National Cholesterol Education Program - Adult Treatment Panel III criteria. Mean patient age was 57.9 ± 10.1 years and 313 (37.2%) patients were males. MetS was detected in 662 (78.6%) patients. A progressive reduction in eGFR was observed as the number of individual MetS components increased (one: 98.2 ± 30.8; two: 92.9 ± 28.1; three: 84.0 ± 25.1; four: 83.8 ± 28.5, and five: 79.0 ± 23.0; P < 0.001). MetS increased the risk for low eGFR (<60 mL·min-1·1.73 (m²)-1) 2.82-fold (95%CI = 1.55-5.12, P < 0.001). Hypertension (OR = 2.2, 95%CI = 1.39-3.49, P = 0.001) and hypertriglyceridemia (OR = 1.62, 95%CI = 1.19-2.20, P = 0.002) were the individual components with the strongest associations with low eGFR. In conclusion, there is an association between MetS and the reduction of eGFR in patients with type 2 DM, with hypertension and hypertriglyceridemia being the most important contributors in this sample. Interventional studies should be conducted to determine if treatment of MetS can prevent renal failure in type 2 DM patients.

Pièces intéressantes et peu connues, pour servir à l'histoire et à la littérature. Tome 2 / . Par M. D. L. P. Tome premier [-septième]

Comprend : Pensées de Montesquieu adressées à son fils, tirées d'un manuscrit que l'on dit être original ; Madrigal et épigramme sur la Troade de Pradon

Incidence of and risk factors for severe hypoglycaemia in treated type 2 diabetes mellitus patients in the UK - a nested case-control analysis

AIMS To assess incidence rates (IRs) of and identify risk factors for incident severe hypoglycaemia in patients with type 2 diabetes newly treated with antidiabetic drugs. METHODS Using the UK-based General Practice Research Database, we performed a retrospective cohort study between 1994 and 2011 and a nested case-control analysis. Ten controls from the population at risk were matched to each case with a recorded severe hypoglycaemia during follow-up on general practice, years of history in the database and calendar time. Using multivariate conditional logistic regression analyses, we adjusted for potential confounders. RESULTS Of 130,761 patients with newly treated type 2 diabetes (mean age 61.7 ± 13.0 years), 690 (0.5%) had an incident episode of severe hypoglycaemia recorded [estimated IR 11.97 (95% confidence interval, CI, 11.11-12.90) per 10,000 person-years (PYs)]. The IR was markedly higher in insulin users [49.64 (95% CI, 44.08-55.89) per 10,000 PYs] than in patients not using insulin [8.03 (95% CI, 7.30-8.84) per 10,000 PYs]. Based on results of the nested case-control analysis increasing age [≥ 75 vs. 20-59 years; adjusted odds ratio (OR), 2.27; 95% CI, 1.65-3.12], cognitive impairment/dementia (adjusted OR, 2.00; 95% CI, 1.37-2.91), renal failure (adjusted OR, 1.34; 95% CI, 1.04-1.71), current use of sulphonylureas (adjusted OR, 4.45; 95% CI, 3.53-5.60) and current insulin use (adjusted OR, 11.83; 95% CI, 9.00-15.54) were all associated with an increased risk of severe hypoglycaemia. CONCLUSIONS Severe hypoglycaemia was recorded in 12 cases per 10,000 PYs. Risk factors for severe hypoglycaemia included increasing age, renal failure, cognitive impairment/dementia, and current use of insulin or sulphonylureas.

Organic matter preservation in turbidites on the Madeira Abyssal Plain

Oxidized intervals of five organic-rich Madeira Abyssal Plain (MAP) turbidites deposited during the Miocene, Pliocene, and Pleistocene all displayed comparable major loss of total organic carbon (TOC) (84 ± 3.1%) accompanied by a negative isotopic (d13C) shift ranging from -0.3 to -2.9 per mil. Major but significantly lower loss of total nitrogen (Ntot, 61 ± 7.1%) also occurred, leading to a decrease in TOC relative to Ntot (C/Ntot) and a +1.3 to 2.7 per mil Ntot isotopic (d15N) shift. Compound specific isotopic measurements on plant wax n-alkanes indicate the terrestrial organic component in the unoxidized deposits is 13C-enriched owing to significant C4 contribution. Selective preservation of terrestrial relative to marine organic carbon could account for the d13C behavior of TOC upon oxidation but only if a 13C-depleted component of the bulk terrestrial signal is selectively preserved in the process. Although the C/Ntot decrease and positive d15N shift seems inconsistent with selective terrestrial organic preservation, results from analysis of a Modern eolian dust sample collected in the vicinity indicate these observations are compatible. Regardless of the specific explanation for these isotopic observations, however, our findings provide evidence that paleoreconstruction of properties such as pCO2 using the d13C of TOC is a goal fraught with uncertainty whether or not the marine sedimentary record considered is 'contaminated' with significant terrestrial input. Nonetheless, despite major and selective loss of both marine and terrestrial components as a consequence of postdepositional oxidation, intensive organic geochemical proxies such as the alkenone unsaturation index, UK'37, appear resistant to change and thereby retain their paleoceanographic promise.

Sea surface temperature reconstruction for sediment core KNO5103-0029GGC

We present a 15 kyr sea surface temperature (SST) record for a high sedimentation rate core (KNR51-29GGC) from the Feni Drift off of Ireland, based on an organic geochemical technique for paleotemperature estimation, U37 K'. We compare the U37 K' temperature record to planktonic foraminiferal delta18O and foraminiferal assemblage SST estimates from the same sample horizons. U37 K' gives SST estimates of 13°C for the early deglacial and 18°C for the Holocene and Recent, whereas assemblages give estimates of 9°C and 13°C, respectively. As in nearby core V23-81, we find Ash Zone 1, the Younger Dryas increase in Neogloboquadrina pachyderma sinistral abundance, and maximum abundance of this species during glaciation. N. pachyderma dextral oxygen isotopic analyses have a late glacial to interglacial range of 1.5 per mil. A reduction of about 1 per mil in delta18O occurred at about 12 ka, whereas U37 K' and the foraminiferal fauna indicate a 2°C warming. This implies a 0.9 per mil salinity effect on delta18O which we attribute to meltwater freshening. All three parameters indicate cooling during the Younger Dryas. U37 K' SST estimates show that the major shift from deglacial to interglacial temperatures occurred after the Younger Dryas in termination 1b, in contrast to the assemblage data, which show this jump in SST at the end of the glaciation during termination Ia. Differences between the two SST estimators, which may result from their different (floral versus faunal) sources, are more pronounced between transitions Ia and Ib. This may reflect different habitats under the unusual sea surface conditions of the deglaciation.