Úlceras en Extremidades Inferiores de Etiología Vascular y Pie Diabético

En el siguiente trabajo se proporcionará una clasificación detallada de las úlceras vasculares y pie diabético, así como de su fisiopatología y epidemiología, posibles complicaciones, métodos diagnósticos, pautas de prevención y tratamiento, y por último, se añade un apartado, con la finalidad de conseguir la comprensión por parte del lector de la repercusión de las úlceras en la calidad de vida del paciente.

Phosphorus substituted hydroxylamine and hydroxamic acid derivatives: synthesis and reactivity

Dedicated to Prof. Julio Alvarez-Builla on the occasion of his 65th anniversary.

Terapia celular para el tratamiento de la enfermedad de Alzheimer: angiogénesis terapéutica inducida por células microencapsuladas secretoras del factor de crecimiento del endotelio vascular

197 p. (Bibliogr. 189-197)

Vascular endothelial growth factor regulates melanoma cell adhesion and growth in the bone marrow microenvironment via tumor cyclooxygenase-2

Background: Human melanoma frequently colonizes bone marrow (BM) since its earliest stage of systemic dissemination, prior to clinical metastasis occurrence. However, how melanoma cell adhesion and proliferation mechanisms are regulated within bone marrow stromal cell (BMSC) microenvironment remain unclear. Consistent with the prometastatic role of inflammatory and angiogenic factors, several studies have reported elevated levels of cyclooxygenase-2 (COX-2) in melanoma although its pathogenic role in bone marrow melanoma metastasis is unknown. Methods: Herein we analyzed the effect of cyclooxygenase-2 (COX-2) inhibitor celecoxib in a model of generalized BM dissemination of left cardiac ventricle-injected B16 melanoma (B16M) cells into healthy and bacterial endotoxin lipopolysaccharide (LPS)-pretreated mice to induce inflammation. In addition, B16M and human A375 melanoma (A375M) cells were exposed to conditioned media from basal and LPS-treated primary cultured murine and human BMSCs, and the contribution of COX-2 to the adhesion and proliferation of melanoma cells was also studied. Results: Mice given one single intravenous injection of LPS 6 hour prior to cancer cells significantly increased B16M metastasis in BM compared to untreated mice; however, administration of oral celecoxib reduced BM metastasis incidence and volume in healthy mice, and almost completely abrogated LPS-dependent melanoma metastases. In vitro, untreated and LPS-treated murine and human BMSC-conditioned medium (CM) increased VCAM-1-dependent BMSC adherence and proliferation of B16M and A375M cells, respectively, as compared to basal medium-treated melanoma cells. Addition of celecoxib to both B16M and A375M cells abolished adhesion and proliferation increments induced by BMSC-CM. TNF alpha and VEGF secretion increased in the supernatant of LPS-treated BMSCs; however, anti-VEGF neutralizing antibodies added to B16M and A375M cells prior to LPS-treated BMSC-CM resulted in a complete abrogation of both adhesion-and proliferation-stimulating effect of BMSC on melanoma cells. Conversely, recombinant VEGF increased adherence to BMSC and proliferation of both B16M and A375M cells, compared to basal medium-treated cells, while addition of celecoxib neutralized VEGF effects on melanoma. Recombinant TNFa induced B16M production of VEGF via COX-2-dependent mechanism. Moreover, exogenous PGE2 also increased B16M cell adhesion to immobilized recombinant VCAM-1. Conclusions: We demonstrate the contribution of VEGF-induced tumor COX-2 to the regulation of adhesion-and proliferation-stimulating effects of TNFa, from endotoxin-activated bone marrow stromal cells, on VLA-4-expressing

2,4-dimethylene-1,3-cyclobutanediyl and 2,4-dimethylenebicyclobutane. Synthesis, spectroscopy, and reactivity of a triplet biradical and its covalent isomer

The preparation and direct observation of triplet 2,4-dimethylene-1,3- cyclobutanediyl (1), the non-Kekule isomer of benzene, is described. The biradical was generated by photolysis of 5,6-dimethylene-2,3- diazabicyclo[2.1.1]hex-2-ene (2) (which was synthesized in several steps from benzvalene) under cryogenic, matrix-isolation conditions. Biradical 1 was characterized by EPR spectroscopy (‌‌‌‌‌│D/hc│ =0.0204 cm^(-1), │E/hc│ =0.0028 cm^(-1)) and found to have a triplet ground state. The Δm_s= 2 transition displays hyperfine splitting attributed to a 7.3-G coupling to the ring methine and a 5.9-G coupling to the exocyclic methylene protons. Several experiments, including application of the magnetophotoselection (mps) technique in the generation of biradical 1, have allowed a determination of the zero-field triplet sublevels as x = -0.0040, y = +0.0136, and z = -0.0096 cm^(-1), where x and y are respectively the long and short in-plane axes and z the out-of-plane axis of 1.

Triplet 1 is yellow-orange and displays highly structured absorption (λ_(max)= 506 nm) and fluorescence (λ_(max) = 510 nm) spectra, with vibronic spacings of 1520 and 620 cm^(-1) for absorption and 1570 and 620 cm^(-1) for emission. The spectra were unequivocally assigned to triplet 1 by the use of a novel technique that takes advantage of the biradical's photolability. The absorption є = 7200 M^(-1) cm^(-1) and f = 0.022, establishing that the transition is spin-allowed. Further use of the mps technique has demonstrated that the transition is x-polarized, and the excited state 1s therefore of B_(1g) symmetry, in accord with theoretical predictions.

Thermolysis or direct photolysis of diazene 2 in fluid solution produces 2,4- dimethylenebicyclo[l.l.0]butane (3), whose ^(l)H NMR spectrum (-80°C, CD_(2)Cl_(2)) consists of singlets at δ 4.22 and 3.18 in a 2:1 ratio. Compound 3 is thermally unstable and dimerizes with second-order kinetics between -80 and -25°C (∆H^(‡) = 6.8 kcal mol^(-1), (∆s^(‡) = -28 eu) by a mechanism involving direct combination of two molecules of 3 in the rate-determining step. This singlet-manifold reaction ultimately produces a mixture of two dimers, 3,8,9- trimethylenetricyclo[5.1.1.0^(2,5)]non-4-ene (75) and trans-3,10-dimethylenetricyclo[6.2.0.0^(2,5)]deca-4,8-diene (76t), with the former predominating. In contrast, triplet-sensitized photolysis of 2, which leads to triplet 1, provides, in addition to 75 and 76t, a substantial amount of trans-5,10- dimethylenetricyclo[6.2.0.0^(3,6)]deca-3,8-diene (77t) and small amounts of two unidentified dimers.

In addition, triplet biradical 1 ring-closes to 3 in rigid media both thermally (77-140 K) and photochemically. In solution 3 forms triplet 1 upon energy transfer from sensitizers having relatively low triplet energies. The implications of the thermal chemistry for the energy surfaces of the system are discussed.

Structural and mechanistic study of monoalkyl diazenes. Synthesis, characterization, and reactivity of 1,6-didehydro[10]annulene

Methodology for the preparation of allenes from propargylic hydrazine precursors under mild conditions is described. Oxidation of the propargylic hydrazines, which can be readily prepared from propargylic alcohols, with either of two azo oxidants, diethyl azodicarboxylate (DEAD) or 4-methyl 1,2-triazoline-3,5-dione (MTAD), effects conversion to the allenes, presumably via sigmatropic rearrangement of a monoalkyl diazene intermediate. This rearrangement is demonstrated to proceed with essentially complete stereospecificity. The application of this methodology to the preparation of other allenes, including two that are notable for their reactivity and thermal instability, is also described.

The structural and mechanistic study of a monoalkyl diazene intermediate in the oxidative transformation of propargylic hydrazines to allenes is described. The use of long-range heteronuclear NMR coupling constants for assigning monoalkyl diazene stereochemistry (E vs Z) is also discussed. Evidence is presented that all known monoalkyl diazenes are the E isomers, and the erroneous assignment of stereochemistry in the previous report of the preparation of (Z)-phenyldiazene is discussed.

The synthesis, characterization, and reactivity of 1,6-didehydro[10]annulene are described. This molecule has been recognized as an interesting synthetic target for over 40 years and represents the intersection of two sets of extensively studied molecules: nonbenzenoid aromatic compounds and molecules containing sterically compressed π-systems.The formation of 1,5-dehydronaphthalene from 1 ,6-didehydro[10]annulene is believed to be the prototype for cycloaromatizations that produce 1,4-dehydroaromatic species with the radical centers disposed anti about the newly formed single bond. The aromaticity of this annulene and the facility of its cycloaromatization are also analyzed.

Reactivity of titanocene methylidene with metal halides, alkene sulfides, and alkene oxides

Titanocene metallacyclobutanes show a wide variety of reactivites with organic and inorganic reagents. Their reactions include methylene transfer to organic carbonyls, formation of enolates, electron transfer from activated alkyl chlorides, olefin metathesis, ring opening polymerization. Recently, preparations of heterobinuclear µ-methylene complexes were reported. In this thesis, mechanistic, synthetic, and structural studies of the heterobinuclear µ-methylene complexes will be described. Also, the reaction of titanocene methylidene trimethylphosphine complex with alkene sulfide and styrene sulfide will be presented.

Heterobinuclear µ-methylene-µ-methyl complexes C_(p2)Ti(µ-CH_2)( µ-CH_3)M(1,5-COD) have been prepared (M = Rh, Ir). X-ray crystallography showed that the methyl group of the complex was bonded to the rhodium and bridges to the titanium through an agostic bond. The ^(1)H,^(13)CNMR, IR spectra along with partial deuteration studies supported the structure in both solution and solid state. Activation of the agostic bond is demonstrated by the equilibration of the µ-CH_3 and µ-CH_2 groups. A nonlinear Arrhenius plot, an unusually large kinetic isotope effect (24(5)), and a large negative activation entropy (-64(3)eu) can be explained by the quantum-mechanical tunneling. Calculated rate constants with Bell-type barrier fitted well with the observed one. This equilibration was best explained by a 4e-4c mechanism (or σ bond metathesis) with the character of quantum-mechanical tunneling.

Heterobinuclear µ-methylene-µ-phenyl complexes were synthesized. Structural study of C_(p2)Ti(µ-CH_(2))(µ-p-Me_(2)NC_(6)H_(4))Rh(l,5-COD) showed that the two metal atoms are bridged by the methylene carbon and the ipso carbon of the p-N,N-dimethylarninophenyl group. The analogous structure of C_(p2))Ti(µ-CH_(2))(µ-o-MeOC_(6)H_(4))Rh(1,5-COD) has been verified by the differential NOE. The aromaticity of the phenyl group observed by ^(1)H NMR, was confirmed by the comparison of the C-C bond lengths in the crystallographic structure. The unusual downfield shifts of the ipso carbon in the ^(13)C NMR are assumed to be an indication of the interaction between the ipso carbon and electron-deficient titanium.

Titanium-platinum heterobinuclear µ-methylene complexes C_(p2)Ti(µ-CH_(2))(µ -X)Pt(Me)(PM_(2)Ph) have been prepared (X= Cl, Me). Structural studies indicate the following:(1) the Ti-CH2 bond possesses residual double bond character, (2) there is a dative Pt→Ti interaction which may be regarded as a π back donation from the platinum atom to the 'Ti=CH_(2)'' group, and (3) the µ-CH_3 group is bound to the titanium atom through a three-center, two-electron agostic bond.

Titanocene (η^(2)-thioformaldehyde)•PMe_3 was prepared from C_(p2)Ti=CH_(2)•PMe_3 and sulfur-containing organic compounds (e.g. alkene sulfide, triphenylphosphine sulfide) including elemental sulfur. Mechanistic studies utilizing trans-styrene sulfide-d_1 suggested the stepwise reaction to explain equimolar mixture of trans- and cis-styrene-d_1 as by-products. The product reacted with methyl iodide to produce cationic titanocene (η_(2)-thiomethoxymethyl) complex. Complexes having less coordinating anion like BF_4 or BPh_4 could be obtained through metathesis. Together with structural analyses, the further reactivities of the complexes have been explored.

The complex C_(p2)TiOCH_(2)CH(Ph)CH_2 was prepared from the compound C_(p2)Ti=CH_(2)-PMe_3 and styrene oxide. The product was characterized with ^(1)H-^(1)H correlated 2-dimensional NMR, selective decoupling of ^(1)H NMR, and differential NOE. Stereospecificity of deuterium in the product was lost when trans-styrene oxide-d_1 was allowed to react. Relative rates of the reaction were measured with varying substituents on the phenyl ring. Better linearity (r = -0.98, p^(+) = -0.79) was observed with σ_(p)^(+)than σ(r = -0.87, p = -1.26). The small magnitude of p^+ value and stereospecificity loss during the formation of product were best explained by the generation of biradicals, but partial generation of charge cannot be excluded. Carbonylation of the product followed by exposure to iodine yields the corresponding β-phenyl γ-lactone.

Mechanistic and reactivity studies of bent metallocene complexes of niobium and tantalum

A variety of olefin hydride complexes of niobium and tantalum has been prepared in order to study their reactivity and to gain insight into organometallic reaction mechanisms. Examination of a series of ethylene and propylene complexes of niobocene (CP_2Nb; Cp = η^5-C_5H_5), permethylniobocene (Cp*_2Nb; Cp* = η^5-C_5(CH_3)_5), tantalocene, and permethyltantalocene has indicated that there are both large electronic and steric effects deriving from the metal (and its ancillary ligands) in the olefin insertion (β-migratory insertion) process. Furthermore, a thermodynamic and kinetic analysis has been completed for a series of substituted styrene complexes of niobocene in order to better understand the important electronic properties of the olefin. The results are in accord with a concerted four-center process with only moderate charge development.

The special case of β-migratory insertion of a hydride ligand into coordinated benzyne has also been studied for the permethyltantalocene system. The coordinatively unsaturated (sixteen electron) phenyl tautomer, which is made accessible by the facile benzyne hydride insertion reaction, readily reacts with a variety of ligands, L, to afford Cp*_2 Ta(C_6H_5)L complexes (L = CO, O_2, NC≡R, :CH_2, H_2, etc.). This family of compounds exhibits interesting reactivity (a-migratory insertion, O_2 activation, and reductive elimination) which is discussed in some detail.

Finally a series of paramagnetic seventeen electron Cp*_2 TaX_2 (X = halide, alkyl, hydride) complexes, and the corresponding cationic and anionic species, have been prepared and studied. The odd electron neutral complexes exhibit surprising thermal stability and undergo very little reactivity. While the chemistry of the anionic compounds is almost completely dominated by their potent reducing power, that of the cations is quite diverse and amenable for study. Therefore the syntheses and reactivity (1 ,2-eliminations, ligand insertions, and deprotonation reactions) of these coordinatively unsaturated sixteen electron species are presented.

Organotitanium and niobium chemistry. I. Structure and reactivity of a titanium ethylene complex. II. Reactivity of decamethyl niobocene derivatives

The synthesis and X-ray diffraction study of bis(pentamethylcyclopentadienyl) ethylene titanium (I) are reported. This complex represents the first example of an isolable ethylene adduct of a group IV metal, a key intermediate in Ziegler-Natta olefin polymerization schemes. While treatment of I with ethylene leads to only traces of polymer after months, I participates in a wide range of stoichiometric and catalytic reactions. These include the catalytic conversion of ethylene specifically to butadiene and ethane and the catalytic isomerization of alkenes. Detailed studies have been carried out on the stoichiometric reactions of I with nitriles and alkynes. At low temperatures, nitriles react to form metallacycloimine species which more slowly undergo a formal 1,3-hydrogen shift to generate metallacycloeneamines. The lowest energy pathway for this rearrangement is an intramolecular hydrogen shift which is sensitive to the steric bulk of the R substituent. The reactions of I with alkynes yield metallacyclopentene complexes with high regioisomer selectivity. Carbonylation of the metallacyclopentene (η-C₅Me₅5)₂TiC(CH₃)=C(CH₃)CH₂ under relatively mild conditions cleanly produces the corresponding cyclopentenone and [C₅(CH₃)₅]₂Ti(CO)₂. Compounds derived from CO₂ and acetaldehyde have also been isolated.

The synthesis and characterization of bis-(η-pentamethylcyclopentadienyl) niobium(III) tetrahydroborate (II) are described and a study of its temperature-dependent proton NMR spectroscopic behavior is reported. The complex is observed to undergo a rapid intramolecular averaging process at elevated temperatures. The free energy of activation, ΔG^≠ = 16.4 ± 0.4 kcal/mol, is calculated. The reinvestigation of a related compound, bis(η-cyclopentadienyl)niobium(III) tetrahydroborate, established ΔG^≠ = 14.6 ± 0.2 kcal/mol for the hydrogen exchange process. The tetrahydroborate complex, II reacts with pyridine and dihydrogen to yield (η-C₅Me₅5)₂NbH₃ (III). The reactivity of III with CO and ethylene is reported.

Segurança na deglutição de pacientes disfágicos pós acidente vascular cerebral: contribuições do enfermeiro

Trata da temática do paciente portador de acidente vascular cerebral, especificamente das ações do enfermeiro para a prevenção das complicações decorrentes da disfagia após um acidente vascular cerebral no atendimento domiciliar. Objetivou-se propor ações de enfermagem que garantam uma deglutição segura em pacientes com disfagia pós-AVC a partir dos dados obtidos junto a pacientes usuários do SAD. Pesquisa desenvolvida no serviço de atendimento domiciliar de um hospital público do Rio de Janeiro com 30 sujeitos. Aplicou-se um instrumento, que descreveu dados sócio-laboriais, presença de disfagia e a consistência dos alimentos ingeridos pelos pacientes. Resultados: dezessete pacientes desenvolveram a disfagia, caracterizando-se como idosos, 76,47% foram do sexo feminino, a média de idade foi de 73,6 ( 9,55). A maioria com ensino fundamental completo (76,48%) e aposentados (70,59%). Todos são hipertensos e a metade diabéticos (58,82%). Com relação ao tipo de AVC, todos tiveram AVC isquêmico, sendo 58,82% um episódio e 41,18% dois episódios. A prevalência da disfagia é de 57%. Não há associação entre a idade e a disfagia e sua presença não dependeu da frequência de episódios de AVC. Pacientes com dois fatores de risco, hipertensão e diabetes apresentam maior prevalência de disfagia para líquidos do que para alimentos sólidos ou ambos. O enfermeiro deve realizar orientações em relação ao ambiente, posicionamento do paciente, aos materiais e utensílios a serem usados na alimentação, quantidade, temperatura e consistência do alimento. Informações como cabeceira elevada, colher de sobremesa para administração de dietas com volume de 3 a 5 ml, além do uso de espessantes para gerar uma consistência segura na deglutição, são fundamentais para garantir o mínimo de complicações. É importante também que a família participe de todo o processo de recuperação do paciente. Considerações finais: após o AVC, a disfagia merece atenção por gerar complicações como a aspiração e a pneumonia, o que serve para nortear o planejamento e orientações de enfermagem direcionadas a limitar o efeito dessa sequela, assim como a possibilidade de realização de pesquisas que tratem de conhecer o que os enfermeiros podem fazer no domicílio dos pacientes disfágicos de forma a melhorar o desempenho nas atividades diárias de vida.

Simulation of shock-induced bubble collapse with application to vascular injury in shockwave lithotripsy

Shockwave lithotripsy is a noninvasive medical procedure wherein shockwaves are repeatedly focused at the location of kidney stones in order to pulverize them. Stone comminution is thought to be the product of two mechanisms: the propagation of stress waves within the stone and cavitation erosion. However, the latter mechanism has also been implicated in vascular injury. In the present work, shock-induced bubble collapse is studied in order to understand the role that it might play in inducing vascular injury. A high-order accurate, shock- and interface-capturing numerical scheme is developed to simulate the three-dimensional collapse of the bubble in both the free-field and inside a vessel phantom. The primary contributions of the numerical study are the characterization of the shock-bubble and shock-bubble-vessel interactions across a large parameter space that includes clinical shockwave lithotripsy pressure amplitudes, problem geometry and tissue viscoelasticity, and the subsequent correlation of these interactions to vascular injury. Specifically, measurements of the vessel wall pressures and displacements, as well as the finite strains in the fluid surrounding the bubble, are utilized with available experiments in tissue to evaluate damage potential. Estimates are made of the smallest injurious bubbles in the microvasculature during both the collapse and jetting phases of the bubble's life cycle. The present results suggest that bubbles larger than 1 μm in diameter could rupture blood vessels under clinical SWL conditions.

Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: Phase III study

Background: Vascular ulcers are commonly seen in daily practice at all levels of care and have great impact at personal, professional and social levels with a high cost in terms of human and material resources. Given that the application of autologous platelet rich plasma has been shown to decrease healing times in various different studies in the hospital setting, we considered that it would be interesting to assess the efficacy and feasibility of this treatment in primary care. The objectives of this study are to assess the potential efficacy and safety of autologous platelet rich plasma for the treatment of venous ulcers compared to the conventional treatment (moist wound care) in primary care patients with chronic venous insufficiency (C, clinical class, E, aetiology, A, anatomy and P, pathophysiology classification C6). Design: We will conduct a phase III, open-label, parallel-group, multicentre, randomized study. The subjects will be 150 patients aged between 40 and 100 years of age with an at least 2-month history of a vascular venous ulcer assigned to ten primary care centres. For the treatment with autologous platelet rich plasma, all the following tasks will be performed in the primary care setting: blood collection, centrifugation, separation of platelet rich plasma, activation of coagulation adding calcium chloride and application of the PRP topically after gelification. The control group will receive standard moist wound care. The outcome variables to be measured at baseline, and at weeks 5 and 9 later include: reduction in the ulcer area, Chronic Venous Insufficiency Quality of Life Questionnaire score, and percentage of patients who require wound care only once a week. Discussion: The results of this study will be useful to improve the protocol for using platelet rich plasma in chronic vascular ulcers and to favour wider use of this treatment in primary care.

Redução de peso na prevenção primária de acidente vascular cerebral

Como as doenças cardiovasculares (DCV) constituem a principal causa de morte na maioria dos países e as tendências de mortalidade não se apresentam totalmente elucidadas nos países em desenvolvimento, torna-se adequado explorar a evolução da mortalidade das DCV, dando ênfase ao acidente vascular cerebral (AVC) no Brasil. Devido à prevalência de AVC e também devido à associação causal entre sobrepeso ou obesidade e AVC não ser clara, é importante avaliar o efeito da perda de peso na prevenção primária de AVC. Baseado no fato do rimonabant ser a primeira droga de uma nova classe de medicamentos promissora não apenas na redução de peso, mas por sua influência sobre os fatores de risco cardiovascular, torna-se pertinente estabelecer sua eficácia e segurança. Inicialmente, para traçar um panorama sobre a epidemiologia das DCV no Brasil, com ênfase em AVC, foram realizados dois estudos com as tendências temporais de mortalidade por DCV ao longo das três últimas décadas, investigando as diferenças entre as regiões do país e entre indivíduos de diversas faixas etárias e de ambos os sexos, (artigo I e II). Além disso, duas revisões sistemáticas foram realizadas: uma para avaliar o efeito da perda de peso na prevenção primária de AVC; a segunda para investigar o uso do medicamento rimonabant no tratamento da obesidade (artigo III e IV). As taxas de mortalidade de AVC diminuíram substancialmente nas últimas três décadas, de 68,2 a 40,9 por 100 000 habitantes. Essa redução foi detectada em ambos os sexos de todas as faixas etárias, e nas diferentes regiões do país, sendo mais acentuadas nas regiões mais ricas (artigo I). A mesma tendência foi observada nas demais DCV, que em geral apresentaram uma redução anual média de 3,9%. As maiores reduções foram encontradas para AVC (média de 4,0% ao ano) seguido por doença coronariana (média de 3,6% ao ano) (artigo II). Não existem estudos avaliando o efeito da redução de peso na prevenção primária de AVC (artigo III). Houve um efeito doseresposta com o uso do rimonabant: comparado com placebo, 20 mg da droga produziu uma redução de peso maior (4,9 kg) em 4 ensaios clínicos com duração de 1 ano. Foram observadas melhoras nos marcadores de risco cardiovascular. Porém 5 mg comparado com placebo mostrou apenas uma redução de 1,3 kg a mais do peso. A maior dose também provocou maiores efeitos adversos. Perdas no seguimento foram de aproximadamente 40% (artigo IV). Durante as últimas décadas, a mortalidade por DCV em geral e AVC diminiu consistentemente no Brasil, porém a magnitude do declínio variou de acordo com as diferenças socioeconômicas. Amplas intervenções poderiam ter mais êxito se planejadas de acordo com as desigualdades sociais e diferenças culturais. Os achados apontam para a necessidade da realização de ensaios clínicos randomizados controlados avaliando a perda de peso na prevenção primária do AVC, devido à alta relevância dessa condição. Como intervenções não são totamente eficazes no tratamento da obesidade, a prevenção, englobando um conjunto articulado de ações, permanece a forma mais eficiente de controlá-la. O medicamento rimonabant apresentou modesta perda de peso, porém os resultados obtidos devem ser interpretados com cautela de acordo com as deficiências na qualidade metodológica apresentadas por todos os estudos. São necessárias pesquisas de alta qualidade para avaliar a eficácia e a segurança do rimonabant em períodos mais longos.

Valoración del riesgo cardiovascular y edad vascular en personas con hipertensión primaria

INTRODUCCIÓN: los factores de riesgo cardiovasculares (FRCV) son los que se asocian a una mayor probabilidad de sufrir una enfermedad cardiovascular (ECV), estos pueden ser no modificables o modificables como la hipertensión primaria que tiene un origen multifactorial. Mediante el método Framingham se describen el perfil del riesgo cardiovascular absoluto (RCV) que es la probabilidad de presentar un evento cardiovascular en 10 años y la edad vascular (EV) la cual indica la edad que le corresponde a las arterias. OBJETIVOS: 1) Estimar el perfil de RCV y EV en personas con HTA primaria a través del método Framingham. 2) Conocer dentro del RCV, si el riesgo es bajo, medio o alto teniendo en cuenta la edad, HDL-colesterol, colesterol total (COL), pensión arterial sistólica (PAS), diabetes tipo 1 y tipo 2 y el tabaquismo. MÉTODOS: participaron en el estudio 58 personas (edad= 51,7 ±7,8 años) 46 hombres y 12 mujeres) diagnosticadas con HTA primaria y sobrepeso u obesidad, incluidas en la investigación EXERDIET-HTA. Se les realizó una estimación del RCV y EV a través del método Framingham. Las variables que se consideraron para la valoración fueron la edad, HDL-C, COL, PAS, si padecían diabetes o no y si eran fumadores o no. RESULTADOS: las personas estudiadas presentan un RCV del 15,5±7,7% que se relaciona con un RCV de nivel medio, siendo más alto en los hombres que en las mujeres (P=0,001). En la totalidad el 24% de los participantes presenta un RCV alto, el 47% medio y el 24% bajo. La EV media estimada es de 65±10 años, 13 años superior a la edad cronológica. CONCLUSIONES: Personas con diagnóstico de HTA primaria y el correspondiente tratamiento farmacológico presentan un RCV medio a sufrir un evento cardiovascular en los próximos 10 años de entre el 10-20%. Se hace necesario un control más exhaustivo de todos los FRCV, de forma especial en los hombres en relación con el hábito del tabaquismo. La EV en personas hipertensas es superior a la edad cronológica, lo que acentúa la necesidad de adopción de un estilo de vida más saludable

Avaliação dos efeitos da hiperglicemia sobre a estrutura vascular peniana em coelhos Nova Zelândia

Pacientes com diabetes mellitus (DM) têm elevadas taxas de disfunção erétil (ED). Diversos estudos examinaram esta associação. A associação entre o processo de hipertrofia vascular diabética e o grau de comprometimento dos seios cavernosos é pouco estudada. A proposta do presente estudo foi avaliar a estrutura vascular do tecido erétil de coelhos diabéticos e coelhos normais, através de histomorfometria computadorizada da artéria dorsal do pênis e dos seios vasculares cavernosos em ambos os grupos. Foram utilizados 20 coelhos adultos machos da raça Nova Zelândia, divididos em dois grupos com 10 animais cada, o grupo diabético (GD) e o grupo controle (GC). Os animais foram previamente anestesiados e os coelhos do grupo GD receberam aloxano na dose de 100mg/kg, via endovenosa para indução da diabetes. Após 10 semanas, os animais foram mortos e os pênis retirados. Fragmentos do pênis foram fixados em formalina tamponada durante 24-48 horas e processados para parafina. Para análise imunohistoquímica e identificação das fibras musculares lisas, foi utilizado o anticorpo anti alfa-actina. Foram feitas análises da espessura média das túnicas íntima e média da parede da artéria dorsal do pênis (ADP), densidade nuclear na túnica média e avaliação por microscopia de polarização do conteúdo colágeno na túnica adventícia. Na túnica íntima foram observadas vacuolizações no endotélio. Os valores encontrados para espessura de GC e GD foram respectivamente (em m): 35,0123,177 e 44,3308,434 (P=0,0350). Foi encontrada diferença na área média da parede da ADP (P=0,0179). Para densidade nuclear GC 0,0071540,001954 núcleos/μm e GD 0,0048080,002069 núcleos/μm (P=0,0855). Foram observadas mudanças na birrefringência das fibras colágenas na túnica adventícia, passando de alaranjado no grupo GC para esverdeado no grupo GD, indicando a mudança em sua espessura. A área ocupada pelos seios cavernosos apresentou diminuição significativa de 37 % no grupo diabético (P=0,0013). Este conjunto de alterações sugere que a hiperglicemia crônica provocada pelo diabetes levou a um processo de hipertrofia da musculatura lisa na parede vascular e nas trabéculas do corpo cavernoso, com diminuição da área dos seios, o que possivelmente altera as propriedades hemodinâmicas do órgão