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

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

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

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

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

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

Glucose biosensor based on multisegment nanowires exhibiting reversible magnetic control

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

Gengivite Plasmocitária induzida por uso de pimenta

The aim of this case report is present a case in which the patient had plasma cell gingivitis induced by consumption of pepper. Patient A.M.S., male, 23 years, presented himself at the Clinic of Periodontology, complaining of severe pain, bleeding gums and tooth mobility. Interview was conducted not observing anything relevant. In oral evaluation, we observed in the anterior swollen gums, bleeding, suppuration and great touch, and tooth mobility. Being an aggressive framework in relation to patient age, we performed the following laboratory tests: complete blood count, blood sugar, and coagulation, and biopsy in the anterior inferior, because a diagnosis of lymphoma. At the end of antibiotic therapy, a significant improvement of clinical symptoms, pain relief, less swollen gums and reduce the suppuration and mobility. Laboratory tests showed no change. Fifteen days later, the patient returned with worsening of clinical status. The pathological diagnosis was plasma cell gingivitis and then performed a new history by placing greater emphasis on dietary habits, and the patient reported consumption of pepper in their meals, and relate this to clinical presentation. After elimination of pepper diet the patient showed remission of clinical data.

Effect of the consumption of a symbiotic shake on the intestinal microflora of erdely people

The consumption of foods containing probiotic and prebiotic ingredients is growing consistently every year, and in view of the limited number of studies investigating their effect in the elderly. Objective The objective of this study was to evaluate the effect of the consumption of a symbiotic shake containing Lactobacillus acidophilus, Bifidobacterium bifidum and fructooligosaccharides on glycemia and cholesterol levels in elderly people. Methods A randomized, double-blind, placebo-controlled study was conducted on twenty volunteers (ten for placebo group and ten for symbiotic group), aged 50 to 60 years. The criteria for inclusion in the study were: total cholesterol > 200 mg/dL; triglycerides > 200 mg/dL and glycemia > 110 mg/dL. Over a total test period of 30 days, 10 individuals (the symbiotic group) consumed a daily dose of 200 mL of a symbiotic shake containing 108 UFC/mL Lactobacillus acidophilus, 108 UFC/mL Bifidobacterium bifidum and 2 g oligofructose, while 10 other volunteers (the placebo group) drank daily the same amount of a shake that did not contain any symbiotic bacteria. Blood samples were collected 15 days prior to the start of the experiment and at 10-day intervals after the beginning of the shake intake. The standard lipid profile (total cholesterol, triglycerides and HDL cholesterol) and glycemia, or blood sugar levels, were evaluated by an enzyme colorimetric assay. Results The results of the symbiotic group showed a non-significant reduction (P > 0.05) in total cholesterol and triglycerides, a significant increase (P < 0.05) in HDL cholesterol and a significant reduction (P < 0.05) in fasting glycemia. No significant changes were observed in the placebo group. Conclusion The consumption of symbiotic shake resulted in a significant increase in HDL and a significant decrease of glycemia.

Monitoring of industrial exposure for chloracne

This study (1) established comedogenicity dose response curves for the pure compounds of 3,3$\sp\prime$,4,4$\sp\prime$-tetrachloroazobenzene (TCAB) and 3,3$\sp\prime$,4,4$\sp\prime$-tetrachloroazoxybenzene (TCAOB) individually and as a couple-compound using a rabbit ear model; (2) used a rabbit ear model to establish comedogenicity potential for TCAB and TCAOB as they existed in a given industrial herbicide manufacture process; (3) evaluated actual environmental contamination in a herbicide industrial setting by air monitoring and wipe sampling; (4) biologically monitored potentially exposed workers for alterations in follicular orifice size as an index of actual exposure to chloracnegenic compounds; and (5) biologically monitored potentially exposed workers for changes in weight, cholesterol, triglycerides and blood sugar.^ A silastic monomer mold (an objective measure) was used to measure change in follicular orifice size over time. This required taking impressions of (1) skin of the forehead and right and left malar crescents of workers and (2) the skin of the external ear of the rabbit. Molds were stained using a solution of hematoxylin and digitized using a Nikon UFX microscope (magnification 300 X), a drawing tube and a digitizing tablet attached to an IBM Personal Computer. Comedogenicity assays were used to establish dose-response curves for TCAB, TCAOB and the couple-compound TCAB + TCAOB.^ No evidence of chloracne or toxicity was observed in any of the workers. Nor, was there a statistically significant increase in size of follicular orifice means measured over time. This was attributed to extensive personal and environmental hygiene programs along with teaching the workers about chloracne, its cause and its prevention. These programs may have been the greatest factor in preventing the development of chloracne in this group of workers. Monitoring of the plant environment showed relatively high concentrations of the couple-compound (TCAB + TCAOB). Comedogenicity assays showed a linear dose-response relationship over time for TCAB, TCAOB and the couple-compound. An antagonistic action was found for the TCAB/TCAOB of the couple-compound; such action may provide some protection to workers in this type of setting. It is speculated that the observed antagonistic action may be due to the difference in binding affinities of TCAB/TCAOB for receptor sites. ^

Study on the effect of metformin in patients of metastatic renal cell cancer with diabetes receiving tyrosine kinase inhibitor therapy

Objective: The primary objective of our study was to study the effect of metformin in patients of metastatic renal cell cancer (mRCC) and diabetes who are on treatment with frontline therapy of tyrosine kinase inhibitors. The effect of therapy was described in terms of overall survival and progression free survival. Comparisons were made between group of patients receiving metformin versus group of patients receiving insulin in diabetic patients of metastatic renal cancer on frontline therapy. Exploratory analyses were also done comparing non-diabetic patients of metastatic renal cell cancer receiving frontline therapy compared to diabetic patients of metastatic renal cell cancer receiving metformin therapy. ^ Methods: The study design is a retrospective case series to elaborate the response rate of frontline therapy in combination with metformin for mRCC patients with type 2 diabetes mellitus. The cohort was selected from a database, which was generated for assessing the effect of tyrosine kinase inhibitor therapy associated hypertension in metastatic renal cell cancer at MD Anderson Cancer Center. Patients who had been started on frontline therapy for metastatic renal cell carcinoma from all ethnic and racial backgrounds were selected for the study. The exclusion criteria would be of patients who took frontline therapy for less than 3 months or were lost to follow-up. Our exposure variable was treatment with metformin, which comprised of patients who took metformin for the treatment of type 2 diabetes at any time of diagnosis of metastatic renal cell carcinoma. The outcomes assessed were last available follow-up or date of death for the overall survival and date of progression of disease from their radiological reports for time to progression. The response rates were compared by covariates that are known to be strongly associated with renal cell cancer. ^ Results: For our primary analyses between the insulin and metformin group, there were 82 patients, out of which 50 took insulin therapy and 32 took metformin therapy for type 2 diabetes. For our exploratory analysis, we compared 32 diabetic patients on metformin to 146 non-diabetic patients, not on metformin. Baseline characteristics were compared among the population. The time from the start of treatment until the date of progression of renal cell cancer and date of death or last follow-up were estimated for survival analysis. ^ In our primary analyses, there was a significant difference in the time to progression of patients receiving metformin therapy vs insulin therapy, which was also seen in our exploratory analyses. The median time to progression in primary analyses was 1259 days (95% CI: 659-1832 days) in patients on metformin therapy compared to 540 days (95% CI: 350-894) in patients who were receiving insulin therapy (p=0.024). The median time to progression in exploratory analyses was 1259 days (95% CI: 659-1832 days) in patients on metformin therapy compared to 279 days (95% CI: 202-372 days) in non-diabetic group (p-value <0.0001). ^ The median overall survival was 1004 days in metformin group (95% CI: 761-1212 days) compared to 816 days (95%CI: 558-1405 days) in insulin group (p-value<0.91). For the exploratory analyses, the median overall survival was 1004 days in metformin group (95% CI: 761-1212 days) compared to 766 days (95%CI: 649-965 days) in the non-diabetic group (p-value<0.78). Metformin was observed to increase the progression free survival in both the primary and exploratory analyses (HR=0.52 in metformin Vs insulin group and HR=0.36 in metformin Vs non-diabetic group, respectively). ^ Conclusion: In laboratory studies and a few clinical studies metformin has been proven to have dual benefits in patients suffering from cancer and type 2-diabetes via its action on the mammalian target of Rapamycin pathway and effect in decreasing blood sugar by increasing the sensitivity of the insulin receptors to insulin. Several studies in breast cancer patients have documented a beneficial effect (quantified by pathological remission of cancer) of metformin use in patients taking treatment for breast cancer therapy. Combination of metformin therapy in patients taking frontline therapy for renal cell cancer may provide a significant benefit in prolonging the overall survival in patients with metastatic renal cell cancer and diabetes. ^

An iPhone-based application for promoting type 2 diabetic patients self- management towards healthy lifestyle habits

— In 2000, according to the World Health Organization, at least 171 million people, 2.8% of the population worldwide, suffered from diabetes. The Centres for Disease Control has defined it as an epidemic disease. Its incidence is increasing rapidly, and it is estimated that by 2030 this number will almost double. Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in the more developed countries. Diabetes is a chronic condition that occurs when pancreas does not assure enough insulin secretion or when the body does not consume the insulin produced. Insulin is a hormone that regulates blood sugar. The effect of uncontrolled diabetes is the hyperglycaemia (blood sugar), which eventually seriously damage many organs and systems, especially the nerves and blood vessels. Diabetes type 2 (most common type of diabetes) is highly correlated with elderly people, obesity or overweight. Promoting a healthy lifestyle helps patients to improve their quality of life and in many cases to avoid complications related to the disease. This paper is intended to describe an iPhone-based application for self-management of type 2 diabetic patients, which allow them improving their lifestyle through healthy diet, physical activity and education

Predictor paramétrico de glucosa subcutánea

La diabetes mellitus es una enfermedad que se caracteriza por la nula o insuficiente producción de insulina, o la resistencia del organismo a la misma. La insulina es una hormona que ayuda a que la glucosa (por ejemplo la obtenida a partir de los alimentos ingeridos) llegue a los tejidos periféricos y al sistema nervioso para suministrar energía. Hoy en día la tecnología actual permite abordar el desarrollo del llamado “páncreas endocrino artificial”, que consta de un sensor continuo de glucosa subcutánea, una bomba de infusión subcutánea de insulina y un algoritmo de control en lazo cerrado que calcule la dosis de insulina requerida por el paciente en cada momento, según la medida de glucosa obtenida por el sensor y según unos objetivos. El mayor problema que presentan los sistemas de control en lazo cerrado son los retardos, el sensor de glucosa subcutánea mide la glucosa del líquido intersticial, que representa la que hubo en la sangre un tiempo atrás, por tanto, un cambio en los niveles de glucosa en la sangre, debidos por ejemplo, a una ingesta, tardaría un tiempo en ser detectado por el sensor. Además, una dosis de insulina suministrada al paciente, tarda un tiempo aproximado de 20-30 minutos para la llegar a la sangre. Para evitar trabajar en la medida que sea posible con estos retardos, se intenta predecir cuál será el nivel de glucosa en un futuro próximo, para ello se utilizara un predictor de glucosa subcutánea, con la información disponible de glucosa e insulina. El objetivo del proyecto es diseñar una metodología para estimar el valor futuro de los niveles de glucosa obtenida a partir de un sensor subcutáneo, basada en la identificación recursiva del sistema glucorregulatorio a través de modelos lineales y determinando un horizonte de predicción óptimo de trabajo y analizando la influencia de la insulina en los resultados de la predicción. Se ha implementado un predictor paramétrico basado en un modelo autorregresivo ARX que predice con mejor precisión y con menor RMSE que un predictor ZOH a un horizonte de predicción de treinta minutos. Utilizar información relativa a la insulina no tiene efecto en la predicción. El preprocesado, postprocesado y el tratamiento de la estabilidad tienen un efecto muy beneficioso en la predicción. Diabetes mellitusis a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin produced. The insulin is a hormone that helps the glucose to reach to outlying tissues and the nervous system to supply energy. Nowadays, the actual technology allows raising the development of the “artificial endocrine pancreas”. It involves a continuous glucose sensor, an insulin bump, and a full closed loop algorithm that calculate the insulin units required by patient at any time, according to the glucose measure obtained by the sensor and any target. The main problem of the full closed loop systems is the delays, the glucose sensor measures the glucose in the interstitial fluid that represents the glucose was in the blood some time ago. Because of this, a change in the glucose in blood would take some time to be detected by the sensor. In addition, insulin units administered by a patient take about 20-30 minutes to reach the blood stream. In order to avoid this effect, it will try to predict the glucose level in the near future. To do that, a subcutaneous glucose predictor is used to predict the future glucose with the information about insulin and glucose. The goal of the proyect is to design a method in order to estimate the future valor of glucose obtained by a subcutaneous sensor. It is based on the recursive identification of the regulatory system through the linear models, determining optimal prediction horizon and analyzing the influence of insuline on the prediction results. A parametric predictor based in ARX autoregressive model predicts with better precision and with lesser RMSE than ZOH predictor in a thirty minutes prediction horizon. Using the relative insulin information has no effect in the prediction. The preprocessing, the postprocessing and the stability treatment have many advantages in the prediction.

Highly efficient potentiometric glucose biosensor based on functionalized InN quantum dots

We present a fast, highly sensitive, and efficient potentiometric glucose biosensor based on functionalized InN quantum-dots (QDs). The InN QDs are grown by molecular beam epitaxy. The InN QDs are bio-chemically functionalized through physical adsorption of glucose oxidase (GOD). GOD enzyme-coated InN QDs based biosensor exhibits excellent linear glucose concentration dependent electrochemical response against an Ag/AgCl reference electrode over a wide logarithmic glucose concentration range (1 × 10−5 M to 1 × 10−2 M) with a high sensitivity of 80 mV/decade. It exhibits a fast response time of less than 2 s with good stability and reusability and shows negligible response to common interferents such as ascorbic acid and uric acid. The fabricated biosensor has full potential to be an attractive candidate for blood sugar concentration detection in clinical diagnoses.

Páncreas artificial basado en un controlador Smith paramétrico

La diabetes mellitus es una enfermedad que se caracteriza por la nula o insuficiente producción de insulina, o la resistencia del organismo a la misma. La insulina es una hormona que ayuda a que la glucosa llegue a los tejidos periféricos y al sistema nervioso para suministrar energía. Actualmente existen dos tipos de terapias aplicada en tejido subcutáneo: mediante inyección múltiple realizada con plumas, y la otra es mediante infusión continua de insulina por bomba (CSII). El mayor problema de esta terapia son los retardos por la absorción, tanto de los carbohidratos como de la insulina, y los retardos introducidos por el sensor subcutáneo de glucosa que mide la glucosa del líquido intersticial, lo deseable es controlar la glucosa en sangre. Para intentar independizar al paciente de su enfermedad se está trabajando en el desarrollo del páncreas endocrino artificial (PEA) que dotaría al paciente de una bomba de insulina, un sensor de glucosa y un controlador, el cual se encargaría de la toma de decisiones de las infusiones de insulina. Este proyecto persigue el diseño de un regulador en modo de funcionamiento en CL, con el objetivo de conseguir una regulación óptima del nivel de glucosa en sangre. El diseño de dicho regulador va a ser acometido utilizando la teoría del control por modelo interno (IMC). Esta teoría se basa en la idea de que es necesario realimentar la respuesta de un modelo aproximado del proceso que se quiere controlar. La salida del modelo, comparada con la del proceso real nos da la incertidumbre del modelo de la planta, frente a la planta real. Dado que según la teoría del modelo interno, estas diferencias se dan en las altas frecuencias, la teoría IMC propone un filtro paso bajo como regulador en serie con la inversa del modelo de la planta para conseguir el comportamiento deseado. Además se pretende implementar un Predictor Smith para minimizar los efectos del retardo de la medida del sensor. En el proyecto para conseguir la viabilidad del PEA se ha adaptado el controlador IMC clásico utilizando las ganancias estáticas de un modelo de glucosa, a partir de la ruta subcutánea de infusión y la vía subcutánea de medida. El modo de funcionamiento del controlador en SCL mejora el rango de normoglucemia, necesitando la intervención del paciente indicando anticipadamente el momento de las ingestas al controlador. El uso de un control SCL con el Predictor de Smith mejora los resultados pues se añade al controlador una variable sobre las ingestas con la participación del paciente. ABSTRACT. Diabetes mellitus is a group of metabolic diseases in which a person has high blood sugar, due to the body does not produce enough insulin, or because cells do not respond to the insulin produced. The insulin is a hormone that helps the glucose to reach to outlying tissues and the nervous system to supply energy. There are currently two types of therapies applied in subcutaneous tissue: the first one consists in using the intensive therapy with an insulin pen, and the other one is by continuous subcutaneous insulin infusion (CSII). The biggest problems of this therapy are the delays caused by the absorption of carbohydrates and insulin, and the delays introduced by the subcutaneous glucose sensor that measures glucose from interstitial fluid, it is suitable to control glucose blood. To try to improve these patients quality of life, work is being done on the development of an artificial endocrine pancreas (PEA) consisting of a subcutaneous insulin pump, a subcutaneous glucose sensor and an algorithm of glucose control, which would calculate the bolus that the pump would infuse to patient. This project aims to design a controller for closed-loop therapy, with the objective of obtain an optimal regulation of blood glucose level. The design of this controller will be formed using the theory of internal model control (IMC). This theory is based on the uncertainties given by a model to feedback the system control. Output model, in comparison with the actual process gives the uncertainty of the plant model, compared to the real plant. Since the theory of the internal model, these differences occur at high frequencies, the theory proposes IMC as a low pass filter regulator in series with the inverse model of the plant to get the required behavior. In addition, it will implement a Smith Predictor to minimize the effects of the delay measurement sensor. The project for the viability of PEA has adapted the classic IMC controller using the gains static of glucose model from the subcutaneous infusion and subcutaneous measuring. In simulation the SemiClosed-Loop controller get on the normoglycemia range, requiring patient intervention announce the bolus priming connected to intakes. Using an SCL control with the Smith Predictor improves the outcome because a variable about intakes is added to the controller through patient intervention.

Contribuição da consulta de enfermagem na adesão ao tratamento do diabetes mellitus na estratégia saúde da família do município de Ribeirão Preto, SP

Trata-se de estudo de intervenção tipo antes e depois, no qual o sujeito é seu próprio controle, fator que permite identificar os efeitos na adesão ao tratamento e controle dos níveis glicêmicos. Teve como objetivo avaliar a contribuição da consulta de enfermagem na adesão ao tratamento do diabetes mellitus tipo 2, em uma Unidade Saúde da Família, de acordo com o \"Protocolo de atendimento as pessoas com diabetes mellitus,\" em Ribeirão Preto, SP. A coleta de dados foi realizada no período de setembro de 2014 a janeiro de 2015. O trabalho foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto, SP, sob Parecer nº 648.970. Participaram 31 pessoas com diabetes mellitus, por meio de três consultas de enfermagem, na unidade de saúde e no domicílio, com intervalo de um mês entre as três consultas de todos os participantes. Foi utilizado um roteiro contendo variáveis sociodemográficos e clínicas e o teste de Medida de Adesão ao Tratamento. Para a análise da adesão, durante e após a intervenção, utilizou-se a estatística descritiva e o teste de Mann- Whitney; para a comparação do antes e após a intervenção, utilizou-se o teste de Wilcoxon; para análise de correlação com as variáveis numéricas, o coeficiente de correlação de Spearman e o teste Q de Cochran, para a comparação dos exames nos momentos anterior, durante e posterior à intervenção. Os resultados mostraram que os participantes tinham entre 33 e 79 anos, sendo 58,1% do sexo feminino; 71% tinham companheiro; renda familiar de 1 a 3 salários-mínimos (83,9%); 80,6% referiram ser profissionalmente inativos (aposentados, pensionistas ou do lar); média de 5,68 anos de estudo e predomínio de menos de 8 anos de estudo (67,7%). Em relação aos valores da pressão arterial sistêmica constatou hipertensão arterial sistêmica grau I em 25,8% das pessoas com diabetes mellitus, 90,3% com índice de massa corporal apresentando excesso de peso, quanto à circunferência abdominal, 32,2% dos homens estavam com valores maiores que 102 cm e 45,2% das mulheres com valores acima de 88 cm. A avaliação dos pés, com uso do monofilamento Semmes-Weinstein de 10g, apresentou 9,7% das pessoas com diabetes mellitus com pé em risco para ulceração e diminuição ou ausência de sensibilidade tátil pressórica protetora dos pés. O tempo de diagnóstico do diabetes mellitus tipo 2 variou entre 1 a 39 anos, predominando as comorbidades hipertensão arterial (83,9%), dislipidemia (58,1%) e obesidade (41,8%). Quanto aos exames laboratoriais, observa-se que, em 64,5% da população estudada, os níveis da glicemia de jejum estavam acima de 100 mg/dL , ocorrendo pequena redução para 61,3% nos casos de pessoas com diabetes mellitus durante a intervenção e se manteve após. No que se refere à glicemia pós-prandial, os casos das pessoas com diabetes mellitus com valores iguais ou acima de 160 mg/dL, antes da intervenção era de 45,2% e durante e após a intervenção caiu para 38,7%. Em contrapartida, aumentou o número de pessoas com diabetes mellitus durante e após a intervenção, com valores da glicemia pós-prandial abaixo de 160 mg/dL, de 54,8% para 61,3%. E, em relação à hemoglobina glicada, foi observado que em 61,3% das pessoas com diabetes mellitus os valores antes da intervenção eram iguais ou acima de 7%. Durante a intervenção, caiu para 19,3% e após a intervenção o número de pessoas com diabetes mellitus, com a hemoglobina glicada igual ou superior a 7%, chegou a 38,7%. Quanto aos valores abaixo de 7%, observou-se aumento de 38,7% antes da intervenção para 80,6 e 61,3% respectivamente, durante e após a intervenção, com diferença estatisticamente significante (p< 0,001). As pessoas com diabetes mellitus desse estudo, apresentaram 83,87% de adesão ao tratamento antes da intervenção, e esses escores subiram para 96,78% após a intervenção, fato corroborado pelo teste de Wilcoxon que mostrou escores estatisticamente significantes (p<0,001), entre antes e após a intervenção. Esse estudo contribui para ressaltar a importância do enfermeiro, enquanto integrante da equipe multiprofissional, seguindo as orientações do \"Protocolo de atendimento ao indivíduo com diabetes\", tanto no atendimento individual quanto em grupo, reorganizando o processo de trabalho, contribuindo para maior adesão ao tratamento e controle dos níveis glicêmicos, ao minimizar a fragmentação e assegurar a continuidade na assistência, por meio de abordagem integral ao diabético

Control glucémico a través del ejercicio físico en pacientes con diabetes mellitus tipo 2; revisión sistemática

Introducción: En España, cerca del 14% de la población es diabética y el 95% corresponde a DM2. Un pobre control glucémico provoca un aumento de la morbilidad y mortalidad. Tres son los pilares en el tratamiento de la DM2: la dieta, la medicación y el ejercicio físico, sin embargo, el potencial de la prescripción de entrenamiento físico no ha sido totalmente explotado. Objetivo: Analizar el efecto de las distintas modalidades de ejercicio físico (AE, RT, Combo, INT) en el control glucémico en pacientes con diabetes mellitus tipo 2. Métodos: La búsqueda bibliográfica se realizó en 3 bases de datos electrónicas (Pubmed, Scopus y Proquest), incluyendo publicaciones desde enero de 2011 hasta mayo de 2014, que realizaran la intervención con AE, RT, Combo o INT, y que midieran la glucemia a través de la glucosa capilar, CGMS o HbA1c. Resultados: Del total de 386 artículos encontrados, 14 cumplieron los criterios de inclusión. Estos artículos fueron clasificados atendiendo a la modalidad de ejercicio físico de la intervención (AE, RT, Combo, INT), y en función de si analizaban el control glucémico como consecuencia del entrenamiento a largo plazo o tras una sesión de entrenamiento. Conclusiones: El AE, RT, Combo e INT muestran eficacia en el control glucémico tanto en el entrenamiento prolongado como en las 24-48h post-entrenamiento. Es necesaria la prescripción de un entrenamiento estructurado con una frecuencia, volumen e intensidad determinados para lograr beneficios en el control glucémico. El combo es la modalidad que obtiene mejores resultados a través del entrenamiento a largo plazo.

Déterminer le lien entre l’hyperglycémie et/ou l’hypoinsulinémie et la dégradation clinique observée avant le diagnostic du Diabète Associé à la Fibrose Kystique

La Fibrose kystique (FK) est une maladie génétique qui se traduit par une destruction progressive des poumons et éventuellement, à la mort. La principale complication secondaire est le diabète associé à la FK (DAFK). Une dégradation clinique (perte de poids et de la fonction pulmonaire) accélérée est observée avant le diagnostic. L’objectif principal de mon projet de doctorat est de déterminer, par l’intermédiaire du test d’hyperglycémie provoquée par voie orale (HGPO), s’il existe un lien entre l’hyperglycémie et/ou l’hypoinsulinémie et la dégradation clinique observée avant le diagnostic du DAFK. Nous allons ainsi évaluer l’importance des temps intermédiaires de l’HGPO afin de simplifier le diagnostic d’une dysglycémie ainsi que d’établir des nouveaux marqueurs indicateurs de patients à risque d’une détérioration clinique. L’HGPO est la méthode standard utilisée dans la FK pour le diagnostic du DAFK. Nous avons démontré que les valeurs de glycémie obtenues au temps 90-min de l’HGPO seraient suffisantes pour prédire la tolérance au glucose des patients adultes avec la FK, autrement établie à l’aide des valeurs à 2-h de l’HGPO. Nous proposons des glycémies à 90-min de l’HGPO supérieure à 9.3 mmol/L et supérieure à 11.5 mmol/L pour détecter l’intolérance au glucose et le DAFK, respectivement. Une cause importante du DAFK est un défaut de la sécrétion d’insuline. Les femmes atteintes de la FK ont un risque plus élevé de développer le DAFK que les hommes, nous avons donc exploré si leur sécrétion était altérée. Contrairement à notre hypothèse, nous avons observé que les femmes avec la FK avaient une sécrétion d’insuline totale plus élevée que les hommes avec la FK, mais à des niveaux comparables aux femmes en santé. Le groupe de tolérance au glucose récemment proposé et nommé indéterminé (INDET : 60-min HGPO > 11.0 mais 2h-HGPO <7.8mmol/L) est à risque élevé de développer le DAFK. Par contre, les caractéristiques cliniques de ce groupe chez les patients adultes avec la FK n’ont pas été établies. Nous avons observé que le groupe INDET a une fonction pulmonaire réduite et similaire au groupe DAFK de novo et aucun des paramètres glucidiques et insulinémiques expliqueraient cette observation. Dans une population pédiatrique de patients avec la FK, une association a été rapportée entre une glycémie élevée à 60-min de l’HGPO et une fonction pulmonaire diminuée. Dans notre groupe de patients adultes avec la FK, il existe une association négative entre la glycémie à 60-min de l’HGPO et la fonction pulmonaire et une corrélation positive entre l’insulinémie à 60-min de l’HGPO et l’indice de masse corporelle (IMC). De plus, les patients avec une glycémie à 60-min HGPO > 11.0 mmol/L ont une fonction pulmonaire diminuée et une sensibilité à l’insuline basse alors que ceux avec une insulinémie à 60-min HGPO < 43.4 μU/mL ont un IMC ainsi qu’une fonction pulmonaire diminués. En conclusion, nous sommes le premier groupe à démontrer que 1) le test d’HGPO peut être raccourci de 30 min sans compromettre la catégorisation de la tolérance au glucose, 2) les femmes avec la FK démontrent une préservation de leur sécrétion de l’insuline, 3) le groupe INDET présente des anomalies précoces de la fonction pulmonaire comparable au groupe DAFK de novo et 4) la glycémie et l’insuline à la première heure de l’HGPO sont associées aux deux éléments clefs de la dégradation clinique. Il est crucial d’élucider les mécanismes pathophysiologiques importants afin de mieux prévoir la survenue de la dégradation clinique précédant le DAFK.