Um modelo analítico da qualidade da dieta de adolescentes estudantes da rede publica de ensino de Natal, Brasil

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

Tratamento de fístulas enterocutâneas através de sistema a vácuo com alta pressão e dieta oral normal

Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increase in hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. Normal oral diet was permitted. Results: No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after five days, 16(22%) after 10 days and 4(5%) after 15 days. Treatment failed in 6(8%) patients, who subsequently underwent surgery. Only one patient with low-output did not close her fistula. The cost of the treatment was US$ 41.75/day and it was considered cost effective. Conclusions: The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns

Biodistribuição do pertecnetato de sódio (Na99mTcO4) em ratos submetidos à ressecção extensa de intestino delgado

Massive resection of the small intestine results in short bowel syndrome with anti-absorptive effect and repercussions on the metabolism. Morphologic and functional evaluation may be necessary in order to control wrapped organs. Scintigraphy an examination with little invading and no biologic damage can be used. The purpose were to assess the biodistribution of sodium pertecnetate in organs of rats subjected to massive resection of the small intestine, the intestinal adaptation of the remnant intestinal mucosa and weight curve evaluation in the postoperative period. Twenty-one Wistar rats were randomly allocated into three groups (n = 7). The operated group named short bowel (SB) after anesthetized was subjected to massive resection of the small intestine; the control group (C), and sham group (SHAM). On the 30th postoperative day, 0.l mL of sodium pertechnetate was injected into the venous orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The percentage of radioactivity per gram of tissue (%ATI/g) was determined using Gama Counter WizardTM 1470, PerkinElmer to all samples. Biopsies of 3 cm remaining jejunum were removed to histological analyses. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. The study had the participation of some departments and laboratories, as Nucleus of Experimental Surgery, Department of Surgery, Laboratory of Radiobiology, Department of Pathology and Service of Nuclear Medicine, certifying the character of a multidisciplinary research. The results were no significant differences in %ATI/g of the sodium pertechnetate in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05. The biodistribution of sodium pertechnetate was not affected by massive intestinal resection in rats. An adaptive response by the intestinal mucosa probably contributed to the reversion of weight loss and the biodistribution of sodium pertechnetate was not affected by the surgery

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

Valores de referência para cobre e zinco no plasma e no eritrócito em adultos universitários na cidade de Natal-RN

This study aimed builds reference values for copper and zinc, of healthy adults in Natal-RN, and to identify the influence of the gender, age, body mass index (BMI) and diet, on those values. They were assessed 123 healthy students of the Universidade Federal do Rio Grande do Norte (UFRN), both genders, with age between 19 and 41 years. The project was approved by the Ethics Committee in Research of UFRN. BMI was determined and the food consume was accomplished through a 24h recordatory. Dietary was evaluated as the energy, macronutrients, copper and zinc, according to the recommendations of National Academy of Sciences (2001; 2002). Analyses of the copper and zinc concentrations in the plasma and erythrocytes were accomplished by flame atomic absorption spectrometry. The casuistic came quite homogeneous as for the distribution for gender and age, being the largest number of individuals between the 19 and 24 years old. Most of the volunteers presented anthropometric nutritional state inside of the normality patterns. Chronic diseases family antecedents and sedentarysm were observed. Diet was characterized with low consumption of zinc, appropriate of copper and of lipids. Average concentrations of plasma copper (p=0,002), erythrocyte copper (μg/dL, p=0,036; μg/gHb, p=0,038), and plasma zinc (p=0,022) were different among the genders, what was demonstrated by the largest values of copper in the female gender and larger of zinc in the masculine. Plasma copper values still suffered interference of the variables: energy, carbohydrate and copper consumption, all classified in agreement with the median, besides the protein classified according to the percentage contribution for the dietary total energy. The study allowed to establish reference values for erythrocyte zinc (1.261,6-1.344,0 μg/dL e 51,0-54,3 μg/gHb) and to suggest "indicative" of reference values for plasma (108,4 130,2 μg/dL) and erythrocyte (female = 85,0 91,4 μg/dL; masculine = 80,2 86,5 μg/dL) copper and plasma zinc (female = 98,8 105,8 μg/dL; masculine = 104,6 111,6 μg/dL)

Osteopenia diabética e pós-menopausa: efeito metabólico do zinco na recuperação do volume ósseo trabecular

Diabetes mellitus has been associated with bone metabolism alterations, such as osteopenia and osteporosis. So, the search of new anabolic agents promote bone mass gain can be important to prevent osteoporosis. The aim of this study was evaluate zinc anabolic effect over bone in diabetic and post-menopausal osteopenic models. Diabetes was induced by STZ (45mg/Kg of body weight) administration and post-menopausal by bilateral ovariectomy. Adults female Wistar rats (n=65) were divided in 5 groups: control group (n=15), ovariectomized without (n=15) and with zinc supplementation (n=10) groups, diabetic and ovarioctomized without (n=15) and with zinc supplementation (n=10) groups. Studied periods had been untill 90 days. Diabetic condition was confirmed hiperglicemic state and alterations of state with polyuria, polyphagia, polydipsia and glucosuria. Histomorphometric analysis showed that zinc supplementation increased trabecular thickness and reduced trabecular distance significantly in diabetic groups with similar values to those showed in control group. Correlation analysis of histomorphometric parameters with serum glucose concentration showed that more time in hyperglycemia more bone damage, as well as, zinc supplementation contributed to prevent this damage. Elevated serum glucose caused hyperzincuria, phosphaturia and calciuria. Zinc supplementation promoted increased levels of calcium and phosphorous ions in 90th days diabetic group. No alteration was observed by ovariectomy in mineral (Ca, P and Zn) serum and urine concentrations. Total serum Alkaline Phosphatase activity increased in diabetic groups, supplemented or not, compared with control group. However, Tartarate-Resistant Acid Phosphatase, magnesium and serum zinc did not altered in studied groups. Serum albumin was reduced only in diabetic groups. Serum creatinine was unaltered. These results support the hypotesis that zinc can be used to prevent and treat diabetic and post-menopausal osteopenia

Avaliação da presença de osteopatia decorremte do diabetes tipo 1 em criança e adolecentes do Rio Grande do Norte

Diabetes Mellitus (DM) and osteoposes are chronic diseases with great socioeconomic consequences, mainly due to the late complications and consequent disabilities. The potential effects of DM on bone metabolism remain a very conroversial issue, and disagreement exists with regard to the clinical implications of diabetic osteopenia and the mechanism of its ocurrence. The issue is further complicated by the contribuicion of the especific factors, such as duration of disease an dthe degree of metabolic control. The objective of this study is to identify the osteopathy in children and adolescents with DM 1 assisted in the hospital of pediatrics, UFRN, through biochemical markers of bone and mineral metabolism and the extent of bone mineral density. The study was composed by 74 diabetics type 1 patients (DM1) of both gender and aged 6 to 20 yars. Normoglicêmic group was composed by 97 healthy subjects of both genders, which showed the same age range of DM1, in addition to same socioeconomic class. These individuals qere students from the networks of public education in the city of Natal-RN, randomly invited to paticipate in our study. Both groups DM1 and NG were divided intofour subgroups, according to the classification of tanner , T1, T2, T3, T4 for achieving a benchmark. Diabetic individuals showed up with a poor glycemic control. the group DN1 T4 showed an incresead value for total protein, albumin, urea and microalbumiuria are predictors of grumelura injury in DM1 patients . The total alkaline phosphatase activitywas kept on high levels for both groups because they are in a stature development age. For osteocalcin there were decreased levels for groups Dm1 T1, T2, and T3 when compared to their NG (s), suggesting that this decrease could be associated with reduction in the number and/or differentiation os osteoblasts thereby contributing to reducing bone formation. There were no changes in the activity of TRAP. The serum concentrations of total and ionized calcium, phosphorus and magnesium were included within the RV. It was observed that the BMD (Z- SCORE ) has always been within the RV for both groups, despite to DM1 T4. Taking all together, our results support the hypothesis that children and adolescents with type 1 DM present the risk in the long run to suffer a reduction in the bone mass, associated to poor glicemic control and disease duration. It could limit the bone growth and increase the probality of development of osteopenia, as well as other complications surch as retinopathy and renal failure

Avaliação do estado nutricional relativo ao selênio e da expressão gênica de selenoproteínas em pacientes com aterosclerose tratados com estatinas

The aim of this study was to determine the effects of the use of rosuvastatin in patients with atherosclerosis, in relation to blood parameters of selenium and selenoproteins, and also observe possible changes in gene expression of selenoproteins in these patients. The sample consisted of 27 adult and elderly patients with a clinical diagnosis of coronary artery disease undergoing angioplasty, treated at Natal Hospital Center hospital, Natal, RN. Patients were treated with rosuvastatin 10 mg/day during four months. Anthropometric variables such as body mass index (BMI) and Waist circumference (WC) were measured before and after treatment, as well as lipid profile, blood glucose and liver enzymes (AST and ALT). The diet of the patients was also analyzed using 24-hour diet recall. We analyzed the concentrations of selenium in plasma and erythrocytes, and also the activity of Glutathione Peroxidase and gene expression by Real Time PCR of selenoproteins GPx1, SelP1 and SelN1. Patients had mean age of 61.0 ± 9.4 years, 59.3% were men and 40.7% were women. After four months of treatment there was significant reduction of CA and, according to BMI, most were overweight. The intake of macronutrients, cholesterol, polyunsaturated fatty acids, monounsaturated and saturated was adequate, but the energy and fiber intake was below the recommendations. Regarding the selenium intake was observed a high prevalence of inadequacy. As expected, after treatment with rosuvastatin, a significant reduction in total cholesterol, LDL and glucose, which was not observed for HDL. Selenium concentrations in plasma and erythrocytes showed no changes, keeping within the established cutoffs. We observed a significant increase in GPx enzyme activity and mRNA expression of GPX1 and SEPN1, but not for gene SEPP1. Thus, it was found that treatment with rosuvastatin did not reduce the expression of selenoproteins. More studies are needed to clarify the effects of rosuvastatin on gene expression of selenoproteins in patients with atherosclerosis

Avaliação do status de zinco e da expressão gênica de metalotioneínas em pacientes com aterosclerose tratados com rosuvastatina

The study had as objective to evaluate the zinc status by means of dietary intake, zinc in plasma and in erythrocytes and the metallothionein gene expression in patients with atherosclerosis in use of rosuvastatin. The research involved 27 adult and elderly patients of both genders with atherosclerosis that were treated with rosuvastatin (10mg/day) during 4 months. We performed the dosage of lipids, glucose, AST and ALT, ultrasensitive C-reactive protein (hsCRP), plasmatic and erythrocyte zinc and 1 and 2 metallothionein gene expression. The assessment of body mass index (BMI) and abdominal circumference (AC) was performed, besides the analysis of dietary intake of patients. The majority of the evaluated patients presented overweight, before and after the treatment, with no significant difference between the times of the study. It was identified that the AC was significantly reduced in the group (p<0.05) after the intervention. The majority of the patients had intake below the recommendation of calories and fibers and above recommendation of proteins. The mono and polyunsaturated fats were adequate for the majority of the patients, however, the saturated fat and cholesterol were consumed in excess by a great part of the individuals. The intake of zinc was inadequate, being noticed an inadequacy of 100% in the male gender and of 84% in the female. After the treatment with rosuvastatin there was a significant reduction in the total cholesterol (TC) and LDL-c (p<0.01) and no alterations were observed in the HDL-c and triacylglycerols. It was also verified that the reduction of glycemia (p<0.05) and of hsCRP (p<0.01). The analysis did not demonstrate significant differences in the plasmatic and erythrocyte zinc concentration after the treatment. There was, after the treatment, reduction of the MT1F gene (p<0.05) without, however, occurring significant alterations in the MT2A gene. The treatment with rosuvastatin was effective in the reduction of TC and LDL-c, and promoted the reduction of inflammatory marker hsCRP. The zinc in the plasma and erythrocyte was not altered by the use of the medication and there was a reduction in the MT1F gene, possibly due to the reduction of inflammation. The majority of patients presented inadequate intake of zinc and this inadequacy did not have relation with the mineral parameters in plasma and erythrocytes or with the metallothionein gene expression

Extra dimensions at the CERN LHC via mini-black holes: Effective Kerr-Newman brane-world effects

We solve Einstein equations on the brane to derive the exact form of the brane-world-corrected perturbations in Kerr-Newman singularities, using Randall-Sundrum and Arkani-Hamed-Dimopoulos-Dvali (ADD) models. It is a consequence of such models that Kerr-Newman mini-black holes can be produced in LHC. We use this approach to derive a normalized correction for the Schwarzschild Myers-Perry radius of a static (4+n)-dimensional mini-black hole, using more realistic approaches arising from Kerr-Newman mini-black hole analysis. Besides, we prove that there are four Kerr-Newman black hole horizons in the brane-world scenario we use, although only the outer horizon is relevant in the physical measurable processes. Parton cross sections in LHC and Hawking temperature are also investigated as functions of Planck mass (in the LHC range 1-10 TeV), mini-black hole mass, and the number of large extra dimensions in brane-world large extra-dimensional scenarios. In this case a more realistic brane-effect-corrected formalism can achieve more precisely the effective extra-dimensional Planck mass and the number of large extra dimensions-in the Arkani-Hamed-Dimopoulos-Dvali model-or the size of the warped extra dimension-in Randall-Sundrum formalism.

Quantization of the electromagnetic field outside static black holes and its application to low-energy phenomena

We discuss the Gupta-Bleuler quantization of the free electromagnetic field outside static black holes in the Boulware vacuum. We use a gauge which reduces to the Feynman gauge in Minkowski spacetime. We also discuss its relation with gauges used previously. Then we apply the low-energy sector of this held theory to investigate some low-energy phenomena. First, we discuss the response rate of a static charge outside the Schwarzschild black hole in four dimensions. Next, motivated by string physics, we compute the absorption cross sections of low-energy plane waves for the Schwarzschild and extreme Reissner-Nordstrom black holes in arbitrary dimensions higher than three.

Do static sources respond to massive scalar particles from the Hawking radiation as uniformly accelerated ones do in the inertial vacuum?

We examine the recently found equivalence for the response of a static scalar source interacting with a massless Klein-Gordon field when the source is (i) static in Schwarzschild spacetime, in the Unruh vacuum associated with the Hawking radiation, and (ii) uniformly accelerated in Minkowski spacetime, in the inertial vacuum, provided that the source's proper acceleration is the same in both cases. It is shown that this equivalence is broken when the massless Klein-Gordon field is replaced by a massive one.

Semiclassical approach to black hole absorption of electromagnetic radiation emitted by a rotating charge

We consider an electric charge, minimally coupled to the Maxwell field, rotating around a Schwarzschild black hole. We investigate how much of the radiation emitted from the swirling charge is absorbed by the black hole and show that most of the photons escape to infinity. For this purpose we use the Gupta-Bleuler quantization of the electromagnetic field in the modified Feynman gauge developed in the context of quantum field theory in Schwarzschild spacetime. We obtain that the two photon polarizations contribute quite differently to the emitted power. In addition, we discuss the accurateness of the results obtained in a full general relativistic approach in comparison with the ones obtained when the electric charge is assumed to be orbiting a massive object due to a Newtonian force.

Scaler radiation emitted from a source rotating around a black hole

We analyse the scalar radiation emitted from a source rotating around a Schwarzschild black hole using the framework of quantum held theory at the tree level. We show that for relativistic circular orbits the emitted power is about 20-30% smaller than what would be obtained in Minkowski spacetime. We also show that most of the emitted energy escapes to infinity. Our formalism can readily be adapted to investigate similar processes.