961 resultados para 0.9 per mil were added


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The aim of this study was to investigate the survival of freeze dried Lactobacillus plantarum cells mixed with several freeze dried instant fruit powders (strawberry, pomegranate, blackcurrant and cranberry) during storage for 12 months as well as after reconstitution with water each month. Inulin and gum arabic were also added to the instant fruit powders at two levels (10% and 20% w/w of dry weight) to improve the cell survival and functional properties of the product. The best cell survival over the 12 months of storage was observed for the blackcurrant powder (almost no decrease) followed by strawberry (~ 0.3 log decrease), pomegranate (~ 0.9 log decrease), whereas the worst survival was obtained in cranberry powder (~ 4.5 logs). To explain these results multiple regression analysis was conducted with the log decrease [log10N0 month − log10N12 months] as the dependent variable and water activity, pH, citric acid, dietary fibre and total phenol as the independent variables. The results indicated that among all the examined factors, the [log10N0 month − log10N12 months] depended only on the water activity (P < 0.05). Inulin and gum arabic demonstrated a substantial protective effect on cell survival (1–1.5 log) in the case of cranberry, which was likely due to a physical interaction between the cells and the carbohydrates. After reconstituting the dried fruit powders at room temperature and measuring cell viability for up to 4 h, it was shown that in the case of strawberry juice there was no decrease, and very little in the case of pomegranate and blackcurrant juices (< 0.5 log). On the other hand, a significant decrease was observed for cranberry juice (P < 0.05), which increased as the storage time of the dried cranberry powder increased, indicating that the cells became more susceptible with prolonged storage. Multiple regression analysis indicated that the main factors influencing cell survival were water activity and pH, while citric acid, dietary fibre and total phenol did not have an effect. Furthermore, inulin and gum arabic addition did not have a significant (P > 0.05) effect upon reconstitution of the dried fruit powder. This study showed that instant juice powders are very good carriers of probiotic cells and constitute good alternatives to highly acidic fruit juices.

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We describe a simple, inexpensive, but remarkably versatile and controlled growth environment for the observation of plant germination and seedling root growth on a flat, horizontal surface over periods of weeks. The setup provides to each plant a controlled humidity (between 56% and 91% RH), and contact with both nutrients and atmosphere. The flat and horizontal geometry of the surface supporting the roots eliminates the gravitropic bias on their development and facilitates the imaging of the entire root system. Experiments can be setup under sterile conditions and then transferred to a non-sterile environment. The system can be assembled in 1-2 minutes, costs approximately 8.78$ per plant, is almost entirely reusable (0.43$ per experiment in disposables), and is easily scalable to a variety of plants. We demonstrate the performance of the system by germinating, growing, and imaging Wheat (Triticum aestivum), Corn (Zea mays), and Wisconsin Fast Plants (Brassica rapa). Germination rates were close to those expected for optimal conditions.

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An in vitro study was conducted to investigate the effects of condensed tannins (CT) structural properties, i.e. average polymer size (or mean degree of polymerization); percentage of cis flavan-3-ols and percentage of prodelphinidins in CT extracts on methane production (CH4) and fermentation characteristics. CT were extracted from eight plants in order to obtain different CT types: black currant leaves, goat willow leaves, goat willow twigs, pine bark, red currant leaves, sainfoin plants, weeping willow catkins and white clover flowers. They were analysed for CT content and CT composition by thiolytic degradation, followed by HPLC analysis. Grass silage was used as a control substrate. Condensed tannins were added to the substrate at a concentration of 40 g/kg, with or without polyethylene glycol (+ or −PEG 6000 treatment) to inactivate tannins, and then incubated for 72 h in mixed buffered rumen fluid from three different lactating dairy cows per run. Total cumulative gas production (GP) was measured by an automated gas production system. During the incubation, 12 gas samples (10 μl) were collected from each bottle headspace at 0, 2, 4, 6, 8, 12, 24, 30, 36, 48, 56 and 72 h of incubation and analyzed for CH4. A modified Michaelis–Menten model was fitted to the CH4 concentration patterns and model estimates were used to calculate total cumulative CH4 production (GPCH4). Total cumulative gas production and GPCH4 curves were fitted using biphasic and monophasic modified Michaelis-Menten models, respectively. Addition of PEG increased GP, GPCH4, and CH4 concentration compared to the −PEG treatment. All CT types reduced GPCH4 and CH4 concentration. All CT increased the half time of GP and GPCH4. Moreover, all CT decreased the maximum rate of fermentation for GPCH4 and rate of substrate degradation. The correlation between CT structure and GPCH4 and fermentation characteristics showed that the proportion of prodelphinidins within CT had the largest effect on fermentation characteristics, followed by average 27 polymer size and percentage of cis-flavan-3-ols.

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P>Aim To evaluate in vitro the effect of calcium hydroxide [Ca(OH)(2)] and Er:YAG laser on bacterial endotoxin [also known as lipopolysaccharide (LPS)] as determined by nitric oxide (NO) detection in J774 murine macrophage cell line culture. Methodology Samples of LPS solution (50 mu gmL-1), Ca(OH)(2) suspension (25 mg mL-1) and LPS suspension with Ca(OH)(2) were prepared. The studied groups were: I - LPS (control); II - LPS + Ca(OH)(2); III - LPS + Er:YAG laser (15 Hz 140 mJ); IV - LPS + Er:YAG laser (15 Hz 200 mJ); V - LPS + Er:YAG laser (15 Hz 250 mJ), VI - Pyrogen-free water; VII - Ca(OH)(2). Murine macrophage J774 cells were plated and 10 mu L of the samples were added to each well. The supernatants were collected for NO detection by the Griess reaction. Data were analysed statistically by one-way anova and Tukey`s test at 5% significance level. Results The mean and SE (in mu mol L-1) values of NO release were: I - 10.48 +/- 0.58, II - 6.41 +/- 0.90, III - 10.2 +/- 0.60, IV - 8.35 +/- 0.40, V - 10.40 +/- 0.53, VI - 3.75 +/- 0.70, VII - 6.44 +/- 0.60; and the values for the same experiment repeated after 1 week were: I - 21.20 +/- 1.50, II - 9.10 +/- 0.60, III - 19.50 +/- 1.00, IV - 18.50 +/- 0.60, V - 21.30 +/- 0.90, VI - 2.00 +/- 0.20, VII - 6.80 +/- 1.70. There was no significant difference (P > 0.05) between the control and the laser-treated groups (III, IV and V), or comparing groups II, VI and VII to each other (P > 0.05). Group I had significantly higher NO release than group II (P < 0.05). Groups II and VI had similar NO release (P > 0.05). Conclusions Calcium hydroxide inactivated the bacterial endotoxin (LPS) whereas none of the Er:YAG laser parameter settings had the same effectiveness.

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The aim of this study was to investigate endothelial venous function, mflammatory markers, and systemic oxidative stress after an oral lipid overload (OLO). We studied 18 healthy adults (9 men; age, 29.2 +/- 0.9 years; body mass index, 22.3 +/- 0.4 kg/m(2)). Blood samples were collected in the fasting state and 3, 4, and 5 hour after the OLO (1000 kcal, 58% fat) for metabolic variables, oxidative stress, inflammatory markers, adiponectin, and resistin. Changes in vein diameter to phenylephrine, acetylcholine, and sodium nitroprusside (dorsal hand vein technique) were measured before and after the OLO. Oral lipid overload increased triglycerides (61 +/- 6 vs 134 +/- 17 mg/dL, P <.001), insulin (7.2 +/- 0.8 vs 10.7 +/- 1.3 mu U/mL, P <.05), and resistin (5.38 +/- 0.5 vs 6.81 +/- 0.7 ng/mL, P <.05) and reduced antioxidant capacity (plasma total antioxidant capacity: 186.7 +/- 56 vs 161.8 +/- 50 U Trolox per microliter plasma, P <.01), vascular reactivity (171.3 +/- 85 vs 894.4 +/- 301 ng/mL, P <.001), and maximum acetylcholine venodilation (105.9% +/- 9% vs 61.0% +/- 7%, P <.05). No changes were observed for sodium nitroprusside. Post-OLO triglycerides were positively correlated with phenylephrine dose (rho = 0.38, P <.05) and resistin (rho = 0.43, P <.01) and negatively correlated with the maximum acetylcholine venodilation (rho = -0.36, P <.05). In conclusion, an OLO impaired venoconstriction responsiveness in healthy subjects, probably because of a reduction in the antioxidant capacity. (C) 2008 Elsevier Inc. All rights reserved.

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We investigate the formation of ferrihydrite nanoparticles (NPs) by hydrolysis of the Fe(III) alkoxide Fe(O(t)Bu)(3). Controlled amounts of water, up to 3.0 vol%, were added to the precursor solution yielding a series of hydrolyzed samples ranging from P0.0 (the unreacted precursor) to P3.0. X-ray diffraction (XRD) analysis evidenced the formation of high-crystalline ferrihydrite NP in sample P3.0, with grain size estimate of about 3.2 nm. The transition from the molecular precursor to the formation of crystalline magnetic NPs was followed through magnetization measurements M(T) and M(H), as well as Mossbauer spectroscopy (MS). M(T) measurements indicate a paramagnetic (PM) behavior for sample P0.0, characteristic of binuclear Fe-O-Fe units, which evolves to a superparamagnetic (SPM) behavior, with an energy barrier for the blocking process estimated for sample P3.0 as E(a) = 4.9 x 10(-21) J (E(a)/k(B) = 355 K), resulting in a high effective anisotropy constant K(eff) = 290 kJ/m(3). Magnetization loops at 5 K progressively change from PM-like to ferromagnetic-like shape upon increasing the hydrolysis process, although hysteresis (H(c) approximate to 500 Oe) only is apparent for P2.0 and higher. MS spectra at room temperature are PM/SPM doublets for all samples, while the MS spectra at T = 4.2 K reveal increasingly well-defined magnetic ordering as hydrolysis of the precursor stepwise progresses until well-crystallized ferrihydrite particles are formed. (C) 2008 Elsevier B.V. All rights reserved.

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The Araes gold deposit, located in eastern Mato Grosso State, central Brazil, is hosted in Neoproterozoic volcanosedimentary rocks of the Paraguay belt, which formed during collision of the Amazonian craton and the Rio Apa block. Ar-40/Ar-39 geochronology and Pb and S isotopic analyses constrain the timing and sources of mineralization. Three biotite flakes from two samples of metavolcanic host rock yield Ar-40/Ar-39 plateau ages between 5941 and 531 Ma, interpreted as cooling ages following regional metamorphism. Clay minerals from a hydrothermal alteration zone yield an Ar-40/Ar-39 integrated age of 503 +/- 3 Ma. Galena grains from ore-bearing veins yield values of Pb-206/(204)pb from 17.952 to 18.383, Pb-207/Pb-204 from 15.156 to 15.811, and Pb-208/Pb-204 from 38.072 to 39.681. Pyrite grains from ore-bearing veins yield values of Pb-206/Pb-204 from 18.037 to 18.202, Pb-207/Pb-204 from 15.744 to 15.901., and Pb-208/(204)pb from 38.338 to 38.800. Pb isotope variations may be explained in terms of mixing a less radiogenic lead component (mu similar to 8.4) from mafic and ultramafic basement host-rocks (Nova Xavantina metavolcanosedimentary rocks) and a more radiogenic lead component (mu similar to 9.2) probably derived from supracrustal rocks (Cuiaba sedimentary groups). Sulfur isotope compositions are homogeneous, with delta S-34 values ranging from -1.1 parts per thousand to 0.9 parts per thousand (galena) and -0.7 parts per thousand to 0.9 parts per thousand (pyrite), suggesting a mantle-derived reservoir for the mineralizing solutions. Based on the Ar, Pb, and S isotope data, we suggest that the precious metals were remobilized from metavolcanic host rocks by hydrothermal solutions during Brasilide-Panafrican regional metamorphism. The Arabs gold deposit probably formed during a late stage of the orogeny, coeval with other mineralization events in the Paraguay Belt.

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Ca isotopic compositions of Marinoan post-glacial carbonate successions in Brazil and NW Canada were measured Both basal dolostones display delta(44/40)Ca values between 1 and 0 7 parts per thousand overlying limestones show a negative Ca isotope excursion to values around 0 1 parts per thousand and delta(44/40)Ca values rapidly increase up-section to near 2 0 parts per thousand In the Brazilian successions those high delta(44/40)Ca values rapidly decrease and stabilize to values between 0 6 and 0 9 parts per thousand These Ca isotope secular variation trends are unlike those of Sturtian post-glacial carbonate successions but similar to those of Marinoan post-glacial carbonate successions in Namibia suggesting that the perturbation of the marine Ca cycle was global This recommends Ca isotope stratigraphy as a tool to correlate Neoproterozoic post-glacial carbonate successions worldwide While the lowermost and uppermost strata have delta(44/40)Ca values typical of Phanerozoic carbonates the extremes 0 1 and 2 0 parts per thousand have not been thus far reported for other marine carbonates These extreme values suggest a short-lived non-actualistic perturbation in the marine Ca cycle Simple box modelling of the Marinoan post-glacial marine Ca cycle can reproduce the extreme values only by postulating a two-step process with Ca input initially exceeding Ca removal trough carbonate precipitation followed by precipitation overtaking a decreased Ca Input (C) 2010 Elsevier B V All rights reserved

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The electrochemical behavior of ISO 5832-9 stainless steel at 37 degrees C in 0.9% NaCl, Ringer Lactate and minimum essential medium (MEM) has been studied, using linear voltammetry, and surface analysis by SEM and EDS. Mechanical and toxicity tests were made. ISO 5832-9 is passivated at corrosion potential (E) and it does not present pitting corrosion on the media studied from to 50 in V above the transpassivation potential (Ei). SEM and EDS analysis have shown that the sample previously immersed in MEM presents a diffirent behavior at 50 in V above El: the manganese oxide inclusions are absent in the surface. E. values and passivation current density values j(pass) changed according to the following. E(corr, RL) < E(corr,NaCl) < E(corr, MEM) and J (MEM) << j(RL) congruent to j(NaCl) The stainless steel was characterized as non toxic in the cytotoxicity assay

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A fast and robust analytical method for amperometric determination of hydrogen peroxide (H(2)O(2)) based on batch injection analysis (BIA) on an array of gold microelectrodes modified with platinum is proposed. The gold microelectrode array (n = 14) was obtained from electronic chips developed for surface mounted device technology (SMD), whose size offers advantages to adapt them in batch cells. The effect of the dispensing rate, volume injected, distance between the platinum microelectrodes and the pipette tip, as well as the volume of solution in the cell on the analytical response were evaluated. The method allows the H(2)O(2) amperometric determination in the concentration range from 0.8 mu mol L(-1) to 100 mu mol L(-1). The analytical frequency can attain 300 determinations per hour and the detection limit was estimated in 0.34 mu mol L(-1) (3 sigma). The anodic current peaks obtained after a series of 23 successive injections of 50 mu L of 25 mu mol L(-1) H(2)O(2) showed an RSD < 0.9%. To ensure the good selectivity to detect H(2)O(2), its determination was performed in a differential mode, with selective destruction of the H(2)O(2) with catalase in 10 mmol L(-1) phosphate buffer solution. Practical application of the analytical procedure involved H(2)O(2) determination in rainwater of Sao Paulo City. A comparison of the results obtained by the proposed ampermetric method with another one which combines flow injection analysis (FIA) with spectrophotometric detection showed good agreement. (C) 2011 Elsevier B.V. All rights reserved.

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The catalytic ethanolysis of soybean oil with commercial immobilized lipase type B from Candida antarctica to yield ethyl esters (biodiesel) has been investigated. Transesterification was monitored with respect to the following parameters: quantity of biocatalyst, reaction time, amount of water added and turnover of lipase. The highest yields of biodiesel (87% by (1)H NMR; 82.9% by GC) were obtained after a reaction time of 24 h at 32 degrees C in the presence of lipase equivalent to 5.0% (w/w) of the amount of soybean oil present. The production of ethyl esters by enzymatic ethanolysis was not influenced by the addition of water up to 4.0% (v/v) of the alcohol indicating that it is possible to use hydrated ethanol in the production of biodiesel catalyzed by lipase. The immobilized enzyme showed high stability under moderate reaction conditions and retained its activity after five production cycles. The (1)H NMR methodology elaborated for the quantification of biodiesel in unpurified reaction mixtures showed good correlations between the signal areas of peaks associated with the alpha-methylene groups of the ethyl esters and those of the triacyl-glycerides in residual soybean oil. Monoacylglycerides, diacylglycerides and triglycerides could also be detected and quantified in the crude biodiesel using (1)H NMR spectroscopic and GC-FID chromatographic methods. The biodiesel production by enzymatic catalysis was promising. In this case, was produced a low concentration of glycerol (0.74%) and easily removed by water extraction. (C) 2010 Elsevier B.V. All rights reserved.

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OBJECTIVES: To develop a method for objective assessment of fine motor timing variability in Parkinson’s disease (PD) patients, using digital spiral data gathered by a touch screen device. BACKGROUND: A retrospective analysis was conducted on data from 105 subjects including65 patients with advanced PD (group A), 15 intermediate patients experiencing motor fluctuations (group I), 15 early stage patients (group S), and 10 healthy elderly subjects (HE) were examined. The subjects were asked to perform repeated upper limb motor tasks by tracing a pre-drawn Archimedes spiral as shown on the screen of the device. The spiral tracing test was performed using an ergonomic pen stylus, using dominant hand. The test was repeated three times per test occasion and the subjects were instructed to complete it within 10 seconds. Digital spiral data including stylus position (x-ycoordinates) and timestamps (milliseconds) were collected and used in subsequent analysis. The total number of observations with the test battery were as follows: Swedish group (n=10079), Italian I group (n=822), Italian S group (n = 811), and HE (n=299). METHODS: The raw spiral data were processed with three data processing methods. To quantify motor timing variability during spiral drawing tasks Approximate Entropy (APEN) method was applied on digitized spiral data. APEN is designed to capture the amount of irregularity or complexity in time series. APEN requires determination of two parameters, namely, the window size and similarity measure. In our work and after experimentation, window size was set to 4 and similarity measure to 0.2 (20% of the standard deviation of the time series). The final score obtained by APEN was normalized by total drawing completion time and used in subsequent analysis. The score generated by this method is hence on denoted APEN. In addition, two more methods were applied on digital spiral data and their scores were used in subsequent analysis. The first method was based on Digital Wavelet Transform and Principal Component Analysis and generated a score representing spiral drawing impairment. The score generated by this method is hence on denoted WAV. The second method was based on standard deviation of frequency filtered drawing velocity. The score generated by this method is hence on denoted SDDV. Linear mixed-effects (LME) models were used to evaluate mean differences of the spiral scores of the three methods across the four subject groups. Test-retest reliability of the three scores was assessed after taking mean of the three possible correlations (Spearman’s rank coefficients) between the three test trials. Internal consistency of the methods was assessed by calculating correlations between their scores. RESULTS: When comparing mean spiral scores between the four subject groups, the APEN scores were different between HE subjects and three patient groups (P=0.626 for S group with 9.9% mean value difference, P=0.089 for I group with 30.2%, and P=0.0019 for A group with 44.1%). However, there were no significant differences in mean scores of the other two methods, except for the WAV between the HE and A groups (P<0.001). WAV and SDDV were highly and significantly correlated to each other with a coefficient of 0.69. However, APEN was not correlated to neither WAV nor SDDV with coefficients of 0.11 and 0.12, respectively. Test-retest reliability coefficients of the three scores were as follows: APEN (0.9), WAV(0.83) and SD-DV (0.55). CONCLUSIONS: The results show that the digital spiral analysis-based objective APEN measure is able to significantly differentiate the healthy subjects from patients at advanced level. In contrast to the other two methods (WAV and SDDV) that are designed to quantify dyskinesias (over-medications), this method can be useful for characterizing Off symptoms in PD. The APEN was not correlated to none of the other two methods indicating that it measures a different construct of upper limb motor function in PD patients than WAV and SDDV. The APEN also had a better test-retest reliability indicating that it is more stable and consistent over time than WAV and SDDV.

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Introdução: Estudos sobre implicações clínicas da nova definição de infarto do miocárdio (IAM), incorporando novos marcadores de lesão miocárdica, são escassos na literatura. A prevalência de IAM e das suas complicações são diretamente dependentes do critério diagnóstico utilizado. Objetivo: Avaliar o impacto diagnóstico, prognóstico e econômico da nova definição de IAM proposta pela AHA/ ESC usando troponina T (TnT) como marcador de lesão cardíaca. Métodos: Um total de 740 pacientes com dor torácica admitidos na Emergência do Hospital de Clínicas de Porto Alegre no período de julho/ 1999 a janeiro/ 2002 foram incluídos no estudo. Creatina quinase total (CK), CK-MB atividade e TnT foram dosados em uma amostra de 363 pacientes, representativa de toda a coorte. Para redefinição de IAM foram utilizados como ponto de corte valores pico de TnT > 0,2 mg/dl. Os desfechos avaliados foram classificados como eventos cardíacos maiores (angina recorrente, insuficiência cardíaca congestiva, choque cardiogênico e óbito) e como procedimentos de revascularização. Também foram avaliados o manejo prescrito, os custos e o faturamento hospitalar. Resultados: Nos 363 pacientes com marcadores dosados, foram diagnosticados 59 casos de IAM (16%) pelos critérios clássicos; enquanto 40 pacientes (11%) tiveram o diagnóstico de IAM pelo critério redefinido, o que corresponde a um incremento de 71% na incidência. Pacientes com IAM redefinido eram significativamente mais idosos e do sexo masculino, apresentaram mais dor atípica e diabetes mellitus. Na análise multivariada, pacientes com infarto redefinido tiveram um risco 5,1 [IC 95% 1,0-28] vezes maior para óbito hospitalar e 3,4 [IC 95% 1,1-10] vezes maior para eventos combinados em relação aqueles sem IAM. O manejo dos casos de IAM redefinido foi semelhante ao manejo daqueles com IAM tradicional, exceto pelos procedimentos de revascularização que foram menos freqüentes (25% vs. 51%, P < 0,001). O grupo com IAM redefinido permaneceu mais tempo internado e foi submetido a procedimentos mais tardiamente. Do ponto de vista institucional, o uso dos novos critérios para IAM poderia resultar em um aumento de 9% (mais R$ 2.756,00 por grupo de 100 pacientes avaliados) no faturamento baseado em diagnóstico segundo a tabela do SUS. Conclusões: O novo diagnóstico de IAM acrescenta um número expressivo de indivíduos com infarto aos serviços de emergência. A incorporação deste critério é importante na medida que estes pacientes têm um prognóstico semelhante aos demais casos tradicionalmente diagnosticados. Como a identificação destes casos poderia resultar em um manejo mais qualificado e eficiente destes pacientes, esforços deveriam ser adotados para reforçar a adoção da redefinição de IAM.

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A procura de um método que permita um melhor resultado na anastomose de um nervo completamente seccionado é antiga. Há muitos anos a técnica, dita convencional, para aproximação dos cotos afastados do nervo lesado, é realizada com pontos de fios microcirúrgicos. Mais recentemente, a utilização da cola de fibrina tem permitido a adesão de tecidos, como pele, fáscia e outras estruturas anatômicas. O uso da cola de fibrina, na aproximação das extremidades nervosas, tem sido propagada pela indústria como um fato incontestável. No entanto, somente com a realização de estudos comparativos clínicos e laboratoriais tornou-se possível comparar a eficácia da cola de fibrina como agente de reconstituição em lesões de nervos periféricos. Com o objetivo de comprovar essa afirmação foi realizado um trabalho através de uma mensuração nas bainhas de mielina de cotos regenerados de nervos entre diferentes tipos de anastomose nervosas em nervo isquiático de ratos da raça Wistar. Com esse mesmo escopo, foi mensurado o número de axônios em regeneração após o uso dessa cola. Foi utilizada uma amostra de 35 ratos divididos em 03 grupos (A, B e C). No grupo A, 25 ratos foram submetidos à cirurgia com o uso da cola de fibrina para a anastomose nervosa. No grupo B, 05 ratos foram submetidos ao mesmo procedimento; entretanto, ao reparo nervoso acrescentou-se a utilização de dois pontos opostos de mononylon 9-0, usando-se cola de fibrina no seu interior. No terceiro grupo (C), 05 ratos foram submetidos a neurorrafia com 6 a 8 pontos de mononylon 9-0 sem auxílio da cola de fibrina (anastomose nervosa convencional). Os animais foram submetidos a um novo procedimento após 90 dias, quando o nervo isquiático tratado foi retirado e encaminhado para o estudo. Após esse procedimento, os animais foram sacrificados. Cabe esclarecer que os espécimens foram submetidas a uma preparação histológica, sendo avaliados. Para tanto, foi realizada uma mensuração da espessura média da bainha de mielina das fibras regeneradas. Também foi realizada uma medição do número de axônios regenerados em um milímetro quadrado. Com base nesses achados, foram comparados os resultados.

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Contexto: O diabetes mellitus (DM) é uma causa importante de morbimortalidade nas sociedades ocidentais devido à carga de sofrimento, incapacidade, perda de produtividade e morte prematura que provoca. No Brasil, seu impacto econômico é desconhecido. Objetivos: Dimensionar a participação do DM nas hospitalizações da rede pública brasileira (1999-2001), colaborando na avaliação dos custos diretos. Especificamente, analisar as hospitalizações (327.800) e os óbitos hospitalares (17.760) por DM como diagnóstico principal (CID-10 E10-E14 e procedimento realizado) e estimar as hospitalizações atribuíveis ao DM, incluindo as anteriores e aquelas por complicações crônicas (CC) e condições médicas gerais (CMG). Métodos: A partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) (37 milhões de hospitalizações), foram calculados indicadores por região de residência do paciente e sexo (ajustados por idade pelo método direto, com intervalos de confiança de 95%), faixas etárias, médias de permanência e de gastos por internação e populacional em US$. Realizou-se regressão logística múltipla para o desfecho óbito. As prevalências de DM foram combinadas aos riscos relativos de hospitalização por CC e CMG (metodologia do risco atribuível) e somadas às internações por DM como diagnóstico principal. Utilizou-se análise de sensibilidade para diferentes prevalências e riscos relativos. Resultados: Os coeficientes de hospitalizações e de óbitos hospitalares e a letalidade por DM como diagnóstico principal atingiram respectivamente 6,4/104hab., 34,9/106hab. e 5,4%. As mulheres apresentaram os coeficientes mais elevados, porém os homens predominaram na letalidade em todas as regiões. O gasto médio (US$ 150,59) diferiu significativamente entre as internações com e sem óbito, mas a média de permanência (6,4 dias) foi semelhante. O gasto populacional equivaleu a US$ 969,09/104hab. As razões de chances de óbito foram maiores para homens, pacientes ≥75 anos, e habitantes das regiões Nordeste e Sudeste. As hospitalizações atribuíveis ao DM foram estimadas em 836,3 mil/ano (49,3/104hab.), atingindo US$ 243,9 milhões/ano (US$ 14,4 mil/104hab.). DM como diagnóstico principal (13,1%), CC (41,5%) e CMG (45,4%) responderam por 6,7%, 51,4% e 41,9% respectivamente dos gastos. O valor médio das internações atribuíveis (US$ 292) situou-se 36% acima das não-atribuíveis. As doenças vasculares periféricas apresentaram a maior diferença no valor médio entre hospitalizações atribuíveis e não-atribuíveis (24%), porém as cardiovasculares destacaram-se em quantidade (27%) e envolveram os maiores gastos (37%). Os homens internaram menos (48%) que as mulheres, porém com gasto total maior (53%). As internações de pacientes entre 45-64 anos constituíram o maior grupo (45%) e gastos (48%) enquanto os pacientes com ≥75, os maiores coeficientes de hospitalização (350/104hab.) e de despesa (US$ 93,4 mil/104hab.). As regiões mais desenvolvidas gastaram o dobro (/104hab.) em relação às demais. Considerações Finais e Recomendações: As configurações no consumo de serviços hospitalares foram semelhantes às de países mais desenvolvidos, com importantes desigualdades regionais e de sexo. O gasto governamental exclusivamente com hospitalizações atribuíveis ao DM foi expressivo (2,2% do orçamento do Ministério da Saúde). A ampliação de atividades preventivas poderia diminuir a incidência do DM, reduzir a necessidade de internações, minimizar as complicações e minorar a severidade de outras condições médicas mais gerais.