RESUMO
OBJECTIVES: Determine if (a) a better trunk stability and endurance are associated with an improved whole-body dynamic balance, and if (b) the assessment tests can be interchanged within each capability. METHODS: Sixty-three physically active young males performed three trunk stability (i.e., the lumbopelvic stability, the unstable sitting and the sudden loading sitting tests), three trunk muscle endurance (i.e., the Biering-Sørensen, the side bridge and the front bridge tests) and four whole-body dynamic balance (i.e., the tandem and the single-leg stance, the Y-Balance, and the single-leg triple hop tests) tests two times. After assessing the reliability of the variables, a Pearson correlation analysis was performed. RESULTS: The correlations between trunk stability and endurance tests with dynamic balance tests were non-significant except for the unstable sitting test with both the tandem (r = 0.502) and the single-leg stance (r = 0.522) tests. Moreover, no relationships were observed between the trunk stability and the trunk muscle endurance tests. Interestingly, no relationships were found between most tests within each capability (i.e., trunk stability, trunk endurance, and dynamic balance) except: (i) the front bridge stability test and the back (r = 0.461) and the side (r = 0.499) bridge stability tests; (ii) the two side bridge endurance tests (r = 0.786); (iii) the tandem and the single-leg stance tests (0.439 ≤ r ≤ 0.463); (iv) the Y-Balance and the single-leg triple hop tests (0.446 ≤ r ≤ 0.477). CONCLUSION: Better trunk function does not seem to be a relevant factor for dynamic balance in young active males. In this population, specific measures are needed as the test interchangeability is questioned.
Assuntos
Estado Nutricional , Postura Sentada , Masculino , Humanos , Reprodutibilidade dos TestesAssuntos
Toxidermias/etiologia , Metotrexato/efeitos adversos , Pele/patologia , Adulto , Toxidermias/diagnóstico , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Injeções Subcutâneas , Masculino , Metotrexato/administração & dosagem , Psoríase/tratamento farmacológico , Pele/efeitos dos fármacosRESUMO
Despite core exercise programs are broadly used to increase muscle function and to promote low back health, there is a lack of scientific evidence on some of the most important characteristics of trunk exercise programs, as for example training frequency. This study aimed to compare the short-term effect of training frequencies of 1, 2 and 3 days per week (d/wk) on abdominal muscle endurance in untrained adolescents. One hundred and eighteen high-school students (59 men and 59 women) with no previous experience in structured abdominal exercise programs were assigned randomly to groups that trained 1 d/wk (G1; N.=21), 2 d/wk (G2; N.=27), 3 d/wk (G3; N.=23), or to a control group (CG; N.=47) that did not train. The training groups performed crunch and cross-crunch exercises 1, 2 or 3 d/wk during six weeks. Before and after the training period, the bench trunk-curl test (BTC test) was carried out to assess abdominal muscle endurance. Men obtained higher BTC test scores than women before and after training. Training frequencies of 1, 2 and 3 d/wk provided a significant increase in BTC test scores; however, no significant differences between the three groups' scores were found after training. Therefore, a small dose of crunch exercise training (1 d/wk) may be sufficient stimulus to increase abdominal endurance in untrained male and female adolescents, at least during the first weeks of an abdominal exercise program, which seems a very relevant finding in terms of time-cost efficiency.
Assuntos
Músculos Abdominais , Exercício Físico , Resistência Física , Adolescente , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
The use of compost from sewage sludge for agricultural application is nowadays increasing, since composting is recognized as one of the most important recycling options for this material, being a source of nutrients for plants but also of contamination by persistent pollutants. In the present work, a multi-residue analytical method for the determination of 17 quinolone antibiotic residues in compost using multivariate optimization strategies and ultra high performance liquid chromatography-tandem mass spectrometry has been developed. It is based on the use of microwave-assisted extraction at drastic conditions with ACN:m-phosphoric acid (1% w/v) for 5 min at 120°C, in order to achieve a quantitative extraction of the compounds (>76% of extraction recovery). Extracts were cleaned-up by salt-assisted liquid-liquid extraction (SALLE) with NaCl at pH 1.5 (with HClO4) and then using a dispersive sorbent (PSA). After LC separation, the MS conditions, in positive electrospray ionization mode (ESI), were individually optimized for each analyte to obtain maximum sensitivity in the selected reaction monitoring mode (SRM). The analytes were separated in less than 7 min. Cincophen was used as surrogate standard. The limits of detection ranged from 0.2 to 0.5 ng g(-1), and the limits of the quantification from 0.5 to 1.5 ng g(-1), while intra- and inter-day variability (% RSD) was under 7% in all cases. A recovery assay was performed with spiked samples. Recoveries ranging from 95.3% to 106.2% were obtained. Cleanup procedure reduced significantly matrix effects, which constitutes an important achievement, considering the important drawbacks of matrix components in quality and validation parameters. This method was applied to several commercial compost samples. Only 6 of the studied antibiotics were not detected in any of the samples. The antibiotics with the highest concentrations were ciprofloxacin (836 ng g(-1)), ofloxacin (719 ng g(-1)), and enrofloxacin (674 ng g(-1)), which were also the only ones found in all the analyzed samples. The results showed that this method could also be potentially adapted for the analysis of other strong sorbed basic pharmaceuticals in solid environmental matrices.
Assuntos
Antibacterianos/análise , Cromatografia Líquida de Alta Pressão/métodos , Extração Líquido-Líquido/métodos , Quinolonas/análise , Solo/química , Espectrometria de Massas em Tandem/métodos , Poluentes Químicos da Água/análise , Esgotos/química , Extração em Fase Sólida/métodosRESUMO
Agricultural regions in semi-arid to arid climates with associated saline wetlands are one of the most vulnerable environments to nitrate pollution. The Pétrola Basin was declared vulnerable to NO3(-) pollution by the Regional Government in 1998, and the hypersaline lake was classified as a heavily modified body of water. The study assessed groundwater NO3(-) through the use of multi-isotopic tracers (δ(15)N, δ(34)S, δ(13)C, δ(18)O) coupled to hydrochemistry in the aquifer connected to the eutrophic lake. Hydrogeologically, the basin shows two main flow components: regional groundwater flow from recharge areas (Zone 1) to the lake (Zone 2), and a density-driven flow from surface water to the underlying aquifer (Zone 3). In Zones 1 and 2, δ(15)NNO3 and δ(18)ONO3 suggest that NO3(-) from slightly volatilized ammonium synthetic fertilizers is only partially denitrified. The natural attenuation of NO3(-) can occur by heterotrophic reactions. However, autotrophic reactions cannot be ruled out. In Zone 3, the freshwater-saltwater interface (down to 12-16 m below the ground surface) is a reactive zone for NO3(-) attenuation. Tritium data suggest that the absence of NO3(-) in the deepest zones of the aquifer under the lake can be attributed to a regional groundwater flow with long residence time. In hypersaline lakes the geometry of the density-driven flow can play an important role in the transport of chemical species that can be related to denitrification processes.
Assuntos
Desnitrificação , Monitoramento Ambiental , Lagos/química , Poluentes Químicos da Água/análise , Água Subterrânea , Nitratos/análiseRESUMO
Bone-tissue engineering is a therapeutic target in the field of dental implant and orthopedic surgery. It is therefore essential to find a microenvironment that enhances the growth and differentiation of osteoblasts both from mesenchymal stem cells (MSCs) and those derived from dental pulp. The aim of this review is to determine the relationship among the proteins fibronectin (FN), osteopontin (OPN), tenascin (TN), bone sialoprotein (BSP), and bone morphogenetic protein (BMP2) and their ability to coat different types of biomaterials and surfaces to enhance osteoblast differentiation. Pre-treatment of biomaterials with FN during the initial phase of osteogenic differentiation on all types of surfaces, including slotted titanium and polymers, provides an ideal microenvironment that enhances adhesion, morphology, and proliferation of pluripotent and multipotent cells. Likewise, in the second stage of differentiation, surface coating with BMP2 decreases the diameter and the pore size of the scaffold, causing better adhesion and reduced proliferation of BMP-MSCs. Coating oligomerization surfaces with OPN and BSP promotes cell adhesion, but it is clear that the polymeric coating material BSP alone is insufficient to induce priming of MSCs and functional osteoblastic differentiation in vivo. Finally, TN is involved in mineralization and can accelerate new bone formation in a multicellular environment but has no effect on the initial stage of osteogenesis.
Assuntos
Células-Tronco Mesenquimais/citologia , Osteoblastos/citologia , Proteína Morfogenética Óssea 2/metabolismo , Diferenciação Celular , Polpa Dentária/citologia , Fibronectinas/metabolismo , Humanos , Sialoproteína de Ligação à Integrina/metabolismo , Células-Tronco Mesenquimais/metabolismo , Osteoblastos/metabolismo , Osteogênese , Osteopontina/metabolismo , Tenascina/metabolismoRESUMO
BACKGROUND: Alopecia areata (AA) occurs with the apparition of asyntomatic non inflamatory alopecia plaques without scars. We distinguish several variants which are divided into two groups: typical forms (AA in single or multiple plaques) and atypical forms (by its presentation, evolution or paradoxical regrowth). OBJETIVES AND METHODS: We describe the cases of AA treated in our Trichology Unit between January 2000 and December 2011. RESULTS: We obtained 488 cases of AA. 114 (23.36%) were unusual form of AA or had paradoxical regrowth. The most common unusual form of AA was sisaipho type (7.37%), followed by AA for black and blonde hair (5.32%), atypical diffuse forms (4.30%), androgenetic alopecia type and (3.89%) and AA rectangular occipital (0.68%). Furthermore, we found nine cases of paradoxical regrowth (1.84%). CONCLUSIONS: Atypical variants of AA in our series are less than 25% of all cases, although it should be noted that since it is a specialized unit, we may be making a selection bias to be more difficult to diagnose cases or poor outcome.
Assuntos
Alopecia em Áreas/classificação , Adulto , Alopecia em Áreas/diagnóstico , Dermoscopia/métodos , Diagnóstico Diferencial , Feminino , Seguimentos , Cabelo/crescimento & desenvolvimento , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
This clinical study evaluated a new surface treatment of ion implantation with CO ions which has previously been subjected to extensive study in animal models. The aim of this work was to assess its effect in humans. Experimental mini-implants were used; half of their longitudinal surface was machined and the other half was treated with CO ion implantation. The study was conducted in healthy volunteer patients who required prosthetic treatment with dental implants, and in accordance with the corresponding ethics committees. Coinciding with the insertion of commercial implants for oral restoration, one or two mini-implants were placed in the upper maxillary tuberosity or in the retromolar trigone of the mandible. The mini-implants were removed with a trephine jointly with a small volume of surrounding bone after a 3-month period. Two evaluation methods were used and both showed a greater degree of bone integration in the mini-implant section that underwent CO ion implantation treatment in comparison with the non-treated surface: 62.9% vs. 57.9%, and 54.8% vs. 46.2%. In addition, no adverse reactions were observed in the surface treatment with CO ion implantation. These results confirm the positive benefits in humans, based on the findings obtained from previous animal experiments.
Assuntos
Monóxido de Carbono , Implantes Dentários , Planejamento de Prótese Dentária , Implantes Experimentais , Arcada Parcialmente Edêntula/cirurgia , Osseointegração/fisiologia , Titânio/química , Adulto , Idoso , Feminino , Humanos , Íons , Masculino , Mandíbula/cirurgia , Microscopia Eletrônica de Varredura , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Propriedades de SuperfícieRESUMO
The potential for osteogenic differentiation of dental pulp mesenchymal stem cells (DPMSCs) in vitro and in vivo has been well documented in a variety of studies. Previously, we obtained a population of cells from human dental pulp called dental pulp pluripotent stem cells (DPPSCs) that could differentiate into mesodermal, ectodermal and endodermal progenies. We compared the osteogenic capacity of DPPSCs and DPMSCs that had been isolated from the same donors (N=5) and cultivated in the same osteogenic medium in 3D (three dimensions) Cell Carrier glass scaffolds. We also compared the architecture of bone-like tissue obtained from DPPSCs and human maxillary bone tissue. Differentiation was evaluated by scanning electron microscopy, whereas the expression of bone markers such as ALP, Osteocalcin, COLL1 and Osteonectin was investigated by quantitative real time polymerase chain reaction (qRT-PCR). We also used calcium quantification, Alizarin red staining and alkaline phosphatase (ALP) activity to compare the two cell types. New bone tissue formed by DPPSCs was in perfect continuity with the trabecular host bone structure, and the restored bone network demonstrated high interconnectivity. Significant differences between DPPSCs and DPMSCs were observed for the expression of bone markers, calcium deposition and ALP activity during osteogenic differentiation; these criteria were higher for DPPSCs than DPMSCs. Both DPPSCs and differentiated tissue showed normal chromosomal dosage after being cultured in vitro and analysed using short-chromosome genomic hybridisation (short-CGH). This study demonstrates the stability and potential for the use of DPPSCs in bone tissue engineering applications.
Assuntos
Técnicas de Cultura de Células/métodos , Polpa Dentária/citologia , Células-Tronco Mesenquimais/citologia , Osteogênese , Adolescente , Adulto , Bioensaio , Diferenciação Celular , Proliferação de Células , Separação Celular , Forma Celular , Células Cultivadas , Hibridização Genômica Comparativa , Feminino , Humanos , Masculino , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/ultraestrutura , Osteoblastos/citologia , Osteoblastos/metabolismo , Fenótipo , Células-Tronco Pluripotentes/citologia , Células-Tronco Pluripotentes/metabolismo , Células-Tronco Pluripotentes/ultraestrutura , Alicerces Teciduais , Adulto JovemRESUMO
The basidiomycete Heterobasidion annosum (Fr.) Bref. (=Fomes annosus (Fr.) Cooke), one of the most important pathogens in coniferous forests in Europe, Asia, and North America, causes root and butt rot. H. annosum was first recorded on Pinus pinaster Ait. (commonly known as Maritime pine) in France and Great Britain in 1961 (4) and Portugal in 1986 (2). P. pinaster is the most widespread conifer in Spain, with more than 700,000 and 600,000 ha in pure and mixed stands, respectively. Over the last few years, P. pinaster decline was observed in several stands in the center of the Iberian Peninsula. Unusual crown transparency, small needles, foliage discoloration, and early tree death are characteristic decline symptoms associated with the high mortality rate on this species. In June of 2010, 11 trees (40 to 60 years old) with a different degree of decline were felled in two zones (42°2'41â³N, 3°18'14â³W, elevation 1,096 m and 41°55'40â³N, 3°12'3â³W, elevation 1,128 m) and cut into sections (stump height, breast height, and near the top). Wood slices were removed from each section and taken to the laboratory. Samples were placed in moist chambers with optimal conditions of humidity and temperature to enhance pathogen growth. After 20 days of incubation in darkness at 25°C, H. annosum (anamorph Spiniger meineckellum [A. Olson] Stalpers) occurred on most of these slices. Conidiophores with subglobose to pyriform conidia (5.8 × 4.2 µm) were observed with a compound microscope. The fungus was isolated to extract DNA by disruption of the mycelium followed by washes with phenol/chloroform/isoamyl alcohol solution (25:24:1). DNA was precipitated with 20% polyethylene glycol solution. PCR was carried out according to the instructions of the manufacturer of Dynazyme II DNA polymerase (Finnzymes Ltd, Espoo, Finland) with ITS primers, 1F (5'-CTTGGTCATTTAGAGGAAGTAA-3') and 4 (5'-TCCTCCGCTTATTGATATGC-3'). After DNA purification, samples were sequenced (SECUGEN, Madrid, Spain) and aligned and corrected with Geneious Pro 5.3 to obtain the consensus sequences. Resulting DNA sequences of two isolates were deposited in GenBank (Nos. FR850494 and FR850495), and compared with a Blastn search at GenBank showing 100% identity and 100% coverage with H. annosum sensu stricto, former ISG-P (intersterility group of pines). For pathogenicity tests, 10 seedlings (2 year old) were inoculated with autoclaved P. pinaster wood chips colonized by H. annosum, and 10 control seedlings were inoculated with noncolonized wood chips. Inoculums were prepared by growing H. annosum on 4-mm-diameter wood chips placed on potato dextrose agar media for 3 weeks. The wood chips were put inside an oblique incision made at 6 cm above the soil line and wrapped with Parafilm. After 8 weeks in a growth chamber at 22.5°C with a 14-h photoperiod, the inoculated seedlings showed typical symptoms and 3 seedlings of 10 were dead. H. annosum was previously recorded on P. sylvestris in central Spain (1), causing needle drop, swelling at the stump height, and presence of dead trees by circular areas. This pathogen was also reported on P. nigra in northeastern Spain, associated with defoliation and mortality (3). To our knowledge, this is the first record of H. annosum on P. pinaster in Spain. References: (1) J. Benito-Martínez. An. Jardín Bot. Madrid 3:23, 1943. (2) N. Neves et al. EPPO Bull. 16:505, 1986. (3) J. Oliva et al. Bol. Sanidad Vegetal. Plagas. 34:415, 2008. (4) P. Spaulding. US Dep. Agric. Agric. Handb. 197:100, 1961.
RESUMO
The use of autogenous grafts is still considered in bone regeneration surgeries. However, the bone cell viability of such grafts after being harvested from donor sites remains a matter of debate. The aim of the present study is to evaluate particulated and block bone cell viability, in terms of presence or absence of apoptosis and necrosis, obtained from different maxillary intra-oral harvesting methods: bone scraper, rotary carbide burs and piezoelectric device. Five healthy patients were enrolled in the study. The patients required sinus augmentation by lateral window approach. The bone was harvested by the bone scraper, piezoelectric device and rotary surgical instrument. The samples were processed with the Annexin V/FITC (fluorescein isothiocyanate stain) kit and were analyzed by means of Fluoresence-Activated Cell Sorted (FACS) technique. Within the limitations of this pilot study, the results indicated that autogenous bone chips collected from the three harvesting methods presented a large percentage of apoptotic cells, although large scale production of necrotic cells was not detected. In summary, although rotary surgical instrument and piezoelectric devices are frequently used instruments for oral osteotomy, fresh autogenous bone chips collected from them did not present a viable bone cell source.
Assuntos
Transplante Ósseo , Maxila/transplante , Osteotomia , Coleta de Tecidos e Órgãos/métodos , Adulto , Apoptose , Separação Celular/métodos , Sobrevivência Celular , Desenho de Equipamento , Feminino , Citometria de Fluxo , Imunofluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Osteotomia/instrumentação , Projetos Piloto , Espanha , Instrumentos Cirúrgicos , Coleta de Tecidos e Órgãos/instrumentaçãoRESUMO
CASE REPORT: An 85 year old male suffered vision loss in both eyes due to ruptured bilateral retinal arterial macroaneurysms. DISCUSSION: We report this unusual case and show the importance of studying these types of patients in order to detect associated systemic diseases.
Assuntos
Aneurisma/etiologia , Hipertensão/diagnóstico , Artéria Retiniana/patologia , Idoso de 80 Anos ou mais , Aneurisma/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrina/análise , Humanos , Hipertensão/complicações , Terapia a Laser , Masculino , Artéria Retiniana/cirurgia , Hemorragia Retiniana/etiologia , Tomografia de Coerência Óptica , Transtornos da Visão/etiologiaRESUMO
OBJECTIVE: Schwannomas are slowly growing tumours derived from Schwann cells. We present a clinical case of schwannoma in the mandibular angle. METHOD: Case report and a review of the world literature concerning intraosseous schwannoma of the maxillofacial region. RESULTS: Schwannomas or neurilemmomas are slow-growing, benign neoplasms derived from Schwann cells. Intraoral lesions are unusual and intraosseous schwannomas are even rarer, representing less than 1 per cent of benign primary tumours of the bones. We present a clinical case of schwannoma in the mandibular angle mimicking a keratocystic odontogenic tumour, with a complicated posterior evolution. CONCLUSION: Clinically, neurilemmomas are slow-growing tumours which may be present for years before becoming symptomatic. Radiographically, the image may be suggestive of a benign process such as an odontogenic keratocyst. Histological analysis of the specimens obtained is extremely important in order to establish the final diagnosis.
Assuntos
Fraturas Espontâneas/patologia , Neoplasias Mandibulares/patologia , Neurilemoma/patologia , Cistos Odontogênicos/patologia , Diagnóstico Diferencial , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Humanos , Masculino , Mandíbula/patologia , Mandíbula/cirurgia , Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Cistos Odontogênicos/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
"Syndrome of recommended patient" is manifested as the presence of numerous unexpected and unusual complications in patients that the treating physician is trying to give a better assistance. Even assuming that a few complications may appear by chance, there are several factors from daily clinical practice that facilitate the presence of such a syndrome, and some of them can be corrected in order to reduce its incidence. All of them come from the change on daily clinical practice on these patients, as if they do not fit for the attention provided for other people. These factors favouring the presence of this syndrome come from: patients' attitude, inefficient use of health resources, absence of an adequate register of clinical data and change in usual clinical practice on interpretation of diagnostic tests as well as in the indication of treatment of these patients. The best way to prevent this "syndrome of recommended patient" is to maintain, even within these patients, an attitude based on solid clinical knowledge and to follow up the same clinical rules accepted for other patients.
Assuntos
Medicina Baseada em Evidências , Doença Iatrogênica , Erros Médicos , HumanosRESUMO
STUDY DESIGN: Multicenter, open, prospective, before-after study. OBJECTIVE: To assess the efficacy and safety of sildenafil therapy for erectile dysfunction in patients with spinal cord injury, and the association between the response to sildenafil and factors such as causes and levels of spinal cord injury, grade of ASIA deficit, time since injury, orgasmic perception, and degree of baseline erection. SETTING: Homes of outpatients of 16 spinal cord injury units in Spain. METHOD: One hundred and seventy patients with erectile dysfunction secondary to spinal cord injury, from whom baseline data were collected on their sexual function, and who started treatment with sildenafil 50 mg. An efficacy assessment was made by the patient and his partner, and the score of the International Index of Erectile Function (IIEF) was recorded. RESULTS: It was reported by 88.2% of the patients and 85.3% of their partners that treatment with sildenafil had improved their erections, regardless of the baseline characteristics of the spinal cord injury and erectile function. In responders, this improvement was confirmed by an increase from 12.5 to 24.8 points (P<0.001) of the Erectile Function Domain of IIEF. A significant improvement was also seen in patients' satisfaction with sexual activity and general satisfaction derived from sexual life. Preservation of orgasmic perception and a baseline degree of erection of 3 or 4 (P=0.006) were predictors of therapeutic success. No serious adverse events occurred. CONCLUSION: Sildenafil is an effective, well-tolerated treatment for erectile dysfunction caused by spinal cord injury, regardless of the cause, neurological level, ASIA grade, and time since injury. SPONSORSHIP: Spanish Society of Paraplegia.
Assuntos
Disfunção Erétil/tratamento farmacológico , Piperazinas/administração & dosagem , Traumatismos da Medula Espinal/tratamento farmacológico , Adulto , Idoso , Distribuição de Qui-Quadrado , Esquema de Medicação , Disfunção Erétil/complicações , Disfunção Erétil/diagnóstico , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Paraplegia , Piperazinas/efeitos adversos , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Purinas , Quadriplegia , Citrato de Sildenafila , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Estatísticas não Paramétricas , Sulfonas , Resultado do TratamentoRESUMO
The altered excretion of isoenzymes of amylase in urine was used as an early indicator of the loss of electric charges in the glomerular basement membrane, in 202 juvenile-onset insulin-dependent diabetic patients, compared with the pattern of excretion in 51 normal subjects matched for age and sex. Diabetics showed an increased excretion of salivary amylase. The salivary to pancreatic amylase ratio in urine (S/P ratio) was always below 1 in control subjects, but was elevated in 33.2% of diabetics, although microalbuminuria was present in only 26.2% of diabetic patients. The concentrations of other proteins in urine were within the reference ranges in nearly all patients, indicating that the kidney was not seriously affected. The increased salivary amylase excretion was not due to changes in the plasma concentration of any of the isoamylases, but to a real increase in excretion, as its fractional excretion in relation to creatinine clearance was clearly increased (1.0 +/- 0.7 vs. 1.52 +/- 1.99, p < 0.05), and the ratio of their clearances was also increased (0.35 +/- 0.18 vs. 0.49 +/- 0.61, p > 0.05). Moreover, the prevalence of altered S/P ratios was higher than the prevalence of microalbuminuria (36.6% vs. 18.8% of patients in the first decade of evolution of insulin-dependent diabetes mellitus). Altered S/P ratios were most prevalent in the first decade, whereas microalbuminuria was most prevalent in the second decade of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Amilases/urina , Diabetes Mellitus Tipo 1/enzimologia , Isoenzimas/urina , Adulto , Albuminúria/urina , Pressão Sanguínea/fisiologia , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/enzimologia , Proteinúria/urina , Saliva/enzimologiaRESUMO
Diabetes mellitus can lead, along the years of its course, to chronic renal failure in a high proportion of cases. An early risk-indicator of later diabetic nephropathy is the presence of microalbuminuria, but it usually takes about fifteen to twenty years to appear. Before that, no clinical signs can disclose the underlying alterations of glomerular basement membrane that will eventually bring forth overt nephropathy. The usefulness of the altered excretion of isoenzymes of amylase as an early marker of the glomerular charge selectivity was tested in 202 juvenile onset insulin-dependent diabetics, compared with 51 normal subjects matched for age and sex. The diabetic patients studied showed increased excretion of salivary amylase into urine. The salivary to pancreatic amylase ratio of concentrations in urine was always below 1 in normal subjects, and was increased over 1 in 33.2% of diabetics, although microalbuminuria was present only in 26.2% of patients. The excretion of other proteins was within reference values in the majority of cases, indicating that the kidney was not seriously affected in those patients. Moreover, the altered salivary to pancreatic amylase ratio in urine was more prevalent than microalbuminuria (36.6% vs 18%) in the first decade of the evolution of the diabetes. These results indicate that the ratio of excretions of both isoamylases into urine is a more sensible and earlier marker of altered glomerular charge barrier for anionic proteins.