Differences in the composition of hip and knee synovial fluid in osteoarthritis: a nuclear magnetic resonance (NMR) spectroscopy study of metabolic profiles.

OBJECTIVE: The hip and knee joints differ biomechanically in terms of contact stresses, fluid lubrication and wear patterns. These differences may be reflected in the synovial fluid (SF) composition of the two joints, but the nature of these differences remains unknown. The objective was to identify differences in osteoarthritic hip and knee SF metabolites using metabolic profiling with Nuclear Magnetic Resonance (NMR) spectroscopy. DESIGN: Twenty-four SF samples (12 hip, 12 knee) were collected from patients with end-stage osteoarthritis (ESOA) undergoing hip/knee arthroplasty. Samples were matched for age, gender, ethnicity and had similar medical comorbidities. NMR spectroscopy was used to analyse the metabolites present in each sample. Principal Component Analysis and Orthogonal Partial Least Squares Discriminant Analysis were undertaken to investigate metabolic differences between the groups. Metabolites were identified using 2D NMR spectra, statistical spectroscopy and by comparison to entries in published databases. RESULTS: There were significant differences in the metabolic profile between the groups. Four metabolites were found in significantly greater quantities in the knee group compared to the hip group (N-acetylated molecules, glycosaminoglycans, citrate and glutamine). CONCLUSIONS: This is the first study to indicate differences in the metabolic profile of hip and knee SF in ESOA. The identified metabolites can broadly be grouped into those involved in collagen degradation, the tricarboxylic acid cycle and oxidative metabolism in diseased joints. These findings may represent a combination of intra and extra-articular factors.

Characterization of sweat induced with pilocarpine, physical exercise, and collected passively by metabolomic analysis.

BACKGROUND/PURPOSE: The elimination of the pain associated with needle picking is a strong motivation for the development of clinical non-invasive diagnostic methods. Sweat has been described as an alternative biological sample that may have a direct relation to the plasma composition. MATERIALS AND METHODS: In this study, analysis of sweat of human volunteers obtained by induction with pilocarpine is compared with sweat samples obtained by physical exercise and by passive collection along 7 hours. The sweat samples have been analyzed by 1H nuclear magnetic resonance spectroscopy. RESULTS: A range of 34 different metabolites has been detected in sweat samples, including lactate, several amino acids, pyroglutamate, and urocanate. Most of the metabolites identified were quantified. The majority of the amino acids detected in sweat seem to have origin in the epidermis surface. No significant differences in sweat samples from female and male were observed by 1H NMR metabolomic analysis. CONCLUSIONS: Principal component analysis (PCA) shows that both physical exercise and pilocarpine methods seem to be equally reproducible methods in terms of sweat metabolite composition presenting better repeatability than natural sweat collection. Nevertheless, this difference is mainly originated from amino acids with origin from the skin surface.

Influence of phosphorus on copper toxicity to Selenastrum gracile (Reinsch) Korshikov.

Microalgae need a variety of nutrients for optimal growth and health. However, this rarely occurs in nature, and if nutrient proportions vary, biochemical changes can occur in phytoplankton community. This may result in modifications of zooplankton food quality, affecting aquatic food chains. Our aim was to investigate the toxicity of copper (Cu) to Selenastrum gracile, a common freshwater Chlorophyceae, at different physiological status induced by varying phosphorus (P) concentration in culture medium. Phosphorus was investigated at 2.3×10(-4), 1.1×10(-4), 2.3×10(-5), 4.6×10(-6) and 2.3×10(-6) mol L(-1) and Cu at six concentrations, ranging from 6.9×10(-9) mol L(-1) to 1.0×10(-7) mol L(-1) free Cu(2+) ions. To guarantee the cells would be in a physiological status that reflected the external P concentration, they were previously acclimated up to constant growth rate at each P concentration. Phosphorus acclimated cells were then exposed to Cu and toxicity was evaluated through population density, growth rates and chlorophyll a content. Free Cu(2+) ions concentrations were calculated through the chemical equilibrium model MINEQL(+). The results showed that higher Cu toxicity was obtained in P-limited than in P-replete cells, and that chlorophyll a/cell was higher in P-limited cells and excess Cu than in P-replete cells. This confirms the importance of microalgae nutritional status to withstand the negative effects of the trace metal.

Growth and biochemical composition of Chlorella vulgaris in different growth media.

The need for clean and low-cost algae production demands for investigations on algal physiological response under different growth conditions. In this research, we investigated the growth, biomass production and biochemical composition of Chlorella vulgaris using semi-continuous cultures employing three growth media (LC Oligo, Chu 10 and WC media). The highest cell density was obtained in LC Oligo, while the lowest in Chu medium. Chlorophyll a, carbohydrate and protein concentrations and yield were highest in Chu and LC Oligo media. Lipid class analysis showed that hydrocarbons (HC), sterol esthers (SE), free fatty acids (FFA), aliphatic alcohols (ALC), acetone mobile polar lipids (AMPL) and phospholipids (PL) concentrations and yields were highest in the Chu medium. Triglyceride (TAG) and sterol (ST) concentrations were highest in the LC Oligo medium. The results suggested that for cost effective cultivation, LC Oligo medium is the best choice among those studied, as it saved the cost of buying vitamins and EDTA associated with the other growth media, while at the same time resulted in the best growth performance and biomass production.

Plankton diversity and limnological characterization in two shallow tropical urban reservoirs of Pernambuco State, Brazil.

Plankton diversity, physical and chemical variables and chlorophyll a were analyzed in two shallow urban reservoirs with different trophic degrees on Pernambuco State, northeastern Brazil. High eutrophication levels were observed in Apipucos reservoir, while Prata reservoir was considered oligotrophic. Values reported for physical and chemical variables and chlorophyll a differed among the studied ecosystems. Richness and plankton diversity were higher in Apipucos reservoir especially for phytoplankton. The presence of potential toxic Cyanophyceae in both reservoirs reflects a problem mainly to Prata reservoir, which is used for public water supply. Differences were observed for some variables among sites of study in Apipucos reservoir, while the differences among strata were negligible in both reservoirs, reflecting the water column mixing by wind action. Rainfall regulated the temporal dynamics for the analyzed variables, with significant seasonal differences, mainly for the major of limnological variables in Apipucos reservoir. Plankton diversity was higher in Apipucos reservoir, especially to phytoplankton, showing that eutrophication and pollution can favor plankton diversity in tropical urban shallow reservoirs.

Can metabolic profiling provide a new description of osteoarthritis and enable a personalised medicine approach?

Osteoarthritis (OA) is a multifactorial disease contributing to significant disability and economic burden in Western populations. The aetiology of OA remains poorly understood, but is thought to involve genetic, mechanical and environmental factors. Currently, the diagnosis of OA relies predominantly on clinical assessment and plain radiographic changes long after the disease has been initiated. Recent advances suggest that there are changes in joint fluid metabolites that are associated with OA development. If this is the case, biochemical and metabolic biomarkers of OA could help determine prognosis, monitor disease progression and identify potential therapeutic targets. Moreover, for focussed management and personalised medicine, novel biomarkers could sub-stratify patients into OA phenotypes, differentiating metabolic OA from post-traumatic, age-related and genetic OA. To date, OA biomarkers have concentrated on cytokine action and protein signalling with some progress. However, these remain to be adopted into routine clinical practice. In this review, we outline the emerging metabolic links to OA pathogenesis and how an elucidation of the metabolic changes in this condition may provide future, more descriptive biomarkers to differentiate OA subtypes.

Training medical students to improve the management of people with epilepsy.

PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.

Lipid composition of Chlorella vulgaris (Trebouxiophyceae) as a function of different cadmium and phosphate concentrations.

Fatty acids are the fundamental structural components of membrane lipids, and the degree of saturation of the long hydrocarbon chains in microalgae contributes to regulation of growth, biomass production and reproduction of aquatic consumers. This research aimed at evaluating the effects of cadmium (2×10(-8); 10(-7) mol L(-1) Cd) on lipid class and fatty acid composition of the microalga Chlorella vulgaris under varying phosphate (PO(4)(3-)) concentrations (6.0×10(-7) to 2.3×10(-4) mol L(-1)). Under PO(4)(3-) limitation and Cd stress, the storage lipid class triacylglycerol (TAG) was the most accumulated among the lipid classes. Fatty acid composition revealed that the degree of saturation increased with increasing Cd stress and PO(4)(3-) limitation. Decreasing PO(4)(3-) and increasing Cd concentrations resulted in higher saturated fatty acid (SAFA) and monounsaturated FA (MUFA) concentrations. Total polyunsaturated FA (PUFA) and ω3 PUFA, and PUFA:SAFA ratios were higher in the control (2.3×10(-4) mol L(-1) PO(4)(3-)) cells than in either PO(4)(3-) limitation or Cd stress, or in the combination of both stresses. Contrasting with all the other PUFAs, 18:2n - 6 increased as PO(4)(3-) limitation increased. A significant positive relationship of PUFAs, acetone mobile polar lipids (AMPL) and phospholipids (PL) with phosphate concentration in the culture media was obtained, while TAG concentrations had a positive association with total MUFA and SAFA. Total SAFA, 14:0, 18:1n - 9 and 18:2n - 6 were positively correlated with Cd and negatively with PO(4)(3-) concentrations. The microalga responded to combined PO(4)(3-) limitation and Cd exposure by increasing its total lipid production and significantly altering its lipid composition. The FA 18:2n - 6 may be considered a stress biomarker for PO(4)(3-) limitation and Cd stress in C. vulgaris.

Violence against pregnant women: prevalence and associated factors.

OBJECTIVE: To identify the factors associated with domestic violence against pregnant women. METHODS: Interviews were conducted with 1,379 pregnant women undergoing antenatal care in basic health care units of the Brazilian Health System, within the municipality of Campinas (Southeastern Brazil). A structured questionnaire on domestic violence, validated in Brazil, was applied between July 2004 and July 2006. The first and second interviews in a cohort study were analyzed. Descriptive and multiple logistic regression analysis of the data were conducted. RESULTS: Psychological violence was reported by 19.1% (n=263) of the total sample of pregnant women and physical/sexual violence was reported by 6.5% (n=89) of them. The factors associated to psychological violence were: adolescent intimate partner (p<0.019) and the pregnant woman had witnessed physical aggression before she was 15 years old (p<0.001). The factors associated to physical/sexual violence were: difficulties encountered by the pregnant woman in attending her antenatal appointments (p<0.014), intimate partner uses drugs (p<0.015) and does not work (p<0.048). The factors associated to psychological and physical/ sexual violence were: low level of education of the interviewee (p<0.013 and p<0.020, respectively), the pregnant woman being responsible for the family (p<0.001 and p=0.017, respectively) pregnant woman had suffered physical aggression during childhood (p<0.029 and p<0.038, respectively), presence of common mental disorder (p<0.001) and intimate partner consumes alcoholic beverage twice or more weekly. (p<0.001). CONCLUSIONS: A high prevalence of different categories of domestic violence by an intimate partner during pregnancy was found as well as different factors associated with them. Appropriate mechanisms are necessary, particularly in primary health care, to identify and deal with domestic violence during pregnancy.

Violência doméstica na gravidez: prevalência e fatores associados / Violence against pregnant women: prevalence and associated factors / Violencia domestica durante el embarazo: prevalencia y factores asociados

OBJETIVO: Identificar os fatores associados à violência doméstica contra gestantes. MÉTODOS: Foram entrevistadas 1.379 gestantes usuárias do Sistema Único de Saúde acompanhadas em unidades básicas de saúde no município de Campinas (SP). Foram analisadas a primeira e a segunda entrevistas de um estudo de coorte, aplicando-se questionário estruturado sobre violência doméstica validado no Brasil, de julho de 2004 a julho de 2006. Foram realizadas análise descritiva e regressão logística múltipla dos dados. RESULTADOS: Do total da amostra, 19,1 por cento (n=263) das gestantes reportaram violência psicológica e 6,5 por cento (n=89) violência física/sexual. Os fatores associados à violência psicológica foram: parceiro íntimo adolescente (p<0,019) e gestante ter presenciado agressão física antes dos 15 anos (p<0,001). Foram associados à violência física/sexual: dificuldade da gestante em comparecer às consultas de pré-natal (p<0,014), parceiro íntimo fazer uso de drogas (p<0,015) e não trabalhar (p<0,048). Os fatores associados à violência psicológica e física/sexual foram: baixa escolaridade da gestante (p<0,013 e p<0,020, respectivamente), gestante responsável pela família (p<0,001 e p=0,017, respectivamente) gestante ter sofrido agressão física na infância (p<0,029 e p<0,038, respectivamente), presença de transtorno mental comum (p<0,001) e parceiro íntimo consumir bebida alcoólica duas ou mais vezes por semana(p<0,001). CONCLUSÕES: Constataram-se altas prevalências das diferentes categorias de violência doméstica praticada pelo parceiro íntimo durante o período gestacional, assim como, com os diversos fatores a elas associados. Mecanismos apropriados para identificação e abordagem da violência doméstica na gestação são necessários, especialmente na atenção primária.

O preparo do enfermeiro da atenção básica para a saúde mental / The nurse´ education from the primary care to the mental health care service

Introdução: De acordo com a Organização Mundial da Saúde (OMS -2003), 450 milhões de pessoas sofrem de transtornos mentais, resultantes de uma complexa interação entre fatores genéticos e ambientais. A rede básica de saúde caracteriza-se por ser a principal porta de entrada das pessoas para serem atendidas as suas necessidades básicas de saúde. Objetivo: Identificar o preparo dos profissionais enfermeiros da UBSF (Unidade Básica da Saúde da Família) diante da doença e do doente mental, e qual a sua atuação para com este e sua família. Metodologia: A pesquisa foi do tipo descritivo-exploratória, de natureza qualitativa, e o material empírico foi analisado pela técnica de análise de conteúdo. Resultados: Os resultados revelaram necessidade de qualificação e treinamento para trabalhar com Saúde Mental na rede básica, medidas dereferência e contra-referência pouco utilizadas dificultando a continuidade da assistência prestada ao doente mental, ausência de Programas Psicoeducacionais para portadores de transtornos mentais e/ou familiares, e nos mostrou a importância de uma equipe qualificada e multiprofissional. Conclusões: Observa-se a necessidade de qualificação dos profissionais que atuam na atenção básica e um maior envolvimento da comunidade junto a ESF, pois só com o desenvolvimento de ações conjuntas, qualificadas e multiprofissionais,com suporte familiar, atividades em grupo, disponibilidade de serviços de referência e contra-referência, poderemos almejar uma desinstitucionalização do portador de transtorno mental e sua reinserção na sociedade.

Introduction: According to WHO (2003), mental disorders account for 450 million people worldwide. These are due to the result of a complex interaction between genetic and environmental factors. The basic health care system can be considered as the main gateway for people searching their primary needs being attended.Objective: To identify the education of the FBHCU (Family Basic Health Care Unit) nurses in relation to the disorder and the mental health individual; their performance toward him/her and the family. Methodology: This is a descriptive-exploratory study, qualitative nature. The empirical material was analyzed by the technique of content analysis. Results: The results revealed the necessity of qualification and training to work with Mental Health care in the basic health service. There are few reference and counterreference measures being used; thus providing difficulty in continuing the effective care to the mental impaired individuals, and the absence of Psychosocial Programs for them and their families. Moreover, these results showed the importance of a qualified and multiprofessional team. Conclusions: The qualification of these professionals performing in the basic health care service is important; besides the community involvement with the FBHCU. Consequently, the development of shared, qualified and multiprofessional actions with reference and counterreference measures will be able to provide to these individuals their reintegration into the society.

Training medical students to improve the management of people with epilepsy

PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.

OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia em estudantes de medicina antes e depois de curso de capacitação. MÉTODO: Foi utilizado o questionário KAP da Campanha Global "Epilepsia fora das sombras", liderada pela OMS, ILAE e IBE. Este questionário avalia conhecimento, atitude e percepção sobre epilepsia em 61 questões. Foi aplicado este questionário em 185 estudantes de medicina, antes e depois de cursos de capacitação sobre epilepsia. As questões foram comparadas para analisar as mudanças obtidas com o treinamento. RESULTADOS: Cento e seis estudantes de medicina responderam ao questionário antes do curso de capacitação e 79 estudantes responderam após um ano do curso. A comparação feita a respeito do conhecimento com estes estudantes mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=53,9; DP=11,4 vs. pós-teste: nota média=63,8; DP=11,9; t-test=5,6; p<0,001). DISCUSSÃO: O curso de capacitação promove melhoras no conhecimento, atitude e percepção sobre epilepsia, mesmo após um ano. Estes resultados salientam a importância de programas de educação continuada dentro do currículo médico.