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1.
Appl Microbiol Biotechnol ; 108(1): 325, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38717668

RESUMO

Actinomycetota have been widely described as valuable sources for the acquisition of secondary metabolites. Most microbial metabolites are produced via metabolic pathways encoded by biosynthetic gene clusters (BGCs). Although many secondary metabolites are not essential for the survival of bacteria, they play an important role in their adaptation and interactions within microbial communities. This is how bacteria isolated from extreme environments such as Antarctica could facilitate the discovery of new BGCs with biotechnological potential. This study aimed to isolate rare Actinomycetota strains from Antarctic soil and sediment samples and identify their metabolic potential based on genome mining and exploration of biosynthetic gene clusters. To this end, the strains were sequenced using Illumina and Oxford Nanopore Technologies platforms. The assemblies were annotated and subjected to phylogenetic analysis. Finally, the BGCs present in each genome were identified using the antiSMASH tool, and the biosynthetic diversity of the Micrococcaceae family was evaluated. Taxonomic annotation revealed that seven strains were new and two were previously reported in the NCBI database. Additionally, BGCs encoding type III polyketide synthases (T3PKS), beta-lactones, siderophores, and non-ribosomal peptide synthetases (NRPS) have been identified, among others. In addition, the sequence similarity network showed a predominant type of BGCs in the family Micrococcaceae, and some genera were distinctly grouped. The BGCs identified in the isolated strains could be associated with applications such as antimicrobials, anticancer agents, and plant growth promoters, among others, positioning them as excellent candidates for future biotechnological applications and innovations. KEY POINTS: • Novel Antarctic rare Actinomycetota strains were isolated from soil and sediments • Genome-based taxonomic affiliation revealed seven potentially novel species • Genome mining showed metabolic potential for novel natural products.


Assuntos
Sedimentos Geológicos , Família Multigênica , Filogenia , Microbiologia do Solo , Regiões Antárticas , Sedimentos Geológicos/microbiologia , Metabolismo Secundário/genética , Actinobacteria/genética , Actinobacteria/metabolismo , Actinobacteria/classificação , Genoma Bacteriano , Biotecnologia/métodos , Vias Biossintéticas/genética , Peptídeo Sintases/genética , Peptídeo Sintases/metabolismo , Policetídeo Sintases/genética , Policetídeo Sintases/metabolismo
2.
Front Pharmacol ; 15: 1352939, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38469410

RESUMO

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common entity (30%-40%) and can significantly limit the quality of life of patients, especially those that persist for more than 6 months after treatment (chronic neuropathy). Studies have shown a possible association between the presence of genetic polymorphisms in ABCB1 and the development of acute CIPN, although this relationship with chronic CIPN remains unexplored. This is an analytical observational case-control study defined by the presence (cases) or absence (controls) of CIPN at 6 months after the end of the neurotoxic drug. Our aim is to demonstrate whether these ABCB1 polymorphisms also influence the chronification of this toxicity, as well as the clinical factors that can help us to predict it. Methods: The study included 152 patients treated with tri-weekly oxaliplatin (O) or weekly paclitaxel (P); 86 cases and 66 controls. Clinical and analytical parameters were analysed including the study of ABCB1 genetic polymorphisms in a blood sample. Results: ABCB1 genetic polymorphisms C1236T (rs1128503) and C3435T (rs1045642) are associated with the development of chronic CIPN in patients treated with P. No differences were found in patients treated with O. Other predictive factors to be considered in the development of this toxicity are age >60 years, BMI ≥30, toxic habits and cardiovascular risk factors. Conclusion: CIPN is a common and understudied toxicity, despite being a limiting factor in the quality of life of many patients. As described in acute CIPN, our study demonstrates the relationship between chronic neuropathy and being a carrier of specific polymorphisms (C1236T and C3435T) of the ABCB1 gene in patients treated with P. In addition, there are modifiable factors (obesity, smoking, or alcohol) that may influence its development. Further prospective studies are needed to investigate genetic and clinical modifiable factors predisposing to CIPPN to develop prevention and treatment strategies.

3.
Front Microbiol ; 14: 1197399, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37538842

RESUMO

Plant-microbiota interactions have significant effects on plant growth, health, and productivity. Rhizosphere microorganisms are involved in processes that promote physiological responses to biotic and abiotic stresses in plants. In recent years, the interest in microorganisms to improve plant productivity has increased, mainly aiming to find promising strains to overcome the impact of climate change on crops. In this work, we hypothesize that given the desertic environment of the Antarctic and the Atacama Desert, different plant species inhabiting these areas might share microbial taxa with functions associated with desiccation and drought stress tolerance. Therefore, in this study, we described and compared the composition of the rhizobacterial community associated with Deschampsia antarctica (Da), Colobanthus quitensis (Cq) from Antarctic territories, and Croton chilensis (Cc), Eulychnia iquiquensis (Ei) and Nicotiana solanifolia (Ns) from coastal Atacama Desert environments by using 16S rRNA amplicon sequencing. In addition, we evaluated the putative functions of that rhizobacterial community that are likely involved in nutrient acquisition and stress tolerance of these plants. Even though each plant microbial rhizosphere presents a unique taxonomic pattern of 3,019 different sequences, the distribution at the genus level showed a core microbiome with a higher abundance of Haliangium, Bryobacter, Bacillus, MND1 from the Nitrosomonadaceae family, and unclassified taxa from Gemmatiamonadaceae and Chitinophagaceae families in the rhizosphere of all samples analyzed (781 unique sequences). In addition, species Gemmatirosa kalamazoonesis and Solibacter usitatus were shared by the core microbiome of both Antarctic and Desert plants. All the taxa mentioned above had been previously associated with beneficial effects in plants. Also, this microbial core composition converged with the functional prediction related to survival under harsh conditions, including chemoheterotrophy, ureolysis, phototrophy, nitrogen fixation, and chitinolysis. Therefore, this study provides relevant information for the exploration of rhizospheric microorganisms from plants in extreme conditions of the Atacama Desert and Antarctic as promising plant growth-promoting rhizobacteria.

4.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1385902

RESUMO

RESUMEN: Porphyromonas gingivalis (P. gingivalis) es un microorganismo frecuentemente aislado en pacientes con periodontitis, en los que también se incluye los de la población chilena. El modelo de "Keystone bacteria" demostró que P. gingivalis induce la disbiosis del biofilm subgingival y permite el desarrollo de algunas especies sobre otras, modulando la patogenicidad de la comunidad microbiológica completa. El tratamiento de la periodontitis es principalmente mecánico, pero en condiciones específicas es necesario el complemento con antibioterapia. Los estudios globales de antibióticos evaluados en ensayos clínicos y estudios in vitro han mostrado resultados mixtos en cuanto a eficacia y susceptibilidad. Este estudio descriptivo tuvo como objetivo evaluar el perfil de susceptibilidad antimicrobiana in vitro a metronidazol, clindamicina, amoxicilina más ácido clavulánico, moxifloxacino y azitromicina de P. gingivalis aisladas de pacientes periodontales chilenos. Se obtuvieron muestras microbiológicas de pacientes con diagnóstico de periodontitis estadíos III y IV generalizada, las que se sometieron a procesos de identificación mediante un espectrómetro de masas (MALDI-TOF MS). Posteriormente, a cada muestra positiva a P. gingivalis se aplicó el protocolo gold standard de susceptibilidad para los cinco antimicrobianos evaluados (Dilución en Agar Sangre Brucella- McFarland 0.5). Se seleccionaron 50 pacientes (25 mujeres, 25 hombres) entre 34-69 años. Finalmente, se recuperaron 25 cepas de P. gingivalis (50 %) para el análisis de susceptibilidad y todas ellas fueron sensibles a todos los antibióticos evaluados (100 % susceptibilidad). Las cepas de P. gingivalis fueron altamente sensibles a los cinco antibióticos evaluados en esta población, lo que podría implicar contar con diferentes alternativas de tratamiento farmacológico antimicrobi ano como complemento al tratamiento mecánico convencional en pacientes específicos.


ABSTRACT: Porphyromonas gingivalis (P. gingivalis) is a microorganism frequently isolated in patients with periodontitis, which also include those of Chilean population. The "Keystone bacteria" model demonstrated that P. gingivalis induces dysbiosis of the subgingival biofilm and allows the development of some species over others, modulating the pathogenicity of the entire microbiological community. The treatment of periodontitis is mainly mechanical; nevertheless, under specific conditions the complement with antibiotherapy is needed. Global studies of antibiotics evaluated in clinical trials and in vitro studies have shown mixed results in terms of efficacy and susceptibility. This descriptive study aimed to evaluate antimicrobial susceptibility profile in vitro to metronidazole, clindamycin, amoxicillin plus clavulanic acid, moxifloxacin and azithromycin of P. gingivalis isolated from Chilean periodontal patients. Microbiological samples were obtained from patients with a diagnosis of generalized periodontitis stages III and IV, which were exposed to identification processes by a mass spectrometer (MALDI-TOF MS). Subsequently, the gold standard susceptibility protocol for the five antimicrobials evaluated was applied to each P. gingivalis- positive sample (Dilution in Brucella-McFarland Blood Agar 0.5). 50 patients (25 women, 25 men) between 34-69 years old were selected. Finally, 25 P. gingivalis strains (50 %) were recovered for susceptibility testing and all of them were susceptible to all antibiotics tested (100 % susceptibility). P. gingivalis strains were highly susceptible to the five antibiotics evaluated in this population, which could implies counting different antimicrobial pharmacological treatment alternatives as a complement to conventional mechanical treatment in specific patients.

5.
Cad. Bras. Ter. Ocup ; 29: e2926, 2021.
Artigo em Espanhol | LILACS-Express | LILACS, Index Psicologia - Periódicos | ID: biblio-1345591

RESUMO

Resumen La Terapia Ocupacional es una disciplina emergente dentro de los equipos educativos multidisciplinarios, por lo que, resulta relevante indagar sobre su rol dentro del contexto educativo chileno. Este artículo presenta una investigación cualitativa cuyo objetivo es analizar desde una perspectiva crítica, cómo influye el diagnóstico clínico en las prácticas de terapeutas ocupacionales que trabajan en contextos educativos, considerando como ejes principales para la investigación, el marco normativo inclusivo vigente en Chile, el discurso de terapeutas ocupacionales a cerca de sus prácticas y las relaciones que se establecen con el diagnóstico clínico en este contexto. La muestra corresponde a diez terapeutas ocupacionales que se desempeñan en establecimientos educativos del sur de Chile, a quienes se les aplicaron entrevistas semi-estructuradas. Los resultados permiten visualizar que las políticas educativas influyen significativamente en las prácticas de terapeutas ocupacionales, aún cuando la normativa no especifica el rol disciplinar. Además, el diagnóstico circula fuertemente en el discurso de terapeutas ocupacionales, funcionando como un dispositivo de poder al interior de las prácticas profesionales, especialmente con el fin de validar el rol profesional dentro del contexto educativo. Se discute el uso del diagnóstico en relación a la identidad profesional y los efectos que tiene sobre los sujetos de intervención. El artículo concluye con la propuesta de adoptar una visión crítica del propio quehacer de la disciplina, basándose en la acción transformadora que ésta busca generar a través de la práctica.


Resumo A Terapia Ocupacional é uma profissão emergente nas equipes educacionais multidisciplinares, portanto, é relevante indagar sobre seu papel, no âmbito educacional, em contexto chileno. Este artigo apresenta uma pesquisa qualitativa cujo objetivo foi analisar, a partir de uma perspectiva crítica, como o diagnóstico clínico influencia nas práticas de terapeutas ocupacionais que atuam em contextos educacionais, considerando como eixos principais para a pesquisa, o marco normativo de inclusão vigente no Chile, o discurso dos profissionais sobre suas práticas e as relações estabelecidas com o diagnóstico clínico. A amostra foi composta de dez terapeutas ocupacionais que atuam em estabelecimentos de ensino no sul do Chile, aos quais foram aplicadas entrevistas semiestruturadas. Os resultados demonstraram que as políticas educacionais influenciam significativamente as práticas dos terapeutas ocupacionais, mesmo quando os regulamentos não especificam seu papel disciplinar. Além disso, o diagnóstico circula fortemente no discurso dos terapeutas ocupacionais, atuando como um dispositivo de poder nas práticas profissionais, com o objetivo de validar o papel profissional no contexto educacional. Discute-se sobre o uso do diagnóstico em relação à identidade profissional e seus efeitos nos sujeitos da intervenção. O artigo conclui com a proposta de adotar uma visão crítica do próprio papel do terapeuta ocupacional, a partir da ação transformadora que esta profissional busca gerar através da prática.


Abstract Occupational Therapy is an emerging discipline within multidisciplinary educational teams, therefore, it's relevant to inquire about its role in the Chilean educational context. This article presents research whose aim was to analyze, from a critical perspective, how clinical diagnosis influences the practices of occupational therapists that work in the school system, considering as the main axes for research, the normative framework that governs the educational system in Chile, the discourse of occupational therapists on their practices and the relationships established with the diagnosis in this context. The sample was ten occupational therapists who work in schools from the south of Chile, to whom semi-structured interviews were applied. The results allow us to visualize that educational policies significantly influence the practices of occupational therapists, even when the regulations do not specify the disciplinary role. In addition, clinical diagnosis emerges strongly in the discourse of occupational therapists, functioning as a device of power within professional practices, especially to validate the professional role within the educational context. The use of diagnosis concerning the professional identity and the effects it has on the people they work with is discussed. This article concludes with the proposal of adopting a critical vision of the discipline's task, based on the transformative action that it seeks to generate through practice.

6.
Rev. colomb. ciencias quim. farm ; 49(3): 740-758, Sep.-Dec. 2020. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1156314

RESUMO

RESUMEN Objetivo: Conocer la prevalencia de enfermedades según el grupo sanguíneo de la población estudiada en la provincia de Cuenca (España). Métodos: Estudio observacional, descriptivo, corte transversal y base poblacional. La muestra de 73 personas (39 varones, 34 mujeres), mayores de 60 años. Se identificaron todos los grupos sanguíneos, estudiándolos por edad y género. Resultados: Los porcentajes de grupos sanguíneos de la población estudiada por género son 42,6% (grupo A); 42,4% (O); 13% (B) y 1,4% (AB). Predomina el A+ (35,6%), seguido del O+ (27,4%). Se estudia la prevalencia de una determinada enfermedad en función del grupo sanguíneo. En este sentido, se detectan diferencias dentro de un mismo grupo, según el fator Rh. Los grupos Rh positivos padecen más de HTA, insomnio y depresión que los Rh negativos. Los grupos A y O padecen mayor aumento de colesterol que los del grupo B. Los del grupo O tienen más HTA que el resto y el O+ padece mayor porcentaje de anemia (Fe), mientras que los A+ anemia (B12). La osteoporosis es mayor en los grupos negativos que en los positivos, salvo en el grupo AB+. Conclusiones: El grupo sanguíneo con el que nacemos puede condicionar las enfermedades que padeceremos a lo largo de nuestra vida. El ser 0 podría predisponerlos a tener HTA, anemia (Fe), colesterol, enfermedades pulmonares e insomnio, mientras que el A depresión, anemia (B12) y problemas de próstata en varones.


SUMMARY Objective: To know the prevalence of diseases according to the blood group of the population studied in the province of Cuenca (Spain). Methods: An observational, descriptive, cross-sectional, and population-based study. The sample is 73 people (39 men and 34 women), over 60 years. All blood groups were identified, studying them by age and gender. Results: The percentages of blood groups of the population studied by gender are 42.6% (group A), 42.4% (O), 13% (B) and 1.4% (AB). A+ predominates (35.6%), followed by O+ (27.4%).The prevalence of a certain disease based on blood group is studied. In this sense, differences are detected within the same group, according to the Rh factor. Rh positive groups suffer more from hypertension, insomnia and depression than Rh negative groups. Groups A and 0 O suffer a greater increase in cholesterol than those of group B. Those in group 0 O have more hypertension than the rest and the 0O + suffer a higher percentage of anemia (Fe), while those A + anemia (B12). Osteoporosis is greater in the negative groups than in the positive ones, except in the AB + group. Conclusions: The blood group with which we are born can condition the diseases that we will suffer throughout our lives. Being 0 could predispose them to have hypertension, anemia (Fe), cholesterol, lung diseases and insomnia, while A could predispose them to have depression, anemia (B12) and prostate problems in men.

7.
Reprod Domest Anim ; 55(2): 229-239, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31868975

RESUMO

Cryopreservation of stallion semen has not reached the level of efficiency and positive results described in other species. This is mainly due to the greater sensitivity of stallion sperm to the freezing process, showing higher rates of oxidative stress and plasma membrane damage, which trigger the activation of several cell damage pathways that ultimately culminate in DNA fragmentation and cell death. Therefore, finding molecules that improve the efficiency of this technique in stallion by preventing oxidative stress and cell damage is required. Thus, the aim of the present study was to evaluate the effect of adding three antioxidants (MnTBAP, NAC and FeTPPS) to the freezing medium on the quality and functional parameters of stallion sperm. Semen samples from three stallions frozen with the antioxidants were evaluated in two conditions: (a) adding the antioxidants before freezing, and (b) before and after freezing. Plasma membrane integrity, mitochondrial membrane potential, lipid peroxidation, intracellular ROS levels, membrane lipid disorder, DNA damage, sperm motility and binding to the zona pellucida were assessed. The results showed that MnTBAP was the antioxidant treatment that best controlled the oxidative stress process and post-thaw cell damage, showing higher plasma membrane integrity, mitochondrial membrane potential, sperm motility, number of spermatozoa bound to the zona pellucida of bovine oocytes and lower lipid disorder. Additionally, it was determined that a second post-thaw application of antioxidants is detrimental since induced higher cell damage and lower sperm motility, without showing any beneficial effect on the spermatozoa.


Assuntos
Antioxidantes/farmacologia , Criopreservação/veterinária , Crioprotetores/farmacologia , Preservação do Sêmen/veterinária , Acetilcisteína/farmacologia , Animais , Membrana Celular/efeitos dos fármacos , Criopreservação/métodos , Fragmentação do DNA , Cavalos , Masculino , Lipídeos de Membrana , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Metaloporfirinas/farmacologia , Estresse Oxidativo , Preservação do Sêmen/métodos , Motilidade dos Espermatozoides/efeitos dos fármacos , Zona Pelúcida/fisiologia
8.
Rev. cientif. cienc. med ; 22(2): 22-28, 2019. ilus
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1126263

RESUMO

Introducción: La prevalencia de la Dermatitis Atópica a nivel mundial se sitúa entre el 10 y el 20%, cifra que va en constante aumento. Constituye un problema con una significativa prevalencia teniendo una gran variabilidad entre las distintas zonas geográficas. Por esta razón, es importante la implementación de herramientas novedosas para su estudio; tal como la encuesta del estudio del International Study of Asthma and Allergy in Childhood (ISAAC) cuyo fin es el determinar el aumento de esta patología. Objetivo: Establecer la prevalencia de Dermatitis Atópica en población pediátrica de tres zonas de Honduras; Comayagua, Santa Rosa de Copán y Cuyali El Paraíso. Asimismo, se comprobó la relación entre la prevalencia de la dermatitis atópica según la edad, sexo; y como ésta afecta la calidad de vida de los que la padecen. Material y Métodos: Se realizó un estudio descriptivo transversal, tomando una muestra de 622 de un universo de 1,351 niños y adolescentes entre las edades de 6 a 7 años y 13 a 14 años. Se obtuvo datos a partir de la aplicación del instrumento de la fase uno del estudio ISAAC en el periodo de tiempo comprendido entre febrero y mayo de 2016. Resultados: Se encontró que la prevalencia total de dermatitis atópica entre los tres lugares fue de 26.5%, siendo más prevalente en el grupo de edad de 6 a 7 años y del sexo masculino. Además, se concluyo que el 20% de los casos presentó afectación importante en la calidad de vida. Conclusión: En nuestra población se comprobó que la dermatitis atópica es una enfermedad con prevalencia alta; sin embargo, cabe mencionar que no se ha recogido datos suficientes para establecer otras posibles comparaciones.


Introduction: It is estimated that the prevalence of atopic dermatitis globally experiences a constant increase, ranging between 10 and 20%. Atopic dermatitis constitutes a problem with a significant prevalence variating considerably among different geographical regions. For this reason and with the aim to study such phenomenon, it is important to implement innovative tools as the International Study of Asthma and Allergy in Childhood's (ISAAC) survey results, whose sole purpose is to determine the increase rate of this pathology. Objective: To establish the prevalence of atopic dermatitis in the pediatric population of three Honduran regions: Comayagua, Santa Rosa de Copán and Cuyalí, El Paraíso. Likewise, the research demonstrates the direct relationship between the prevalence of atopic dermatitis with age, sex; while exposes how this disease affects the quality of life of those who suffer it. Material and Methods: A cross-sectional descriptive study was carried out where a sample of 622 was taken from a universe of 1,351 children and adolescents between the ages of 6 to 7 years and 13 to14 years. The data was obtained by applying the ISAAC study’s instrument of phase one during the period between February and May of 2016. Results: The total prevalence of atopic dermatitis among the three places was 26,5%, presenting a higher prevalence in males, and in the age group of 6 to 7 years old. In addition, it was concluded that 20% of the cases had a significant impact in the children's life quality. Conclusion: We conclude that atopic dermatitis is a disease with a high prevalence, though not enough researches have been performed to enable possible comparisons.

9.
Rev. cientif. cienc. med ; 21(1): 60-63, 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-959735

RESUMO

INTRODUCCIÓN: actualmente se reconoce a la eisfunción eréctil como una enfermedad multifactorial en la que coexisten causas de tipo psicológicas, neurológicas, endocrinológicas, vasculares, traumáticas, estilos de vida, medio ambiente e iatrogénicas. Si bien es cierto es una enfermedad benigna, afecta tanto la salud física como psicosocial, resultando en la afectación de la calidad de vida de quienes la sufren. OBJETIVO: determinar la prevalencia de disfunción eréctil en pacientes masculinos hipertensos que asisten a la consulta externa del Centro de Atención Integral del Adulto Mayor. METODOLOGIA: se realizó un estudio descriptivo transversal, tomando una muestra de 210 individuos de un universo de 465, obteniendo datos a partir de la aplicación de dos encuestas a los pacientes masculinos e hipertensos en los meses de octubre y noviembre del año 2013. Las encuestas incluían preguntas de carácter general y el índice internacional de disfunción eréctil (IIEF-5). RESULTADOS: en la muestra se encontró que la prevalencia de disfunción eréctil en los pacientes masculinos hipertensos que asisten a la consulta externa del Centro de Atención Integral del Adulto Mayor fue de 58%. CONCLUSIONES: en nuestra población geriátrica masculina e hipertensa que asiste a la consulta externa del Centro de Atención Integral del Adulto Mayor hay una prevalencia alta de disfunción eréctil, presentándose con mayor frecuencia en un rango de edad avanzada debido a causa de enfermedades concomitantes.


INTRODUCTION: Erectile Dysfunction is currently recognized as a multifactorial disease in which psychological, neurological, endocrine, vascular, traumatic, life-style, environmental and iatrogenic causes coexist. Although it is a benign disease, it affects both physical and psychosocial health, resulting in the affectation of the quality of life of those who suffer it. OBJECTIVE: to determine the prevalence of erectile dysfunction in hypertensive male patients attending the outpatient clinic of the Centro de Atención Integral del Adulto Mayor. METHODOLOGY: across-sectional descriptive study was carried out, taking a sample of 210 individuals from a universe of 465, obtaining data from the application of two surveys to male and hypertensive patients in the months of October and November of the year 2013. Surveys Included general questions and the IIEF-5 International Erectile Dysfunction Index. RESULTS: the sample showed that the prevalence of erectile dysfunction in hypertensive male patients attending the outpatient clinic of the Centro de Atención Integral del Adulto Mayor was 58%. CONCLUSIONS: in our male and hypertensive geriatric population attending the outpatient clinic of the Centro de Atencion Integral del Adulto Mayor, there is a high prevalence of erectile dysfunction, presenting more frequently in a range of advanced age due to concomitant diseases.


Assuntos
Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Disfunção Erétil , Idoso , Diabetes Mellitus
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