Accuracy and safety of 3D printed surgical guides combined with monitored guidewires for placement of cervicothoracic pedicle screws: Technical note.

Subaxial cervical pedicle screws provide rigid fixation, but their placement poses an important neurovascular injury risk. 3D printed guides have successfully been used to place pedicle screws, but experience in the subaxial cervical spine is limited. We present a case of cervicothoracic dissociation after a pathological fracture due to tumour involvement of the upper thoracic spine, causing paraparesis and intense pain. The cervicothoracic junction is of difficult visualization on fluoroscopy and the patients' severe instability made navigation unreliable. 3D printed individualized guidewire guides were used to help place canulated pedicle screws from C4 to T6. We successfully report the use of impedance guidewire monitoring to prevent pedicle violation and improve procedure safety.

Brazilian FRED Registry: A Prospective Multicenter Study for Brain Aneurysm Treatment-The BRED Study.

BACKGROUND AND PURPOSE: The development of flow diverters has changed the endovascular approach to intracranial aneurysms. On the basis of good results, the indications for flow diverters have expanded to include aneurysms of different shapes, locations, and sizes. The objective of the study was to report on the performance of the Flow Re-Direction Endoluminal Device (FRED) in intracranial aneurysm treatment at early and medium-term follow-up. MATERIALS AND METHODS: This single-arm, multicentric, prospective, observational study assessed aneurysm treatment with the FRED. The primary outcome was complete aneurysm occlusion at 6 and 12 months, and the secondary outcome was to evaluate the safety of the FRED with respect to stroke and death rates. RESULTS: Between June 2016 and August 2018, a total of 100 consecutive patients with 131 aneurysms were treated in 107 procedures. Total occlusion rates were 91% and 95% at 6 and 12 months. There was 1 death, and the total final morbidity rate was 1.8%. The complication rate was 4.6%. CONCLUSIONS: As reported previously, the FRED has proved to be a safe and effective tool, with high occlusion rates. The design of the stent makes it more difficult to perform balloon angioplasty compared with similar devices. A branch arising from the aneurysm sac was found to be a predictor of nonocclusion at 12 months, though larger series are needed to estimate the magnitude of the association.

Pontine Myelinolysis Caused by Hypovolemic Hypernatremia.

Introduction. Central pontine myelinolysis is characterized by the occurrence of acute demyelinating lesions of cells in the pons secondary to abrupt oscillations of serum osmolarity. Its exact incidence is not well defined, but studies show a prevalence of 0.25 to 0.5% in the general population, 2.5% in the intensive care unit, and up to 10% in patients with risk factors, such as chronic liver disease and hepatic transplantation, alcoholism, malnutrition, diuretic therapy, electrolyte imbalance, hypoglycemia, and hyperglycemia. Case Report. A 70-year-old white female with extranodal diffuse large B-cell non-Hodgkin's lymphoma (extensive mass on the left anterior chest wall), stage IVA, developed pontine myelinolysis secondary to hypovolemic acute hypernatremia, which occurred due to diarrhea caused by chemotherapy (rituximab, cyclophosphamide, doxorubicin, and vincristine). Discussion. Pontine myelinolysis occurs most often due to the rapid correction of chronic hyponatremia. But here, we describe a case of the disease secondary to the occurrence of hypovolemic acute hypernatremia in a patient with a hematological malignancy under treatment, who was on chronic treatment with thiazide diuretics and who presented with other electrolyte disturbances as risk factors for the development of pontine myelinolysis.

Organoleptic excipients used in pediatric antibiotics.

Taste is a crucial factor that determines the palatability of the oral dosage form and patient compliance. OBJECTIVE: The aim of this work was to evaluate the organoleptic excipients in oral antibiotics for pediatric use marketed in Brazil. METHODS: The information was obtained from the GuidetoPharmacy, a reference for the pharmaceutical trade. The analysis included dosage forms for oral administration and drugs and their combination with antibacterial action. After this survey, we identified the constitution of the flavoring, sweetening, and coloring agents of each medicine. The results are presented in a descriptive form. RESULTS: Twelve drugs or associations are distributed in 70medicines. Oral suspension was the most common pharmaceutical dosage form. Sweeteners were sucrose, sodium saccharin, and sodium cyclamate. All the coloring agents observed are synthetic and the most frequent ones were yellow twilight no. 6, yellow tartrazine no. 5, and red ponceau 4R. The presence of two or more types of flavorings per medicine was observed. CONCLUSION: Antibacterials use coloring agents, flavorings, and sweeteners to facilitate the administration of medicines for children, using up to six different substances per formulation. No natural coloring agent was observed, demonstrating an issue to be explored in the future. It is important to note that, although necessary, these excipients are responsible for a high incidence of allergic reactions in children.

Consumers' Impression of Minimally Processed Gala Apples Using Word Association.

This study aimed to identify consumers' preferences and impressions of minimally processed "Gala" cultivar apples, using preference tests and word associations. The study was conducted online via the Google Docs tool and sent out via social networks. The participants were 607 individuals, mostly women, mainly between the ages of 18 and 45, with education up to undergraduate and postgraduate level. As regards the preference for minimally processed apples, the profile of the consumer did not influence the choice. The profiles analyzed were gender and education. For the word association test, 11-word categories were formed, and among these, the most important aspect was appearance, followed by taste and texture, which was confirmed by correspondence analysis. Sample A (0 days-no storage) was the most preferred one, differing significantly from the other samples, whereas sample B (3 days of storage) and sample C (6 days of storage) were associated with characteristics for choice of product. The word association methodology revealed the consumer's impressions of the product, in addition to demonstrating simplicity, low cost, speed, and an exploratory character. PRACTICAL APPLICATION: Gender and level of schooling did not influence the choice of minimally processed apples. Appearance was the most cited word in the word association test. Word association is a simple, fast, inexpensive, and projective technique.

Ultrastructure of bovine placenta during all gestational period / Ultraestrutura de placenta bovina durante todo o período gestacional

Placentas from pregnant cows with different gestation periods were used. Placental fragments of all groups were processed and evaluated by transmission electron microscopy. After fragment analysis, bovine placenta was observed to be epitheliochorial type in early pregnancy, becoming progressively sinepiteliocorial at the beginning of the second trimester. There are no ultrastructural evidences of inflammation in the region of caruncles throughout gestation, despite the invasion of caruncle proper lamina by trophoblast cells. However, throughout pregnancy and especially at the end, there were evident signs of cell degeneration in both trophoblast and the uterine epithelium. The active trophoblast cells intensely phagocytize cellular debris. There are complex interdigitations between the surface of the trophoblast and the uterine epithelium, which is related to the increase of the exchange surface between mother and fetus. At the end of pregnancy, interdigitations disappear, favoring the detachment and expulsion of the placenta after birth.(AU)

Foram utilizadas placentas de vacas abatidas em frigorífico com diversos tempos gestacionais. Fragmentos de placentomo de todos os grupos foram processados e avaliados em microscopia eletrônica de transmissão. Após análise dos fragmentos, observou-se que a placenta bovina é do tipo epiteliocorial no início da gestação, tornando-se sinepiteliocorial progressivamente a partir do início do segundo mês de gestação. Não existem evidências ultraestruturais de inflamação na região das carúnculas durante toda a gestação, apesar da invasão da lâmina própria caruncular por células trofoblásticas. No entanto, durante toda a gestação e em especial ao seu final, foram observados sinais evidentes de degeneração celular, tanto do trofoblasto como do epitélio uterino. As células trofoblásticas ativas fagocitam intensamente os debris celulares originados dessas degenerações. Existem complexas interdigitações entre a superfície do trofoblasto e do epitélio uterino, o que estaria relacionado com o aumento da superfície de troca entre mãe e feto. Ao final da gestação, praticamente desaparecem essas interdigitações, favorecendo o descolamento e a expulsão da placenta após o parto.(AU)

TSHR intronic polymorphisms (rs179247 and rs12885526) and their role in the susceptibility of the Brazilian population to Graves' disease and Graves' ophthalmopathy.

PURPOSE: Intronic thyroid-stimulating hormone receptor polymorphisms have been associated with the risk for both Graves' disease and Graves' ophthalmopathy, but results have been inconsistent among different populations. We aimed to investigate the influence of thyroid-stimulating hormone receptor intronic polymorphisms in a large well-characterized population of GD patients. METHODS: We studied 279 Graves' disease patients (231 females and 48 males, 39.80 ± 11.69 years old), including 144 with Graves' ophthalmopathy, matched to 296 healthy control individuals. Thyroid-stimulating hormone receptor genotypes of rs179247 and rs12885526 were determined by Real Time PCR TaqMan(®) SNP Genotyping. RESULTS: A multivariate analysis showed that the inheritance of the thyroid-stimulating hormone receptor AA genotype for rs179247 increased the risk for Graves' disease (OR = 2.821; 95 % CI 1.595-4.990; p = 0.0004), whereas the thyroid-stimulating hormone receptor GG genotype for rs12885526 increased the risk for Graves' ophthalmopathy (OR = 2.940; 95 % CI 1.320-6.548; p = 0.0083). Individuals with Graves' ophthalmopathy also presented lower mean thyrotropin receptor antibodies levels (96.3 ± 143.9 U/L) than individuals without Graves' ophthalmopathy (98.3 ± 201.9 U/L). We did not find any association between the investigated polymorphisms and patients clinical features or outcome. CONCLUSION: We demonstrate that thyroid-stimulating hormone receptor intronic polymorphisms are associated with the susceptibility to Graves' disease and Graves' ophthalmopathy in the Brazilian population, but do not appear to influence the disease course.

Chemical composition of essential oil from ripe fruit of Schinus terebinthifolius Raddi and evaluation of its activity against wild strains of hospital origin.

The essential oil (EO) composition of ripe fruit of S. terebinthifolius Raddi was analyzed by GC-MS. The oil extraction yielded 6.54 ± 1.06% (w/w). Seventeen compounds were identified, accounting for 91.15% of the total oil, where monoterpenes constituted the main chemical class (85.81%), followed by sesquiterpenes (5.34%). The major monoterpene identified was δ-3-carene (30.37%), followed by limonene (17.44%), α-phellandrene (12.60%) and α-pinene (12.59%). Trans-caryophyllene (1.77%) was the major sesquiterpene identified. The antibacterial activity of the essential oil was evaluated against wild strains of hospital origin (Escherichia coli, Pseudomonas sp., Klebsiella oxytoca, Corynebacterium sp., Staphylococcus aureus, Enterobacter sp., Enterobacter agglomerans, Bacillus sp., Nocardia sp. and Streptococcus group D). The essential oil of the ripe fruit of S. terebinthifolius Raddi has shown to be active against all tested wild strains, with minimum inhibitory concentration ranging from 3.55 µg/mL to 56.86 µg/mL. However, it has revealed some differences in susceptibility: the general, Gram-positive species showed greater sensitivity to the action of EO, which is probably due to the lower structural complexity of their cell walls.

Graft-versus-host disease after simultaneous pancreas-kidney transplantation: a case report and review of the literature.

Graft-versus-host disease (GVHD) after solid organ transplantation is rare and usually fatal. We present, to our knowledge, the second successfully treated case in a simultaneous pancreas-kidney (SPK) transplant recipient. A 29-year-old female with end-stage renal disease from type 1 diabetes mellitus received an SPK transplant from a male donor, with rabbit-antithymocyte globulin induction. Twelve days posttransplant, she was readmitted with abdominal pain, nausea and vomiting. She developed leukopenia, abnormal liver enzymes, fever and a skin rash. Skin biopsy showed interface dermatitis consistent with allergic reaction versus GVHD. Fluorescence in situ hybridization of the skin biopsy showed 28% of cells had a Y chromosome confirming GVHD. Short tandem repeats (STR) enriched for CD3+ cells from peripheral blood showed a mixed chimerism. She was successfully treated with a single plasmapheresis to remove antithymocyte globulin, high-dose steroids, photopheresis and high tacrolimus levels (12-15 ng/mL). Five months after transplantation, she has normal renal function and white blood cell count, normal hemoglobin A1C and no evidence of peripheral blood donor chimerism. In conclusion, early diagnosis of GVHD after SPK transplantation may allow successful treatment. STR enriched for CD3+ may be useful to evaluate the response to therapy.

Chemical composition of essential oil from ripe fruit of Schinus terebinthifolius Raddi and evaluation of its activity against wild strains of hospital origin

The essential oil (EO) composition of ripe fruit of S. terebinthifolius Raddi was analyzed by GC-MS. The oil extraction yielded 6.54 ± 1.06% (w/w). Seventeen compounds were identified, accounting for 91.15% of the total oil, where monoterpenes constituted the main chemical class (85.81%), followed by sesquiterpenes (5.34%). The major monoterpene identified was δ-3-carene (30.37%), followed by limonene (17.44%), α-phellandrene (12.60%) and α-pinene (12.59%). Trans-caryophyllene (1.77%) was the major sesquiterpene identified. The antibacterial activity of the essential oil was evaluated against wild strains of hospital origin (Escherichia coli, Pseudomonas sp., Klebsiella oxytoca, Corynebacterium sp., Staphylococcus aureus, Enterobacter sp., Enterobacter agglomerans, Bacillus sp., Nocardia sp. and Streptococcus group D). The essential oil of the ripe fruit of S. terebinthifolius Raddi has shown to be active against all tested wild strains, with minimum inhibitory concentration ranging from 3.55 μg/mL to 56.86 μg/mL. However, it has revealed some differences in susceptibility: the general, Gram-positive species showed greater sensitivity to the action of EO, which is probably due to the lower structural complexity of their cell walls.

Efeito fungitóxico do óleo essencial de aroeira da praia (Schinus terebinthifolius RADDI) sobre Colletotrichum gloeosporioides / Fungitoxic effect of essential oil from aroeira (Schinus terebinthifolius RADDI) on Colletotrichum gloeosporioides

Neste trabalho foi avaliado o efeito do óleo essencial do fruto de Schinus terebinthifolius sobre o crescimento micelial do fungo Colletotrichum gloeosporioides in vitro, e no desenvolvimento da antracnose no período de pós-colheita em mamões. As diferentes concentrações de óleo foram diluídas em Tween 80 a 8%. No experimento in vitro foram preparados meios de cultura BDA nas concentrações de 0,05; 0,10; 0,25 e 0,50% do óleo essencial. O controle negativo foi realizado apenas com meio BDA e o controle solvente com meio BDA e Tween 80 a 8%. A inibição do crescimento do fungo foi diretamente proporcional à quantidade do óleo e a maior inibição encontrada foi de 79,07% na concentração de óleo de 0,50%. No experimento in vivo os frutos do mamoeiro foram inoculados com o fungo em quatro tratamentos: com biofilme; com biofilme mais 0,50% do óleo; com fungicida Prochloraz e frutos controle. Embora o tratamento com óleo tenha sido eficiente contra o fungo, não foi indicado comercialmente, pois apresentou valores elevados de perda de massa fresca, de firmeza, e também sintomas de fitotoxidade. O óleo tem propriedade antifúngica contra C. gloeosporioides in vitro e in vivo, contudo, não é recomendado para o mamão em função da fitotoxidez.

This study evaluated the effect of essential oil from Schinus terebinthifolius fruit on the mycelial growth of the fungus Colletotrichum gloeosporioides in vitro and on the anthracnose development during the postharvest period of papaya fruits. The different oil concentrations were diluted in 8% Tween 80. For the in vitro experiment, PDA culture media were prepared at the concentrations of 0.05, 0.10, 0.25 and 0.50% essential oil. Negative control was prepared with PDA medium alone, while solvent control was prepared with PDA medium and 8% Tween 80. Fungal growth inhibition was directly proportional to the oil amount and the greatest inhibition was 79.07% at 0.50% oil concentration. For the in vivo experiment, papaya fruits were inoculated with the fungus in four treatments: with biofilm, with biofilm plus 0.50% oil, with the fungicide Prochloraz and control fruits. Although treatment with oil was efficient against the fungus, it was not commercially recommended since it presented high values of loss of fresh mass and firmness, as well as phytotoxicity symptoms. The oil has antifungal property against C. gloeosporioides both in vitro and in vivo; however, it is not recommended for papaya fruits due to its phytotoxicity.

Schistosomiasis mansoni: ultrasound-evaluated hepatic fibrosis and serum concentrations of hyaluronic acid.

Schistosomiasis mansoni is a fibrogenic liver disease that constitutes a major health problem in north-eastern Brazil. Although one common manifestation of the disease, periportal fibrosis (PPF), can be assessed by ultrasonography by well-trained physicians, the necessary equipment and personnel are not always readily available. Serum markers, including hyaluronic acid (HA), have been used as alternative means of measuring fibrosis. Recently serum concentrations of HA have been evaluated in 77 Brazilians (61 cases of schistosomiasis mansoni and 16 healthy controls) and compared against the ultrasound-evaluated PPF in the same subjects. The HA was measured using a non-competitive fluorescence-based assay, while the PPF was explored using a portable ultrasound scanner (SSD-500; Aloka, Tokyo) and graded, as patterns A-F, according to the World Health Organization's 'Niamey protocol'. In general, the serum concentrations of HA were found to be positively correlated with the severity of the PPF. The mean concentration of HA in the sera of the 16 controls was significantly lower than that recorded in the schistosomiasis cases who showed PPF of patterns D or E (P<0·001 for each). The cases who showed pattern-C PPF also had significantly less HA in their sera than the cases with PPF of patterns D or E (P<0·001 for each), and the cases with pattern-D fibrosis had significantly lower HA concentrations in their sera than the cases with PPF of pattern E (P<0·001). In an analysis based on a receiver-operating-characteristic (ROC) curve, an HA concentration of 20·2 µg/litre of serum was identified as a threshold that could be used to distinguish moderate cases of PPF (i.e. patterns C or D) from the more advanced cases (i.e. patterns E or F), with a sensitivity of 60% and specificity of 65%. In conclusion, it appears that serum concentrations of hyaluronic acid could be used as markers for periportal fibrosis in patients with schistosomiasis mansoni.

Is diffuse and peritumoral lymphocyte infiltration in papillary thyroid cancer a marker of good prognosis?

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most frequently diagnosed endocrine neoplasia, representing 70 to 80% of all diagnosed thyroid cancers. Furthermore, Hashimoto's thyroiditis is a frequent inflammatory thyroid disease and the main cause of hypothyroidism. The relationship between Hashimoto's thyroiditis and PTC remains controversial. METHODS: Surgery for PTC was performed at our institution on 157 consecutive patients. They were classified by the degree of lymphocyte infiltration (LI). LI was classified as diffuse LI or peritumoral LI (only in or around the tumor), or absent. In addition, age, gender, tumor size, histopathological findings, lymph-node metastasis, extra- thyroidal extension, multifocal tumor, coexistence of LI and clinical outcomes were analyzed. RESULTS: Out of the 141 patients included in the study, 83 (59%) had diffuse LI and 22 (16%) had peritumoral LI. In 36 patients (25%) LI was absent. A comparison of patients in the 3 groups revealed no significant difference in their genders, ages, smoking status, thyroid function, or nodule size at the time of surgery. The characteristics of PTC showed no differences in lymph-node metastasis, tumor invasion into contiguous neck structures, angioinvasion, or PTC subtypes. Tumor-node-metastasis (TNM) classification and classes did not differ among the 3 groups. During the follow-up, 64 out of 141 patients with PTC (55%) had recurrences from 6 to 130 months after the initial treatment. After a mean follow-up period of 8 yr we observed a significantly (p=0.01) high recurrence (66.6%) in the LI absent group with 24 of 36 patients when compared to patients from the diffuse LI group (32 out of 83 patients; 38.5%) and peritumoral LI group (8 out of 22 patients; 25%). CONCLUSIONS: Although the role of the inflammatory-immune cells is complex and little understood, we found a more favorable course of PTC in the presence of LI (diffuse or peritumoral); this supports the hypothesis that LI represents a form of immune reaction to control tumor growth and proliferation.

Seasonal variations in the biochemical composition and lipoperoxidation of Hyalella curvispina (Crustacea, Amphipoda).

We assessed the effect of seasonal variations on the biochemical composition and lipoperoxidation of an amphipod crustacean, Hyalella curvispina, which inhabits the coastal plain of the state of Rio Grande do Sul, and correlated this with information on the biology of the species. The animals were collected monthly from September 2003 to August 2005, in Gentil Lagoon, Tramandaí, Rio Grande do Sul, Brazil. Glycogen levels, total proteins, total lipids, triglycerides, and lipoperoxidation were measured for each sex separately. The results suggest that these animals have seasonal storage and degradation of the energy substrates investigated. During summer, glycogen, total lipids, and triglycerides were stored, and were utilized especially during autumn and winter. Proteins were utilized differently in males and females. Females stored proteins especially in spring and used them in summer; whereas males stored proteins especially in spring and used them in winter. The levels of lipoperoxidation during the year differed between females and males. These variations may be related to biotic factors (e.g., reproduction period and others) and to abiotic factors (e.g., water temperature, salinity and others).

Diagnostic ability of computed tomography to evaluate external root resorption in vitro.

OBJECTIVES: The aim of this study was to evaluate the diagnostic ability of CT to detect simulated external root resorption defects. METHODS: External root resorption defects of different sizes and in different locations were simulated in 59 human mandibular incisors. Cavities simulating root resorption defects of 0.6 mm, 1.2 mm, or 1.8 mm in diameter and 0.3 mm, 0.6 mm, or 0.9 mm in depth (small, medium and large defects) were drilled in the cervical, middle and apical thirds of buccal surfaces. Axial CT was used to obtain cross-sectional images of the teeth, and 177 root thirds were assessed by a blinded observer. RESULTS: Of the 131 cavities, 117 were detected (89%). 32 of the 44 (72.72%) cavities located in the apical third were identified. A statistically significant difference (P<0.01) was found between the sizes of defects examined in the apical third. CONCLUSIONS: The evaluation of CT diagnostic ability revealed high sensitivity and excellent specificity. However, small cavities located in the apical third were more difficult to detect than all other cavities.

Seasonal variations of the energy metabolism of two sympatric species of Hyalella (Crustacea, Amphipoda, Dogielinotidae) in the southern Brazilian highlands.

Aquatic organisms exist in a constantly fluctuating habitat, with changes in photoperiod, temperature, pH, dissolved organic content, dissolved oxygen and food supply. Organisms must alter past of their physiological and biochemical processes to cope with these changes. We compared the effect of seasonal variations in factors related to energy metabolism of two species of sympatric amphipods, Hyalella pleoacuta and Hyalella castroi. The animals were collected monthly from April 2004 through March 2006. Contents of glycogen, proteins, lipids, triglycerides and the levels of lipoperoxidation were determined in males and females throughout the year by using spectrophotometric methods. Observations revealed significant seasonal differences in biochemical composition, as well as differences among sexes and species. Environmental conditions (e.g., trophic conditions) and reproduction are supposed to be the main processes influencing the seasonal patterns of variation in biochemical composition. Both species of Hyalella show ecological and behavioral differences, especially by resources such as food, space and seasonal variations of energy metabolism, which might facilitate their coexistence in the same habitat.

Portopulmonary hypertension syndrome in schistosomiasis mansoni.

Portopulmonary hypertension syndrome (PPHS) is a complication of portal hypertension where the substrate is micro-vessel lesions which are indicative of plexogenic arteriopathy. PPHS has not been linked to pulmonary schistosomiasis. We report, to the best of our knowledge for the first time, a case of PPHS associated with schistosomiasis mansoni.

Manipulation of cold atomic collisions by cavity QED effects.

We show how the dynamics of collisions between cold atoms can be manipulated by a modification of spontaneous emission times. This is achieved by placing the atomic sample in a resonant optical cavity. Spontaneous emission is enhanced by a combination of multiparticle entanglement together with a higher density of modes of the modified vacuum field, in a situation akin to superradiance. A specific situation is considered and we show that this effect can be experimentally observed as a large suppression in trap-loss rates.

Análise crítica da terapêutica insulínica: dificuldades a serem resolvidas em diferentes níveis de atençäo à saúde / Critical analysis of insulinic therapy: dificulties to be solved in different health care levels

Após os animadores resultados do DCCT, a terapêutica insulínica intensiva tem sido recomendada indistintamente em todos os países. Em nossa experiência, aplicada à população de pacientes diabéticos em uso de insulina, atendidos no Hospital Universitário da PCCAMP, tal esquema se mostrou inviável e inadequado, a despeito de contarmos com o atendimento multiprofissional recomendado à assistência do paciente diabético. As razões socioeconômicas e culturais constituíram o principal fator limitante a esta prática. Devido a isto utilizamos em nosso serviço um esquema terapêutico adaptado, que denominamos "insulinização por etapas, através de doses duplas combinadas". Tal método foi o que mostrou melhores resultados devido à fácil inteligibilidade, e porque atribui responsabilidades ao paciente quanto aos resultados a serem obtidos. Desta forma, entre 50 pacientes em uso de insulina, obtivemos sessenta e quatro por cento de bom controle em um tempo médio de seguimento ambulatorial semanal que durou oito semanas. Os pacientes com mau controle glicêmico (trinta e sies por cento) foram reanalisados, caso, para correção das possíveis causas. A casuística final computou oitenta e seis por cento de bom controle glicêmico, sendo que em quatorze por cento dos casos este objetivo não foi alcançado. Entendemos, que algumas das causas de mau controle glicêmicosão de fácil detecção e podem ser corrigidos em nível primário de atenção à saúde. Entretanto, outras causas bastante complexas que dificultam o controle deverão ser referendadas aos setores secundários e terciário de atendimento, visando propiciar o controle glicêmico ótimo a todos os pacientes diabéticos