High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal: The PICT2RE observational study.

INTRODUCTION AND OBJECTIVES: Portugal is a country with a high prevalence of type 2 diabetes (T2D) and cardiovascular disease (CVD). The prevalence of CVD and cardiovascular (CV) risk factors among T2D patients followed in hospitals in Portugal is not known. The primary objective of this study was to assess the prevalence of CVD and CV risk factors among T2D patients in a hospital setting in Portugal. The clinical management of CVD in the hospital setting was also assessed. METHODS: We performed a non-interventional, multicenter, cross-sectional study with a retrospective phase. T2D patients were consecutively invited to participate. Data were collected retrospectively. RESULTS: A total of 715 patients were included in the study. Mean age and diabetes duration were 66.6 and 17.4 years, respectively. Of these, 286 patients (40.0%) had been diagnosed with CVD, mostly ischemic heart disease (50.4%). All patients had at least one CV risk factor. CVD was significantly associated with hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, hypertriglyceridemia and smoking. During the three years prior to study inclusion, the incidence of hyperglycemic episodes and T2D complications increased among patients with established CVD, but the numbers of hospitalization episodes and specialist appointments remained stable. An improvement was observed in key cardiometabolic risk factors. CONCLUSIONS: Our study revealed a high prevalence of CVD and CV risk factors among a sample of T2D patients in a hospital setting. Patients with established CVD seem to be adequately managed but further efforts are needed at the prevention stage for better control of risk factors and morbidity.

Maternal height as a predictor of glucose intolerance in the postpartum and its relationship with maternal pre-gestational weight.

PURPOSE: Short stature predicts higher risk of developing type 2 diabetes. We studied the association between height and glucose intolerance in women with gestational diabetes mellitus (GDM) and whether this association differed according to body mass index (BMI). METHODS: Retrospective study of the Portuguese GDM registry. EXCLUSION CRITERIA: missing data on postpartum oral glucose tolerance test (OGTT) or BMI. ENDPOINT: postpartum glucose intolerance (diabetes mellitus or prediabetes on the 6-8 weeks postpartum OGTT). Women were divided by mean height and compared. A multivariate logistic regression was used, and the analysis was stratified by BMI (cut-off: 30 kg/m2) and interaction was tested. RESULTS: We included 7402 women; mean height was 161.9 ± 6.2 cm. Taller women had lower BMI and lower rates of glucose intolerance (6.8 vs. 8.8%, p = 0.002). Women with BMI < 30 kg/m2 were taller than those with obesity. Height associated with glucose intolerance. The multivariate adjusted OR of glucose intolerance was 0.98 (95% CI 0.96-0.99), p = 0.001, per 1 cm increase in height. This association was only observed in women with BMI < 30 kg/m2: OR 0.97 (95% CI 0.95-0.99), < 0.001. There was no such association in women with BMI ≥ 30 kg/m2: OR 0.99 (95% CI 0.97-1.02), p = 0.65. P for interaction between BMI and height was 0.09. CONCLUSIONS: In non-obese pre-gestational women, height is inversely associated with postpartum glucose intolerance. Per 1 cm increase in height, women present a 3% decrease in the risk of developing diabetes mellitus or prediabetes.

First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy.

Hyperglycaemia first detected during pregnancy is either gestational diabetes mellitus (GDM) or previous undiagnosed diabetes. We aimed to study if there were a first trimester fasting glycaemia (FTG) and a glycated haemoglobin (HbA1c) cut-off values associated with type 2 diabetes mellitus (T2DM) or abnormal glucose homeostasis (AGH) at the post-partum oral glucose tolerance test (OGTT) reclassification. We retrospectively studied a group of pregnant women from the Portuguese National Registry of GDM. Receiver-operating characteristic (ROC) curves were used to determine the best FTG and HbA1c cut-offs to predict T2DM and AGH. We studied 4068 women. The area under the ROC curves (AUC) for the association with T2DM was 0.85 (0.80-0.90) for FTG and 0.85 (0.80-0.91) for HbA1c. The best FTG cut-off for association with T2DM was 99 mg/dL: sensitivity 77.4%, specificity 74.3%, positive predictive value (PPV) 4.8%, and negative predictive value (NPV) 99.5%. The best HbA1c cut-off for association with T2DM was 5.4%: sensitivity 79.0%, specificity 80.1%, PPV 5.7%, and NPV 99.6%. The AUC for the association of FTG and HbA1c with AGH were 0.73 (0.70-0.76) and 0.71 (0.67-0.74), respectively. The best FTG cut-off for predicting AGH was 99 mg/dL: sensitivity 59.4%, specificity 76.2%, PPV 17.0%, and NPV 95.8%. The best HbA1c cut-off was 5.4%: sensitivity 48.7%, specificity 81.5%, PPV 17.8%, and NPV 95.1%. We suggest an FTG of 99 mg/dL and an HbA1c of 5.4% as the best cut-offs below which T2DM is unlikely to be present. Almost all patients with FTG < 99 mg/dL and HbA1c < 5.4% did not reclassify as T2DM. These early pregnancy cut-offs might alert the physician for the possibility of a previous undiagnosed diabetes and alert them to the importance of testing for it after delivery.

Concepts, spaces, and leisure practices from the perspective of youth

Abstract Aim: To investigate how the choices of young people for public or private spaces during their leisure practices, regardless of gender and age group, can be a starting point for the definition of agendas for the constitution of governmental public policies. Methods: The empirical task was accomplished through the application of electronic questionnaires to young university students from Portugal (20%), Brazil (70%), and South Africa (10%). The sample consisted of 705 randomly chosen young people, with an average age of 24 years. The data were analyzed using SPSS and content analysis. The analysis was divided into three categories: comprising the student's profile; referring to leisure and relating to the provision of leisure and space. Results: The youngest people choose the public spaces for their leisure practices and conceive leisure as a moment when they can do whatever they want, without obligations, followed by leisure as fun and free time. There is no difference between men and women in the concept of leisure. The main conclusions highlighted that leisure means to 'do what I want without any obligation to do so', followed by 'fun' and 'free time, and young people like to 'go out with friends, 'play sports' and 'do nothing'. The public space is the most used for leisure. Conclusion: The meaning of leisure is loaded with subjectivities, so we understand that the demands for political actions that enable the use of public spaces safely and with quality are the way to guarantee the rights of the population.

Um olhar sociológico sobre o privilégio epistémico da biomedicina: desconstruindo a metanarrativa / A sociological view on the epistemic privilege of biomedicine: deconstructing the metanarrative

Resumo Apesar do crescente reconhecimento público da sua incompletude e da necessidade de a fazer dialogar com outros saberes, a biomedicina continua a figurar como metanarrativa, como modelo médico epistemologicamente superior, definidor e regulador do que se entende por "saber médico". É na persistência dessa representação de superioridade que reside um dos grandes obstáculos - senão mesmo o maior - à criação de uma efetiva ecologia de saberes no campo dos cuidados de saúde. Com base numa revisão da literatura sobre o tema, este artigo toma justamente por objetivo a desconstrução da versão essencialista da superioridade biomédica, evidenciando o modo como essa suposta superioridade é, na verdade, decorrente de um complexo quadro sociocultural de produção histórica. Assim, revisitando a literatura existente, o artigo desenvolve perspectiva condensada em torno dos principais pilares da construção do poder hegemónico da biomedicina no contexto da modernidade ocidental, a saber: (1) a ligação umbilical da biomedicina à ciência moderna e à sua trajetória de colonização; (2) o processo de anatomoclínica e o modo como, por esse processo, a biomedicina se estabeleceu como poder normativo/regulador, passando a auferir legitimidade e proteção por parte dos Estados; (3) a suposta maior eficácia da biomedicina no quadro de sua maior compatibilidade com os novos imperativos capitalistas; e (4) a constituição de forte movimento profissional biomédico e suas estratégias de fechamento na construção de sua hegemonia.

Abstract Despite the growing public recognition of its incompleteness and its need to make it dialog with other knowledges, biomedicine continues to figure as a metanarrative, as an epistemologically superior medical model, defining and regulating what is meant by "medical knowledge". One of the great obstacles - if not the greatest - to the creation of an effective ecology of knowledges in the field of health care lies in the persistence of this representation of superiority. Based on a review of the literature about the subject, this article aims precisely at deconstructing the essentialist version of biomedicine's superiority, showing how this supposed superiority results, in fact, from a complex sociocultural framework of historical production. In this sense, revisiting the existing literature, the article develops a condensed perspective around the main pillars of the construction of the hegemonic power of biomedicine in the context of Western modernity: (1) the umbilical connection of biomedicine to modern science and its colonization trajectory; (2) the anatomical-clinical process and how biomedicine established itself, through this process, as a normative/regulatory power, gaining legitimacy and protection by the States; (3) the alleged greater effectiveness of biomedicine in the context of its greater compatibility with the new capitalist imperatives; and (4) the constitution of a strong biomedical professional movement and its closing strategies in the construction of its hegemony.

Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database.

Acromegaly is a rare disorder caused by chronic growth hormone (GH) hypersecretion. While diagnostic and therapeutic methods have advanced, little information exists on trends in acromegaly characteristics over time. The Liège Acromegaly Survey (LAS) Database, a relational database, is designed to assess the profile of acromegaly patients at diagnosis and during long-term follow-up at multiple treatment centers. The following results were obtained at diagnosis. The study population consisted of 3173 acromegaly patients from ten countries; 54.5% were female. Males were significantly younger at diagnosis than females (43.5 vs 46.4 years; P < 0.001). The median delay from first symptoms to diagnosis was 2 years longer in females (P = 0.015). Ages at diagnosis and first symptoms increased significantly over time (P < 0.001). Tumors were larger in males than females (P < 0.001); tumor size and invasion were inversely related to patient age (P < 0.001). Random GH at diagnosis correlated with nadir GH levels during OGTT (P < 0.001). GH was inversely related to age in both sexes (P < 0.001). Diabetes mellitus was present in 27.5%, hypertension in 28.8%, sleep apnea syndrome in 25.5% and cardiac hypertrophy in 15.5%. Serious cardiovascular outcomes like stroke, heart failure and myocardial infarction were present in <5% at diagnosis. Erythrocyte levels were increased and correlated with IGF-1 values. Thyroid nodules were frequent (34.0%); 820 patients had colonoscopy at diagnosis and 13% had polyps. Osteoporosis was present at diagnosis in 12.3% and 0.6-4.4% had experienced a fracture. In conclusion, this study of >3100 patients is the largest international acromegaly database and shows clinically relevant trends in the characteristics of acromegaly at diagnosis.

Agronomic efficiency of Rhizobium strains from the Amazon region in common bean / Eficiência agronômica de estirpes de Rhizobium isoladas da Amazônia sobre o feijoeiro-comum

To maximize the contribution of biological nitrogen fixation in common bean, it is necessary to use bacterial strains that are more adapted, competitive, and efficient in the symbiotic process. In this regard, the aim of this study was to evaluate the agronomic efficiency (AE) of three bacterial strains isolated from acid soils with high Al content from the Amazon region in an Argissolo Vermelho Distrófico típico soil (Typic Rhodustults - USDA Classification) from the municipality of Formiga, MG, Brazil. We compared their AE to that of the reference strain CIAT 899T and of two controls without inoculation (one without and another with 80 kg ha-1 of N-urea). The results indicated that inoculation with the strains UFLA 02-100 and UFLA 02-127 provides grain yield equivalent to inoculation with the reference strain and to the control with mineral N. Thus, both have potential for recommendation as inoculants for common bean.

Para maximizar a contribuição da fixação biológica de nitrogênio no feijoeiro-comum é necessária a utilização de estirpes de bactérias mais adaptadas, competitivas e eficientes no processo simbiótico. Nesse sentido, objetivou-se avaliar, em um Argissolo Vermelho Distrófico típico do município de Formiga-MG, a eficiência agronômica (EA) de três estirpes isoladas de solos ácidos e com alto teor de Al da Amazônia e comparar suas EA à da estirpe referência CIAT 899T e à de dois controles sem inoculação (um sem e outro com 80 kg ha-1 of N-ureia). Os resultados indicaram que a inoculação com as estirpes UFLA 02-100 e UFLA 02-127 propicia rendimento de grãos equivalente ao da estirpe referência e ao do controle com N mineral e que por isso, ambas têm potencial para ser recomendadas como inoculantes para o feijoeiro-comum.

Equivalence class formation via class-specific consequences in children diagnosed with autism spectrum disorder / Formação de classes de equivalência via consequências específicas das classes em crianças diagnosticadas com transtorno do espectro do autismo / Formación de clases equivalentes a través de consecuencias específicas de clase en niños diagnosticados con trastorno del espectro autista

Previous equivalence-class formation studies, with class-specific consequences, found inter-subject variability, probably due to loss of efficacy of the consequences as reinforcers. This study evaluated (a) the efficacy of introducing variations of events (within a category) as class-specific consequences and (b) the inclusion of these consequences into the equivalence classes. Two children diagnosed with Autism Spectrum Disorder (ASD), and with intellectual disabilities, were given identity matchingto-sample training (Set A - Sample A1, S+A1/S-A2 and Sample A2, S+A2/S-A1) and simple discrimination reversal training (Set B - S+B1/S-B2 and reversals). Two sets of assorted videos on the same theme plus two sets of assorted food items within the same category were used as class-specific consequences. The data show that the variety of elements was efficient to maintain reinforcement efficacy and encourage the use of similar procedures in the applied context. Both participants showed strong evidence of equivalence class formation, confirming the theoretical prediction regarding the inclusion of the class-specific consequences in the classes. The data confirm that equivalence relations can be found in three-term contingencies.

Estudos anteriores sobre a formação de classes de equivalência, com consequências específicas para as classes, apontaram variabilidade intersujeitos provavelmente devida a perda de eficácia das consequências como reforçadores. O presente estudo avaliou (a) a eficácia da introdução de variações de eventos (dentro de uma categoria) como consequências específicas das classes e (b) a inclusão de tais consequências nas classes. Duas crianças diagnosticadas com Transtorno do Espectro do Autismo (TEA), e com deficiência intelectual, foram submetidas a treino de emparelhamento ao modelo (Conjunto A - Modelo A1, S+A1/S-A2 e Modelo A2, S+A2/S-A1) e treino de reversões de discriminações simples (Conjunto B - S+B1/S-B2 e reversões). Dois conjuntos de vídeos variados de um mesmo tema e dois conjuntos de alimentos variados dentro de uma mesma categoria foram usados como consequências específicas. Os dados mostram que a variedade de elementos foi eficiente para manter a eficácia do reforçamento e encoraja o uso de procedimentos similares em contexto aplicado. Ambos os participantes mostraram forte evidência de formação de classes de equivalência, confirmando a predição teórica sobre a inclusão de consequências específicas nas classes. Os dados confirmam que relações de equivalência podem ser encontradas em contingências de três termos.

Estudios previos de formación de clases de equivalencia, con consecuencia específica de clase, encontraron variabilidad interindividual probablemente debido a la pérdida de eficacia de las consecuencias como reforzadores. Este estudio evaluó (a) la eficacia de la introducción de variaciones de eventos (dentro de una categoría) como consecuencias específicas de clase y (b) la inclusión de tales consecuencias en las clases de equivalencia. Dos niños diagnosticados con Trastorno del Espectro Autista y con discapacidad intelectual, recibieran entrenamiento de igualación de identidad a la muestra (Conjunto A - Muestra A1, S+A1/S-A1 y Muestra A2, S+A2/S-A1) y entrenamiento de inversión de la discriminación simple (Conjunto B - S+B1/S-B2 y inversiones). Se utilizaron dos conjuntos de vídeos diversos de un mismo tema, más dos conjuntos de alimentos diversos dentro de la misma categoría como consecuencias específicas de clase. Los datos muestran que la variedad de elementos fue eficiente para mantener la eficacia del refuerzo y fomentan el uso de procedimientos similares en contexto aplicado. Ambos los participantes mostraron una fuerte evidencia de la formación de clases de equivalencia, lo que confirma la predicción teórica sobre la inclusión de las consecuencias específicas de clase en las clases de equivalencia. Los datos confirman que las relaciones de equivalencia pueden ser encontradas en las contingencias de tres términos.

Equivalence class formation via class-specific consequences in children diagnosed with autism spectrum disorder / Formação de classes de equivalência via consequências específicas das classes em crianças diagnosticadas com transtorno do espectro do autismo / Formación de clases equivalentes a través de consecuencias específicas de clase en niños diagnosticados con trastorno del espectro autista

Previous equivalence-class formation studies, with class-specific consequences, found inter-subject variability, probably due to loss of efficacy of the consequences as reinforcers. This study evaluated (a) the effi cacy of introducing variations of events (within a category) as class-specific consequences and (b) the inclusion of these consequences into the equivalence classes. Two children diagnosed with Autism Spectrum Disorder (ASD), and with intellectual disabilities, were given identity matchingto-sample training (Set A – Sample A1, S+A1/S-A2 and Sample A2, S+A2/S-A1) and simple discrimination reversal training (Set B – S+B1/S-B2 and reversals). Two sets of assorted videos on the same theme plus two sets of assorted food items within the same category were used as class-specific consequences. The data show that the variety of elements was efficient to maintain reinforcement efficacy and encourage the use of similar procedures in the applied context. Both participants showed strong evidence of equivalence class formation, confirming the theoretical prediction regarding the inclusion of the class-specific consequences in the classes. The data confirm that equivalence relations can be found in three-term contingencies.(AU)

Estudos anteriores sobre a formação de classes de equivalência, com consequências específicas para as classes, apontaram variabilidade intersujeitos provavelmente devida a perda de eficácia das consequências como reforçadores. O presente estudo avaliou (a) a eficácia da introdução de variações de eventos (dentro de uma categoria) como consequências específicas das classes e (b) a inclusão de tais consequências nas classes. Duas crianças diagnosticadas com Transtorno do Espectro do Autismo (TEA), e com deficiência intelectual, foram submetidas a treino de emparelhamento ao modelo (Conjunto A – Modelo A1, S+A1/S-A2 e Modelo A2, S+A2/S-A1) e treino de reversões de discriminações simples (Conjunto B – S+B1/S-B2 e reversões). Dois conjuntos de vídeos variados de um mesmo tema e dois conjuntos de alimentos variados dentro de uma mesma categoria foram usados como consequências específicas. Os dados mostram que a variedade de elementos foi eficiente para manter a eficácia do reforçamento e encoraja o uso de procedimentos similares em contexto aplicado. Ambos os participantes mostraram forte evidência de formação de classes de equivalência, confirmando a predição teórica sobre a inclusão de consequências específicas nas classes. Os dados confirmam que relações de equivalência podem ser encontradas em contingências de três termos.(AU)

Estudios previos de formación de clases de equivalencia, con consecuencia específi ca de clase, encontraron variabilidad interindividual probablemente debido a la pérdida de efi cacia de las consecuencias como reforzadores. Este estudio evaluó (a) la efi cacia de la introducción de variaciones de eventos (dentro de una categoría) como consecuencias específi cas de clase y (b) la inclusión de tales consecuencias en las clases de equivalencia. Dos niños diagnosticados con Trastorno del Espectro Autista y con discapacidad intelectual, recibieran entrenamiento de igualación de identidad a la muestra (Conjunto A – Muestra A1, S+A1/S-A1 y Muestra A2, S+A2/S-A1) y entrenamiento de inversión de la discriminación simple (Conjunto B – S+B1/S-B2 y inversiones). Se utilizaron dos conjuntos de vídeos diversos de un mismo tema, más dos conjuntos de alimentos diversos dentro de la misma categoría como consecuencias específi cas de clase. Los datos muestran que la variedad de elementos fue efi ciente para mantener la efi cacia del refuerzo y fomentan el uso de procedimientos similares en contexto aplicado. Ambos los participantes mostraron una fuerte evidencia de la formación de clases de equivalencia, lo que confi rma la predicción teórica sobre la inclusión de las consecuencias específi cas de clase en las clases de equivalencia. Los datos confi rman que las relaciones de equivalencia pueden ser encontradas en las contingencias de tres términos.(AU)

Value of septoturbinal flap in the frontal sinus drill-out type IIb according to draf.

OBJECTIVES/HYPOTHESIS: The Draf IIb aims at widening the frontal sinus drainage in a minimally invasive fashion. However, this technique is associated with a high stenosis rate. Hence, local nasal flaps have been recently introduced or designed to speed up mucosal healing and prevent scarring. STUDY DESIGN: The objective of this study was to present the septoturbinal flap (STF), its use in a Draf IIb, and to examine postoperative outcomes of this procedure. METHODS: From an initial pool of 48 patients with frontal sinus disease to be treated with a Draf IIb, we prospectively selected 46 (95.84%) patients, submitted to a Draf IIb with STF in two Institutions, from November 2010 to November 2014. We excluded two cases (4.16%) for which a flap could not be performed for anatomic restrictions. We present the STF technique and describe demographic data, indication for surgery, and surgery type. RESULTS: Indications for surgery included 24 (52.17%) mucoceles or mucopyoceles, 12 (26.1%) chronic rhinosinusitis, four (8.7%) osteomas, two (4.35%) meningoencephaloceles, and four (8.7%) inverted papillomas. Difficult anatomic conditions were encountered in half of the patients. Restenosis of the frontal sinus drainage pathway occurred in one (2.17%) patient. Far-seated frontal mucoceles recurred in two cases (4.35%), with frontal drainage pathway remaining patent. Rescue treatment comprised a Draf III in two cases and one frontal sinus obliteration. Outcome was favorable for 43 (93.5%) patients. CONCLUSION: The use of STF was associated with a high rate of success for a Draf IIb. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2428-2432, 2016.

Permanent neonatal diabetes by a new mutation in KCNJ11: unsuccessful switch to sulfonylurea

Permanent neonatal diabetes (PNDM) can result from activating heterozygous mutations in KCNJ11 gene, encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channels (KATP). Sulfonylureas promote KATP closure and stimulate insulin secretion, being an alternative therapy in PNDM, instead of insulin. Male, 20 years old, diagnosed with diabetes at 3 months of age. The genetic study identified a novel heterozygous mutation in exon 1 of the KCNJ11 gene – KCNJ11:c1001G>7 (p.Gly334Val) – and confirmed the diagnosis of PNDM. Therefore it was attempted to switch from insulin therapy to sulfonylurea. During glibenclamide institution C-peptide levels increased, however the suboptimal glycemic control lead us to restart an intensive insulin scheme. This new variant of KCNJ11 mutation had a phenotypic lack of response to sulfonylurea therapy. Age, prior poor metabolic control and functional change of KATP channel induced by this specific mutation may explain the observed unsuccessful switch to sulfonylurea. Interestingly, C-peptide levels raise during glibenclamide administration support some degree of improvement in insulin secretory capacity induced by the treatment. Understanding the response to sulfonylurea is crucial as successful treatment may be life-changing in these patients.

Permanent neonatal diabetes by a new mutation in KCNJ11: unsuccessful switch to sulfonylurea.

Permanent neonatal diabetes (PNDM) can result from activating heterozygous mutations in KCNJ11 gene, encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channels (KATP). Sulfonylureas promote KATP closure and stimulate insulin secretion, being an alternative therapy in PNDM, instead of insulin. Male, 20 years old, diagnosed with diabetes at 3 months of age. The genetic study identified a novel heterozygous mutation in exon 1 of the KCNJ11 gene - KCNJ11:c1001G>7 (p.Gly334Val) - and confirmed the diagnosis of PNDM. Therefore it was attempted to switch from insulin therapy to sulfonylurea. During glibenclamide institution C-peptide levels increased, however the suboptimal glycemic control lead us to restart an intensive insulin scheme. This new variant of KCNJ11 mutation had a phenotypic lack of response to sulfonylurea therapy. Age, prior poor metabolic control and functional change of KATP channel induced by this specific mutation may explain the observed unsuccessful switch to sulfonylurea. Interestingly, C-peptide levels raise during glibenclamide administration support some degree of improvement in insulin secretory capacity induced by the treatment. Understanding the response to sulfonylurea is crucial as successful treatment may be life-changing in these patients.

The swing-door island flap canalplasty technique.

OBJECTIVE: This article describes a new canalplasty technique for the treatment of symptoms resulting from chronic refractory otitis externa. METHODS: We report on our experience using a swing-door island flap and a periosteal flap. Thirteen patients underwent treatment and a total of 19 ears were operated on. The range of preoperative symptoms was 3 to 22 years (mean length of symptoms = 12 years). RESULTS: The postoperative course in all the patients showed this to be a satisfactory treatment with no recurrence of symptoms. CONCLUSION: The swing-door island flap canalplasty technique is an effective surgical treatment in patients with refractory otitis externa.

Refsum's disease and cochlear implantation.

OBJECTIVES: The objective was to describe a case of bilateral cochlear implantation in a 59-year-old man with hearing and visual impairment due to Refsum's disease. METHOD: A retrospective case review was performed. RESULTS: After cochlear implantation, the patient demonstrated much improved audiometric performance and reported improved sound localization. CONCLUSIONS: Bilateral cochlear implantation is an important strategy in the improvement of hearing and quality of life in individuals with Refsum's disease.

Oral glucose lowering drugs in type 2 diabetic patients with chronic kidney disease.

Chronic kidney disease (CKD) represents a challenge in the treatment of type 2 diabetic patients. Renal impairment may affect drug clearance and other pharmacokinetic processes which can increase toxicity and drug to drug interactions or cause ineffective therapy. There are many oral glucose lowering drugs available for the treatment of type 2 diabetes mellitus (T2DM) with different mechanisms of action and different pharmacokinetic profiles. While all classes may be used in patients with mild renal impairment, therapeutic options for patients with moderate to severe CKD are still limited. This review focuses on the pharmacokinetics, metabolism, and safety of oral glucose lowering drugs in patients with T2DM and CKD.

A divisão sexual do trabalho no sistema de integração agroindustrial / The sexual division of labor in the agribusiness system of integration

Neste texto mostramos algumas das transformações nas relações de trabalho no setor da agroindústria, ocorridas nas pequenas propriedades familiares rurais, localizadas no oeste catarinense e que são vinculadas ao sistema de integração da Sadia. Analisa particularmente a manutenção da desigual divisão sexual do trabalho na pequena unidade produtiva familiar avícola. Destacamos ainda alguns elementos presentes na divisão sociossexual nesse setor e concluímos indicando alguns desafios para o Serviço Social.

In this text we show some of the tranformatios in the labour relations in the agroindustry sector that ocurred in the small rural family properties, located in the west of Santa Catarina's State and that are vinculated to Sadia's sistem of integration. Analise in particular the maintenance of the unequal sexual division of labour in the small poultry familiar productive unity. We underline yet some elements in the social‑sexual division of labour in this sector and indicate some challenges for the social service.

Agarose gel electrophoresis of cerebrospinal fluid proteins of dogs after sample concentration using a membrane microconcentrator technique.

BACKGROUND: Cerebrospinal fluid (CSF) is produced in the cerebral ventricles through ultrafiltration of plasma and active transport mechanisms. Evaluation of proteins in CSF may provide important information about the production of immunoglobulins within the central nervous system as well as possible disturbances in the blood-brain barrier. OBJECTIVE: The objective of this study was to measure the concentration and fractions of protein in CSF samples using a membrane microconcentrator technique followed by electrophoresis, and to compare the protein fractions obtained with those in serum. METHODS: CSF samples from 3 healthy dogs and 3 dogs with canine distemper virus infection were concentrated using a membrane microconcentrator having a 0.5 to 30,000 d nominal molecular weight limit (Ultrafree, Millipore, Billerica, MA, USA). Protein concentration was determined before and after concentration. Agarose gel electrophoresis was done on concentrated CSF samples, serum, and serial dilutions of one of the CSF samples. RESULTS: Electrophoretic bands were clearly identified in densitometer tracings in CSF samples with protein concentrations as low as 1.3 g/dL. The higher CSF protein concentration in dogs with distemper was mainly the result of increased albumin concentration. CONCLUSION: The microconcentrating method used in this study enables characterization of the main protein fractions in CSF by routine electrophoresis and may be useful for interpreting the underlying cause of changes in CSF protein concentrations.