Conferência Nacional de Saúde, 14ª, 2011 - Agenda Estratégica para a Saúde no Brasil.

Apresentação de Ligia Bahia, vice-presidente da Abrasco. Ressalta a importância do debate dentro da ENSP, uma vez que esta instituição tem grande peso na formulação de políticas de saúde para o país, principalmente neste momento, em que a conferência nacional precisa adquirir maior potência e reacender as discussões sobre o papel da saúde no desenvolvimento do Brasil. Espera que esse Centro de Estudos tenha uma importância histórica lá na frente: "Nossa interferência na CNS deve ser grande, já que as conferências perderam seu papel de protagonistas no debate da saúde, na avaliação, análise e formulação de diretrizes sobre o sistema. Houve um descolamento da forma de pensar a saúde como modelo de desenvolvimento do país". Arquivo disponível para audição e/ou download no ícone ao lado.

Rosiglitazone decreases intra- to extramyocellular fat ratio in obese non-diabetic adults with metabolic syndrome.

BACKGROUND: Insulin resistance is intrinsically related to intramyocellular (IMCL) rather than extramyocellular (EMCL) triglyceride content. Conflicting results have been reported on the ability of insulin sensitizer agents, such as thiazolidinediones, to modify muscle fat distribution. The aim of this study was to investigate the role of rosiglitazone on muscle fat compartment distribution in an adult population of obese non-diabetic metabolic syndrome patients. PATIENTS AND METHODS: Fifteen obese, non-diabetic, metabolic syndrome patients were studied by means of proton nuclear magnetic resonance ((1)H-NMR) spectroscopy before and after treatment with rosiglitazone 8 mg/day for 6 months. Anthropometrical and metabolic variables were assessed. RESULTS: After rosiglitazone, body weight and hip circumference increased [100.9 (91.12-138.7) vs. 107.0 (79.6-142.8) kg and 118 (107-126) vs. 122 (110-131) cm]; while waist-hip ratio (WHR) decreased from 0.93 (0.87-1.00) to 0.89 (0.82-0.97) (P < 0.001 for all). Additionally, fasting plasma glucose, insulin and homeostatis model assessment of insulin resistance (HOMA-IR) significantly decreased while adiponectin increased over threefold [9.7 (3.7-17.7) vs. 38.0 (19.3-42.4) microg/ml] without any changes in resistin. Finally, the IMCL did not change [267.54 (213.94-297.94) vs. 305.75 (230.80-424.75) arbitrary units (AU), P = 0.15] while the EMCL increased [275.53 (210.39-436.66) vs. 411.39 (279.92-556.59) AU; P < 0.01] therefore decreasing the IMCL-to-EMCL (IMCL/EMCL) ratio [1.07 (0.78-1.23) vs. 0.71 (0.53-0.96); P < 0.01]. CONCLUSION: Rosiglitazone treatment increased body weight and hip circumference and decreased WHR. More importantly, it decreased the IMCL/EMCL ratio by increasing the EMCL without any significant change on the IMCL.

Adiponectin is related to intramyocellular lipid content in non-diabetic adults.

OBJECTIVE: Insulin resistance (IR) is associated with intramyocellular lipid (IMCL) content and low serum adiponectin (ADP) levels and ADP is also involved in muscle fat oxidation. However, the relationship between ADP and IMCL content is still controversial and in this study we explored it further in non-diabetic adults. DESIGN: Cross-sectional clinical study. SUBJECTS: Thirty-three adult subjects, 24 obese non-diabetic patients with metabolic syndrome (MS) and 9 lean healthy controls. MEASUREMENTS: Proton nuclear magnetic resonance spectroscopy (1H-NMRS) was performed to quantify IMCL content. The latter plus serum ADP, anthropometrics and biochemical parameters were evaluated and compared in these 2 groups. RESULTS: MS patients had higher body mass index, waist, waist-to- hip ratio, glucose, insulin, and triglycerides and lower HDL cholesterol (HDLc) compared to controls. Homeostasis model assessment of IR (HOMA-IR) [3.25 (2.58-4.13) vs 1.02 (0.73- 1.29); p<0.0001] and IMCL content [266.1 (189.9-296.3) vs 72.85 (55.3-109.4) AU, p<0.0001] were higher, and quantitative insulin-sensitivity check index (QUICKI) [0.32 (0.31-0.33) vs 0.38 (0.37-0.40); p<0.0001] and ADP [8.6 (4.05-15.95) vs 21.1 (12.9- 24.4) microg/ml; p=0.02] were lower in MS subjects compared to controls. IMCL content was directly associated to glucose, insulin, triglycerides, and HOMA-IR and inversely to HDLc, QUICKI and, more importantly, to ADP (r=-0.41; p<0.05). Only in the MS group, ADP partially influenced IMCL content. CONCLUSION: ADP is inversely related to IMCL content in non-diabetic adults. This finding has possible implications for the role of ADP in muscle fat oxidation, IR, and MS.

Metformin improves skin capillary reactivity in normoglycaemic subjects with the metabolic syndrome.

AIMS: Insulin resistance and a parental history of diabetes mellitus are independently associated with endothelial dysfunction. Oxidative stress has a pivotal role in the pathophysiology of vascular injury. Metformin, in addition to its glucose-lowering properties, has vasculoprotective effects. We investigated whether metformin has beneficial effects on the nutritive skin capillary circulation and deceases oxidative stress in a group at high risk for Type 2 diabetes mellitus (T2DM) and cardiovascular disease. METHODS: Thirty normoglycaemic subjects with the metabolic syndrome (MS),who had first-degree relatives with T2DM, participated. The mean age was 39.1 +/- 8.4 years and body mass index (BMI) 35.7 +/- 4.8 kg/m2 (mean +/- SD). SUBJECTS: were randomized 1 : 1 to receive placebo (n=14) or metformin (n=16; 1700 mg/day) in a double-blind study. At baseline and post treatment, blood and urine samples were collected for biochemical and 8-epi-prostaglandin F2alpha (8-epi-PGF2alpha) analysis, respectively. Microcirculation was assessed by nailfold videocapillaroscopy, analysing afferent (AF), efferent (EF) and apical (AP) diameters of capillary loops, functional capillary density (FCD), red blood cell velocity at rest (RBCV), after 1 min arterial occlusion (RBCVmax) and time (TRBCVmax)taken to reach it. RESULTS: Groups did not differ significantly in anthropometric, clinical, laboratory or microvascular measurements at baseline. In the metformin group, weight,BMI, systolic blood pressure and fasting plasma glucose fell, and lipid profile and microcirculatory parameters FCD, AF, EF, AP, RBCVmaxand TRBCVmax improved (all P<0.01). No relationship between clinico-laboratory parameters and microvascular reactivity was observed, except for changes in total and low density lipoprotein-cholesterol and RBCVmax* 8-epi-PGF2alpha did not change significantly in either group. CONCLUSIONS: Metformin improved skin capillary reactivity in normoglycaemic MS subjects independently of significant changes in 8-epi-PGF2alpha levels.

Coronary artery disease, microalbuminuria and lipid profile in patients with non-insulin dependent diabetes mellitus.

PURPOSE: To determine the frequency of coronary artery disease, microalbuminuria and the relation to lipid profile disorders, blood pressure and clinical and metabolic features. METHODS: Fifty-five type 2 diabetic patients (32 females, 23 males), aged 59.9 +/- 9 years and with known diabetes duration of 11 +/- 7.3 years were studied. Coronary artery disease (CAD) was defined as a positive history of myocardial infarction, typical angina, myocardial revascularization or a positive stress testing. Microalbuminuria was defined when two out of three overnight urine samples had a urinary albumin excretion ranging 20-200 micrograms/min. RESULTS: CAD was present in 24 patients (43.6%). High blood pressure (HBP) present in 32 patients (58.2%) and was more frequent in CAD group (p = 0.05) HBP. Increased the risk of CAD 3.7 times (CI[1.14-12]). Microalbuminuria was present in 25 patients (45.5%) and tended to associate with higher systolic blood pressure (SBP) (p = 0.06), presence of hypertension (p = 0.06) and known diabetes duration (p = 0.08). In the stepwise multiple logistic regression the systolic blood pressure was the only variable that influenced UAE (r = 0.39, r2 = 0.14, p = 0.01). The hypertensive patients had higher cholesterol levels (p = 0.04). CONCLUSION: In our sample the frequency of microalbuminuria, hypertension, hypercholesterolemia and CHD was high. Since diabetes is an independent risk factor for cardiovascular disease, the association of others risk factors suggest the need for an intensive therapeutic intervention in primary and in secundary prevention.

Efeito do pai do feto sobre a produçäo de leite em curso de vacas primíparas da raça Caracu / Effects of sire of the fetus on current first lactation yield of Caracu cows

Foram analisadas 2926 lactaçöes de vaca primíparas da raça Caracu, nascidas no período de 1968 a 1988, filhas de 172 reprodutores e acasaladas com 110 touros. Os componentes de variância atribuídos ao reprodutor (pai do feto ou da novilha) foram determinados pelo uso do procedimento VARCOMP, SAS (1985). A análise revelou que o componente de variância devido ao pai do feto foi responsável por 5,3 por cento da variaçäo da produçäo de leite. A inclusäo ou näo do pai do feto näo alterou substancialmente o componente de variaçäo atribuído ao pai da vaca em relaçäo à variaçäo fenotípica total

Efeito da endogamia sobre a idade ao primeiro parto de seis rebanhos da raça Nelore / Effect of inbreeding on age at first calving in six Nelore herds

Analisaram-se os registros genealógicos de 1701 novilhas da raça Nelore, nascidas no período de 1967-84, em seis rebanhos localizados nos Estados de Säo Paulo, Mato Grosso e Mato Grosso do Sul. A média ajustada da idade ao primeiro parto foi de 1246,63 mais ou menos 8,53 dias. As análises estatísticas, desenvolvidas pelo método dos quadrados mínimos com números desiguais nas sub-classes, identificaram os efeitos negativos (P<0,01) de reprodutor, populaçäo, ano de nascimento e efeito linear da endogamia. Mês de nascimento näo afetou (P>0,05) a característica em foco. O coeficiente médio de endogamia foi de 4,45 mais ou menos 5,97. Pela regressäo linear, constatou-se que a cada 1 por cento de aumento no coeficiente de endogamia houve correspondente aumento de 3,22 mais ou menos 0,90 dias na idade do primeiro parto

The human immune response to defined immunogens of Schistosoma mansoni: elevated antibody levels to paramyosin in stool-negative individuals from two endemic areas in Brazil.

Sera from individuals living in 2 areas endemic for Schistosoma mansoni in Minas Gerais, Brazil were assayed for the presence of antibodies against paramyosin and glutathione-S-transferase (GST), molecules previously implicated as vaccine immunogens from studies in laboratory hosts. A group was identified consisting of subjects who were stool-negative and had no record of previous infection but who were seropositive by enzyme-linked immunosorbent assay against crude adult worm antigen (SWAP). These individuals had anti-paramyosin antibody levels which were dramatically elevated with respect to those measured in infected (stool-positive) individuals living in the same endemic area. In contrast, the same 2 groups of stool-positive and stool-negative subjects could not be distinguished on the basis of their seroreactivity to either GST or SWAP. After chemotherapy, anti-paramyosin antibodies rose above pre-treatment levels and remained elevated in those individuals who became stool-negative. In contrast, anti-paramyosin antibodies decreased to pretreatment values in drug-treated individuals who failed to show complete parasitological cure. These results suggest that the immune response of humans to paramyosin may play a role in natural resistance to schistosome infection, and that an elevated antibody level against this antigen may be a useful correlate of drug-induced cure.

Saúde no Brasil: Condições de saúde e inovações nas políticas de saúde no Brasil: o caminho a percorrer.

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