Morphometric analysis and pattern of protein and gene expression of apoptosis in focal cerebral ischemia in rats and the neuroprotetive action of hypothermia and ketoprofen / Análisis morfométrico y modelo de expresión de proteína y genes de apoptosis en isquemia cerebral focal en ratas y la acción neuroprotectora de hipotermia y ketoprofeno

This study aimed to investigate the morphometric and the pattern of protein and gene expression related to the extrinsic apoptotic pathway in experimental focal cerebral ischemia and the hole of neuroprotection with hypothermia and ketoprofen. For this analysis, 120 rats were randomly divided into 3 groups (20 animals each): control - no surgery (20 animals); sham - simulation of surgery (20 animals); ischemic - focal ischemia for 1 hour, without reperfusion (80 animals) and divided into four subgroups with 20 animals each: ischemic + intraischemic hypothermia; ischemic + previous intravenous ketoprofen, and ischemic + hypothermia and ketoprofen. The infarct volume was measured using morphometric analysis of infarct areas defined by triphenyl tetrazolium chloride and the patterns of expression of the apoptosis genes (Fas, c-Flip, caspase-8 and caspase-3) and the apoptosis protein caspase-3 were evaluated by quantitative real-time PCR and immunohistochemistry, respectively. Hypo expression of genes of extrinsic pathway of apoptosis was observed: Fas receptor, c-Flip and caspase-8 in the ischemics areas. Increases in the gene and protein caspase-3 in the ischemic areas were also observed, and these increases were reduced by hypothermia and ketoprofen, also noted in the morphometric study. The caspases-3 increase suggests that this gene plays an important role in apoptosis, probably culminating in cell death and that the neuroprotective effect of hypothermia and ketoprofen is involved.

Este estudio tuvo como objetivo investigar la morfometría y el patrón de expresión de proteínas y genes relacionados con la vía apoptótica extrínseca en la isquemia cerebral focal experimental y el agujero de neuroprotección con hipotermia y ketoprofeno. Se dividieron aleatoriamente 120 ratas en 3 grupos (20 animales cada uno): control - sin cirugía (20 animales); simulación - simulación de cirugía (20 animales); isquemia isquemia focal durante 1 hora, sin reperfusión (80 animales) y dividida en cuatro subgrupos con 20 animales cada uno: isquemia + hipotermia intraisquémica; isquemia + ketoprofeno intravenoso previo, e isquemia + hipotermia y ketoprofeno. El volumen del infarto se midió utilizando un análisis morfométrico de áreas de infarto definidas por cloruro de trifenil tetrazolio y los patrones de expresión de los genes de apoptosis (Fas, c-Flip, caspase-8 y caspase-3) y la proteína de apoptosis caspase-3 fueron evaluados por PCR cuantitativa en tiempo real e inmunohistoquímica, respectivamente. Se observó hipoexpresión de genes de la vía extrínseca de la apoptosis: receptor Fas, c-Flip y caspasa-8 en las áreas isquémicas. También se observaron aumentos en el gen y la proteína caspasa-3 en las áreas isquémicas y estos aumentos se redujeron por hipotermia y ketoprofeno, también observado por estudio morfométrico. El aumento de caspasas-3 sugiere que este gen tiene un papel importante en la apoptosis, y probable causa de muerte celular, involucrando el efecto neuroprotector de la hipotermia y el ketoprofeno.

Metabolic Syndrome Among Young Health Professionals in the Multicenter Latin America Metabolic Syndrome Study.

Background: Metabolic syndrome (MS) and its components increase the risk of a number of chronic diseases. Evidence regarding its prevalence among health professionals, particularly in Latin America, is limited. The purpose of this study was to assess the overall prevalence of MS and its components among health professionals and students from five Latin American countries. Methods: A cross-sectional multicenter study entitled LATIN America METabolic Syndrome (LATINMETS) was conducted on five groups of apparently healthy volunteer subjects. Sociodemographic factors, lifestyle variables (smoking and physical activity), anthropometric measurements (weight, height, and waist circumference), standard biochemical analyses [triglycerides, glucose, and high-density lipoprotein cholesterol (HDL-C)], and blood pressure measurements were assessed. MS was diagnosed based on internationally harmonized criteria. Associations between MS components and sociodemographic, lifestyle, and anthropometric variables were analyzed using multivariate logistic regression. Results: A total of 1,032 volunteers (n = 316-Mexico, n = 285-Colombia, n = 223-Brazil, n = 132-Paraguay, and n = 76-Argentina) were recruited. The majority of them were women (71.9%), students (55.4%), and younger than 28 years (67.2%). The overall prevalence of age-standardized MS was 15.5% (23.1% men and 12.2% women). The majority (59.3%) presented at least one MS component, mainly abdominal obesity (29.7%) and low HDL-C levels (27.5%). After adjusting for age and sex, MS and its components were positively associated with being overweight or obese. Conclusions: MS prevalence in this study was similar to that generally found among young populations in Latin-American countries. More than half of the sample had at least one MS component, suggesting that preventive measures and treatments aimed at achieving low-risk health status are essential in this population.

BASAL-BOLUS REGIMEN WITH INSULIN ANALOGUES VERSUS HUMAN INSULIN IN MEDICAL PATIENTS WITH TYPE 2 DIABETES: A RANDOMIZED CONTROLLED TRIAL IN LATIN AMERICA.

OBJECTIVE: Few randomized studies have focused on the optimal management of non-intensive care unit patients with type 2 diabetes in Latin America. We compared the safety and efficacy of a basal-bolus regimen with analogues and human insulins in general medicine patients admitted to a University Hospital in Asunción, Paraguay. METHODS: In a prospective, open-label trial, we randomized 134 nonsurgical patients with blood glucose (BG) between 140 and 400 mg/dL to a basal-bolus regimen with glargine once daily and glulisine before meals (n = 66) or Neutral Protamine Hagedorn (NPH) twice daily and regular insulin before meals (n = 68). Major outcomes included differences in daily BG levels and frequency of hypoglycemic events between treatment groups. RESULTS: There were no differences in the mean daily BG (157 ± 37 mg/dL versus 158 ± 44 mg/dL; P = .90) or in the number of BG readings within target <140 mg/dL before meals (76% versus 74%) between the glargine/glulisine and NPH/regular regimens. The mean insulin dose in the glargine/glulisine group was 0.76 ± 0.3 units/kg/day (glargine, 22 ± 9 units/day; glulisine, 31 ± 12 units/day) and was not different compared with NPH/regular group (0.75 ± 0.3 units/kg/day [NPH, 28 ± 12 units/day; regular, 23 ± 9 units/day]). The overall prevalence of hypoglycemia (<70 mg/dL) was similar between patients treated with NPH/regular and glargine/glulisine (38% versus 35%; P = .68), but more patients treated with human insulin had severe (<40 mg/dL) hypoglycemia (7.6% versus 25%; P = .08). There were no differences in length of hospital stay or mortality between groups. CONCLUSION: The basal-bolus regimen with insulin analogues resulted in equivalent glycemic control and frequency of hypoglycemia compared to treatment with human insulin in hospitalized patients with diabetes.

Determination of the cutoff point for waist circumference that establishes the presence of abdominal obesity in Latin American men and women.

AIMS: The recent definitions of the metabolic syndrome (MS) recognize the need for ethnic and region-specific waist circumference (WC) cut-offs that identify people with abdominal obesity. We tested WC as a diagnostic tool to identify people with visceral adiposity in Hispanics from the Latin America region. METHODS: We used the area of visceral adipose tissue (VAT) ≥ 100 cm² at the level between the 4th and 5th lumbar vertebrae in abdominal CT scans as a marker of visceral adiposity and established the optimal WC threshold for men and women by means of receiver operating characteristic (ROC) curves. RESULTS: 179 men and 278 women from Mexico, El Salvador, Venezuela, Colombia and Paraguay were included. The ROC curves were highly discriminative of excess VAT for men and women (area under the curve 0.9 and 0.8 respectively) and the WC threshold was identified at 94 cm for men and between 90 and 92 cm for women. CONCLUSION: In men the WC cutoff was equal to that proposed for europids and suggested for US adults who may have strong genetic contribution to insulin resistance such as Hispanics. In women the threshold was significantly higher than previously proposed for South and Central Americans.

Evaluación del estado nutricional por el método de la valorización subjetiva global en pacientes con VIH/SIDA internados en el hospital LACIMET / Assessment of the nutritional status using the global subjetive evaluation method with HIV/AIDS patients hospitalized at LACIMET hospital

Objetivo: Determinar el estado nutricional por el método de la EGS en pacientes con diagnóstico de SIDA internados en LACIMET. Se estudiaron 50 pacientes internados en Lacimet con el dx de SIDA; 37 pac (74pto) masculino y 13 pac(26pto) femenino. Edad promedio 36,6+-8,5 años. El estado nutricional medido por la EGS informa que el 6 pto estaba nutrido y el 94 pto presentaban algún grado de desnutrición, de este último porcentaje el 15,5 pto estaba con desnutrición moderada y el 33,3 pto tenía desnutrición severa; comparando con otro método de dianóstico nutricional como el IMC se halló que los pacientes desnutridos graves presentaban una media del IMC de 17, en comparación a los nutridos que presentaban una media del IMC de 22. Conclusión: El porcentaje de desnutrición global encontrado por este método es del 94pto, cifra similar a la encontrada en estudios de todo el mundo, resultados estadísticamente significativos al compararlos con otro método como la medición del IMC. La EGS podría formar parte de la evaluación clínica de todo paciente portador del VIH, que requiera terapia nutricional.

Factores de riesgo de la enfermedad cardiovascular en Asunción y area metropolitana / Annual reports 1994 / Risk factors for the cardiovascular diseases in Asunción and metropolitan area

Estudios epidemiológicos internacionales están de acuerdo en que los factores de riesgo más importantes a tener en cuenta para el desarrollo de las enfermedades cardiovasculares son, hipertensión arterial, diabetes mellitus, dislipidemias, obesidad, sedentarismo, tabaquismo y alcoholismo, entre otros, y el peso o significado que ellos tienen varía notablemente entre los países y los grupos humanos. El siguiente estudio de corte transversal realizado por un grupo de profesionales del área de la salud, tuvo como propósito cuantificar la presencia de factores de riesgo de enfermedad cardiovascular y la magnitud de la asociación de esos factores entre sí, en una población de nivel socioeconómico medio de la República del Paraguay, teniendo presente que la primera causa de mortalidad registrada en varios países del mundo, incluyendo al nuestro, son las enfermedades del aparato circulatorio. Las mediaciones del estudio fueron a través de encuestas, exámen físico y análisis laboratorial de la población en estudio. Las conclusiones de esta investigación fueron llamativas; en una muestra de un total de 1606 personas estudiadas representativas del Gran Asunción, se encontró que el 53,8 por ciento de esa población era obesa, el 40 por ciento era de vida sedentaria, el 26,5 por ciento tenía hábitos tabáquicos, 11,5 por ciento presentaba hipertensión arterial y el 6 por ciento era diabética

Prevalencia de hiperlipemia en Asunción y área metropolitana / Annual Reports 1992 / Prevalence of hyperlipemia in Asunción and metropolitan areas

In this study, 1606 individuals were studied in order to establish the prevalence of hyperlipemia in Asunción and metropolitan areas. The prevalence of hyperlipemia was 12.8 percent, and acoording to age the hypercholesterolemia was: 7.4 percent (20 to 49 years), 8.5 percent (50 to 59 years), and 12.9 percent (more than 60 years) for a moderate fisk of acquiringa cardiovascular diseae. For a high risk, percentages were as follows: 6.7 percent (20 to 49 years), 95 percent (50 to 59 years) and 13.3 percent (more than 60 years). Our results and the frequent association of hyperlipemia to risk factors of cardiovascular disease show the necessity of considering hyperlipemia as a public health problem

Prevalencia de los factores de riesgo de enfermedades cardiovasculares en Asunción, Paraguay. Informe preliminar / Annual Reports 1992 / Prevalence of risk factors for cardiovascular diseaes in Asunción, Paraguay. Preliminary Report

This is the first research effort investigating cardiovascular risk in Paraguay. We report results of our ongoing cross-sectional prevalence study of riskfactors for coronary heart disease in the first 497 of 2,000 adult volunteers recruited from a population-based sample of households selected by a random process from the catchment area of 10 public outpatient health care facilities in grater Asunción. Consenting adults were interviewed, received a physical examination and grave blood specimens after a 12-huor fast at the corresponding facility to measure glycemia, cholesterol, triglycerides, insulinemia and 2-huor glucose tolerance. Specimens were processed at the IICS according to international standards. Although there is a preponderance of female subjects in this first group studied, results are similar to those obtained in population elsewhere, particulary with respect to high blood pressure (about 24 percent), diabetes mellitus (8 percent) and glucose intolerance (11 percent), diagnosed according to WHO criteria.Almost one half of diabetic and about one fifth of hypertensives had not known of their diagnosis. In accordance to body mass index, over 27 percent of women and about 32 percent of men were found obese, but 28 percent of obese women hes extreme obesity in comparison to only 17 percent of men. Hypercholesterolemia compatible with a moderate risk for CVD ranged from 7.5 to 9.8 percent, but the cholesterol level associated with a high risk for CVD was almost double (13 percent) in individuals over 40 years of age. About 13 percent of the population had a triglyceride level superior o igual a 200 mg/dl.About 2 percent of subjects studied were smokers

Estimación del estado nutricional de niños en una comunidad rural / Annual Reports 1991 / Estimation of the nutritional status of children in a rural community

The nutritional status of the children in the rural community of Guazu-Cuá, Paraguarí Department, Paraguay, was evaluated within the frame of a project on primary health care. The study was carried out twice (July 1989 and July 1990) in children of both sexs with ages from one month to ten years, using anthropometric parameters and derived indexes such as boby weight:age ratio, height:ages ratio, and boby weight:height ratio. From the 86 evaluated chlidren, 74.5 percent showed normal values, 11.5 percent display signs of a previous malnutrcicion, 2.5 percent actual malnutricion, and 11.5 pervcent were overweight. It is very interesting to emphasize that the percentages of malnourished and overweight children were similar in the two evaluations

Diagnóstico, tratamiento y control del dengue en la República del Perú: informe final / Diagnostic, treatment and control of dengue at Peru: final report

Presenta los antecedentes y situaciones epidemiológicas, entomológicas y asistenciales; acciones contra la epidemia; recomendaciones; programa de control del aedes aegypti y prevención de la introducción del aedes albopictus en Perú; anexos

Plano de Intervenção Educativa para pacientes com Hipertensão Arterial Sistêmica de Unidade Básica de Saúde de Baturité, Ceará

"Durante o trabalho diário em nossa comunidade, a hipertensão arterial sistêmica foi a queixa que mais levou a população a procurar atendimento médico na unidade básica de saúde Candeia São Sebastião, no município de Baturité, Ceará. Do mesmo modo, através de consultas e visitas domiciliares encontramos uma alta prevalência de HAS. Os principais fatos identificadas foram: medicamentos estocados nas residências, pacientes tomando medicação errada, a baixa autoestima, o alto índice de stress, o excesso de peso, o tabagismo, alcoolismo, a hipercolesterolêmia, a falta de exercício físico, a dieta não saudável e a pouca promoção e prevenção de saúde. As possibilidades de realizar um projeto educativo que promovesse um bom controle da HAS, contar com o apoio da população e da equipe de saúde que reconheceram ser este o principal problema de saúde, foram as principais motivações para realizar este trabalho educativo. Será necessário o apoio da gestão municipal para que as medidas preventivas, de promoção, educação, tratamento e reabilitação, todas juntas possam obter êxito na implementação deste projeto de intervenção de educação e saúde de nossa Comunidade."