Incidência de neoplasias malignas em Porto Alegre e Salvador em 2020 de acordo com o DATASUS / Incidence of malignant neoplasms in Porto Alegre and Salvador in 2020 according to DATASUS / Incidencia de neoplasias malignas en Porto Alegre y Salvador en 2020 según DATASUS

Objetivo: analisar a incidência de neoplasias malignas em 2020. Métodos: estudo ecológico com análise comparativa entre as populações de Porto Alegre e Salvador. Foram extraídos dados do DATASUS, analisados em tabelas e apresentados em gráficos. Resultados: A incidência de neoplasias malignas em mulheres entre 30 a 34 anos é maior em Porto Alegre que em Salvador, sendo quase o dobro de casos de mulheres em relação aos homens. Entre 65 a 69 anos, mulheres representaram 20 casos a mais em Porto Alegre, e, em Salvador, o sexo masculino apresentou 28 casos a mais. As mulheres realizaram mais quimioterapias e os homens mais cirurgias. Conclusão: Houve diferença entre a incidência de neoplasias nas cidades podendo associar variáveis determinantes como sexo biológico feminino ao tipo de câncer e idade avançada. A maior incidência de casos na região sul pode estar associada aos hábitos de vida como alimentação e cultura desta região.

Objective: to analyze the incidence of malignant neoplasms in 2020 in two Brazilian cities. Methods: this is an ecological study with comparative analysis between the populations of the cities of Porto Alegre, and Salvador. Data were extracted from the DATASUS, analyzed in tables and presented in descriptive. Results: The incidence of malignant neoplasms in women aged 30 to 34 years is higher of Porto Alegre than in Salvador, with almost double the number of cases in women compared to men in both cities. In the age 65 to 69, women accounted for 20 more cases in Porto Alegre, and in Salvador, males had 28 more cases. Women underwent more chemotherapy and men more surgical in both cities. Conclusion: Differences were observed between the incidence of neoplasms for the cities compared, which could associate determinant variables such as female biological sex with the type of cancer and advanced age. In addition, there is evidence that the southern region of Brazil has a higher incidence than the northeast region, which may be associated with lifestyle habits such as food and culture in the region.

Objetivo: analizar la incidencia de neoplasias malignas en 2020 en dos ciudades brasileñas. Métodos: se trata de un estudio ecológico con análisis comparativo entre las poblaciones de Porto Alegre y Salvador. Los datos fueron extraídos del DATASUS, analizados en tablas y presentados en gráficos. Resultados: La incidencia de neoplasias malignas en mujeres de 30 a 34 años es mayor en Porto Alegre que en Salvador, con casi el doble de casos en mujeres que en hombres. Entre 65 a 69 años, las mujeres representaron 20 casos más en Porto Alegre, y en Salvador, los hombres tuvieron 28 casos más. Las mujeres se sometieron más a quimioterapia y los hombres más a quirúrgias. Conclusión: Se observaron diferencias entre la incidencia de neoplasias, que podrían asociar variables determinantes como el sexo biológico femenino con el tipo de cáncer y la edad avanzada. Existe evidencia de que la región sur de Brasil tiene una mayor incidencia que la región noreste, lo que puede estar asociado con hábitos de estilo de vida como la alimentación y la cultura en la región.

Incidência de neoplasias malignas em Porto Alegre e Salvador em 2020 de acordo com o DATASUS / Incidence of malignant neoplasms in Porto Alegre and Salvador in 2020 according to DATASUS / Incidencia de neoplasias malignas en Porto Alegre y Salvador en 2020 según DATASUS

Objetivo: analisar a incidência de neoplasias malignas em 2020. Métodos: estudo ecológico com análise comparativa entre as populações de Porto Alegre e Salvador. Foram extraídos dados do DATASUS, analisados em tabelas e apresentados em gráficos. Resultados: A incidência de neoplasias malignas em mulheres entre 30 a 34 anos é maior em Porto Alegre que em Salvador, sendo quase o dobro de casos de mulheres em relação aos homens. Entre 65 a 69 anos, mulheres representaram 20 casos a mais em Porto Alegre, e, em Salvador, o sexo masculino apresentou 28 casos a mais. As mulheres realizaram mais quimioterapias e os homens mais cirurgias. Conclusão: Houve diferença entre a incidência de neoplasias nas cidades podendo associar variáveis determinantes como sexo biológico feminino ao tipo de câncer e idade avançada. A maior incidência de casos na região sul pode estar associada aos hábitos de vida como alimentação e cultura desta região.

Objective: to analyze the incidence of malignant neoplasms in 2020 in two Brazilian cities. Methods: this is an ecological study with comparative analysis between the populations of the cities of Porto Alegre, and Salvador. Data were extracted from the DATASUS, analyzed in tables and presented in descriptive. Results: The incidence of malignant neoplasms in women aged 30 to 34 years is higher of Porto Alegre than in Salvador, with almost double the number of cases in women compared to men in both cities. In the age 65 to 69, women accounted for 20 more cases in Porto Alegre, and in Salvador, males had 28 more cases. Women underwent more chemotherapy and men more surgical in both cities. Conclusion: Differences were observed between the incidence of neoplasms for the cities compared, which could associate determinant variables such as female biological sex with the type of cancer and advanced age. In addition, there is evidence that the southern region of Brazil has a higher incidence than the northeast region, which may be associated with lifestyle habits such as food and culture in the region.

Objetivo: analizar la incidencia de neoplasias malignas en 2020 en dos ciudades brasileñas. Métodos: se trata de un estudio ecológico con análisis comparativo entre las poblaciones de Porto Alegre y Salvador. Los datos fueron extraídos del DATASUS, analizados en tablas y presentados en gráficos. Resultados: La incidencia de neoplasias malignas en mujeres de 30 a 34 años es mayor en Porto Alegre que en Salvador, con casi el doble de casos en mujeres que en hombres. Entre 65 a 69 años, las mujeres representaron 20 casos más en Porto Alegre, y en Salvador, los hombres tuvieron 28 casos más. Las mujeres se sometieron más a quimioterapia y los hombres más a quirúrgias. Conclusión: Se observaron diferencias entre la incidencia de neoplasias, que podrían asociar variables determinantes como el sexo biológico femenino con el tipo de cáncer y la edad avanzada. Existe evidencia de que la región sur de Brasil tiene una mayor incidencia que la región noreste, lo que puede estar asociado con hábitos de estilo de vida como la alimentación y la cultura en la región.

Processo de enfermagem em atendimento pré-hospitalar de paciente com anorexia e bulimia / Nursing process in pre-hospital care of a patient with anorexia and bulimia

Este estudo teve como objetivo apresentar um relato de uma adolescente com anorexia nervosa e bulimia e descrever o manejo realizado durante dois atendimentos pré-hospitalares até sua internação. Trata-se de um relato de caso com a descrição da conduta efetivada durante dois atendimentos por uma equipe de atendimento pré-hospitalar. Foram realizadas duas visitas domiciliares até o momento da internação hospitalar da paciente. Adolescente, 18 anos, anorexia nervosa e bulimia. Peso 37 kg e altura 1,67 m. Histórico de dietas restritivas há pelo menos 4 anos. Alteração da avaliação da imagem corporal. O transtorno alimentar se agravou durante o puerpério, com a perda de 17 quilos em 4 meses, chegando a um índice de massa corporal de 13 kg/m². Mau relacionamento com os pais e parentes. Negligência em relação à filha de 4 meses. Necessitava de internação hospitalar devido ao seu quadro geral, porém não aceitava nenhuma conduta terapêutica. Os profissionais que trabalham com pré-hospitalar devem aprofundar o conhecimento sobre as manifestações clínicas, as consequências e o manejo com pacientes que apresentam transtornos alimentares. Dessa forma, é possível que a implementação de medidas terapêuticas se definam com maior facilidade, favorecendo o prognóstico e o tratamento da doença.

Sybil: discutindo um caso de Transtorno Dissociativo de Identidade / Sybil: discussing a case of Dissociative Identity Disorder

Trata-se de uma resenha sobre o filme "Sybil", de 2007, dirigido por Joseph Sargent, escrito com base no livro de Flora Rheta Schreiber, de 1973. O filme aborda a vida de Shirley Mason, uma mulher que nasceu no estado de Minnesota, Estados Unidos. Traz discussões sobre o drama vivido pela protagonista ­ violência infantil, trauma psicológico, transtorno dissociativo de identidade e tratamento psicoterápico.

Micro RNA 146a-5p expression in Kidney transplant recipients with delayed graft function / Expressão do Micro RNA 146a-5p em pacientes transplantados renais com disfunção inicial do enxerto

ABSTRACT Introduction: The development of novel non-invasive biomarkers of kidney graft dysfunction, especially in the course of the delayed graft function period would be an important step forward in the clinical practice of kidney transplantation. Methods: We evaluated by RT-PCR the expression of miRNA-146 to -5p ribonucleic micro-acids (miRNAs) in the peripheral blood and renal tissue obtained from kidney transplant recipients who underwent a surveillance graft biopsy during the period of delayed graft function. Results: In biopsy samples, the expression of miR-146a-5p was significantly increased in the group of patients with delayed graft function (DGF) (n = 33) versus stables patients (STA) (n = 13) and patients with acute rejection (AR) (n = 9) (p = 0.008). In peripheral blood samples, a non-significant increase of miR-146a-5p expression was found in the DGF group versus STA and AR groups (p = 0.083). No significant correlation was found between levels of expression in biopsy and plasma. ROC curve analysis revealed an AUC of 0.75 (95% CI: 0.62-0.88) for the renal tissue expression and 0.67 (95% CI 0.52-0.81) for the peripheral blood expression. Conclusion: We conclude that miR-146a-5p expression has a distinct pattern in the renal tissue and perhaps in the peripheral blood in the setting of DGF. Further refinements and strategies for studies should be developed in the field of non-invasive molecular diagnosis of kidney graft dysfunction.

RESUMO Introdução: O desenvolvimento de novos biomarcadores não invasivos para disfunção do enxerto renal, especialmente no decurso da disfunção inicial do enxerto, seria de enorme valia para a prática clínica do transplante renal. Métodos: A técnica de RT-PCR foi utilizada para avaliar a expressão de microRNA 146a-5p no sangue periférico e no tecido renal de receptores de transplante submetidos a biópsia renal de controle no decurso de disfunção inicial do enxerto. Resultados: A expressão de miR-146a-5p estava significativamente aumentada nas amostras de biópsia do grupo de pacientes com disfunção inicial do enxerto (DIE) (n = 33) em relação aos pacientes estáveis (n = 13) e aos com rejeição aguda (RA) (n = 9) (p = 0,008). Foi detectado aumento não significativo da expressão de miR-146a-5p nas amostras de sangue periférico do grupo com DIE em comparação aos pacientes estáveis e com RA (p = 0,083). Não foi identificada correlação significativa entre os níveis de expressão no plasma e na biópsia. A análise da curva COR revelou uma ASC de 0,75 (IC 95%: 0,62-0,88) para a expressão no tecido renal e de 0,67 (IC 95% 0,52-0,81) no sangue periférico. Conclusão: A expressão de miR-146a-5p tem um padrão distinto no tecido renal e talvez no sangue periférico em cenários de DIE. Maiores refinamentos e estratégias adicionais de estudo devem ser desenvolvidos na área do diagnóstico molecular não invasivo da disfunção do enxerto renal.

Micro RNA 146a-5p expression in Kidney transplant recipients with delayed graft function.

INTRODUCTION: The development of novel non-invasive biomarkers of kidney graft dysfunction, especially in the course of the delayed graft function period would be an important step forward in the clinical practice of kidney transplantation. METHODS: We evaluated by RT-PCR the expression of miRNA-146 to -5p ribonucleic micro-acids (miRNAs) in the peripheral blood and renal tissue obtained from kidney transplant recipients who underwent a surveillance graft biopsy during the period of delayed graft function. RESULTS: In biopsy samples, the expression of miR-146a-5p was significantly increased in the group of patients with delayed graft function (DGF) (n = 33) versus stables patients (STA) (n = 13) and patients with acute rejection (AR) (n = 9) (p = 0.008). In peripheral blood samples, a non-significant increase of miR-146a-5p expression was found in the DGF group versus STA and AR groups (p = 0.083). No significant correlation was found between levels of expression in biopsy and plasma. ROC curve analysis revealed an AUC of 0.75 (95% CI: 0.62-0.88) for the renal tissue expression and 0.67 (95% CI 0.52-0.81) for the peripheral blood expression. CONCLUSION: We conclude that miR-146a-5p expression has a distinct pattern in the renal tissue and perhaps in the peripheral blood in the setting of DGF. Further refinements and strategies for studies should be developed in the field of non-invasive molecular diagnosis of kidney graft dysfunction.

Diuretic or sodium-restricted diet for obstructive sleep apnea-a randomized trial.

Study Objectives: Interventions that decrease leg fluid retention reduce obstructive sleep apnea (OSA) severity in nonrandomized experiments. We aimed to investigate in a randomized trial the effect of interventions that reduce fluid volume on OSA severity. Methods: Men diagnosed with severe OSA were randomized to receive daily spironolactone 100 mg + furosemide 20 mg or nutritional counseling to sodium-restricted diet plus placebo pill or placebo pill. All participants underwent home sleep apnea testing at baseline and after 1 week follow-up. The change in apnea-hypopnea index (AHI) was the primary outcome. Results: The study included 54 participants and all were assessed at follow-up. The average baseline value of the AHI was similar among groups and from baseline to follow-up the AHI reduced 14.4 per cent (δ value -7.3 events per hour; 95% confidence interval, -13.8 to -0.9) in the diuretic group, 22.3 per cent (-10.7; 95% CI, -15.6 to -5.7) in the diet group, and 0.8 per cent (0.4; 95% CI, -2.5 to 3.2) in the placebo group (p = .001 for time × group interaction). None of the patients had their AHI returned to normal. The reduction in the total body water was 2.2 ± 2.2 L in the diuretic group (p < .001) and 1.0 ± 1.6 l in the low salt diet group (p = .002). Sleepiness and neck circumference were significantly reduced only in the diet group (p = .007 and p < .001 for the time × group interactions, respectively). Conclusions: Interventions to reduce bodily fluid content in men with severe OSA promoted a limited decrease of apnea frequency. This finding suggests that rostral fluid displacement affects only partially the OSA severity and/or that other factors prevail in determining pharyngeal collapsibility. Clinical Trial: Sodium-Restricted Diet and Diuretic in the Treatment of Severe Sleep Apnea (DESALT), https://clinicaltrials.gov/ct2/show/NCT01945801 ClinicalTrials.gov number: NCT01945801.

Protective effects of quercetin treatment in a pristane-induced mouse model of lupus nephritis.

INTRODUCTION: Lupus nephritis (LN) is one of the most severe complications of systemic lupus erythematosus. As murine models of LN are valuable tools to better understand its pathophysiology and to search for new effective treatments, we investigated the effects of the bioflavonoid quercetin on pristane-induced LN mice through histomorphological analyses. METHODS: Immunofluorescence and biochemical assays were used to evaluate the expression of markers of inflammation (interleukin-6, IL-6; tumour necrosis factor-α, TNF-α), oxidative stress (catalase, CAT; superoxide dismutase 1, SOD1; thiobarbituric acid reactive substances, TBARS), apoptosis (Bax), and fibrosis (transforming growth factor-ß1, TGF-ß1). Glomerular and tubular ultrastructure was analysed, and tissue messenger RNA of podocin, podoplanin and α3ß1-integrin were quantified using the real-time polymerase chain reaction. RESULTS: Pristane-induced LN mice showed severe kidney injury, characterized by increased proteinuria, glomerular mesangial expansion and inflammation, high expression of the pro-fibrotic, apoptotic and prooxidant markers and reduction of antioxidants. In the kidney ultrastructure, foot process (FP) effacement, apoptotic mesangial cells and abnormal mitochondria with disrupted cristae were observed, along with suppressed tissue mRNA of podocin, podoplanin and α3ß1-integrin. Treatment with quercetin in the pristane-induced LN mice model was nephroprotective, decreasing proteinuria levels and significantly lowering tissue expression of IL-6, TNF-α, TGF-ß1, Bax and TBARS. Simultaneously, quercetin significantly increased CAT and SOD1 expressions in these mice. In addition, it was observed improvement of the kidney ultrastructure, and tissue mRNA of podocin, but not podoplanin and α3ß1-integrin, was restored to the levels found in the control mice. CONCLUSION: In conclusion, these findings provide experimental evidence of the renoprotective effects of quercetin in the pristane-induced LN mice model. We suggest that quercetin effectively ameliorates the kidney damage caused by pristane, a bioflavonoid to be further evaluated as a new therapeutic strategy in this disease.

Cuidados paliativos: um comentário sobre o livro A morte de Ivan Ilitch / Palliative care: a comment on the book "The death of Ivan Ilyich"

Trata-se de um comentário sobre o livro A morte de Ivan Ilitch, de Liev Tolstói. Traz discussões e passagens da narrativa a respeito de questões que envolvem terminalidade e cuidados paliativos. Profissionais da saúde devem estabelecer como princípios o respeito, a autonomia e a ética no cuidado a pacientes em terminalidade.(AU)

This article is a commentary on the book "A Morte de Ivan Illitch" ("The Death of Ivan Ilyich"), by Leo Tolstoy. It presents discussions and narrative passages concerning issues that involve terminal illness and palliative care. Health professionals must establish some principles like respect, autonomy, and ethics in the care of terminal patients.(AU)

Melatonin prevents hyperglycemia in a model of sleep apnea.

OBJECTIVE: Obstructive sleep apnea is a common disorder associated with aging and obesity. Apneas cause repeated arousals, intermittent hypoxia, and oxidative stress. Changes in glucolipidic profile occur in apnea patients, independently of obesity. Animal models of sleep apnea induce hyperglycemia. This study aims to evaluate the effect of the antioxidants melatonin and N-acetylcysteine on glucose, triglyceride, and cholesterol levels in animals exposed to intermittent hypoxia. MATERIALS AND METHODS: Two groups of Balb/c mice were exposed to intermittent hypoxia (n = 36) or sham intermittent hypoxia (n = 36) for 35 days. The intermittent hypoxia group underwent a total of 480 cycles of 30 seconds reducing the inspired oxygen fraction from 21% to 7 ± 1% followed by 30 seconds of normoxia, during 8 hours daily. Melatonin or N-acetylcysteine were injected intraperitonially daily from day 21 on. RESULTS: At day 35, glucose levels were significantly higher in the intermittent hypoxia group than in the control group. The intermittent hypoxia groups receiving N-acetylcysteine and vehicle showed higher glucose levels than the group receiving melatonin. The lipid profile was not affected by intermittent hypoxia or antioxidant administration. CONCLUSIONS: The present results suggest that melatonin prevents the well-recognized increase in glucose levels that usually follows exposure to intermittent hypoxia. Further exploration of the role of melatonin in sleep apnea is warranted.

Uncoupling protein-2 mRNA expression in mice subjected to intermittent hypoxia.

OBJECTIVE: To investigate the effect of intermittent hypoxia-a model of obstructive sleep apnea (OSA)-on pancreatic expression of uncoupling protein-2 (UCP2), as well as on glycemic and lipid profiles, in C57BL mice. METHODS: For 8 h/day over a 35-day period, male C57BL mice were exposed to intermittent hypoxia (hypoxia group) or to a sham procedure (normoxia group). The intermittent hypoxia condition involved exposing mice to an atmosphere of 92% N and 8% CO2 for 30 s, progressively reducing the fraction of inspired oxygen to 8 ± 1%, after which they were exposed to room air for 30 s and the cycle was repeated (480 cycles over the 8-h experimental period). Pancreases were dissected to isolate the islets. Real-time PCR was performed with TaqMan assays. RESULTS: Expression of UCP2 mRNA in pancreatic islets was 20% higher in the normoxia group than in the hypoxia group (p = 0.11). Fasting serum insulin was higher in the hypoxia group than in the normoxia group (p = 0.01). The homeostasis model assessment of insulin resistance indicated that, in comparison with the control mice, the mice exposed to intermittent hypoxia showed 15% lower insulin resistance (p = 0.09) and 21% higher pancreatic ß-cell function (p = 0.01). Immunohistochemical staining of the islets showed no significant differences between the two groups in terms of the area or intensity of α- and ß-cell staining for insulin and glucagon. CONCLUSIONS: To our knowledge, this is the first report of the effect of intermittent hypoxia on UCP2 expression. Our findings suggest that UCP2 regulates insulin production in OSA. Further study of the role that UCP2 plays in the glycemic control of OSA patients is warranted.

Effect of diuretics and sodium-restricted diet on sleep apnea severity: study protocol for a randomized controlled trial.

BACKGROUND: Obstructive sleep apnea occurs as a result of increased collapsibility of the upper airway. Overnight fluid displacement from the legs to the neck causes pharyngeal narrowing and increased apnea severity. Sodium intake is associated with apnea severity. We hypothesized that interventions that decrease bodily fluid content might reduce the severity of sleep apnea. METHODS/DESIGN: This is a randomized clinical trial including men with an apnea-hypopnea index greater than 30 events/hour, previously diagnosed by full-night in-laboratory polysomnography. A total of 54 men will be included and randomly assigned to three groups: Diuretic (n = 18), sodium-restricted diet (n = 18), and control (n = 18). The intervention will last one week. Intention-to-treat and per-protocol analyses will be performed. The diuretic group will receive combined spironolactone 100 mg plus furosemide 20 mg daily, taken in the morning. The diet group will receive a regimen with a maximum intake of 3 g of sodium per day. The control group will receive a placebo pill and will maintain all eating habits while keeping a recall diary of their dietary behavior. The primary outcome measure will be change in apnea-hypopnea index. The secondary outcome measures will be variations of: anthropometric and bioelectrical impedance variables, office blood pressure, respiratory variables from in-home level III polysomnography, excessive daytime sleepiness, glycolipid profile, C-reactive protein, 24 h urinary variables, and adverse events. DISCUSSION: Despite the high efficacy of continuous positive airway pressure to reverse upper airway obstruction in sleep apnea, partial adherence to this form of treatment reduces its efficiency. Thus, additional forms of treating apnea need to be investigated. If the results of this proof-of-concept trial show that decreases in bodily fluid content, either by diuretic or dietary intervention, reduces the severity of sleep apnea, further investigation will be necessary before these results can be translated and adopted as an adjunct apnea therapy. TRIAL REGISTRATION: clinicaltrials.gov NCT01945801.

Uncoupling protein-2 mRNA expression in mice subjected to intermittent hypoxia / Expressão do mRNA da uncoupling protein-2 em camundongos submetidos à hipóxia intermitente

Objective: To investigate the effect of intermittent hypoxia-a model of obstructive sleep apnea (OSA)-on pancreatic expression of uncoupling protein-2 (UCP2), as well as on glycemic and lipid profiles, in C57BL mice. Methods: For 8 h/day over a 35-day period, male C57BL mice were exposed to intermittent hypoxia (hypoxia group) or to a sham procedure (normoxia group). The intermittent hypoxia condition involved exposing mice to an atmosphere of 92% N and 8% CO2 for 30 s, progressively reducing the fraction of inspired oxygen to 8 ± 1%, after which they were exposed to room air for 30 s and the cycle was repeated (480 cycles over the 8-h experimental period). Pancreases were dissected to isolate the islets. Real-time PCR was performed with TaqMan assays. Results: Expression of UCP2 mRNA in pancreatic islets was 20% higher in the normoxia group than in the hypoxia group (p = 0.11). Fasting serum insulin was higher in the hypoxia group than in the normoxia group (p = 0.01). The homeostasis model assessment of insulin resistance indicated that, in comparison with the control mice, the mice exposed to intermittent hypoxia showed 15% lower insulin resistance (p = 0.09) and 21% higher pancreatic β-cell function (p = 0.01). Immunohistochemical staining of the islets showed no significant differences between the two groups in terms of the area or intensity of α- and β-cell staining for insulin and glucagon. Conclusions: To our knowledge, this is the first report of the effect of intermittent hypoxia on UCP2 expression. Our findings suggest that UCP2 regulates insulin production in OSA. Further study of the role that UCP2 plays in the glycemic control of OSA patients is warranted. .

Objetivo: Investigar o efeito da hipóxia intermitente com um modelo de apneia obstrutiva do sono (AOS) sobre a expressão de uncoupling protein-2 (UCP2), assim como sobre perfis glicêmicos e lipídicos, em camundongos C57BL. Métodos: Camundongos C57BL machos foram expostos a hipóxia intermitente ou hipóxia simulada (grupo controle) 8 h/dia durante 35 dias. A condição de hipóxia intermitente envolveu a exposição dos camundongos a uma atmosfera de 92% de N e 8% de CO2 por 30 s, com redução progressiva de fração de O2 inspirado até 8 ± 1%, seguida por exposição a ar ambiente por 30 s e repetições do ciclo (480 ciclos no período experimental de 8 h). Os pâncreas foram dissecados para isolar as ilhotas. Foi realizada PCR em tempo real utilizando o método TaqMan. Resultados: A expressão do mRNA da UCP2 nas ilhotas pancreáticas foi 20% maior no grupo controle que no grupo hipóxia (p = 0,11). A insulina sérica de jejum foi maior no grupo hipóxia do que no grupo controle (p = 0,01). O modelo de avaliação da homeostase de resistência à insulina indicou que, em comparação com os camundongos controle, aqueles expostos à hipóxia intermitente apresentaram 15% menor resistência à insulina (p = 0,09) e 21% maior função das células beta (p = 0,01). A coloração das ilhotas pancreáticas por imuno-histoquímica não mostrou diferenças significativas entre os grupos em termos da área ou da intensidade das células alfa e beta, marcadas por insulina e glucagon. Conclusões: Segundo nosso conhecimento, esta é a primeira descrição do efeito da hipóxia intermitente sobre a expressão da UCP2. Nossos achados sugerem que UCP2 regula a produção de insulina na AOS. Futuras investigações sobre o papel da UCP2 no controle glicêmico em pacientes com AOS são justificadas. .

Melatonin prevents hyperglycemia in a model of sleep apnea

Objective Obstructive sleep apnea is a common disorder associated with aging and obesity. Apneas cause repeated arousals, intermittent hypoxia, and oxidative stress. Changes in glucolipidic profile occur in apnea patients, independently of obesity. Animal models of sleep apnea induce hyperglycemia. This study aims to evaluate the effect of the antioxidants melatonin and N-acetylcysteine on glucose, triglyceride, and cholesterol levels in animals exposed to intermittent hypoxia. Materials and methods Two groups of Balb/c mice were exposed to intermittent hypoxia (n = 36) or sham intermittent hypoxia (n = 36) for 35 days. The intermittent hypoxia group underwent a total of 480 cycles of 30 seconds reducing the inspired oxygen fraction from 21% to 7 ± 1% followed by 30 seconds of normoxia, during 8 hours daily. Melatonin or N-acetylcysteine were injected intraperitonially daily from day 21 on. Results At day 35, glucose levels were significantly higher in the intermittent hypoxia group than in the control group. The intermittent hypoxia groups receiving N-acetylcysteine and vehicle showed higher glucose levels than the group receiving melatonin. The lipid profile was not affected by intermittent hypoxia or antioxidant administration. Conclusions The present results suggest that melatonin prevents the well-recognized increase in glucose levels that usually follows exposure to intermittent hypoxia. Further exploration of the role of melatonin in sleep apnea is warranted. Arch Endocrinol Metab. 2015;59(1):66-70 .

Ecocardiografia em pacientes com apneia do sono grave com e sem pressão arterial controlada: estudo transversal / Echocardiography in patients with severe sleep apnea with and without controlled blood pressure: cross sectional study

A apneia obstrutiva do sono (AOS) afeta a anatomia e função do coração. Ocorre hipertensão arterial em metade dos casos de AOS, dificultando atribuir a etiologia dessas alterações separadamente à hipertensão arterial ou à apneia do sono. Métodos: Estudo transversal de pacientes com índice de apneia-hipopneia maior que 50 eventos por hora. As variáveis ecocardiográficas comparadas em indivíduos com hipertensão arterial controlada e não controlada foram: 1) fração de ejeção, 2) diâmetro da aorta, 3) diâmetro do átrio esquerdo, 4) diâmetro de ventrículo direito, 5) diâmetros do ventrículo esquerdo diastólico e sistólico, 6) percentagem delta, 7) espessura do septo, 8) espessura da parede posterior. Resultados: Foram incluídos 83 voluntários, 50 com pressão arterial não controlada. Em média, a idade era 47 ± 9,5 anos, o índice de massa corporal 34 ± 5,4 Kg/m2 , o índice de apneia-hipopneia 86 ± 18 eventos/hora. Sessenta pacientes apresentaram anormalidade no ecocardiograma. A hipertrofia de ventrículo esquerdo foi o achado mais comum, sem diferença de frequência em controles (39%) e em hipertensos (48%), seguida por disfunção diastólica em controles (27%) e em hipertensos (32%). Conclusões: Indivíduos com apneia do sono grave e pressão arterial controlada apresentam alterações no ecocardiograma de tipo e frequência semelhantes aos com hipertensão não controlada. Isso sugere que a apneia do sono pode causar dano cardíaco independentemente de hipertensão. Quando não explicáveis por hipertensão arterial, achados como hipertrofia de ventrículo esquerdo podem ser provocados por apneia do sono...

Obstructive sleep apnea (OSA) affects the cardiac anatomy and function. Hypertension occurs in half the OSA cases, making it difficult to attribute the cause of these changes separately to arterial hypertension or sleep apnea. Methods: Prospective cross-sectional study of volunteers with apnea-hypopnea index >50 events per hour. The echocardiographic variables were analyzed: 1) ejection fraction, 2) aortic diameter, 3) left atrial diameter, 4) right ventricular diameter, 5) diastolic and systolic diameters of the left ventricle, 6) delta percentage, 7) septum thickness, 8) posterior wall thickness. Results: There were 83 participants, 74 men, 50 with hypertension. The average age was 47 ± 9.5 years, body mass index of 34 ± 5.4 kg/m2 , apnea-hypopnea index of 86±18 events/hour, and minimum oxygen saturation of 55 ± 17%. Left ventricular hypertrophy was the most common echocardiographic abnormality in subjects without hypertension (39%) and with hypertension (48%), followed by diastolic dysfunction in subjects with normal blood pressure (27%) and with high blood pressure (32%). There was no statistically significant difference in echocardiographic characteristics between hypertensive subjects with those with normal pressure. Conclusions: Individuals with normal blood pressure and severe sleep apnea show abnormalities in the echocardiogram with frequency similar to that observed in patients with high blood pressure. This suggests that sleep apnea can cause ventricular overload independently of hypertension. When not explained by high blood pressure, left ventricular hypertrophy can be caused by sleep apnea...

Downregulation of uncoupling protein-1 mRNA expression and hypoadiponectinemia in a mouse model of sleep apnea.

PURPOSE: The knowledge on the effect of intermittent hypoxia on adipose tissue-mediated processes is incipient. The aim of the present study was to assess the effect of a sleep apnea model on a limited set of specific molecular, biochemical, histological, and behavioral parameters of adipose tissue function. METHODS: Mice were exposed to either intermittent hypoxia or sham hypoxia during 8 h a day for 37 days. Uncoupling protein-1 expression in brown adipose tissue was measured by real-time PCR and immunohistochemistry. Digital quantification of adipose cells and immunohistochemistry of uncoupling protein-1 were performed to determine cell dimensions, positive area, and staining intensity. Serum levels of leptin, adiponectin, and cortisol were measured by ELISA. RESULTS: In comparison with the control group, animals in the hypoxia group had significantly lower chow ingestion, weight gain, and smaller white and brown adipocytes on histological examination. Adiponectin levels were also lower in the hypoxia group. Uncoupling protein-1 mRNA was abolished in the mice exposed to hypoxia; accordingly, fewer cells positive for uncoupling protein-1 and lighter staining intensity were observed in brown adipocytes. CONCLUSIONS: An experimental model of sleep apnea produced changes in uncoupling protein-1 expression and adiponectin levels. These results confirm previous findings on the response of brown adipose tissue to intermittent hypoxia and indicate a yet-unknown interference of intermittent hypoxia on energy control, which may participate in the propensity to weight gain observed in patients with sleep apnea. Brown adipose tissue activity in this patient population needs to be further investigated.