Effect of volume of participation in exercise programs on biochemical parameters of women / Efeito do volume de participação em programas de exercícios nos parâmetros bioquímicos de mulheres

The aim of the study was to evaluate the effect of the volume of participation in exercise programs offered in Primary Health Care (PHC), for 24 weeks on blood biochemical parameters of adult women. Three Basic Health Units in Rio Claro City (São Paulo) were selected and 2 exercise inter-ventions were implemented with different volumes (3 weekly sessions, 90 minutes each; 2 weekly sessions, 60 minutes each). In total, 53 participants remained until the end of the interventions. Regardless of their number of absences, they were divided into 4 groups, according to the volume of participation (calculated individually according to the duration of sessions and the number of classes held), forming groups according to quartiles: Low Volume Group (LVG; 57.62 ± 9.97 years-old), Low Medium Volume Group (LMVG; 56.31 ± 12.18 years-old), High Medium Volume Group (HMVG; 53.00 ± 10.25 years-old), and High-Volume Group (HVG; 59.69 ± 7.66 years-old). Blood biochemical parameters were dosed using the ELISA method. The Generalized Estimation Equa-tion Model was used to compare the biochemical parameters (time, group, and interaction; p ≤ 0.05). The analysis showed significant and positive time effect for low-density lipoproteins (LDL) and glycemia in all groups and for total cholesterol (TC) in LVG, LMVG and HMVG; a significant group effect for HVG on TC (higher levels compared to all other groups) and LDL (higher levels compared to LVG and LMVG). It is concluded that the physical exercise programs offered in the PHC contributed to a significant reduction in LDL and blood glucose levels, regardless of the vol-ume of participation of individuals in the programs

O objetivo do presente estudo foi avaliar o efeito do volume de participação em programas de exercícios, ofer-tados na Atenção Primária à Saúde (APS), durante 24 semanas, nos parâmetros bioquímicos sanguíneos de mulheres adultas. Foram selecionadas 03 Unidades Básicas de Saúde de Rio Claro-São Paulo e implementa-das 2 intervenções de exercícios com diferentes volumes (3 sessões/semana, 90 minutos cada; 2 sessões/semana, 60 minutos cada). No total, 53 participantes se mantiveram até o final das intervenções, independentemente do número de faltas foram divididos em 4 grupos, de acordo com o volume de participação (calculado con-forme a duração das sessões e a quantidade de aulas realizadas de forma individual), formando os grupos segundo os quartis: Grupo Baixo Volume (GBV; 57,62 ± 9,97 anos), Grupo Baixo Médio Volume (GBMV; 56,31 ± 12,18 anos), Grupo Médio Alto Volume (GMAV; 53,00 ± 10,25 anos) e Grupo Alto Volume (GAV; 59,69 ± 7,66 anos). Os parâmetros bioquímicos sanguíneos foram dosados pelo método ELISA. Foi utilizado o Modelo de Equações de Estimações Generalizadas para a comparação dos parâmetros bioquímicos (tempo, grupo e interação; p ≤ 0,05). A análise evidenciou efeito significativo favorável do tempo para lipoproteínas de baixa densidade (LDL) e glicemia em todos os grupos e para colesterol total (CT) no GVB, GBMV e GMAV; e efeito significativo do grupo para GAV no CT (maiores níveis comparado a todos os grupos) e LDL (maiores níveis comparados ao GBV e GBMV ). Conclui-se que o programa de exercício físico ofertado na APS contribuiu para a redução significativa dos níveis de LDL e glicemia, independentemente do volume de participação dos indivíduos nos programas

Prevalência de hiperglicemia de estresse em uma unidade de terapia intensiva / Prevalence of stress hyperglycemia in an intensive care unit

Objetivo: Avaliar a prevalência e o manejo da hiperglicemia de estresse em pacientes internados em uma unidade de terapia intensiva. Métodos: Estudo retrospectivo, realizado de janeiro a junho de 2018. Os dados foram obtidos a partir de 582 prontuá- rios eletrônicos, considerando os valores glicêmicos durante a hospitalização, história prévia ou não de diabetes mellitus, causas do internamento, tempo de permanência na unidade de terapia intensiva, presença de complicações durante o internamento e conduta utilizada em caso de hiperglicemia de estresse. Resulta- dos: Dos 582 pacientes internados na unidade de terapia intensi- va, 579 tiveram sua glicemia indicada nos prontuários analisados; 341 (58,9%) apresentaram hiperglicemia em algum momento da internação, sendo a hiperglicemia de estresse caracterizada em 200 pacientes (35%). A duração média de internamento desses pacientes foi de 8,39±10,9 dias, e a causa mais frequente de inter- namento foi devido a pós-operatório por diversas causas, somando 148 indivíduos (74%). Dentro os pacientes, 72 (36%) apresenta- ram alguma complicação. Além disso, 13 casos (6,5%) evoluíram para óbito. Conclusão: Estudos disponíveis sobre alvos de gli- cose em pacientes críticos das unidades de terapia intensiva apresentam difícil interpretação devido às diferenças subs- tanciais no grupo de populações e aos protocolos de gestão de pacientes utilizados em vários centros. Todavia, a prevalência da hiperglicemia de estresse encontrada nesta amostra é se- melhante à de outras casuísticas estudadas. O índice eleva- do de complicações enfatiza a necessidade de padronização nos critérios para diagnóstico e tratamento da hiperglicemia de estresse objetivando melhor prognóstico desses pacientes independentemente da causa do internamento.

Objective: To evaluate the prevalence and management of stress hyperglycemia in patients hospitalized in anintensive care unit. Methods: Retrospective study, carried out from January to June 2018. Data were obtained from 582 electronic medical records, considering glycemic values during hospitalization, existence of previous history of Diabetes Mellitus, causes of hospitalization, length of stay in the intensive care unit, presence of complications during hospitalization, and behavior used in case of stress hyper- glycemia. Results: Of the 582 patients admitted in the ICU, 579 had their glycemia indicated in the charts analyzed: 341 (58,9%) had hyperglycemia in a certain moment of hospitalization, with stress hyperglycemia being present in 200 patients (35%). The average duration of hospitalization of these patients was 8,39 ± 10,9 days, and the most frequent cause of hospitalization was postoperative for various causes, totaling 148 individuals (74%). Of the patients, 72 (36%) presented some type of complication and 13 patients (6,5%) died. Conclusion: Available studies on glucose targets in critical intensive care unit patients are difficult to be interpre- ted because of substantial differences in the study populations and of patient management protocols used at various centers. However, the prevalence of stress hyperglycemia found in this sample is similar to that of other study groups. The high com- plication rate emphasizes the need for standardization of the criteria for diagnosis and treatment of stress hyperglycemia aiming at a better prognosis of these patients regardless of the cause of hospitalization.

Efectos de un programa de entrenamiento multicomponente sobre indicadores de salud física y cognitiva de mujeres mayores / Effects of a multicomponent training program on physical and cognitive health indicators of older women

RESUMEN: Objetivo: Analizar el efecto de un programa de Entrenamiento MultiComponente (EMC) sobre autonomía funcional, fuerza muscular, composición corporal, capacidad cognitiva y perfil glucémico de mujeres mayores. Material y Métodos: 13 mujeres con edad 61,0 ± 6,0 años, participaron del estudio durante 12 semanas, siendo ­ Entrenamiento Resistido (ER); martes y viernes ­ Entrenamiento Funcional (EF) y Entrenamiento de Judo Adaptado (EJA), en la misma sesión; se utilizó el protocolo de autonomía funcional ­ GDLAM, Mini Examen del Estado Mental (MEEM), test de predicción de 1RM, índices: glicémico, masa corporal (IMC), relación cintura-cadera (IRCQ), relación cintura-estatura (RCE) y siete pliegues cutáneos. Resultados:Hubo mejora (p<0,05) para todos los test del GDLAM y el índice general (∆% = -21,31%; p-valor = 0,0006). Para el MEEM fue identificado mejoría en el puntaje general (∆%=8,98%; p-valor= 0,002), atención, cálculo y lenguaje. También hubo mejora (p<0,05) para todos los ejercicios de fuerza. Para composición corporal: porcentaje de grasa (%G) (∆%= -11,8%; p-valor= 0,001). Conclusión: El programa de EMC realizado cuatro veces en la semana, durante 12 semanas fue eficaz para mejorar la autonomía funcional, la fuerza muscular, la función cognitiva, para variables % G, masa magra y grasa de las mujeres estudiadas.

BSTRACT: Objective: To analyze the effect of a Multi-Component Training (CMT) program on functional autonomy, muscle strength, body composition, cognitive capacity and glycemic profile of older women. Material and Methods: 13 women aged 61.0 ± 6.0 years, participated in the study for 12 weeks, being -Resisted Training (ER); Tuesday and Friday - Functional Training (EF) and Adapted Judo Training (EJA), in the same session; The functional autonomy protocol was used - GDLAM, Mini Mental State Examination (MMSE), 1RM prediction test, glycemic index, body mass (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR) and seven skin folds. Results:There was improvement (p <0.05) for all GDLAM tests and the general index (Δ% = -21.31%; p-value = 0.0006). For the MMSE, an improvement was identified in the general score (Δ% = 8.98%; p-value = 0.002), attention, calculation and language. There was also improvement (p <0.05) for all resistance exercises. For body composition: fat percentage (% G) (Δ% = -11.8%; p-value = 0.001). Conclusion:The CME program performed four times a week for 12 weeks was effective in improving functional autonomy, muscle strength, cognitive function, for variables % F, lean mass and fat of the women studied.

Consumo de bebidas açucaradas em pacientes com doença aterosclerótica manifesta / Consumption of sugar-sweetened beverages in patients with established atherosclerosis disease

Resumo O presente estudo investigou a associação entre o consumo de bebidas açucaradas e variáveis antropométricas e bioquímicas em análise transversal, realizado com dados secundários referentes à primeira consulta do ensaio clínico randomizado Dieta Cardioprotetora Brasileira (2013-2014). Foram coletados peso, altura, circunferência da cintura, perfil lipídico e glicemia de jejum e dados de um recordatório alimentar de 24 horas. Diferenças entre o consumo e não consumo de bebidas açucaradas foram avaliadas pelo teste T de student. Para analisar a associação entre o consumo de bebidas açucaradas e fatores bioquímicos e antropométricos foi utilizado o teste qui quadrado. A amostra foi de 2.172 indivíduos, sendo a maioria homens (58,5%), idosos (63,6%), do nível econômico C (57,3%), com ensino fundamental (45,8%) e com excesso de peso (62,7%). Houve associação significativa entre o consumo de bebidas açucaradas e maior valores de índice de massa corporal (p=0,029), circunferência da cintura (p=0,004) e triglicerídeos (p=0,023). Esses resultados reforçam a necessidade de intervenção nutricional quanto ao consumo de bebidas açucaradas como parte do tratamento dietético desta população.

Abstract This study investigated the association between consumption of sugar-sweetened beverages and anthropometric and biochemical variables in a cross-sectional study conducted with secondary data from the first visit of the randomized clinical trial of the Brazilian Cardioprotective Nutritional Program (BALANCE Program) (2013-2014). Weight, height, waist circumference, lipid profile and fasting glycemia and a 24-hour diet recall were collected. Differences between consumption and non-consumption of sugar-sweetened beverages were evaluated by Student's t-test. The Chi-square test was employed to analyze the association between consumption and non-consumption of sugar-sweetened beverages and biochemical and anthropometric factors. The sample consisted of 2,172 individuals, mostly men (58.5%), elderly (63.6%), C-rated economic class (57.3%), and overweight (62.7%). A statistically significant difference was found between the consumption of sugar-sweetened beverages and higher BMI values (p=0.029), waist circumference (p=0.004) and triglycerides (p=0.023). These results emphasize the need for nutritional intervention regarding the consumption of sugar-sweetened beverages as part of the dietary treatment of this population.

Acupuntura e auriculoterapia no tratamento de diabete melito tipo 2 em adultos e idosos: qual é a eficácia/efetividade e a segurança da acupuntura e da auriculoterapia para o tratamento de diabete melito tipo 2 (DM2) em adultos e/ou idosos? / Acupuncture and auriculotherapy in the treatment of type 2 diabetes mellitus in adults and the elderly: what is the efficacy / effectiveness and safety of acupuncture and auriculotherapy for the treatment of type 2 diabetes mellitus (DM2) in adults and/or the elderly?

A acupuntura se caracteriza pela estimulação de pontos cutâneos específicos por meio do uso de agulhas. A auriculoterapia consiste na estimulação mecânica de pontos específicos do pavilhão auricular com esferas de aço, ouro, prata, plástico, agulhas ou sementes de mostarda. A acupuntura é recomendada para promoção, manutenção e recuperação da saúde, bem como prevenção de agravos e doenças. Além disso, parece propiciar a liberação de neurotransmissores e outras substâncias responsáveis pela promoção da analgesia. A auriculoterapia promove a regulação psíquico-orgânica do indivíduo. Ambas as práticas foram incorporadas no SUS mediante Portaria nº 971, de 03 de maio de 2006. Qual é a eficácia/efetividade e a segurança da acupuntura e da auriculoterapia para o tratamento de diabete melito tipo 2 (DM2) em adultos e/ou idosos? As buscas foram realizadas em cinco bases de dados sem restrição de ano de publicação. Foram incluídas revisões sistemáticas em inglês, português e espanhol que avaliaram os efeitos de ambas as tecnologias no tratamento da diabete melito tipo 2 na população adulta e idosa. A avaliação da qualidade metodológica foi realizada por meio do AMSTAR 2, feita por uma pesquisadora e revisada por outra. Nesta revisão rápida, produzida em cinco dias, foram utilizados atalhos metodológicos, de maneira que apenas o processo de seleção foi realizado em duplicidade e de forma independente. Resultados Dos 66 relatos encontrados nas bases, foi incluída uma revisão sistemática com metanálise que atendeu aos critérios de elegibilidade. A avaliação da qualidade indica que a revisão é de baixa qualidade metodológica. A revisão apresentou resultados sobre o uso de acupuntura e auriculoterapia no controle glicêmico de pessoas com DM2. Houve pouca informação sobre a segurança da prática de acupuntura e nenhuma sobre auriculoterapia. A prática de acupuntura, da eletroacupuntura e auriculoterapia combinadas com cuidado usual mostraram efeito no controle da glicemia de jejum, glicemia duas horas depois de um teste de tolerância à glicose e hemoglobina glicosilada. Somente em relação a prática de acupressão que houve resultados sem significância estatística. A revisão sistemática abordou o uso da auriculoterapia, observando resultados benéficos no controle glicêmico. Foram encontradas poucas informações sobre eventos adversos para avaliar essas práticas são seguras. Embora os resultados sejam favoráveis à acupuntura, eles são baseados em uma única revisão sistemática que analisou estudos primários com alto risco de viés. A própria revisão foi avaliada como de baixa qualidade metodológica, por isso as evidências devem ser vistas com cautela. Além disso, a heterogeneidade dos resultados estatísticos é elevada e faltam informações sobre o tempo de acompanhamento dos participantes dos ensaios. Os relatos sobre eventos adversos são escassos e não permitem tecer considerações sobre a segurança do uso dessas tecnologias em pacientes diabéticos

Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016 / Prevalence of diabetes and poor glycemic control in Mexico: results from Ensanut 2016

Resumen: Objetivo: Estimar la prevalencia de diabetes (total, diagnosticada y no diagnosticada), de descontrol glucémico en México y sus factores asociados. Material y métodos: Se analizaron 3 700 adultos participantes en la Encuesta Nacional de Salud y Nutrición de 2016. Se estimaron las prevalencias con ponderadores poblacionales y los factores asociados con diabetes total y descontrol glucémico con modelos de regresión de Poisson. Resultados: La prevalencia total de diabetes fue de 13.7% (9.5% diagnosticada, 4.1% no diagnosticada); 68.2% de los diagnosticados presentó descontrol glucémico. Mayor tiempo de diagnóstico, vivir en el centro/sur del país y ser atendido en farmacias se asoció con descontrol glucémico, mientras que ser atendido en los servicios de seguridad social se asoció con mejor control glucémico. Conclusión: Se requieren esfuerzos multisectoriales para fortalecer el tamizaje, diagnóstico oportuno y control de la enfermedad, considerando las diferencias por región y tipo de servicio de salud.

Abstract: Objective: To estimate the prevalence of total, diagnosed and undiagnosed diabetes, and the prevalence of poor glycemic control in Mexico, and its associated factors. Materials and methods: Data from 3 700 adult participants were analysed in the 2016 National Health and Nutrition Survey. Diabetes prevalences were estimated with population weights, and the factors associated with total diabetes and poor glycemic control with Poisson regression models. Results: The total prevalence of diabetes was 13.7% (9.5% diagnosed, 4.1% undiagnosed); 68.2% of people with diagnosed diabetes presented poor glycemic control. Longer disease duration, living in the centre or south of the country and being treated in pharmacies were associated with poor glycemic control. Being treated in a social security system was associated with better glycemic control. Conclusion: Multisectoral efforts are needed to strengthen screening, timely diagnosis and disease control, considering differences by region and type of health service.

Education in Diabetes Mellitus for blood glucose self-monitoring: a quasi-experimental study / Educación en Diabetes Mellitus para automonitorización de la glucemia: estudio cuasi-experimental / Educação em Diabetes Mellitus para automonitorização da glicemia: estudo quase-experimental

ABSTRACT Objective: to evaluate the contributions of an educational program for capillary blood glucose self-monitoring. Method: a quasi-experimental study performed in an outpatient unit of a tertiary health care service in a sample of 25 people with Type 2 Diabetes Mellitus, from July 2016 to December 2017, developed through interactive tools for care with capillary blood glucose self-monitoring. Results: among the items of capillary blood glucose self-monitoring that showed improvement after participation in the educational program, the most noteworthy are the "postprandial blood glucose values" (p=0.0039), "Interpretation of capillary blood glucose results with meals and medications" (p=0.0156), "recognition of the 'weakness' symptom for hyperglycemia" (p=0.0386) and "administration of medications correctly" for hyperglycemia prevention (p=0.0063). Conclusion: the study made it possible to recognize the main characteristics of blood glucose self-monitoring that may contribute to the care for the person with diabetes.

RESUMEN Objetivo: evaluar las contribuciones de un programa educativo para la automonitorización de la glucemia capilar. Método: el estudio cuasi-experimental, realizado en unidad ambulatoria de un servicio de atención terciaria a la salud, en muestra de 25 personas con Diabetes Mellitus tipo 2, en el período de julio de 2016 a diciembre de 2017, desarrollado por medio de herramientas interactivas para el cuidado con la automonitorización de la glucemia capilar. Resultados: entre los ítems de la automonitorización de la glucemia capilar que presentaron mejoría después de la participación en el programa educativo, se destacan los "valores de la glucemia postprandial" (p=0,0039), "Interpretación de los resultados de glucemia capilar con las comidas y medicamentos" (p=0,0156), "reconocimiento del síntoma" debilidad "para la hiperglicemia" (p=0,0386) y "administración de medicamentos correctamente" para prevenir la hiperglucemia (p=0,0063). Conclusión: el estudio posibilitó reconocer las principales características de la automonitorización de la glucemia que pueden contribuir para el cuidado a la persona portadora de la enfermedad.

RESUMO Objetivo: avaliar as contribuições de um programa educativo para a automonitorização da glicemia capilar. Método: estudo quase-experimental, realizado em unidade ambulatorial de um serviço de atenção terciária à saúde, em amostra de 25 pessoas com Diabetes Mellitus tipo 2, no período de julho de 2016 a dezembro de 2017, desenvolvido por meio de ferramentas interativas para o cuidado com a automonitorização da glicemia capilar. Resultados: entre os itens da automonitorização da glicemia capilar que apresentaram melhora após a participação no programa educativo, destacam-se os "valores da glicemia pós-prandial" (p=0,0039), "interpretação dos resultados de glicemia capilar com as refeições e medicamentos" (p=0,0156), "reconhecimento do sintoma 'fraqueza' para a hiperglicemia" (p=0,0386) e "administração de medicamentos corretamente" para prevenção da hiperglicemia (p=0,0063). Conclusão: o estudo possibilitou reconhecer as principais características da automonitorização da glicemia que poderão contribuir para o cuidado à pessoa portadora da doença.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy / Sensibilidade, especificidade e concordância do método point of care: um estudo de precisão diagnóstica

Abstract The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Resumo O uso de novas tecnologias pode melhorar o screening em comunidades de difícil acesso à saúde. O objetivo deste artigo é avaliar a sensibilidade, especificidade e concordância do teste de point of care em comparação com método laboratorial para dosagem de Glicose (GLI), Triglicerídeo (TG) e Colesterol total (CT). Estudo prospectivo com dados de população de adultos remanescentes de quilombolas no Brasil. Exames laboratoriais convencionais para análise foram obtidos por venopunção, utilizados como método padrão para mensuração das concentrações de GLI (mg/dL), TG (mg/dL) e CT (mg/dL) e comparados a mensuração por meio de técnica de ponta de dedo (point of care). Tabelas de contingência (2x2) foram utilizadas para estimar sensibilidade e especificidade dos métodos e o coeficiente de Lin e análises de Bland & Altman foram métodos de concordância com nível de significância de 5%. Houve concordância substancial entre os métodos para mensuração de TG e fraca concordância para mensuração de CT e GLI. Os coeficientes de Bland & Altman indicam que o método de ponta de dedo não apresentou boa mensuração. O método point of care não apresentou boa capacidade de mensuração de Glicose, Triglicerídeo e Colesterol total tendo como referência o método laboratorial.

Is hypoalbuminemia a predictor for acute kidney injury after coronary bypass grafting in diabetes mellitus patients?

Abstract Objective: Acute kidney injury (AKI) is one of the most important complications after coronary artery bypass grafting (CABG) procedure. Serum albumin, which is an acute phase reactant, is suggested to be associated with AKI development subsequent to various surgical procedures. In this study, we research the relation between preoperative serum albumin levels and postoperative AKI development in diabetes mellitus (DM) patients undergoing isolated CABG. Methods: We included a total of 634 diabetic patients undergoing CABG (60.5±9.1 years, 65.1% male) into this study, which was performed between September 2009 and January 2014 in a single center. The relation between preoperative serum albumin levels and postoperative AKI development was observed. AKI was evaluated and diagnosed using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. Results: AKI was diagnosed in 230 (36.3%) patients. Multiple logistic regression analysis was performed to determine the independent predictors of AKI development. Proteinuria (odds ratio [OR] and 95% confidence interval [CI], 1.066 [1.002-1.135]; P=0.043) and low preoperative serum albumin levels (OR and 95% CI, 0.453 [0.216-0.947]; P=0.035) were found to be independent predictors of AKI. According to the receiver operating characteristic curve analysis, albumin level <3mg/dL (area under the curve: 0.621 [0.572-0.669], P<0.001) had 83% sensitivity and 10% specificity on predicting the development of AKI. Conclusion: We observed that a preoperative low serum albumin level was associated with postoperative AKI development in patients with DM who underwent isolated CABG procedure. We emphasize that this adjustable albumin level should be considered before the operation since it is an easy and clinically implementable management for the prevention of AKI development.

Fatores associados à tuberculose em população de diabéticos: um estudo caso-controle / Factors associated with tuberculosis in a population of diabetics: A case-control study

Resumo Este estudo analisou os fatores associados à tuberculose em diabéticos atendidos nas unidades de saúde de Vitória/ES, Brasil. Trata-se de um estudo caso-controle, sendo 45 casos de diabéticos atendidos nas 30 unidades do município e notificados no SINAN com diagnóstico de tuberculose no período de 2007 a 2013 e 90 de controles diabéticos. Utilizaram-se dados do SINAN, do Sistema de Informação em Saúde de Vitória e do Laboratório Central Municipal, e uma entrevista estruturada. Foram realizadas análises bivariada e multivariada, mediante regressão logística com as variáveis significativas (p < 0,05). O grupo caso apresentou maior frequência de hábitos de vida danosos à saúde em comparação com o grupo controle, como consumo compulsivo de álcool (p < 0,001) e tabagismo (p = 0,060), além de piores parâmetros bioquímicos, como glicemia de jejum (p < 0,001) e hemoglobina glicosilada (p = 0,034). A ingestão regular de bebida alcoólica (OR 6,612; IC 2,151-20,330), o contato prévio com pessoas com tuberculose (OR 4,418; IC 1,678-11,631) e a glicemia de jejum (OR 1,017; IC 1,007-1,026) foram associados à tuberculose nos diabéticos. O estudo revela que piores hábitos de vida e controle glicêmico, e o contato anterior com tuberculose ativa aumentam a chance de o diabético desenvolver tuberculose.

Abstract This study analyzed the factors associated with tuberculosis in diabetics seen at health units of Vitória, ES, Brazil. This is a case-control study of 45 cases of diabetics seen in the 30 units of the municipality and reported in the SINAN with a diagnosis of tuberculosis in the 2007-2013 period and 90 cases of diabetic controls. We used data from the SINAN, the Health Information System of Vitória, and the Central Municipal Laboratory, as well a structured interview. Bivariate and multivariate analyses were performed, using logistic regression with the significant variables (p < 0.05). The case group presented a higher frequency of health-damaging life habits as compared to the control group, such as compulsive drinking (p < 0.001) and tobacco smoking (p = 0.060), as well as worse biochemical parameters, such as fasting blood sugar (p < 0.001) and glycosylated hemoglobin (p = 0.034). Regular drinking (OR 6.612, CI 2,151-20.330), previous contact with people with tuberculosis (OR 4.418, CI 1.678-11.631), and fasting blood sugar (OR 1.017, CI 1.007-1.026) were associated with tuberculosis in diabetics. The study reveals that poorer lifestyle habits and glycemic control and previous contact with active tuberculosis increase the chance of diabetics developing tuberculosis.

Brazilian multicenter study on pegvisomant treatment in acromegaly

ABSTRACT Objective Investigate the therapeutic response of acromegaly patients to pegvisomant (PEGV) in a real-life, Brazilian multicenter study. Subjects and methods Characteristics of acromegaly patients treated with PEGV were reviewed at diagnosis, just before and during treatment. All patients with at least two IGF-I measurements on PEGV were included. Efficacy was defined as any normal IGF-I measurement during treatment. Safety data were reviewed. Predictors of response were determined by comparing controlled versus uncontrolled patients. Results 109 patients [61 women; median age at diagnosis 34 years; 95.3% macroadenomas] from 10 Brazilian centers were studied. Previous treatment included surgery (89%), radiotherapy (34%), somatostatin receptor ligands (99%), and cabergoline (67%). Before PEGV, median levels of GH, IGF-I and IGF-I % of upper limit of normal were 4.3 µg/L, 613 ng/mL, and 209%, respectively. Pre-diabetes/diabetes was present in 48.6% and tumor remnant in 71% of patients. Initial dose was 10 mg/day in all except 4 cases, maximum dose was 30 mg/day, and median exposure time was 30.5 months. PEGV was used as monotherapy in 11% of cases. Normal IGF-I levels was obtained in 74.1% of patients. Glycemic control improved in 56.6% of patients with pre-diabetes/diabetes. Exposure time, pre-treatment GH and IGF-I levels were predictors of response. Tumor enlargement occurred in 6.5% and elevation of liver enzymes in 9.2%. PEGV was discontinued in 6 patients and 3 deaths unrelated to the drug were reported. Conclusions In a real-life scenario, PEGV is a highly effective and safe treatment for acromegaly patients not controlled with other therapies.

Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during cabg: a double-blind controlled randomized trial

Abstract Objective: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

Cardiometabolic risk factors associated with active commuting to school / Fatores de risco cardiometabólicos associados ao deslocamento ativo à escola

ABSTRACT Objective: To verify if there is an association between cardiometabolic risk factors and active daily commuting to school among children and adolescents. Methods: A total of 1,743 schoolchildren aged 7 to 17 years old were evaluated in the city of Santa Cruz do Sul (RS). The way of commuting to school was investigated with a questionnaire, and the cardiometabolic risk factors analyzed were body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, blood glucose, triglycerides, total cholesterol (TC) and fractions, LDL and HDL. Results: The prevalence of active commuting among schoolchildren was 48.0% (95%CI 45.7-50.4), and it was associated, in the crude analysis, with blood glucose and LDL cholesterol levels. Passive schoolchildren had a 1.1 higher prevalence ratio of high glucose and LDL cholesterol levels. However, when sociodemographic variables were included in the model, these associations were not maintained. Conclusions: The prevalence of active commuting in the sample studied is low and it was shown to have a crude association with glucose and LDL cholesterol levels in students. However, sociodemographic factors seem to influence these associations.

RESUMO Objetivo: Verificar se existe associação entre fatores de risco cardiometabólicos e deslocamento ativo à escola em crianças e adolescentes. Métodos: Foram avaliados 1.743 escolares, de sete a 17 anos, do município de Santa Cruz do Sul (RS). A forma de deslocamento até a escola foi investigada por meio de questionário e os fatores de risco cardiometabólicos analisados foram: o índice de massa corpórea (IMC), a circunferência da cintura (CC), a pressão arterial sistólica (PAS) e a diastólica (PAD), glicose, triglicerídeos, colesterol total (CT), LDL e HDL. Resultados: A prevalência de deslocamento ativo entre os escolares foi de 48,0% (IC95% 45,7-50,4) e associou-se, na análise bruta, com os níveis de glicose e colesterol LDL. Escolares que se deslocavam de forma passiva apresentaram uma razão de prevalência (RP) 1,1 vez maior de glicose e colesterol LDL elevados. No entanto, ao serem incluídas variáveis sociodemográficas no modelo, essas associações não se mantiveram. Conclusões: Conclui-se que a prevalência de deslocamento ativo na amostra estudada é baixa e que o deslocamento ativo à escola apresentou associação bruta com os níveis sanguíneos de glicose e de colesterol LDL dos escolares, sendo que se deslocar de forma ativa parece auxiliar na redução desses níveis. Porém, fatores sociodemográficos parecem exercer influência sobre estas associações.

Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus / Influência dos fatores socioeconômicos e psicológicos no controle glicêmico em crianças jovens com diabetes mellitus tipo 1

Abstract Objective: To evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. Methods: This was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. Results: A total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n = 50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. Conclusions: The socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.

Resumo Objetivo: Avaliar a influência dos fatores socioeconômicos e psicológicos no controle glicêmico de crianças pequenas portadoras de diabetes mellitus tipo 1. Métodos: Estudo de corte transversal, avaliou crianças pré-púberes, com diabetes mellitus tipo 1. Foram analisados os fatores socioeconômicos com o Critério de Classificação Econômica Brasil e as condições psicológicas através da versão brasileira do Problem Areas in Diabetes (B-Paid), associado ao controle glicêmico, mensurado pela hemoglobina glicada. Foi utilizada análise descritiva. As variáveis foram avaliadas bivariada e multivariantemente pelo modelo de regressão de Poisson robusto, os testes Exato de Fisher e Qui-Quadrado de Pearson para as razões de prevalência bruta e ajustada, sendo o intervalo de confiança estimado em 95%. Resultados: Foram incluídas no estudo 68 crianças com diabetes mellitus tipo 1. Foi observada uma associação negativa entre controle glicêmico (níveis de hemoglobina glicada), status socioeconômico (Critério de Classificação Econômica Brasil) e condição psicológica (versão brasileira do Problem Areas in Diabetes). Entre os participantes do estudo, 73,5% (n = 50) das crianças apresentaram status socioeconômico desfavorável, esses participantes apresentaram 1,4 vezes mais chances de apresentar valores alterados de hemoglobina glicada. Em relação a indivíduos com estado psicológico comprometido, houve uma prevalência de 26 (38,2%) apresentou uma pontuação acima de 70, sendo assim classificada com estresse psicológico, essas crianças foram 1,68 vezes mais prováveis (intervalo de confiança 95%: 1,101, 1,301) de apresentar níveis mais elevados de hemoglobina glicada. Conclusão: As condições socioeconômicas e as características psicológicas dos participantes do estudo foram negativamente associadas aos resultados da hemoglobina glicada. Esses dados reforçam a importância das variáveis estudadas como preditores de controle glicêmico.

Implantação de um serviço sobre orientação de insulina na transição do cuidado: contribuições para o autocuidado / Setting up a service for insulin orientation during the transition in care: contributions to self-care

O diabetes mellitus é uma doença crônica responsável por inúmeras complicações que comprometem a qualidade de vida dos pacientes, sendo necessário para prevenção a adoção de medidas educativas que enfatize a importância do autocuidado e da adesão ao tratamento. Objetivo deste artigo é descrever as ações realizadas e os resultados alcançados com a implementação do Serviço de Orientação Sobre o Uso de Insulina (SOSUI). Trata-se de um estudo observacional, realizado no período de agosto de 2014 a fevereiro de 2015. Foram selecionados pacientes diabéticos insulinizados, sendo eles idosos e adultos frágeis submetidos à amputação devido a comprometimento de pé diabético. O SOSUI foi constituído em duas fases, sendo uma no período da internação hospitalar (pré-alta), e a segunda no período pós-alta hospitalar. No período pré-hospitalar, farmacêuticos vinculados a um programa de residência multiprofissional realizaram uma abordagem entre os pacientes, seguida de treinamentos práticos individualizados sobre a administração da insulina. Passado um período mínimo de quatro meses após a alta hospitalar, foi realizada interação mediada por telefone com o intuito de identificar mudanças nos relatos dos pacientes em relação ao uso da insulina, assim como melhora nos valores glicêmicos. Os dados foram registrados no programa Microsoft Excel, seguido de análise univariada. Foram 17 pacientes elegíveis para o estudo, com idade média de 63 anos, sendo 76,47% do sexo masculino e 23,53% do sexo feminino. O tempo médio de internação foi de 21 dias. Em relação ao perfil glicêmico dos participantes, observa-se que houve melhora nos níveis de glicemia de jejum e hemoglobina glicada dos pacientes orientados pelo serviço, e que estavam sob os cuidados da Atenção Primária. Além de melhoras nos relatos sobre técnicas de homogeneização e administração da insulina, foi evidenciada entre os pacientes uma hemoglobina glicada média de 9,97%, sendo esse valor médio reduzido para 7,0% após a alta hospitalar. Isso indica melhora do controle glicêmico pelos pacientes, o que pode ser influenciado pelas experiências de adoecimento, internação e amputação decorrente de complicações do diabetes, associadas ao fato de os pacientes terem também recebido orientações educacionais sobre o uso da insulina, favorecendo melhor entendimento sobre o uso desse medicamento. A implementação do SOSUI serviu como importante ferramenta no processo de educação em saúde sobre o diabetes para os pacientes acompanhados pelo Serviço de Farmácia Clínica, proporcionando melhora no gerenciamento da farmacoterapia com insulina; melhor conhecimento sobre o diabetes e suas complicações; e para a importância da adesão ao tratamento.

Diabetes mellitus is a chronic disease that causes numerous complications that impair the quality of life of patients, making the adoption of educational measures that emphasize the importance of self-care and adherence to treatment necessary for prevention. Objective: To describe the actions and results achieved with the implementation of the Insulin Usage Guidance Service(SOSUI). Methodology: This is a observational study conducted from August / 2014 to February / 2015. Diabetic patients treated with insulin were selected, all of them elderly and vulnerable adults subjected to amputation due to pre-diabetic impairment. SOSUI constituted of two phases, one of them being during the hospitalization period (pre-discharge), and the second one being after hospital discharge. During the hospitalization period, pharmacists part of a multidisciplinary residency program approached patients, followed by individual practical training on insulin handling. After a period of at least 4 months of hospital discharge, a post-discharge contact was performed, mediated by phone to identify changes in the accounts of patients regarding insulin handling as well as improvement on glycemic levels. The data was recorded on Microsoft Excel, followed by univariate analysis. Results: 17 of the participants qualified for the study, with average age of 67, 76.47% were male and 23.53% female. The average length of hospitalization was 21 days. Regarding the glycemic profile of the participants, it was observed that there was an improvement in fasting glucose levels and glycated hemoglobin of patients guided by the service, and under the care of Primary Care. Conclusion: The implementation of SOIRI served as an important tool in the health education process about diabetes for patients guided by the Clinical Pharmacy Service providing an improvement of the management of pharmacotherapy with insulin, a better knowledge about diabetes, its complications and the importance of adherence to treatment.

Alta prevalencia de dislipidemias y riesgo aterogénico en una población infanto-juvenil / High prevalence of dyslipidemia and high atherogenic index of plasma in children and adolescents

Background: Dyslipidemias in childhood increase the risk of cardiovascular events in adult life. Aim: To evaluate the prevalence of dyslipidemia and risk of atherogenicity based in the atherogenic index of plasma (AIP) in a sample of school children and adolescents. Material and Methods: Cross-sectional study of 208 children aged 10.4 ± 1.0 years (107 women). Demographic data were obtained, and a clinical evaluation was conducted, including pubertal development according to Tanner and anthropometric parameters. A fasting blood sample was obtained to measure total cholesterol (CT), HDL cholesterol (cHDL) and triglycerides (TG), glucose and insulin. LDL cholesterol (cLDL), Non-HDL cholesterol and the indices CT/cHDL, cLDL/cHDL and AIP (log[TG/cHDL]) were calculated. Risk categories according to AIP for the pediatric population were also determined (low: AIP < 0.11, intermediate: AIP 0.11-0.21, high: AIP > 0.21). Results: Thirty eight percent of participants had dyslipidemia, without differences by gender and pubertal development. The frequency of dyslipidemia was significantly higher in children with obesity (54%, p < 0.01) and a waist circumference over percentile 90 (61%; p < 0.01). The later conditions had also higher CT/cHDL, cLDL/cHDL and AIP. According to AIP, 54% of children had a high atherogenicity risk along with alterations in anthropometric parameters and insulin resistance. All anthropometric and insulin resistance parameters were significantly correlated with the AIP. Conclusions: There is a high prevalence of dyslipidemia in the studied population, which is associated with an increased cardiometabolic risk. The indices of atherogenicity and particularly AIP are correlated with nutritional status, abdominal obesity and parameters of insulin resistance.

Impact of an inpatient multidisciplinary glucose control management program

ABSTRACT Objective: Glycemic control has been increasingly recognized as a critical element in inpatient care, but optimal management of blood glucose in the hospital setting remains challenging. The aims of this study were to describe and evaluate the impact of the implementation of an inpatient multidisciplinary glucose control management program on glucose control in hospitalized patients. Materials and methods: Retrospective analysis of medical records and glucose monitoring data obtained by point- of-care testing (POCT) in hospitalized patients before (May 2014) and after (June 2015 and May 2017) the implementation of the program. Results: We analyzed 6888, 7290, and 7669 POCTs from 389, 545, and 475 patients in May 2014, June 2015, and May 2017, respectively. Hyperglycemia (≥ 180 mg/ dL) occurred in 23.5%, 19.6%, and 19.3% POCTs in May 2014, June 2015, and May/2017, respectively (p < 0.001), while severe hyperglycemia (≥ 300 mg/dL) was observed in 2.5%, 2.2%, and 1.8% of them, respectively (p = 0.003). Hyperglycemia (≥ 180 mg/dL) reduced significantly from May 2014 to June 2015 (16.3%, p < 0.001) and from May 2014 to May 2017 (178%, p < 0.001). No significant changes occurred in hypoglycemic parameters. Conclusions: The implementation of an inpatient multidisciplinary glucose control management program led to significant reductions in hyperglycemic events. The key elements for this achievement were the development of institutional inpatient glycemic control protocols, establishment of a multidisciplinary team, and continuing educational programs for hospital personnel. Altogether, these actions resulted in improvements in care processes, patient safety, and clinical outcomes of hospitalized patients.

ABSI is a poor predictor of insulin resistance in Chinese adults and elderly without diabetes

ABSTRACT Objective: Recently, a new obesity index (A Body Shape Index, ABSI) based on waist circumference (WC) was developed, and high ABSI corresponds to a more central concentration of body volume. It is well known that central obesity is closely linked with insulin resistance (IR). Therefore, our study aimed to examine the discriminatory power of ABSI for IR in Chinese adults and elderly without diabetes. Subjects and methods: In 2007, a cross-sectional study was made. In this study, 570 individuals without diabetes were available for analysis (male: 56.1%, mean age: 62.3 ± 6.5 years). Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). Areas under the receiver operating characteristic (ROC) curves were determined to identify variables/models that could predict insulin resistance. Results: ABSI was associated with IR, the cut-off points was 0.0785 m11/6kg-2/3 to identifying IR and the area under the ROC (AUC) curve was 0.618 (95%CI: 0.561-0.675), which was not better than body mass index BMI (AUC = 0.753; 95%CI: 0.706-0.801), WC (AUC = 0.749; 95%CI: 0.700-0.797), and fasting plasma glucose (FPG, AUC = 0.752; 95%CI: 0.705-0.799). Furthermore, combination with ABSI could improve the discriminatory power of other variables for IR. The AUC curve increased from 0.753 to 0.771for BMI, 0.749 to 0.754 for WC, 0.752 to 0.769 for FPG, respectively. Conclusions: ABSI is associated with IR in the general Chinese adults and elderly without diabetes, but the discriminatory power for IR is poor. It is recommended that ABSI be used in combination with other variables.

Redução da resistência à insulina após resposta virológica sustentada com agentes antivirais diretos: nem toda população melhora / Insulin resistance reduction after sustained virological response with direct acting antiviral: not every population improves

ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is a serious public health problem, that affects approximately 170 million people worldwide. Chronic HCV infection is associated with hepatic insulin resistance and an increased risk of diabetes HCV-infected patients has been well documented. OBJECTIVE: To assess the homeostasis model assessment of insulin resistance (HOMA-IR) index in patients treated with direct acting antiviral (DAAs) medication in the sustained virological response (SVR), categorized by the presence or absence of cirrhosis. METHODS: A prospective study was conducted. Data were collected at the beginning of treatment (t-base) and in the twelfth week after the completion of treatment (t-SVR12). The inclusion criteria were presence of: HCV infection (RNA-HCV positive), age ≥18 years, completion of DAAs' therapy, and presence of diabetes with use of oral hypoglycemic agents. All samples were collected during the study period. The exclusion criteria were: presence of HBV/HIV co-infection, hepatocellular carcinoma at baseline, diabetic patients taking insulin and transplanted patients (liver/kidney). Fibrosis was assessed by hepatic elastography or biopsy (METAVIR). Cirrhosis was determined by clinical results or imaging. HOMA-IR was calculated as fasting insulin (μU/mL) × fasting glucose (mmol/L)/22.5) The patients were divided into two groups: the general study population (all patients, including the diabetic patients) and the special population (patients with normal values of HOMA-IR, which is >2.5, and without diabetes). The delta HOMA-IR value was calculated as: HOMA-IR at t-base - HOMA-IR at t-SVR12. For the descriptive statistical analysis, the paired t-test and generalized linear model assuming the log binding function were performed. A P value of < 0.05 was considered significant. RESULTS: We included 150 patients, and 75 were cirrhotic. The mean age was 55.3±9.97 and body mass index was 27.4±5.18. Twenty-two (14.67%) were diabetic patients using oral hypoglycemic agents, and 17 (11%) were cirrhotic. In the general study population, the mean glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. Delta HOMA-IR was negative at t-SVR12, but there was no significant difference. Excluding diabetic patients and those with normal HOMA-IR values (<2.5), mean glucose, insulin and HOMA-IR decreased at t-SVR12. Delta HOMA-IR decreased significantly at t-SVR12 (P: 0.02). CONCLUSION: In the general population, glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. In the special population, glucose, insulin, HOMA-IR and Delta HOMA-IR decreased at t-SVR12.

RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (VHC) é um grave problema de saúde pública, que afeta aproximadamente 170 milhões de pessoas no mundo. A infecção crônica pelo VHC está associada à resistência à insulina hepática e a um risco aumentado de diabetes. Os doentes infetados pelo VHC foram bem documentados. OBJETIVO: Avaliar o modelo de avaliação da homeostase do índice de resistência à insulina (HOMA-IR) em pacientes tratados com medicação antiviral de ação direta na resposta virológica sustentada (RVS), categorizada pela presença ou ausência de cirrose. MÉTODOS: Foi realizado um estudo prospectivo. Os dados foram coletados no início do tratamento (t-base) e na décima segunda semana após o término do tratamento (t-RVS12). Os critérios de inclusão foram presença de: infecção pelo VHC (RNA-VHC positivo), idade ≥18 anos, conclusão da terapia de antivirais de ação direta e presença de diabetes com uso de hipoglicemiantes orais. Todas as amostras foram coletadas durante o período do estudo. Os critérios de exclusão foram: presença de coinfecção VHB/HIV, carcinoma hepatocelular no início do estudo, pacientes diabéticos em uso de insulina e pacientes transplantados (fígado/rim). A fibrose foi avaliada por elastografia hepática ou biópsia (METAVIR). A cirrose foi determinada por resultados clínicos ou exames de imagem. O HOMA-IR foi calculado como insulinemia de jejum (μU/mL) x glicemia de jejum (mmol/L) /22,5). Os pacientes foram divididos em dois grupos: a população geral do estudo (todos os pacientes, incluindo os diabéticos) e a população especial (pacientes com valores normais de HOMA-IR, que é <2,5 e sem diabetes). O valor do delta HOMA-IR foi calculado como: HOMA-IR no t-base - HOMA-IR no t-RVS12. Para a análise estatística descritiva, foram utilizados o teste t pareado e o modelo linear generalizado, assumindo a função de ligação logarítmica. Um valor de P<0,05 foi considerado significativo. RESULTADOS: Foram incluídos 150 pacientes e 75 eram cirróticos. A idade média foi de 55,3±9,97 e o índice de massa corpórea foi de 27,4±5,18. Vinte e dois (14,67%) eram pacientes diabéticos em uso de hipoglicemiantes orais e 17 (11%) eram cirróticos. Na população geral do estudo, os valores médios de glicose e HOMA-IR aumentaram na t-SVR12, mas a insulina diminuiu. O delta HOMA-IR foi negativo em t-SVR12, mas não houve diferença significativa. Excluindo pacientes diabéticos e aqueles com valores normais de HOMA-IR (<2,5), a média de glicose, insulina e HOMA-IR diminuiu no t-RVS12. O delta HOMA-IR diminuiu significativamente em t-RVS12 (P: 0,02). CONCLUSÃO: Na população geral, os valores de glicose e HOMA-IR aumentaram no t-RVS12, mas a insulina diminuiu. Na população especial, glicose, insulina, HOMA-IR e delta HOMA-IR diminuíram no t-RVS12.

Oxidative stress effects in the uterus, placenta and fetus of pregnant rats submitted to acute and chronic stress

Abstract Purpose: To evaluate the effects of oxidative stress in pregnant rats submitted to acute and chronic stress, relating to alterations in the uterus, placenta and fetus. Methods: Twenty-four female Wistar albino (Rattus norvegicus), were divided into four groups, for induction of oxidative stress the animals were submitted to cold and physical immobilization. Plasma fasting glucose and MDA were determined in all groups and the fetuses and placentas were measured. Results: There were no statistical differences in the levels of malonic dialdehyde (MDA), however the averages of chronic stress group were higher compared to control groups, which could explain the observed adverse effects; there was no correlation between puppies' size, the weight of the placenta and MDA values. Conclusions: Chronic stress causes adverse effects, when compared to control groups; chronic stress group had fetuses, placentas and number of puppies, significantly lower compared to other groups. The rats exposed to chronic stress, also presented a higher frequency of fetal resorption.