Pharmaceutic guidance to hypertensive patients at USP University Hospital: effect on adherence to treatment

This study was carried out in the outpatient unit of the Teaching Hospital of the University of São Paulo (USP), and studied the impact of an educational program aimed at improving hypertensive patients' compliance to treatment. Seventy five (75) hypertensive patients of both sexes took part in the study which had no age or race discrimination. Participants presented no other concomitant pathology, except obesity, diabetes and dyslipidemia. Forty one patients were allocated to an experimental group (EG). Experimental patients attended lectures on the use of medication and artery hypertension (AH) and received personal pharmaceutical guidance for nine months. The control group (CG) comprised 34 patients who did not attend lectures or receive pharmaceutical advice in this period. The results were assessed by means of serum levels of cholesterol and fractions of tryacylglicerol (TG), urine sodium and potassium, arterial pressure (AP), body mass index (BMI), waist-hip ratio (WHR), and also based on responses to a questionnaire focusing on AH and treatment. Patients who received the guidance showed a greater decrease in AP, TG and WHR, besides an increase of potassium excretion through urine. The experimental group also scored higher on the questionnaires compared to the CG. It was concluded that the educational process, applied under the conditions of the present study, improves clients' clinical response to antihypertensive treatment and should be included in therapeutic strategies of health care services dealing with hypertensive patients.Este trabalho, realizado no ambulatório do Hospital Universitário da USP, estudou a repercussão de um programa educacional visando melhorar a adesão do paciente hipertenso ao tratamento. Participaram do trabalho 75 pacientes de ambos os sexos, sem discriminação de idade ou raça, sem outras patologias concomitantes, exceto obesidade, diabetes e dislipidemia. Quarenta e um pacientes assistiram palestras sobre uso de medicamentos e hipertensão arterial (HA), receberam orientação farmacêutica individualizada durante nove meses e foram denominados grupo experimental (GE); o grupo controle (GC), composto por 34 pacientes não assistiu palestras nem recebeu orientação farmacêutica, neste período. Os resultados foram avaliados por meio de níveis séricos de colesterol e frações, triacil-gliceróis (TG), sódio e potássio urinários, pressão arterial (PA), índice de massa corpórea (IMC), relação cintura/quadril (RCQ), além de respostas a questionário enfocando HA e tratamento. Verificou-se que os pacientes orientados apresentaram maior decréscimo da PA, TG e da RCQ, além de aumento da excreção urinária de potássio e do percentual de acertos em questionários, em relação ao GC. Concluiu-se que o processo educativo, utilizado nas condições deste estudo, melhora a resposta clínica do paciente ao tratamento anti-hipertensivo e deve fazer parte das estratégias terapêuticas de serviços de atendimento a pacientes hipertensos

Efeitos da intervenção fisioterapêutica nas respostas sensoriais e funcionais de diabéticos neuropatas

The purpose of this study was to elaborate and apply a physical therapy treatment for diabetic neuropathic patients, comparing their sensorial, motor and functional responses before and after treatment to those of a healthy control group. Ten healthy subjects (CG) and 10 neuropathic diabetes patients (DG) clinically diagnosed were studied. Motor, functionaland sensorial evaluations were performed pre and post-intervention in both groups. Treatment was individually applied in 45-minute sessions twice a week, during 5 weeks. Therapy program consisted in stretching exercises for hamstrings, triceps surae and tibialis anterior muscles, actively-resisted exercises for intrinsic and extrinsic foot and ankle muscles, practice of daily activities and feet self-care orientations. Data were statistically analysed. When comparing DG post treatment data to DG-pre and CG, thermal sensitivity showed improvement in heel, hallux, lateral and medial forefoot; DG ankle dorsiflexion and eversion ROM reached values similar to those of CG's; DG showed significant improvement in ankle extension and inversion; and DG-post reached the same muscular functions observed in CG in intrinsic feet muscles, tibialis anterior and triceps surae. The physical therapy treatment showed effective in reducing distal numbness, tingling and pricking and it was also effective in preventing muscle function and mobility limitations in diabetic neuropathic patients.O objetivo foi elaborar e aplicar um tratamento fisioterapêutico para diabéticos neuropatas e comparar suas respostas sensoriais, motoras e funcionais, pré e pós-intervenção, com um grupo de sujeitos não-diabéticos assintomáticos. Participaram do estudo 10 sujeitos controle (GC) e 10 diabéticos neuropatas (GD) diagnosticados clinicamente. Realizou-se uma avaliação motora, funcional e sensorial nos dois grupos pré e pós-intervenção. O tratamento foi aplicado individualmente duas vezes por semana, por 45 minutos, durante 5 semanas. Foram feitos alongamentos de cadeia posterior e tibial anterior; exercícios ativos resistidos para musculatura intrínseca do pé e tornozelo; treino de atividades de vida diária e fornecidas orientações de autocuidado com os pés. Os dados foram analisados estatisticamente. Comparando-se os dados do GD pós-tratamento com os do GC, verificou-se melhora na sensibilidade térmica nas regiões de calcanhar, hálux, antepé lateral e medial; a amplitude ativa de dorsiflexão e eversão do tornozelo igualou-se à do GC; houve melhora significativa da extensão e inversão do pé; e o GD alcançou funções musculares (musculatura intrínseca do pé,tríceps sural e tibial anterior) semelhantes às do GC. Em diabéticos neuropatas, o tratamento fisioterapêutico proposto mostrou-se eficaz na atenuação dos sintomas dormência, formigamento e queimação, além de contribuir para a mobilidade e prevenção de limitações de função muscular

ADIPOQ and IL6 variants are associated with a pro-inflammatory status in obeses with cardiometabolic dysfunction

Abstract\ud \ud Background\ud Polymorphisms in genes encoding adiponectin (ADIPOQ) and interleukin-6 (IL6) have been associated with adiposity and obese-related phenotypes. This study investigated the relationship of ADIPOQ and IL6 gene polymorphisms with pro-inflammatory and cardiometabolic markers in obese patients.\ud \ud \ud Methods\ud Anthropometric and body composition parameters were measured in 249 Brazilian subjects (30 to 68 yr). Metabolic and inflammatory markers and adipokines were analyzed in blood samples. ADIPOQ rs2241766 (45 T > G) and IL6 rs1800795 (−174G > C) polymorphisms were analyzed by real-time PCR and PCR-RFLP, respectively.\ud \ud \ud Results\ud Type 2 diabetes, hypertension, dyslipidemia and increased values of waist circumference, body fat, leptin, fibrinogen, IL-1β, hsCRP and TNFα were related to obesity (p < 0.05). Multiple linear regression analysis showed a positive correlation between BMI and waist circumference, body fat, leptin, fibrinogen, PAI-1, IL-1β, hsCRP and TNFα values (p < 0.001) but not with adiponectin. Obese group had altered metabolic status, resistance to leptin and insulin, and atherogenic and pro-inflammatory profiles. ADIPOQ and IL6 variants were not directely related to obesity, leptin resistance or alterations in cardiometabolic markers. Individuals carrying ADIPOQ 45G allele (TG + GG genotype) had higher IL-6, IL-1β and TNFα levels than TT genotype carriers (p < 0.05). IL6 -174GG genotype was associated with increased IL-1β levels (p = 0.033).\ud \ud \ud Conclusion\ud Obesity is associated with leptin resistance, cardiometabolic alterations and a pro-inflammatory status. Our results are suggestive that ADIPOQ and IL6 polymorphisms contribute to cardiometabolic risk in obese individuals.FAPESPCAPESCNPqCONICY