Predisposing factors for amputation of lower extremities in diabetic patients with foot ulceration in the state of Sergipe

OBJECTIVE: To determine the predisposing factors for amputation of lower limbs in diabetic patients with foot ulceration. METHODS: The research was carried out in hospitals, and all diabetic patients with foot ulceration were included. Amputation was studied in relation to age, sex, previous amputation, number of ulcers, time of diagnosis of diabetes mellitus, time of ulceration, average number of days in hospital, Wagner's classification, and presence of foot pulse. RESULTS: We verified that 55% (44/80) of the patients progressed to some type of amputation of the lower limbs; mean age was 61 years, but the occurrence of amputation was significantly higher in the age group between 60 and 90 years (P = 0.03). We did not observe a significant variation in the following variables: time of diagnosis of diabetes, time of ulceration, and hospitalization time in relation to the group of patients who were amputated. Nevertheless, the most severe lesions, when evaluated by Wagner's classification (P <0.001) and by the absence of both distal pulses (P <0.001) of lower limbs, turned out to be very significant in relation to the amputation outcome. CONCLUSION: The severity of lesions, the absence of pulse and age over 60 years were considered predisposing factors for amputation in these patients.OBJETIVO: Determinar os fatores predisponentes para a amputação de membros inferiores nos doentes internados com diabetes melito e úlceras nos pés. MÉTODOS: Foram acompanhados os pacientes diabéticos com úlceras nos pés internados no período de 6 meses e analisadas as amputações nesses doentes em relação à idade, sexo, amputação prévia, número de ulcerações, tempo de diagnóstico do diabete, tempo de ulceração, tempo médio de internação, gravidade das lesões, presença de pulso. RESULTADOS: Verificou-se que 55% (44/80) dos doentes evoluíram para algum tipo de amputação de membros inferiores; a mediana das idades foi de 61 anos, porém a ocorrência de amputação foi significativamente maior na faixa etária dos 60 aos 90 anos (P = 0,03). Não se observou uma variação significativa da mediana do tempo de diagnóstico do diabetes, do tempo de ulceração e do tempo médio de internação em relação ao grupo de pacientes que foram amputados. Entretanto, as lesões mais graves, quando avaliadas pela classificação de Wagner (P <0,001) e pela ausência de detecção dos dois pulsos distais (P <0,001) dos membros inferiores, revelaram-se bastante significativas com relação ao desfecho de amputação. CONCLUSÃO: Foram considerados fatores predisponentes para a ocorrência de amputação nesses doentes a gravidade das lesões, a ausência de pulsos e as idades acima de 60 anos.Universidade TiradentesUniversidade Federal de Sergipe Departamento de MedicinaFundação Universitária de Ciências da Saúde de Alagoas Departamento de Medicina SocialEscola de Ciências Médicas de Alagoas Fundação Universitária de Ciências da Saúde de Alagoas Departamento de Clínica CirúrgicaUniversidade Federal de São Paulo (UNIFESP) Departamento de CirurgiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, Depto. de CirurgiaUNIFESP, EPMSciEL

Percepción del servicio de transporte público en la ciudad de Cuenca-Ecuador

La ciudad de Cuenca-Ecuador cuenta con tres tipos de transporte público: bus y taxi (negocios particulares) y el tranvía, medio administrado por el Gobierno Autónomo Descentralizado&nbsp; del cantón Cuenca, quien tiene como objetivo mejorar el sistema de movilidad de sus habitantes, desarrollando e implementando planes de mejora continua en la movilidad. El objetivo de esta investigación fue medir la percepción sobre el servicio de transporte público recibido por parte de los usuarios. El enfoque de investigación fue mixto: el estudio cualitativo utilizó como herramienta la entrevista semiestructurada realizada a 22 participantes; en cuanto al estudio cuantitativo, su alcance fue descriptivo y de corte transversal con un muestreo no probabilístico por convenienciaa 1.056 usuarios de transporte público. Para el análisis de datos, se aplicó técnicas de estadística descriptiva. Los resultados de la investigación cualitativa y cuantitativa evidencian la falta de educación vial, irrespeto a la capacidad máxima de buses, descontento con la infraestructura de las estaciones y/o paradas, así como en la ventilación y espacio de las unidades de transporte. Con loshallazgos obtenidos se puede crear una estrategia de marketing de servicios como herramienta de mejora continua.Palabras clave: Transporte público, marketing de servicios, comportamiento del consumidor, satisfacción del client

Fatores de compra para medicamentos pediátricos de venda livre: Purchase factors for over-the-counter pediatric medications

La industria farmacéutica contribuye al desarrollo de medicamentos para mejorar el estilo de vida de los seres humanos. El objetivo de este trabajo es identificar los factores de compra de medicamentos pediátricos de venta libre. En la investigación cualitativa se realizaron entrevistas a expertos, en la investigación cuantitativa se empleó un enfoque concluyente descriptivo con la aplicación de encuestas para el análisis de las variables en el segmento pediátrico. El principal resultado cualitativo mostró que los analgésicos no deberían considerarse OTC (Over the counter.) por seguridad de los menores, en cuanto al cuantitativo evidenció que los padres consideran a la publicidad como el factor más importante para adquirir medicamentos

Rcor2 underexpression in senescent mice: a target for inflammaging?

BACKGROUND: Aging is characterized by a low-grade systemic inflammation that contributes to the pathogenesis of neurodegenerative disorders such as Alzheimer's disease (AD). However, little knowledge is currently available on the molecular processes leading to chronic neuroinflammation. In this context, recent studies have described the role of chromatin regulators in inflammation and longevity including the REST corepressor (Rcor)-2 factor, which seems to be involved in an inflammatory suppressive program. METHODS: To assess the impact of Rcor2 in age-related inflammation, gene expression levels were quantified in different tissues and ages of the spontaneous senescence-accelerated P8 mouse (P8) using the SAMR1 mouse (R1) as a control. Specific siRNA transfection in P8 and R1 astrocyte cultures was used to determine Rcor2 involvement in the modulation of neuroinflammation. The effect of lipopolysaccharide (LPS) treatment on Rcor2 levels and neuroinflammation was analyzed both in vivo and in vitro. RESULTS: P8 mice presented a dramatic decrease in Rcor2 gene expression compared with R1 controls in splenocytes, an alteration also observed in the brain cortex, hippocampus and primary astrocytes of these mice. Rcor2 reduction in astrocytes was accompanied by an increased basal expression of the interleukin (Il)-6 gene. Strikingly, intraperitoneal LPS injection in R1 mice downregulated Rcor2 in the hippocampus, with a concomitant upregulation of tumor necrosis factor (Tnf-α), Il1-β and Il6 genes. A negative correlation between Rcor2 and Il6 gene expression was also verified in LPS-treated C6 glioma cells. Knock down of Rcor2 by siRNA transfection (siRcor2) in R1 astrocytes upregulated Il6 gene expression while siRcor2 further increased Il6 expression in P8 astrocytes. Moreover, LPS activation provoked a further downregulation of Rcor2 and an amplified induction of Il6 in siRcor2-tranfected astrocytes. CONCLUSIONS: Data presented here show interplay between Rcor2 downregulation and increased inflammation and suggest that Rcor2 may be a key regulator of inflammagin

Long-term exercise modulates hippocampal gene expression in sencescent females mice

Altres ajuts: FI-DGR 2011 de la Generalitat de CatalunyaThe senescence-accelerated SAMP8 mouse is considered a useful non-transgenic model for studying aspects of progressive cognitive decline and Alzheimer's disease (AD). Using SAMR1 mice as controls, here we explored the effects of 6 months of voluntary wheel running in 10-month-old female SAMP8 mice. Exercise in SAMP8 mice improved phenotypic features associated with premature aging (i.e., skin color and body tremor) and enhanced vascularization and BDNF gene expression in the hippocampus compared with controls. With the aim of identifying genes involved in brain aging responsive to long-term exercise, we performed whole genome microarray studies in hippocampus from sedentary SAMP8 (P8sed), SAMR1 (R1sed), and exercised SAMP8 (P8run) mice. The genes differentially expressed in P8sed versus R1sed were considered as putative aging markers (i) and those differentially expressed in P8run versus P8sed were considered as genes modulated by exercise (ii). Genes differentially expressed in both comparisons (i and ii) were considered as putative aging genes responsive to physical exercise. We identified 34 genes which met both criteria. Gene ontology analysis revealed that they are mainly involved in functions related to extracellular matrix maintenance. Selected genes were validated by real-time quantitative PCR assays, i.e., collagen type 1 alpha 1 (col1a1), collagen type 1 alpha 2 (col1a2), fibromodulin (fmod), prostaglandin D(2) synthase (ptgds), and aldehyde dehydrogenase (Aldh1a2). As a whole, our study suggests that exercise training during adulthood may prevent or delay gene expression alterations and processes associated with hippocampal aging in at-risk subjects

Verification of the ΔKeff hypothesis along the fatigue crack path in thin and thick Al specimens

Elber assumed that the actual driving force for fatigue crack growth (FCG) is the effective stress intensity factor ΔKeff. To verify this hypothesis, both DC(T) and C(T) specimens are cut from a 6351-T6 Al alloy circular bar with two different thicknesses, 2 and 30mm, tested under fixed ΔK and Kmax to simulated plane stress and plane strain FCG conditions. A strain-gage bonded on the back face of the specimens is used to measure the crack length and a custom-made Labview program is used to control the applied load, maintaining ΔK and Kmax constant along the crack path. Moreover, the crack opening load is redundantly measured during the FCG tests, using far field strains from the back face gage and near field strains from a series of gages bonded along the crack path, as well as an independent digital image correlation system to measure displacement/strain fields on the face of the specimens. These tests show that the Al specimens reproduce the behavior previously observed in similar tests in 1020 steel: a significant decrease of the opening load as the cracks grow along the specimens, while maintaining a FCG rate essentially constant under the fixed {ΔK, Kmax} loading, a behavior that cannot be explained by the ΔKeff hypothesis

Processo para a esterificação de cargas vegetais

DepositadaA presente invenção descreve um processo para a esterificação de cargas vegetais, o qual compreende a reação de uma corrente de ácidos graxos livres com uma quantidade estequiométrica ou excesso de um álcool em um solvente gasoso pressurizado utilizando catálise enzimática

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool

Abstract: Background: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme’s performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. Methods: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm’s performance and sensitivity to surveillance quality. Results: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. Conclusion: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions