Taxa de excreção urinária de albumina e taxa de filtração glomerular em pacientes com diabetes tipo 2 e apenas um rim

OBJECTIVE: To evaluate the urinary albumin excretion rate and the glomerular filtration rate of single-kidney type 2 diabetic patients and of single-kidney nondiabetic patients. PATIENTS AND METHODS: Patients who had only one kidney for at least 5 years, with no renal disease or hypertension at the time of the nephrectomy and with no calculus or systemic disease at the time of the evaluation, were included in this controlled cross-sectional study. A total of 20 single-kidney type 2 diabetic patients (eight men, age 62 ± 9 years; diabetes duration 8.5 ± 7 years), 17 single-kidney nondiabetic patients (two men, age 57 ± 13 years), and 184 type 2 diabetic patients who were matched to the single-kidney diabetic group for age, sex and body mass index were studied. Urinary albumin excretion rate was measured by immunoturbidimetry in timed 24-h sterile urine, and glomerular filtration rate was determined by the 51CrEDTA single-injection method. RESULTS: Single-kidney type 2 diabetic patients presented a higher proportion (eight of 20; 40%) of microalbuminuria (urinary albumin excretion rate 20-200 mg/min) than single-kidney nondiabetic patients (three of 17; 17.6%) and type 2 diabetic patients (37 of 184; 20%). Single-kidney diabetic patients presented a higher proportion of macroalbuminuria (urinary albumin excretion rate >200 mg/min; six of 20; 30%) than single-kidney nondiabetic patients (one of 17; 6%) but were similar to type 2 diabetic patients (43 of 184; 23%). The glomerular filtration rates of normaoalbuminuric singlekidney nondiabetic patients (71.7 ± 21.4 ml × min-1 × 1.73 m-2 ) and single-kidney type 2 diabetic patients (73.0 ± 21.5 ml × min-1 × 1.73 m-2 ) were similar but higher than the one-kidney glomerular filtration rate (GFR¸ 2) of the age-, sex-, and body mass index-matched normoalbuminiric type 2 diabetic patients (54.0 ± 11.6ml × min-1 × 1.73m-2). CONCLUSIONS: Increased GFR related to single-kidney status confers an increased risk of developing renal disease in the presence of diabetes.OBJETIVO: Avaliar a taxa de excreção urinária de albumina e a taxa de filtração glomerular em pacientes com apenas um rim e diabetes tipo 2 e em pacientes não-diabéticos com apenas um rim. PACIENTES E MÉTODOS: Foi feito um estudo controlado, de corte transversal. Este estudo incluiu pacientes que tivessem apenas um rim por, pelo menos, 5 anos, que não apresentaram doenças renais ou hipertensão quando da nefroctomia, e que não tivessem cálculo ou doença sistêmica quando da avaliação. Foram avaliados 20 pacientes com apenas um rim e diabetes tipo 2 (oito homens, idade 62 + 9 anos; duração da diabete 8,5 + 7 anos), 17 pacientes não-diabéticos com apenas um rim (dois homens, idade 57 + 13 anos), e 184 pacientes com diabetes tipo 2, que foram agrupados por idade, sexo e índice de massa corporal com os pacientes diabéticos com apenas um rim. A taxa de excreção urinária de albumina foi medida por imunoturbidimetria através de coletas de urina esterilizada obtidas a cada 24 h. A taxa de filtração glomerular foi determinada pelo método 51Cr-EDTA de injeção única. RESULTADOS: Os pacientes com diabetes tipo 2 e apenas um rim apresentaram uma proporção maior (oito em 20; 40%) de microalbumnuria (taxa de excreção urinária de albumina 20-200 mg/min) do que os pacientes não-diabéticos e com apenas um rim (três em 17; 17,6%) e do que os pacientes diabéticos do tipo 2 (37 em 184, 20%). Pacientes diabéticos com apenas um rim apresentaram uma proporção maior de macroalbuminuria (taxa de excreção urinária de albumina>200 mg/min; seis em 20; 30%) do que os pacientes não-diabéticos e com apenas um rim (um em 17; 6%), mas semelhante à mesma proporção dos pacientes com diabetes tipo 2 (43 em 184; 23%). As taxas de filtração glomerular dos pacientes não-diabéticos e normoalbuminúricos com apenas um rim (71,7 + 21,4 ml x min-1 x 1,73m- 2), e de pacientes com diabetes tipo 2 e apenas um rim (73,0 + 21,5 ml x min- 1 x 1,73m-2) foram semelhantes. No entanto, estas foram mais elevadas do que a taxa de filtração glomerular (TFR ¸ 2) dos pacientes com diabetes tipo 2 e normoalbuminúricos, agrupados por idade, sexo e índice de massa corporal (54,0 + 11,6 ml x min-1 x 1,73m-2). CONCLUSÕES: Uma TFR elevada, associada à condição de um único rim, confere um aumento do risco de desenvolvimento de doença renal na presença de diabetes

Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee

OBJECTIVES: To evaluate the difference in isokinetic strength of hip muscles between patients with knee osteoarthritis (OA) and matched healthy controls, and to establish the correlation between this isokinetic strength and pain and function in patients with knee OA. METHODS: 25 patients with a diagnosis of unilateral knee OA, 25 patients with bilateral knee OA, and 50 matched controls were evaluated using the visual analog scale for pain, knee Lequesne index, Western Ontario and McMaster Universities questionnaire and an isokinetic test. RESULTS: The groups were matched for age, gender and body mass index. The results of the isokinetic test revealed lower peak torque of the hip in patients with OA of the knee than in the control group for all movements studied. Strong correlations were found between the peak torque, visual analog scale and function. CONCLUSIONS: Patients with OA of the knee exhibit lower isokinetic strength in the hip muscles than healthy control subjects. Strengthening the muscles surrounding the hip joint may help to decrease pain in people with knee OA. Some correlations between pain/function and peak torque were found

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients

I. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Protein uric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94% vs 23% ), peripheral neuropathy (94% vs 23%) and arterial hypertension (73% vs 16%) than normoalbuminuric patients. Age >50 years, body mass index >28.6 kgfm2, known duration of diabetes> 10 years, presence of arterial hypertension, and fasting plasma glucose> 160 mg/dl were significantly and independently associated with development of proteinuria

The potential impact of PM2.5 on the covid-19 crisis in the Brazilian Amazon region

OBJECTIVE: This study aims to assess covid-19 morbidity, mortality, and severity from 2020 to 2021 in five Brazilian Amazon states with the highest records of wildfires. METHODS: A distributed lag non-linear model was applied to estimate the potential exposure risk association with particulate matter smaller than 2.5-μm in diameter (PM2.5). Daily mean temperature, relative humidity, percentual of community mobility, number of hospital beds, days of the week, and holidays were considered in the final models for controlling the confounding factors. RESULTS: The states of Para, Mato Grosso, and Amazonas have reported the highest values of overall cases, deaths, and severe cases of covid-19. The worrying growth in the percentual rates in 2020/2021 for the incidence, severity, and mortality were highlighted in Rondônia and Mato Grosso. The growth in 2020/2021 in the estimations of PM2.5 concentrations was higher in Mato Grosso, with an increase of 24.4%, followed by Rondônia (14.9%). CONCLUSION: This study establishes an association between wildfire-generated PM2.5 and increasing covid-19 incidence, mortality, and severity within the studied area. The findings showed that the risk of covid-19 morbidity and mortality is nearly two times higher among individuals exposed to high concentrations of PM2.5. The attributable fraction to PM2.5 in the studied area represents an important role in the risk associated with covid-19 in the Brazilian Amazon region

Mental disorders that most affect university teachers: a study in a medical expertise service

Objectives: verifying the types of mental disorders that most affect teachers treated in a service of medical expertise. Method: a retrospective study of documental nature with a quantitative approach developed in a Higher Education Institution of João Pessoa city - PB. The sample was composed of 254 sheets of teachers treated in a service of medical expertise of the institution selected for the study, in the period from January to 1999 to March 2011. Data obtained were analyzed through frequency and percentage. Results: almost all the sample was composed of female teachers, aged between 40 and 49, and depression was responsible for 52% absenteeism of teachers, followed by schizophrenia (12%), bipolar disorder (10%), acute reaction to stress (8%), anxiety (7%), delusional disorder (4%), and others (8%). Conclusion: the mental disorder that most affects the searched teacher category is depression. Therefore, further investigations are needed that can analyze the severity of this problematic pathology in academic area

Mental disorders in university teachers: study in a service of medical investigation

Objective: To verify the types of mental disorders that affects more teachers treated in a service of medical investigation. Method: Retrospective study of documental nature, with quantitative approach, developed in a Higher Education Institution of João Pessoa city – PB. It was composed of 254 records of teachers treated in a service of medical investigation of the institution selected for the study, in the period from January to 1999 to March 2011. Data obtained were analyzed through frequency and percentage. Results: Almost all the sample was composed of female teachers, aged between 40 and 49 years old, and depression was responsible for 52% absenteeism of teachers, followed by schizophrenia (12%), bipolar disorder (10%), acute reaction to stress (8%), anxiety (7%), delusional disorder (4%), and others (8%). Conclusion: The mental disorder that affects more the searched teacher category is depression. Therefore, further investigations are needed to analyze the gravity of this problematic pathology in academic area

Análise da inclusão da modelagem matemática como instrumento da política nacional do meio ambiente

A crise social e ambiental na qual o Brasil está inserido, caracterizada pelo atual e predatório modelo de desenvolvimento, coloca em risco a sobrevivência das espécies humanas e não humanas da presente e das futuras gerações, de maneira que novas estratégias devem ser utilizadas, a fim de evitar novos danos ao meio ambiente. O presente artigo busca investigar como e em que medida a modelagem matemática pode contribuir na forma de instrumento da Política Nacional do Meio Ambiente (PNMA), Lei nº 6.938/81, em um novo inciso, a fim de agregar confiabilidade ao Estudo de Impacto Ambiental e ao seu respectivo Relatório de Impacto Ambiental, bem como exercer função mais preventiva e cautelosa no gerenciamento dos efeitos dos impactos ambientais. Para tanto, percebe-se, inicialmente, a crise ambiental, na qual a sociedade está inserida, como um meio impulsionador de mudanças de percepções e paradigmas. Por conseguinte, faz-se a análise da PNMA, de seus objetivos e instrumentos para, finalmente, explorar a possibilidade de utilização da precisão da modelagem matemática nesta lei, como um meio efetivo para que sejam evitados mais danos ambientais. A metodologia envolve pesquisa interdisciplinar, com orientação epistemológica na teoria crítica, que congrega teoria e práxis, e articula as áreas de Sociologia, Direito Ambiental e Economia. Conclui-se que, para a concretização do direito ao meio ambiente ecologicamente equilibrado, a utilização da modelagem matemática se mostra adequada à proteção ecológica e pró-ativa à efetivação de uma análise mais precisa, preventiva, precaucional e menos descritiva dos riscos de impacto ante os prejuízos ambientais

VIOLÊNCIA OBSTÉTRICA E OS DIREITOS DAS GESTANTES: O QUE AS MULHERES SABEM?

Obstetric violence consists of acts of violence against women, carried out by health professionals, at any stage of the pregnancy-puerperal cycle, using abusive interventions as routine procedures or preventing women from exercising their rights during pregnancy, childbirth, and the puerperium. Obstetric violence is a social problem and is unknown to many women, therefore, this research aimed to analyze the level of knowledge of women, pregnant women and/or mothers, about obstetric violence and their rights during the pregnancy-puerperal cycle. It is descriptive field research with a quantitative approach, in which a questionnaire was applied through an online platform, from March to April 2021, with the inclusion criterion of mothers and/or pregnant women, from 18 to 40 years, who lived in the municipality of Valparaíso de Goiás and used the public health network. The questionnaire was answered by 56 women who agreed to participate in the research. From the analysis of 56 questionnaires answered, it was observed that 80% of the women interviewed know the meaning of the term obstetric violence, however, they partially know the forms of violence. Although women are partially aware of obstetric violence, the results reveal the importance of disseminating more information on the subject, and the importance of the commitment of health professionals to guide pregnant women and prepare them for a future humanized delivery, making them aware of their rights and their autonomy of their choices.Violência obstétrica consiste em atos de violência contra mulher, realizado por profissionais de saúde, em qualquer fase do ciclo gravídico-puerperal, utilizando intervenções abusivas como procedimentos de rotina ou impedindo a mulher de exercer seus direitos durante a gestação, parto e puerpério. A violência obstétrica é um problema social e é desconhecida para muitas mulheres, portanto, esta pesquisa teve como objetivo analisar o nível de conhecimento das mulheres, gestantes e/ou mães, acerca da violência obstétrica e dos seus direitos durante o ciclo gravídico-puerperal. Trata-se de uma pesquisa de campo descritiva com abordagem quantitativa, na qual foi aplicado um questionário por meio de uma plataforma online, no período de março a abril de 2021, tendo como critério de inclusão mães e/ou gestantes, de 18 a 40 anos, que residiam no município Valparaíso de Goiás e utilizavam a rede pública de saúde. O questionário foi respondido por 56 mulheres que aceitaram participar da pesquisa. A partir da análise de 56 questionários respondidos, foi observado que 80% das mulheres entrevistadas conhecem o significado do termo violência obstétrica, entretanto, conhecem parcialmente as formas de violência. Apesar das mulheres conhecerem parcialmente a violência obstétrica, os resultados revelam a importância de disseminar mais informações sobre o assunto, e a importância do comprometimento dos profissionais de saúde em orientar as gestantes e prepará-las para um futuro parto humanizado, deixando-as ciente sobre seus direitos e da sua autonomia frente às suas escolhas