Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the brazupa study

CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOStudies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. Methods: This study presents cross sectional, Baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. Results: Patients with ulcer had longer disease duration (17.2 +/- 9.9 vs. 13.2 +/- 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 +/- 2.03 vs. 8.35 +/- 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. Conclusions: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population825CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOCNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOsem informaçã

O cuidado em saúde mental pelos agentes comunitários de saúde: o que aprendem em seu cotidiano de trabalho?

Este trabalho visa descrever o conhecimento em saúde mental construído pelo agente comunitário de saúde, concomitante à produção de cuidado em saúde mental. Trata-se de pesquisa qualitativa, cujo referencial teórico é o Construcionismo Social. Os dados foram produzidos em grupos focais, analisados e elencados nas seguintes categorias temáticas: “A gente precisa orientar as famílias”, que agrupa os entidos relacionados à construção do cuidado às famílias que convivem com o sofrimento mental; “Só de você parar e ouvir...”, onde se descrevem os repertórios relacionados ao uso de tecnologias relacionais de cuidado; “Nós sabemos disso, porque nós andamos ali”, que delineia as estratégias para construção de saberes e, finalmente, a categoria que descreve os sentidos do medo do louco: “A gente tem medo daquilo que a gente vê”. Conclui-se que os conhecimentos construídos no cotidiano de trabalho dos agentes comunitários de saúde, quando refletidos e sistematizados, são potentes para a produção de práticas de cuidado condizentes com o paradigma psicossocial de atenção a pessoas e famílias em sofrimento mental

Interference of natural extract from Jatobá (Hymenaea martiana Hayne) with the physico-chemical characteristics and yield of goat milk and cheese

ABSTRACT Several studies have assessed the therapeutic potential of natural products against mastitis, but only a few have evaluated the impacts of this alternative therapy on the main properties of milk and dairy products. In this study, we observed how the treatment of mastitis with ethanolic extract of Jatobá (Hymenaea martiana Hayne) influenced the physicochemical and sensory characteristics of coalho cheese. An ointment containing the ethanolic extract was prepared for intramammary use in six dairy goats. The experiment was conducted in three experimental moments. Milking was performed, manually, and both milk and cheese were subjected to physicochemical and sensory tests. No difference was observed (p&gt;0.05) in the physicochemical aspects of milk between the studied groups. The solids-non-fat showed a statistical difference between experimental moments M1 and M2. The protein means varied from 3.33 to 3.62, and there was a statistical difference between the two moments, while the lactose means varied from 4.79 to 5.38%. The physicochemical aspects of cheese remained similar with both treatments. Except for appearance, the sensory characteristics showed no statistical difference. In conclusion, the use of Jatobá extract ointment did not influence the physicochemical and sensory characteristics of goat milk or cheese.</jats:p

Esterification of 4-methyloctanoic acid with polyethylene glycol at different aw

Novozym 435? (immobilized Candida antarctica lipase B) was used to esterify 4-methyloctanoic acid with polyethylene glycols (PEGs) of different molecular weights (PEG-600, PEG-3000 and PEG-20000) at different water activities. A system composed of 4-methyloctanoic acid and PEG-600 was monophasic, except at a high water activity. Even at a water activity of 0.8, PEG was still converted to its mono- or diester, which proves the unique character of PEG. The PEG-esters accumulated in the apolar phase