Update on prevention of diabetic foot ulcer

The diabetic foot ulcer is the most important reason for non-traumatic limb amputation. Based on recent data, it has been estimated that up to 34% of type 2 diabetes patients may develop diabetic foot ulcers once in their lifetime. Risk factors for developing foot ulcers are distal sensorimotor peripheral neuropathy, peripheral arterial disease, previous ulcers, and/or amputations. Understanding the factors that place patients with diabetes mellitus at high ulceration risk and the early treatment of risk factors, and continuous education of the patient (and/or caregivers) are essential for the prevention and management of diabetic foot complications. Implementing strategies to prevent these complications is a key aspect of diabetes care, but the most effective strategy in prevention has to be investigated. More evidence from well-designed studies is needed on this topic

Saúde e sociedade

Este módulo discute sobre a estreita relação entre saúde e sociedade, na realidade do trabalho, da Equipe de Saúde da Família. Precisamos conhecer a realidade da comunidade para o trabalho na Estratégia Saúde da Família, tanto em termos contextuais (a partir de informações da realidade demográfica, epidemiológica, social, política e cultural), como em termos conceituais (os modos de ver e conceber a realidade).1.0Ministério da Saúde/OPAS/OM

Saúde e sociedade na realidade do trabalho da equipe de saúde da família

O vídeo, apresenta o modelo biomédico e a determinação social da doença. Reflete sobre a influência das relações sociais na constituição dos modelos de saúde e sobre as diferentes formas de pensar o processo saúde-doença. Vídeo 1 do módulo 2 que compõe o Curso de Especialização em Saúde da Família.1.0Ministério da Saúdes/OPAS/OM

Modeling Doxorubicin Pharmacokinetics in Multiple Myeloma Suggests Mechanism of Drug Resistance

Objective: Multiple myeloma (MM) is a plasma cell malignancy often treated with chemotherapy drugs. Among these, doxorubicin (DOXO) is commonly employed, sometimes in combined-drug therapies, but it has to be optimally administered in order to maximize its efficacy and reduce possible side effects. To support DOXO studies and treatment optimization, here we propose an experimental/modeling approach to establish a model describing DOXO pharmacokinetics (PK) in MM cells. Methods: A series of in vitro experiments were performed in MM1R and MOLP-2 cells. DOXO was administered at two dosages (200 nM, 450 nM) at [Formula: see text]=0 and removed at [Formula: see text]=3 hrs. Intracellular DOXO concentration was measured via fluorescence microscopy during both drug uptake ([Formula: see text]=0-3 hrs) and release phases ([Formula: see text]=3-8 hrs). Four PK candidate models were identified, and were compared and selected based on their ability to describe DOXO data and numerical parameter identification. Results: The most parsimonious model consists of three compartments describing DOXO distribution between the extracellular space, the cell cytoplasm and the nucleus, and defines the intracellular DOXO efflux rate through a Hill function, simulating a threshold/saturation drug resistance mechanism. This model predicted DOXO data well in all the experiments and provided precise parameter estimates (mean ± standard deviation coefficient of variation: 15.8±12.2%). Conclusions: A reliable PK model describing DOXO uptake and release in MM cells has been successfully developed. Significance: The proposed PK model, once integrated with DOXO pharmacodynamics, has the potential of allowing the study and the optimization of DOXO treatment strategies in MM

Saúde e sociedade

O módulo Saúde e Sociedade enfatiza o reconhecimento do trabalho da Estratégia Saúde da Família na Atenção Básica como um processo complexo no que se refere aos saberes, às práticas e às relações envolvidas. Tal processo requer a articulação de bases teóricas, metodológicas e éticas, bem como a contribuição de diferentes profissionais para alcançar uma atenção integral. Nesse sentido, o percurso adotado iniciou com a apresentação dos diferentes modos de pensar e fazer saúde, para, na sequência, discutir a influência da organização da sociedade no processo saúde-doença. Adentrando ao universo das políticas públicas de saúde, sobre as condições de instalação do modelo de saúde brasileiro e sobre o processo histórico de construção da atual política de saúde, o Sistema Único de Saúde. Foram apresentadas suas diretrizes e princípios, além de alguns dos dispositivos legais e operacionais para a concretização do SUS na prática. Abordou-se, também, as concepções de Atenção Primária da Saúde, suas características, eixos, diretrizes e seu sentido no âmbito do SUS.Textos: 2.ed.Ministério da Saúde/OPAS/OM

Evidence for an Independent and Cumulative Effect of Postprandial Hypertriglyceridemia and Hyperglycemia on Endothelial Dysfunction and Oxidative Stress Generation

Background— Postprandial hypertriglyceridemia and hyperglycemia are considered risk factors for cardiovascular disease. Evidence suggests that postprandial hypertriglyceridemia and hyperglycemia induce endothelial dysfunction through oxidative stress; however, the distinct role of these two factors is a matter of debate. Methods and Results— Thirty type 2 diabetic patients and 20 normal subjects ate 3 different meals: a high-fat meal; 75 g glucose alone; and high-fat meal plus glucose. Glycemia, triglyceridemia, nitrotyrosine, and endothelial function were assayed during the tests. Subsequently, diabetics took 40 mg/d simvastatin or placebo for 12 weeks. The 3 tests were performed again at baseline, between 3 to 6 days after the start, and at the end of each study. High-fat load and glucose alone produced a decrease of endothelial function and an increase of nitrotyrosine in normal and diabetic subjects. These effects were more pronounced when high fat and glucose were combined. Short-term simvastatin treatment had no effect on lipid parameters but reduced the effect on endothelial function and nitrotyrosine observed during each different test. Long-term simvastatin treatment was accompanied by a lower increase in postprandial triglycerides, which was followed by smaller variations of endothelial function and nitrotyrosine during the tests. Conclusions— This study shows an independent and cumulative effect of postprandial hypertriglyceridemia and hyperglycemia on endothelial function, suggesting oxidative stress as common mediator of such effect. Simvastatin shows a beneficial effect on oxidative stress and endothelial dysfunction, which may be ascribed to a direct effect as well as the lipid-lowering action of the drug

Effect of Postprandial Hypertriglyceridemia and Hyperglycemia on Circulating Adhesion Molecules and Oxidative Stress Generation and the Possible Role of Simvastatin Treatment

Adhesion molecules, particularly intracellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, and E-selectin, have been associated with cardiovascular disease. Elevated levels of these molecules have been reported in diabetic patients. Postprandial hypertriglyceridemia and hyperglycemia are considered risk factors for cardiovascular disease, and evidence suggests that postprandial hypertriglyceridemia and hyperglycemia may induce an increase in circulating adhesion molecules. However, the distinct role of these two factors is a matter of debate. Thirty type 2 diabetic patients and 20 normal subjects ate three different meals: a high-fat meal, 75 g of glucose alone, and a high-fat meal plus glucose. Glycemia, triglyceridemia, plasma nitrotyrosine, ICAM-1, VCAM-1, and E-selectin were assayed during the tests. Subsequently, diabetic subjects took simvastatin 40 mg/day or placebo for 12 weeks. The three tests were performed again at baseline, between 3 and 6 days after starting the study, and at the end of each study. High-fat load and glucose alone produced an increase of nitrotyrosine, ICAM-1, VCAM-1, and E-selectin plasma levels in normal and diabetic subjects. These effects were more pronounced when high fat and glucose were combined. Short-term simvastatin treatment had no effect on lipid parameters, but reduced the effect on adhesion molecules and nitrotyrosine, which was observed during every different test. Long-term simvastatin treatment was accompanied by a lower increase in postprandial triglycerides, which was followed by smaller variations in ICAM-1, VCAM-1, E-selectin, and nitrotyrosine during the tests. This study shows an independent and cumulative effect of postprandial hypertriglyceridemia and hyperglycemia on ICAM-1, VCAM-1, and E-selectin plasma levels, suggesting oxidative stress as a common mediator of such effects. Simvastatin shows a beneficial effect on oxidative stress and the plasma levels of adhesion molecules, which may be ascribed to a direct effect in addition to the lipid-lowering action of the drug

Produtividade e proteína bruta de pastagens consorciadas com trevo branco e amendoim forrageiro.

O objetivo desse trabalho foi avaliar dois sistemas forrageiros (SF) com capim elefante (CE) + azevém (AZ) + espécies de crescimento espontâneo (ECE) + trevo branco, como SF1; e CE + AZ + ECE + amendoim forrageiro, como SF2. O capim elefante foi plantado em linhas afastadas a cada 4m de distância entre elas. No período hibernal foi semeado azevém entre as linhas formadas pelo capim elefante; em um sistema foi semeado o trevo branco e em outro foi preservado o amendoim forrageiro. O delineamento experimental foi o inteiramente casualizado, com dois tratamentos (SF), duas repetições (piquetes) e parcelas subdivididas no tempo (pastejos). Foram avaliadas a massa de forragem inicial (MF), a composição botânica e a carga animal. Foram coletadas amostras pelo método de pastejo simulado para análise da proteína bruta (PB) da forragem. Durante o período experimental (331 dias) foram conduzidos sete pastejos. Os valores médios da MF e lotação foram de 2968; 2905 kg de MS/ha e de 1,93; 1,65 UA/ha para os respectivos SF. No período hibernal foram observados teores elevados de PB para o capim elefante. Houve similaridade entre as pastagens quanto à produtividade e PB da forragem