Lipid profile disturbances are highly prevalent in Japanese-Brazilians

Alta prevalência de diabetes em população nipo-brasileira de Bauru/SP foi previamente relatada. Visando a complementar a avaliação do risco cardiometabólico, este estudo analisou distúrbios no perfil lipídico de 1.330 nipo-brasileiros (46% homens) > 30 anos. Definiu-se hipercolesterolemia por níveis de colesterol total > 240 mg/dL; hipertrigliceridemia por valores > 150 mg/dL e HDL-colesterol baixo por valores < 40 mg/dL e < 50 mg/dL para homens e mulheres, respectivamente. A prevalência desses distúrbios foi comparada pelo qui-quadrado, estratificando-se por sexos e categorias glicêmicas. As médias dos lipídeos e lipoproteínas foram comparadas entre sexos pelo teste t de Student. A prevalência de hipertrigliceridemia foi de 66,0% (IC95%:63,5 - 68,5%), sendo mais comum em homens e aumentando com a piora da categoria glicêmica; a trigliceridemia média foi 235,7 &plusmn; 196,3 mg/dL. A prevalência de hipercolesterolemia foi 24,4% (IC95%:22,1 - 26,7%); HDL-C baixo foi observado em 43,0% (IC95%:39,4 - 46,6%] das mulheres e 17,5% (IC95%:14,5 - 20,5%) dos homens, porém a razão colesterol total/HDL-C foi menor em mulheres (4,23 &plusmn; 0,68 vs. 4,40 &plusmn; 0,73; p < 0,001). Em nipo-brasileiros, a hipertrigliceridemia é a anormalidade lipídica mais comum, em concordância com a elevada prevalência de diabetes. Os homens apresentaram pior perfil lipídico que as mulheres. Sugere-se que hábitos de vida ocidental possam estar deteriorando a saúde desses indivíduos.High prevalence of diabetes has been previously reported in Japanese-Brazilians. In an attempt to better estimate the cardiometabolic risk, this study evaluated lipid disorders in 1,330 Japanese-Brazilians (46% men) aged >30 years. Hypercholesterolemia was defined as serum cholesterol > 240 mg/dL, hypertriglyceridemia as values > 150 mg/dL and low-HDL-C as values <40 mg/dL and <50 mg/dl for men and women respectively. The prevalence of dyslipidemias was compared by the chi-square test between gender and glycemic category. Mean and Standard Deviation of lipids and lipoproteins were compared by the Student t-Test between gender. Hypertriglyceridemia was detected in 66.0% [95% CI: 63.5-68.5] of the population, being more common in men and increasing with deterioration of glucose metabolism. Mean level of triglycerides was 235.7&plusmn;196.3 mg/dL. The prevalence of hypercholesterolemia was 24.4% [95% CI: 22.1- 26.7]. Low HDL-C was observed in 17.5% [95% CI: 14.5-20.5] of men and 43.0% [95% CI: 39.4- 46.6] of women but total / HDL-cholesterol ratio was lower in women (4.23 &plusmn; 0.68 vs. 4.40 &plusmn; 0.73, p<0.001). In Japanese-Brazilians, hypertriglyceridemia is the commonest dyslipidemia, in agreement with the high prevalence of diabetes. Men showed a worse lipid profile than women; it was suggested that the Western diet and living habits could be deteriorating their health.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Phenotypic and immunohistochemical characterization of sarcoglycanopathies

INTRODUCTION: Limb-girdle muscular dystrophy presents with heterogeneous clinical and molecular features. The primary characteristic of this disorder is proximal muscular weakness with variable age of onset, speed of progression, and intensity of symptoms. Sarcoglycanopathies, which are a subgroup of the limb-girdle muscular dystrophies, are caused by mutations in sarcoglycan genes. Mutations in these genes cause secondary deficiencies in other proteins, due to the instability of the dystrophin-glycoprotein complex. Therefore, determining the etiology of a given sarcoglycanopathy requires costly and occasionally inaccessible molecular methods. OBJECTIVE: The aim of this study was to identify phenotypic differences among limb-girdle muscular dystrophy patients who were grouped according to the immunohistochemical phenotypes for the four sarcoglycans. METHODS: To identify phenotypic differences among patients with different types of sarcoglycanopathies, a questionnaire was used and the muscle strength and range of motion of nine joints in 45 patients recruited from the Department of Neurology - HC-FMUSP (Clinics Hospital of the Faculty of Medicine of the University of São Paulo) were evaluated. The findings obtained from these analyses were compared with the results of the immunohistochemical findings. RESULTS: The patients were divided into the following groups based on the immunohistochemical findings: a-sarcoglycanopathies (16 patients), b-sarcoglycanopathies (1 patient), y-sarcoglycanopathies (5 patients), and nonsarcoglycanopathies (23 patients). The muscle strength analysis revealed significant differences for both upper and lower limb muscles, particularly the shoulder and hip muscles, as expected. No pattern of joint contractures was found among the four groups analyzed, even within the same family. However, a high frequency of tiptoe gait was observed in patients with a-sarcoglycanopathies, while calf pseudo-hypertrophy was most common in patients with non-sarcoglycanopathies. The a-sarcoglycanopathy patients presented with more severe muscle weakness than did y-sarcoglycanopathy patients. CONCLUSION: The clinical differences observed in this study, which were associated with the immunohistochemical findings, may help to prioritize the mutational investigation of sarcoglycan genes.CNP

Five-year review of an international clinical research-training program

The exponential increase in clinical research has profoundly changed medical sciences. Evidence that has accumulated in the past three decades from clinical trials has led to the proposal that clinical care should not be based solely on clinical expertise and patient values, and should integrate robust data from systematic research. As a consequence, clinical research has become more complex and methods have become more rigorous, and evidence is usually not easily translated into clinical practice. Therefore, the instruction of clinical research methods for scientists and clinicians must adapt to this new reality. To address this challenge, a global distance-learning clinical research-training program was developed, based on collaborative learning, the pedagogical goal of which was to develop critical thinking skills in clinical research. We describe and analyze the challenges and possible solutions of this course after 5 years of experience (2008-2012) with this program. Through evaluation by students and faculty, we identified and reviewed the following challenges of our program: 1) student engagement and motivation, 2) impact of heterogeneous audience on learning, 3) learning in large groups, 4) enhancing group learning, 5) enhancing social presence, 6) dropouts, 7) quality control, and 8) course management. We discuss these issues and potential alternatives with regard to our research and background

Construção do papel materno a partir da vivência de internação em UTI neonatal em dois modelos assistenciais / The formation of the maternal role from experience of hospitalization in the Neonatal Intensive Care Unit in two models of care

Introdução: O nascimento de um recém-nascido pré-termo que necessita de internação em Unidade de Terapia Intensiva (UTI) Neonatal representa uma crise na família. Os sentimentos maternos são contraditórios, envolvendo medo, culpa e negação. Objetivo: Analisar a construção do papel materno a partir do nascimento de um filho pré-termo internado em UTI Neonatal. Métodos: Estudo qualitativo realizado em quatro maternidades, duas no Rio de Janeiro e duas em São Luís. Em cada estado uma unidade utilizava o cuidado tradicional e a outra o Método Canguru. Foram realizadas 20 entrevistas semi-estruturadas, onze em unidades convencionais e nove em unidades canguru. A amostra foi definida pelo critério de saturação. Foram entrevistadas mães de bebês com internação de um a três meses. Realizada análise de conteúdo na modalidade temática. Resultados: Foram identificadas diferenças nos dois modelos assistenciais. Nos locais que utilizavam o Método Canguru, o contato pele a pele e a participação nos cuidados foram fundamentais para a construção da auto-imagem como mãe, influenciando na expectativa materna em relação ao período pós-alta e na construção de projetos de vida para o bebê. As mães do modelo tradicional tinham falas mais influenciadas pelo medo do bebê adoecer e preocupações como medo de visitas, de morte súbita e de doenças incuráveis. Conclusão: O Método Canguru facilita o desempenho do protagonismo materno, privilegiando a utilização de recursos próprios na compreensão e condução do que se passa com a mãe e com seu filho, levando ao seu empoderamento. Essa nova tecnologia de cuidado é facilitadora da construção do papel materno.Palavras-chave: Cuidados intensivos. Método mãe canguru. Recém-nascido de baixo-peso.AbstractIntroduction: The birth of a preterm baby who needs hospitalization in the Neonatal Intensive Care Unit (NICU) represents a crisis for the family. The maternal feelings are contradictory, involving fear, guilt and denial. Objective: To analyze the maternal role formation after the birth of preterm infants hospitalized in the NICU. Methods: This is a qualitative study conducted in four neonatal intensive care units, two in Rio de Janeiro and two in São Luís. In each State one of the units used the traditional care and the other one the Kangaroo care method. Twenty semi-structured interviews were conducted, being eleven in conventional units and nine in kangaroo units. The number of interviews was defined by the saturation criterion. We interviewed mothers of hospitalized infants of one to three months of age. Data were analyzed by thematic approach. Results: There were differences in the two care models. At those units where the Kangaroo method was used, the skin contact between the mother and child as well as the participation in the care were essential to build their self-image as a mother, influencing the maternal expectations in relation to post-discharge period and to the planning of life projects for the baby. Mothers who experienced the traditional model had reported to be more influenced by fear of infant to be sick and concerns such as fear of visits, sudden death and incurable diseases. Conclusion: Kangaroo care facilitates the performance of maternal protagonism, favoring the use of their own resources in understanding and dealing with problems that are happening with her and her child, leading to their empowerment. This new technology facilitates the formation of the maternal role.Keywords: Neonatal intensive care. Kangaroo mother method. Low birth weight infant

Analysis of the Virulence of an Atypical Enteropathogenic Escherichia coli Strain In Vitro and In Vivo and the Influence of Type Three Secretion System

Atypical enteropathogenic Escherichia coli (aEPEC) inject various effectors into intestinal cells through a type three secretion system (T3SS), causing attaching and effacing (A/E) lesions. We investigated the role of T3SS in the ability of the aEPEC 1711-4 strain to interact with enterocytes in vitro (Caco-2 cells) and in vivo (rabbit ileal loops) and to translocate the rat intestinal mucosa in vivo. A T3SS isogenic mutant strain was constructed, which showed marked reduction in the ability to associate and invade but not to persist inside Caco-2 cells. After rabbit infection, only aEPEC 1711-4 was detected inside enterocytes at 8 and 24 hours pointing to a T3SS-dependent invasive potential in vivo. In contrast to aEPEC 1711-4, the T3SS-deficient strain no longer produced A/E lesions or induced macrophage infiltration. We also demonstrated that the ability of aEPEC 1711-4 to translocate through mesenteric lymph nodes to spleen and liver in a rat model depends on a functional T3SS, since a decreased number of T3SS mutant bacteria were recovered from extraintestinal sites. These findings indicate that the full virulence potential of aEPEC 1711-4 depends on a functional T3SS, which contributes to efficient adhesion/invasion in vitro and in vivo and to bacterial translocation to extraintestinal sites

A construção dos prontuários como expressão da prática dos profissionais de saúde

O artigo aborda a temática da construção dos prontuários a partir de análise documental no sentido de entender as práticas dos profissionais de saúde que integram equipes de pré-natal de adolescentes em dois ambulatórios da rede pública de atenção básica de saúde estadual e municipal. Partindo da definição contemporânea de prontuário, que entende que, para além da missão de ser um instrumento jurídico de registro de propriedade do paciente, ele também atua como mediador da comunicação intraequipe de saúde e da comunicação dessa equipe com o usuário, fazemos um resgate histórico e crítico, baseado na análise de Michel Foucault sobre a origem do registro como tecnologia disciplinar que caracterizou o nascimento da instituição hospitalar e da clínica moderna. Identificamos que o aspecto comunicativo, segundo conceito do 'agir comunicativo' de Jürgen Habermas, vem sendo negligenciado pelas equipes pesquisadas, fruto de uma visão profissional focada no 'sigilo' e no individual em detrimento da construção de saberes coletivos.The focus of the paper is the construction of medical records by health professionals in two public health assistance services for pregnant teenagers. The medical record, beyond its judicial character, must be understood nowadays as a tool for promoting communication between the staff members, as well as between staff and patients, an instrument that mediates communication actions. Based on Michel Foucault's historical approach to registration as part of a disciplinary technology that emerges together with the modern hospital and clinical view, it was identified that health professionals neglect the communicative aspect, according to the concept of 'communicative acting' developed by Jürgen Habermas, of the registration action, and show a conception of clinical procedures based on 'secrecy' rather than a social construction of new knowledge

Os livros brancos da defesa da República Popular da China 1998-2010

Este estudo é uma análise da evolução das perceções de (in)segurança da República Popular da China (RPC), através da aferição quantitativa e qualitativa de expressões idiomáticas caracterizadoras da evolução do sistema internacional, as quais foram selecionadas e associadas a tais perceções, e que constam das sete edições do Livro Branco da Defesa publicadas pelo Conselho de Estado entre 1998 e 2010. Procura-se através de um enquadramento conceptual e metodológico derivado da análise crítica do discurso baseado nas teorias de Michel Foucault e de Norman Fairclough, bem como do da perceção de ameaças por parte dos Estados no sistema internacional formulado por Robert Jervis, identificar e justificar variações nas perceções de (in)segurança da RPC entre 1998 e 2010, concluindo-se que estas refletem uma visão de natureza essencialmente realista estrutural e Lockeana quanto à evolução do sistema internacional

Multiple effects of toxins isolated from Crotalus durissus terrificus on the hepatitis C virus life cycle

Hepatitis C virus (HCV) is one of the main causes of liver disease and transplantation worldwide. Current therapy is expensive, presents additional side effects and viral resistance has been described. Therefore, studies for developing more efficient antivirals against HCV are needed. Compounds isolated from animal venoms have shown antiviral activity against some viruses such as Dengue virus, Yellow fever virus and Measles virus. In this study, we evaluated the effect of the complex crotoxin (CX) and its subunits crotapotin (CP) and phospholipase A2 (PLA2-CB) isolated from the venom of Crotalus durissus terrificus on HCV life cycle. Huh 7.5 cells were infected with HCVcc JFH-1 strain in the presence or absence of these toxins and virus was titrated by focus formation units assay or by qPCR. Toxins were added to the cells at different time points depending on the stage of virus life cycle to be evaluated. The results showed that treatment with PLA2-CB inhibited HCV entry and replication but no effect on HCV release was observed. CX reduced virus entry and release but not replication. By treating cells with CP, an antiviral effect was observed on HCV release, the only stage inhibited by this compound. Our data demonstrated the multiple antiviral effects of toxins from animal venoms on HCV life cycle