Showing papers by "Federal University of São Paulo published in 2005"

The genome sequence of Trypanosoma cruzi, etiologic agent of Chagas disease

Abstract: Whole-genome sequencing of the protozoan pathogen Trypanosoma cruzi revealed that the diploid genome contains a predicted 22,570 proteins encoded by genes, of which 12,570 represent allelic pairs. Over 50% of the genome consists of repeated sequences, such as retrotransposons and genes for large families of surface molecules, which include trans-sialidases, mucins, gp63s, and a large novel family (>1300 copies) of mucin-associated surface protein (MASP) genes. Analyses of the T. cruzi, T. brucei, and Leishmania major (Tritryp) genomes imply differences from other eukaryotes in DNA repair and initiation of replication and reflect their unusual mitochondrial DNA. Although the Tritryp lack several classes of signaling molecules, their kinomes contain a large and diverse set of protein kinases and phosphatases; their size and diversity imply previously unknown interactions and regulatory processes, which may be targets for intervention.

Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group.

Abstract: The Codex Alimentarius Commission of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) develops food standards, guidelines and related texts for protecting consumer health and ensuring fair trade practices globally. The major part of the world's population lives in more than 160 countries that are members of the Codex Alimentarius. The Codex Standard on Infant Formula was adopted in 1981 based on scientific knowledge available in the 1970s and is currently being revised. As part of this process, the Codex Committee on Nutrition and Foods for Special Dietary Uses asked the ESPGHAN Committee on Nutrition to initiate a consultation process with the international scientific community to provide a proposal on nutrient levels in infant formulae, based on scientific analysis and taking into account existing scientific reports on the subject. ESPGHAN accepted the request and, in collaboration with its sister societies in the Federation of International Societies on Pediatric Gastroenterology, Hepatology and Nutrition, invited highly qualified experts in the area of infant nutrition to form an International Expert Group (IEG) to review the issues raised. The group arrived at recommendations on the compositional requirements for a global infant formula standard which are reported here.

A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders.

Abstract: Interpersonal psychotherapy (IPT) is a time–limited psychotherapy for major depression. The aim of this study is to summarize findings from controlled trials of the efficacy of IPT in the treatment of depressive spectrum disorders (DSD) using a meta–analytic approach. Studies of randomized clinical trials of IPT efficacy were located by searching all available data bases from 1974 to 2002. The searches employed the following MeSH categories: Depression/ Depressive Disorder; Interpersonal therapy; Outcome/Adverse Effects/Efficacy; in the identified studies. The efficacy outcomes were: remission; clinical improvement; the difference in depressive symptoms between the two arms of the trial at endpoint, and no recurrence. Drop out rates were used as an index of treatment acceptability. Thirteen studies fulfilled inclusion criteria and four meta–analyses were performed. IPT was superior in efficacy to placebo in nine studies (Weight Mean Difference (WMD) – 3.57 [–5.9, –1.16]). The combination of IPT and medication did not show an adjunctive effect compared to medication alone for acute treatment (RR 0.78 [0.30, 2.04]), for maintenance treatment (RR 1.01 [0.81, 1.25]), or for prophylactic treatment (RR 0.70 [0.30, 1.65]). IPT was significantly better than CBT (WMD –2.16 [–4.16,–0.15]). The efficacy of IPT proved to be superior to placebo, similar to medication and did not increase when combined with medication. Overall, IPT was more efficacious than CBT. Current evidence indicates that IPT is an efficacious psychotherapy for DSD and may be superior to some other manualized psychotherapies.

Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire.

Abstract: The objective of the present study was to translate, adapt and validate a Brazilian Portuguese version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The study was carried out in two steps. The first was to translate the DASH into Portuguese and to perform cultural adaptation and the second involved the determination of the reliability and validity of the DASH for the Brazilian population. For this purpose, 65 rheumatoid arthritis patients of either sex (according to the classification criteria of the American College of Rheumatology), ranging in age from 18 to 60 years and presenting no other diseases involving the upper limbs, were interviewed. The patients were selected consecutively at the rheumatology outpatient clinic of UNIFESP. The following results were obtained: in the first step (translation and cultural adaptation), all patients answered the questions. In the second step, Spearman's correlation coefficients for interobserver evaluation ranged from 0.762 to 0.995, values considered to be highly reliable. In addition, intraclass correlation coefficients ranged from 0.97 to 0.99, also highly reliable values. Spearman's correlation coefficients and the intraclass correlation coefficients obtained during intra-observer evaluation ranged from 0.731 to 0.937 and from 0.90 to 0.96, respectively, being highly reliable values. The Ritchie Index showed a weak correlation with Brazilian DASH scores, while the visual analog scale of pain showed a good correlation with DASH score. We conclude that the Portuguese version of the DASH is a reliable instrument.

Ambiente familiar e desenvolvimento cognitivo infantil: uma abordagem epidemiológica

Abstract: OBJETIVO: Analisar a associacao entre a qualidade do estimulo domestico e o desempenho cognitivo infantil, identificando o impacto da escolaridade materna sobre a qualidade dessa estimulacao. METODOS: Estudo de corte transversal, com 350 criancas entre 17 e 42 meses, examinadas em 1999, em areas centrais e perifericas de Salvador, Estado da Bahia. Utilizou-se um questionario socioeconomico, o inventario Home Observation for Measurement of the Environment Scale (HOME) para mensurar a estimulacao no ambiente familiar, e a escala Bayley de desenvolvimento infantil. Foram realizadas analises univariadas e multiplas, por meio da regressao linear, considerando nivel de significância de 5%. RESULTADOS: Encontrou-se associacao positiva (beta=0,66) e estatisticamente significante entre a qualidade da estimulacao no ambiente domestico e o desempenho cognitivo infantil. Parte do efeito da estimulacao sobre a cognicao foi mediada pela condicao materna de trabalho e seu nivel de escolaridade. Verificou-se que as criancas ocupando as primeiras ordens de nascimento, convivendo com reduzido numero de menores de cinco anos, usufruem de melhor qualidade da estimulacao no ambiente domestico. Esse padrao de estimulacao se mantem entre criancas convivendo com seus pais, cujas maes possuem melhor escolaridade, trabalham fora e convivem com companheiros no ambiente familiar. CONCLUSOES: Confirma-se a importância da qualidade do estimulo domestico para o desenvolvimento cognitivo infantil, alem do relevante papel das condicoes materiais e dinâmica familiar. Os achados apontam a pertinencia de acoes de intervencao que favorecam a qualidade do ambiente e da relacao cuidador-crianca para o desenvolvimento cognitivo.

Factors associated with stress in mothers of children with autism

Abstract: The objective of this case-control study was to investigate the determinants of maternal stress in mothers of children with autism. Mothers of 31 children with autism from mental health clinics were matched by child age/gender and mother age to 31 mothers of children without mental health problems, drawn from public schools and a primary care unit. Logistic regression models showed that the presence of stress in mothers was primarily associated with having a child with autism. However, poor expression of affect, little interest in people, being an older mother, and having a younger child also contributed to increased stress levels. Although having a child with autism was the main factor responsible for stress, the presence of the other factors further increased maternal stress. The implication is that a subgroup of mothers of children with autism is more prone to experience stress, thus requiring special attention from mental health professionals.

Autophagy induction favours the generation and maturation of the Coxiella‐replicative vacuoles

Abstract: Pathogens evolved mechanisms to invade host cells and to multiply in the cytosol or in compositionally and functionally customized membrane-bound compartments. Coxiella burnetii, the agent of Q fever in man is a Gram-negative gamma-proteobacterium which multiplies in large, acidified, hydrolase-rich and fusogenic vacuoles with phagolysosomal-like characteristics. We reported previously that C. burnetii phase II replicative compartments are labelled by LC3, a protein specifically localized to autophagic vesicles. We show here that autophagy in Chinese hamster ovary cells, induced by amino acid deprivation prior to infection with Coxiella increased the number of infected cells, the size of the vacuoles, and their bacterial load. Furthermore, overexpression of GFP-LC3 or of GFP-Rab24 - a protein also localized to autophagic vacuoles - likewise accelerated the development of Coxiella-vacuoles at early times after infection. However, overexpression of mutants of those proteins that cannot be targeted to autophagosomes dramatically decreased the number and size of the vacuoles in the first hours of infection, although by 48 h the infection was similar to that of non-transfected controls. Overall, the results suggest that transit through the autophagic pathway increases the infection with Coxiella by providing a niche more favourable to their initial survival and multiplication.

Endocrinological and catecholaminergic alterations during sleep deprivation and recovery in male rats.

Abstract: Since previous data of our group showed increased concentrations in HPA axis hormones in sleep deprived rats, we hypothesized that this augmentation could produce effects in other hormonal systems, particularly in the sexual system. Considering that little is known about how the hormonal system changes during the recovery period after sleep deprivation (SD), our objective was to examine from what point SD alters sexual and stress-related hormones along with plasma catecholamine concentrations during 4 days. We also sought to verify the time course of their recovery after an equivalent period of recovery sleep. Rats were deprived of sleep by the platform technique for 1-4 days and were allowed to recover for the same period. Plasma catecholamines [dopamine (DA) and noradrenaline (NOR)], testosterone, estrone, progesterone, prolactin, corticosterone and adrenocorticotropic hormone (ACTH) concentrations were measured. Comparisons between groups showed that the SD procedure used in the present study produced marked alterations in almost all studied hormones from 24 h of SD, except for estrone and prolactin (which required 96 h of SD to become altered). Testosterone and estrone decreased, whereas progesterone, prolactin, corticosterone, ACTH, DA and NOR increased. During recovery period, progesterone, prolactin and corticosterone concentrations returned to control levels, whereas testosterone, estrone, NOR and DA did not. In addition, after 48 h of recovery ACTH and NOR decreased below control concentrations, remaining low until 96 h of sleep recovery. Thus, SD showed long lasting, differential effects upon these neurochemicals suggesting that each has its own pattern of responses to SD as well as variable periods of recovery.

Treatment with Benznidazole during the Chronic Phase of Experimental Chagas' Disease Decreases Cardiac Alterations

Abstract: Chagas' disease, caused by Trypanosoma cruzi infection, is one of the main causes of death due to heart failure in Latin American countries. Benznidazole, the chemotherapeutic agent most often used for the treatment of chagasic patients, is highly toxic and has limited efficacy, especially in the chronic phase of the disease. In the present study we used a mouse model of chronic Chagas' disease to investigate the effects of benznidazole treatment during the chronic phase on disease progression. The hearts of benznidazole-treated mice had decreased parasitism and myocarditis compared to the hearts of untreated chagasic mice. Both groups of Trypanosoma cruzi-infected mice had significant alterations in their electrocardiograms compared to those of the healthy mice. However, untreated mice had significantly higher cardiac conduction disturbances than benznidazole-treated mice, including intraventricular conduction disturbances, atrioventricular blocks, and extrasystoles. The levels of antibodies against T. cruzi antigens (epimastigote extract, P2beta, and trans-sialidase) as well as antibodies against peptides of the second extracellular loops of beta1-adrenergic and M2-muscarinic cardiac receptors were also lower in the sera from benznidazole-treated mice than in the sera from untreated mice. These results demonstrate that treatment with benznidazole in the chronic phase of infection prevents the development of severe chronic cardiomyopathy, despite the lack of complete parasite eradication. In addition, our data highlight the role of parasite persistence in the development of chronic Chagas' disease and reinforce the importance of T. cruzi elimination in order to decrease or prevent the development of severe chagasic cardiomyopathy.

The role of dopamine in reward and pleasure behaviour--review of data from preclinical research.

Abstract: Objective: The purpose of this article is to review some of the basic aspects of the dopaminergic system and its role in reward and pleasure behaviour. We also discuss the association between dopamine and unpleasant symptoms that are commonly found in neuropsychiatric disorders and may also be side-effects of neuroleptic drugs. Method: A computer-based search of the literature, augmented by extensive bibliography-guided article reviews, were used to find basic information on the dopamine and the reward systems, and symptoms such as dysphoria, anhedonia and depression. Results: Central dopaminergic neurotransmission is complex, having multiple actions at each level of the mesocorticolimbic reward pathway. The role of dopamine in the reward process was classically associated with the ability to experience pleasure; recent data suggest a more motivational role. Dysfunction of the dopamine transmission in the reward circuit is associated with symptoms such as anhedonia, apathy and dysphoria found in several neuropsychiatric disorders, including Parkinson's disease, depression, drug addiction, and neuroleptic-induced dysphoria. Conclusion: Viewing the dysfunctions of the reward pathways within a broader spectrum and exploring its complex relations with the dopaminergic transmission may help understand the pathophysiology of these neuropsychiatric disorders and lead to a rational development of novel treatments.

Association of the length polymorphism in the human Per3 gene with the delayed sleep-phase syndrome: does latitude have an influence upon it?

Abstract: Study objectives The objective of this study is to analyze the influence of a previously reported hPer3 gene-length polymorphism in the delayed sleep-phase syndrome and in morningness-eveningness tendencies at low latitudes in the southern hemisphere. Design We have genotyped a length polymorphism in the hPer3 gene characterized by a short repeat allele (4-repeat) and a long repeat allele (5-repeat). Participants Seventeen patients with delayed sleep-phase syndrome; 156 volunteers chosen according to Horne-Ostberg questionnaire to have morning, intermediate, or evening preference; and 110 volunteers with no Horne-Ostberg score as a sample of the general population. Results We have found a higher frequency of 5-repeat allele in the delayed sleep-phase syndrome group and an association of this polymorphism with diurnal preference. Conclusion Our results suggest that latitude has a role in the influence of hPer3 gene polymorphism on delayed sleep-phase syndrome and confirm previous data showing its association with morningness-eveningness tendencies.

MR Cerebral Blood Volume Maps Correlated with Vascular Endothelial Growth Factor Expression and Tumor Grade in Nonenhancing Gliomas

Abstract: BACKGROUND AND PURPOSE: Relative cerebral blood volume (rCBV) measurements derived from perfusion-weighted imaging (PWI) may be useful to evaluate angiogenesis and preoperatively estimate the grade of a glioma. We hypothesized that rCBV is correlated with vascular endothelial growth factor (VEGF) expression as marker of the angiogenic stimulus in presumed supratentorial low-grade gliomas (LGGs). METHODS: From February 2001 to February 2004, we examined 20 adults (16 men, four women; mean age 36 years; range, 23–60 years) with suspected (nonenhancing) supratentorial LGG on conventional MR imaging. Preoperative MR imaging used a dynamic first-pass gadolinium-enhanced, spin-echo echo-planar PWI. In heterogeneous tumors, we performed stereotactic biopsy in the high-perfusion areas before surgical resection. Semiquantitative grading of VEGF immunoreactivity was applied. RESULTS: Nine patients had diffuse astrocytomas (World Health Organization grade II), and 11 had other LGG and anaplastic gliomas. In patients with heterogeneous tumors on PWI, the high-rCBV focus had areas of oligodendroglioma or anaplastic astrocytoma on stereotactic biopsy, whereas the surgical specimens were predominantly astrocytomas. Anaplastic gliomas had high rCBV ratios and positive VEGF immunoreactivity. Diffuse astrocytomas had negative VEGF expression and mean rCBV values significantly lower than those of the other two groups. Three diffuse astrocytomas had positive VEGF immunoreactivity and high rCBV values. CONCLUSION: Our results confirmed the correlation among rCBV measurements, VEGF expression, and histopathologic grade in nonenhancing gliomas. PWI may add useful data to the preoperative assessment of nonenhancing gliomas. Its contribution in predicting tumor behavior and patient prognosis remains to be determined.

Prevalência de sobrepeso e obesidade em crianças e adolescentes de diferentes condições socioeconômicas

Abstract: OBJECTIVES: to compare overweight and obesity in preschool children, school children and adolescents belonging to different socioeconomic conditions. METHODS: cross-sectional and based on a 1616 children and adolescents sample. Nutritional indicators were defined according to the National Center of Health Statistics 2000 recommendations, overweight being BMI equal to or above 85 percentile and below percentile 95; obesity indicator being defined with BMI equal to or above the 95 percentile. RESULTS: overweight was detected in 234 (14.5%) individuals and obesity in 134 (8.3%). Overweight prevalence was higher among preschool children (22.2%), though prevalence reduction was noted in younger school children (12.9%) and adolescents (10.8%). A similar pattern was found for obesity in 13.8% of preschool children, 8.2% of school children, and 4.9% of adolescents. Overweight and obesity were mostly observed among children and adolescents of high income families. CONCLUSIONS: as age increases overweight and obesity diminish. Similar overweight prevalence was detected among preschool children irrespective of socioeconomic conditions. Overweight prevalence was highest among school children with high socioeconomic conditions and adolescents with low socioeconomic conditions.

Validade da versão em português da Clinical Dementia Rating

Abstract: OBJETIVO: Analisar a validade da versao em portugues da Clinical Dementia Rating para classificar a funcao cognitiva de idosos. METODOS: Utilizou-se o instrumento Mini-Mental State Examination para rastreamento de deficit cognitivo em coorte composta por 424 idosos. Foram selecionados todos que obtiveram escores 26. Os 156 idosos selecionados foram submetidos a uma avaliacao clinica e testes neuropsicologicos para diagnostico de casos de demencia. Tanto os casos como os nao-casos foram classificados segundo a versao em portugues da Clinical Dementia Rating em: normais, casos questionaveis e casos de demencia leve, moderada ou grave. RESULTADOS: Entre os 156 avaliados, 122 eram nao-casos, destes 62 (51%) foram classificados como normais (CDR=0) e questionaveis 60 (49%) (CDR=0,5). Entre os 34 casos de demencia, 17 (50%) foram classificados como demencia leve (CDR=1), 8 (23%) moderada (CDR=2) e 6 (18%) grave (CDR=3). Apenas tres (9%) dos casos foram considerados questionaveis pelo Clinical Dementia Rating. Sua sensibilidade foi de 91,2% e a especificidade de 100%, com valor preditivo positivo de 100% e negativo de 97,6%. As pontuacoes no Mini-Mental State Examination declinaram significativamente conforme o grau de demencia. CONCLUSOES: O Clinical Dementia Rating mostrou ser instrumento valido para classificar o grau de demencia entre idosos. Quase metade dos nao-casos foram casos questionaveis pelo Clinical Dementia Rating e podem corresponder a casos de transtorno cognitivo leve, com maior risco de conversao em demencia.

Desenhos de pesquisa

Abstract: O presente estudo de revisao visa uniformizar a nomenclatura e os conceitos classificatorios existentes na literatura, relativos aos desenhos ou modelos de estudo cientifico mais comumente utilizados em pesquisas na area clinico-cirurgica geral. Procurou-se facilitar a elaboracao do delineamento de um projeto de pesquisa cientifica, visando sua aplicabilidade. Esta revisao tambem tem o intuito de auxiliar o cirurgiao-pesquisador a identificar qual foi o delineamento proposto em um artigo, assim como desenvolver um senso de critica metodologica mais apurada sobre o mesmo, alem de desmistificar a miscelânea conceitual existente na literatura.

Partial characterization and anticoagulant activity of a heterofucan from the brown seaweed Padina gymnospora.

Abstract: The brown algae Padina gymnospora contain different fucans. Powdered algae were submitted to proteolysis with the proteolytic enzyme maxataze. The first extract of the algae was constituted of polysaccharides contaminated with lipids, phenols, etc. Fractionation of the fucans with increasing concentrations of acetone produced fractions with different proportions of fucose, xylose, uronic acid, galactose, and sulfate. One of the fractions, precipitated with 50% acetone (v/v), contained an 18-kDa heterofucan (PF1), which was further purified by gel-permeation chromatography on Sephadex G-75 using 0.2 M acetic acid as eluent and characterized by agarose gel electrophoresis in 0.05 M 1,3 diaminopropane/acetate buffer at pH 9.0, methylation and nuclear magnetic resonance spectroscopy. Structural analysis indicates that this fucan has a central core consisting mainly of 3-beta-D-glucuronic acid 1-> or 4-beta-D-glucuronic acid 1 ->, substituted at C-2 with alpha-L-fucose or beta-D-xylose. Sulfate groups were only detected at C-3 of 4-alpha-L-fucose 1-> units. The anticoagulant activity of the PF1 (only 2.5-fold lesser than low molecular weight heparin) estimated by activated partial thromboplastin time was completely abolished upon desulfation by solvolysis in dimethyl sulfoxide, indicating that 3-O-sulfation at C-3 of 4-alpha-L-fucose 1-> units is responsible for the anticoagulant activity of the polymer.

The ergosterol biosynthesis pathway, transporter genes, and azole resistance in Aspergillus fumigatus

Abstract: The continuous use of triazoles can result in the development of drug resistance. Azole-resistant clinical isolates, spontaneous and induced mutants of Aspergillus fumigatus have been documented. The azoles block the ergosterol biosynthesis pathway by inhibiting the enzyme 14-α-demethylase, product of the CYP51. Fungal azole resistance involves both amino acid changes in the target site that alter drug-target interactions and those that decrease net azole accumulation. The reduced intracellular accumulation has also been correlated with overexpression of multidrug resistance (MDR) efflux transporter genes of the ATP-binding cassette (ABC) and the major facilitator superfamily (MFS) classes. About 20 genes are involved in the A. fumigatus ergosterol biosynthesis pathway. There are several duplicated genes in this pathway. Interestingly, erg3 and erg11 showed two copies in A. fumigatus. In general, Aspergillus spp. have proportionally more MFS transporter encoding genes than Saccharomyces cerevisiae, S. pom...

Pre-operative mechanical bowel cleansing or not? an updated meta-analysis.

Abstract: Objectives Pre-operative mechanical bowel preparation has been considered an efficient regimen against leakage and infectious complications, after colorectal resections. This dogma is based only on observational data and experts' opinions. The aim of this study was to evaluate the efficacy and safety of prophylactic pre-operative mechanical bowel preparation before elective colorectal surgery. Methods EMBASE, LILACS, MEDLINE and The Cochrane Library and abstracts from major gastroenterological congresses were searched. No language restrictions were applied. The selection criterion used was randomised clinical trials (RCT) comparing any kind of mechanical bowel preparation with no preparation in patients submitted to elective colorectal surgery and where anastomotic leakage, mortality, and wound infection were outcome measurements. Data were independently extracted by the reviewers and cross-checked. The methodological quality of each trial was assessed by the same reviewers. For meta-analysis the Peto-Odds ratio was used. Results Of 1592 patients (9 RCTs), 789 were allocated to mechanical bowel preparation (Group A) and 803 to no preparation (Group B) before elective colorectal surgery. Anastomotic leakage developed in 48 (6%) of 772 patients in A compared with 25 (3.2%) of 777 patients in B; Peto OR 2.03, 95% (CI: 1.28–3.26; P = 0.003). Wound infection occurred in 59 (7.4%) of 791 patients in A and in 43 (5.4%) of 803 patients in B; Peto OR 1.46, 95% (CI: 0.97–2.18; P = 0.07); Five (1%) of 509 patients died in group in A compared with 3 (0.61%) of 516 patients in group B; Peto OR 1.72, 95% (CI: 0.43–6.95; nonsignificant). Conclusion There is no evidence that patients benefit from mechanical bowel preparation. On the contrary taking colorectal surgery as a whole, pre-operative bowel cleansing leads to a higher rate of anastomotic leakage. The dogma that mechanical bowel preparation is necessary before elective colorectal surgery has to be reconsidered.

Evaluation of pulmonary function and quality of life in women with osteoporosis

Abstract: Osteoporotic vertebral fractures generally result in an increased kyphotic angle, which in turn may lead to disturbances in pulmonary function. The objective of the present study was to evaluate pulmonary function and quality of life in a group of osteoporotic patients. Fifteen women with osteoporosis and thoracic vertebral fractures (group 1), 20 women with osteoporosis without vertebral fracture (group 2) and 20 control women (group 3) were submitted to spirometry using a Vitatrace-130 SL spirometer and to an SF-36 quality of life questionnaire. Women with osteoporosis and vertebral fractures showed an increased kyphotic angle (median=60°) and decreased forced vital capacity (group 1 vs. group 2, P =0.020; group 1 vs. group 3, P =0.039) and forced expiratory volume in 1 s (group 1 vs. group 2, P =0.008; group 1 vs. group 3, P =0.014) when compared with women without vertebral fractures or osteoporosis. A negative correlation was observed between thoracic kyphosis and the predicted value of expiratory forced volume in 1 s ( r =−0.713, P =0.003). No differences in the quality of life were detected between the three groups studied. We conclude that women with thoracic vertebral fractures have an increased kyphotic angle and present a decrease in lung volume.

Perinatal outcomes and the use of oral hypoglycemic agents.

Abstract: Objective To compare neonatal results from patients with gestational diabetes mellitus (GDM) who were treated with insulin, glyburide and acarbose. Results Seventy patients diagnosed with GDM who needed therapy to complement diet and physical activities were included in the study. One group was assigned to insulin therapy (n = 27), a second group was assigned to glyburide therapy (n = 24) and a third group was assigned to acarbose therapy (n = 19). Maternal characteristics were similar in the three groups. Glucose control was not achieved in five (20.8%) of the patients using glyburide and in eight (42.1%) of patients using acarbose. No statistical difference was observed in fasting and post-prandial glucose levels or in average newborn weight in the three groups. The rate of large for gestational age (LGA) fetuses was 3.7, 25 and 10.5% in the groups treated with insulin, glyburide and acarbose, respectively. Neonatal hypoglycemia was observed in eight newborns, six of which from the glyburide group. Conclusion We believe that glyburide and acarbose can be promising alternative therapies for the treatment of GDM. Glyburide controlled glucose levels in most patients and it was more efficient than acarbose. Glyburide showed a higher rate of macrosomia and neonatal hypoglycemia as compared to other therapies.

La situación social del anciano en Brasil: una breve consideración

Abstract: El envejecimiento es un asunto explorado por investigadores, epidemiologos y estadisticos por medio de investigaciones cientificas encontradas en la literatura nacional e internacional, que revelan la proyeccion notoria de esta poblacion de ancianos. En el panorama mundial, asi como en los paises en desarrollo, la poblacion anciana aumenta significativamente y el contrapunto de esta realidad senala que el soporte para esa nueva condicion no ha evolucionado con la misma velocidad. Frente a esto, la preocupacion por ese nuevo perfil poblacional viene generando, en los ultimos anos, innumerables discusiones y la realizacion de diversos estudios con el objetivo de ofrecer datos que subsidien el desarrollo de politicas y programas adecuados para esa parcela de la poblacion. Esto se debe al hecho de que la referida poblacion requiere cuidados especificos y orientados a las peculiaridades advenidas con el proceso del envejecimiento sin segregarlos de la sociedad. Siendo asi, en este articulo se tuvo como objetivo discutir sobre la situacion social del anciano en Brasil, considerando los aspectos demograficos, epidemiologicos y los aspectos psicosociales con destaque de la jubilacion, la importancia de la familia y las relaciones interpersonales.

Risco, proteção e resiliência no desenvolvimento da criança e do adolescente

Abstract: Risk, protection and resilience are current issues in mental development researches. Risk factor concept is already well Risk, protection and resilience are current issues in mental development researches. Risk factor concept is already well delimited, but protection factors and resilience are still mixed. Risk factors are related to environmental variables that increase the probability of bad consequences in development. On the other hand, the protection factors are associated to individual resources that decrease the risk effects, while resilience is usually related to individual protection factors that predict positive consequences in individuals exposed to an environment of risk. This paper shows how some studies describe those issues (risk, protection and resilience), pointing factors that can make an individual more or less vulnerable to risk, and also, the way some can be resilient when facing the adversities. That is, how some children and adolescents can overcome all the risk factors they have been exposed to and still develop as expected.