Qualidade de vida de indivíduos com diabetes mellitus e hipertensão acompanhados por uma equipe de saúde da família

Objetivou-se descrever o perfil epidemiológico e avaliar a qualidade de vida dos indivíduos com Diabetes mellitus e hipertensão arterial associados, acompanhados por uma equipe de Saúde da Família. Trata-se de um estudo observacional do tipo inquérito transversal. Os dados foram coletados no 1º semestre de 2006, através da ficha do HIPERDIA e por entrevistas utilizando-se o WHOQOL-bref. Para análise dos dados utilizou-se estatística descritiva e sintaxe do WHOQOL-bref no SPSS. Foram entrevistados 30 indivíduos, sendo 75% do tipo 2 e 25% do tipo 1. A média de idade foi de 56 anos, sendo a maioria com 1° grau incompleto (56,7%) e analfabetos (33,3%). Dentre eles, 80,6% faziam uso de medicamentos; 19,4% tinham hábito de fumar, 27,8% não praticavam exercícios físicos e 47,2% eram obesos. Os participantes apresentaram uma avaliação positiva para a qualidade de vida geral e para os domínios: relações sociais, físico, psicológico e meio ambiente, diferentemente do esperado.

Competences and Barriers for the Evidence-Based Practice in Nursing: an integrative review

ABSTRACT Objective: To analyze knowledge, attitudes, practices, and frequent barriers to the implementation of the Evidence-Based Practice among nursing assistants in the hospital. Method: This is an integrative review, whose search for primary studies occurred in the PubMed, CINAHL and LILACS databases. For the analysis, cross-sectional observational studies were included in English, Portuguese and Spanish, published in nursing journals, from January 2007 to July 2016. Results: The search resulted in 363 articles, including nine primary studies. The sources of recurrent evidence among care nurses were: personal experience and local care protocols. These professionals presented weaknesses in the implementation of the Evidence-Based Practice related to the lack of knowledge for evidence evaluation, work overload and resistance to change of practice. Final considerations Nurses presented favorable attitudes, however, with little knowledge to perform the Evidence-Based Practice. Results can support interventions for its implementation in the hospital.

Incapacidade funcional entre idosos residentes em um município do interior de Minas Gerais

Essa pesquisa objetivou identificar as cinco maiores prevalências dentre as atividades da vida diária que levaram às incapacidades funcionais entre idosos residentes na zona urbana de um município no interior de Minas Gerais e comparar essas atividades entre os sexos e por faixa etária. Participaram 2.924 idosos, entrevistados no domicílio, selecionados através da técnica de amostragem estratificada proporcional com seleção sistemática, considerando os bairros como estratos. Os dados foram digitados, em dupla entrada, no EpiInfo 3.2. Considerou-se análise descritiva seguida de testes chi2 e exato de Fisher (p<0,05). As maiores prevalências foram: cortar unhas dos pés (18,93%); fazer compras diversas (9,4%), subir e descer escadas (4,77%); medicar-se na hora (4,12%) e andar perto de casa (3,82%). Há maior proporção de mulheres com incapacidade funcional quando comparada aos homens. Ao verificar as faixas etárias, no sexo masculino e feminino há maior proporção de incapacidades entre os idosos com 80 anos e mais.

Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

OBJECTIVE:

to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.

METHOD:

cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.

RESULTS:

The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001).

CONCLUSION:

the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.

Tonsillar hyperplasia and recurrent tonsillitis: clinical-histological correlation

Hypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects.

Objective

Search for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis.

Method

A prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils).

Results

The patients' ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (≥ 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (≤ 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I.

Conclusion

This study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups.

Pain intensity among institutionalized elderly: a comparison between numerical scales and verbal descriptors

AbstractOBJECTIVECorrelating two unidimensional scales for measurement of self-reported pain intensity for elderly and identifying a preference for one of the scales.METHODA study conducted with 101 elderly people living in Nursing Home who reported any pain and reached ( 13 the scores on the Mini-Mental State Examination. A Numeric Rating Scale - (NRS) of 11 points and a Verbal Descriptor Scale (VDS) of five points were compared in three evaluations: overall, at rest and during movement.RESULTSWomen were more representative (61.4%) and the average age was 77.0±9.1 years. NRS was completed by 94.8% of the elderly while VDS by 100%. The association between the mean scores of NRS with the categories of VDS was significant, indicating convergent validity and a similar metric between the scales.CONCLUSIONPain measurements among institutionalized elderly can be made by NRS and VDS; however, the preferred scale for the elderly was the VDS, regardless of gender.

Impaired pubertal development and testicular hormone function in males with sickle cell anemia

Changes in weight/height ratio, delayed sexual maturation, hypogonadism and impaired fertility have been demonstrated in sickle cell disease (SCD). This study aimed to evaluate the clinical and laboratory views of the Leydig cells function after stimulation with hCG in adults with sickle cell disease. We studied 15 patients with SCD (18 to 40 years; median=27 years old), fourteen homozygous S, and one with SC disease. The control group, composed by adult males, was divided into two groups: I - 10 relatives (18-39 years, median=26 years) with the same socioeconomic level of the patients, and II - 9 normal individuals (23-28, median=31 years) randomly chosen. Clinically it was observed a slight degree of malnutrition, important puberty delay, rarefaction of chest, underarm and pubic hair, and important reduction of the testis and penis size, featuring a mild hypogonadism in patients with SCD. The hormonal level assessment of testosterone at baseline and at 24, 48 and 72 h after hCG stimulation showed no significant differences between the groups studied. We can presume that adult men with SCD showed clinical hypoandrogenism with normal testicular hormonal function, a fact inconsistent with the hypothesis of primary hypogonadism.

Características epidemiológicas de casos de câncer de boca registrados em hospital de Uberaba no período 1999-2003: um alerta para a necessidade de diagnóstico precoce

Foi realizado estudo de 101 casos de carcinoma epidermóide de boca registrados em Hospital de Uberaba, no período de 1999 a 2003. Informações sobre sexo, idade, cor de pele, nível instrucional, tabagismo, etilismo, uso de prótese, localização da lesão, estado da doença ao final do seguimento, estádio clínico e origem do encaminhamento foram obtidos dos prontuários e analisados estatisticamente pelos testes de correlação linear, Qui-quadrado, t-Student e Kaplan-Meier. A relação homem/mulher foi de 3,8:1. A faixa etária prevalente foi de 50 a 60 anos, com a idade média de 58,55 anos para o sexo masculino e 54,66 anos para o sexo feminino; 88,12% eram caucasianos. A língua foi a localização anatômica mais freqüente; 74,48% estavam nos estádios III e IV. A sobrevida em 5 anos foi de 38,71%. Os baixos índices de sobrevivência e o grande percentual de estádios III e IV refletem a necessidade de uma maior atenção ao câncer bucal nessa população.

Clinical and epidemiological profile of alloimmunized and autoimmunized multi-transfused patients against red blood cell antigens in a blood center of Minas Gerais

Background

The large diversity of red blood cell antigens favors, especially in multi-transfused patients, the occurrence of autoimmunization and alloimmunization with the risk of hemolytic transfusion reactions. Thus, this study aimed to determine the rates of alloimmunization and autoimmunization in these individuals, as well as the types of alloantibodies and their systems, clinical and epidemiological aspects and the frequency of autoimmunity in alloimmunized and non-alloimmunized patients.

Methods

In a retrospective study, 153 multi-transfused patients from 2006 to 2014 were evaluated. Sixty-eight had onco-hematological diseases, 64 had hemoglobinopathies and 21 had chronic renal failure. Descriptive analyses were carried out with the proportions being compared using the chi-square test, with the significance level set at 5%.

Results

The Rh system was the most frequently involved (53.11%) and anti-E and anti-K (Kell system) were the most prevalent alloantibodies (21.87% each). Autoantibodies were found in ten patients (6.54%) with the percentages of autoimmunization in alloimmunized and non-alloimmunized individuals being 29.16% and 2.32%, respectively (p = 0.0001). There was a significant difference between autoimmunization and the number of transfusions (16.21% in 6–10 vs. 5.26% <6 vs. 2.56% >10; p = 0.0203) and diseases (19.04% in chronic renal failure vs. 6.25% in hemoglobinopathies vs. 2.94% in onco-hematological diseases; p = 0.0329).

Conclusion

The results show a strong correlation between alloimmunization and autoimmunization. Moreover, they reinforce the need for further studies on the clinical and epidemiological profile of multi-transfused patients in relation to alloimmunity and autoimmunity, especially the latter, for a better understanding of its etiopathogenesis and physiopathogenesis.

Functional and histopathological study of the pancreas in hamsters (Mesocricetus auratus) infected and reinfected with Trypanosoma cruzi

Histopathological and functional changes in the pancreas were studied in 94 hamsters infected and reinfected with Trypanosoma cruzi VIC strain and in 73 non-infected normal controls. Infection in each animal was verified by microhematocrit, hemoculture, specific peroxidase anti-peroxidase, polymerase chain reaction and seroagglutination. Blood glucose and insulin were determined. The number of islets per section and the number of islet cells marked with antibodies were counted. Insulitis, neuritis, fibrosis, atrophy and inflammatory infiltrates were evaluated. Experimental chagasic infection caused pancreatitis similar to human Chagas' disease, involving acini, islets and nerves, with atrophy and fibrosis, although without correlation to the number of reinfections. Erratic blood glucose levels and a tendency to hypoinsulinemia were observed in infected animals. During the acute phase, the number of somatostatin and pancreatic polipeptide producer islet cells was lower in infected hamsters, which was eventually related to changes in blood sugar levels and hypoinsulinemia. Our findings favor the hypothesis of the existence of an endocrine form of chronic chagasic infection.

Declínio da prevalência do HTLV-1/2 em doadores de sangue do Hemocentro Regional da Cidade de Uberaba, Estado de Minas Gerais, 1995 a 2008

INTRODUCÃO: Estudo retrospectivo com o objetivo de avaliar a prevalência e fatores associados à soropositividade para o HTLV-1/2, no período de 1995 a 2008, no Hemocentro Regional de Uberaba e descrever os doadores soropositivos quanto ao gênero, idade, estado civil, cor de pele e procedência. MÉTODOS: Foram realizados análise estatística descritiva, testes qui-quadrado e odds ratio para comparação de proporções e gráfico de dispersão com coeficiente de correlação linear. RESULTADOS: Dentre x doadores testados, foi encontrada a prevalência de sorologia positiva para o HTLV de 0,02% e indeterminada de 0,09%. Houve uma redução significativa da sorologia positiva para HTLV, no período de 2002 a 2008, em comparação ao período de 1995 a 2001. Dentre os soropositivos, observou predomínio significante no gênero feminino. CONCLUSÕES: Imputamos a queda gradativa de soropositividade no período à exclusão permanente dos doadores de repetição soropositivos e ao aprimoramento dos métodos de triagem clínica e dos testes sorológicos ao longo dos anos com reflexos positivos na segurança transfusional.

Sintomas depressivos em adolescentes de um colégio particular

Este trabalho objetivou avaliar o índice de sintomas depressivos, bem como sua distribuição por gênero e série, dos alunos de um colégio particular, da cidade de Uberaba-MG, no final do segundo e do terceiro ano do Ensino Médio e no 'cursinho pré-vestibular', próximo ao concurso vestibular. Foram avaliados 791 estudantes, utilizando o questionário SRQ-20 - Self Reporting Questionnaire, um instrumento desenvolvido pela Organização Mundial da Saúde com 20 questões, que serve para rastrear e avaliar a ocorrência de transtornos mentais comuns, dentre eles a depressão, na população geral. Foram encontradas duas vezes mais sintomatologia depressiva no sexo feminino e um aumento do indicativo de depressão de acordo com o progresso acadêmico dos sujeitos. Conclui-se que existe a presença de sintomas depressivos em 45,7% da amostra, com maior prevalência de casos no sexo feminino. Foi sugerido acompanhamento psicológico aos alunos.

Male sickle cell patients, compensated transpubertal hypogonadism and normal final growth

OBJECTIVE

Investigate the gonadal hormonal function in sickle cell individuals.

CONTEXT

Sickle cell disease (SCD) is associated with delayed physical and sexual development, and it has been related to both primary testicular failure and hypothalamo-pituitary-gonadal axis abnormalities.

DESIGN

The study of the pituitary gonadotrophin reserve was done evaluating the hormonal levels before and after stimulation by gonadoliberin.

PATIENTS

Male patients with homozygous SCD (18-39 years, median = 29.5 years).

MEASUREMENTS

Gonadal function was evaluated through clinical parameters and the hormonal quantification.

RESULTS

Although low body weight and other clinical signs of undernutrition such as clinical hypoandrogenism and the extreme retardation of puberty were seen in these patients, final stature and hormonal testicular reserve to hCG stimulation were proved to be normal according to our previous data. In the present investigation, the basal luteotropic gonadotropin (LH), follicle-stimulating hormone (FSH) and testosterone (T) levels were similar between the patients and controls. Prostate-specific antigen (PSA) levels-used as a biochemical marker of androgenicity, mainly in puberty-were lower in the patients than in the controls and were only correlated with T. A subtle abnormality in the pituitary responsivity to gonadotropin-releasing hormone (GnRH) was disclosed, with a higher response to LH 60 minutes after stimulation in patients than in controls.

CONCLUSIONS

These data, in addition to both the clinical and biochemical signs of hypoandrogenism associated with normal to elevated T levels strongly suggest a peripheral origin of hypogonadism, which is probably due to androgen resistance in the patients with SCD.

Pancreatic hepatocytes in hamsters (Mesocricetus auratus) infected with Trypanosoma cruzi

Hepatocytic metaplasia may be induced in hamsters by carcinogens, and associated with aging, diabetes or chronic pancreatitis. By means of histopathologic and immunohistochemic studies, we observed pancreatic hepatocytes in hamsters infected and reinfected with Trypanosoma cruzi. The change was seen in 18 (19%) out of 94 infected animals, and was not found among 53 controls, Normal islet cells were immunoreactive for neuron-specific enolase and not reactive for NCL-HAS. Metaplastic cells were immunoreactive for NCL-HAS and not reactive for islet hormones and enolase. No relationship was observed between number of inoculations and metaplasia; however, the intensity of the inflammatory process and sequels seems to favor the development of metaplastic cells. Hamsters infected with T. cruzi may be useful to study hepatocytic metaplasia, and contribute to clarify aspects of Chagas' disease and pancreatic changes. Our data indicate that aging, in addition to inflammation and atrophy, plays a role in this change.

Avaliação da presença de Staphylococcus aureus nos leitos do Centro de Terapia Intensiva do Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, em relação à posição no colchão antes e após a limpeza

Através de meios de cultura, foi pesquisada a posição de colônias de Staphylococcus aureus em colchões, visando avaliar a eficácia do procedimento de limpeza e desinfecção dos leitos do Hospital Escola da Faculdade de Medicina do Triângulo Mineiro (Uberaba). Foram analisadas amostras de 50 colchões no período de 22 de outubro de 2000 a 16 de janeiro de 2001. As amostras foram coletadas e semeadas, pela técnica de esgotamento, em dois meios de cultivo (ágar sangue e manitol) com posterior realização de provas de catalase e coagulase . Na análise estatística, foram utilizados os testes não paramétricos Mann-Whitney, Kruswkal- Wallis e Wilcoxon Matched Pairs Test com nível de significância p < 0,05. Foram utilizadas 600 placas de meio de cultivo. Houve crescimento em 94 (15,6%), sendo 82 (87,2%) antes e 12 (12,8%) após a limpeza e desinfecção. Em relação à posição no leito, as amostras semeadas no meio de cultivo com manitol mostraram que não houve redução significativa na posição inferior do leito (p>0,05). Os resultados apontam e alertam para falhas no procedimento de limpeza e desinfecção dos leitos hospitalares por nós estudados.

Epidemiological profile of hepatitis C in blood donors at the Uberaba Regional Blood Center

The aim of the present study was to outline the serological profile of hepatitis C among blood donors seen at the Uberaba Regional Blood Center, Hemominas Foundation, over the last 14 years. The frequency of hepatitis C was compared between first-time and repeat donors and the epidemiological characteristics of those with positive and indeterminate ELISA anti-HCV (third and fourth generation) were analyzed based on the donor histories kept in the archives of the Uberaba Regional Blood Center. The serological ineligibility rate was 0.3%, with higher prevalence in the group of first-time donors. We did not find any significant differences regarding age, skin color, marital status or place of residence between eligible and ineligible donors; however, the frequency of positive serology was higher among men. The lower (0.3%) rate of ineligibility due to hepatitis C that was observed at the Uberaba Regional Blood Center, in relation to most Brazilian blood centers, is probably due to the large number of repeat donors (83.3%). This reinforces the importance of achieving donor commitment for increasing transfusion safety.

Causes of microcytic anaemia and evaluation of conventional laboratory parameters in the differentiation of erythrocytic microcytosis in blood donors candidates

CONTEXT AND OBJECTIVE

Microcytic anaemia results from defective synthesis of haemoglobin in the erythroid precursors, causing a reduction in its mean corpuscular volume (MCV). The most common causes of microcytosis, without the increase in HbA₂ levels, are iron deficiency anaemia (IDA) and α-thalassemia. The aim of this study was to identify the causes of microcytic anaemia and evaluate the haematological parameters from blood donors deemed ineligible (due to the low haematocrit level) that would differentiate the IDA and α-thal, whether isolated or in association.

METHODS

Genomic DNA was submitted to the polymerase chain reaction multiplex for the diagnosis of the most common allele deletions of α-thal and erythrogram and in order to verify haematological parameters. Iron deficiency (ID) was determined through the measurement of serum ferritin.

RESULTS

Of the 204 samples, 82 (40.2%) were identified with ID, 24 (17.8%) with α-thal and 10 (4.9%) with ID associated with α-thal. In the α-thal with ID group haemoglobin (Hb), MCV, mean corpuscular Hb concentration (MCHC) and mean corpuscular Hb (MCH) values were significantly lower compared to the isolated α-thal. In the group with ID Hb, MCV, MCHC and MCH values were significantly lower compared to those with isolated α-thal. The α-thal with ID group, showed Hb, MCV, MCHC and MCH significantly reduced when compared to those with IDA.

CONCLUSIONS

This study showed that the values of haematological parameters, especially haematocrit, Hb, MCV, MCH, MCHC and red blood cell distribution width (RDW), are lower in patients with IDA, especially when associated with α-thal and therefore it may be useful to discriminate between the different types of microcytic anaemia.

Evaluation of the NNECDSG Score in a Brazilian public hospital

OBJECTIVE

To compare the observed incidence of mediastinitis and strokes versus the expected incidence according to the NNECDSG score (Northern New England Cardiovascular Disease Study Group) in a population submitted to coronary artery bypass graft surgery.

METHODS

A retrospective consultation was made of medical records of all patients submitted to isolated CABG from January 1st, 2000 to December 31st, 2004, at the Cardiac Surgery Service of the Triângulo Mineiro Federal University (UFTM). Data regarding the incidences of observed mediastinitis and strokes and those estimated by the NNECDSG score were submitted to the Kolmogorov-Smirnov normality test. A comparison was achieved using the paired Student t test, with the level of significance determined as p=0.05.

RESULTS

A group of 230 patients were analyzed, including 144 (62.60%) men and 86 (37.39%) women. Sixty-one (26.52%) presented with diabetes, 30 (13.04%) with chronic obstructive pulmonary disease (COPD) and 23 (10%) had peripheral vascular disease (PVD). Emergency surgery occurred in 34 (14.78 %) cases. In 37 (16.08%) patients an ejection fraction (EF) of less than 40% was identified. Mediastinitis occurred in 12 (5.21%) patients and despite the greater general incidence in the sample studied, no statistical significance was found. Strokes occurred in 12 patients (5.21%) and in spite of the higher mean percentage incidence of observed strokes for all scores, a level of statistical significance was not found.

CONCLUSIONS

Although the incidences of mediastinitis and strokes were greater in the population studied, these values showed no statistical significance, confirming the score recommended by the NNECDSG as a safe and efficient method for predicting postoperative mediastinitis and strokes in patients submitted to myocardial revascularization surgery in the UFTM.

Assessment of an intervention for the diffusion of evidence-based nursing in a teaching hospital

Objective

To evaluate an intervention for the diffusion of evidence-based practice among the nurse leaders of a public teaching hospital.

Methods

This is a descriptive-quantitative study based on the evaluation of workshops at a teaching hospital in the Triângulo Mineiro region of the state of Minas Gerais, Brazil, in 2016, conducted from the conceptual perspective of "Diffusion of Innovation and Skills for the Use of Evidence-Based Nursing in Care Settings". We applied an Evidence-Based Practice Questionnaire and analysed the individual evaluations of each participant according to the frequency of cores of meaning and the calculation of content validity index.

Results

Ninety percent of the nurse leaders agreed to participate in the evaluation. The leaders had a positive attitude toward incorporating evidence into practice (average = 5.4; SD = ±1.3). Their main difficulty was the ability to understand research (average = 3.5; SD = ±1.3). Motivational aspects related to intervention had the highest content validity index (CVI = 0.9).

Conclusion

The workshops encouraged the diffusion of information regarding the need to incorporate scientific evidences to better qualify the care provided by nurse leaders in the public teaching hospital.

[Postoperative pain in children: a gender approach]

The objective of this study was to verify and describe, from a gender focus, the associations between gender and specific postoperative pain variables in pediatrics. This is a cross-sectional study of 77 children between 6 and 13 years of age (M=9 years; sd=2.2 years), ASA I and II, 77.9% from low-income classes, 68.8% boys and 32.8% girls. Data were collected on the first postoperative (1st PO) day through semi-structured interviews and four measurement scales. The main baseline diseases were adenotonsillitis and fractures. Prevalence of pain on the 1st PO was 91.7% for girls and 75.5% for boys (p>0.05). No association was found between pain intensity and gender. The most used pain descriptors were it cuts and it squeezes. The preferred scale was the EFMC (with faces from a Brazilian cartoon: Monica's Gang). Pediatric pain management is still inadequate and gender may influence the pain response.

Evaluation of clinical and laboratory markers of cardiometabolic risk in overweight and obese children and adolescents

OBJECTIVE:

This study analyzed the frequency of cardiometabolic risk markers and metabolic syndrome occurrence in overweight and obese children and adolescents.

METHODS:

The participants included 161 overweight (n=65) and obese (n=96) individuals aged between 5 and 19 years. Clinical markers were assessed (body mass index, body fat percentage, waist circumference, acanthosis, systolic and diastolic blood pressures, laboratory parameters [glucose, insulin, cholesterol (total and fractions) and triglyceride levels and homeostasis model assessment of insulin resistance (HOMA-IR) index] and leptin and adiponectin levels). The frequency of changes, odds ratios and correlations among markers were determined. Metabolic syndrome was assessed according to International Diabetes Federation criteria.

RESULTS:

A high frequency of acanthosis (51.6%); increased waist circumference (45.4%), systolic blood pressure / diastolic blood pressure (8.1% / 9.3%), glucose (10%), insulin (36.9%) and HOMA-IR (44.3%) values; and reduced high-density lipoprotein levels (47.2%) were observed. Leptin levels were increased in 95% of obese and in 66% of overweight subjects. Adiponectin was decreased in 29.5% of obese and in 34% of overweight subjects. An odd ratio analysis revealed a greater probability of increased waist circumference (9.0), systolic blood pressure (4.1), triglyceride (2.3) and insulin (2.9) levels and HOMA-IR (3.0) in the obese group than in the overweight group. The clinical and laboratory parameters and leptin levels exhibited significant correlations, whereas adiponectin was negatively correlated with systolic blood pressure. The occurrence rate of metabolic syndrome was 13.6%.

CONCLUSIONS:

The high frequency of changes in clinical, laboratory and adipokine markers indicates the need for early interventions aimed at preventing cardiometabolic complications in adulthood.

Chagas disease: Performance analysis of immunodiagnostic tests anti-Trypanosoma cruzi in blood donors with inconclusive screening results

Background

The screening ofTrypanosoma cruzi-infected blood donors using two serological techniques frequently leads to conflicting results. This fact prompted us to evaluate the diagnostic performance of four “in-house” immunodiagnostic tests and two commercially available enzyme-linked immunosorbent assays (ELISAs).

Material and Methods

One hundred and seventy-nine blood donors, whose screening for Chagas disease was doubtful, underwent three in-house ELISAs, one in-house immunoblotting test (TESA-blot), and two commercial ELISAs (bioMérieux and Wiener) in an attempt to define the presence or absence of infection. Simultaneously, 29 donors with previous positive results from three conventional serological tests and 30 donors with constant negative results were evaluated.

Results

The ELISA-Wiener showed the highest rate in sensitivity (98.92%) and the ELISA-bioMérieux, the highest specificity (99.45%), followed by the TESA-blot, which showed superior performance, with lower false-negative (2.18%) and false-positive (1.12%) rates. In series, the combination composed of the TESA-blot and ELISA-bioMérieux showed slightly superior performance, with trifunctional protein deficiency (TFP) = 0.01%.

Conclusion

Our study confirms the high sensitivity and specificity of commercial kits. To confirm the presence or absence of T. cruzi infection, the combination of TESA-blot and ELISA-bioMérieux may be suggested as the best alternative. Individually, the TESA-blot performed the closest to the gold standard; however, it is not commercially available.

Condições de saúde de idosos com diabetes no município de Uberaba, Minas Gerais

Este estudo, do tipo inquérito domiciliar, teve como objetivo comparar as condições de saúde dos idosos com Diabetes Mellitus, segundo as variáveis sexo e faixa etária. Participaram 417 idosos, entrevistados no domicílio, no período de dezembro 2005 a fevereiro 2006. Os dados foram analisados através de freqüência simples e teste qui-quadrado (p < 0,05). A maioria dos idosos possuía de 60 a 70 anos (50,1%), era mulher (71,2%) e fazia uso de medicamentos (96,1%). Os principais problemas de saúde foram a hipertensão arterial (75,5%), os problemas de visão (73,6%) e de coluna (56,4%). As mulheres consideram a autopercepção da saúde má ou péssima e referem o custo dos remédios como problema para a sua aquisição, quando comparada aos homens, diferença estatisticamente significativa. Conforme elevou-se a faixa etária, verificou-se maior proporção de idosos que utilizam aparelhos, com problemas de coluna e que usavam diuréticos.

Chronic osteo-articular changes in patients with sickle cell disease

BACKGROUND

Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ⁰), on a steady-state fasis.

METHODS

Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations.

RESULTS

In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea.

CONCLUSIONS

There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.

Epidemiological survey of hepatitis C in a region considered to have high prevalence: the state of Minas Gerais, Brazil

INTRODUCTION

The prevalence of hepatitis C virus (HCV) infection is affected by demographic, virological, clinical, and lifestyle-related factors and varies in different regions in Brazil or worldwide. The present study aimed to clarify the epidemiological patterns of HCV infection in the interior region of Brazil.

METHODS

This study was conducted in the Southern Triangle Macro-region of the state of Minas Gerais, Brazil, according to the guidelines of the National Program for the Prevention and Control of Viral Hepatitis. The participants answered a structured questionnaire on social and epidemiological factors. Immunochromatographic rapid tests were used for the qualitative detection of antibodies against HCV in whole blood (Alere HCV® Code 02FK10) in adult subjects by a free-standing method.

RESULTS

Of 24,085 tested individuals, 184 (0.76%) were anti-HCV positive. The majority of anti-HCV-positive individuals were born between 1951 and 1980 (n=146 [79.3%]), with 68 women and 116 men. Identified risk factors included syringe and/or needle sharing (p = 0.003), being in prison (p = 0.004), and having tattoos or piercings (p = 0.005) and were significantly associated with the decade of birth.

CONCLUSIONS

The study shows the importance of testing populations at risk for HCV infection, including incarcerated individuals, those with tattoos or piercings, those who share or have shared syringes or needles, and those in high-risk birth cohorts (1950s, 1960s, and 1970s) in the Southern Triangle Macro-region.