Blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in patients with symptoms suggesting reactive hypoglycemia

We evaluated the impact of postprandial glycemia on blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in non-diabetic patients with symptoms suggesting reactive hypoglycemia. Eleven patients with clinical symptoms suggesting reactive hypoglycemia received an oral glucose solution (75 g) Blood was collected at 0 (baseline), 30, 60, 120 and 180 min after glucose ingestion and the plasma concentrations of interferon-α (IFN-α), interferon-γ (IFN-γ), interleukin-1 receptor antagonist (IL-1RA), interleukin 2 (IL-2), interleukin-2 receptor (IL-2R), interleukin 4 (IL-4), interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10), interleukin-12 (IL-12), interleukin 13 (IL-13), interleukin 15 (IL-15), interleukin 17 (IL-17), IFN-γ inducible protein 10 (IP-10), monocyte chemotactic protein 1 (MCP1), monokine induced by IFN-γ (MIG), macrophage inflammatory protein-1α (MIP-1α), interleukin-1β (IL-1β), colony stimulating factor (G-CSF), granulocyte-macrophage CSF (GM-CSF), basic fibroblast growth factor (FGF-basic), eotaxin, tumor necrosis factor α (TNFα), epidermal growth factor (EGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), macrophage inflammatory protein-1α (MIP-1α), and 1β (MIP-1β) were evaluated. Overall, glycemic levels increased, reached its maximum at 30 min (phase 1), returned to baseline levels at 120 min (phase 2), followed by a mild hypoglycemia at 180 min (phase 3). During phase 1, cytokine blood levels were maintained. However, we observed a synchronous fall (P<0.05) in the concentrations of pro-inflammatory (IL-15, IL-17, MCP-1) and anti-inflammatory cytokines (FGF-basic, IL-13, IL-1RA) during phase 2. Furthermore, a simultaneous rise (P<0.05) of pro-inflammatory (IL-2, IL-5, IL-17) and anti-inflammatory cytokines (IL-4, IL-1RA, IL-2R, IL-13, FGF-basic) occurred during phase 3. Thus, mild acute hypoglycemia but not a physiological increase of glycemia was associated with increased blood levels of anti-inflammatory and pro-inflammatory cytokines.

Fatores interferentes na taxa de adesão à farmacoterapia em idosos atendidos na rede pública de saúde do Município de Salto Grande - SP, Brasil / Factors interfering with the medication adherence rate of elderly patients in the public health system in the town of Salto Grande, São Paulo State, Brazil

O objetivo deste estudo foi determinar a taxa de adesão à farmacoterapia e identificar os fatores que interferem nesta taxa em pacientes idosos atendidos em uma Unidade Básica de Saúde (UBS) no município de Salto Grande, São Paulo. Foram recrutados 120 pacientes idosos para participar de estudo transversal, desenvolvido no período de maio a setembro de 2009. Foi aplicado questionário para determinar a taxa de adesão (MMAS-8) e identificar as características sócio-econômicas, de saúde autorreferidas, da farmacoterapia utilizada e da satisfação dos pacientes com os serviços de saúde da UBS estudada. Um total de 102 pacientes completo o estudo, sendo que a maioria dos indivíduos apresentou taxa de adesão insatisfatória (14,7% alta adesão, 48,0% adesão média e 37,3% baixa adesão). Apresentaram forte correlação com adesão, satisfação com os serviços de saúde (r= 0,884; p < 0,0001) e o Índice de Complexidade da Farmacoterapia (ICFT) (r= - 0,705; p < 0,001). O número de medicamentos consumidos (r= - 0,604; p < 0,001), número de doenças relatadas (r = - 0,604; p < 0,001) e número de moradores por residência (r= 0,428; p < 0,001) apresentaram correlação intermediária com adesão. Foi encontrada uma correlação fraca entre adesão e escolaridade (r= 0,263; p < 0,001), raça (r= 0,090; p < 0,001), sexo (r= 0,080; p < 0,001), renda familiar (r= 0,054; p < 0,001) e idade (r= -0,090; p < 0,001). Esses resultados indicam que a população estudada não adere adequadamente à farmacoterapia, com forte influência da satisfação dos pacientes com os serviços de saúde e ICFT nesses resultados.

The aim of this study was to determine the rate of adherence to pharmacotherapy and to identify the factors that interfere with this adherence in elderly patients attended at a local Health Center (BHU) in Salto Grande, a country town in Sao Paulo. One hundred and twenty patients were recruited to participate in a cross-sectional study, conducted from May to September 2009. A questionnaire was used to determine the adherence rate (MMAS-8) and to identify the socio-economic factors, health condition (self-reported), medication used and satisfaction of the patients with the health services provided at the BHU. A total of 102 patients completed the study, most of whom showed unsatisfactory adherence rates (14.7% high adherence, 48.0% mean adherence and 37.3% poor adherence). Adherence was strongly correlated with patient satisfaction with health services (r= 0.884; p < 0.0001) and the Medication Regimen Complexity Index (MRCI) (r= - 0.705; p < 0.001). The number of drugs consumed (r = - 0.604, p <0.001), number of reported diseases (r = - 0.604, p <0.001) and number of residents per house (r = 0.428, p <0.001) showed intermediate correlation with intermediate adherence. Weak correlation was found between adherence and education level (r = 0.263, p <0.001), race (r = 0.090, p <0.001), sex (r = 0.080, p <0.001), family income (r = 0.054, p <0.001 ) and age (r = -0.090, p <0.001). These results indicate that the population does not adhere adequately to medication prescribed at the BHU and that patients? satisfaction with health services and the MRCI influence these results strongly.