Prevalência de doenças crônicas não transmissíveis e associação com autoavaliação de saúde: Pesquisa Nacional de Saúde, 2013 / Prevalence of chronic non-communicable diseases and association with self-rated health: National Health Survey, 2013

Resumo: Objetivo: Analisar o perfil de dez doenças crônicas não transmissíveis investigadas na Pesquisa Nacional de Saúde realizada no Brasil em 2013 e sua associação com a autoavaliação da saúde. Métodos: Estudo transversal de base populacional e abrangência nacional com 60.202 indivíduos com 18 anos ou mais. Foi utilizado processo amostral por conglomerado com três estágios de seleção: setor censitário, domicílio e indivíduo. Calculou-se a prevalência das doenças crônicas e os intervalos de confiança de 95% por idade, sexo e escolaridade, a idade média do primeiro diagnóstico e a proporção de limitação das atividades habituais. Para testar a associação com a autoavaliação de saúde, utilizou-se o procedimento de regressão logística ajustada por sexo e idade. Resultados: As doenças mais prevalentes foram hipertensão arterial (21,4%), depressão (7,6%), artrite (6,4%) e diabetes mellitus (6,2%). Indivíduos com diagnóstico de acidente vascular cerebral (AVC) referiram maior limitação das atividades habituais (38,6%). Observou-se um gradiente na prevalência segundo idade e escolaridade, e todas as doenças foram mais frequentes entre as mulheres. Pior autoavaliação de saúde foi encontrada entre aqueles com diagnóstico de AVC (OR = 3,60; valor de p < 0,001) e nos que referiram duas doenças (OR = 5,53; valor de p < 0,001) ou três ou mais doenças (OR = 10,86; valor de p < 0,001). Conclusões: Por se tratar de doenças associadas a fatores de risco modificáveis, a prevenção com foco populacional é a melhor estratégia para redução da carga dessas doenças.

ABSTRACT: Objective: To analyze the profile of 10 chronic noncommunicable diseases investigated in the National Health Survey carried out in Brazil in 2013 and their association with the self-rated health. Methods: A cross-sectional, population-based nationwide study with 60,202 individuals aged 18 years old or more. Sampling process by conglomerate was carried out in three stages of selection: census tract, household, and individual. The prevalence of chronic diseases by age, gender and educational status and the confidence intervals of 95% , the mean age at the first diagnosis and the proportion of limitation of the usual activities were calculated. To test the association with self-rated health, the logistic regression procedure adjusted for gender and age was used. Results: The more prevalent diseases were hypertension (21.4%), depression (7.6%), arthritis (6.4%), and diabetes mellitus (6.2%). Individuals diagnosed with stroke reported greater limitations in the daily activities (38.6%). There was a gradient in the prevalence by age and educational level, and all the diseases were more frequent among women. A worse self-rated health was observed among those with a diagnosis of stroke (OR = 3.60; p < 0.001) and those who referred two diseases (OR = 5.53; p < 0.001) or three or more diseases (OR = 10.86; p < 0.001). Conclusions: Because these diseases are associated with modifiable risk factors, the prevention with population focus is the best strategy to reduce the burden of these diseases.

Isolation and characterization of a serine proteinase with thrombin-like activity from the venom of the snake Bothrops asper

A serine proteinase with thrombin-like activity was isolated from the venom of the Central American pit viper Bothrops asper. Isolation was performed by a combination of affinity chromatography on aminobenzamidine-Sepharose and ion-exchange chromatography on DEAE-Sepharose. The enzyme accounts for approximately 0.13 percent of the venom dry weight and has a molecular mass of 32 kDa as determined by SDS-PAGE, and of 27 kDa as determined by MALDI-TOF mass spectrometry. Its partial amino acid sequence shows high identity with snake venom serine proteinases and a complete identity with a cDNA clone previously sequenced from this species. The N-terminal sequence of the enzyme is VIGGDECNINEHRSLVVLFXSSGFL CAGTLVQDEWVLTAANCDSKNFQ. The enzyme induces clotting of plasma (minimum coagulant dose = 4.1 µg) and fibrinogen (minimum coagulant dose = 4.2 µg) in vitro, and promotes defibrin(ogen)ation in vivo (minimum defibrin(ogen)ating dose = 1.0 µg). In addition, when injected intravenously in mice at doses of 5 and 10 µg, it induces a series of behavioral changes, i.e., loss of the righting reflex, opisthotonus, and intermittent rotations over the long axis of the body, which closely resemble the `gyroxin-like' effect induced by other thrombin-like enzymes from snake venoms.

The N-terminal 1-16 peptide derived in vivo from protein seminal vesicle protein IV modulates alpha-thrombin activity: potential clinical implications

We have previously shown that seminal vesicle protein IV (SV-IV) and its 1-70 N-terminal fragment have anti-inflammatory activity and modulate anti-thrombin III (AT) activity. Moreover, mass spectrometry analysis of purified SV-IV has shown that the protein was found to be highly heterogeneous and 14% of the total SV-IV molecules are truncated forms, of particular interest the 1-16, 1-17, and 1-18 peptides. In this work we report experimental data which demonstrate that the 1-16 peptide (P1-16) possesses a marked effect on the AT activity by preventing the formation of the thrombin-AT complex. We found that the formation of thrombin-AT complex is markedly decreased in the presence of P1-16 used at equimolar concentration with thrombin as evaluated with SDS-PAGE. We also monitored the conformational changes of thrombin in the presence of different P1-16 concentrations, and calculated the K(d) of thrombin/P1-16 system by circular dichroism technique. The probable interaction sites of P1-16 with thrombin have been also evaluated by molecular graphics and computational analyses. These results have potential implications in the treatment of sterility and thrombotic diseases.

Plasma Level of IL-6 and Its Relationship to Procoagulant and Fibrinolytic Markers in Acute Ischemic Stroke

Procoagulant or impaired fibrinolytic states as well as inflammatory reactions mediated by cytokines are likely involved in the pathogenesis of acute ischemic stroke. We examined the potential relationship between interleukin 6 (IL-6) and hemostatic markers. The procoagulant and fibrinolytic states were assessed in 46 patients with acute stroke by measuring plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT), and plasminogen-antiplasmin complex (PAP). Circulating IL-6 levels were measured using ELISA (Quantikine, R and D systems, MN, USA). Circulating IL-6 (mean, 26.5 pg/mL) and PAI-1 (mean, 19.9 ng/mL) levels were higher in patients with acute stroke than in healthy subjects (mean, 3.0 pg/mL, 10.4 ng/mL, respectively). TAT levels were statistically different according to the etiologic subtypes of stroke (atherogenic, 2.5 ng/mL; lacunar 3.2 ng/mL; cardiogenic 9.9 ng/mL, p = 0.021). Neither procoagulant levels nor fibrinolytic markers significantly correlated with circulating IL-6 levels. Our findings suggest that elevated proinflammatory cytokines during the initial hours of ischemic stroke may be an independent pathogenic factor or a consequence of the thrombotic event with no relationship to the procoagulant or fibrinolytic states.

Two related thrombin-like enzymes present in Bothrops atrox venom

This article describes the presence of two new forms of a thrombin-like enzyme, both with apparent molecular masses of 38 kDa, in Bothrops atrox venom. Both share the ability to cleave fibrinogen into fibrin and to digest casein. Both present identical Km on the substrate BApNA. Their N-terminal amino acid sequences are identical for 26 residues, sharing 80 percent homology with batroxobin and flavoxobin. Two groups of monoclonal antibodies (mAbs) raised against the purified enzyme forms recognized different epitopes of the putative corresponding enzymes present in B. atrox crude venom. On Western blotting analysis of B. atrox crude venom, mAbs 5DB2C8, 5AA10 and 5CF11, but not mAbs 6CC5 and 6AD2-G5, revealed two or more protein bands ranging from 25 to 38 kDa. By immunoprecipitation assays, the 6AD2-G5 mAb was able to precipitate protein bands of 36-38 kDa from B. atrox, B. leucurus, B. pradoi, B. moojeni, B. jararaca and B. neuwiedii crude venoms. Fibrinogen-clotting activity was inhibited when the same venom specimens were pre-incubated with mAb 6AD2-G5, except for B. jararaca and B. neuwiedii

Activación plaquetaria por trombina / Platelet activation by thrombin

Cuando un agonista se une a su receptor específico sobre la membrana plaquetaria se inician una serie de cambios morfológicosy metabólicos que llevan al cambio de forma, agregación y secreción de contenidos granulares. La trombina, serinoproteasa multifuncional y fuerte agonosta plaquetario, tiene dos tipos de receptores sobre la membrana plaquetaria: de alta y de moderada afinidad. Este último pertenece a la familia de receptores ß2 adrenérgicos que presentan siete dominios de intramembrana, e inician la activación a través de G proteínas específicas. De esta manera se desencadenan diversos pasos metabólicos a través de varias enzimas claves. La actividad de la fosfolipasa Cß (PLCß) origina dos segundos mensajeros: Inositol 3 fosfato (IP3) que promueve la movilización de calcio del sistema tubular denso al citosol y el diacilglicerol (DG) que activa proteína quinasa C (PKC). Si bien la plaqueta no prolifera se han detectado enzimas relacionadas a oncogenes. De esta manera se han estudiado y comprendido nuevos caminos de activación. La familia de la tirosina quinasas, relacionas a la proliferación celular y oncogenes, fosforilan residuos tirosinas; en su mayoría son quinasas del tipo no receptor que se encuentran en el citosol como ser: Scr, Syk y FAK. La fosfolipasa Cy necesita la presencia de RasGAP, Rap 1b para hidrolizar fosfoinosítidos de membrana. La formación de este complejo trimérico se induce por trombina. La fosfoinositol-3-quinasa fosforila la posición 3 del anillo del inositol generando nuevos compuestos. La regulación completa de estos mecanismos de activación llevan a la respuesta hemostática plaquetaria. Su conocimiento hace posible el desarrollo de moléculas inhibitorias como terapéutica en los procesos trombóticos y tromboembólicos

Estudio de la actividad procoagulante de las plaquetas en el síndrome de Bernard Soulier / Procoagulant activity of platelets study in the Bernard Soulier's syndrome

En el síndrome de Bernard soulier (SBS) han sido demostradas alteraciones específicas que dan lugar a un trastorno en la adhesividad plaquetaria. También se le han atribuido otros defectos que condicionan una alteración en el actividad procoagulante de sus mismas plaquetas, los cuales no han logrado definirse satisfactoriamente. En el presente trabajo se estduió el efecto procoagulante de las plaquetas, en cuatro pacientes con SBS, comparándolo con los resultados en controles sanos y enfermos trombocitopénica, para tal fin se efectuaron modificaciones en el cosumo de protrombina (CP) y tiempo de recalcificación del plasma, para evaluar el efecto de la trombocitopenia y el de plasmas con deficiencias intensas y específicas de factores de coagulación V, VIII y XI sobre el mecanismo procoagulante de las plaquetas con SBS. Los resultados observados difieren de los informados por otros investigadores, pues no se detectó ningún defecto en la actividad procoagulante en las plaquetas de los pacientes con SBS, considerando que su actividad procoagulante es normal, o bien, que existan variante de dicho síndrome