Hypoxia-Inducible Factor 1-Alpha and Glucose Metabolism during Cardiac Remodeling Progression from Hypertrophy to Heart Failure.

In pathological cardiac hypertrophy, the heart is more dependent on glucose than fatty acids. This shift in energy metabolism occurs due to several factors, including the oxygen deficit, which activates hypoxia-inducible factor-1α (HIF-1α), a critical molecule related to glucose metabolism. However, there are gaps regarding the behavior of key proteins in the glycolytic pathway and HIF-1α during the transition from hypertrophy to heart failure (HF). This study assesses the hypothesis that there is an early change and enhancement of HIF-1α and the glycolytic pathway, as well as an association between them during cardiac remodeling. Sham and aortic stenosis Wistar rats were analyzed at 2, 6, and 18 weeks and in HF (n = 10-18). Cardiac structure and function were investigated by echocardiogram. Myocardial glycolysis, the aerobic and anaerobic pathways and glycogen were analyzed by enzymatic assay, Western blot, and enzyme-linked immunosorbent assay (ELISA). The following were observed: increased left ventricular hypertrophy; early diastolic function change and severe systolic and diastolic dysfunction in HF; increased HIF-1α in the 2nd week and in HF; precocious alteration and intensification of glycolysis with a shift to anaerobic metabolism from the 6th week onwards; association between HIF-1α, glycolysis, and the anaerobic pathway. Our hypothesis was confirmed as there was an early change and intensification in glucose metabolism, alteration in HIF-1α, and an association between data during the progression from hypertrophy to heart failure.

MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM DISTINCT SOCIOECONOMIC CLASSES.

Background: Obesity and metabolic syndrome can be labeled as worldwide outbreak; thus, both have led to serious public health problem. Oral health can be worsened by both, obesity and metabolic syndrome. Tooth loss harms masticatory function, essential status to whom will be submitted to bariatric surgery. Aim: Assess masticatory function of obese candidates to bariatric surgery, who belong to distinct socioeconomic class range, in order to recognize hazard factors and the bias of socioeconomic factor in this context. Methods: Observational cross-section study, with samples comprised by two groups of patients, with distinct socioeconomic class range, one of them belonging to public health system (SUSG) and the other to private clinic (CPG), candidates to bariatric surgery. Were assessed anthropometric data, comorbidities and medicines usage, blood tests, habits and the number of dental functional units. Results: The groups SUSG and CPG were homogeneous taking into account gender (p=0,890) and age range (p=0,170). The number of dental functional units was higher in the private group (p<0.001). The impaired masticatory function was rather present among public group (p<0.001) and female gender (p<0,001). Regarded as blood tests, fasting glucose was higher in female in SUSG (p<0,001). The following hazard factors have corroborated to have patients rated as impaired masticatory function: belong to public service (OR: 8.420, p=0.003), higher age (OR: 1.186, p<0.001), female gender (OR: 0.153, p=0.029), diabetes mellitus (OR: 2.545, p=0.045) and smokers (OR: 2.951, p=0.043). Conclusion: The general health and masticatory function of female SUSG were worse, highlighting the socioeconomic condition as hazard factor.

Racional: Obesidade e síndrome metabólica são graves problemas de saúde pública, com características de epidemia mundial. A saúde bucal é agravada por ambas as condições. Perda dentária prejudica função mastigatória, condição essencial para o paciente que será submetido à cirurgia bariátrica. Objetivo: Avaliar a função mastigatória de pacientes obesos candidatos à cirurgia bariátrica pertencentes a dois serviços de saúde com padrões socioeconômicos distintos, afim de identificar fatores de risco e a influência do fator socioeconômico nesta condição. Métodos: Estudo observacional transversal, com amostra constituída por dois grupos de pacientes obesos, com condições socioeconômicas distintas, um pertencente ao sistema público de saúde (GSUS) e outro à clínica privada (GCP), candidatos à cirurgia bariátrica. Foram analisados dados antropométricos, comorbidades e uso de medicamentos para seu controle, exames laboratoriais, hábitos e o número de unidades funcionais dentárias presentes. Resultados: Os grupos GSUS e GCP foram homogêneos quanto ao gênero (p=0,890) e faixa etária (p=0,170). A média de unidades funcionais dentárias foi maior no grupo privado (p<0,001). A função mastigatória prejudicada foi mais presente no grupo GSUS e no gênero feminino (p<0,001). Quanto aos exames laboratoriais: glicemia de jejum esteve mais alterada em mulheres do GSUS (p<0,001). Foram fatores de risco independentes para ter função mastigatória prejudicada: ter origem no serviço público de saúde (OR: 8,420 - p=0,003), maior idade (OR: 1,186 - p<0,001), ser do gênero feminino (OR: 0,153 - p=0,029), portador de diabete melito (OR: 2,545 - p=0,045) e tabagista (OR: 2,951 - p=0,043). Conclusão: A saúde geral e função mastigatória de mulheres do GSUS foram piores, ressaltando a condição socioeconômica como fator de risco.

MASTICATORY FUNCTION OF OBESE CANDIDATES TO BARIATRIC SURGERY FROM DISTINCT SOCIOECONOMIC CLASSES / FUNÇÃO MASTIGATÓRIA DE OBESOS CANDIDATOS À CIRURGIA BARIÁTRICA ORIUNDOS DE CLASSES SOCIOECONÔMICAS DISTINTAS

ABSTRACT Background: Obesity and metabolic syndrome can be labeled as worldwide outbreak; thus, both have led to serious public health problem. Oral health can be worsened by both, obesity and metabolic syndrome. Tooth loss harms masticatory function, essential status to whom will be submitted to bariatric surgery. Aim: Assess masticatory function of obese candidates to bariatric surgery, who belong to distinct socioeconomic class range, in order to recognize hazard factors and the bias of socioeconomic factor in this context. Methods: Observational cross-section study, with samples comprised by two groups of patients, with distinct socioeconomic class range, one of them belonging to public health system (SUSG) and the other to private clinic (CPG), candidates to bariatric surgery. Were assessed anthropometric data, comorbidities and medicines usage, blood tests, habits and the number of dental functional units. Results: The groups SUSG and CPG were homogeneous taking into account gender (p=0,890) and age range (p=0,170). The number of dental functional units was higher in the private group (p<0.001). The impaired masticatory function was rather present among public group (p<0.001) and female gender (p<0,001). Regarded as blood tests, fasting glucose was higher in female in SUSG (p<0,001). The following hazard factors have corroborated to have patients rated as impaired masticatory function: belong to public service (OR: 8.420, p=0.003), higher age (OR: 1.186, p<0.001), female gender (OR: 0.153, p=0.029), diabetes mellitus (OR: 2.545, p=0.045) and smokers (OR: 2.951, p=0.043). Conclusion: The general health and masticatory function of female SUSG were worse, highlighting the socioeconomic condition as hazard factor.

RESUMO Racional: Obesidade e síndrome metabólica são graves problemas de saúde pública, com características de epidemia mundial. A saúde bucal é agravada por ambas as condições. Perda dentária prejudica função mastigatória, condição essencial para o paciente que será submetido à cirurgia bariátrica. Objetivo: Avaliar a função mastigatória de pacientes obesos candidatos à cirurgia bariátrica pertencentes a dois serviços de saúde com padrões socioeconômicos distintos, afim de identificar fatores de risco e a influência do fator socioeconômico nesta condição. Métodos: Estudo observacional transversal, com amostra constituída por dois grupos de pacientes obesos, com condições socioeconômicas distintas, um pertencente ao sistema público de saúde (GSUS) e outro à clínica privada (GCP), candidatos à cirurgia bariátrica. Foram analisados dados antropométricos, comorbidades e uso de medicamentos para seu controle, exames laboratoriais, hábitos e o número de unidades funcionais dentárias presentes. Resultados: Os grupos GSUS e GCP foram homogêneos quanto ao gênero (p=0,890) e faixa etária (p=0,170). A média de unidades funcionais dentárias foi maior no grupo privado (p<0,001). A função mastigatória prejudicada foi mais presente no grupo GSUS e no gênero feminino (p<0,001). Quanto aos exames laboratoriais: glicemia de jejum esteve mais alterada em mulheres do GSUS (p<0,001). Foram fatores de risco independentes para ter função mastigatória prejudicada: ter origem no serviço público de saúde (OR: 8,420 - p=0,003), maior idade (OR: 1,186 - p<0,001), ser do gênero feminino (OR: 0,153 - p=0,029), portador de diabete melito (OR: 2,545 - p=0,045) e tabagista (OR: 2,951 - p=0,043). Conclusão: A saúde geral e função mastigatória de mulheres do GSUS foram piores, ressaltando a condição socioeconômica como fator de risco.

Identification of a statistical method as a quality tool: patient's length of stay in the operating room.

OBJECTIVE: To identify a statistical method that may express the patient length of stay in the operating room and build a 'matrix of relationship' for optimizing this time, the real and exact time of the operation. METHODS: The analysis of survival and the Kaplan-Meier estimator allowed to calculate the survival curves for different times and the 'matrix of relationship' with 10 hypothesis to help in choosing the new operation. The study consisted of a simple random sample of 71 patients, from elective operations for adults in Cardiac Surgery/Clinics Hospital/Unicamp, with confidence level of 95% in 2008. RESULTS: On average, the times of the operations over at a range of 140 minutes to 200 minutes and excess from 5 minutes to 90 minutes. In general, on average, one operation was daily performed within 520 minutes, for a time of 720 minutes. CONCLUSION: 1) With the maximum available time of 720 minutes is not possible to perform surgery, unless using the 'matrix of relationship', whereas the maximum time available varies between 660 minutes and 690 minutes, considering the range of cleaning of the room. 2) The time of the patient in the operating room is a time that includes the time of learning by the student in an university hospital school. 3) When optimizing the time, most patients will benefit, causing a decrease from the waiting list for new opeartions. 4) The 'matrix of relationship' allows to view and express opinion on a better decision making in addition to decide upon several assumptions.

Identificação de um método estatístico como instrumento da qualidade: tempo da presença do doente na sala de operação / Identification of a statistical method as a quality tool: patient's length of stay in the operating room

OBJETIVO: Identificar um método estatístico que expresse o tempo da presença do doente na sala de operação e construir a "matriz de relação" de otimização deste tempo, o tempo exato e real da operação. MÉTODOS: A análise de sobrevivência e o estimador de Kaplan-Meier permitiram calcular as curvas de sobrevivência para os diferentes tempos e a "matriz de relação" com 10 hipóteses para auxiliar na escolha da nova operação. A amostra aleatória simples de 71 indivíduos, das operações eletivas de adultos da Cirurgia Cardíaca/Hospital de Clínicas/UNICAMP, no ano 2008, no nível de confiança de 95 por cento. RESULTADOS: Os tempos das operações em média sobram em um intervalo de 140 a 200 minutos e excedem de 5 a 90 minutos. No geral, realizou-se em média diariamente uma operação dentro de 520 minutos, para um tempo disponível de 720 minutos. CONCLUSÃO: 1) Com o tempo máximo disponível de 720 minutos não é possível realizar operação, a não ser utilizando da "matriz de relação", sendo que o tempo máximo disponível varia entre 660 e 690 minutos, considerando-se intervalo de limpeza da sala. 2) O tempo do doente na sala de operação tem nele incluso o tempo de aprendizado pelo aluno, em um hospital escola, universitário. 3) Ao otimizar o tempo, mais doentes serão beneficiados, acarretando diminuição da fila de espera para novas operações. 4) A "matriz" de relação permite visualizar, opinar e decidir mediante várias hipóteses, resultando em melhor tomada de decisão

OBJECTIVE: To identify a statistical method that may express the patient length of stay in the operating room and build a "matrix of relationship" for optimizing this time, the real and exact time of the operation. METHODS: The analysis of survival and the Kaplan-Meier estimator allowed to calculate the survival curves for different times and the "matrix of relationship" with 10 hypothesis to help in choosing the new operation. The study consisted of a simple random sample of 71 patients, from elective operations for adults in Cardiac Surgery/Clinics Hospital/Unicamp, with confidence level of 95 percent in 2008. RESULTS: On average, the times of the operations over at a range of 140 minutes to 200 minutes and excess from 5 minutes to 90 minutes. In general, on average, one operation was daily performed within 520 minutes, for a time of 720 minutes. CONCLUSION: 1) With the maximum available time of 720 minutes is not possible to perform surgery, unless using the "matrix of relationship", whereas the maximum time available varies between 660 minutes and 690 minutes, considering the range of cleaning of the room. 2) The time of the patient in the operating room is a time that includes the time of learning by the student in an university hospital school. 3) When optimizing the time, most patients will benefit, causing a decrease from the waiting list for new opeartions. 4) The "matrix of relationship" allows to view and express opinion on a better decision making in addition to decide upon several assumptions