Fatores associados à sobrecarga e a qualidade de vida de cuidadores de idosos com demência / Factors associated with burden and quality of life for the caregivers of elderly people with dementia

O presente estudo objetivou analisar os fatores associados à sobrecarga e qualidade de vida de cuidadores de idosos com demência a partir das características do idoso e do cuidador. Trata-se de um estudo transversal, realizado na cidade de Maceió, Alagoas. A amostra foi composta por 170 indivíduos, 85 pares cuidador/idoso, sendo os idosos com diagnóstico de síndrome demencial e seus respectivos cuidadores principais. A coleta foi realizada por meio de entrevistas com aplicação de escalas validadas. Foi avaliada a sobrecarga e a qualidade de vida do cuidador, através da escala Zarit Burden Interview e do Whoqol-bref, respectivamente, e o estado cognitivo e capacidade funcional dos idosos com a Clinical Dementia Rating (CDR) e o Índice de Katz. Para os cuidadores, predominou o sexo feminino (88,2%), com média de idade de 51,9 (± 12,0), estado civil casado (55,3%), nível educacional acima de nove anos de estudo (77,6%) e renda per capita de até um salário (43,6%). A maior média de qualidade de vida foi encontrada no domínio físico e a menor no ambiental. Encontrou-se relação estatisticamente significativa entre a capacidade funcional e a sobrecarga. Correlação inversa estatisticamente significativa foi evidenciada entre sobrecarga e qualidade de vida. Os achados desta pesquisa sugerem que o declínio funcional dos idosos com demência mostrou exercer influência sobre a sobrecarga dos cuidadores principais, onde foi identificado maior sobrecarga com níveis intermediários de demência.(AU)

The present study aimed to analyze the influence of the functional decline of elderly people with dementia related to the burden and the quality of life of their main caregivers. This is a cross-sectional study carried out in the city of Maceió, Alagoas. The sample consisted of 170 individuals, 85 caregiver/elderly pairs, the elderly being diagnosed with dementia syndrome and their respective main caregivers. The data were collected through interviews with the application of validated scales. Caregiver burden and quality of life were assessed using the Zarit Burden Interview and Whoqol-bref scale, respectively, and the cognitive status and functional capacity of the elderly with the Clinical Dementia Rating (CDR) and the Katz Index. The caregivers were predominately female (88.2%), with a mean age of 51.9 (± 12.0) years old, married marital status (55.3%), educational level above nine years of study (77, 6%) and per capita income of up to one salary (43.6%). The highest average quality of life was found in the physical domain and the lowest in the environmental domain. A statistically significant relationship was found between functional capacity and burden. A statistically significant inverse correlation was found between burden and quality of life. The findings of this research suggest that(AU)

Association between vitamin D and cardioprotection in adult patients.

OBJECTIVE: To conduct a review of articles which have evaluated the relationship between vitamin D and cardioprotection in adult. METHODS: A literature search was performed in the Pubmed and Scielo databases. The results were extracted from primary and secondary sources and will be presented in the form of a bibliographic review. RESULTS: Twenty-three articles were identified from the electronic search that reported on physiological mechanisms relating the vitamin D axis and the cardiovascular system through receptors. Of the ten studies that evaluated the therapeutic effect of vitamin D in cardiovascular diseases, none reported significant results. CONCLUSION: The articles assessed in this review did not demonstrate a cardioprotective effect of vitamin D, despite the epidemiological correlation of vitamin D deficiency with a higher prevalence of cardiovascular diseases.

Association between vitamin D and cardioprotection in adult patients

SUMMARY OBJECTIVE: To conduct a review of articles which have evaluated the relationship between vitamin D and cardioprotection in adult. METHODS: A literature search was performed in the Pubmed and Scielo databases. The results were extracted from primary and secondary sources and will be presented in the form of a bibliographic review. RESULTS: Twenty-three articles were identified from the electronic search that reported on physiological mechanisms relating the vitamin D axis and the cardiovascular system through receptors. Of the ten studies that evaluated the therapeutic effect of vitamin D in cardiovascular diseases, none reported significant results. CONCLUSION: The articles assessed in this review did not demonstrate a cardioprotective effect of vitamin D, despite the epidemiological correlation of vitamin D deficiency with a higher prevalence of cardiovascular diseases.

Association between visual impairment and depression in the elderly: a systematic review.

A systematic review was conducted to investigate the relationship between visual impairment and depression in the elderly. We searched electronic databases (LILACS, SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials) from inception to August 2014 and researched the described references. The search strategy used the following terms: (visual impairment or blindness) and (elderly) and (depression). Of the 641 electronics, 42 works were selected in full and another 20 were identified as being possibly relevant. Ten studies were included. The studies ranged in sample size from 31 to 21,995 participants. Depression was associated with visual impairment in all studies; however, without standardization of diagnostic tests, we could not conduct a meta-analysis or establish a relationship between visual impairment and depression in the elderly.

Association between visual impairment and depression in the elderly: a systematic review / Associação entre deficiência visual e depressão em idosos: uma revisão sistemática

ABSTRACT A systematic review was conducted to investigate the relationship between visual impairment and depression in the elderly. We searched electronic databases (LILACS, SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials) from inception to August 2014 and researched the described references. The search strategy used the following terms: (visual impairment or blindness) and (elderly) and (depression). Of the 641 electronics, 42 works were selected in full and another 20 were identified as being possibly relevant. Ten studies were included. The studies ranged in sample size from 31 to 21,995 participants. Depression was associated with visual impairment in all studies; however, without standardization of diagnostic tests, we could not conduct a meta-analysis or establish a relationship between visual impairment and depression in the elderly.

RESUMO A revisão sistemática foi realizada para investigar a correlaçõa entre deficiência visual e depressão em idosos. Foram pesquisados nas bases eletrônicas (LILACS, SCIELO, MEDLINE e Cochrane Central Register of Controlled Trials) do início até agosto de 2014 e pesquisas de referências descritas. A estratégia de busca utilizou os termos: (deficiência visual ou cegueira) e (idosos) e (depressão). Dos 641 eletrônicos, 42 trabalhos na íntegra foram selecionados e mais 20 trabalhos foram identificados como possivelmente relevantes da lista destes. Do total de estudos, 10 foram incluidos. Os estudos variaram entre 31 e 21.995 participantes. A depressão foi relacionada com deficiência visual em todos os estudos, mas sem padronização de testes diagnósticos não foi possível realizar a metanálise, nem estabelecer relação entre deficiência visual e depressão em idosos.

Fecal occult blood test and flexible rectosigmoidoscopy: tools for the screening of colorectal neoplasms in asymptomatic patients / Teste de sangue oculto nas fezes e retossigmoidoscopia flexível: instrumentos para o rastreamento de neoplasias colorretais em pacientes assintomáticos

PURPOSE: To assess the feasibility and effectiveness of the fecal occult blood test (FOBT) and flexible rectosigmoidoscopy (RSS), as tools used in the CRC screening, in asymptomatic patients, from 50 years of age. METHODS: The study is transversal and presents a sample of 102 individuals. The FOBT used was the guaiaco, FECA-CULT(r) method, held at a single time, in feces collected from a complete evacuation. Individuals, who presented the positive FOBT, were sent to colonoscopy complement, although this is not primary variable examined in this study. All subjects underwent to flexible RSS, after bowel preparation, using a solution of sodium phosphate monobasic monohydrate and dibasic sodium phosphate heptahydrate. RESULTS: Individuals showed minimum age of 50 years and maximum 82 years, 61.6 years average and standard deviation +8.1. Of the 102 individuals, 42 (41%) belong to the males, whereas 60 (58.8%) female. The FOBT presented 10 positive cases (9.8%) (IC 95%: 4.8-17.3%) and 92 negative cases (90.2%) (IC 95%; 82.7-95.2%). The FOBT was effective at 2.9% and presented false-positive result in 6.9%. The result of the FBOT association with flexible RSS showed that 70% of neoplastic polyps showed no bleeding. Its sensitivity was 30% (IC 95%: 0.00-63.40%), the value of the relative risk was 3.94 (IC 95%: 1.20-12.89) and 5.20 valued odds ratio (IC 95%: -23.15 to 1.21). The specificity was 92.40% (IC 95%: 86.43-98.35%). The flexible RSS detected 15 polyps, among which, after histopathological study, 10 were neoplastic, being 09 adenomatous polyps (60%) and 01 malignity (6.7%) (IC 95%: 0.20-31.90%) and 05 non-neoplastic polyps (33.3%), and 03 inflammatory polyps (20%) (IC 95%: 4.3-48.1%) and 02 hyperplastic polyps (13.3%) (IC 95%: 1.7-40.5%). Neoplastic polyps were present in 60% of individuals over 60 years of age. Among the adenomatous polyps, the adenomatous polyp tubular prevalence is 53.33%. Among the 102 individuals, flexible RSS detected 09 adenomatous polyps (8.82%) and 01 (0.98%) malignity polyp. CONCLUSION: The tools FOBT and flexible RSS presented feasibility and, when associated demonstrated statistical significance in detecting polyps in general and important clinical significance on the detection of adenomatous polyps and colorectal cancer. (AU)

OBJETIVO: Avaliar a viabilidade e eficácia do teste de sangue oculto nas fezes (TSOF) e retossigmoidoscopia (RSS) flexível, como instrumentos utilizados na triagem do CCR, em pacientes assintomáticos a partir dos 50 anos. MÉTODOS: Esse é um estudo transversal e apresenta uma amostra de 102 indivíduos. O TSOF utilizado foi o método do guaiaco FECA-CULT(r), realizado em uma única vez, em fezes coletadas de uma evacuação completa. Indivíduos com TSOF positivo foram encaminhados para o complemento de colonoscopia, embora essa não seja a variável primária examinada neste estudo. Todos os pacientes foram submetidos a uma RSS flexível, após a preparação do intestino com o uso de uma solução de fosfato de sódio monobásico mono-hidratado e de fosfato de sódio dibásico hepta-hidratado. RESULTADOS: Os participantes tinham idade mínima de 50 anos e máxima de 82 anos (média ± desvio padrão, 61,6 ± 8,1 anos). Dos 102 pacientes, 42 (41%) eram homens, enquanto 60 (58,8%) eram mulheres. O TSOF revelou 10 casos positivos (9,8%) (IC 95%: 4,8-17,3%) e 92 casos negativos (90,2%) (IC 95%; 82,7-95,2%). O TSOF foi eficaz em 2,9% e apresentou resultado falso-positivo em 6,9%. O resultado da associação de TSOF com RSS flexível demonstrou que 70% dos pólipos neoplásicos não exibiam qualquer sangramento. Sua sensibilidade foi de 30% (IC 95%: 0,00-63,40%), com risco relativo de 3,94 (IC 95%: 1,20-12,89) e razão de sensibilidade (odds ratio) de 5,20 (IC 95%: 1,21-23,15). A especificidade da associação foi de 92,40% (IC 95%: 86,43-98,35%). A RSS flexível detectou 15 pólipos, tendo sido contatado que, depois do estudo histopatológico, 10 eram neoplásicos: 9 pólipos adenomatosos (60%) e 1 malignidade (6,7%) (IC 95%: 0,20-31,90%). Além disso, a RSS flexível detectou 5 pólipos não neoplásicos (33,3%): 3 pólipos inflamatórios (20%) (IC 95%: 4,3-48,1%) e 2 pólipos hiperplásicos (13,3%) (IC 95%: 1,7% -40,5%). Os pólipos neoplásicos estavam presentes em 60% dos pacientes com mais de 60 anos de idade. Entre os pólipos adenomatosos, houve prevalência tubular de pólipos adenomatosos em 53,33%. Entre os 102 indivíduos, a RSS flexível detectou 9 pólipos adenomatosos (8,82%) e 1 (0,98%) pólipo maligno. CONCLUSÃO: Foi constatada a viabilidade dos instrumentos TSOF e RSS flexível; quando associados, demonstraram significância estatística na detecção de pólipos em geral e importante significado clínico para a detecção de pólipos adenomatosos e do câncer colorretal. (AU)

Comparative study of 1, 2-dimethylhydrazine and azoxymethane on the induction of colorectal cancer in rats / Estudo comparativo das substâncias 1, 2-dimetil-hidrazina e azoximetano na indução de câncer colorretal em ratos

The induced colorectal carcinogenesis in rodents has a long history and currently uses the substances 1,2-dimethylhydrazine and azoxymethane. Objective: The aim of this study was to compare the inductive effect of the substances azoxymethane and 1,2-dimethylhydrazine in colorectal carcinogenesis. Method: 30 randomly chosen male Wistar rats were divided into four groups. G1 group was treated with 1,2-dimethylhydrazine and C1 was its control group; G2 group was treated azoxymethane and C2 was its control group. The animals were weekly weighed until euthanasia, when their intestines were removed, processed and analyzed by an experienced pathologist. Results: Among the control groups (C1 and C2) no histologic changes were observed; moderate dysplasia was detected in G2 group; hyperplasia, mild dysplasia, severe dysplasia and carcinoma were observed in G1 group. When this study compared the cost of the substances, 1,2-dimethylhydrazine was more than 50 times less expensive than azoxymethane. Conclusion: Azoxymethane is able to promote histological changes consistent with colorectal carcinogenesis. 1,2-Dimethylhydrazine produced neoplasia and dysplasia, and, compared to the azoxymethane, was more efficient in the induction of colorectal cancer. (AU)

A carcinogênese colorretal induzida em roedores tem longa história e utiliza, atualmente, as substâncias 1,2 dimetil-hidrazina (DMH) e azoximetano (AOM). Objetivo: Comparar o efeito indutivo das substâncias AOM e DMH para o câncer colorretal (CCR). Método: 30 ratos Wistar machos foram randomizados em quatro grupos. O grupo G1 foi inoculado com DMH, o grupo C1 foi seu controle; G2 recebeu o AOM e C2 foi seu controle. Os animais foram pesados semanalmente até a eutanásia, quando tiveram seus intestinos retirados, processados e analisados por um patologista experiente. Resultados: Os animais dos grupos de controle apresentaram tecido colorretal normal e os animais do grupo G2 apresentaram um padrão de displasia moderada. Nas lâminas do grupo G1, foram encontradas regiões de hiperplasia, displasia leve, displasia grave, e carcinoma. Comparado o custo das substâncias AOM e DMH, este último teve um preço mais de 50 vezes menor ao do AOM. Conclusão: AOM é capaz de promover alterações histológicas compatíveis com a carcinogênese colorretal. DMH produziu neoplasia e displasia grave e, comparada ao AOM, foi mais eficiente na indução do câncer colorretal. (AU)

Síndrome de Burnout em médicos docentes de uma instituição pública

Trata-se de um estudo correlacional e de comparação entre participantes, em que foram considerados dois conjuntos principais de variáveis: critério (síndrome de burnout e fadiga) e antecedentes (estresse no trabalho e indicadores de situação de trabalho). Participaram deste estudo 60 professores/médicos de instituições públicas de ensino superior de Maceió - AL, sendo 36 (60%) homens e 24 (40%) mulheres, com idade variando de 32 até 67 anos (M = 52,31; DP = 8,41). Os participantes foram solicitados a responder a: (a) o Inventário de Burnout de Maslach; (b) a Escala de Avaliação da Fadiga; (c) a Escala de Estresse no Trabalho; além de (d) fornecer suas características sociodemográficas. Evidenciou-se que o estresse no trabalho tem implicações negativas, como a síndrome de burnout e a fadiga. Por fim, chama-se a atenção para necessidade de intervenção e de mais estudos junto a esta população.(AU)

This is a correlational and comparative study among participants, in which two main variable groups were considered: criteria (burnout syndrome and fatigue) and antecedents (work stress and work situation indicators). Sixty teaching physicians from higher education public institutions in Maceió, State of Alagoas, Brazil, participated in this study, including 36 (60%) men and 24 (40%) women, with average age between 32 and 67 years old (m= 52,21; SD=8,41). The participants were requested to answer the Maslach's Burnout Inventory, the Fatigue Evaluation Scale, the Work Stress Scale, and to give their socio-demographic characteristics. It was shown that work stress has negative effects such as burnout syndrome and fatigue, and argued that more studies and interventions in this population are needed.(AU)

Síndrome de burnout em médicos docentes de uma instituição pública / The burnout syndrome in teaching physicians from a public service institution

Trata-se de um estudo correlacional e de comparação entre participantes, em que foram considerados dois conjuntos principais de variáveis: critério (síndrome de burnout e fadiga) e antecedentes (estresse no trabalho e indicadores de situação de trabalho). Participaram deste estudo 60 professores/médicos de instituições públicas de ensino superior de Maceió - AL, sendo 36 (60%) homens e 24 (40%) mulheres, com idade variando de 32 até 67 anos (M = 52,31; DP = 8,41). Os participantes foram solicitados a responder a: (a) o Inventário de Burnout de Maslach; (b) a Escala de Avaliação da Fadiga; (c) a Escala de Estresse no Trabalho; além de (d) fornecer suas características sociodemográficas. Evidenciou-se que o estresse no trabalho tem implicações negativas, como a síndrome de burnout e a fadiga. Por fim, chama-se a atenção para necessidade de intervenção e de mais estudos junto a esta população.

This is a correlational and comparative study among participants, in which two main variable groups were considered: criteria (burnout syndrome and fatigue) and antecedents (work stress and work situation indicators). Sixty teaching physicians from higher education public institutions in Maceió, State of Alagoas, Brazil, participated in this study, including 36 (60%) men and 24 (40%) women, with average age between 32 and 67 years old (m= 52,21; SD=8,41). The participants were requested to answer the Maslach's Burnout Inventory, the Fatigue Evaluation Scale, the Work Stress Scale, and to give their socio-demographic characteristics. It was shown that work stress has negative effects such as burnout syndrome and fatigue, and argued that more studies and interventions in this population are needed.(AU)

Analysis of the immunohistochemical expressions of p53, bcl-2 and Ki-67 in colorectal adenocarcinoma and their correlations with the prognostic factors.

CONTEXT: Search of tumors markers that allow treatment with higher survival rates, and indicate the response to treatment and recurrence of cancer OBJECTIVE: To analyze the immunoexpression of the proteins p53, bcl-2 and Ki-67 in colorectal adenocarcinoma and correlate them with the clinical-pathological prognostic factors. METHOD: Tissue microarray paraffin blocks were made from colorectal adenocarcinoma tissue resected from 82 patients who had undergone surgery but not chemotherapy or radiotherapy, at "Hospital São Paulo", São Paulo, SP, Brazil, between 2002 and 2005. Thin sections (4 microm) were subjected to immunohistochemical reactions, and immunoexpression staining scores were obtained. The scores were correlated with the degree of cell differentiation, staging, disease-free interval, recurrence, survival and specific mortality. The study variables were analyzed using the chi-square and Kaplan-Meier tests to investigate associations with the markers. The significance of the differences between the curves of the disease-free interval and survival was analyzed using the Logrank and Wilcoxon tests. RESULTS: The immunohistochemical expression of p53 was positive in 70 tumors (85.4%) and negative in 12 (14.6%). The expression of bcl-2 was positive in 26 (31.7%) and negative in 56 (68.3%). The expression of Ki-67 was positive in 62 (75.6%) and negative in 20 (24.4%). There was no statistically significant correlation between the expressions of these markers separately or in conjunction, in relation to the degree of cell differentiation, staging, disease-free interval, survival and specific mortality. In relation to recurrence, there was a statistically significant correlation with positive expression of Ki-67 (P = 0.035). CONCLUSION: The immunohistochemical expression of Ki-67 in colorectal cancer is associated with recurrence of this disease.

Analysis of the immunohistochemical expressions of p53, bcl-2 and Ki-67 in colorectal adenocarcinoma and their correlations with the prognostic factors / Análise das expressões imunoistoquímicas da p53, bcl-2 e Ki-67 no adenocarcinoma colorretal e suas correlações com os fatores prognósticos

CONTEXT: Search of tumors markers that allow treatment with higher survival rates, and indicate the response to treatment and recurrence of cancer OBJECTIVE: To analyze the immunoexpression of the proteins p53, bcl-2 and Ki-67 in colorectal adenocarcinoma and correlate them with the clinical-pathological prognostic factors. METHOD: Tissue microarray paraffin blocks were made from colorectal adenocarcinoma tissue resected from 82 patients who had undergone surgery but not chemotherapy or radiotherapy, at "Hospital São Paulo", São Paulo, SP, Brazil, between 2002 and 2005. Thin sections (4 µm) were subjected to immunohistochemical reactions, and immunoexpression staining scores were obtained. The scores were correlated with the degree of cell differentiation, staging, disease-free interval, recurrence, survival and specific mortality. The study variables were analyzed using the chi-square and Kaplan-Meier tests to investigate associations with the markers. The significance of the differences between the curves of the disease-free interval and survival was analyzed using the Logrank and Wilcoxon tests. RESULTS: The immunohistochemical expression of p53 was positive in 70 tumors (85.4 percent) and negative in 12 (14.6 percent). The expression of bcl-2 was positive in 26 (31.7 percent) and negative in 56 (68.3 percent). The expression of Ki-67 was positive in 62 (75.6 percent) and negative in 20 (24.4 percent). There was no statistically significant correlation between the expressions of these markers separately or in conjunction, in relation to the degree of cell differentiation, staging, disease-free interval, survival and specific mortality. In relation to recurrence, there was a statistically significant correlation with positive expression of Ki-67 (P = 0.035). CONCLUSION: The immunohistochemical expression of Ki-67 in colorectal cancer is associated with recurrence of this disease.

CONTEXTO: Pesquisa de marcadores tumorais que permitam tratamento com maiores índices de sobrevida, além de indicarem a resposta ao tratamento e a recurrência da neoplasia. OBJETIVO: Analisar as expressões imunoistoquímicas das proteínas p53, bcl-2 e Ki-67 no adenocarcinoma colorretal, correlacionando-as com os fatores prognósticos clínico-patológicos. MÉTODO: Foram confeccionados blocos de parafina de TMA com tecido de adenocarcinoma colorretal ressecados cirurgicamente em 82 pacientes no Hospital São Paulo da Universidade Federal der São Paulo, São Paulo, SP, de 2002 a 2005, não submetidos a radio ou quimioterapia. Cortes de 4 µm foram submetidos a reação imunoistoquímica e obtidos escores de intensidade das imunoexpressões, que foram correlacionados com o grau de diferenciação celular, estádio, tempo livre de doença, recidiva, sobrevida e mortalidade específica. As variáveis do estudo foram analisadas pelos testes do qui ao quadrado e de Kaplan-Meier para verificar as associações com os marcadores. A significância das diferenças entre as curvas do tempo livre de doença e da sobrevida foi analisada pelos testes de Logrank e Wilcoxon. RESULTADOS: A expressão imunoistoquímica da p53 foi positiva em 70 tumores (85,4 por cento) e negativa em 12 (14,6 por cento). A bcl-2 foi positiva em 26 tumores (31,7 por cento) e negativa em 56 (68,3 por cento). A expressão imunoistoquímica da Ki-67 foi positiva em 62 tumores (75,6 por cento), sendo em 20 (24,4 por cento) negativa. Não houve correlação estatisticamente significante entre as expressões imunoistoquímicas dos marcadores analisadas separadamente ou em conjunto, envolvendo o grau de diferenciação celular, estádio, tempo livre de doença, sobrevida e mortalidade específica. Com relação à recidiva, observou-se correlação estatisticamente significante com a expressão imunoistoquímica positiva da Ki-67 (P = 0,035). CONCLUSÃO: A expressão imunoistoquímica positiva da Ki-67 no câncer colorretal está...

Applications of magnesium sulfate in obstetrics and anesthesia.

BACKGROUND AND OBJECTIVES: Magnesium is predominantly an intracellular ion. Its blocking effects on NMDA receptors are responsible for the analgesic and sedative characteristics of this ion. The objective of this study was to review the physiology, pharmacology, and decreased plasma levels of magnesium, as well as its applications in obstetrics and anesthesia. CONTENTS: Magnesium is an intracellular cation with multiple functions: it is a cofactor for enzymes of the glucose metabolism and those that participate in the degradation of nucleic acids, proteins, and fatty acids; it regulates the movements of transmembrane ions; and it intervenes in the activity of several enzymes. Critical patients have a tendency to develop hypomagnesemia, and the treatment consists in correcting the cause, whenever possible, and replacement of magnesium. A reduction in the minimum alveolar concentration (MAC) of inhalational agents in animals and the use of opioids in humans under anesthesia has been demonstrated. CONCLUSIONS: Magnesium sulfate has been used in obstetrics with good results, inhibiting premature labor and in the treatment of eclampsia-associated seizures. It is potentially analgesic and sedative, and could be used as adjuvant during general anesthesia, attenuating the blood pressure response to tracheal intubation and decreasing the need of anesthetics.

Usos do sulfato de magnésio em obstetrícia e em anestesia: [revisão] / Applications of Magnesium Sulfate in Obstetrics and Anesthesia: [review] / Usos del sulfato de magnesio en obstetricia y en anestesia: [revisión]

Justificativa e objetivos: O magnésio é um íon predominantemente intracelular. Seu efeito bloqueador do receptor NMDA lhe confere características analgésicas e sedativas. O objetivo desse artigo foi revisar a fisiologia, a farmacologia e a diminuição da concentração plasmática do magnésio, assim como algumas das suas aplicações em obstetrícia e em anestesia. Conteúdo: O magnésio é um cátion intracelular que possui múltiplas funções: é cofator de enzimas do metabolismo glicídico e de enzimas da degradação dos ácidos nucleicos, proteínas e ácidos graxos; regula a passagem de íons transmembrana e intervém na atividade de várias enzimas. O paciente em estado crítico apresenta tendência à hipomagnesemia e o tratamento consiste em corrigir a causa quando possível acompanhada da reposição do magnésio. Já foi demonstrada a redução da concentração alveolar mínima (CAM) dos agentes inalatórios em animais e do uso de opioides em humanos sob anestesia. Conclusões: O sulfato de magnésio vem sendo utilizado em obstetrícia com boa efetividade para inibição do trabalho de parto prematuro e para o tratamento das crises convulsivas associadas ao quadro de eclâmpsia. É um fármaco com potencial analgésico e sedativo que pode ser utilizado como coadjuvante durante a anestesia geral atenuando a resposta pressórica à intubação traqueal e diminuindo a necessidade de anestésicos.

Background and objectives: Magnesium is predominantly an intracellular ion. Its blocking effects on NMDA receptors are responsible for the analgesic and sedative characteristics of this ion. The objective of this study was to review the physiology, pharmacology, and decreased plasma levels of magnesium, as well as its applications in obstetrics and anesthesia. Contents: Magnesium is an intracellular cation with multiple functions: it is a cofactor for enzymes of the glucose metabolism and those that participate in the degradation of nucleic acids, proteins, and fatty acids; it regulates the movements of transmembrane ions; and it intervenes in the activity of several enzymes. Critical patients have a tendency to develop hypomagnesemia, and the treatment consists in correcting the cause, whenever possible, and replacement of magnesium. A reduction in the minimum alveolar concentration (MAC) of inhalational agents in animals and the use of opioids in humans under anesthesia has been demonstrated. Conclusions: Magnesium sulfate has been used in obstetrics with good results, inhibiting premature labor and in the treatment of eclampsia-associated seizures. It is potentially analgesic and sedative, and could be used as adjuvant during general anesthesia, attenuating the blood pressure response to tracheal intubation and decreasing the need of anesthetics.

Justificativa y objetivos: El magnesio es un ión predominantemente intracelular. Su efecto bloqueador del receptor NMDA le confiere características analgésicas y sedativas. El objetivo de este artículo, fue revisar la fisiología, la farmacología y la disminución de la concentración plasmática del magnesio, como también de algunas de sus aplicaciones en obstetricia y en anestesia. Contenido: El magnesio es un catión intracelular que posee múltiples funciones: es cofactor de enzimas del metabolismo glicídico y de enzimas de la degradación de los ácidos nucleicos, proteínas y ácidos grasos; regula el paso de los iones transmembrana e interviene en la actividad de varias enzimas. El paciente en estado crítico, presenta una tendencia a la hipomagnesemia, y el tratamiento consiste en corregir la causa cuando es posible, acompañada de la reposición del magnesio. Ya ha quedado demostrada la reducción de la concentración alveolar mínima (CAM), de los agentes inhalatorios en animales y el uso de opioides en humanos bajo anestesia. Conclusiones: El sulfato de magnesio, ha venido siendo utilizado en obstetricia con una buena efectividad para la inhibición del parto prematuro y para el tratamiento de las crisis convulsivas asociadas al cuadro de eclampsia. Es un fármaco con potencial analgésico y sedativo que puede ser utilizado como coadyuvante durante la anestesia general, atenuando la respuesta presórica a la intubación traqueal y disminuyendo la necesidad del uso de anestésicos.

Correlation between the immunohistochemical expressions of MMP-1, MMP-7 and VEGF and prognostic factors in colorectal adenocarcinoma.

PURPOSE: To analyze the expression of metalloproteinase-1, metalloproteinase-7 and vascular endothelial growth factor (VEGF) in colorectal adenocarcinoma, and to correlate these with the clinical-pathological prognostic factors. METHODS: Tumor tissue from 82 patients was fixed in formalin and embedded in paraffin blocks. These samples were analyzed by means of the streptavidin-biotin immunohistochemical method, using the tissue microarray technique. Marker positivity was evaluated using categorical scores that determined cutoff percentages of stained tumor cells. Protein tissue expression was correlated with the variables of degree of cell differentiation, staging, disease-free interval, recurrence, survival and specific mortality. The Fisher exact and Kaplan-Meier tests were used to assess associations between the markers and the study variables. The log-rank and Wilcoxon tests were used to assess the significance of differences between curves of disease-free interval and survival. RESULTS: All tumors were positive for metalloproteinase-1; 50 (61%) were positive and 32 (39%) were negative for metalloproteinase-7; and 60 (74.1%) were positive and 21 (25.9%) were negative for VEGF. Correlation of marker expression, both in groups and individually, did not show statistical significance in relation to the degree of cell differentiation, staging, disease-free interval, survival or specific mortality. Recurrence showed a statistically significant correlation with positive expression of the three markers, when analyzed as a group (p = 0.038). CONCLUSION: The associated expression of metalloproteinase-1, metalloproteinase-7 and VEGF in colorectal adenocarcinoma is related to the incidence of disease recurrence.

Correlation between the immunohistochemical expressions of MMP-1, MMP-7 and VEGF and prognostic factors in colorectal adenocarcinoma / Correlação entre as expressões imunohistoquímicas da MMP-1, MMP-7 e do VEGF no adenocarcinoma colorretal com fatores prognósticos

PURPOSE: To analyze the expression of metalloproteinase-1, metalloproteinase-7 and vascular endothelial growth factor (VEGF) in colorectal adenocarcinoma, and to correlate these with the clinical-pathological prognostic factors. METHODS: Tumor tissue from 82 patients was fixed in formalin and embedded in paraffin blocks. These samples were analyzed by means of the streptavidin-biotin immunohistochemical method, using the tissue microarray technique. Marker positivity was evaluated using categorical scores that determined cutoff percentages of stained tumor cells. Protein tissue expression was correlated with the variables of degree of cell differentiation, staging, disease-free interval, recurrence, survival and specific mortality. The Fisher exact and Kaplan-Meier tests were used to assess associations between the markers and the study variables. The log-rank and Wilcoxon tests were used to assess the significance of differences between curves of disease-free interval and survival. RESULTS: All tumors were positive for metalloproteinase-1; 50 (61 percent) were positive and 32 (39 percent) were negative for metalloproteinase-7; and 60 (74.1 percent) were positive and 21 (25.9 percent) were negative for VEGF. Correlation of marker expression, both in groups and individually, did not show statistical significance in relation to the degree of cell differentiation, staging, disease-free interval, survival or specific mortality. Recurrence showed a statistically significant correlation with positive expression of the three markers, when analyzed as a group (p = 0.038). CONCLUSION: The associated expression of metalloproteinase-1, metalloproteinase-7 and VEGF in colorectal adenocarcinoma is related to the incidence of disease recurrence.

OBJETIVO: Analisar as expressões da metaloproteinase-1, metaloproteinase-7 e do fator de crescimento endotelial vascular no adenocarcinoma colorretal e correlacionar com os fatores prognósticos clínico-patológicos. MÉTODOS: Foram analisados tecidos fixados em formol e dispostos em blocos de parafina dos tumores de 82 pacientes, por imunohistoquímica, pelo método da estreptavidina-biotina, usando-se a técnica de arranjo em matriz de amostras teciduais (tissue microarray). Na avaliação da positividade dos marcadores foi utilizado um escore categórico, que predeterminou o valor de corte na percentagem de células coradas do tumor. As expressões teciduais das proteínas foram correlacionadas com as varáveis representadas pelo grau de diferenciação celular, estadiamento, tempo livre de doença, recidiva, sobrevida e mortalidade específica. Foram empregados os testes exato de Fisher e de Kaplan-Meier para verificar as associações dos marcadores com as varáveis estudadas. Para testar a significância das diferenças entre as curvas do tempo livre de doença e da sobrevida foram utilizados os testes de longrank e Wilcoxon. RESULTADOS: A metaloproteinase-1 foi positiva em todos os tumores. A metaloproteinase-7 foi positiva em 50 (61 por cento) e negativa em 32 (39 por cento) tumores. O fator de crescimento endotelial vascular foi positivo em 60 (74,1 por cento) e negativo em 21 (25,9 por cento) tumores. A correlação das expressões dos marcadores realizada separadamente e em conjunto não apresentou significância estatística com o grau de diferenciação celular, estadiamento, tempo livre de doença, sobrevida e mortalidade específica. A recidiva apresentou correlação estatística significante com a expressão positiva dos três marcadores, quando foram analisados em conjunto (p = 0,038). CONCLUSÃO: As expressões associadas da metaloproteinase-1, metaloproteinase-7 e do fator de crescimento endotelial vascular no adenocarcinoma colorretal se relacionam com ...

Artificial oxygen carriers as a possible alternative to red cells in clinical practice.

Fluid resuscitation is intended to eliminate microcirculatory disorders and restore adequate tissue oxygenation. The safety limits for a restrictive transfusion policy are given by patients' individual tolerance of acute normovolemic anemia. Artificial oxygen carriers based on perfluorocarbon or hemoglobin are attractive alternatives to allogenic red blood cells. There are many risks involved in allogenic blood transfusions and they include transmission of infections, delayed postoperative wound healing, transfusion reactions, immunomodulation and cancer recurrence. Regardless of whether artificial oxygen carriers are available for routine clinical use, further studies are needed in order to show the safety and efficacy of these substances for clinical practice.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy.

PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

Neuroaxis block compared to general anesthesia for revascularization of the lower limbs in the elderly. A systematic review with metanalysis of randomized clinical studies.

BACKGROUND AND OBJECTIVES: Currently, it is controversial on whether neuroaxis block (NB) is more effective than general anesthesia (GA) in elderly individuals undergoing non-cardiac surgeries. The objective of this study was to determine the efficiency of NB in comparison to GA for revascularization of the lower limbs (RLL) in the elderly. METHODS: A search of the following data base was conducted: MEDLINE (1955 to 2007), CINHAL (1982 to 2007), EMBASE (1980 to 2007), LILACS (1982 to 2007), and ISI (1945 to 2007). Two investigators undertook an independent analysis of the studies published to identify randomized clinical trials (RCTs) comparing NB with GA for RLL. The full text of the RCTs that fulfill the inclusion criteria was analyzed. Disagreements were analyzed in consensus meetings. The software Review Manager was used for the Metanalysis by means of odds ratio with a confidence interval of 95%. RESULTS: Three studies involving 465 patients were selected. Metanalysis of the following parameters did not show statistically significant differences: mortality (OR: 0.90; CI 95%: 0.30-2.73; p = 0.85 for spinal anesthesia; OR: 1.30, CI 95%: 0.38-4.48, p = 0.68, for epidural block); myocardial infarction (OR: 1.38, CI 95%: 0.29-6.46, p = 0.68); and rate of lower limb amputation (OR: 0.81, CI 95%: 0.30-2.19, p = 0.68, for spinal block; OR: 0.70, CI 95%: 0.24-2.07, p = 0.52 for epidural block). A statistically significant difference was observed for pneumonia (OR: 0.37, CI 95%: 0.15-0.89, p = 0.03); however, clinical heterogeneity was present. CONCLUSIONS: This metanalysis did not generate enough evidence to demonstrate that NB is more efficient, equivalent, or less efficient than GA for RLL in the elderly.

Assessing the quality of random clinical anesthesiology trials published on the Brazilian Journal of Anesthesiology from 2005 to 2008.

BACKGROUND AND OBJECTIVES: A random clinical trial (RCT) is defined as a study involving intervention and control groups with random distribution of the participants. The objective of the present study was to assess the quality of RCT in anesthesiology published during a specific time. DESIGN OF THE STUDY: descriptive. METHODS: A manual search of the articles published by the Brazilian Journal of Anesthesiology between January 2005 and February 2008 was undertaken to identify studies with characteristics of RCTs. The quality of RCTs was the primary parameter; secondary parameters included: approval by the Ethics on Research Committee (ERC), use of the informed consent (IC), description of the source of the grant, the sample size was calculated, number of authors, place of origin, statistical tests used, level of significance adopted, and classification of the type of study. The quality scale, descriptive statistics, and calculation of the 95% confidence interval were used to evaluate the quality of the RCTs. RESULTS: Out of 114 studies, 42 were identified as RCT. Only 3 (7.1%) of those were classified as having good methodological quality considering the random distribution, double blind, losses, and exclusions. One-hundred and seven out of 114 studies were submitted to the ERC, 67 used IC, none of them described the source of the grant, 17 calculated the size of the sample, the studies had a mean of 4.49 authors; 60 publications were from São Paulo; the Student t test was used more often (47.4%), a level of significance of 5% was adopted by 97 studies; and 42 were RCTs. CONCLUSIONS: After the manual search, 7.1% of the random clinical assays were considered of good methodological quality.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy / Quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo em ratos Wistar submetidos à gastrojejunostomia

PURPOSE: To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS: Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info®, version 3.4.3. RESULTS: Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION: Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

OBJETIVO: Avaliar a quimioprevenção pelo celecoxibe no adenocarcinoma gástrico induzido por refluxo, em ratos Wistar, submetidos a gastrojejunostomia. MÉTODOS: Sessenta ratos machos Wistar, com média de idade de três meses foram operados e distribuídos em 03 grupos: Grupo 1 - Os animais foram submetidos a laparotomia exploradora. Grupo 2 - Os animais foram submetidos a gastrojejunostomia. Grupo 3 - Os animais foram submetidos a gastrojejunostomia e tomaram celecoxib, diariamente. Após um período de 53 semanas, os animais foram sacrificados. As alterações da mucosa do corpo gástrico dos animais do grupo 1 e da anastomose gastrojejunal dos animais dos grupos 2 e 3 foram analisadas no exame histopatológico e imuno-histoquímica e foram comparadas. Todas as análises estatísticas foram realizadas pelo programa Epi Info®, versão 3.4.3. RESULTADOS: No cotejo entre os animais dos grupos 2 e 3 com relação à presença de adenocarcinoma observou-se uma diferença estatística significante (p=0,0023). A análise de associação entre os grupos 2 e 3 com relação à expressão da COX-2, também evidenciou uma diferença estatística significante (p=0,0018). CONCLUSÃO: O celecoxib teve efeito inibidor da carcinogênese gástrica, induzida pelo refluxo em ratos.