Parâmetros de qualidade físico-químicos e avaliação da atividade antioxidante de folhas de Plectranthus barbatus Andr. (Lamiaceae) submetidas a diferentes processos de secagem / Quality of the leaves of Plectranthus barbatus Andr. (Lamiaceae) dried in solar dryer and oven

RESUMO O presente trabalho descreve a composição físico-química, a avaliação da atividade antioxidante pelo método de sequestro de radicais livres DPPH, determinação de flavonoides e de fenóis totais dos extratos etanol, acetona e aquoso de Plectranthus barbatus Andr. (Lamiaceae), desidratadas em secador solar e em estufa de circulação de ar a 60 oC. Os valores de atividade de água encontrados para as duas secagens foram inferiores ao mínimo necessário para o crescimento e produção de toxina de patógenos de importância alimentar. Os resultados das análises físico-químicas demonstraram que ambos os processos mostraram-se eficientes na desidratação de P. barbatus. Os resultados demonstraram que os extratos acetona (estufa) e etanol (estufa e secador solar) foram os que apresentaram maior conteúdo de fenóis totais. O extrato etanólico (estufa) apresentou maior quantidade de flavonoides e melhor potencial antioxidante (IC50 = 75,71 ± 10,57 µg mL-1).

ABSTRACT This paper describes the physicochemical composition, the evaluation of the antioxidant activity by free DPPH radicals using the scavenging method, the determination of flavonoids and total phenolic compounds of ethanol, acetone and aqueous extracts of the medicinal plant Plectranthus barbatus Andr. (Lamiaceae), dehydrated in solar dryer and circulation oven at 60 °C. Water activity rates for two drying methods were below the minimum necessary for growth and toxin production of important food pathogens. Physicochemical results showed that both processes were effective in the dehydration of P. barbatus. The results demonstrated that the acetone (over) and ethanol (over and solar dryer) extracts showed the highest content of total phenols. The ethanol extract (over) showed the highest amount of flavonoids and better antioxidant activity (75.71 ± 10.57 µg L-1).

NEbivolol inhibition of coronary artery smooth muscle cell proliferation after percutaneous coronary artery intervention. Results of the NESCIO Study, a randomized, double blind trial.

OBJECTIVES: This study compared the efficacy of metoprolol and nebivolol in reducing the frequency of in-stent restenosis (ISR) after a percutaneous coronary intervention (PCI). BACKGROUND: ISR results from excessive neointimal proliferation. Nebivolol inhibits proliferation of human coronary endothelial and smooth muscle cells in vitro. Its efficacy has not been studied in clinical trials. MATERIAL AND METHODS: In a single-centre double-blind study, 79 subjects with de novo lesions were randomly assigned to receive either nebivolol (n=37) or metoprolol (n=42) 3 to 7 days before elective PCI with bare metal stents. The study medication was continued for 6 months. Nebivolol was administered at 5 mg/day for 3 weeks, then at 10 mg/day. Metoprolol was administered at 100 mg/day. The endpoints were the difference in fractional flow reserve (deltaFFR) between values immediately after PCI and those at 6 months and ISR during the 6 months following PCI The study was powered to detect a deltaFFR of 6% with 30 subjects per treatment group. RESULTS: Among subjects who underwent angiography at 6 months, mean deltaFFR was--0.08 for the nebivolol group (n=25) and -0.12 in the metoprolol group (n=26; p = 0.367). ISR occurred in 11 subjects (26.2%) on metoprolol and in 3 (8.1%) on nebivolol during treatment, and in 7 subjects on metoprolol and in 3 on nebivolol at 6 months (p = 0.014) CONCLUSION: There was a non-significant trend toward less decline in detaFFR at 6 months with nebivolol. Nebivolol should be investigated further in larger trials. Nebivolol significantly reduced the frequency of ISR as compared to metoprolol.

[Diagnosis and treatment of oculomotor deficits in Möbius sequence]. / Diagnose und Therapie okulomotorischer Defizite bei Patienten mit Möbius-Sequenz.

This article reviews the spectrum of possible motility disorders and ocular misalignment in patients with Möbius sequence. The various options for strabismus surgery are discussed and a stepwise algorithm is presented.

[Non-oculomotor eye involvement in Moebius sequence]. / Nichtokulomotorische Augenbeteiligung bei Möbius-Sequenz.

Moebius sequence is a congenital disorder that not only affects the oculomotor system but also the eyes themselves. Ocular involvement might be sight-threatening and needs regular follow-up by an ophthalmologist.

[Lower incidence of type 2 diabetes mellitus with changes in lifestyle: clues from World War II]. / Lagere incidentie van diabetes mellitus type 2 bij verandering van leefstijl: aanwijzingen uit de Tweede Wereldoorlog.

OBJECTIVE: To investigate the relation between diabetes and food consumption on a population level. DESIGN: Retrospective, descriptive. METHOD: Data were collected from the archives of the Public Health Service of Amsterdam and the diabetes aftercare outpatient clinic ('Diabetes Nazorg') in Utrecht, the Netherlands, to determine the incidence of diabetes between 1940 and 1950. The number of outpatient visits for newly-diagnosed diabetes in Amsterdam and Utrecht were used to investigate whether the incidence of diabetes decreased during World War II, when food was scarce. RESULTS: Between 1940 and 1945 there was a considerable decrease in the incidence of diabetes in the Netherlands. The number of outpatient consultations at the Public Health Service of Amsterdam for newly-diagnosed diabetes declined from 140 in 1940 (18% of the total number of consultations) to only 3 in 1940 (2%). This figure rose to 112 (21%) in 1949. CONCLUSION: The marked decrease in the number of new cases of diabetes during the last years ofWorld War II supports the hypothesis that shortage of food induced a decrease in the incidence of type 2 diabetes in The Netherlands.

Metabolic risk factors, insulin-resistance and lifestyle in children of type 2 diabetes patients in Karachi, Pakistan.

AIMS: To assess metabolic risk factors, insulin-resistance and lifestyle in children aged 8-20 years of patients with type 2 diabetes and to compare these with children aged 8-20 years of non-diabetic subjects. METHODS: Case-control study. Data were collected from 37children/adolescents of type 2 diabetes patients and 37 controls from parents without diabetes. Variables included physical activity, diet, socioeconomic class, family history, ethnic background, anthropometric measures, blood pressure and fasting glucose and insulin. RESULTS: Groups were comparable for age and gender. Differences between cases and controls were found for BMI (22.6 vs. 19.1kg/m(2), p=0.004), waist circumference (70.1 vs. 62.1cm, p=0.014), systolic blood pressure (104.5+/-15.1 vs. 97.9+/-13.4mmHg, p=0.05), diastolic blood pressure (66.2+/-10.9 vs. 60.7+/-10.1mmHg, p=0.025). Vegetable intake (3% of cases having two and 19% one full serving a day vs., respectively, 14% and 32% amongst controls, p=0.01) was less favourable in cases, and physical activity tended to be (5h vs. 9h/week, p=0.065). CONCLUSIONS: Children of type 2 diabetes patients have higher BMI and blood pressure than controls but also lead a less healthy lifestyle. This suggests that both genetic and lifestyle factors contribute to the increased risk of metabolic syndrome in children and early preventive measures towards changing lifestyle could help in prevention.

Glucose fluctuations and activation of oxidative stress in patients with type 1 diabetes.

AIMS/HYPOTHESIS: Glucose fluctuations may help predict diabetic complications. We evaluated the relation between glucose variability and oxidative stress in patients with type 1 diabetes. METHODS: Continuous glucose monitors were inserted subcutaneously in 25 patients. During the measurement, patients collected two 24 h urine samples, while 24 healthy controls collected one 24 h urine sample for determination of 15(S)-8-iso-prostaglandin F2alpha(PGF2alpha) using HPLC tandem mass spectrometry. Mean of the daily differences (MODD), mean amplitude of glycaemic excursions (MAGE) and continuous overlapping net glycaemic action calculated with n hour time-intervals (CONGA-n) were calculated as markers for glucose variability and correlation with 15(S)-8-iso-PGF2alpha excretion was calculated. RESULTS: Median [interquartile range (IQR)] urinary 15(S)-8-iso-PGF2alpha was higher in patients than healthy controls: 161 (140-217) pg/mg creatinine vs 118 (101-146) pg/mg creatinine (p = 0.001). Median (IQR) MODD was 3.7 (3.2-5.0) mmol/l, MAGE 7.6 (6.4-9.0) mmol/l and CONGA-1 2.3 (2.1-2.8) mmol/l. Univariate regression did not reveal an association for MODD (r2 = 0.01), MAGE (0.08) or CONGA-1 (0.07) with 15(S)-8-iso-PGF2alpha excretion, nor was an association revealed when corrected for HbA1c, age, sex and smoking. Spearman correlation coefficients (r) between 15(S)-8-iso-PGF2alpha excretion and MODD, MAGE and CONGA-1 were non-significant: -0.112, -0.381 and -0.177. CONCLUSIONS/INTERPRETATION: We report that there is no relationship between glucose variability and urinary 15(S)-8-iso-PGF2alpha. We also confirm that patients with type 1 diabetes have higher levels of urinary 15(S)-8-iso-PGF2alpha than healthy controls, suggesting that in addition to glucose variability, other factors favouring oxidative stress may exist. We did not see a relation between high glucose variability and elevated levels of oxidative stress in patients with type 1 diabetes.

The organic preservation of fossil arthropods: an experimental study.

Modern arthropod cuticles consist of chitin fibres in a protein matrix, but those of fossil arthropods with an organic exoskeleton, particularly older than Tertiary, contain a dominant aliphatic component. This apparent contradiction was examined by subjecting modern cockroach, scorpion and shrimp cuticle to artificial maturation (350 degrees C/700 bars/24 h) following various chemical treatments, and analysing the products with pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS). Analysis of artificially matured untreated cuticle yielded moieties related to phenols and alkylated substituents, pyridines, pyrroles and possibly indenes (derived from chitin). n-Alkyl amides, C16 and C18 fatty acids and alkane/alk-1-ene homologues ranging from C9 to C19 were also generated, the last indicating the presence of an n-alkyl component, similar in composition to that encountered in fossil arthropods. Similar pyrolysates were obtained from matured pure C16 and C18 fatty acids. Py-GC/MS of cuticles matured after lipid extraction and hydrolysis did not yield any aliphatic polymer. This provides direct experimental evidence that lipids incorporated from the cuticle were the source of aliphatic polymer. This process of in situ polymerization appears to account for most of the fossil record of terrestrial arthropods as well as marine arthropods that lacked a biomineralized exoskeleton.

Magnification--a new look at a long-known optical property of dentin.

Light propagation in human dentin exhibits a strong directional dependence featuring the long-known optical magnification property. We hypothesized that this anisotropic effect is caused by multiple scattering at the dentin tubules, and not by fiberoptic effects, as had been previously assumed. We performed measurements of the transmitted intensity from dentin disks and compared them with Monte Carlo simulations of light propagation in dentin, considering the scattering by the tissue's microstructure. We found that the optical anisotropy of dentin can be fully explained with this model. We concluded that the magnification property of dentin is due to multiple scattering by the dental microstructure.

Glucose tolerance at age 58 and the decline of glucose tolerance in comparison with age 50 in people prenatally exposed to the Dutch famine.

AIMS/HYPOTHESIS: People who were small at birth have an increased risk of type 2 diabetes in later life. People who were in utero during the Dutch famine had decreased glucose tolerance and raised insulin concentrations at age 50. We aimed to evaluate whether prenatal famine exposure leads to more rapid progression of impaired glucose/insulin homeostasis with increasing age. METHODS: We performed an OGTT in 702 men and women at age 50 and in 699 men and women at age 58, all born as term singletons immediately before, during or after the 1944-1945 Dutch famine. RESULTS: People who had been exposed to famine in utero had significantly higher 120-min glucose concentrations at age 58 compared with people who had not been exposed to famine (difference=0.4 mmol/l, 95% CI 0.1 to 0.7, adjusted for sex and BMI). Glucose tolerance deteriorated between the age of 50 and 58. The unadjusted 120-min glucose concentrations rose by 0.2 mmol/l (95% CI 0.0 to 0.4), while 120-min insulin concentrations had increased by 64 pmol/l (95% CI 48 to 82). There were no differences in the rates of glucose and insulin level increase between the famine-exposed group and the unexposed group (p=0.28 for the difference in increase in glucose concentrations and p=0.09 for insulin concentrations). CONCLUSIONS/INTERPRETATION: Although we confirmed that undernutrition during gestation is linked to decreased glucose tolerance, the effect does not seem to become more pronounced at age 58 as compared with age 50.

[Continuous subcutaneous insulin infusion is sometimes a good choice in case of poorly regulated diabetes mellitus type I]. / Continue subcutane insuline-infusie soms goede optie bij slecht gereguleerde diabetes mellitus type I.

Continuous subcutaneous insulin infusion (CSII) was initiated in 3 patients with diabetes mellitus type I who experienced difficulties with their glucose regulation: a woman aged 26 years and two men aged 56 and 41 years. 2 patients responded very well, while the third, the youngest man, did not benefit. Although interest in CSII has been growing in recent years, considerable uncertainty exists about which patients will benefit from it. In most studies, patients have attained a lower HbA,, and fewer blood glucose fluctuations. Recently, the advantages of CSII have been confirmed in 2 large studies in patients with diabetes mellitus type I. Motivated patients in poor glycaemic control seem to benefit most from CSII. Some questions remain, especially whether these advantages can be confirmed in studies comparing CSII with injection regimens using the new long-acting insulin analogues. Motivated patients in poor control and those with an unpredictable daily life, needing a flexible mode of therapy, should not be denied a trial of CSII.

Anecortave acetate for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: Anecortave acetate is a novel angiostatic cortisene being evaluated clinically for treatment of exudative age-related macular degeneration (ARMD). A randomized, placebo-controlled, efficacy and safety dose duration study of anecortave acetate for depot suspension (3 mg, 15 mg, 30 mg) in this patient population was completed in June 2003. As part of this trial, 128 patients with subfoveal choroidal neovascularization (CNV) secondary to ARMD were enrolled and treated for up to 2 years by 18 clinical sites in the United States and European Union. METHODS: Study patients were evaluated clinically with detailed ophthalmic examinations, general physical examinations, assessments of best-corrected logMAR visual acuity, and angiographic evaluations. The Digital Angiography Reading Center (New York City, NY) assessed lesion eligibility while the clinical investigators assessed overall patient eligibility prior to treatment. As part of this study, study medication was delivered as a posterior juxtascleral depot using a specially designed curved cannula at 6-month intervals if in the masked investigator's opinion the patient's lesion could benefit from additional treatment. RESULTS: The 2-year efficacy results of this placebo-controlled study demonstrated that RETAANE 15 mg (anecortave acetate for depot suspension) was statistically superior to placebo for stabilization of vision (<3 logMAR line change from baseline) and for inhibition of neovascular lesion growth. There were no serious treatment-related safety issues associated with either the study medication or the procedure for administration. CONCLUSIONS: Anecortave acetate 15 mg for depot suspension is clinically efficacious compared to placebo for treatment of subfoveal exudative ARMD lesions when administered at 6-month intervals as a posterior juxtascleral depot.

Regional implementation of the NWC guideline on ST-elevation myocardial infarction: Report from the Task Force Prehospital Triage Zuidoost Brabant (PHT ZoB).

BACKGROUND: The NVVC guideline on ST-elevation myocardial infarction forms the basis for the regional prehospital triage (PHT) project in Zuidoost Brabant. In this project diagnosis and treatment strategies are determined in the ambulance. AIM: To summarise quality assessment and clinical results after one year. METHODS: We evaluated the protocol and patient record form, the patient's call, assignment of tasks, diagnosis, treatment, time intervals, information to hospitals, cooperation and data transmission. Time delays were compared with time delays in a regional dry run before the start of the project and with time delays reported in the literature. RESULTS: Patients still wait over one hour before seeking medical attention. The GP received the majority (65%) of patient calls. In half of all cases (51%), GPs call the ambulance centre only after they have seen the patient. When the patient calls the ambulance centre (35%), information to the GP is either prompt or absent. In 77% of calls to 112 it remains unclear whether the GP was informed at all. The treatment strategy was correct in 97% of cases. Time between symptoms and call decreased in comparison with our local preliminary investigation. Quality assessment after one year shows protocol deviations that are either logical procedural improvements or correctable flaws with no substantial negative influence. CONCLUSION: Short-term clinical results are good, but structured follow-up is needed to reduce mortality in the long term, especially after thrombolysis. A guideline is a snapshot of a dynamic process. The PHT project allows rapid adaptations to be made to new paradigms.

ACS, myocardial bridging, Tako-tsubo syndrome and mitral regurgitation.

Isolated systolic compression of the mid portion of the left anterior descending artery (LAD) by a bridge of overlying cardiac muscle is an infrequent but well-recognised angiographic anomaly that is often considered harmless. The long-term prognosis appears to be excellent, but occasional reports of patients with angina pectoris, myocardial infarction and sudden death indicate that this is not always true. The prevalence of the anomaly in the normal population is unknown, but the incidence is low and ischaemic events are rare. Tako-tsubo-like left ventricular dysfunction syndrome (TTS) is characterised by ischaemia, anterior ST-segment elevation, no significant coronary artery disease and reversible ampulla-like left ventricular ballooning in postmenopausal females after emotional or physical stress. Dynamic left ventricular outflow tract (LVOT) obstruction is a rare but potentially fatal complication of acute anterior wall infarction. We present a patient with an acute coronary syndrome (ACS) with ST-segment elevation in the anterior leads, transient TTS and transient LVOT obstruction with systolic anterior motion (SAM) of the mitral valve and severe mitral regurgitation. This is the first report of myocardial bridging associated with TTS, and the first report of TTS associated with dynamic LVOT obstruction with SAM and mitral regurgitation.

[Photodynamic therapy for choroidal hemangioma. Long-term results]. / Photodynamische Therapie bei chorioidalen Hämangiomen. Langzeitergebnisse.

AIM: Evaluation of functional and anatomical long-term results of patients with symptomatic choroidal hemangioma treated with photodynamic therapy (PDT). PATIENTS AND METHODS: All 8 patients suffered from progressive loss of vision caused by exudation into the macular area. PDT with a verteporfin dose of 6 mg/m(2) body surface area and a light dose of 100 J/cm(2) at 692 nm was carried out. Two to four treatments were applied at 6 week intervals using a single laser spot. Standardized evaluation was used before and at 6-week intervals after each treatment and at 3, 6 and 12 months. In the further follow-up control intervals were extended up to 1 year in the case of stable anatomical and functional results. RESULTS: All patients showed complete regression of the tumor. The tumor height was reduced from an average of 3.64 mm to undetectable. One patient showed a stable visual acuity, seven patients a significant increase. Central scotometry showed withdrawal of scotomas from the macula. No patient showed any sign of recurrence during the follow-up of up to 60 months. CONCLUSION: The long-term results of patients with active choroidal hemangioma demonstrate that PDT is a most effective and safe treatment option. Complete tumor regression is combined with good functional recovery.

Quality of life and metabolic control in patients with diabetes mellitus type 1 treated by continuous subcutaneous insulin infusion or multiple daily insulin injections.

OBJECTIVE: To assess the quality of life and metabolic control in patients with diabetes mellitus type 1 on continuous subcutaneous insulin infusion (CSII) in comparison with patients on multiple daily insulin injections (MDII). RESEARCH DESIGN AND METHODS: The study included 49 patients (13 males, 36 females), aged 41.4+/-11.3 years (mean+/-SD) on CSII for >1 year and 79 patients (43 males, 36 females), aged 43.1+/-14.8 years on MDII for >1 year, from three Dutch diabetic clinics. There were no statistically significant differences in duration of diabetes, social class, level of education, marital status, smoking or recent admissions to hospital. The questionnaires used were a Diabetes Quality of Life scale adapted from the DCCT, the Diabetes Satisfaction Questionnaire (DTSQ), and the WHO Well-Being Questionnaire. HbA1c was measured with an HPLC method (reference range 4.3 to 6.1 %). RESULTS: Using two-sided t-tests no statiscally significant differences were found between the patients on CSII and MDII with respect to quality of life (version A (<30 years) 4.32+/-0.22 vs 4.20+/-0.30; version B (> or =30 years) 4.18+/-0.25 vs 4.29+/-0.28), well-being (48.59+/-9.23 vs 50.99 +/-8.70), satisfaction with treatment (5.10+/-0.69 vs 5.15+/-0.71) and HbA1c (8.14+/-1.51 vs 8.47+/-1.40). Frequency of daily blood glucose monitoring was slightly higher in CSII than in MDII patients (4.52+/-1.19 vs 3.60+/-1.47; p<0.0001). CONCLUSION: The present data indicate that patients on CSII have similar QoL based on questionnaires when compared with patients on MDII. These data suggest that in patients with less optimal control on MDII, converting the treatment strategy to CSII is not associated with decreased quality of life.

Comparison of psychiatric ICD-10 diagnoses in Denmark and Germany.

A dataset of psychiatric ICD-10 diagnoses from the Danish case register concerning psychiatric hospitals was compared with a sample of psychiatric diagnoses from 27 psychiatric hospitals in Germany. The comparison shows a higher proportion of F1 diagnoses in the German dataset and a difference in the coding of alcohol dependence and harmful use. Some further differences in the groups F0-F6 are demonstrated and some of them are discussed. The most frequent diagnoses found in both datasets but in different sequence are alcohol dependence syndrome and paranoid schizophrenia and, in third place, adjustment disorder. Various aspects of the problem of rarely used diagnoses are discussed.

A synthetic factor-Xa inhibitor (ORG31540/SR9017A) as an adjunct to fibrinolysis in acute myocardial infarction. The PENTALYSE study.

BACKGROUND: ORG31540/SR90107A, a synthetic pentasaccharide, is a selective inhibitor of factor-Xa. It was hypothesized that prolonged factor-Xa inhibition with pentasaccharide may be an effective and safe antithrombotic co-therapy in acute myocardial infarction. METHODS AND RESULTS: Patients (n=333) with evolving ST-segment elevation acute myocardial infarction were treated with aspirin and alteplase and randomized to unfractionated heparin, given intravenously during 48 to 72 h, or to a low, medium or high dose of pentasaccharide, administered daily for 5 to 7 days, intravenously on the first day, then subcutaneously. Coronary angiography was performed at 90 min and on days 5 to 7. Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 rates at 90 min were similar in the four treatment groups. Among patients with TIMI 3 flow at 90 min and who did not undergo a coronary intervention (n=155), a trend towards less reocclusion of the infarct-related vessel on days 5 to 7 was observed with pentasaccharide: 0.9% vs 7.0% with unfractionated heparin (P=0.065). Also, fewer revascularizations during the 30-day follow-up period were performed in patients given pentasaccharide (39% vs 51% for unfractionated heparin;P=0.054). The primary safety end-point, the combined incidence of intracranial haemorrhage and need for blood transfusion, was identical with pentasaccharide and unfractionated heparin (7.1%). One non-fatal intracranial haemorrhage occurred in the 241 patients given pentasaccharide (0.4%). CONCLUSIONS: In this study, pentasaccharide given together with alteplase was safe and as effective as unfractionated heparin in restoring coronary artery patency. Prolonged administration of pentasaccharide was associated with a trend towards less reocclusion and fewer revascularizations. Selective factor-Xa-inhibition seems to be an attractive therapeutic concept in patients presenting with ST-segment elevation acute myocardial infarction.

Evaluation of the multiaxial system of ICD-10 (preliminary praft): correlations between multiaxial assessment and clinical judgements of aetiology, treatment indication and prognosis.

Forty-five raters in 7 German centres took part in a multicentric field trial of the multiaxial system of ICD-10, delivering a total of 488 multiaxial assessments of 12 written case summaries. In addition to the multi-axial ratings (including main and subsidiary psychiatry diagnoses, level of social dysfunctioning and psychosocial stressors), assessments were made by the raters of the aetiology, treatment indications and prognosis of the main psychiatric disorder. There were significant correlations between these judgements and the measures of the multiaxial ratings: 62% of the cases diagnosed as endogenous were assessed as having a high level of social dysfunctioning (the proportion for all cases being 50.4%) and 63.4% as having a low number of stressors (vs. 52.8% in all cases). In contrast, cases diagnosed as reactive were assessed as having a lower level of social dysfunctioning and more social stressors. Cases whose prognosis was poor showed a higher rate of comorbidity and a high level of social dysfunctioning. The results demonstrate that the multiaxial approach reflects factors important to the process of clinical treatment and decision making and delivers preliminary evidence of this system's treatment and prognostic validity.