Urinary calcium excretion and insulin resistance in patients with acromegaly.

BACKGROUND: Renal complications in acromegaly include glomerular hyperfiltration, insulin resistance, hypercalciuria and urolithiasis. The aim of this study was to investigate whether urinary calcium (U(Ca)) excretion is a direct consequence of growth hormone secretion or secondary to hyperfiltration and/or insulin resistance. METHODS: We performed a cross-sectional study of 58 patients diagnosed with acromegaly. Demographic data were obtained, serum analysis was performed, including insulin-like growth factor (IGF)-1, and 24-h urine collection, to measure urinary protein excretion, U(Ca) and phosphate excretion, as well as fractional excretion of sodium and potassium. We also calculated the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Patients were predominantly male (60.3%), and their mean age was 45.9 ± 14 years. Hypercalciuria was present in 24% of patients. Patients with higher HOMA-IR had higher IGF-1 levels, a trend toward higher body mass index and higher U(Ca) excretion. In univariate analysis, U(Ca) excretion was associated with HOMA-IR (r = 0.472, P = 0.001), phosphaturia (r = 0.457, P = 0.001), IGF-1 (r = 0.398, P = 0.002) and creatinine clearance (r = 0.394, P = 0.001). HOMA-IR and phosphaturia were independently associated with U(Ca) excretion. No independent associations were found between phosphaturia and HOMA-IR or IGF-1. CONCLUSIONS: The present study revealed an association between hypercalciuria and insulin resistance in patients with acromegaly. Further studies are required to fully understand the pathogenesis of these abnormalities in patients with acromegaly.

Health team training and active community surveillance: strategies for the detection of TB cases.

OBJECTIVE: To evaluate the impact that Family Health Program (FHP) team training and active surveillance have on the detection of TB cases in a low-income community in the city of Fortaleza, Brazil. METHODS: The study was performed in an area with approximately 25,000 inhabitants, served by a health care center with five FHP teams, in the city of Fortaleza, Brazil. Although all of the teams were trained, active surveillance was carried out only in one of the areas (area 5). We compared the number of TB cases detected in each of the five areas prior to and after the intervention. We also compared the number of TB cases detected in area 5 to the number of those detected in the other areas, as well as to the citywide number of reported TB cases in Fortaleza, within the same period. RESULTS: The number of TB cases detected in the area studied increased from 1 in 2002 to 22 in 2004 (p < 0.05). There was no significant difference between the number of TB cases in area 5 and that observed for each of the other four areas (p > 0.05). There was a significant increase in the number of TB cases detected in the area studied when compared to the city as a whole (p < 0.05). CONCLUSIONS: Training and sensitization of FHP professionals were effective in promoting an increase in the number of TB cases detected in a low-income community.

Treinamento da equipe de saúde e busca ativa na comunidade: estratégias para a detecção de casos de TB / Health team training and active community surveillance: strategies for the detection of TB cases

OBJETIVO: Avaliar o impacto do treinamento da equipe do Programa Saúde da Família (PSF) e da busca ativa domiciliar na detecção de casos de TB em uma comunidade de baixa renda de Fortaleza. MÉTODOS: Intervenção realizada na área de abrangência de um centro de saúde de Fortaleza, Ceará, com cinco equipes do PSF, responsáveis por cerca de 25.000 pessoas. Treinaram-se todas as equipes de saúde do centro de saúde e implantou-se a busca ativa domiciliar apenas na área de abrangência da Equipe 5. Comparou-se o número de casos detectados em cada uma das cinco áreas antes e depois da intervenção, bem como os casos na área 5 com os das outras áreas e com os casos notificados no município de Fortaleza durante o mesmo período. RESULTADOS: Observou-se um aumento no número de casos de TB detectados na área do estudo: de 1 caso em 2002 para 22 em 2004 (p < 0,005), sem diferença entre a área em que foi feita a busca domiciliar e as outras quatro (p > 0,05). Houve um aumento significativo no número de casos detectados na área do estudo em comparação com aquele no município como um todo (p < 0,05). CONCLUSÕES: O treinamento e a sensibilização da equipe de saúde da família foram capazes de promover um aumento na detecção de casos de TB em uma comunidade de baixa renda.

OBJECTIVE:To evaluate the impact that Family Health Program (FHP) team training and active surveillance have on the detection of TB cases in a low-income community in the city of Fortaleza, Brazil. METHODS: The study was performed in an area with approximately 25,000 inhabitants, served by a health care center with five FHP teams, in the city of Fortaleza, Brazil. Although all of the teams were trained, active surveillance was carried out only in one of the areas (area 5). We compared the number of TB cases detected in each of the five areas prior to and after the intervention. We also compared the number of TB cases detected in area 5 to the number of those detected in the other areas, as well as to the citywide number of reported TB cases in Fortaleza, within the same period. RESULTS: The number of TB cases detected in the area studied increased from 1 in 2002 to 22 in 2004 (p < 0.05). There was no significant difference between the number of TB cases in area 5 and that observed for each of the other four areas (p > 0.05). There was a significant increase in the number of TB cases detected in the area studied when compared to the city as a whole (p < 0.05). CONCLUSIONS: Training and sensitization of FHP professionals were effective in promoting an increase in the number of TB cases detected in a low-income community.