Diuretic effects and urinary electrolyte excretion induced by Aspidosperma subincanum Mart. and the involvement of prostaglandins in such effects.

ETHNOPHARMACOLOGICAL RELEVANCE: Aspidosperma subincanum Mart. is a medicinal herb known for its diuretic properties and used for the treatment of cardiovascular-related illnesses. Although our earlier study has shown that the ethanol extract of Aspidosperma subincanum (EEAS) induces hypotension and vasodilation, no scientific data have been recorded to evaluate the diuretic effects of this Brazilian medicinal plant. The aim of this study was to evaluate the diuretic activity of EEAS, and possible mechanism of action, using Wistar rats. MATERIAL AND METHODS: EEAS (60 and 120mg/kg), furosemide (20mg/kg) or saline (control) were orally administered to rats individually held in metabolic cages for urine collection 1, 2, 4, 6, 8, 12 and 24h after treatment. In order to evaluate the involvement of prostaglandins in the diuretic action of EEAS, the animals received piroxicam (5mg/kgi.p.), a nonselective inhibitor of cyclooxygenase, before treatment with EEAS at 120mg/kg. The control groups received only saline (NaCl, 0.9%), or saline and piroxicam. Urinary volume, electrolyte excretion and pH were measured. RESULTS: Oral administration of EEAS 60 and 120mg/kg significantly increased diuresis and electrolyte excretion of Na(+) and K(+) on a continuous basis throughout the study period. Both EEAS 60 and 120mg/kg caused a relative increase of around 77% and 142%, respectively, in cumulative diuresis compared with the control group. From 4th hour until the end of the experiment, the group treated with EEAS 120mg/kg provided a greater excretion of Na(+) than the furosemide group. The diuretic effects of EEAS were neutralized by piroxicam between 4 and 8h after treatment. CONCLUSION: The results suggest that EEAS could present compound(s) responsible for diuretic activities, and the mechanism could involve the prostaglandin system.

Impact of Bariatric Surgery on Patients from Goiás, Brazil, Using the BAROS Method - A Preliminary Study.

INTRODUCTION: As obesity is currently a major public health problem, bariatric surgery has been widely indicated due to the difficulties involved in the clinical management of obese adults. OBJECTIVES: Assess the quality-of-life (QOL) of patients who had undergone Roux-en-Y Gastric Bypass (RYGB) in the State of Goiás, Brazil, where as yet no studies have been published on the QOL of patients who underwent bariatric surgery. METHODS: A retrospective study, using the Bariatric Analysis and Reporting Outcome System (BAROS), was carried out in Goiânia and Rio Verde, Goiás, Brazil, with 50 over 18-year-old patients of both genders, who had undergone RYGB and had at least three months of postoperative time. RESULTS: Before RYGB, 48% of the individuals were classified as morbidly obese. Average weight and body mass index (BMI) of the 50 patients interviewed were 119.37 ± 18.44 kg and 43.54 ± 5.33 kg/m2, respectively. By contrast, after the RYGB these parameters decreased significantly to 78.01 ± 11.06 kg and 28.46 ± 3.61 kg/m2, respectively, mainly from the 3rd to 85th month of postoperative time (p < 0.0001). As well as that, 78% reported having presented preoperative comorbidities, especially hypertension (44%), rheumatism (34%), dyslipidemia (24%) and diabetes (20%). However, after surgery, the resolution rates were 77, 24, 100 and 100%, respectively, for these same clinical conditions. In terms of QOL, some patients reported feeling better (8%) or much better (92%) after RYGB. The outcome of the BAROS method for those patients was classified as fair (2%), good (8%), very good (24%) and excellent (66%). CONCLUSIONS: Preliminary results indicated that RYGB could be a successful surgical procedure to promote satisfactory and sustained reduction in the body measurements of morbidly obese patients from Goiás, Brazil. Furthermore, the final BAROS score showed improvements in associated comorbidity and also in the QOL of these patients.

INTRODUÇÃO: Como a obesidade é atualmente um grande problema de saúde pública, a cirurgia bariátrica tem sido amplamente indicada devido às dificuldades envolvidas no manejo clínico de adultos obesos. OBJETIVOS: Avaliar a qualidade de vida (QDV) de pacientes submetidos ao Desvio Gástrico em Y-de-Roux (DGYR) no Estado de Goiás, Brasil, onde ainda não há estudos sobre a QDV de pacientes submetidos à cirurgia bariátrica. MÉTODOS: Um estudo retrospectivo, utilizando o Bariatric Analysis and Reporting Outcome System (BAROS), foi realizado em Goiânia e Rio Verde, Goiás, Brasil, com 50 pacientes com idade superior a 18 anos, de ambos os gêneros, que realizaram DGYR com tempo pós-operatório mínimo de três meses. RESULTADOS: Antes da DGYR, 48% dos indivíduos foram classificados como obesos mórbidos. A média de peso e índice de massa corporal (IMC) dos 50 pacientes entrevistados foram 119,37 ± 18,44Kg e 43,54 ± 5,33Kg/m2, respectivamente. Em contrapartida, após a DGYR, esses parâmetros diminuíram significativamente para 78,01 ± 11,06 kg e 28,46 ± 3,61 kg/m2, respectivamente, principalmente do 3° ao 85° mês de tempo pós-operatório (p < 0.0001). Além disso, 78% reportaram tendo apresentado comorbidades pré-operatórias, especialmente hipertensão (44%), reumatismo (34%), dislipidemia (24%) e diabetes (20%). Entretanto, após a cirurgia, as taxas de resolução foram de 77, 24, 100 e 100%, respectivamente, para essas mesmas condições clínicas. Em termos de QDV, alguns pacientes relataram se sentir melhor (8%) ou muito melhor (92%) após a DGYB. O resultado do método BAROS para esses pacientes foi classificado como insuficiente (2%), bom (8%), muito bom (24%) e excelente (66%). CONCLUSÕES: Resultados preliminares indicaram que a DGYB pode ser um procedimento cirúrgico para promover com sucesso a redução satisfatória e sustentada nas medidas corporais de pacientes com obesidade mórbida provenientes de Goiás, Brasil. Além disso, a pontuação final do BAROS mostrou melhorias das comorbidades associadas e também na QDV desses pacientes.

Avaliação do serviço de saúde prestado aos pacientes diabéticos em uma unidade de saúde de Goiânia-GO / Evaluation of the health service provided to diabetic patients at health units in Goiânia, GO

O diabetes mellitus é uma síndrome de etiologia múltipla e um dos principais agravos de saúde pública no Brasil. O controle desse agravo nos serviços básicos é fundamental, em virtude de sua magnitude crescente, transcendência e complexa vulnerabilidade. O objetivo deste estudo foi avaliar o tratamento e acompanhamento de pacientes diabéticos, segundo as recomendações da Sociedade Brasileira de Diabetes (SBD), em duas unidades básicas de saúde do município de Goiânia ? GO. Os dados foram obtidos por meio da revisão de prontuários médicos referentes ao período de janeiro de 2007 a dezembro de 2009, totalizando 250 prontuários, consolidados no software Epi InfoTM . Houve maior frequência de diabetes mellitus tipo 2 (96,65%) em relação ao tipo 1. Em 78% dos prontuários, havia descrição de hipertensão arterial e, destes, 77,4% tinham prescrição de IECA, e em 30,4% dos prontuários havia prescrição de AAS. Em média, pequena porcentagem de prontuários atendeu às recomendações da SBD: quase 50% dos pacientes estavam com pressão arterial controlada na unidade UBESF ?A? e 35%, na unidade UBESF ?B?; cerca de 25% estavam com LDL inferior a 100mg/dL em ambas as unidades e aproximadamente 25% dos prontuários da unidade UBESF ?B? tinham HbA1c inferior a 7%, e 18%, na UBESF ?A?. Quanto ao estudo de utilização de medicamentos, 41,1% dos prontu- ários tinham prescrição de metformina e um secretagogo, e apenas 20,4% dos pacientes com HbA1c>9% tinham prescrição de insulina.

Diabetes mellitus is a syndrome of multiple etiology and a major public health problem in Brazil. The control of this disease in basic services is crucial because of its growing magnitude, transcendence, and complex vulnerability. This retrospective study aimed to evaluate the treatment and monitoring of diabetic patients according to the Brazilian Diabetes Society guidelines in two basic health units (UBESFs) in the city of Goiânia/GO. Data were collected by review of medical records from January 2007 to December 2009, resulting in 250 records, consolidated in the Epi InfoTM software. There was a higher frequency of diabetes mellitus type 2 (96.65%) compared to type 1. In 78% of the records, arterial hypertension had been detected and of these, 77.4% had a prescription for ACE inhibitors. In 30.4% of the records, aspirin had been prescribed. On average, a small percentage of the medical records met the recommendations of the Brazilian Diabetes Society: almost 50% of the patients had controlled blood pressure in UBESF unit ?A? and over 35% in UBESF unit ?B?; about 25% had LDL less than 100mg/dL in both units, and approximately 25% had HbA1c below 7% in UBESF unit ?B? and 18% in UBESF unit ?A?. As to the study of medication use, 41.1% of the records had prescriptions for metformin and a secretagogue, and only 20.4% of the patients with HbA1c >9% had an insulin prescription.