Multidimensional frailty connection in older patients with diabetes mellitus.

BACKGROUND AND OBJECTIVE: Patients with diabetes mellitus (DM) experience accelerated aging and, thus, a high prevalence of frailty. Our aim is to outline the type of frailty and prefrailty from a multidimensional perspective and the interaction of these dimensions in this scenery. MATERIAL AND METHODS: Observational study of patients with DM over 60 years-old. Variables related to nutrition, cognitive and emotional status, physical and instrumental functional capacity and social resources were collected. They were divided into three groups (robust, prefrail and frail) according to the Fried scale. Each of the variables in the groups were compared and a correspondence analysis was carried out to see the influence of some dimensions with others in each stage of frailty. RESULTS: 188 patients (mean age 72.6 + 7.5) were analysed. Of them, 105 patients had prefrailty and 66 were frail. With the exception of social resources, the rest of the variables had an increasing prevalence depending on the stage of frailty. However, in the correspondence analysis (with 22.9% of variation explained by two dimensions) it was only patients with frailty who were associated with worse functional capacity, cognitive and emotional situation and mild to moderate social incapacity. CONCLUSIONS: In our sample there was a high prevalence of prefrailty, and frailty associated with an increase in the prevalence of other different dimensions except social resources. However, the interaction between these dimensions was only evident in the case of patients with frailty.

Predictive toxicological effects of Artemisia absinthium essential oil on hepatic stellate cells.

Medicinal plants are important worldwide, considering their properties for treating diseases; however, few studies have evaluated their toxicological potential. Among them, Artemisia absinthium is frequently used to treat liver diseases, because its essential oil has several popular therapeutic properties. Based on this information, in the present study, we investigated molecular connectors of physiological effects of the Artemisia absinthium essential oil on human hepatic stellate cell line, LX-2, to explore the potential toxicity of the plant on liver cells. LX-2 is a cellular model to investigate mechanisms of liver fibrosis; then, to analyze the essential oil effects LX-2 was cultured under different conditions, treated or not with the essential oil at 0.4 µg/µL for 24 h. Next, fluorescence microscopy analyses, gene expression measurements, and biochemical approaches revealed that the essential oil reduced pro-fibrogenic markers; however, disrupt lipid metabolism, and cause cellular stress, by the activation of cellular detoxification and pro-inflammatory processes. In conclusion, the hepatic stellate cells incubated with the essential oil present an antifibrotic potential, supporting its popular use; however, the combined results suggest that the essential oil of Artemisia absinthium should be used with caution.

Extremely aggressive course in a poorly differentiated thyroid carcinoma presenting a double mutation of the TERT promoter.

BRAF and TERT oncogenes hotspot mutations are associated with a more aggressive outcome in thyroid carcinomas (TC). TERT promoter (pTERT) mutations (C228T and C250T) are related to cancer growth and reduced overall- and disease-free survivals in TC. We report a patient followed up for 8 years with a poorly differentiated thyroid carcinoma (PDTC) presenting an extremely aggressive course, who developed a large volume of metastases in a short period. Molecular analysis of the primary tumor revealed two pTERT mutations (C228T and C250T), and no BRAF V600E mutation. pTERT mutations C228T and C250T have been described as mutually exclusive, indicating that one mutation is enough for telomerase activation and exerts its action in thyroid tumorigenesis. This report describes both pTERT hotspot mutations in the same PDTC patient presenting a very aggressive course, even for PDTC, suggesting a relationship between the two events. However, more studies are needed to prove this causality.

Relación entre obesidad y enfermedades crónicas no transmisibles e infecciosas / Relationship between obesity and chronic non-communicable and infectious diseases

Introducción: la obesidad aumenta el riesgo a padecer de enfermedades crónicas no transmisibles (ECNT) y afecta el curso de enfermedades de origen infeccioso. Objetivo: examinar la literatura sobre cómo influye la obesidad en la gravedad del cuadro clínico de algunas de las enfermedades no transmisibles y transmisibles de mayor impacto en el Perú. Métodos: investigación documental. Se hace un análisis de contenidos de artículos y documentos de estudios desarrollados en diversos contextos asociados a la presencia de obesidad junto con infecciones o ECNT y en base de datos. Resultados: la condición de obesidad alcanzada por malos hábitos de consumo y baja actividad física, es la principal responsable del elevado índice de las ECNT y por consecuente de las tasas de mortalidad. Conclusiones: el exceso de peso afecta al sistema inmunológico, contribuyendo específicamente en los fenómenos exacerbados de respuesta inflamatoria sistémica, determinada por el aumento de secreción de adipocitoquinas, que predispone al organismo a desarrollar y contraer ECNT y enfermedades infecciosas. (AU)

Introduction: Obesity increases the risk of chronic non-communicable diseases (NCDs) and affects the course of diseases of infectious origin. Objective: Reviewing the literature on how obesity influences the severity of the clinical picture of some of the non-communicable and communicable diseases of greatest impact in Peru. Methods:Documentary research, from studies developed in various contexts associated with the presence of obesity along with infections or NCDs. Results: The condition of obesity reached by bad consumption habits and low physical activity is the main responsible for the high rate of NCDs, consequently, mortality. Conclusions: Excess weight affects the immune system, contributing specifically to exacerbated phenomena of a systemic inflammatory response, determined by increased secretion of adipocytokines, which predisposes the body to develop and contract NCDs and infectious diseases. (AU)

Genitourinary Malignancies in Transplant or Dialysis Patients: The Frequency of Two Newly Described 2016 World Health Organization Histopathologic Types.

BACKGROUND: The aim of this study was to revise the histopathologic types of neoplasias in the genitourinary tract and determine the frequency of 2 new entities included in the 2016 book of World Health Organization classification of renal tumors. It is not established so far whether these 2 recently described tumors are the most frequent in association with end-stage kidney disease. METHODS: In a retrospective analysis, we revised the histopathologic type of 37 genitourinary tumors from 21 patients in dialysis and/or submitted to renal transplantation from 2003 to 2016 aiming to find the frequency of acquired cystic disease-associated renal cell carcinoma and clear cell papillary (tubulopapillary) renal cell carcinoma. RESULTS: From the total of 37 tumors, 34 were from native end-stage kidneys, 1 from the pelvis of the transplant kidney, and 2 from the urinary bladder. The frequencies from native kidneys were: papillary carcinoma, 13/34 (38.2%); papillary adenoma, 9/34 (26.5%); acquired cystic disease-associated renal cell carcinoma, 4/34 (11.8%); oncocytoma, 3/34 (8.8%); conventional clear cell renal cell carcinoma, 3/34 (8.8%); and clear cell papillary (tubulopapillary) renal cell carcinoma, 2/34 (5.34%). The pelvis and urinary bladder tumors were high-grade urothelial carcinomas. The patients with urinary bladder tumors had been treated for polyomavirus infection. CONCLUSIONS: The frequencies of acquired cystic disease-associated renal cell carcinoma and clear cell papillary renal cell carcinoma were 11.8% and 5.9%, respectively. However, the spectrum of adenoma/carcinoma papillary tumors composed the majority, 64.7%, of tumors.

Asthma in adolescents - Prevalence trends and associated factors in northeast Brazil

BACKGROUND: Asthma is the most common chronic disease affecting children and adolescents (AD). We evaluated the prevalence of asthma and associated factors in adolescents living in a developing region in northeast Brazil using the ISAAC (International Study of Asthma and Allergies in Childhood) methodology. METHODS: According to the ISAAC protocol, AD (13-14 year olds, n = 3,043 in 2003 and 3,009 in 2011-12) answered the standardised written questionnaire by themselves. In addition, in 2011-12 a random sample of these AD (n = 430) also answered a complementary questionnaire (associated factors) and underwent a skin prick test with aeroallergens (Dermatophagoides pteronyssinus, Blomia tropicalis, Blatella germanica, Periplaneta americana, dog dander, cat dander, mixed grass pollen and mixed moulds, including 10 mg/mL histamine and negative controls). Data were analysed by univariate and multivariate analysis using Poisson regression. RESULTS: The prevalence of asthma in 2011-12 in Aracaju was 12.8%, which is lower than that recorded in 2003 (18.7%). Individuals with a dog outside the home (PR = 0.93; 95%CI = 0.88-0.98; p = 0.018) and those with an older sibling (PR = 0.94; 95%CI = 0.91-0.98; p = 0.005) were identified as protective. The presence of smokers in the residence (PR = 1.04; 95%CI = 1.00-1.09; p = 0.039) was associated with an increased risk of developing asthma. CONCLUSIONS: The prevalence of asthma was significantly lower than the last ISAAC figures reported for Aracaju. Tobacco smoking, a preventable factor, continues to be associated with an increase in the occurrence of asthma and other associations may concur with the hygiene hypothesis

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Doctors' awareness concerning primary immunodeficiencies in Brazil.

BACKGROUND: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.

Asthma in adolescents--Prevalence trends and associated factors in northeast Brazil.

BACKGROUND: Asthma is the most common chronic disease affecting children and adolescents (AD). We evaluated the prevalence of asthma and associated factors in adolescents living in a developing region in northeast Brazil using the ISAAC (International Study of Asthma and Allergies in Childhood) methodology. METHODS: According to the ISAAC protocol, AD (13-14 year olds, n=3,043 in 2003 and 3,009 in 2011-12) answered the standardised written questionnaire by themselves. In addition, in 2011-12 a random sample of these AD (n=430) also answered a complementary questionnaire (associated factors) and underwent a skin prick test with aeroallergens (Dermatophagoides pteronyssinus, Blomia tropicalis, Blatella germanica, Periplaneta americana, dog dander, cat dander, mixed grass pollen and mixed moulds, including 10mg/mL histamine and negative controls). Data were analysed by univariate and multivariate analysis using Poisson regression. RESULTS: The prevalence of asthma in 2011-12 in Aracaju was 12.8%, which is lower than that recorded in 2003 (18.7%). Individuals with a dog outside the home (PR=0.93; 95%CI=0.88-0.98; p=0.018) and those with an older sibling (PR=0.94; 95%CI=0.91-0.98; p=0.005) were identified as protective. The presence of smokers in the residence (PR=1.04; 95%CI=1.00-1.09; p=0.039) was associated with an increased risk of developing asthma. CONCLUSIONS: The prevalence of asthma was significantly lower than the last ISAAC figures reported for Aracaju. Tobacco smoking, a preventable factor, continues to be associated with an increase in the occurrence of asthma and other associations may concur with the hygiene hypothesis.

Mitochondrial DNA in Basque descendants from the city of Trinidad, Uruguay: Uruguayan- or Basque-like population?

Like other countries in the Americas, during its colonization Uruguay was the recipient of immigrants from several ethnic groups from Europe, as well as of enslaved Africans. After its independence in 1830, Basques were the first group of Europeans to arrive in the country. In this paper, we aim to contribute to the understanding of the process of integration of these migratory waves into the Uruguayan society. For that purpose, individuals of Basque origin from the city of Trinidad, Uruguay, were chosen to participate in this study. Particularly, we wanted to determine if Basque descendants in Uruguay remained relatively isolated or if they mixed with other ethnic groups. Mitochondrial DNA (mtDNA) of 60 self-identified Basque descendants, taken from a larger sample of subjects with Basque ancestors, was analyzed. The origin of mtDNA haplogroups was 77.8% European, 20.4% Amerindian, and 1.8% African, showing similar frequencies to other Uruguayan regions. Very few sequences showed a clear Basque origin, although other sources such as the Canary Islands are likely. Moreover, genetic distances clearly show that Basque descendants are genetically closer to other Uruguayan groups than to European populations, including Basques. It is possible to conclude that Basques and their descendants in the region of Trinidad did not remain isolated and that their marriage behavior was similar to that of other Uruguayan populations. However, to have a more accurate picture of the way Basques intermarried with other populations in Uruguay, new analyses are needed that take into account paternal lineages as well as biparental genetic markers.

Consanguinity in two Uruguayan cities: historical evolution and characteristics (1800--1994).

BACKGROUND: Information about consanguinity in Uruguay is scarce and limited to the end of the 20th century. AIM: To determine the frequency and characteristics of consanguineous marriages, as well as chronological trends, in two Uruguayan cities over almost two centuries. SUBJECTS AND METHODS: We analysed 28,393 Roman Catholic Church marriage records and Diocesan consanguinity dispensations belonging to the cities of Melo (Northeast), and Montevideo (South), for the period 1800--1994. RESULTS: 633 (2.23%) marriages were consanguineous. Among them, first cousin marriages were the most common (58.8% of all consanguineous marriages, including double consanguineous), especially those where the bride and groom were related through their maternal side. During the first decades of the 19th century both regions showed low levels of consanguinity. Consanguinity reached its maximum during the mid-1800s and decreased significantly throughout the 20th century. The overall mean coefficients of inbreeding were moderate in both cases, being greater in the Northeast (alpha=0.00165) than in the South (alpha = 0.00089). CONCLUSIONS: The low level of consanguinity as well as the structure of consanguineous marriages (distribution by degrees) is similar to that found in other southern South American countries. Temporal trends are similar to those found in industrialized regions in Europe, with maximum inbreeding levels during the middle-late 19th century; however, the clear predominance of first cousin unions, differs from most of the data for European countries. Small differences between the two cities can be related to diverse facts, such as socio-economic conditions, ethnic origin, immigration, and sampling.

[Nursing representation in the state of Goiás]. / A representatividade da enfermagem no estado de Goiás.

The objective of this case study report is to stress the way nursing professionals in the federal state of Goiás are represented. It was concluded the Brazilian Association of Nursing (ABEn) in Goiás and other educational institutions, have promoted changes in the practices, attitudes and behavior of the nursing professionals through the incentive and investment on courses, seminars and other kind of events. The study also shows that the efforts to qualify the nursing profession have increased the participation of these workers in areas, which were not disputed by them before.

[Surveillance of infant deaths in local health systems: assessment of verbal autopsy reports and of information gathered from health agents]. / Vigilância de óbitos infantis em sistemas locais de saúde: avaliação da autópsia verbal e das informações de agentes de saúde.

Knowing the vital statistics of a population is fundamental in controlling morbidity and mortality and improving living conditions. In Brazil, however, the available health information systems do not provide reliable vital statistics. This study was carried out in Quixadá, Icapuí, and Jucás, three municipalities in the state of Ceará that had good coverage by primary health care services. The study used an epidemiological instrument known as a "verbal autopsy" and investigated 215 (90%) of the 237 deaths of children younger than 1 year identified in 1993 and 1994 in the three communities. We investigated socioeconomic characteristics; sanitary conditions; nutritional status; the course of illness, health care, and death; the cause of death; and the operation of the national mortality information system and of the community health agents system. According to the verbal autopsies, diarrhea was the cause of death in 39% of the cases, followed by premature birth (17%), and acute respiratory infections (10%). Even though 79% of the families had sought formal health care services during the child's illness, 49% of the infants had died at home. This suggests limited effectiveness in the identification and treatment of sick infants. In 84% of the cases the family sought help from folk healers. Although community health agents reported 78% of the deaths, only 29% of the families had sought help from the agents during the children's illnesses. In terms of the statistical agreement between the information on the cause of death provided by community health agents and by the verbal autopsies, the agreement was good for diarrhea, intermediate for other causes, and low for acute respiratory infections. Making verbal autopsy a routine part of primary health care services in Ceará would provide invaluable information for local health care teams and would raise a critical consciousness fostering a reduction in infant mortality.

Characterization of mitochondrial DNA and Y-chromosome haplotypes in a Uruguayan population of African ancestry.

We used a set of informative mtDNA and Y-chromosome-specific markers to determine the origin of maternal and paternal lineages in a sample of 41 Uruguayan black individuals. We found that 20 maternal lineages were African, 13 were Amerindian, and 5 were Caucasian. In three individuals we were unable to determine the ethnic origin of the mtDNA lineages. Of the 22 males analyzed we found 4 Y chromosomes of African origin, 5 of Caucasian origin, and 13 of undetermined ancestry. Our results suggest that mtDNA and Y-chromosome-specific DNA variants may be a useful tool in determining the level of mtDNA and Y chromosome ethnic introgression in a population of a given ethnic origin.

[Seventieth anniversary of the Brazilian Nursing Association]. / Os setenta anos da Associação Brasileira de Enfermagem (ABEn).

The celebration of the Brazilian Nursing Association seventieth anniversary, former Brazilian Graduated Nurses Association, represents, in fact, seventy years of the history of Nursing in Brazil. We have certified, in a historical retrospective that the entity's creation, its organization which has been through several changes, adapting itself to the demands imposed by the conjunctures; the cultural landmarks, where the Brazilian Nursing Magazine, Brazilian Nursing Week, National Seminar of Research in Nursing, the Nursing Regional Meetings and the Brazilian Congress of Nursing are highlighted and are a demonstration of power and guts of this entity that survives from the struggle, conquests and achievements for the category. We also highlight the political advance these last two decades for the political and structural organization, the more democratic decisory process both internal and externally (ABEn's National Council); an autonomous social and political expression while civil society, better relationship with other national and international entities. Finally, we relate the challenges which appear to the entity's present management.

Prognosis of bacterial meningitis in children.

We studied the incidence and prognosis of acute neurologic complications in 281 children under 13 years of age with a diagnosis of acute bacterial meningitis. All the patients were examined daily by the same group of neurologists, using a standardized neurological examination. Patients with signs of encephalic lesions, unsatisfactory response to antibiotics or decreased level of consciousness were submitted to brain computer tomography. The overall lethality rate was 20.3% and cases whose causative agent was identified presented a higher lethality rate (23.7%) than those in which the agent was not found. The most important neurological abnormalities were meningeal signs (88.3%) followed by decreased consciousness (47.7%), irritability (35.2%), seizures (22.4%), fontanel bulging (20.6%) and cranial nerve palsy (14.2%). Seizures, cranial nerve palsy and the absence of meningeal signs were related to higher rates of lethality. Diminished consciousness, seizures, subdural effusion, abscess and hydrocephalus were the most important complications, respectively. We can conclude that acute bacterial meningitis continues to be an important health problem in developing countries and that public health measures will be necessary to minimize the impact of sequelae and reduce the mortality rate in children with that pathology.