Prevalência de diabete mellitus e correlação entre testes de glicemia em pacientes idosos atendidos no ambulatório do Instituto de Geriatria e Gerontologia, PUCRS / Prevalence of diabetes mellitus and correlation between tests of glucose in elderly patients

Este artigo visa correlacionar os diferentes testes de glicemia em pacientes idosos atendidos no Ambulatório do IGG, PUCRS, bern como demonstrar a prevalência de Diabete Mellitus nesta população. Entre 355 idosos avaliados no estudo, 66 (18,59 %) foram diagnosticados diabéticos. Foram avaliadas a glicemia de jejum, a glicemia média estimada (GME) e o hemoglicoteste (HGT) de 33 pacientes sendo 28 mulheres e 5 homens, com uma idade media de 74 anos. Os resultados da GME, HGT e glicemia, apresentaram valores acima das metas em 16 (48,0 %), 9 (27,0 %) e 7 (21,0 %) pacientes, respectivamente. A análise estatfstica demonstra uma diferença significativa nos resultados apresentados por homens e mulheres, estando as mulheres em uma situação considerada adequada em relação aos níveis glicêmicos e os homens apresentando valores muito acima das metas. 0 estudo estatístico demonstrou existir uma correlação muito significativa (p < 0,0001) entre os valores da glicemia de jejum e da hemoglobina glicada (A1c) das mulheres, embora a correlação entre aA1ce o HGT não seja significativa (p <0,59). A correlação entre os valores da glicemia de jejum e da A1c demonstrou não ser significativa (p< 0,75). Entretanto a A1c e o HGT demonstraram-se fortemente correlacionados (p < 0,01).

This paper aims to correlate the different tests of blood glucose in elderly patients treated at the IGG, PUCRS, as well as to demonstrate the prevalence of DM in this population. Among 355 individuals evaluated in the study, 66 (18.59%) were diagnosed with diabetes. We have measured the fasting blood glucose, the estimated average glucose and hemoglucotest of 33 patients with 28 women and 5 men, with a mean age of 74 years. The results of eAG, HGT, showed values above the targets in 16 (48.0 %), 9 (27.0 %) and 7 (21.0 %) patients, respectively. The statistical analysis showed a significant difference in the results presented by men and women, with women in a situation deemed appropriate in regard to the blood glucose levels and men with values well above the targets. Statistical analysis demonstrated that there was a vety significant correlation (p <0.0001) between the values of fasting blood glucose and A1c women, although the correlation between A1c and HGT is not significant (p <0.59). The correlation between the values of fasting plasma glucose and A1c showed not significant (p <0.75). However, theA1c and HGT showed to be strongly correlated (p <0.01).

Toxicity of capecitabine compared with 5-fluorouracil in elderly patients with breast or gastrointestinal tract cancer

OBJECTIVES: The aim of this study was to evaluate the toxicity of capecitabine compared with 5-fluorouracil in elderly patients with breast or gastrointestinal tract cancer. MATERIAL AND METHODS: A cohort study was used to evaluate toxicity parameters in elderly patients undergoing chemotherapy treatment. This study was conducted between 2006 and 2008 and was composed of 76 patients from the Oncology Ambulatory of Hospital São Lucas, PUCRS. Eligible patients included elderly individuals (aged 60 years or above) of both sexes who suffered from breast or gastrointestinal tract cancer and who used daily oral capecitabine or intravenous 5-fluorouracil. General side effects were evaluated and graded on a four-point scale. The study also analyzed the values of blood markers such as alanine aminotransferase and aspartate aminotransferase for hepatic toxicity, and troponine I and electrocardiogram for cardiotoxicity. RESULTS: The data showed a higher frequency of general adverse effects in the patients who used 5-fluorouracil in relation of capecitabine. However, only the patients that used capecitabine suffered from hand-and-foot syndrome. Conversely, the levels of ALT in the elderly men who used capecitabine were significantly higher (p = 0.027) than those who used 5-fluorouracil. With regard to cardiac function, a significant difference (p = 0.023) in the median QT interval between the groups was found, while all the other exams presented normal results. CONCLUSION: The use of capecitabine should be frequently monitored in order to minimize or avoid the toxic effects of the chemotherapy in elderly patients. Other parameters should be subsequently analyzed to confirm this conclusion.

Giardia lamblia: distribuição de microtúbulos no citoesqueleto de trofozoítos e cistos utilizando taxóide fluorescente / Giardia lamblia: distribution of microtubules on the cytoskeleton of trophozoites and cysts by use of fluorescent taxoid

Giardia lamblia é um protozoário parasito do intestino delgado, agente etiológico da giardiose, o qual apresenta um complexo citoesqueleto composto por microtúbulos. Neste estudo, a distribuição dos microtúbulos no citoesqueleto de trofozoítos e cistos de G. lamblia foi investigada por meio de um taxóide fluorescente, o FLUTAX-2 - um derivado do Taxol que se liga aos dímeros polimerizados de alfabeta-tubulina. O efeito do metronidazol sobre o citoesqueleto do organismo também foi avaliado. FLUTAX-2 foi capaz de se ligar aos microtúbulos de trofozoítos e cistos de G. lamblia, tornando possível a visualização de estruturas do citoesqueleto do microrganismo, como flagelos, funis e disco adesivo. Além disso, FLUTAX-2 marcou os trofozoitos cultivados por diferentes períodos, revelando que o intervalo de 48 horas é o melhor tempo de cultivo. A incubação dos parasitos na presença de metronidazol não demonstrou alteração significativa na marcação microtubular por FLUTAX-2. Nosso grupo já apresentou a marcação pelo FLUTAX-2 em outros protozoários, Trichomonas vaginalis, T. gallinae e Tritrichomonas foetus, e este é o primeiro trabalho a revelar o perfil de ligação em G. lamblia. Os resultados contribuem para o conhecimento de aspectos biológicos e morfológicos do parasito e sugerem perspectivas para o diagnóstico laboratorial da giardiose.

G. lamblia is a protozoan parasite of the small intestine and the etiologic agent ofgiardiosis, which presents a complex cytoskeleton composed of microtubules. In this study, the microtubule cytoskeleton was labeled in trophozoites and cysts of G. lamblia, using a fluorescent taxoid (FLUTAX-2), a derivative of Taxol, which binds to áâ-tubulin dimer polymerized. In addition, the effect of metronidazole on the cytoskeleton of the parasite was also evaluated. FLUTAX-2 was able to labelthe microtubules of trophozoites and cysts, allowing the observation of cytoskeletal structures, such as flagella, funis, adhesive disk, and median body. Moreover, FLUTAX-2 labeled the trophozoites from several different cultivation times, revealing the 48 hours as the best incubation period. The incubation of parasites in presence of metronidazole did not show significant alteration on the microtubulelabeling by FLUTAX-2. We have shown the FLUTAX-2 labeling in other protozoa,Trichomonas vaginalis, T. gallinae and Tritrichomonas foetus, and this is the first report revealing the binding profile in G. lamblia. Our results contribute to the knowledge of biological and morphological features of this intestinal pathogen. Furthermore, our data showed no modification of microtubule profile labeling in presence of metronidazole. Finally, a new perspective for giardiosis diagnosticis suggested, since trophozoites and cysts of G. lamblia were labeled withFLUTAX-2.

Anti-Trichomonas vaginalis activity of synthetic lipophilic diamine and amino alcohol derivatives.

Taking in account the increased prevalence of metronidazole-resistant infections, alternative drugs are necessary for the treatment of trichomonosis. We report in this work the preparation and the in vitro anti-trichomonads activity of two diamines 1 and 2, and three different lipophilic amino alcohol derivatives 3, 4 and 5. These compounds were tested for in vitro activity against two isolates of Trichomonas vaginalis and displayed inhibition of the parasite growth. Five concentrations of each compound were tested. The butanediamine derivative 1, at a final concentration of 5.85 microM, presented a cytotoxic effect against 47% of T. vaginalis trophozoites. Furthermore, the cytotoxicity of 1 did not present statistically significant difference when compared to metronidazole in the same range of concentration (0.1-1.5 microg/mL).

Efeitos dos medicamentos hipolipêmicos no perfil lipídico de população idosa de Porto Alegre, RS, Brasil / Effects of hypolipemic drugs on the lipidic profile of Porto Alegre, RS, Brasil in older population

O perfil lipídico pode estar relacionado com doenças crônico-degenerativas e suas complicações. Alguns dos medicamentos usados para controlar os níveis lipêmicos são estatinas e fibratos. O objetivo deste trabalho foi verificar o perfil lipídico da população idosa de Porto Alegre, RS, Brasil, que faz uso desses medicamentos. Foram coletadas amostras de sangue de 456 idosos e as dosagens foram realizadas através da metodologia química seca. Para análise estatística foram utilizados os testes Student e Qui-quadrado. Analisou-se o perfil lipídico de 22 homens e 51 mulheres que faziam uso de medicamentos hipolipêmicos e comparou-se esse perfil com o de 85 homens e 161 mulheres que não faziam uso destes. Os resultados demonstraram diferença significativa na classificação dos riscos e nos valores médios de colesterol total, LDL e triglicerídeos, nas idosas que usavam hipolipêmicos em relação às quenão os utilizavam. No entanto, para os homens, ocorreu uma diminuição significativa nos resultados de LDL, nos que faziam uso dos hipolipêmicos, apresentando valores controlados para todos os índices. É necessário um maior acompanhamento para a utilização correta dos medicamentos citados pelas pacientes idosas, a fim de se obter um melhor controle da lipemia e uma melhoria nas condições de saúde dessas pacientes.

The lipidic profile can be related to chronic degenerative diseases and their complications. Some of the drugs used to control the lipidic levels are statins and fibrates. The aim of the study was to verify the lipidic profile of the elderly population of Porto Alegre, RS, Brazil that makes use of these medicines. Blood samples were collected from 465 elderly and the dosages were determined by drought chemical methodology. For statistical analysis were used the Student t test and Chi-square test. There were examined the lipidic profile of 22 men and 51 women that made use of hypolipemic drugs and compared with 85 men and 161 women that did not use these. The results showed significant differences in the classification of risk and the average values of total cholesterol, LDL and triglycerides in the elderly that used hypolipemic in relation to those that did not use. However, for men there was a significant decrease in LDL results of those that made use of hypolipemic drugs, presenting controlled values for all indexes. It’s necessary a better monitoring for the correct use of the drugs mentioned by elderly women patients in order to get a better control of lipidic profile and an improvement in the health conditions of these patients.

Terapia anti-hipertensiva utilizada por pacientes idosos de Porto Alegre/RS, Brasil / Antihypertensive therapy used by elderly patients fron Porto Alegre/RS, Brasil

Objetivos: Descrever o perfil de utilização de medicamentos com ação no sistema cardiovascular, especialmente anti-hipertensivos, por idosos residentes na cidade de Porto Alegre. Métodos: Estudo transversal exploratório e observacional com base populacional, realizado em 2006, sobre a utilização qualitativa e quantitativa de medicamentos por pacientes idosos. O instrumento utilizado para a coleta de dados foi uma ficha de seguimento farmacológico. Resultados: Do total de 385 pacientes entrevistados, 62,3% utilizavam medicamentos com ação do sistema cardiovascular, sendo que destes, 86,3% utilizavam anti-hipertensivos. Entre os 35,3% pacientes que faziam uso de monoterapia, 38,4% utilizavam inibidores da enzima conversora de angiotensina (ECA) E 26% utilizavam beta-bloqueadores. Dos 207 pacientes em monoterapia ou terapia combinada de dois ou mais medicamentos, 59,4% utilizavam diuréticos e 51,2% inibidores da ECA. Conclusões: Os diuréticos, inibidores da ECA e betabloqueadores foram anti-hipertensivos mais utilizados. Muitas vezes o usuário comete erros na medicação, o que pode ser resolvido com uma assistência correta a esse paciente. Diante da prevalência da hipertenção entre os idosos, observa-se a necessidade de uma maior atenção dos profissionais de saúde a esses pacientes.

Scanning electron microscopy study of Tritrichomonas augusta.

Tritrichomonas augusta is a flagellated protozoan that parasitizes amphibians and reptiles. According to scanning electron microscopy (SEM), the cell shape of T. augusta varies from slender pyriform to ovoidal. Our data show the morphological features of the trophozoites: the emergence of the anterior flagella, the structure of the undulating membrane and the position and shape of the pelta, axostyle and posterior flagellum. In addition, herein we describe spherical forms which are probably pseudocysts. The description of the external structure of T. augusta, as demonstrated by SEM, contributes to the understanding of the biology of this parasite.

Trichomonas vaginalis: cytochemical localization of a NTPDase1 and an ecto-5'-nucleotidase and effects of adenine nucleotides on cellular viability.

Nucleoside triphosphate diphosphohydrolase 1 (NTPDase1), which hydrolyzes extracellular ATP and ADP, and ecto-5'-nucleotidase, which hydrolyzes AMP, are characterized for Trichomonas vaginalis. Ultrastructural cytochemical microscopy showed NTPDase1 and ecto-5'-nucleotidase activities on the surface of the parasites. High levels of extracellular adenine nucleotides and adenosine did not exert cytolytic effects in intact cells of T. vaginalis. Our results suggest that these enzymes are relevant for the survival of the parasite during exposure to extracellular nucleotides. Since the ecto-localization of these enzymes is essential for the maintenance of adenosine extracellular levels, this nucleoside could be important for the purine salvage pathway in the parasite.

Study of enteroparasites infection frequency and chemotherapeutic agents used in pediatric patients in a community living in Porto Alegre, RS, Brazil.

Parasitic infections caused by intestinal protozoan and helminths affect more than two billion people worldwide and chemotherapy is the most commonly used therapeutic procedure. Considering the problems created by parasitic infections and the incorrect use of drugs, the aim of this work was to detect the frequency of enteroparasites infection and to estimate the use of chemotherapeutic agents in children living in the periphery of the city of Porto Alegre, RS, Brazil. Ninety-six preschool age children, who had parasitological exams and who used antiparasitic drugs, were analyzed. The efficacy of treatment was evaluated by stool examination repeated six months after treatment. The same diagnostic test was used to evaluate parasitological cure, which was defined as absence of eggs and cysts in the stool. From these children, 79 (82.3%) were contaminated by some species of parasite, the most prevalent were Ascaris lumbricoides, Trichuris trichiura and Giardia lamblia. The most commonly used drugs were mebendazole (86% of prescriptions) and metronidazole (30.3%). The cure rate in the 79 children, examined 6 months after treatment, was 65.3% for A. lumbricoides and 66.1% for T. trichiura. This study suggests that a continuous education program regarding the prevention and treatment of parasitic infections is an essential tool for their eradication.

Study of enteroparasites infection frequency and chemotherapeutic agents used in pediatric patients in a community living in Porto Alegre, RS, Brazil

As parasitoses provocadas por protozoários ou helmintos patogênicos afetam mais de dois bilhões de pessoas no mundo. Considerando os problemas gerados por infecções parasitárias e a necessidade do uso correto dos medicamentos prescritos, o objetivo deste trabalho foi detectar a freqüência de infecção por enteroparasitos e o uso de agentes quimioterápicos em crianças moradoras na periferia de Porto Alegre, RS, Brasil. Foram analisadas noventa e seis crianças em idade pré-escolar, que realizaram o exame parasitológico de fezes e que fizeram uso de antiparasitários. A eficácia do tratamento foi avaliada pelo exame parasitológico repetido seis meses após o tratamento. O mesmo teste diagnóstico foi utilizado para avaliar a cura que foi definida como a ausência de ovos e cistos nas fezes. Das crianças estudadas, 79 (82,3 por cento) estavam infectadas com um ou mais parasitas, os mais prevalentes foram Ascaris lumbricoides, Trichuris trichiura e Giardia lamblia. Os antiparasitários mais utilizados foram mebendazol (86 por cento das prescrições) e metronidazol (30,3 por cento) de acordo com a prevalência da infecção. A porcentagem de cura das 79 crianças estudadas após 6 meses do tratamento foi 65,3 por cento para A. lumbricoides e 66,1 por cento para T. trichiura. Este estudo sugere que um programa de educação continuada voltado para a prevenção e tratamento das infecções parasitárias tem se mostrado uma ferramenta útil na erradicação destas patologias.

Prevalência de infecções pelo Strongyloides stercoralis em uma área específica, Vila dos Papeleiros, na cidade de Porto Alegre, RS / Prevalence of Strongyloides stercoralis infection in selected area in the slum of Papeleiros in the city of Porto Alegre, RS

Estudos sobre a entrongiloidiase em paises em desenvolvimento sao relativamente raros quando comparados aos inqueritos epidemiologicos de outros helmintos transmitidos pelo solo. Esta observação fundamenta-se na rara ocorrência de Strongiloides stercoralis nestes paises quando comparada com a ascaridiase, tricuriase e ancilostomiase. Neste inquerito coproparasitologico as amostras fecais foram submetidas a tecnica da sedimentaçao espontanea (Hoffman, Pons e Janer) e ao metodo de Baermann-Moraes. Pelos dados obtidos das 439 amostras examinadas, 67,9 por cento (298) apresentaram resultados positivos e 32,1 por cento.

Scanning electron microscopy study of Trichomonas gallinae.

A scanning electron microscopy (SEM) study of Trichomonas gallinae (Rivolta, 1878), provided more information about the morphology of this flagellated protozoan. SEM showed the morphological features of the trophozoites; the emergence of the anterior flagella, the structure of the undulating membrane, the position and shape of the pelta, axostyle and posterior flagellum. Of special interest were the pseudocyst forms.

Perspective of a new diagnostic for human trichomonosis.

Several diagnostic techniques have been employed for the detection of Trichomonas vaginalis. Microtubules constitute the cytoskeleton in eukaryotic cells and are sensitive to antimitotic drugs, such as Taxol (paclitaxel). We used FLUTAX a fluorescent taxoid - to analyze the microtubule distribution in living trophozoites of T. vaginalis in urine and in vaginal discharge. A high intensity of fluorescence was observed in living T. vaginalis, epithelial cells and leukocytes present in urine and vaginal discharge. Our preliminary results show the perspective of a new diagnostic technique for trichomonosis and will contribute to the understanding of the cytoskeleton of T. vaginalis.

Perspective of a new diagnostic for human trichomonosis

Several diagnostic techniques have been employed for the detection of Trichomonas vaginalis. Microtubules constitute the cytoskeleton in eukaryotic cells and are sensitive to antimitotic drugs, such as Taxol (paclitaxel). We used FLUTAX a fluorescent taxoid - to analyze the microtubule distribution in living trophozoites of T. vaginalis in urine and in vaginal discharge. A high intensity of fluorescence was observed in living T. vaginalis, epithelial cells and leukocytes present in urine and vaginal discharge. Our preliminary results show the perspective of a new diagnostic technique for trichomonosis and will contribute to the understanding of the cytoskeleton of T. vaginalis

Characterization of an ecto-5'-nucleotidase (EC 3.1.3.5) activity in intact cells of Trichomonas vaginalis.

The enzymatic properties of an ecto-5'-nucleotidase were described in Trichomonas vaginalis. The enzyme hydrolyzes nucleoside monophosphates in optimum pH values of 7.5 and 6.5 for the 30236 strain and for the 30238 strain, respectively. Mg(2+) and Ca(2+) were activators of AMP hydrolysis in both strains. The apparent K(m) (Michaelis constant) values for Mg(2+)-AMP were 111.4+/-28.1 microM (mean+/-SD, n=3) for 30236 strain and 420.2+/-35.7 microM (mean+/-SD, n=3) for 30238 strain. The ecto-5'-nucleotidase activity was insensitive to levamisole and tetramisole, inhibitors of alkaline phosphatases, whereas alpha,beta-methylene-ADP inhibited the enzymatic activity of both strains. Our results showed that the AMP hydrolysis presents differences in some kinetic parameters between the two strains investigated. An analysis of the enzymatic chain involved in the ATP hydrolysis to adenosine will contribute to understanding the biochemical aspects of the parasite and the mechanisms related to host-parasite interactions.

Prevalência de enteroparasitos em moradores de vilas periféricas de Porto Alegre, RS / Survey of intestinal parasites among inhabitants of Porto Alegre Metropolitan area

Realizou-se um trabalho integrado de pesquisa e extensão comunitária com o objetivo de determinar a prevalência das enteroparasitoses na vila Fátima (Mato Sampaio), Campo da Tuca e Vila dos Papeleiros, vilas periféricas de Porto Alegre. este estudo foi realizado durante os anos de 1999 e 2002 em uma população de 594 pessoas, todas residentes nestas vilas. As amostras fecais foram examinadas pela técnica de Hoffman, Pons e Janer. O maior percentual geral de infecção obtido para nematóides foi de 39,5% (235) para Ascaris lumbricoides e, entre os protozoários, a Giardia lamblia com 18,0% (107). As altas taxas de enteroparasitoses entre crianças e adultos jovens moradores destas vilas mostrou o baixo nível sócio-econômico, a falta de escolaridade e a inexistência de saneamento básico.

Shape variations of trichomonas vaginalis in presence of different substrates

Shape variations of strains of Trichomonas vaginalis were demonstrated by scanning electron microscopy (SEM) following inoculation on McCoy cell monolayers and after interaction with human erythrocytes. The parasites adhered to both cells and presented amoeboid forms, with pseudopodia-like extensions. Several amoeboid organisms swam freely over the cell monolayers and produced aggregates. These unusual forms of the urogenital flagellate may be a response to the composition of the culture medium and may play an important role in the pathogenic process of T. vaginalis

Scanning electron microscopy in the investigation of the in vitro hemolytic activity of Trichomonas vaginalis.

The in vitro hemolytic activity of Trichomonas vaginalis has been previously demonstrated, but the mechanisms involved remain to be elucidated. In this work we used scanning electron microscopy to investigate the contact dependency of the hemolytic phenomenon caused by the parasites. The erythrocytes adhered to the parasites' surface and were phagocytosed. These observations suggest that the contact between T. vaginalis and erythrocytes may be an important mechanism in the injury caused to the erythrocytes. The hemolytic activity of T. vaginalis may be an efficient means of obtaining nutrients for the parasite and allow the investigation of the mechanism used by T. vaginalis to damage cellular membranes.

Trichomonas vaginalis: microtubule cytoskeleton distribution using fluorescent taxoid.

Trichomonas vaginalis is a flagellated parasitic protist of the human urogenital tract. The parasite has a poorly known cytoskeleton formed by an axostyle and a pelta, which are formed by stable structures such as microtubules, essential for the maintenance of cell shape and organization. FLUTAX-2 is an active fluorescent derivative of Taxol, binds to alphabeta-tubulin dimer polymerized. In this paper we present the analysis of microtubule distribution in living trophozoites of T. vaginalis using FLUTAX-2.

Ocorrência de cryptosporidium parvum entre pacientes sidéticos do Centro de Saúde de Porto Alegre, RS / Search cryptosporidium parvum oocysts in diarrheic feces from AIDS patients in a state medical unit in Porto Alegre, RS

A prevalência de oocistos de Cryptosporidium parvum foi determinada em amostras fecais de 25 sidéticos de ambos os sexos com gastroenterite, durante o período de abril a maio de 2002 no Centro de Saúde Vila dos Comerciários em Porto Alegre, RS. Os oocistos foram detectados pela coloraçäo da safranina modificada a quente. Pelos dados observados das 25 amostras estudadas, 16 porcento (4) apresentaram resultados positivos e 84 porcento (21) foram negativas para a pesquisa de oocistos. No que se refere à ocorrência de oocistos de C. parvum, em relaçäo ao sexo, foi verificado que os maiores percentuais de infecçäo foram obtidos entre as pacientes do sexo feminino 12 porcento (3), enquanto que entre os sidéticos do sexo masculino o índice de infecçäo foi igual a 4 porcento (1).