Association of the rs5186 polymorphism of the AGTR1 gene with decreased eGFR in patients with type 2 diabetes from Mexico City.

BACKGROUND: Early biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years. The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination. OBJECTIVE: The aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. METHODS: We analyzed 297 not related patients with T2DM, divided into 221 controls (KDOQI 1) and 76 cases (KDOQI 2). Arterial pressure, anthropometric and biochemical parameters were measured. rs5186 of AGTR1 genotyping was performed by TaqMan assay real-time PCR method. Allele and genotype frequencies, and Hardy-Weinberg equilibrium were measured. Normality test for data distribution was analyzed by Shapiro-Wilk test, variable comparison by Student's t-test for continuous variables, and Chi-squared test for categorical variables; ANOVA test was used for mean comparison of more than two groups. Effect of rs5186 to DKD was estimated by multiple heritability adjustment models for risk variables of DKD. Statistical significance was indicated by p<0.05. Data was analyzed using Statistical Package STATA v11 software. RESULTS: Dominant and Over-dominant models showed a likelihood ratio to GFR depletion of 1.89 (1.05-3.39, p=0.031) and 2.01 (1.08-3.73, p=0.023) in patients with T2DM. Risk factor increased to 2.54 (1.10-5.89) in women in Over-dominant model. CONCLUSION: In clinical practice, most of nephropathies progress at a slow pace into a total breakdown of renal function, even asymptomatic. This is the first study, reporting that rs5186 polymorphism of AGTR1 gene contribution to GFR depletion, and this could be evaluated as a predisposing factor for DKD in patients with T2DM.

Asesoramiento anticoncepcional para mujeres con trombofilia hereditaria / Contraception counseling for women with inherited thrombophilia / Aconselhamento de contracepção para mulheres com trombofilia hereditária

Resumen: La anticoncepción en las pacientes con trombofilia es un desafío para el equipo de salud. La función de asesoramiento en materia de planificación familiar va más allá de la simple prescripción, ya que para definir el mejor método anticonceptivo no es suficiente la consideración de los antecedentes médicos y obstétricos de la mujer, sino que es imprescindible considerar las preferencias de la paciente. El asesoramiento sobre anticoncepción en las mujeres con trombofilia hereditaria debe abordar los riesgos de enfermedad tromboembólica venosa, incrementada en este grupo de pacientes, considerando cada uno de los métodos anticonceptivos, así como los de un embarazo no buscado, con el objetivo de contribuir a que la decisión se tome de manera informada. La presente revisión aborda este riesgo según cada tipo anticonceptivo en pacientes con distintos tipos de trombofilia hereditaria.

Abstract: Contraception in patients with thrombophilia is a challenge for the health team. The role of family planning counseling goes beyond simple prescription, since in order to define the best contraceptive method, it is not enough to consider the woman's medical and obstetric history, but rather it is essential to consider the patient's preferences . Counseling on contraception in women with hereditary thrombophilia should address the risks of venous thromboembolic disease, increased in this group of patients, considering each of the contraceptive methods, as well as those of an unintended pregnancy, in order to contribute to the the decision is made in an informed manner. The present review addresses this risk according to each contraceptive type in patients with different types of inherited thrombophilia.

Resumo: A contracepção em pacientes com trombofilia é um desafio para a equipe de saúde. O papel do aconselhamento de planejamento familiar vai além da simples prescrição, pois para definir o melhor método anticoncepcional não basta considerar a história médica e obstétrica da mulher, mas sim considerar as preferências da paciente. O aconselhamento sobre contracepção em mulheres com trombofilia hereditária deve abordar os riscos de doença tromboembólica venosa, aumentados neste grupo de pacientes, considerando cada um dos métodos contraceptivos, bem como os de gravidez indesejada, a fim de contribuir para a tomada de decisão de uma forma informada. A presente revisão aborda esse risco de acordo com cada tipo de contraceptivo em pacientes com diferentes tipos de trombofilia hereditária.

Predictive value of blood measurement of Complement System proteins and metabolic components for early detection of obstetric complications linked to poor placental function.

Preeclampsia-eclampsia syndrome (PES) is associated with severe obstetric complications and there are no efficient methods available for an early detection. We studied blood concentration of some immunological and metabolic markers in association with obstetric outcome in healthy pregnant women and patients with obstetric risk factors, by ELISA and biochemical tests. Patients with complications showed higher levels of CRP and C4 positively correlated with Triglycerides and Cholesterol concentrations. Our results provide evidence that Immunological and metabolic alterations contribute to obstetric complications and that biomarkers linked to these alterations could be useful for an early detection of these problems.

Teaching tobacco cessation to large student cohorts through train-the-trainers and problem based learning strategies.

BACKGROUND: Smoking is a leading cause of preventable deaths worldwide. Graduates of medical schools receive limited training on tobacco cessation and are ill-equipped to treat tobacco dependence. In this paper, we describe and present evidence from an educational intervention based on a train-the-trainers model and problem-based learning strategy aimed to educate a large number of first-year medical students on tobacco-related issues. METHODS: A survey assessing students' knowledge, attitudes and beliefs was conducted before and after educational intervention. Tobacco experts from the faculty staff, who are trained problem-based learning tutors, served as facilitators in the problem-based learning setting with 1000 medical students. RESULTS: Significant changes in knowledge and beliefs were observed. Items such as need for further training in cessation, importance, and effectiveness of brief advice showed significant variations after the educational intervention. DISCUSSION: Educational intervention based on a train-the-trainers and problem-based learning approaches are feasible and effective to educate a large cohort of first-year medical students in tobacco issues. Further research is needed to find out whether this intervention improves overall patient care management.

Conocimientos, creencias, prácticas y actitudes con respecto al consumode tabaco de estudiantes de medicina de primer año en Uruguay, 2009 / Knowledge, beliefs, practices and attitudes regarding tobacco dependence among first year medical school students in Uruguay, 2009

Introducción: a partir de la nueva legislación de control del tabaco enUruguay y la obligatoriedad de los servicios de salud de incorporar eltratamiento del tabaquismo se incrementó la necesidad de formar alos futuros médicos en este tema.Objetivo: determinar conocimientos, creencias, prácticas y actitudes con respecto al tabaquismo en estudiantes de Medicina de primer año y evaluar el impacto de una intervención educativa sobre los mismos.Material y método: se aplicó encuesta de la Organización Mundial de la Salud a estudiantes de Medicina de primer año antes y después de una intervención educativa. Esta consistió en una instancia de formación sobre tabaquismo de los tutores seguida del abordaje del tema por los tutores con sus estudiantes, con la metodología deaprendizaje basado en problemas.Resultados: 28,1% eran fumadores y 44,6% quería dejar de fumar; 70,7% de los no fumadores reconocían la efectividad del consejo médico para la cesación mientras que 59,1% de los fumadores lo reconocían (p = 0,006) y 79,75% de los no fumadores y 64,8% de los fumadores (p < 0,001) señalaban el rol modélico de los médicos.Luego de la intervención educativa se observaron cambios significativoscon respecto a la necesidad de entrenamiento en cesación (p = 0,039), rol de aconsejar (p = 0,026) y conocimiento de que el consejoaumenta la cesación (p = 0,001).Conclusiones: el ser estudiante fumador afecta significativamente los conocimientos y las creencias acerca del tabaquismo. La intervención fue efectiva en modificar conocimientos, creencias y actitudes en relación con la efectividad de dar consejo y la necesidad derecibir entrenamiento en cesación.

Introduction: upon the new legislation to control tobacco consumption being enforced and the health care centerÆsobligation to include the treatment of tobacco dependence within their health care services, the need to train future physicians in this field significantly increased.Objectives: to determine knowledge, beliefs, practices and attitudes regarding tobacco dependence amongfirst year Medical Students, and to evaluate the impact of an educational intervention on these beliefs, practicesand attitudes.Method: a survey designed by the World Health Organization was applied to first year Medical Students a year before and a year after the educational intervention.Tutors were trained on tobacco dependence and subsequently, these tutors worked together with the medicalstudents by means of a problem based learning methodology.Results: 28.1% were smokers and 44.6% wished to quit smoking; 70.7% of non-smokers admitted medicalcounseling was effective for quitting, whereas 59.1% of smokers did not admit so (p = 0,006), and 79,75% ofnon-smokers and 64.8% of smokers (p < 0,001) emphasized on the importance of the medical role model.After the educational intervention significant changes were observed regarding the need to provide trainingon quitting smoking (p = 0,039), the counselorÆs role (p = 0,026) and knowledge that counseling contributesto quitting (p = 0,001).Conclusions: smoking significantly affects studentsÆ knowledge and beliefs about tobacco dependence.The intervention turned out to be useful to modify knowledge, beliefs and attitudes regarding the effectivenessof providing counseling and the need for medical doctors to be trained in quitting smoking.

Introdução: a nova legislação de controle do tabaco no Uruguai e a obrigatoriedade dos serviços de saúde de incorporar o tratamento do tabagismo aumentaram a necessidadede formar os futuros médicos neste tema.Objetivos: determinar conhecimentos, crenças, práticas e atitudes relacionados ao tabagismo de estudantes do primeiro ano de Medicina e avaliar o impacto de uma intervenção educativa sobre os mesmos.Material e método: aplicou-se a pesquisa da Organização Mundial da Saúde a estudantes do primeiro ano deMedicina antes e depois de uma intervenção educativa. Esta intervenção incluía informação sobre tabagismopor tutores e uma discussão do tema entre os tutores e seus estudantes, utilizando a metodologia de aprendizagem baseada em problemas.Resultados: 28,1% eram tabagistas e 44,6% queriam deixar de fumar; 70,7% dos não tabagistas reconheciam a efetividade do conselho médico para a cessação enquanto 59,1% dos tabagistas o reconheciam (p = 0,006)e 79,75% dos não tabagistas e 64,8% dos tabagistas (p <0,001) destacavam o papel dos médicos como exemplo.Depois da intervenção educativa se observaram mudanças significativas com relação à necessidade de formaçãoem cessação (p = 0, 039), o papel do aconselhamento (p = 0,026) e o conhecimento de que o aconselhamentoaumenta a cessação (p = 0,001).Conclusões: ser estudante fumante afeta significativamente os conhecimentos e as crenças sobre tabagismo. A intervenção foi efetiva na modificação de conhecimentos, crenças e atitudes relacionadas com a efetividade de aconselhar e a necessidade de receber formação em cessação de tabagismo.