Search

INTRODUÇÃO: O desenvolvimento de autoanticorpos é considerado o primeiro estágio do diabetes mellitus tipo 1 (DM1). O estágio 2 caracteriza-se pela presença de autoimunidade associado a disglicemia assintomática. A presença de sintomas define o estágio 3. Não há, até o momento, terapia capaz de parar o processo de autoimunidade. A utilização de tecnologia de computação na área da pesquisa em saúde pode ser útil para ultrapassar esses desafios. OBJETIVO: Desenvolvimento de um aplicativo capaz de facilitar a realização da pesquisa clínica com DDPi-4 em pacientes portadores de DM1 estágio 2. MÉTODOS: Este web aplicativo (APP) foi desenvolvido para apoiar o PRE1BRAZIL, um estudo homônimo, longitudinal, multicêntrico, randomizado, aberto de intervenção clínica com um inibidor da enzima Dipeptil Peptidase 4 (DDPi-4), em pacientes de 18 a 35 anos portadores de DM1 estágio 2. Será comparado a taxa de progressão para o estágio 3 ao final de 2 anos entre os grupos tratamento (alogliptina 25mg/dia) e controle. RESULTADOS: O PRE1BRAZIL é um web APP fácil e intuitivo, desenvolvido para conduzir, unificar e padronizar, remotamente, uma pesquisa clínica randomizada (ECT) homônima. O APP valida os critérios de exclusão e inclusão, e randomiza o paciente, informa os exames a serem solicitados para o retorno e salva os dados automaticamente. CONCLUSÃO: Este é o primeiro web APP desenvolvido e validado para suportar um estudo de prevenção de DM1 totalmente automatizado.

Objetivos: Este artigo apresenta a experiência do uso da moulage na simulação clínica para aquisição de competências em ginecologia e obstetrícia no Laboratório de Habilidades do Complexo Hospitalar da Universidade Federal do Ceará/EBSERH e descreve a aplicação desta técnica na confecção de cenários de hemorragia pós-parto (HPP) e úlceras genitais. Metodologia: Sangue artificial foi utilizado para caracterizar um treinamento de quantificação de perda sanguínea na HPP e técnicas de maquiagem foram aplicadas em manequins para simular lesões ulcerativas em uma capacitação de úlceras genitais, aproveitando-se de equipamentos como absorventes, fraldas descartáveis, compressas, corantes, tintas, água, gel e cola à base de água e de silicone, amido de milho, base líquida e sombra rosa. Resultados: Materiais de baixo custo, fácil aquisição e manuseio foram aplicados nesta técnica, ocasionando efeitos especiais em modelos e promovendo maior realismo aos cenários. A moulage facilitou a percepção sensorial e engajamento dos alunos, com consequente melhora em seus desempenhos e aprendizado. Conclusão: Quando previamente planejada e executada com exatidão, a moulage demonstrou ser uma ferramenta útil na aquisição de competências em simulação clínica.

Objetivo: Discutir o uso do centro de simulação na educação em saúde. Metodologia: estudo de caráter descritivo caracterizado como uma revisão narrativa. Foram utilizadas as bases de dados Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências de Saúde (LILACS) e Pubmed, e utilizou-se os Descritores em Ciências da Saúde (DECs) “simulação”, “treinamento por simulação” e “treinamento com simulação de alta fidelidade”. Resultados: O uso da simulação clínica na formação dos profissionais de saúde tornou-se mais prevalente nas últimas décadas, devido à sua eficácia e capacidade como modalidade educacional de treinar habilidades clínicas de forma prática e realista em várias especialidades da área da saúde, sem colocar pacientes ou profissionais em risco. Dessa forma, a simulação em saúde se tornou uma solução atraente para fornecer oportunidades educacionais que preenchem lacunas em treinamentos e capacitações enquanto diminui os riscos do pacientes e exposição dos profissionais. Conclusão: O uso dos centros de simulação na educação em saúde está em crescente expansão, especialmente na formação de profissionais de saúde e alunos de graduação e pós-graduação, sendo considerada uma ferramenta promissora no treinamento e capacitação dos profissionais da área da saúde.

Objective: to evaluate the acute adverse effects and comfort of the diving mask interface as a ventilatory support strategy during non-invasive ventilation. Methodology: Clinical, experimental and descriptive study, carried out in the laboratory of the Clinical Research Unit, of the Federal University of Ceará, in the period of June and July 2020. Twelve healthy volunteers were studied. A single-limb circuit noninvasive ventilatory support model was used, coupled with a diving mask, compressed air cylinder (flow of 15L/min) and PEEP valve (5cmH2O), during the period of 60 minutes. The variables evaluated were: physiological parameters (heart rate, respiratory rate, blood pressure and peripheral oxygen saturation), venous blood gases, visual analog scale and adverse effects related to the interface. Results: The sample consisted of 12 women with an average age of 25.58 ± 3.47. There was no statistically significant difference between the gasometric data when comparing the values before and after using the interface. The level of respiratory distress was scored as mild during the use of the interface. The adverse effects with the greatest degree of problem were: mask pressure, chest discomfort, mask weight and pressure in the ear. Conclusion: The diving mask interface seems to be feasible, with no serious levels of adverse effects that would make its use unfeasible, however, to expand its clinical applicability, improvements are necessary. Objetivo: avaliar os efeitos adversos agudos e conforto da interface máscara de mergulho como estratégia de suporte ventilatório durante a ventilação não invasiva. Metodologia: Estudo clínico, experimental e descritivo, realizado no laboratório da Unidade de Pesquisas Clínicas, da Universidade Federal do Ceará, no período de junho e julho de 2020. Foram estudados 12 voluntários saudáveis. Utilizou-se um modelo de suporte ventilatório não invasivo de circuito único, acoplado a máscara de mergulho, cilindro de ar comprimido (fluxo de 15L/min) e válvula de PEEP (5cmH2O), durante o período de 60 minutos. As variáveis avaliadas foram: parâmetros fisiológicos (frequência cardíaca, frequência respiratória, pressão arterial e saturação periférica de oxigênio), gasometria venosa, escala visual analógica e efeitos adversos relacionados a interface. Resultados: A amostra foi composta por 12 mulheres com idade média 25,58 ± 3,47. Não foi observada diferença estatisticamente significante entre os dados gasométricos quando comparado os valores antes e após o uso da interface. O nível de desconforto respiratório foi pontuado como leve durante o uso da interface. Os efeitos adversos com maior grau de problema foram: pressão da máscara, desconforto torácico, peso da máscara e pressão no ouvido. Conclusão: A interface máscara de mergulho parece ser viável, não apresentando graves níveis de efeitos adversos que inviabilize a sua utilização, porém para ampliar a sua aplicabilidade clínica são necessárias implementações de melhorias.

RESUMO Objetivo: Avaliar a qualidade da dieta de crianças e adolescentes com excesso de peso e determinar a relação com fatores de risco cardiometabólico. Métodos: Estudo quantitativo, transversal e analítico, realizado entre dezembro de 2016 e agosto de 2018, com crianças e adolescentes. Coletaram-se variáveis comportamentais (prática de atividade física e tempo de tela), antropométricas (peso, altura, índice de massa corporal, circunferência abdominal e do pescoço) e dietéticas (recordatório de 24 horas) e os dados bioquímicos foram consultados nos prontuários. Avaliou-se a resistência à insulina (RI), usando Homeostasis Model Assessment – Insulin Resistance (HOMA-IR), e a qualidade da dieta, por meio do Índice de Qualidade da Dieta Revisado (IQD-R). Análises realizadas pelos testes de Spearman e Mann-Whitney U, com nível de significância de 5%. Resultados: A amostra incluiu 100 crianças e adolescentes, sendo 71 (71%) do sexo feminino, média de idade de 9,42 ± 2,89 anos. IQD-R apresentou valor médio de 61,16 (IC 95%: 59,14 – 63,19) e nenhum participante apresentou dieta de boa qualidade. Não foram encontradas associações entre o escore do IQD-R e marcadores cardiometabólicos. Observaram-se associações negativas entre os componentes “vegetais totais e leguminosas” e HOMA-IR (r= -0,290), “vegetais verde-escuros, alaranjados e leguminosas” e HOMA-IR (r= -0,333) e “vegetais verde-escuros, alaranjados e leguminosas” com insulina de jejum (r= -0,291). Participantes com mais de três fatores de risco cardiometabólico tiveram pontuação significativamente maior do componente “gordura sólida e açúcar de adição”. Conclusão: Nenhum participante investigado apresentou dieta qualitativamente adequada. A baixa ingestão de vegetais e leguminosas foi associada com marcadores de RI. Descritores: Promoção da Saúde, Obesidade Pediátrica; Consumo de Alimentos; Resistência à Insulina; Doenças Cardiovasculares

Introdução: A resistência à insulina, apesar de pouco investigada em indivíduos com Diabetes mellitus tipo 1, pode ser frequente nesse público. Assim, parâmetros acessíveis à prática clínica são necessários para facilitar o rastreio dessa condição. Objetivo: Avaliar a presença de resistência à insulina em pacientes com diabetes mellitus tipo 1 por meio do índice triglicerídeos/glicose e associar com estado nutricional, perfil glicêmico e lipídico. Métodos: Estudo original transversal realizado com 45 pacientes adultos (≥19 anos) atendidos no ambulatório de Endocrinologia e Diabetes de um Hospital Universitário de Fortaleza-CE. Obtiveram-se, a partir dos prontuários, dados sociodemográficos, antropométricos (peso e altura), bioquímicos e clínicos (comorbidades e tratamento farmacológico) dos pacientes. Utilizou-se os pontos de corte propostos para a população mexicana para classificação do índice triglicerídeos/glicose, considerando-se alterado, valores ≥ 4,55 para mulheres e ≥ 4,68 para homens. A normalidade das variáveis quantitativas foi avaliada por meio do teste de Shapiro Wilk e, para investigar associações utilizou-se o teste t de Student e o teste de Mann-Whitney. Adotou-se um nível de significância de 5% para todos os testes utilizados. Resultados: Observou-se que 62,22% dos indivíduos revelaram níveis alterados do índice triglicerídeos/glicose. Indivíduos que apresentaram níveis alterados revelaram valores mais elevados de glicemia de jejum, triglicerídeos e colesterol total (p

Studies of subcutaneous and visceral abdominal fat thickness evaluated by ultrasound as a predictor of gestational diabetes mellitus (GDM) have been published, but the best technique and standardization are unknown. To identify, critically evaluate, and analyze studies using subcutaneous and visceral abdominal fat as a model for predicting GDM in the first and second trimesters of pregnancy and evaluate their methodological quality.PubMed, Scopus, and Web of Science databases were searched from May to July 2019. We included studies of any sample size performed for any duration and in any configuration. Model development and validation studies were eligible for inclusion. Two authors independently performed the eligibility assessment of the studies by reviewing the titles and abstracts. Data on study design, gestational age, diagnostic criteria for GDM, device, ultrasound fat measurement technique, and cutoff point for GDM prediction were extracted.The electronic search resulted in 1331 articles, of which 14 were eligible for systematic review. Different criteria for diagnosing GDM and fat measurement techniques were used. The cutoff point for subcutaneous, visceral, and total abdominal fat for predicting GDM in the first and second trimesters varied between the studies.No study validated the model for predicting GDM using subcutaneous and visceral abdominal fat measurements. External validation studies are recommended to improve the generalization of this GDM predictor in clinical practice.

Interleukin-18 (IL-18), a proinflammatory and proatherogenic cytokine, has been associated with type 2 diabetes, metabolic syndrome, stroke and coronary artery disease. Some studies have indicated that the IL-18 promoter -137 G/C polymorphism seems to be associated with changes in the IL-18 expression and may contribute to the development of cardiovascular disease (CVD). The aim of this study was to evaluate the association between -137 G/C polymorphism and the levels of IL-18, biochemical markers for cardiovascular disorders, anthropometric profile and cardiovascular disease in Brazilian patients with type 2 diabetes (T2DM).Study subjects comprised 125 T2DM patients undergoing follow-up at a reference endocrinology service in northeastern Brazil. The -137G/C polymorphism in the IL-18 gene and serum IL-18 levels were determined by using allele-specific polymerase chain reaction (PCR) and enzyme-linked immune assay (ELISA), respectively. The anthropometric parameters were assessed using a Body Composition Monitor with Scale, and the laboratory data were measured using an automatic analyzer as well as spectrophotometric analysis.The genotype distribution of IL-18 -137 G/C genetic polymorphism was significantly different among T2DM patients with and without CVD. The results show an association between the CC genotype of -137G/C polymorphism and CVD in T2DM patients (p 0.001). Serum levels of IL-18 were significantly higher in CC carriers (843.1 pg/mL) compared with GG or GC carriers (303.6 pg/mL and 292.0 pg/mL, respectively). In addition, the present study showed that carriers of the CC genotype also had significantly higher concentrations of creatinine and albuminuria than carriers of the GG or GC genotypes (p 0.05 in both).These results suggest that Brazilian T2DM patients with the CC genotype seem to show a predisposition to CVD, as well as an elevation in markers of renal function.

A literature review on the clinical, laboratory, and treatment features of type B insulin resistance syndrome (TBIRS). Data from PubMed, the Virtual Health Library and Cochrane database were selected and analyzed using the REDCap application and R statistical program. From 182 papers, 65 were selected, which assessed 119 clinical cases, 76.5% in females and 42.9% in African-Americans, with an average age of 44 years. A common feature of TBIRS is co-occurrence of autoimmune diseases, such as systemic lupus erythematosus (most frequently reported). Hyperglycemia of difficult control was the mostly reported condition. Tests for anti-insulin receptor antibodies were positive in 44.2% of the cases. Disease management comprised fractional diet, insulin therapy (maximum dose given was 57 600 IU/day), plasmapheresis and immunosuppression with several classes of drugs, mainly glucocorticoids. Remission occurred in 69.7% of cases, in 30.3% of these spontaneously. The mortality rate was 15.38%. There was an inverse relationship between anti-insulin antibodies and remission (p = 0.033); and a positive correlation between combined immunosuppressive therapy and remission (p = 0.002). Relapse occurred in 7.6% of the cases. This rare syndrome has difficult-to-control diabetes, even with high doses of insulin, and it is usually associated with autoimmune diseases. Therapeutic advances using immunomodulatory therapy have led to significant improvements in the rate of remission.

To identify dietary patterns and assess their association with the presence or absence of type 1 diabetes (T1D) and biochemical markers of cardiovascular risk. The study involved patients with T1D and healthy individuals (n=90). Patients with T1D were recruited at the Endocrinology and Diabetes Outpatient Clinic of the Hospital from the Federal University of Ceará (HUWC-UFC) and healthy adult individuals were recruited at the State University of Ceará (UECE) and UFC, in the period from 2016 to 2017. Dietary intake was obtained through 24-hour recalls. Dietary patterns were identified by principal component factor analysis, followed by orthogonal varimax rotation. Poisson regression estimated the prevalence ratios of independent variables in relation to outcomes. Three main patterns were identified: prudent (poultry, fish, tame fruits, whole grains, vegetables, fruits, skimmed milk, and with a negative charge for beef, pork, cereal, legumes, and whole milk), snack (sandwich and fruit smoothie) and western (industrialized drinks, sweets, snacks, and foods rich in fats). Association was observed between prudent pattern with lower HDL cholesterol level; snack pattern with lower fasting blood glucose and higher triglyceride level and the western one with higher fasting blood glucose level. There was no association between patterns and the presence or absence of T1D. The patterns identified were not associated with the presence or absence of T1D, but have been related with HDL cholesterol, triglycerides, and blood glucose. Identificar patrones dietéticos y evaluar su asociación con la presencia o ausencia de diabetes tipo 1 (DT1) y marcadores bioquímicos de riesgo cardiovascular. El estudio involucró a pacientes con DM1 e individuos sanos (n=90). Los pacientes con DT1 fueron reclutados en la Consulta Externa de Endocrinología y Diabetes del Hospital de la Universidad Federal de Ceará (HUWC-UFC) y adultos sanos en la Universidad Estatal de Ceará (UECE) y la UFC, en el período de 2016 a 2017. La ingesta dietética se obtuvo a través de recordatorios de 24 horas. Los patrones dietéticos se identificaron mediante un análisis factorial de componentes principales, seguido de una rotación varimax ortogonal. La regresión de Poisson estimó las razones de prevalencia de las variables independientes en relación con los resultados. Se identificaron tres patrones principales: prudente (aves, pescado, frutas mansas, cereales integrales, verduras, frutas, leche desnatada, y con carga negativa la carne de res, cerdo, cereales, legumbres y leche entera), snack (bocadillo y fruta smoothie) y western (bebidas industrializadas, dulces, snacks y alimentos ricos en grasas). Se observó asociación entre patrón prudente con menor nivel de colesterol HDL; patrón de merienda con menor nivel de glucosa en sangre en ayunas y mayor nivel de triglicéridos y el occidental con mayor nivel de glucosa en sangre en ayunas. No hubo asociación entre los patrones y la presencia o ausencia de T1D. Los patrones identificados no se asociaron con la presencia o ausencia de DT1, pero se han relacionado con el colesterol HDL, triglicéridos y glucosa en sangre. Identificar padrões alimentares e avaliar sua associação com a presença ou ausência de diabetes tipo 1 (DM1) e marcadores bioquímicos de risco cardiovascular. O estudo envolveu pacientes com DM1 e indivíduos saudáveis (n=90). Pacientes com DM1 foram recrutados no Ambulatório de Endocrinologia e Diabetes do Hospital da Universidade Federal do Ceará (HUWC-UFC) e indivíduos adultos saudáveis foram recrutados na Universidade Estadual do Ceará (UECE) e UFC, no período de 2016 a 2017. A ingestão alimentar foi obtida por meio de recordatórios de 24 horas. Os padrões alimentares foram identificados por análise fatorial de componentes principais, seguida de rotação ortogonal varimax. A regressão de Poisson estimou as razões de prevalência das variáveis independentes em relação aos desfechos. Foram identificados três padrões principais: prudente (aves, peixes, frutas mansas, grãos integrais, hortaliças, frutas, leite desnatado e com carga negativa para carne bovina, suína, cereais, leguminosas e leite integral), lanche (sanduíche e frutas smoothie) e ocidental (bebidas industrializadas, doces, salgadinhos e alimentos ricos em gorduras). Observou-se associação entre padrão prudente com menor nível de colesterol HDL; padrão de lanche com menor glicemia de jejum e maior nível de triglicerídeos e o ocidental com maior nível de glicemia de jejum. Não houve associação entre os padrões e a presença ou ausência de DM1. Os padrões identificados não foram associados à presença ou ausência de DM1, mas foram relacionados com colesterol HDL, triglicérides e glicemia.

Background A new strain of human coronavirus (HCoV) spread rapidly around the world. Diabetes and obesity are associated with a worse prognosis in these patients. Congenital Generalized Lipodystrophy (CGL) patients generally have poorly controlled diabetes and require extremely high doses of insulin. There is no documentation in the literature of cases of COVID in CGL patients. Thus, we aimed to evaluate the prevalence of SARS-CoV-2 infection in CGL patients, and the association of their clinical and metabolic characteristics and outcomes. Methods This is a cross-sectional study carried out between July and October 2020. Clinical data collected were respiratory or other flu-like symptoms, need of hospitalization in the last three months, CGL comorbidities, and medications in use. Cholesterol, triglycerides, glycohemoglobin A1c levels, anti-SARS-CoV-2 antibodies and nasopharyngeal swab for RT-qPCR were also obtained in all CGL patients. Mann-Whitney U test was used to analyze the characteristics of the participants, verifying the non-adherence of the data to the Gaussian distribution. In investigating the association between categorical variables, we used Pearson's chi-square test and Fisher's exact test. A significance level of 5% was adopted. Results Twenty-two CGL patients were assessed. Eight subjects (36.4%) had reactive anti-SARS-CoV-2 antibodies. Only one of these, also presented detectable RT-qPCR. Five individuals (62.5%) were women, median age of 13.5 years (1 to 37). Symptoms like fever, malaise, nausea, diarrhea and chest pain were present, and all asymptomatic patients were children. All subjects had inadequate metabolic control, with no difference between groups. Among positive individuals there was no difference between those with AGPAT2 (75%) and BSCL2 gene mutations (25%) (p > 0.05). No patient needed hospitalization or died. Conclusions We described a high prevalence of SARS-CoV-2 infection in CGL patients with a good outcome in all of them. These findings suggest that at least young CGL patients infected by SARS-COV-2 are not at higher risk of poor outcome, despite known severe metabolic comorbidities.

Background Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by the absence of subcutaneous adipose tissue, severe insulin resistance, diabetes mellitus, and cardiovascular complications, including cardiac autonomic neuropathy (CAN), left ventricular hypertrophy (LVH), and atherosclerosis. The present study aimed to access the association between CAN parameters and cardiovascular abnormalities in CGL patients. Methods A cross-sectional study was conducted with 10 CGL patients and 20 healthy controls matched for age, sex, BMI, and pubertal stage. We evaluated clinical, laboratory, and cardiovascular parameters—left ventricular mass index (LVMI), interventricular septum thickness (IVS), systolic and diastolic function determined by two-dimensional transthoracic echocardiography; carotid intimal media thickness (cIMT); and cQT interval. Heart rate variability (HRV) was evaluated by spectral analysis components—high frequency (HF), low frequency (LF), very low frequency (VLF), LF/HF ratio, and total amplitude spectrum (TAS)—and cardiovascular reflexes tests (postural hypotension test, respiratory, orthostatic and Valsalva coefficients). Results In CGL group, four patients (40%) had LVH and diastolic dysfunction. HF component (parasympathetic control) was lower in LVH patients. CGL patients presented higher values of cIMT and cQT interval than heathy subjects. Inverse association between LVMI and LF (p = 0.011), IVS and LF (p = 0.007), and cIMT and leptin (p

Background New-onset diabetes after transplant is a severe complication that can present in liver transplant recipients, negatively impacting quality of life and graft survival. It also contributes to increased risk of infection, cardiovascular disease, and rejection, which are the main causes of death among liver transplant recipients. The aim of the present study was to assess the risk factors associated with new-onset diabetes after transplant. Method This was a case control study based on the data from 146 liver transplant patients at a reference hospital. The data from the charts were collected using a 2-part form: Part I (sociodemographic variables) and Part II (clinical variables). Results Multiple analysis showed that pre-existing systemic arterial hypertension (odds ratio [OR], 2.65; 95% CI, 1.12–6.28) and the use of sodium mycophenolate associated with tacrolimus (OR, 2.68; 95% CI, 1.02–7.06) increased the risk of new-onset diabetes after transplant. On comparing the anthropometric variables, lipid panel, and blood glucose levels of liver transplant patients with and without diabetes, higher glycemic levels were found in the group with diabetes (P Conclusion Pre-existing systemic arterial hypertension and the associated use of sodium mycophenolate and tacrolimus increased the risk of new-onset diabetes after transplant.

Introduction: the standard hypoparathyroidism treatment consists of replacing calcium and active vitamin D (calcitriol), but it does not correct the underlying abnormality, parathyroid hormone (PTH) deficiency. Both the disease and its treatment are responsible for many morbidities that affect multiple organs and systems. Therefore, parathyroid allotransplantation has been described as an alternative treatment option, especially in refractory cases. Objectives: to verify if parathyroid allotransplantation is effective as a treatment for permanent hypoparathyroidism. Methodology: fresh parathyroid tissue was obtained from a 36-year- old male with a past medical history of hyperparathyroidism secondary to end-stage renal disease and immediately implanted in the recipient’s non-dominant forearm, a 57-year-old female with refractory hypoparathyroidism, despite high doses of calcium and calcitriol replacement. Corticosteroid immunosuppression was performed for 10 days. Results: the allograft showed no evidence of functionality eleven months after transplant. The procedure was considered safe. Conclusion: more studies are required to validate this technique and improve its results Introdução: o tratamento padrão do hipoparatireoidismo consiste na reposição de cálcio e vitamina D ativa (calcitriol), mas não corrige a anormalidade de base: a deficiência de paratormônio (PTH). Tanto a doença quanto o seu tratamento são responsáveis por diversas morbidades que afetam múltiplos órgãos e sistemas. O alotransplante de paratireóide tem sido descrito como uma alternativa de tratamento, especialmente em casos refratários. Objetivo: verificar se o alotransplante de paratireoide é efetivo como tratamento do hipoparatireoidismo permamente. Metodologia: tecido paratireoideano fresco foi obtido de um doador de 36 anos do sexo masculino, portador de hiperparatireoidismo secundário a insuficiência renal crônica terminal e imediatamente implantado no antebraço não dominante da receptora, uma mulher de 57 anos com controle inadequado da doença, apesar de reposição de altas doses de cálcio e de calcitriol. Imunossupressão com corticosteroides foi realizada por 10 dias. Resultado: o aloenxerto não mostrou evidência de funcionalidade onze meses após o transplante. O procedimento foi considerado bastante seguro. Conclusão: mais estudos são necessários para validar esta técnica e melhorar seus resultados.

Adequate management of diabetes requires professional improvement programs. This study aimed to analyze the effect of a simulation activity on the acquisition of knowledge about blood glucose monitoring and hypoglycemia management. The study employed a pre-post intervention approach and was carried out in a university hospital located in Brazil. The participants were 82 graduating nursing students and nursing professionals studying/working at the university hospital. The intervention consisted of theoretical sessions, a practical simulation about glycemic monitoring and hypoglycemia management, and the pre- and post-tests. The simulation consisted of a rubber hand mannequin that allows simulating the glucose testing. There was a significant increase in knowledge after intervention with the total number of correct answers increasing from 186 in the pre-test to 326 in the post-test (+140, p < .001). The intervention was effective in increasing the participants' knowledge about glycemic monitoring and hypoglycemia management, favoring a better nursing care for people with diabetes. El manejo adecuado de la diabetes requiere programas de desarrollo profesional. Este estudio tuvo como objetivo analizar el efecto de una actividad de simulación en la adquisición de conocimientos sobre el control glucémico y el manejo de la hipoglucemia. El estudio utilizó un enfoque pre y post intervención y se llevó a cabo en un hospital universitario de Brasil. Los participantes fueron 82 estudiantes de enfermería y profesionales de enfermería que estudian o trabajan en un hospital universitario. La intervención consistió en sesiones teóricas, simulación práctica de monitorización glucémica y manejo de hipoglucemias, pre y post test. La simulación se realizó mediante un maniquí que permite simular la prueba de glucosa. Hubo un aumento significativo en el conocimiento después de la intervención y el número total de respuestas correctas aumentó de 186 en la prueba previa a 326 en la prueba posterior (+140, p

Type 1 diabetes mellitus (T1DM) results from the immune cell-mediated destruction of functional pancreatic β-cells. In the presymptomatic period, T1DM is characterized by the presence of two or more autoantibodies against the islet cells in patients without glycemic decompensation. Therapeutic strategies that can modify the autoimmune process could slow the progression of T1DM. Dipeptidyl peptidase-4 (DPP-4) or CD26, a multifunctional serine protease with a dual function (regulatory protease and binding protein), can modulate inflammation and immune cell-mediated β-cell destruction. CD26 is involved in T-cell co-stimulation, migration, memory development, thymic maturation, and emigration patterns. DPP-4 degrades the peptide hormones GLP-1 and GIP. In addition to regulating glucose metabolism, DPP-4 exerts anti-apoptotic, regenerative, and proliferative effects to promote β-cell mass expansion. GLP-1 receptor signaling may regulate murine lymphocyte proliferation and maintenance of peripheral regulatory T-cells. In patients with T1DM, the serum DPP-4 activity is upregulated. Several studies have suggested that the upregulated DPP-4 activity is correlated with T1DM pathophysiology. DPP-4, which is preferentially expressed on the Th1 surface, can promote the polarization of Th1 immunity, a prerequisite for T1DM development. CD26 inhibition can suppress T-cell proliferation and Th1 cytokine production and stimulate tumor growth factor beta-1 (TGF-β1) secretion, which plays an important role in the regulation of autoimmunity in T1DM. Studies on humans or animal models of T1DM have suggested that DPP-4 inhibitors can improve β-cell function and attenuate autoimmunity in addition to decreasing insulin dependence. This review summarizes the emerging roles of DPP-4 inhibitors in potentially delaying the progression of T1DM.

A simulação realística figura entre as mais modernas e eficientes metodologias ativas de aprendizado de profissionais da saúde. Na UFC, a simulação já integra, há alguns anos, como estratégia utilizada para a formação de estudantes dos cursos de Medicina e Enfermagem. Ambos os cursos dispõem de laboratórios e acervos próprios, voltados para o desenvolvimento de competências e habilidades inerentes à suas respectivas grades curriculares, possibilitando o ensino em ambientes seguros e controlados.

Objective This study aimed to determine the thyroid-stimulating hormone (TSH) reference interval (RI) and to assess the influence of the use of thyroid ultrasonography (TUS) on reference individual selection from a healthy adult population in Fortaleza, Brazil. Subjects and methods This cross-sectional study recruited patients (N = 272; age = 18-50 years) with normal thyroid function (NTF) and placed them in three groups according to their test results: NTF (n = 272; all participants), TUS (n = 170; participants who underwent thyroid US), RI (n = 124; reference individuals with normal TSH levels). TSH, FT4, TT3, TgAb, and TPOAb concentrations were determined by electrochemiluminescence assay. TUS was performed using a 7-12 MHz multifrequency linear transducer by two radiologists. The 2.5th and 97.5th percentiles of the distribution curve corresponded to lower and upper TSH RI levels, respectively. Results The mean TSH level was 1.74 ± 0.96 mIU/L, and TSH range was 0.56-4.45 mIU/L. There was no difference in the TSH concentrations between men and women nor between the groups. TUS did not appear to be an essential tool for the reference group selection. Conclusion The upper limit of TSH was comparable to the reference interval provided by the assay manufacturer (4.45 vs. 4.20 mIU/L) but the lower limit was not (0.56 vs. 0.27 mIU/L). This finding may have a clinical impact since these values may lead to the misdiagnosis of euthyroid patients with subclinical hyperthyroidism.

Background Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by the near-total loss of subcutaneous adipose tissue soon after birth, resulting in ectopic fat deposition and severe metabolic disturbances. Most cases are caused by AGPAT2 or BSCL2 gene mutations. We aimed to report two unrelated CGL patients with a novel frameshift mutation in AGPAT2 (p.Leu124Serfs*26). Methods Clinical features and laboratory were obtained by medical interview and medical records review. DNA was extracted, amplified and sequenced. Mutation Taster was used to estimate the potential biological impact of the AGPAT2 mutations on the protein function. Results Patient 1: a 30-year-old woman with lipodystrophy phenotype at birth and diagnosis of diabetes at age 13 presented with severe hypertriglyceridemia and pancreatitis at age 17, hypertension and albuminuria at age 18, proliferative diabetic retinopathy with visual loss at age 25, and an acute myocardial infarction due to multivessel coronary disease during a hospitalization for forefoot amputation at age 29. At this time, she required hemodialysis due to end-stage renal disease. Patient 2: a 12-year-old girl with lipodystrophy phenotype and hypertriglyceridemia detected in the first year of life and abnormalities in the global longitudinal strain, evaluated by speckle-tracking echocardiography last year. Molecular analysis identified a c.369_372delGCTC (p.Leu124Serfs*26) AGPAT2 mutation in both unrelated patients, a compound heterozygous mutation in Patient 1, and homozygous mutation in Patient 2. Conclusion We describe two unrelated patients with type 1 CGL due to Leu124Serfs*26, a novel AGPAT2 frameshift mutation, presenting as early cardiovascular disease. These findings suggest an association between Leu124Serfs*26 and a more aggressive phenotype.

Christiane Bezerra Rocha Liberato, 1, 2 Natália Bitar da Cunha Olegario, 1, 2 Virginia Oliveira Fernandes, 1–3 Ana Paula Dias Rangel Montenegro, 2 Grayce Ellen da Cruz Paiva Lima, 1, 2 Lívia Aline de Araújo Batista, 1, 2 Lívia Vasconcelos Martins, 1, 2 Jaquellyne Gurgel Penaforte-Saboia, 1, 2 Ivan Lucas Rocha Liberato, 2 Larissa Ferreira Lopes, 2 Catarina Brasil d’Alva, 1, 2 Frederico Luís Braz Furtado, 1, 2 Ricardo Luiz De Medeiros Lima, 4 Lucia Helena Coelho Nóbrega, 4 Josivan Gomes Lima, 4 Renan Magalhães Montenegro Junior 1–3 Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO) 1Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil; 2Clinical Research Unit, Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Brazil; 3Department of Community Health, Federal University of Ceará, Fortaleza, Brazil; 4Department of Clinical Medicine, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, BrazilCorrespondence: Renan Magalhães Montenegro Junior Rua Professor Costa Mendes, 1608, Fortaleza, Ceará 60416-200, BrazilTel +55 85 3366-8600Fax +55 85 3366-8619Email renanmmjr@gmail.comPurpose: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by the absence of functional adipocytes resulting in ectopic lipid storage, metabolic disorders and early cardiovascular disease. Two-dimensional speckle-tracking (2D-STE) allows the detection of early abnormalities in myocardial function. We aimed to evaluate myocardial deformation in a large sample of CGL patients using 2D-STE.Patients and Methods: A cross-sectional study of 22 patients with CGL and 22 healthy subjects, matched for sex and age, was conducted from 2013 to 2018. All participants had undergone standard conventional echocardiography (ECHO) and 2D-STE. Determination of blood glucose, lipids, insulin, and leptin were performed in all CGL patients.Results: In the CGL group the mean age was 14.6± 10.7 years where 68.2% (n=15) were younger than 18 years old. All the patients had hypoleptinemia, 95.4% (21/22) low HDL-c, 86.4% (19/22) hypertriglyceridemia, 68.2% (15/22) diabetes, 50% (11/22) hepatic steatosis, 41% (9/22) insulin resistance, 41% (9/22) hypercholesterolemia, and 18.2% (4/22) hypertension. ECHO showed that 36.6% (8/22) of CGL patients presented diastolic dysfunction, 31.8% (7/22) left ventricular hypertrophy (LVH), 27.3% (6/22) increased left atrial volume index (LAVI), and 18.2% (4/22) increased left ventricular systolic diameter (LVDS) but normal ejection fraction (EF), whether using 2D-STE, 68.2% (15/22) of CGL patients showed abnormal global longitudinal strain (GLS) (p< 0.01), and in almost LV segments. Positive association between abnormal GLS and A1c (r=0.57, p=0.005), glucose (r=0.5, p=0.018) and basal insulin (r= 0.69, p= 0.024), and negative association with leptin (r = − 0.51, p = 0.005) were found in these patients.Conclusion: The 2D-STE revealed precocious left ventricular systolic dysfunction in a young CGL population with normal systolic function by ECHO. Early exposure to common metabolic abnormalities as insulin resistance, hyperglycemia, and hypoleptinemia must be involved in myocardial damage in these patients.Keywords: Berardinelli-Seip congenital lipodystrophy, global longitudinal strain, cardiac function, early detection

Background and aims Metabolic Syndrome (MS) is increasing in developing countries. Different definitions of MS lead to discrepancies in prevalence estimates and applicability. We assessed the prevalence of MS as defined by the International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Plan III (Modified NCEP) and Joint Interim Statement (JIS); compared the diagnostic performance and association of these definitions of MS with pre-diabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. Methods A total of 714 randomly selected subjects from Northeastern Brazil were investigated in a cross-sectional study. Sociodemographic, anthropometric, and clinical data were recorded. Diagnostic test performance measures assessed the ability of the different MS definitions to identify those with pre-diabetes, T2DM and increased CVD risk. Results The adjusted prevalence of MS was 36.1% applying the JIS criteria, 35.1% the IDF and 29.5% Modified NCEP. Women were more affected by MS according to all definitions. MS was significantly associated with pre-diabetes, T2DM and CVD risk following the three definitions. However, the JIS and IDF definitions showed higher sensitivity than the Modified NCEP to identify pre-diabetes, T2DM and CVD risk. The odds ratios for those conditions were not significantly different when comparing the definitions. Conclusions MS is highly prevalent in Brazil, particularly among those with pre-diabetes, T2DM, and high CVD risk. The IDF and JIS criteria may be better suited in the Brazilian population to identify pre-diabetes, T2DM and CVD risk. This may also signify the importance of the assessment of MS in clinical practice.

Background A premature myocardial infarction (PMI) is usually associated with a familial component. This study evaluated cardiovascular risk factors in first-degree relatives (FDR) of patients with PMI not presenting the familial hypercholesterolemia phenotype. Methods A cross-sectional study comprising FDR of non-familial hypercholesterolemia patients who suffered a myocardial infarction

Congenital Generalized Lipodystrophy (CGL) is a rare syndrome characterized by the almost total absence of subcutaneous adipose tissue due to the inability of storing lipid in adipocytes. Patients present generalized lack of subcutaneous fat and normal to low weight. They evolve with severe metabolic disorders, non-alcoholic fatty liver disease, early cardiac abnormalities, and infectious complications. Although low body weight is a known risk factor for osteoporosis, it has been reported that type 1 and 2 CGL have a tendency of high bone mineral density (BMD). In this review, we discuss the role of bone marrow tissue, adipokines, and insulin resistance in the setting of the normal to high BMD of CGL patients. Data bases from Pubmed and LILACS were searched, and 113 articles published until 10 April 2021 were obtained. Of these, 76 were excluded for not covering the review topic. A manual search for additional literature was performed using the bibliographies of the studies located. The elucidation of the mechanisms responsible for the increase in BMD in this unique model of insulin resistance may contribute to the understanding of the interrelationships between bone, muscle, and adipose tissue in a pathophysiological and therapeutic perspective.