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We aimed to evaluate mortality and hospital admissions for chronic kidney disease in young adults according to sex and state in the northern region of Brazil, between 1996 and 2017. A population-based time series study using official data on mortality and hospital admissions due to chronic kidney disease in individuals aged 20 to 49 years old, residents of the northern region of Brazil, in the periods 1996-2017 and to 2008-2017, respectively. Chronic kidney disease was defined according to the International Classification of Diseases, 10th revision (N18). The evolution of mortality from chronic kidney disease decreased by 0.881% per year over the period (1996-2017). In the states of Acre and Amapá, there was a reduction of 5.85% and -5.68% per year, respectively, and in Tocantins, an increase of 4.16% per year. The incidence of hospitalization did not vary between 2008 and 2017. However, 2 states showed an increase in hospitalization rates: Acre (6.08% per year) and Pará (2.83% per year), and 2 states showed a reduction: Amazonas (5.09% per year) and Tocantins (6.23% per year). In general, there was decrease in mortality rate overtime. However, rate of mortality due to chronic kidney disease increased in the state of Tocantins. The evolution of hospitalization due to chronic kidney disease in a population of young adults remained stationary.

PURPOSE: The pharmacological treatment for Type 2 diabetes mellitus (T2DM) is continuous and adherence to medication is critical for disease control. Restricted access to medicines is one of the most important barriers to adherence to T2DM treatment. This study aimed to evaluate other factors for medication non-adherence by studying patients with full access to oral hypoglycemic agents. METHODS: Cross-sectional study with 300 patients receiving their medication without costs from a referral center for diabetes care in Crato, Ceará (Brazil). Participants were recruited from January to December 2017. Information was obtained by self-applied questionnaires, and the drugs used were confirmed in the prescription. Adherence to medication was determined by the Morisky Medication Adherence Scale (MMAS-4). Patient perceptions of drugs were assessed by the Beliefs about Medicines Questionnaire (BMQ). RESULTS: Only 22.7% of participants met the criterion of high adherence to medication. The most frequent characteristics in the low adherence group were married; hypertension; no regular physical activity; therapy based on the combination of two or more oral antidiabetic agents without insulin; low score in the BMQ necessity scale. Necessity score in BMQ increased with age and the number of medications used and decreased if the patient had family members with the same disease and had children. CONCLUSIONS: Full access to medicines did not assure high adherence to pharmacological treatment of type 2 diabetes mellitus. Distinctive factors to medication non-adherence may be found and specific barriers should be considered when planning actions for improving adherence in such populations.

Genetic variations of type III collagen may compromise the supportive structures of the female pelvic floor and consequently favor pelvic organ prolapse. The single nucleotide polymorphism G/A rs1800255 located in the coding region for type III collagen (COL3A1) was evaluated as a risk factor for pelvic organ prolapse. A single-center prospective cohort study including women with clinical diagnosis of stage III and IV prolapse (POP group) and prolapse stage 0 or I (control group). Sociodemographic, clinical data and obstetric history were retrieved by physician interview. DNA including the rs1800255 polymorphism was amplified by polymerase chain reaction from blood genomic cells and digested with AluI restriction enzyme for distinction of G and A variants. Qualitative variables were compared using the chi-square and Fisher’s exact tests and unpaired t-test for quantitative variables. After stratification of the groups, risk factors for POP were estimated using odds ratios (ORs) from the binary logistic regression model. A total of 292 women were included, 112 in the POP group and 180 in the control group. There was no significant difference between groups regarding rs1800255. Age and home birth were the only significant risk factors for pelvic organ prolapse. Polymorphism rs1800255 from COL3A1 gene was not a risk factor for pelvic organ prolapse.

Objective: To analyze the polymorphism -1171 5A / 6A rs3025058 of the MMP-3 gene and the risk for pelvic organ prolapse (POP). Study Design: This is a cohort study. All patients attended the Urogynecology and Vaginal Surgery Section of the FMABC, from 2014 to 2016 and they were randomly recruited by the researchers at the first medical appointment. We selected 112 patients with symptomatic POPs and 180 patients with normal pelvic floors. The single nucleotide polymorphism (SNP) 5A / 6A of MMP-3 was determined by polymerase chain reaction (PCR) and analysis of the restriction fragments in both groups. Chi-squared test was used to compare the frequencies of polymorphisms between the groups. For those characteristics with statistical relevance, the crude odds ratio (OR) and its respective 95% confidence intervals were calculated; and, by logistic regression, were adjusted for each of the other characteristics, obtaining the adjusted OR. Hardy-Weinberg gene balance was determined using Pearson's Chi-squared test. Values of p

Objective To evaluate the C-1562T matrix metalloproteinase 9 (MMP9) gene polymorphisms as risk factors related to the occurrence of pelvic organ prolapse (POP) and to identifytheclinicalvariablesassociatedwith theoccurrenceof thedisease.Epidemiological studies of risk factors for POP do not explain why nulliparous women with no known risk factors also develop POP. Therefore, genetic factors may be involved. Methods Cohort study with 86 women with symptomatic POP (cases), and 158 women withoutapriororcurrentdiagnosisof thisdisorder(controls).Thegroupswereanalyzedfor the presence of MMP9 gene polymorphisms. Genotyping was performed using polymerase chainreaction(PCR)with DNA obtained froma peripheral venouspuncture ofboth groups. Results There were no differences between the cases and controls even when we grouped the mutant homozygous and heterozygous genotypes. The analysis of patients with a complete absence of POP versus patients with total POP also showed no statistically significant differences. Ageand home birth were found to be independent risk factors for POP. Conclusions There were no statistically significant differences in the C-1562T MMP9 polymorphisms between the cases and controls in Brazilian women. Resumo Objetivo Avaliar polimorfismos do gene C-1562T do gene matriz de metaloproteinase 9 (MMP9) como fatores de risco relacionados à ocorrência de prolapsode órgão pélvico(POP)e identificar variáveis clínicas associadas à ocorrência da doença. Estudos epidemiológicos de fatores de risco para POP não explicam por que mulheres nulíparas sem fatores de risco conhecidos também desenvolvemPOP. Portanto, fatores genéticospodem estar envolvidos. Métodos Estudo de coorte com 86 mulheres com POP sintomático (casos) e 158 mulheres sem diagnóstico prévio ou atual deste transtorno (controles). Os grupos foram analisados quanto à presença de polimorfismo do gene MMP9. A genotipagem foi realizada por reação em cadeia da polimerase (RCP) com DNA obtido por punção venosa periférica dos indivíduos em ambos os grupos. Resultados Não houve diferenças entre os casos e controles, mesmo quando agrupamos os genótipos mutantes homozigotos e heterozigotos. A análise de pacientes com ausência completa de POP versus pacientes com POP total também não mostrou diferenças estatisticamente significativas. Idade e parto domiciliar foram considerados fatores de risco independentes para o POP. Conclusão Não houve diferenças estatisticamente significativas no polimorfismo C-1562T do gene MMP9 entre os casos e controles em mulheres brasileiras.

Objective Epidemiological studies have shown evidence of the effect of genetic variations in the pathogenesis of breast cancer and have suggested a relationship of the disease with genetic polymorphisms. Matrix metallopeptidase 9 (MMP-9) is a collagenase responsible for the degradation of type IV collagen, the major component of the basement membrane, and other essential extra cellular matrix components, being involved in the tumor cell invasion and metastasis. Our objective was to evaluate the relationship between the MMP-9-1562 C/T polymorphism (rs 3918242) and the risk of developing breast cancer. Methods In this case-control study, the frequency of the MMP-9-1562 C/T polymorphism (rs 3918242) was determined in 148 women with breast cancer and 245 women without the disease. The DNA was extracted from plasma samples, and the gene was amplified by polymerase chain reaction (PCR); the presence of the polymorphism was determined using restriction enzymes. Results After adjusting for confounding variables, we found that the polymorphism was not associated with the occurrence of breast cancer (odds ratio [OR] = 1.159, 95% confidence interval [CI]: 0.6625–1.997, p = 0.5964). We also found no association with more advanced disease, the presence of hormone receptors, human epidermal growth factor receptor 2 (HER2) overexpression, or rate of tumor cell proliferation. Conclusion We did not observe a relationship between MMP-9–1562 C/T polymorphism (rs 3918242) and the occurrence of breast cancer.

A osteoporose é uma doença metabólica do tecido ósseo, caracterizada pela perda gradual de massa óssea, ocasionando a deterioração da microarquitetura tecidual, que se torna mais frágil e suscetível a fraturas. O objetivo desta pesquisa foi avaliar os fatores relacionados ao tratamento medicamentoso de pacientes portadores de osteoporose atendidos na farmácia municipal da cidade do Crato-CE. Tratou-se de um estudo do tipo exploratório descritivo com abordagem quantitativa, realizado em março de 2016. Dentre os entrevistados 36,10% afirmaram realizar tratamento da osteoporose à 3-4 anos e 37,82% faz acompanhamento médico anualmente. Os medicamentos destinados ao tratamento da osteoporose foram o alendronato de sódio (69,75%) e carbonato de cálcio mais vitamina D3 (92,45%). Durante a consulta médica, 97,48% dos entrevistados afirmaram receber orientação sobre a posologia e 43,70% sobre o horário de administração. O tratamento medicamentoso destinado aos portadores de osteoporose no âmbito desta pesquisa atendeu aos preceitos básicos que visam o controle da doença e a recuperação da saúde do paciente.

Introduction: University students are exposed to many factors related to Night Eating Syndrome (NES), an eating disorder that may be associated with obesity. Objective: To determine the prevalence of NES among students from a Brazilian university and evaluate the association of syndrome behaviours with emotional, biological, and environmental factors. Methods: Cross-sectional study with 200 students from a private higher education institution located in the city of Juazeiro do Norte, Ceara, Brazil. NES was evaluated using the Night Eating Questionnaire (NEQ), considering the NEQ score ≥ 25 as the cut-off value for indication of the syndrome. Depression, anxiety, and stress symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21) questionnaire. Additional information was collected about the participants (gender, age, weight, and height), their academic status (enrolled course, study period, and year), and their employment status (whether the participant worked at least four h daily in addition to studying). Results: 30 participants (15.0%) presented NEQ scores ≥ 25, indicative of NES. There was no association between the NEQ score and other variables: gender, nutritional status, work, enrolled course, study period, and academic year. There was an association between NEQ score and severity of depression (p=0.0001), anxiety (p=0.0001), and stress (p=0.0218). Conclusion: Evidence of a high prevalence of NES was found among Brazilian university students, as well as an association between the behaviours of the syndrome with depressive, anxiety, and stress symptoms was found.

Estatísticas recentes mostram que milhões de brasileiros apresentam dependência de álcool. Uma das principais estratégias para o tratamento desses dependentes é a terapia farmacológica, que ainda apresenta baixas taxas de sucesso. Nesse contexto, é de suma importância que grupos de pesquisa nacionais conduzam estudos de avaliação de fármacos para o tratamento de dependentes de álcool. Este estudo é uma revisão bibliográfica narrativa crítica realizada na base de dados MEDLINE que teve por objetivo identificar os grupos de pesquisa brasileiros interessados no tratamento farmacológico do alcoolismo. Foi realizada busca de todos os artigos publicados a partir de 1996 com a seguinte combinação de termos: alcoholism, drug therapy, humans e Brazil. Nove artigos foram localizados, sendo sete ensaios clínicos, uma revisão e um relato de caso. Esses estudos foram conduzidos em quatro instituições diferentes, sendo que uma foi responsável por mais da metade dos artigos. Considerando as publicações no MEDLINE sobre quimioterapia do alcoolismo em humanos, esses artigos representariam 0,71% da produção científica mundial no mesmo período. Os estudos envolvem cinco fármacos, sendo três aprovados para tratamento do alcoolismo — dissulfiram, naltrexona e acamprosato; e dois em avaliação — topiramato e gabapentina. Conclui-se que os pesquisadores brasileiros estão contribuindo efetivamente para a análise do arsenal terapêutico do tratamento do alcoolismo, assim como sua expansão com novos fármacos. Entretanto, o número de grupos de pesquisa nacionais interessados por esta questão ainda é muito pequeno para a extensão do problema no País.

Acquired middle ear cholesteatoma is a benign keratinizing hyperproliferative squamous epithelial lesion that may result in the destruction of the bone structures surrounding the temporal bone. Recent studies show that variations in cellular production of matrix metalloproteinases (MMPs) and their specific inhibitors (TIMPs) contribute to the pathophysiology of cholesteatoma.This study aims to analyze the use of RNA amplification tests to evaluate the expression of MMP and TIMP isoforms in cholesteatomas and their correlation with disease severity.This is a prospective study. Nineteen cholesteatoma cases at different stages were selected. RNA collected from biopsy specimens was submitted to reverse transcription polymerase chain reaction (RT-PCR) for semiquantitative amplification of MMP2, MMP3, MMP9, MMP13 and TIMP1.Six cholesteatomas were positive for at least one of the studied genes. Four samples amplified a single gene (MMP2 or MMP13) and two samples amplified three genes (MMP2, TIMP1 and MMP3 or MMP13). No sample amplified MMP9.RT-PCR can be used to assess MMP and TIMP gene expression in cholesteatomas despite technical difficulties. Gene expression profiles could not be related to disease severity.

The classical view of adipose tissue as a passive reservoir for energy storage is no longer valid. In the past decade, adipose tissue has been shown to have endocrine functions and the most abundant peptide secreted by adipocytes is adiponectin. Pericardial adipose tissue (PAT) is distributed around coronary arteries and endovascular injury, caused by the presence of intracoronary bare-metal stent (BMS), could promote inflammatory changes in the periadvential fat, contributing to vascular restenosis.We sought to determine gene expression of inflammatory mediator in pericardial adipose tissue after bare-metal stent implantation and vascular restenosis that had been referred to operative treatment.Paired samples of PAT were harvested at the time of elective coronary artery bypass surgery (CABG) in 11 patients (n = 22), one sample was obtained of the tissue around BMS area and another sample around coronary artery without stent. Local expression of adiponectin was determined by real-time polymerase chain reaction (RT-PCR) using Taq DNA polymerase.In two samples, there was no gene expression of adiponectin. We are able to identify adiponectin in 20 samples, however, the pattern of gene expression were heterogeneous.We did not notice specificity when we compared PAT obtained near BMS area or far from BMS area.There were no correlation between adiponectin gene expression and presence of BMS.

Com o final de 2010 encerra-se o terceiro ano dos Arquivos Brasileiros de Ciencias da Saude. Muitos dos desafios que se apresentavam ao inicio do novo titulo estao sendo conquistados, fasciculo apos fasciculo: pontualidade no cumprimento da periodicidade proposta, captacao de artigos de todo o pais, ampliacao da abrangencia de temas nas Ciencias da Saude. Outra meta importante que se encontra em fase final de implantacao e a divulgacao eletronica livre de todos os artigos publicados. Aos autores, e importante destacar que o processamento dos manuscritos tem sido bastante aperfeicoado e tornado significativamente mais agil. Como consequencia, varios artigos submetidos em 2010 ja estao sendo publicados aqui. Isso tambem e possivel gracas a qualidade e eficiencia dos revisores externos, aos quais a revista e profundamente grata (pagina 244). Este fasciculo e um marco na historia dos Arquivos Brasileiros de Ciencias da Saude, trazendo o primeiro artigo completo em lingua inglesa. Apesar da politica editorial da revista projetar um lugar relevante no ambiente cientifico nacional, a democratizacao das informacoes pela rede mundial permite ambicoes maiores e este e o primeiro passo nessa direcao. Como o ingles e o idioma mundial padrao para as Ciencias da Saude, espera-se que tal iniciativa seja compreendida e apoiada pelos leitores. Neste fasciculo: • Santos e Gallo (pagina 174) detalham uma condicao frequente (lombalgia no periodo gravidico-puerperal), mas surpreendentemente pouco discutida em artigos cientificos, reunindo e organizando informacoes necessarias para apontar medidas terapeuticas preventivas; • Oliveira e colaboradores (pagina 180) confrontam as informacoes da tomografia helicoidal sobre câncer gastrico com os respectivos achados cirurgicos para determinar a real contribuicao da referida tecnica radiologica no diagnostico dessa doenca; • Malafaia e colaboradores (pagina 188) alertam para possivel descuido com o detalhamento dos cuidados eticos em pesquisas publicadas em revistas cientificas brasileiras; • Sasseron e colaboradores (pagina 196) estudam o impacto da ocorrencia de incisao na pleura durante cirurgia de revascularizacao do miocardio para a recuperacao do paciente; • Bariani e colaboradores (pagina 202) ressaltam as vantagens da morfometria nuclear como tecnica assessoria na avaliacao de lesoes malignas da mama; • Negrete e colaboradores (pagina 208) analisam efeitos adversos da poluicao sobre a saude em uma regiao ainda pouco explorada no que concerne a esse aspecto, confirmando relacoes ja estabelecidas e colaborando para sensibilizacao frente a questoes ambientais; • Matos e colaboradores (pagina 213) revisam as caracteristicas das linfadenopatias cervicais na infância relacionando-as as condutas adequadas dos profissionais de saude frente a essas doencas; • Oliveira e colaboradores (pagina 220) destacam a relevância do Sistema de Classificacao da Funcao Motora Grossa (GMFCS) na avaliacao do potencial das criancas com paralisia cerebral; • Goncalves e colaboradores (pagina 225) discutem o aumento do estresse oxidativo na insuficiencia cardiaca e o possivel papel regulador da atividade fisica nessa condicao; • Della Negra e colaboradores (pagina 231) ilustram a necessidade do esclarecimento profundo das lesoes vasculares antes da realizacao de procedimento operatorio; • Okazaki e colaboradores (pagina 234) abordam um assunto raro que e a anosmia, discutindo uma possivel associacao com hipospadia, o que poderia ser potencialmente relevante, ja que existem relatos de defeitos similares.

Recentemente, os Arquivos Brasileiros de Ciencias da Saude assinaram convenio de cessao da Metodologia SciELO e, em breve, os artigos serao disponibilizados livremente no portal do NEPAS no formato eletronico que ja e familiar a comunidade cientifica brasileira e internacional. Espera-se que essa exposicao ampliada permita maior visibilidade dos artigos dos ABCS, atraindo mais leitores, favorecendo mais citacoes e estimulando novas submissoes. Esta e mais uma medida na direcao de qualificar a revista, com o objetivo maior de solicitar indexacao em novas bases de dados cientificas. Neste fasciculo dos Arquivos Brasileiros de Ciencias da Saude: • Malafaia e Rodrigues (p. 86) refletem sobre o processo de geracao de um artigo cientifico e a qualidade do produto final, ressaltando algumas dificuldades adicionais encontradas por pesquisadores jovens; • Fabra et al. (p. 89) estudam a contribuicao de um Servico de Dermatologia Cosmetica para a melhoria da qualidade de vida e diminuicao do sofrimento de pacientes em tratamento oncologico; • Masuchi et al (p. 95) avaliam a importância do Terapeuta Ocupacional na equipe multiprofissional para oferta de assistencia integral a idosos, promovendo melhor conservacao da memoria; • Vanni et al. (p. 99) apresentam um saldo positivo para a tecnica classica do uso de retalho pediculado temporofrontal em cirurgia reparadora de cabeca e pescoco. Apesar de menos sofisticado, esse procedimento e bastante acessivel e produz bons resultados; • Bianco et al. (p. 103) discutem o possivel papel de contaminantes ambientais na origem da endometriose, ressaltando a capacidade de interferencia de algumas dessas substâncias sobre a acao e a sinalizacao de hormonios esteroides; • Sanches et al. (p. 111) revisam o impacto da sindrome autoimune antifosfolipides como causa de abortos recorrentes, sugerindo a investigacao dessa condicao em pacientes com problemas de fertilidade; • Speranzini et al. (p. 117) relatam caso pouco usual da transformacao maligna de tecido de endometriose em adenocarcinoma endometrioide.

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Metformin is one of the most commonly prescribed oral antidiabetic agents worldwide. However, its mechanism of action remains unknown. The Diabetes Prevention Program Research Group studies have shown that metformin administration and lifestyle-intervention (diet and exercise) reduce the incidence of Diabetes Mellitus type 2 (DM2). A possible biochemical connection between both therapies may be the AMP-activated protein kinase (AMPK). This enzyme was originally described as a sensor of cellular energy status, being activated in exercise. On the other hand, several experimental evidences indicate that AMPK may be an important target of metformin action. This paper discusses various ways for AMPK regulation, suggesting a possible mechanism for its activation by metformin that involves the production of reactive nitrogen species. AMPK activation determines a wide variety of physiological effects, including enhanced glucose uptake by skeletal muscle and enhanced lipid catabolism. Thus, it may be a key player not only in the prevention and treatment of DM2, but also in the development of new treatments for obesity and the metabolic syndrome. The finding of AMPK activation by metformin draws attention to this enzyme as an important pharmacological target.