ABSTRACT Introduction: In some countries, the abuse of opioids is increasing considerably, however, in Chile there is no official data. The aim of this study was to identify and to describe all patients in treatment for chronic non-cancer pain (CNCP) at risk of opioid misuse within the Rehabilitation Department of Hospital del Trabajador, Santiago de Chile, from August 14, 2018 to February 02, 2020. Material and methods: A descriptive cross-sectional study was carried out in 120 opioid users with a diagnosis of CNCP. A structured survey was applied to characterize them based on demographic, clinical data, opioid misuse (COMM(r)), and health-related quality of life (SF 36 v.2). Results: We found 35 patients (29.17 %) with risk of opioid abuse. The median age was 50.7 years. The mean time of opioid consumption was 32.4 months. Tramadol in association with paracetamol was the most widely used opioid. Statistically significant increased misuse was observed in patients diagnosed with amputation (p-value = 0.026) and alcohol use (p-value = 0.003). Furthermore, misuse was significantly associated with a lower score in the domains of physical role (p-value = 0.0299), general health (p-value = 0.0166), vitality (p-value = 0), mental health (p-value = 0) and global score of the SF 36 scale (p-value = 0.0003). Conclusion: Our study showed a 29,1 % prevalence of risk of opioid misuse, which is similar to that found in the literature. There is a relationship between opioid misuse and alcohol consumption, amputation diagnosis, and a lower quality of life, which generates greater disability in these patients. This is the first report in Chile.

RESUMEN Introducción: En algunos países el uso indebido de opioides está aumentando considerablemente, sin embargo en Chile no hay datos oficiales. El objetivo de este estudio fue identificar y describir a todos los pacientes en tratamiento por dolor crónico no oncológico (DCNO) con riesgo de uso indebido de opioides del Departamento de Rehabilitación del Hospital del Trabajador, Santiago de Chile, entre el 14 de agosto de 2018 y el 2 de febrero de 2020. Material y métodos: Se realizó un estudio descriptivo transversal en 120 pacientes usuarios de opioides, con diagnóstico de DCNO. Se les aplicó una encuesta estructurada para caracterizarlos en base a datos demográficos, clínicos, uso indebido de opioides (COMM(r)) y calidad de vida relacionada con salud (SF 36 v.2). Resultados: Se encontraron 35 pacientes (29,17 %) con riesgo de uso indebido de opioides. La mediana de edad fue de 50,7 años. El tiempo medio de consumo de opioides fue de 32,4 meses. El tramadol en asociación con paracetamol fue el opioide más utilizado. Se observó un mayor uso indebido, estadísticamente significativo, en los pacientes con diagnóstico de amputación (p = 0,026) y consumo de alcohol (p = 0,003). Además, el uso indebido se asoció de manera significativa con una menor puntuación en los dominios de rol físico (p = 0,0299), salud general (p = 0,0166), vitalidad (p = 0), salud mental (p = 0) y puntuación global de la escala SF 36 (p = 0,0003). Conclusión: Nuestro estudio arrojó una prevalencia de un 29,1 % de riesgo de uso indebido de opioides, siendo esta similar a la encontrada en la literatura. Existe una relación entre uso indebido de opioides y consumo de alcohol, diagnóstico de amputación y una menor calidad de vida, lo que genera una mayor discapacidad en estos pacientes. Este es el primer informe en Chile al respecto.

ABSTRACT Forest cover in areas degraded by mining is an alternative way of mitigating CO2 concentrations in the atmosphere by fixing C in tree biomass. This study evaluated the growth and C stocks of forest cover in an area of bauxite mining with four sources of fertilizer. Height (Ht), diameter at ground level (DGL), and diameter at breast height (DBH) were determined in Anadenanthera peregrina (Ap), clonal Eucalyptus (Euc), and a mixed plantation of 16 native forest species (Nat) at 6, 18, 36, and 56 months of age. Trunk+bark volume, biomass, and C stock were also determined for these forest covers at 56 months of age. The fertilization treatments were a standard (SF) adopted by the company, SF plus organic fertilizer (OF), chemical fertilizer (CF), and OF+CF. Euc displayed greater values of Ht, DGL, and DBH under OF+CF and OF. Fertilization did not influence the Ht and DBH of Ap, but DGL was higher under OF+CF at 36 months compared to SF. The Ht values of Nat were influenced by fertilization at 18 months, with the lowest values under SF. The fertilization influenced the DGL of Nat at 36 and 56 months, which did not occur with DBH. The pioneer species had higher Ht, DGL, and DGB compared to non-pioneer species, regardless of the type of fertilization studied. Fertilization influenced the Ht and DGL of pioneer species at 18 and 36 months of age and only the Ht of non-pioneer species. The estimates of Euc biomass (255 Mg ha-1) and C stocks (120 Mg ha-1) under OF+OC were four times greater than in Ap and Nat, which showed no difference between themselves or the types of fertilization. The growth and estimates of volume, biomass, and C stocks of the forest cover were comparable to those of unmined areas. Euc had the greatest growth, biomass, and C stocks.

Abstract BACKGROUND: Hemodialysis (HD) and peritoneal dialysis (PD) cor rect some patient symptoms causing changes in the lifestyle. Studies show improved quality of life in PD compared with HD. The scale Kidney Disease Quality of Life (KDQOL SF 36) adequately assesses the quality of life. OBJECTIVE: To show higher scores on the scale of quality of life of patients with peritoneal dialysis (PD) for more than 4 years compared to patients on hemodialysis (HD). MATERIAL AND METHOD: An observational, transversal, descriptive, multicenter study, performed from April 1st to May 31st, 2016. The KDQOL SF 36 scale was used in PD or HD patients in North Central Hospital and Poza Rica Regional Hospital, Mexico. The results were compared with t-Student and χ2. RESULTS: Mental effects in the group of PD 39.5% vs 47% in HD, p 0.05; physical effects on DP 34% vs 35% in HD, p 0.758; burden of kidney disease on PD 27% vs 46% in HD, p 0.03; effects of kidney disease in PD 61% vs 55% in HD, p 0.391; symptoms in PD 71% vs 71% in HD, p 0.893. CONCLUSIONS: Peritoneal dialysis has better score than hemodialysis on effects of kidney disease; PD with lower score that HD in burden of kidney disease, mental effects area; in physical effects, symptoms area with no statistical difference. No significant difference in long-term dialysis (>4 years) between both groups. Therefore, the physician and patient should find dialysis modality that best fits their needs and lifestyle adjustment.

Resumen ANTECEDENTES: la hemodiálisis y diálisis peritoneal corrigen algunos síntomas del paciente provocando cambios en el estilo de vida. Hay estudios que demuestran mejor calidad de vida con diálisis peritoneal comparada con hemodiálisis. La escala Kidney Disease Quality of Life (KDQOL SF 36) evalúa adecuadamente la calidad de vida. OBJETIVO: demostrar mayor puntaje en la escala de calidad de vida en pacientes con diálisis peritoneal por más de cuatro años comparados con pacientes en hemodiálisis. MATERIAL Y MÉTODO: estudio observacional, transversal, descriptivo y multicéntrico, realizado del 1 de abril al 31 de mayo de 2016. Se utilizó la escala KDQOL SF 36 en pacientes en diálisis peritoneal o hemodiálisis en el Hospital Central Norte y Regional Poza Rica. Los resultados se compararon con t de Student y χ2. RESULTADOS: se observaron efectos mentales en 39.5% del grupo de diálisis peritoneal vs 47% en hemodiálisis, p 0.05; efectos físicos en 34% de diálisis peritoneal vs 35% en hemodiálisis, p 0.758; carga de la enfermedad renal en 27% en diálisis peritoneal vs 46% en hemodiálisis, p 0.03; efectos de la enfermedad renal en 61% en diálisis peritoneal vs 55% en hemodiálisis, p 0.391; síntomas en 71% en diálisis peritoneal vs 71% en hemodiálisis, p 0.893. CONCLUSIONES: en pacientes con diálisis peritoneal el puntaje es mejor que en pacientes en hemodiálisis en cuanto a efectos de la enfermedad renal. También se observó menor puntaje en pacientes en diálisis peritoneal vs hemodiálisis en carga de la enfermedad renal, área de efectos mentales, efectos físicos y área de síntomas, sin dife rencia estadística. Tampoco hubo diferencia significativa en diálisis a largo plazo (más de cuatro años) entre ambos grupos. Por tanto, el médico y el paciente deben encontrar la modalidad de diálisis que se ajuste mejor a sus necesidades y estilo de vida.

Objetivo: determinar a diferença da média de hiperplasia miointimal pós-angioplastia na artéria ilíaca de coelhos tratados e não tratados com extrato das folhas de Moringa oleifera. Métodos: ensaio aleatório em animais de laboratório por cinco semanas de seguimento, desenvolvido no Biotério do Laboratório de Tecnologia Farmacêutica da Universidade Federal da Paraíba. Foram utilizadas coelhas da raça Nova Zelândia, submetidas à dieta hipercolesterolêmica e angioplastia da artéria ilíaca externa, randomizadas em dois grupos: Grupo M200 (n=10), coelhas tratadas com 200mg/kg/dia de extrato de folhas de Moringa oleifera, por via oral; Grupo SF (n=10), coelhas tratadas com soro fisiológico 0,9%, por via oral. Após cinco semanas, os animais foram eutanaziados e as artérias ilíacas preparadas para histologia. Os cortes histológicos foram analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student. O nível de significância foi 0,05. Resultados: comparando as artérias ilíacas submetidas à angioplastia do grupo M200 com as do grupo SF, não houve diferença significativa da hiperplasia miointimal Conclusão: não houve diferença da hiperplasia miointimal nos grupos tratados com soro fisiológico e Moringa oleifera após angioplastia.

Objective: to assess post-angioplasty myointimal hyperplasia in iliac artery of rabbits treated with extract of Moringa oleifera leaves. Methods : we conducted a randomized trial in laboratory animals for five weeks of follow-up, developed in the Vivarium of Pharmaceutical Technology Laboratory of the Universidade Federal da Paraíba. We used rabbits from the New Zealand breed, subjected to a hypercholesterolemic diet and angioplasty of the external iliac artery, randomized into two groups: M200 Group (n=10) - rabbits treated with 200mg/kg/day of Moringa oleifera leaves extract orally; SF group (n=10) - rabbits treated with 0.9% saline orally. After five weeks, the animals were euthanized and the iliac arteries prepared for histology. Histological sections were analyzed by digital morphometry. Statistical analysis was performed using the Student's t test. The significance level was 0.05. Results : there was no significant difference in myointimal hyperplasia between M200 and SF groups when comparing the iliac arteries submitted to angioplasty. Conclusion : there was no difference of myointimal hyperplasia between groups treated with saline and Moringa oleifera after angioplasty.

Introduction: the regular consumption of fish brings benefits to health due to its content of n-3 fatty acids, but cooking enhances or damages the concentration of fatty acids (FA) since they are susceptible to oxidation by temperatures and cooking times. Objectives: to analyze the effect of six cooking techniques on total lipids (TL) and (FA) content in marlin and hake and select which one helps the best conservation of health beneficial FA. Methods: fillets were subjected to different cooking techniques: steam (ST), foiled-aluminum-paper (FAP), foiled- banana-leaf (FBL), gas-oven (GO), microwave-oven (MO) and fried-lightly (FL). FA were identified by gas chromatography/FID. Results and discussion: Marlin: FL increased the concentration of TL and MO decreased it. Statistically, PUFA, SFA and EPA + DHA increased with FAP, MUFA decreased with FBL and increased in FL. Hake: FL increased concentration in all groups of FA while ST decreased it. SFA values and index of atherogenicity (IA), thrombogenicity (IT), peroxidisability and hipocolesterolemic/ hipercolesterolemic fatty acid ratio (HH) found, suggested that hake is a fish with greater health benefits, regardless of the technique you employ. By its EPA + DHA content, marlin seems to be an excellent choice if cooked FAP. FL technique in both species decreased the IA, IT and significantly increased the HH; however n3/n6 ratio decreased. ST seems to be the least desirable cooking technique for both species.

Introducción: el consumo frecuente de pescado aporta beneficios a la salud por su contenido en ácidos grasos n-3. Generalmente se consume cocinado pero la cocción mejora o perjudica la concentración de ácidos grasos(AG), pues son susceptibles a oxidarse por las temperaturas y tiempos de cocción. Objetivos: analizar el efecto de seis técnicas de cocción sobre los lípidos totales (LT) y AG de marlín y merluza y seleccionar la que favorece una mejor conservación de AG de importancia para la salud. Métodos: se sometieron los filetes a diferentes técnicas de cocción: vapor (VA), empapelado papel-aluminio (EA), empapelado hoja-plátano (EP), horno-gas (HG), horno-microondas (HM) y sofrito (SF). Los AG se identificaron por cromatografía de gases/FID. Resultados y discusión: Marlín: el SF aumentó la concentración de LT y el HM la disminuyó. Estadísticamente, los AGS, AGP y EPA + DHA aumentaron con EA, los AGM disminuyeron con EP y aumentaron en el SF. Merluza: el SF aumentó la concentración en todos los grupos de AG, mientras que el VA la disminuyó. Por los valores de AGS, índices de aterogenicidad (IA), trombogenicidad (IT), susceptibilidad a la peroxidación y relación hipocolesterolémica/ hipercolesterolémica de los ácidos grasos (HH) encontrados, se sugiere que la merluza es un pescado con mayores beneficios para la salud, independientemente de la técnica que se aplique. Por su contenido en EPA + DHA el marlín parece ser una excelente opción si se cocina en papel aluminio. La técnica de sofrito en ambas especies disminuyó el IA, IT y aumentó significativamente la HH, sin embargo la relación n3/n6 disminuyó. La técnica menos conveniente para ambas especies resultó ser el VA.

O objetivo deste trabalho foi identificar os saberes e fazeres constituídos na prática da Saúde da Família (SF), na visão dos enfermeiros, no que se refere ao atendimento à pessoa e família em sofrimento mental na perspectiva dos saberes profissionais de Le Boterf. Método: Foi feito uma pesquisa descritiva exploratória de abordagem qualitativa, delineada para apresentar e aprofundar a construção de competências dos profissionais enfermeiros, foi aplicada em 3 Unidades da SF. Resultados: fazendo uma análise temática, chegou-se às seguintes categorias: “Saber agir com pertinência”; “Saber mobilizar saberes e conhecimentos em um contexto profissional”; “Saber interagir saberes múltiplos”; “Saber transpor”; “Saber aprender e saber aprender a aprender”; “Saber envolver-se”. Considerações finais: verificou-se que entre os saberes a maior dificuldade é a de “saber transpor”, e que o cotidiano das equipes de SF exige muito desse saber. Foi verificado pouca transposição de saberes/fazeres em situações reais.

Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. Method: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. Result: Doing a thematic analysis, came to the following categories: “Knowing how to act and react with relevance”; “Knowing how to combine resources and mobilize them in a professional context”; “Knowing how to interact with multiple knowledges”; “Knowing how to transpose”; “Knowing how to learn and knowing how to learn to learn”; “Knowing how to engage”. Final considerations: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.

El objetivo del estudio fue identificar los conocimientos y acciones en la práctica de la Salud de la Familia (SF), a la vista de las enfermeras en relación con la persona y la familia en el cuidado angustia mental en términos de conocimientos profesionales de Le Boterf. Método: Un estudio cualitativo exploratorio descriptivo, se indica para introducir y profundizar en el desarrollo de habilidades de las enfermeras, aplicado a 3 unidades SF. Resultados: hacer un análisis temático, llegó a las siguientes categorías: “Saber actuar correctamente”; “Conociendo a movilizar conocimientos y experiencia en el ámbito profesional”; “Sabiendo que interactúan múltiples saberes”; “Sabiendo transponer”; “El saber aprender y saber cómo aprender a aprender”; “Sabiendo participar”. Consideraciones finales: se encontró el conocimiento de la mayor dificultad es la de "ser capaz de incorporar", y que los equipos diarias SF requiere mucho este conocimiento. Poco transposición del saber/hacer en situaciones reales ha sido verificada.

Aim of this study was to identify knowing-doing actions constituted the practice of Family Health (FH), in view of nurses in relation to the person and family care in mental distress in terms of professional knowledge of Le Boterf. Method: Descriptive exploratory qualitative study, to deepen contruction of nurse in FH. The survey was conducted in 3 Units FH. Result: Doing a thematic analysis, came to the following categories: “Knowing how to act and react with relevance”; “Knowing how to combine resources and mobilize them in a professional context”; “Knowing how to interact with multiple knowledges”; “Knowing how to transpose”; “Knowing how to learn and knowing how to learn to learn”; “Knowing how to engage”. Final considerations: the greatest difficulty was "be able to transpose," and that the daily demand of the FH teams requires a lot of this knowledge. Little transposition of knowing-doing in real situations has been verified.

El objetivo del estudio fue identificar los conocimientos y acciones en la práctica de la Salud de la Familia (SF), a la vista de las enfermeras en relación con la persona y la familia en el cuidado angustia mental en términos de conocimientos profesionales de Le Boterf. Método: Un estudio cualitativo exploratorio descriptivo, se indica para introducir y profundizar en el desarrollo de habilidades de las enfermeras, aplicado a 3 unidades SF. Resultados: hacer un análisis temático, llegó a las siguientes categorías: “Saber actuar correctamente”; “Conociendo a movilizar conocimientos y experiencia en el ámbito profesional”; “Sabiendo que interactúan múltiples saberes”; “Sabiendo transponer”; “El saber aprender y saber cómo aprender a aprender”; “Sabiendo participar”. Consideraciones finales: se encontró el conocimiento de la mayor dificultad es la de "ser capaz de incorporar", y que los equipos diarias SF requiere mucho este conocimiento. Poco transposición del saber/hacer en situaciones reales ha sido verificada.

O objetivo deste trabalho foi identificar os saberes e fazeres constituídos na prática da Saúde da Família (SF), na visão dos enfermeiros, no que se refere ao atendimento à pessoa e família em sofrimento mental na perspectiva dos saberes profissionais de Le Boterf. Método: Foi feito uma pesquisa descritiva exploratória de abordagem qualitativa, delineada para apresentar e aprofundar a construção de competências dos profissionais enfermeiros, foi aplicada em 3 Unidades da SF. Resultados: fazendo uma análise temática, chegou-se às seguintes categorias: “Saber agir com pertinência”; “Saber mobilizar saberes e conhecimentos em um contexto profissional”; “Saber interagir saberes múltiplos”; “Saber transpor”; “Saber aprender e saber aprender a aprender”; “Saber envolver-se”. Considerações finais: verificou-se que entre os saberes a maior dificuldade é a de “saber transpor”, e que o cotidiano das equipes de SF exige muito desse saber. Foi verificado pouca transposição de saberes/fazeres em situações reais.

Se analizó y evaluó biomecánicamente, desde el plano sagital izquierdo, la Salida Frontal (SF) y la Salida Lateral (SL) en pruebas de velocidad de pista Contra el Reloj Individual (CRI), de once (11) Patinadores de Velocidad Sobre Ruedas (VSR), empleando el Software SIMI°Twinner Pro y el software SPSS (versión 19); lo que permitió determinar que la SF es la más efectiva que la SL para el desarrollo de las pruebas CRI en el patinaje de VSR.

We analyzed and evaluated biomechanically, from the left sagittal plane, the front output (SF) and the side outlet (SL) in speed track individual time trial (CRI) of eleven (11) skaters penultimate (RSV) using the software SIMI°Twinner Pro software and SPSS (version 19); which it allowed to determine that the SF is more effective than the SL for the development of tests CRI RSV skating.

Foram analisados e avaliados biomecanicamente, a partir do plano sagital esquerdo, a saída frontal (SF) ea saída lateral (SL) na velocidade rastrear contra-relógio individual (CRI) de onze (11) patinadores penúltimo (RSV) usando o software SIMI° Twinner software Pro e SPSS (versão 19); que permitiu determinar que o SF é mais eficaz do que o SL para o desenvolvimento de testes de CRI RSV patinagem.

Objetivo : Este estudo avalia polimorfismos (SNPs) do NR3C1 na população brasileira, que possui origem étnica heterogênea. Materiais e métodos : SNPs do NR3C1 foram avaliados em brasileiros de ancestralidade caucasiana, africana ou japonesa (n = 380). Em um subgrupo (n = 40), os genótipos foram comparados à sensibilidade aos glicocorticoides (GC), previamente avaliada por cortisol plasmático (PF) e salivar (SF) após supressão com dexametasona (DEX), ensaio de afinidade do receptor ao GC (K d ) e inibição por DEX de 50% da proliferação de mononucleares estimulada por concanavalina-A (IC 50 ). Discriminação alélica de p.N363S (rs6195), p.ER22/23EK (rs6189-6190) e BclI (rs41423247) foi realizada por PCR em tempo real. Éxons 3 a 9 e transições éxon/íntron foram amplificados e sequenciados. Resultados : Frequências genotípicas (%) foram: rs6195 (n = 380; AA:96,6/AG:3,14/GG:0,26), rs6189-6190 (n = 264; GG:99,6/GA:0,4), rs41423247 (n = 264; CC:57,9/CG:34,1/GG:8,0), rs6188 (n = 155; GG:69,6/GT:25,7/TT:4,7), rs258751 (n = 150; CC:88,0/CT:10,7/TT:1,3), rs6196 (n = 176; TT:77,2/TC:20,4/CC:2,4), rs67300719 (n = 137; CC:99,3/CT:0,7), e rs72542757 (n = 137; CC:99,3/CG:0,7). Enquanto rs67300719 e rs72542757 foram exclusivos dos nipodescendentes, p.N363S e p.ER22/23EK estavam ausentes nesses indivíduos. p.ER22/23EK foi exclusivo dos descendentes de caucasianos. Equilíbrio de Hardy-Weinberg foi observado, exceto nos nipodescendentes para rs6188 e rs258751 e nos afrodescendentes para p.N363S. K d , IC 50 , PF ou SF basal ou após DEX foram semelhantes entre os genótipos. Entretanto, a dose média de DEX que suprimiu PF ou SF diferiu entre os genótipos BclI (P = 0,03), sendo maior nos carreadores GG (0,7 ± 0,2 mg) comparada aos GC (0,47 ± 0,2 mg) e CC (0,47 ± 0,1 mg). Conclusão : As frequências genotípicas dos SNPS de NR3C1 na população brasileira são semelhantes a outras populações. BclI foi associado à alteração da sensibilidade ao GC no eixo hipófise-adrenal.

Objective : The Brazilian population has heterogeneous ethnicity. No previous study evaluated NR3C1 polymorphisms in a Brazilian healthy population. Materials and methods : We assessed NR3C1 polymorphisms in Brazilians of Caucasian, African and Asian ancestry (n = 380). In a subgroup (n = 40), we compared the genotypes to glucocorticoid (GC) sensitivity, which was previously evaluated by plasma (PF) and salivary (SF) cortisol after dexamethasone (DEX) suppression tests, GC receptor binding affinity (K d ), and DEX-50% inhibition (IC 50 ) of concanavalin-A-stimulated mononuclear cell proliferation. p.N363S (rs6195), p.ER22/23EK (rs6189-6190), and BclI (rs41423247) allelic discrimination was performed by Real-Time PCR (Polymerase Chain Reaction). Exons 3 to 9 and exon/intron boundaries were amplified by PCR and sequenced. Results : Genotypic frequencies (%) were: rs6195 (n = 380; AA:96.6/AG:3.14/GG:0.26), rs6189-6190 (n = 264; GG:99.6/GA:0.4), rs41423247 (n = 264; CC:57.9/CG:34.1/GG:8.0), rs6188 (n = 155; GG:69.6/GT:25.7/TT:4.7), rs258751 (n = 150; CC:88.0/CT:10.7/TT:1.3), rs6196 (n = 176; TT:77.2/TC:20.4/CC:2.4), rs67300719 (n = 137; CC:99.3/CT:0.7), and rs72542757 (n = 137; CC:99.3/CG:0.7). The rs67300719 and rs72542757 were found only in Asian descendants, in whom p.N363S and p.ER22/23EK were absent. The p.ER22/23EK was observed exclusively in Caucasian descendants. Hardy-Weinberg equilibrium was observed, except in the Asian for rs6188 and rs258751, and in the African for p.N363S. The K d , IC 50 , baseline and after DEX PF or SF did not differ between genotype groups. However, the mean DEX dose that suppressed PF or SF differed among the BclI genotypes (P = 0.03). DEX dose was higher in GG- (0.7 ± 0.2 mg) compared to GC- (0.47 ± 0.2 mg) and CC-carriers (0.47 ± 0.1 mg). Conclusion : The genotypic frequencies of NR3C1 polymorphisms in Brazilians are similar to worldwide populations. Additionally, the BclI polymorphism was associated with altered pituitary-adrenal axis GC sensitivity.

INTRODUÇÃO: A revascularização percutânea de diabéticos é frequente e a utilização de stents farmacológicos (SF) é desejável, pois estes reduzem a reestenose e a necessidade de nova revascularização. O objetivo desse estudo foi comparar os resultados clínicos de longo prazo entre diabéticos tratados com e sem SF. MÉTODOS: Analisou-se uma coorte consecutiva de diabéticos submetidos à intervenção coronária percutânea (ICP) entre janeiro de 2009 e dezembro de 2012, em hospital terciário da rede pública. Esses pacientes foram acompanhados prospectivamente. RESULTADOS: Avaliamos 939 diabéticos, sendo 359 (38,3%) tratados com SF e 580 (61,7%) tratados com stents não farmacológicos (SNF). A taxa de eventos cardiovasculares adversos maiores (ECAM) em 12,6 ± 3,4 meses foi maior no grupo SNF (9,5% vs. 14,8%; risco relativo - RR = 1,56; intervalo de confiança de 95% - IC 95% 1,07-2,27; P = 0,02), assim como o óbito (2,8% vs. 6,7%; RR = 2,41; IC 95% 1,22-4,77; P < 0,01) e a revascularização do vaso alvo (3,9% vs. 7,2%; RR = 1,85; IC 95% 1,03-3,35; P = 0,04). Não foram observadas diferenças na incidência de infarto do miocárdio (1,7% vs. 0,5%; RR = 0,30; IC 95% 0,07-1,23; P = 0,08) ou acidente vascular encefálico (1,1% vs. 0,2%; RR = 0,15; IC 95% 0,01-1,37; P = 0,07). A análise multivariada revelou que a doença renal crônica (RR = 2,05; IC 95% 1,40-2,98; P < 0,01) e a síndrome coronária aguda (RR = 2,08; IC 95% 1,42-3,02; P < 0,01) foram os únicos preditores independentes de ECAM. CONCLUSÕES: Em pacientes diabéticos não selecionados, a evolução clínica tardia foi pior para os tratados com SNF. Após o ajuste das variáveis de confusão, o uso de SF não se mostrou preditor independente da redução de ECAM.

BACKGROUND: Percutaneous revascularization in diabetic is frequent and the use of drug-eluting stents (DES) is desirable, reducing restenosis and the need for repeat revascularization. The objective of this study was to compare the long-term outcomes of diabetic patients treated with and without DES. METHODS: A consecutive cohort of diabetic patients undergoing percutaneous coronary intervention (PCI) between 01/2009 and 12/2012 in a public tertiary hospital was prospectively followed-up. RESULTS: Nine hundred and thirty-nine diabetic patients (38.3%) treated with DES and 580 (61.7%) treated with bare metal stents (BMS) were evaluated. The rate of major adverse cardiac events (MACE) in 12.6 ± 3.4 months was greater in the BMS group (9.5% vs. 14.8%; RR, 1.56; 95% CI, 1.07-2.27; P = 0.02), as well as death (2.8% vs. 6.7%; RR, 2.41; 95% CI, 1.22-4.77; P < 0.01), and target vessel revascularization (3.9% vs. 7.2%; RR, 1.85; 95% CI, 1.03-3.35; P = 0.04). There were no differences in the incidence of myocardial infarction (1.7% vs. 0.5%; RR, 0.30; 95% CI, 0.07-1.23; P = 0.08) or stroke (1.1% vs. 0.2%; RR, 0.15; 95% CI, 0.01-1.37; P = 0.07). Multivariate analysis indicated that chronic kidney disease (RR, 2.05; 95% CI, 1.40-2.98; P < 0.01) and acute coronary syndrome (RR, 2.08; 95% CI 1.42-3.02; P < 0.01) were the only independent predictors of MACE. CONCLUSIONS: In non-selected diabetic patients the long-term clinical outcome was worse for patients treated with BMS. After adjusting for confounding variables, the use of DES was not an independent predictor of reduced MACE.

OBJECTIVE: The aim of this article is to provide an outcome evaluation model for preparedness of pharmaceutical services (PS) in disaster situations. METHODS: A five-step evaluation model development was conducted. The first step was a search of disaster preparedness and PS literature. The second step consisted of a description of the political and organizational aspects, external context, implementation, and performance of PS in disaster preparedness. A theoretical model on PS preparedness in disaster situations, encompassing pharmaceutical services variables and measures of preparedness, was developed as the third step. The fourth step produced a comprehensive theoretical model for evaluating PS preparedness, combining the two approaches used in steps two and three. The fifth and final step examined the development of the indicator framework. RESULTS: The results of this methodological approach are presented in the logic model of PS preparedness and the indicator framework, both of which were developed based on the disaster preparedness and PS literature and organized to provide a structured evaluation approach. CONCLUSIONS: PS was conceptualized as a program that can be evaluated by measurable effects. These effects can only be measured based on documented, on-site conditions before and after an event recognized as a disaster situation. This conceptual approach is context-modulated and therefore only applicable where the logistic cycle has been adopted as the rationale for PS.

OBJETIVO: Proporcionar un modelo de evaluación de resultados relativos al estado de preparación de los servicios farmacéuticos (SF) para situaciones de desastre. MÉTODOS: Se elaboró un modelo de evaluación en cinco pasos. El primer paso fue una búsqueda bibliográfica sobre preparativos para situaciones de desastre y SF. El segundo consistió en una descripción de los aspectos políticos y técnicos, el contexto externo, la implementación y el desempeño de los SF en la preparación para situaciones de desastre. El tercer paso fue la elaboración de un modelo teórico sobre el estado de preparación de los SF para situaciones de desastre, que comprendía variables relativas a los SF y medidas del estado de preparación. El cuarto paso consistió en la creación de un modelo teórico integral para evaluar el estado de preparación de los SF, mediante la combinación de los enfoques usados en los pasos dos y tres. El quinto y último paso fue el análisis de la elaboración del marco de indicadores. RESULTADOS: Se presentan los resultados de este enfoque metodológico en el modelo lógico del estado de preparación de los SF y el marco de indicadores, ambos elaborados con base en la bibliografía sobre preparativos para casos de desastre y SF, y organizados para poder proporcionar un método estructurado de evaluación. CONCLUSIONES: A efectos de la elaboración de este marco conceptual se consideró a los SF como un programa que podría ser evaluado a partir de sus efectos cuantificables. Estos efectos solo pueden ser medidos sobre la base de condiciones documentadas en el lugar de los hechos antes y después del evento considerado una situación de desastre. Este enfoque conceptual está modulado en función del contexto y por lo tanto se considera aplicable solamente donde se haya adoptado el ciclo logístico como fundamento de los SF.

Objective To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). Materials and Methods One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and “de novo” urinary symptoms after 12 months of surgery in both groups. Results Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and “de novo” urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. Conclusion There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and “de novo” urinary symptoms between both groups after 12 months of surgery.

A síndrome de Frasier (SF), caracterizada por disgenesia gonadal e nefropatia, é causada por mutações específicas no gene supressor do tumor de Wilms (WT1) localizado em 11p23. Pacientes com cariótipo 46,XY apresentam genitália feminina normal com gônadas disgenéticas e alto risco de tumor gonadal, principalmente o gonadoblastoma. Por isso, a gonadectomia bilateral eletiva está indicada. A nefropatia na SF consiste de síndrome nefrótica com proteinúria que se inicia na infância e aumenta progressivamente com a idade, principalmente devido à glomeruloesclerose focal e segmentar (GESF). Esses pacientes não respondem ao tratamento com esteroides e imunossupressores e desenvolverão insuficiência renal crônica durante a segunda ou terceira década de vida. Neste trabalho, são relatados quatro casos de SF cujo diagnóstico foi definido após o rastreamento molecular do gene WT1. O caso 1 faz parte de um grande grupo de pacientes que tiveram diagnóstico de síndrome nefrótica corticorresistente e no qual o rastreamento de mutações no fragmento 8-9 do gene WT1 identificou a mutação IVS9+5G>A. Além da SF, essa paciente apresentou características incomuns, tais como malformação urinária (rins em ferradura) e disgerminoma bilateral. Os casos 2 e 3 também apresentaram a mutação IVS9+5G>A, e, no caso 4, foi identificada a mutação IVS9+1G>A, sendo que esses três casos foram encaminhados para estudo molecular em decorrência de GESF e/ou atraso no desenvolvimento puberal. Além disso, as pacientes 2 e 4 desenvolveram tumor gonadal bilateral. Visto que a maioria dos pacientes com SF apresenta genitália externa feminina, não há suspeita de sexo reverso até apresentarem atraso puberal e/ou amenorreia primária. Portanto, o rastreamento molecular do gene WT1 é de fundamental importância para se confirmar o diagnóstico de SF. Arq Bras Endocrinol Metab. 2012;56(8):525-32

Frasier syndrome (FS) is characterized by gonadal dysgenesis and nephropathy. It is caused by specific mutations in the Wilms' tumor suppressor gene (WT1) located in 11p23. Patients with the 46,XY karyotype present normal female genitalia with streak gonads, and have higher risk of gonadal tumor, mainly, gonadoblastoma. Therefore, elective bilateral gonadectomy is indicated. Nephropathy in FS consists in nephrotic syndrome (NS) with proteinuria that begins early in childhood and progressively increases with age, mainly due to nonspecific focal and segmental glomerular sclerosis (FSGS). Patients are generally unresponsive to steroid and immunosuppressive therapies, and will develop end-stage renal failure (ESRF) during the second or third decade of life. We report here four cases of FS diagnosis after identification of WT1 mutations. Case 1 was part of a large cohort of patients diagnosed with steroid-resistant nephrotic syndrome, in whom the screening for mutations within WT1 8-9 hotspot fragment identified the IVS9+5G>A mutation. Beside FS, this patient showed unusual characteristics, such as urinary malformation (horseshoe kidney), and bilateral dysgerminoma. Cases 2 and 3, also bearing the IVS9+5G>A mutation, and case 4, with IVS9+1G>A mutation, were studied due to FSGS and/or delayed puberty; additionally, patients 2 and 4 developed bilateral gonadal tumors. Since the great majority of FS patients have normal female external genitalia, sex reversal is not suspected before they present delayed puberty and/or primary amenorrhea. Therefore, molecular screening of WT1 gene is very important to confirm the FS diagnosis. Arq Bras Endocrinol Metab. 2012;56(8):525-32

INTRODUÇÃO: Os stents farmacológicos (SFs) ainda não estão disponíveis para uso clínico em pacientes do Sistema Único de Saúde (SUS). Este estudo teve como objetivo avaliar o quanto a disponibilidade de SFs para utilização em pacientes do SUS poderia impactar na conduta do cardiologista intervencionista com relação à indicação de revascularização miocárdica, cirúrgica ou percutânea. MÉTODOS: Análise retrospectiva dos casos submetidos a revascularização cirúrgica pelo SUS em 2010 na Santa Casa de Misericórdia de Barra Mansa (Barra Mansa, RJ, Brasil). As coronariografias, classificadas pelo SYNTAX Score, foram submetidas à avaliação de três cardiologistas intervencionistas, juntamente com o seguinte questionário: 1) Concorda com a indicação inicial de cirurgia? 2) Utilizando SF, considera que a intervenção coronária percutânea (ICP) seria tão benéfica quanto ou superior à cirurgia? 3) Caso optasse pelo implante de SF, quantos seriam utilizados? 4) Com SF, a revascularização seria completa? Foram excluídos os casos de revascularização cirúrgica prévia, plastia/troca valvar concomitante, e resposta "não" à questão 1 do questionário. RESULTADOS: O estudo incluiu 67 pacientes, com média de idade de 59,7 ± 9,8 anos, 59,7% do sexo masculino e 38,8% diabéticos. Em 29,8% a ICP foi considerada o procedimento de escolha, com revascularização completa em 90% dos casos e uso médio de 1,82 ± 0,83 stent por paciente. De acordo com o SYNTAX Score, a ICP foi indicada em 66,6% dos pacientes com escore < 23, em 23% dos pacientes com escore entre 23 e 32, e em nenhum paciente com escore > 32. CONCLUSÕES: A disponibilização de SF para pacientes do SUS pode influenciar significativamente as indicações de revascularização miocárdica percutânea, principalmente naqueles com SYNTAX Score < 23.

BACKGROUND: Drug-eluting stents (DES) are still not accessible for patients from the Public Healthcare System (PuHS). This study aimed to evaluate how the availability of DES for use in PuHS patients could impact the conduct of the interventional cardiologist regarding the indication for percutaneous or surgical myocardial revascularization. METHODS: Retrospective analysis of PuHS patients undergoing surgical revascularization at Santa Casa de Misericórdia de Barra Mansa (Barra Mansa, RJ, Brazil) in 2010. Coronary angiographies classified by the SYNTAX score were submitted to the evaluation of 3 interventional cardiologists who answered the following questionnaire: 1) Do you agree with the initial indication for surgery? 2) If a DES was available, do you believe the percutaneous coronary intervention (PCI) would be as beneficial as or superior to surgical revascularization? 3) If you decide to use DES, how many would be used? 4) After using DES, would revascularization be complete? Patients submitted to previous surgical revascularization, concomitant valvoplasty/valve replacement and a negative answer to question 1 were excluded. RESULTS: A total of 67 patients were included, with mean age of 59.7 ± 9.8 years, 59.7% were male and 38.8% diabetics. PCI was the therapy of choice in 29.8%, with complete revascularization in 90% of the cases and a mean use of 1.82 ± 0.83 stents per patient. According to the SYNTAX score, PCI was indicated in 66.6% of the patients with a score < 23, in 23% of the patients with a score from 23 to 32 and none of the patients with a score > 32. CONCLUSIONS: The availability of DES for PuHS patients may significantly influence indications for percutaneous coronary revascularization, especially among those with a SYNTAX score < 23.

Na natação, atualmente, a avaliação do desempenho dos nadadores, apóiam-se em diversas metodologias de observação da competição. As variáveis biomecânicas representam um importante recurso para análise da performance esportiva por serem indicadores da eficiência do nado, com aplicação simples e objetiva. O objetivo deste estudo foi realizar uma análise descritiva do desempenho na prova de 100 metros nado Livre feminino, baseada nas variáveis: comprimento de braçada (CB), frequência de braçada (FB), velocidade de nado (VN), índice de nado (IN), velocidade média escalar (Vm), tempo de saída (Ts) e tempo de virada (Tv), a fim de observar o comportamento e influências na performance. Foram capturadas imagens por uma câmera mini-DV, analisadas por um "software" editor de vídeo. As variáveis CB, VN e IN foram encontradas indiretamente, sem considerar as fases de saída e virada. Ts e Tv foram obtidos através da linha do tempo do software. A análise de dados mostra para atleta 1: CB 2,00 m, FB 0,89 Hz, VN 1,78 m/s e IN 3,56 m²/s; atleta 2: CB 1,82 m, FB 0,97 Hz, VN 1,76 m/s, IN 3,20 m²/s; atleta 3: CB 1,91 m, FB 0,92 Hz, VN 1,75 m/s, IN 3,32 m²/s. Conclui-se que: o desempenho final apresentou comportamentos similares nos três primeiros trechos da prova indicando uma influência semelhante dessas variáveis sobre o desempenho das atletas. No último quarto da prova as variáveis apresentam maior interferência na performance final, sendo este decorrente de uma possível diminuição da eficiência mecânica do nado devido ao aumento do arrasto e redução da força propulsiva.

The performance evaluation of swimmers is based on many methodologies of watching the competition. Biomechanical variables represent an important resource for analyzing the performance of swimmers because they are simple and objective indicators of swimming efficiency. The objective of this research was to observe how biomechanical variables affect swimmers' performance in of the female 100 meters freestyle in order to observe the behavior and influence stroke length (SL), stroke frequency (SF), swimming velocity (SV), swimming index (SI), average speed (AS), time of departure (Td), time of turning (Tt). On swimming performance images were captured using a mini-DV camera, which were subsequently analyzed with the help of a software video editor. The variables SL, SV and SI were indirectly measured, without considering start and turning phases. Td and Tt were obtained through the timeline of the software. Data analysis shows for athlete 1: SL = 2.00 m, SF = 0.89 hz, SV = 1.78 m/s, SI = 3.56 m²/s, athlete 2: SL = 1.82 m, SF = 0,97Hz, SV = 1.76 m/s, SI = 3.20 m²/s, athlete 3: SL = 1.91 m, SF = 0.92 Hz, SV = 1.75 m/s, SI = 3.32 m²/s. We concluded that the final performance presented similar behavior in the first three parts of the race, indicating a similar influence of these variables on the performance of athletes. In the last quarter of the race showed that variables have greater interference in the final performance, this probably due to a possible decrease in mechanical efficiency of swimming due to increase in drag and reduction in propulsive force.