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Introducción: Se suele aplicar en pacientes con SARS-CoV-2 el decúbito prono (DP) prolongadamente, pues ha demostrado beneficios para solventar la falta de equipos de ventilación mecánica; sin embargo, también tiende a producir lesiones por presión (LPP) en regiones anatómicas no experimentadas en otras prácticas. Objetivo: Calcular la incidencia de LPP en el paciente crítico de COVID-19 en DP, describir características de los pacientes y las lesiones. Metodología: Estudio observacional, descriptivo, de carácter transversal con enfoque retrospectivo. La recolección de datos se realizó en un hospital de tercer nivel de la Ciudad de México, incluyó 230 pacientes que desarrollaron LPP posterior a su ingreso. Se analizó el expediente electrónico y los registros de la clínica de heridas, la recolección de datos se generó en Excel y el análisis estadístico en el programa SPSS. Resultados: La incidencia fue de 18.05%, las LPP con esfacelo corresponden al 33.9% y las de necrosis al 40%. La localización anatómica en pabellón auricular, pómulos y tórax fue de 36.1% y 46.5% fueron lesiones de categoría III con afectación de las estructuras musculares. La correlación con el IMC demostró que pacientes con sobrepeso presentaron mayor incidencia de LPP con fibrina y esfacelo en un 60.3%. Limitación del estudio: No se consideraron variables como la carga de trabajo de enfermería. Originalidad: Esta investigación no ha sido postulada previamente en ningún órgano editorial. Conclusiones: La incidencia coincide con estudios en otros países, por lo que es necesario estandarizar las acciones para la prevención de LPP y reducir su incidencia.
Introduction: Prolonged prone decubitus (PD) is usually applied in patients with SARSCoV2, as it has shown benefits to solve the lack of mechanical ventilation equipment; however, it also tends to produce pressure injuries (PI) in anatomical regions not experienced in other practices. Objective: To calculate the incidence of PI in the critical patient of COVID-19 in PD, describe patient characteristics and injuries. Methodology: Observational, descriptive, cross-sectional study with retrospective approach. Data collection was performed in a tertiary level hospital in Mexico City, including 230 patients who developed PI after admission. The electronic file and wound clinic records were analyzed, data collection was generated in Excel and statistical analysis in the SPSSs program. Results: The incidence was 18.05%, PI with slough corresponded to 33.9% and those with necrosis to 40%. The anatomical location in the pinna, cheekbones and thorax was 36.1% and 46.5% were category III lesions with involvement of muscular structures. Correlation with BMI showed that overweight patients had a higher incidence of PI with fibrin and sphacel in 60.3%. Limitation of the study: variables such as nursing workload were not considered. Originality: This research has not been previously postulated in any editorial body. Conclusions: The incidence coincides with studies in other countries, so it is necessary to standardize actions for the prevention of PI and reduce its incidence.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Ferimentos e Lesões , Pneumonia , Pronação , Estado TerminalRESUMO
Infectious diseases constitute a problem of great importance for animal and human health, as well as the increasing bacterial resistance to antibiotics. In this context, medicinal plants emerge as an effective alternative to replace the use antibiotics. The essential oil (EO) of Minthostachys verticillata (Griseb.) Epling (Lamiaceae) has demonstrated a strong antimicrobial activity. However, its instability and hydrophobicity under normal storage conditions are limitations to its use. Nanoemulsion technology is an excellent way to solubilize, microencapsulate, and protect this compound. This study aimed to obtain a nanoemulsion based on M. verticillata EO and evaluate its antibacterial activity against Staphylococcus aureus. The EO was obtained by steam distillation. Identification and quantification of their components were determined by GC-MS revealing that the dominated chemical group was oxygenated monoterpenes. Nanoemulsions (NE) were characterized by measuring pH, transmittance, separation percentage, release profile, and morphology. The effect of NE on the growth of S. aureus and cyto-compatibility was also evaluated. The results showed that NE containing a higher percentage of tween 20 exhibited higher stability with an approximated droplet size of 10 nm. The effect of encapsulation process was evaluated by GC-MS revealing that the volatile components in EO were no affected. After 24 h, 74.24 ± 0.75% of EO was released from NE and the antibacterial activity of EO was enhanced considerably by its encapsulation. The incubation of S. aureus with the NE and pure EO, show a bacterial growth inhibition of 58.87% ± 0.99 and 46.72% ± 3.32 (p < 0.05), respectively. In addition, nanoemulsión did not cause toxicity to porcine and equine red blood cells. The results obtained showed that NE could be a potential vehicle for M. verticillata EO with promissory properties to emerge as a tool for developing advanced therapies to control and combat infections.
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The sugarcane stem weevil, Acrotomopus atropunctellus (Boheman) (Curculionidae: Molytinae: Cholini) is an important economic pest from the Northwestern region of Argentina. Analyses of the headspace volatiles produced by separated males and females revealed one male-specific compound. Its structural identification is reported here in using gas chromatography coupled with mass spectroscopy analysis and chemical micro-reactions. Besides, two laboratory olfactometry assays allowed us to propose 6-methyl-5-hepten-2-one (sulcatone) as an aggregation pheromone for this insect, being attractive to both conspecific males and females. This compound is reported for the first time as involved in the Curculionidae family communication.
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Feromônios/metabolismo , Gorgulhos/metabolismo , Animais , Comportamento Animal , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Masculino , Feromônios/química , Feromônios/isolamento & purificação , Gorgulhos/químicaRESUMO
OBJECTIVE: The aim is to analyse how the Hippocratic Oath's commitments of not cutting for stone and referral to experts was modified in medical oaths of Hippocratic stemma from different time periods. METHODS: Nineteen oaths of Hippocratic stemma were studied: 4 Medieval, 2 Modern, and 13 Contemporary. They were selected according to: name of the oath when it includes the word «Hippocratic¼ or because their authors recognized having based their oaths on the Hippocratic Oath. Their historical significance and representativity regarding time period, renowned medical schools, and importance and reliability of the sources was also taken into consideration. RESULTS: Four oaths prohibit cutting for stone (one Medieval, 2 Modern, one Contemporary); 4 oaths mention seeking consultation about patients (all Contemporary); 3 mention not performing criminal operations (all Contemporary); 8 do not mention these commitments (3 Medieval, 5 Contemporary). CONCLUSION: The commitment of the Hippocratic Oath of not cutting for stone and referral to experts has been modified mainly in Contemporary oaths. The original commitment seems to have been split into 2 tendencies: those that mention obtaining consultation, and those that refer to not performing criminal operations. Due to the bioethics movement in the second half of the 20th century, referring patients that exceed the physician's limitations to more skilled colleagues constitutes an ethical obligation. Thus, it should be a commitment present in every Contemporary oath.
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Juramento Hipocrático , Cálculos Urinários/cirurgia , Humanos , Encaminhamento e ConsultaRESUMO
BACKGROUND: All humans have the right to receive a thorough medical attention, and should not be discriminated. AIMS: To determine if there is a significant relationship between Medical Oaths that commit to the principle of no discrimination in health care and the time, origin and source of the modifications to the Hippocratic Oath. To specify which are the conditions for no discrimination. MATERIALS AND METHODS: Fifty Oaths found in different articles and publications were analyzed and selected considering their historical context. RESULTS: Of the fifty Oaths that were analyzed, nineteen express a commitment towards no discrimination, whereas one of the texts is discriminatory. The only significant relationship found was the origin and source of the texts. The most frequently discriminating factors found are social class, religion, nationality and race. At present, other factors can be found such as ideology, moral, aptitude, sex and political and sexual preferences. CONCLUSIONS: The commitment towards no discrimination is not widely found in Medical Oaths of all times (30/50). According to the bioethics principle of justice, physicians should find the limit of their obligation as doctors in providing medical assistance to everyone alike, wealthy or poor; Christians, Hebrews or Muslims; men or women; children, adults or old; with or without infectious diseases. Non discrimination should be a vow that physicians must be willing to take despite any of the factors that could influence health care.
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Humanos , Acessibilidade aos Serviços de Saúde , Juramento Hipocrático , Preconceito , Qualidade da Assistência à SaúdeRESUMO
BACKGROUND: Information is lacking on the effects of hormone replacement therapy in women with diabetes, especially during moderate chronic hyperglycemia. OBJECTIVES: To study the effects of HRT on the lipid profile and the low density lipoprotein subclass distribution in women with type 2 diabetes under satisfactory and non-satisfactory glycemic control. METHODS: Fifty-four postmenopausal women after a 6 week run-in diet were randomized to receive either placebo (HbA1c < 8%, n = 13; HbA1c > 8%, n = 17) or HRT (HbA1c < 8%, n = 11; HbA1c > 8%, n = 13) for 12 weeks. HRT consisted of cyclical conjugated estrogens 0.625 mg/day plus medrogestone 5 mg/day. At the beginning and at the end of each treatment period the LDL subclass distribution was estimated by density gradient ultracentrifugation. RESULTS: At the baseline and during the study, the HbA1c level was significantly higher in hyperglycemic patients than in the near-normoglycemic controls (baseline 10.2 +/- 2.9 vs. 6.5 +/- 0.7%, P < 0.01). They showed a trend for higher total and LDL cholesterol, triglycerides and lower high density lipoprotein-cholesterol compared to near-normoglycemic controls, as well as significantly higher triglyceride concentrations in very low density lipoprotein, intermediate density lipoprotein and LDL-1 particles and cholesterol content in LDL-1 and -2 particles. HRT decreased LDL-cholesterol in both groups. In the normoglycemic patients a small increase in HbA1c was observed (6.5 +/- 0.7 vs. 7.4 +/- 1%, P = 0.04). In all cases, HRT did not modify the proportion of LDL represented by denser LDLs. CONCLUSIONS: HRT did not modify the LDL subclass distribution, even in the presence of moderate chronic hyperglycemia in women with type 2 diabetes.
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Apolipoproteínas B/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Estrogênios Conjugados (USP)/administração & dosagem , Terapia de Reposição Hormonal/efeitos adversos , Lipoproteínas LDL/efeitos dos fármacos , Medrogestona/administração & dosagem , Idoso , Apolipoproteínas B/análise , Glicemia , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/diagnóstico , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Lipoproteínas LDL/análise , Pessoa de Meia-Idade , Pós-Menopausa , Probabilidade , Valores de Referência , Resultado do TratamentoRESUMO
The objective of this study was to investigate possible defects in the insulin sensitivity and/or the acute insulin response in a group of Mexican patients displaying early-onset type 2 diabetes and to evaluate the contribution of mutations in three of the genes linked to maturity-onset diabetes of the young. We studied 40 Mexican patients with an age of diagnosis between 20 and 40 yr in which the insulin sensitivity as well as the insulin secretory response were measured using the minimal model approach. A partial screening for possible mutations in 3 of the 5 genes linked to maturity-onset diabetes of the young was carried out by PCR-single strand conformation polymorphism analysis. A low insulin secretory capacity (AIRg = 68.5 +/- 5 muU/mL.min) and a near-normal insulin sensitivity (3.43 +/- 0.2 min/muU.mL x 10(4)) were found in these patients. Among this group we found two individuals carrying missense mutations in exon 4 of the hepatocyte nuclear factor-1alpha (HNF-4alpha) gene (Asp(126)-->His/Tyr and Arg(154)-->Gln, respectively) and one carrying a nonsense mutation in exon 7 of the HNF-1alpha gene (Gln(486)-->stop codon); 7.5% had positive titers for glutamic acid decarboxylase antibodies. Thirty-five percent of cases had insulin resistance; these subjects had the lipid abnormalities seen in the metabolic syndrome. A defect in insulin secretion is the hallmark in Mexican diabetic patients diagnosed between 20 and 40 yr of age. Mutations in either the HNF-1alpha or the HNF-4alpha genes are present among the individuals who develop early-onset diabetes in our population. These particular sequence changes have not been previously reported and therefore represent putative new mutations. Even in the absence of endogenous hyperinsulinemia, insulin resistance is associated with an adverse lipid profile.
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Proteínas de Ligação a DNA , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Proteínas Nucleares , Adulto , Idade de Início , Anticorpos/análise , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Glucoquinase/genética , Glutamato Descarboxilase/imunologia , Fator 1 Nuclear de Hepatócito , Fator 1-alfa Nuclear de Hepatócito , Fator 1-beta Nuclear de Hepatócito , Fator 4 Nuclear de Hepatócito , Humanos , Insulina/metabolismo , Resistência à Insulina , Secreção de Insulina , Lipoproteínas/sangue , Masculino , México , Pessoa de Meia-Idade , Mutação , Linhagem , Fosfoproteínas/genética , Fatores de Transcrição/genéticaRESUMO
BACKGROUND: HbA1c is considered the gold standard of long-term glycemic control and is recommended as a routine test for every diabetic patient. However, its common use in clinical practice has some problems related to lack of standardization and its relative cost. Recent studies have suggested, that postprandial blood glucose could be better than a fasting sample, as a marker of diabetes control. The objective of the present study was to evaluate the relative value of plasma glucose samples at different times of the day, and easy and accessible programs for home blood and urinary glucose measurements compared with HbA1c in assessing the mean glycemic control of type 2 diabetic patients. METHODS: Sixty type 2 diabetic patients were instructed to do home blood and urine glucose monitoring for two months, at the end, plasma glucose profiles were obtained. RESULTS: The mean of all the capillary BG measurements had the best correlation with the HbA1c (r = 0.84, p < 0.001), followed by the mean of the capillary BG measurements before breakfast and supper (r = 0.82, p < 0.001), and the 2 hr. postbreakfast plasma glucose (r = 0.79 p < 0.001). The fasting PG had a low correlation (r = 0.65, p < 0.001), but a good sensitivity to predict a fair or a poor metabolic control. Diabetes duration and type of treatment explained 17% and 28% of variance in HbA1c levels. CONCLUSIONS: A bimonthly fasting PG correlated well with the glycosylated hemoglobin and is the easiest and cheapest way of monitoring glycemic control in type 2 diabetic patients with some preserved insulin reserve (diabetes for less than 10 years and on treatment with only one hypoglycemic agent). A sample of capillary BG, fasting, once per week correlates better with the HbA1c than a fasting PG every 2-3 months. The 2 hr and 5 hr postbreakfast PG have a good correlation with the HbA1c, but are not a substitute for doing BG monitoring. Glycosuria may be a useful parameter to rule out a fair or poor metabolic control in some patients.
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Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Adulto , Idoso , Automonitorização da Glicemia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Previous reports have provided evidence of a reticulo-thalamic system, extending from the mesencephalic reticular formation (MRF) to the ventrolateral thalamus (VL), involved in the production of tremor. In humans, a funnel of fibers in the posterior subthalamus named the prelemniscal radiations (Raprl) has been described as an exquisite target to treat tremor in cases of Parkinson's disease. In the present study, a group of 14 patients suffering from Parkinson's disease, with prominent unilateral tremor and rigidity, were implanted with tetrapolar depth brain stimulation (DBS) electrodes in Raprl to perform chronic electrical stimulation (ES) for the treatment of patient symptoms. Electrodes were left externalized to corroborate their placement throughout MRI studies and also to perform the following electrophysiological battery: (a) recording of somatosensory-evoked responses (SEP) through different electrode contacts and scalp by means of a paradigm to study the attention process; (b) evoking scalp EEG responses by stimulation with low (3 cps, 6 cps) and high (60-120 cps) frequencies with stimuli delivered through different electrode contacts, and (c) studying recovery cycle (RC) potentials in the Raprl while the upper MRF was being stimulated and, conversely, the RC in MRF while Raprl was being stimulated, before and after subacute Raprl stimulation. Thereafter, the electrodes were internalized and connected to a pulse generator (IPG) to carry on chronic ES, while the effects of stimulation were determined through a quantitative evaluation that measured phasic and tonic muscular activity with EMG recordings during different motor tasks. Results indicate the following: (a) that late, but not early, SEP components were recorded in Raprl and modulated in different attentive conditions; (b) that bilateral recruiting responses and spike and wave complexes were elicited by Raprl through low-frequency stimulation, while bilateral positive DC shifts induced by high-frequency stimulation were recorded, similar to those obtained in animals from MRF, and (c) that Raprl-ES induced RC inhibition at Raprl, but Raprl ES did not change MRF-RC. Long-term Raprl-ES induced a significant decrease in tremor and rigidity. It was concluded that Raprl represents a subthalamic circuit electrophysiologically related to MRF in the genesis of tremor and rigidity and in the process of selective attention. Raprl-ES induced a significant improvement in tremor and rigidity by causing inhibition of the stimulated area.
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Potenciais Somatossensoriais Evocados/fisiologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Núcleos Posteriores do Tálamo/fisiopatologia , Tegmento Mesencefálico/fisiopatologia , Potenciais de Ação/fisiologia , Animais , Terapia por Estimulação Elétrica , Eletroencefalografia , Eletromiografia , Haplorrinos , Humanos , Rigidez Muscular/diagnóstico , Rigidez Muscular/fisiopatologia , Rigidez Muscular/terapia , Vias Neurais , Doença de Parkinson/diagnóstico , Tremor/diagnóstico , Tremor/fisiopatologia , Tremor/terapia , Núcleos Ventrais do Tálamo/fisiopatologiaRESUMO
From July to December 1998, a hospital- and health center-based surveillance system for dengue was established at selected sites in Nicaragua to better define the epidemiology of this disease. Demographic and clinical information as well as clinical laboratory results were obtained, and virus isolation, reverse transcriptase-polymerase chain reaction, and serologic assays were performed. World Health Organization criteria were used to classify disease severity; however, a number of patients presented with signs of shock in the absence of thrombocytopenia or hemoconcentration. Therefore, a new category was designated as "dengue with signs associated with shock" (DSAS). Of 1,027 patients enrolled in the study, 614 (60%) were laboratory-confirmed as positive cases; of these, 268 (44%) were classified as dengue fever (DF); 267 (43%) as DF with hemorrhagic manifestations (DFHem); 40 (7%) as dengue hemorrhagic fever (DHF); 20 (3%) as dengue shock syndrome (DSS); and 17 (3%) as DSAS. Interestingly, secondary infection was not significantly correlated with DHF/DSS, in contrast to previous studies in Southeast Asia. DEN-3 was responsible for the majority of cases, with a minority due to DEN-2; both serotypes contributed to severe disease. As evidenced by the analysis of this epidemic, the epidemiology of dengue can differ according to geographic region and viral serotype.
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Vírus da Dengue/classificação , Dengue/epidemiologia , Surtos de Doenças , Adolescente , Criança , Pré-Escolar , Dengue/sangue , Dengue/diagnóstico , Dengue/virologia , Vírus da Dengue/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Nicarágua/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estações do Ano , Índice de Gravidade de DoençaRESUMO
Confidentiality, together with the ethical principles of beneficence and non-maleficence, is the most important rule in Medical Oaths at the present time. However, the scientific-technical advances in medicine have made this rule one of the most controversial ones because of its exceptions. In consequence, the aim of the present paper is to comparatively analyze the rule of confidentiality in Medical Oaths of different places, times, origins and in different versions of the Hippocratic Oath in order to determine what should be kept a secret and with what degree of commitment (absolute or "prima facie"). Of the thirty six analyzed Oaths, twenty-seven manifest this rule and nine do not. No relation was found between the manifestation of this rule and the place, time, origin and different versions of the Hippocratic Oath. Most pledges suggest not to reveal what has been seen or heard during the medical act, the same as in the Hippocratic Oath. Seven texts point out that confidentiality should be absolute and four give exceptions in connection with beneficence and justice principles and the moral duty of causing no damage to third parties. Two pledges specify protection of privacy. In conclusion, today confidentiality is considered to be a moral duty for the benefit of the patient and out of consideration for his autonomy; however, at the present time in medicine the duty of keeping absolute secrecy is being reconsidered.
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Confidencialidade , Juramento Hipocrático , Relações Médico-Paciente , HumanosRESUMO
Confidentiality, together with the ethical principles of beneficence and non-maleficence, is the most important rule in Medical Oaths at the present time. However, the scientific-technical advances in medicine have made this rule one of the most controversial ones because of its exceptions. In consequence, the aim of the present paper is to comparatively analyze the rule of confidentiality in Medical Oaths of different places, times, origins and in different versions of the Hippocratic Oath in order to determine what should be kept a secret and with what degree of commitment (absolute or [quot ]prima facie[quot ]). Of the thirty six analyzed Oaths, twenty-seven manifest this rule and nine do not. No relation was found between the manifestation of this rule and the place, time, origin and different versions of the Hippocratic Oath. Most pledges suggest not to reveal what has been seen or heard during the medical act, the same as in the Hippocratic Oath. Seven texts point out that confidentiality should be absolute and four give exceptions in connection with beneficence and justice principles and the moral duty of causing no damage to third parties. Two pledges specify protection of privacy. In conclusion, today confidentiality is considered to be a moral duty for the benefit of the patient and out of consideration for his autonomy; however, at the present time in medicine the duty of keeping absolute secrecy is being reconsidered.
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The principles of beneficence and no-maleficence, already set forth in the Hippocratic Oath, have been the foundation of medical ethics for the last twenty-five centuries. The principle of beneficence is currently maintained in most wordings of the pledges of medical schools of the United States, Canada and Argentina; it is not the same with the principle of non-maleficence. The aim of this paper is to determine whether these principles are described in medical oaths at different times. These principles did not remain in an oaths. Of twenty-nine analyzed texts, nine describe both principles simultaneously, eleven only mention beneficence; three only express non-maleficence, and six indicate neither of them. Most wordings that describe these principles are modifications of the Hippocratic Oath. Two contemporary wordings describe the achievement of the greatest benefit with minimum harm. Two current wording also subordinate the principle of beneficence to the principle of respect for the patient's autonomy, and eight wordings indicate not only patients' benefit in particular but that of society in general. It is not possible to ignore that it is no enough to fulfill only these two principles. Physicians should encourage the development of patients' responsibility in managing their own health and respect their autonomy.
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Ética Médica , Juramento Hipocrático , HumanosRESUMO
OBJECTIVE: To evaluate the efficacy of acarbose in the treatment of secondary failures to sulphonylurea-metformin therapy, its comparison against bedtime NPH insulin, and to measure the changes in postprandial metabolism resulting from both treatments. METHODS: One hundred type 2 diabetic patients in a secondary failure were included. The study begun with a run-in diet period of 6 weeks, in which an isocaloric diet was prescribed. Only subjects who continued hyperglycaemic were randomly assigned to placebo and acarbose (n = 17) or bedtime NPH insulin (n = 12). Acarbose (300 mg/day) or placebo were administered using a randomized, double blind, crossover design. Treatment periods of 3 months were separated by a 3-week washout period. Insulin was administered during 3 months. At the beginning and the end of each treatment period, an i.v. glucose tolerance test and a meal test were performed. Safety tests were done every 4 weeks. RESULTS: Acarbose resulted in a small but significant improvement in fasting plasma glucose (13.5 +/- 2.4 vs. 11.3 +/- 3.9 mmol/l, p = 0.05), HbA1c (11.1 +/- 3.4 vs. 10.3 +/- 2.5%, P = 0.3) and in a decreased plasma glucose during the meal test. Bedtime insulin significantly decreased fasting plasma glucose (13.1 +/- 2.9 vs. 8.2 +/- 2.3 mmol/l, p < 0.01), HbA1c (11.7 +/- 2.9 vs. 9.4 +/- 2.7%, p < 0.01) and plasma cholesterol. No change in insulin secretion resulted from insulin and acarbose treatment. CONCLUSIONS: Acarbose decreases blood glucose in secondary failure to sulphonylurea-metformin therapy; however, the decrease is not enough to reach the desired metabolic control. Bedtime NPH insulin is, by far, a more effective alternative.
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Acarbose/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina Isófana/uso terapêutico , Metformina/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Glicemia/análise , Ritmo Circadiano , Estudos Cross-Over , Diabetes Mellitus Tipo 2/sangue , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Insulina Isófana/administração & dosagem , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Retratamento , Falha de TratamentoRESUMO
Differences in the quality of meat obtained from four animal species (beef, horse, rabbit and chicken) treated with two concentrations of calcium chloride (75 or 150 mM) were evaluated by a sensory panel. Physicochemical variables analysed were water holding capacity, instrumental colour and pH. Sensory analysis was by recognition index (R-index) by untrained and trained panels. CaCl(2) led to an increase in enzymatic activity, although it was not significantly different in treated compared to untreated samples. Lightness was higher (paler) in treated meat for all species studied. R-index showed that treatment of raw beef with 75mM CaCl(2) had negligible effect on odour compared to fresh, untreated beef. More juicy meat resulted from marination. Treatments with 150 mM CaCl(2) caused a more tender meat. The best combinations of cooking method and CaCl(2) concentration to obtain the most acceptable meat varied from attribute to attribute. The best odour was obtained when beef was treated with 150 mM CaCl(2) and cooked in a convection oven, whereas juiciness was improved if beef was treated with 150 mM CaCl(2) and cooked in a microwave oven. The highest scores for tenderness were for 75 mM CaCl(2)-treated samples regardless of cooking method. Flavour profile showed that the most marked feature in marinated beef is the predominance of a bitter flavour and after taste, which probably masks other flavour attributes. It is concluded that, in accordance with other authors, marination has no adverse effects on beef odour and improves texture, producing more tender material. However, marination at the CaCl(2) levels tested caused a bitter after taste and flavour.
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Ochenta y tres pacientes con artirtis reumatoidea y que recibían diclofenac sódico para el control de su enfermedad fueron seleccionados para ingresar a un estudio doble-ciego placebo controlado de 4 semanas de duración, recibiendo la mitad de ellos 50 ml de diclofenac sódico tres veces al día, y la otra mitad 50 mg de Diclofenac sódico tres veces al día más placebo. El propósito del estudio fue evaluar el efecto del misoprostol sobre las lesiones erosivas o sangrantes, dándoseles un puntaje de acuerdo a nuestro protocolo de investigación. Los pacientes que recibieron misoprostol mostraron un descenso significativo en las lesiones erosivas (112 a 31, p menor de 0.05) que al compararlas con los que recibieron placebo (123 a 60) también fué estadísticamente significativa (p menor de 0.05). No se observaron diferencias significativas en relación con las lesiones sangrantes al comparar los dos grupos. Cinco pacientes desarrollaron úlceras para el final de estudio (4 antrales y una duodenal), 4 de ellos recibieron placebo. Hubo un discreto efecto atenuante de la acción antiinflamatoria del diclonac sódico en nuestros pacientes. Se concluye que el misoprostol disminuyó significativamente las lesiones erosivas en los pacientes reumatoideos y protegió contra el efecto ulcerogénico del diclofenac sódico
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Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Anti-Inflamatórios/uso terapêutico , Artrite Reumatoide/terapia , Diclofenaco/uso terapêutico , Placebos/uso terapêutico , Prostaglandinas Sintéticas/uso terapêutico , Gastropatias/patologiaRESUMO
The frequency of HLA antigens was determined in 82 unrelated patients who had been hospitalized with the most severe form of dengue hemorrhagic fever: shock, dehydration and severe hemorrhages (DHF/DSS). The HLA-A1, HLA-B plank, HLA Cw1 and HLA-A29 antigens showed a significant difference when their values were compared with the normal control group.