Adriana Sanudo

Analysis of criteria for metabolic syndrome in a population‐based study of Japanese‐Brazilians

Objective:  Criteria for metabolic syndrome (MS) differ particularly regarding the definition of central obesity and consequently, there could be differences in the assessment of cardiovascular risk. We estimated the prevalence of metabolic syndrome, compared the agreement of the World Health Organization (WHO) criteria with the standard and a modified National Cholesterol Education Program (NCEP) criterion and investigated whether additional factors were associated with the diagnosis of the syndrome in a Japanese descendant population.

Effects of simvastatin and metformin on inflammation and insulin resistance in individuals with mild metabolic syndrome

BackgroundIn addition to lipid-lowering and insulin-sensitizing actions, statins (HMG-CoA reductase inhibitors) and metformin may have pleiotropic effects.ObjectiveTo study the effect of simvastatin and metformin on insulin sensitivity and inflammatory markers.MethodsForty-one subjects with body mass index (BMI) 25–39.9 kg/m2 and impaired glucose tolerance were randomized to receive simvastatin or metformin for 16 weeks. Blood samples were obtained for measurement of metabolic and inflammatory parameters before and after each treatment.ResultsAs expected, when compared with simvastatin, metformin therapy resulted in significant reductions in mean BMI, fasting plasma glucose, and homeostasis model assessment-insulin resistance (HOMA-IR), whereas simvastatin treatment resulted in significantly reduced total cholesterol, low-density lipoprotein-cholesterol (LDL-C), and apolipoprotein B levels. Independently of the medication used, significant decreases in C-reactive protein (CRP) and interleukin (IL)-6 were detected from baseline to treatment end. CRP showed a mean reduction of 0.12 ± 0.04 mg/dL (p = 0.002) over the 16-week intervention period and IL-6 a mean reduction was 0.35 ± 0.17 pg/mL (p = 0.046). No change was observed in the tumor necrosis factor-α levels. Baseline values of CRP and IL-6 and their percentage declines were correlated (r = 0.71 and r = 0.67, respectively; p < 0.001). In simvastatin recipients, no correlation was detected between reductions in CRP or IL-6 and lipids, whereas in metformin recipients, reductions in inflammatory markers were not correlated to BMI and HOMA-IR. Conclusion: Our findings suggest that both metformin and simvastatin have similar beneficial effects on low-grade inflammation, in addition to their classical effects on glucose and lipid metabolism. Moreover, they confirm the importance of treating at-risk individuals even before the precipitation of overt diabetes mellitus or full-blown metabolic syndrome.

Metabolic Profile and Cardiovascular Risk Patterns of an Indian Tribe Living in the Amazon Region of Brazil

AbstractThe Parkatêjê Indians, belonging to the Jê group and inhabiting the Mãe Maria Reservation in the southeast of the state of Pará in the Amazon Region of Brazil, have suffered rapid and intensive cultural changes in recent years. This survey was designed to characterize the metabolic profile and the frequency of cardiovascular risk factors in this community. Ninety subjects (90.0% of the adult population without admixture) were investigated. Anthropometric measurements were performed and the following clinical characteristics measured: glycemia, serum insulin and proinsulin (fasting and 2-hr post 75 g of glucose load), ß-cell function (%B) and insulin sensitivity (%S) estimated by HOMA, HbA1c, GAD65 antibody, serum lipids, uric acid, creatinine, leptin, and blood pressure. Information about alcohol use, smoking, and medical history was obtained through individual interviews. The prevalences were: overweight, 67.8%; obesity, 14.4%; central obesity, 72.2%; hypertension, 4.4%; dyslipidemia, 44.4%; hyperuricemia, 5.6%; GAD65 antibody positivity, 4.4%; smoking, 25.6%; chronic alcohol use, 0.0%. One case of impaired glucose tolerance (1.1%) and one case of impaired fasting glycemia (1.1%) were diagnosed during this study and one case of diabetes (1.1%) was diagnosed previously. The diabetic woman was excluded from the analyses involving HbA1c, glycemia, insulin, proinsulin, %B, and %S. All creatinine values were normal. Blood pressure did not correlate with age, anthropometric measurements, insulin, proinsulin, and natural logarithm (ln) transformed %S. After adjustment for age and sex, there were positive correlations between total cholesterol and body mass index (BMI; r = 0.24), triglycerides and BMI (r = 0.44), triglycerides and waist-to-hip ratio (WHR; r = 0.52), ln leptin and BMI (r = 0.41), ln leptin and WHR (r = 0.29), uric acid and systolic blood pressure (r = 0.34), uric acid and triglycerides (r = 0.22). Systolic (r = 0.04; r = 0.70) and diastolic (r = 0.14; p = 0.18) blood pressure did not correlate with BMI. Ln leptin had a weak positive correlation with 2-hr insulin (r = 0.14) adjusted for age, sex, and BMI. The multiple linear regression model containing the variables sex, BMI, and 2-hr insulin concentrations explained 77.2% of the variation of ln leptin. In conclusion, the high rates of cardiovascular risk factors found among these Indians point to there being a high-risk group to develop diabetes and cardiovascular diseases. To reduce this risk they need to receive preventive interventions.

Differences in the pattern of drug use between male and female adolescents in treatment

INTRODUCTION/OBJECTIVES: The pattern of drug use among adolescents is not well known. Epidemiologic studies have reported no difference in the prevalence of drug use between genders. The present study wanted to assess the difference in drug use between genders in adolescents. The following variables were assessed: gender ratio of those looking for treatment; age they looked for treatment; age of the first drug use; substances used; with whom they first used drugs; pattern of drug use; possibly-related behavior (illegal acts, problems with the police and school delay). METHODS: Medical records of adolescents treated between 1993 and 2000 in a public medical center of the city Sao Paulo were analyzed. RESULTS: One-hundred and five medical records of adolescents aged 10 to 17 were reviewed. There were no differences between genders according to: age they looked for treatment; age of the first drug use; substances used; and illegal acts. There was a higher prevalence of male adolescents regarding to problems with the police and school delay. CONCLUSIONS: Data suggest that the behavioral consequences of drug use in female adolescents are less evident than in male adolescents, what could explain the lower frequency in which female adolescents had specialized treatment.

The relationship between symptoms and electrophysiological detected compression of the median nerve at the wrist.

Objective – The aim of this study was to evaluate the relationship between carpal tunnel syndrome symptoms and compression of the median nerve at the wrist in symptomatic patients.

Low-dose oral isotretinoin versus topical retinoic acid for photoaging: a randomized, comparative study

Oral isotretinoin (ISO) is the only drug which promotes prolonged remission or cure of severe acne. It also has other properties, supporting its use for non‐acne indications. Retinoic acid (RA) is gold standard treatment for photoaging. ISO for photoaging treatment was reported in non‐controlled trials as alternative to RA, which causes skin irritation.

Efficacy of tramadol versus fentanyl for postoperative analgesia in neonates

Objective To assess, in newborn infants submitted to surgical procedures, the efficacy of two opioids—fentanyl and tramadol—regarding time to extubate, time to achieve 100 ml/kg of enteral feeding and pain in the first 72 h after surgery. Design Controlled, blind, randomised clinical trial. Setting Neonatal intensive care unit. Patients 160 newborn infants up to 28 days of life requiring major or minor surgeries. Interventions Patients were randomised to receive analgesia with fentanyl (1–2 μg/kg/h intravenously) or tramadol (0.1–0.2 mg/kg/h intravenously) in the first 72 h of the postoperative period, stratified by surgical size and by patients gender. Main outcome measures Pain assessed by validated neonatal scales (Crying, Requires oxygen, Increased vital signs, Expression and Sleepless Scale and the Neonatal Facial Coding System), time until extubation and time to reach 100 ml/kg enteral feeding. Statistical analysis included repeated measures analysis of variance adjusted for confounding variables and Kaplan–Meier curve adjusted by a Cox model of proportional risks. Results Neonatal characteristics were (mean±SD) birth weight of 2924±702 g, gestational age of 37.6±2.2 weeks and age at surgery of 199±63 h. The main indication of surgery was gastrointestinal malformation (85 newborns; 53%). Neonates who received fentanyl or tramadol were similar regarding time until extubation, time to reach 100 ml/kg of enteral feeding and pain scores in the first 72 h after surgery. Conclusion Tramadol was as effective as fentanyl for postoperative pain relief in neonates but does not appear to offer advantages over fentanyl regarding the duration of mechanical ventilation and time to reach full enteral feeding. Trial registration NCT00713726

Transcutaneous Bilirubin in Exclusively Breastfed Healthy Term Newborns Up to 12 Days of Life

OBJECTIVE: To determine the curve of transcutaneous bilirubin in breastfed term neonates up to 12 days of life. METHODS: In a prospective cohort study, we performed a 12-day evaluation of 223 healthy, exclusively breastfed, appropriate-for-gestational-age neonates who roomed-in for at least 48 hours. Each newborn had forehead transcutaneous bilirubin and body weight measured at the end of 1, 2, 3, 4, 5, 6, 8, 10, and 12 days. Regression analysis was used with bilirubin as a third-degree polynomial function of time. The 25th, 50th, 75th, 90th, and 95th percentile curves were constructed by using the residual mean square for each day. RESULTS: Patients were 46% white, 34% mixed race, and 20% black, the mean birth weight was 3260 g (range: 2560–4090 g), the mean gestational age was 39.4 weeks (range: 37.0–41.9 weeks), 51% were male, 74% were born by vaginal delivery, and 66% had been breastfed since delivery. The mean highest weight loss was 4.7% (range: 1%–12%) at the second or third day, and in most infants the weight returned to the birth weight at the fifth day. With 2007 total bilirubin measurements, bilirubin concentrations reached the 50th percentile level (5.6 mg/dL) at the third and fourth days and returned to the 24-hour level (4.8 mg/dL) at the sixth day. The 95th percentile bilirubin level was 8.2 mg/dL at 24 hours of life, reached 12.2 mg/dL on the fourth day, and declined to 8.5 mg/dL on the 12th day. CONCLUSIONS: The transcutaneous bilirubin curve represents the natural history of bilirubinemia in exclusively breastfed healthy term newborns in the first 12 days of life.

Efficacy evaluation of the school program Unplugged for drug use prevention among Brazilian adolescents

BackgroundMost Brazilian schools do not have a continuous program for drug use prevention and do not conduct culturally adapted activities for that purpose. This study evaluated the impact of the Unplugged program on drug use prevention among children and adolescents in public middle schools of Brazil.MethodsA non-randomized controlled trial was conducted in 2013 with 2185 students in 16 public schools from 3 Brazilian cities. The intervention group attended 12 weekly classes of the Unplugged program for drug use prevention, and the control group did not attend to any school prevention programs in the same year. Multilevel analyses were used to evaluate temporal and between group changes in the consumption of each drug.ResultsThe study suggested that there was no evidence that Unplugged effected 11- to 12-year-old students. However, the program seemed to stimulate a decrease in recent marijuana use (transition from use to non-use in 85.7% of intervention cases and 28.6% of control cases, OR = 17.5, p = 0.039) among 13- to 15-year-old students. In addition, students in this age range who received the Unplugged program had similar drug consumption levels to those observed before the program began. However, students in the control group presented a significant tendency to increase marijuana use and binge drinking.ConclusionsThis study adds to the evidence of program efficacy among Brazilian middle school students by presenting marginal effects on binge drinking and marijuana use. An 18-month randomized controlled trial is recommended for a future study.

Long‐wave infrared radiation reflected by compression stockings in the treatment of cellulite: a clinical double‐blind, randomized and controlled study

Cellulite refers to changes in skin relief on the thighs and buttocks of women, with a prevalence of 80–90%, causing dissatisfaction and search for treatment. Etiopathogenesis is multifactorial, as follows: herniation of the hypodermis towards the dermis, facilitated by perpendicular fibrous septa, changes in the dermal extracellular matrix, decreased adiponectin, genetic polymorphism, microcirculation alterations and inflammatory process. There are numerous therapeutic approaches, with little evidence of effectiveness. The long‐wave infrared (LWIR) radiation interacts with water, improves microcirculation and stimulates metabolic processes. To date, the use of tissues with potential reflection of LWIR radiation has not been systematically investigated as adjuvant treatment for cellulite.