Cibele Isaac Saad Rodrigues

Parameters of glycemic control in type 2 diabetic patients on hemodialysis or peritoneal dialysis: implications for clinical practice

OBJECTIVE To better explore the relationship between parameters of glycemic control of T2DM in RRT, we studied 23 patients on hemodialysis (HD), 22 on peritoneal dialysis (PD), and compared them with 24 T2DM patients with normal renal function (NRF). MATERIALS AND METHODS We performed, on four consecutive days, 10 assessments of capillary blood glucose [4 fasting, 2 pre- and 4 postprandial (post-G) and average (AG)], random glycemia, and HbA1c in all patients. RESULTS Preprandial blood glucose was greater in patients on RRT compared with NRF. Correlations between AG and HbA1c were 0.76 for HD, 0.66 for PD, and 0.82 for NRF. The regression lines between AG and HbA1c were similar for patients on HD and with NFR, but they were displaced upward for PD. CONCLUSION Similar HbA1c values in PD patients may correspond to greater levels of AG than in HD or NRF patients.

Tutorial Group and Mental Health in Medical Education

– Saúde Mental. RESUMO Esta pesquisa objetivou investigar a presença de conteúdos de saúde mental no currículo real do ensino médico nos quatro primeiros anos da Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo. Trata-se de um estudo quantitativo e documental de caráter descritivo que avaliou esses conteúdos nos objetivos de aprendizagem dos problemas utilizados na estratégia de ensino-aprendizagem denominada tutoria nos quatro primeiros anos do curso. Como resultado, menos de 15% dos problemas estudados apresentou conteúdos de saúde mental em seus objetivos de aprendizagem no primeiro, segundo e quarto anos do curso. No terceiro ano, 36% dos problemas apresentaram tais conteúdos. A pesquisa não permite concluir o nível de exploração desses temas, bem como o aprendizado sobre eles, porém diagnostica o empobrecimento da exploração dos temas de saúde mental que permeiam o ensino médico das doenças clínicas e cirúrgicas.

Chronic Hypertension: so much to learn

Sabe-se que a hipertensao arterial (HA) esta presente em aproximadamente 7,5% das gestacoes, segundo estudo de base populacional brasileiro, e responde por 20 a 25% de todas as causas de obito materno. HA cronica (HAC) e geralmente de etiologia primaria (90-95%), precede a gestacao ou esta presente antes de 20 semanas e e definida por pressao arterial (PA) sistolica ≥ 140/90 mmHg e/ou PA diastolica ≥ 90 mmHg, em pelo menos duas medidas. Revisao sistematica e metanalise de 55 estudos [...]

Educação nutricional para pacientes renais crônicos em programa de hemodiálise

Introduction: Nutritional education is an important matter for hemodialysis patients because it can change patient behavior and, therefore, improve nutritional status, decreasing risks of inadequate diets. Objectives: To evaluate the effects of a specific nutritional education program developed for patients undergoing hemodialysis and the changes that may be induced by the program. Methodology: The effects of the nutritional education program were studied in 27 hemodialysis patients (13 men) with mean age of 50.2±13 years. Before and after the nutritional program, patients answered feed surveys and had their basic nutritional knowledge, laboratory test results, and interdialytic weight gain evaluated. The educational nutrition program itself was evaluated by questioning patients on their impressions and perceptions on the course. Results: A low level of knowledge of nutritional basic aspects was observed before the course, while a significant improvement of understanding was verified after the course (24% and 60% of correct answers before and after the course, respectively; p<0.0001). It was possible to observe a significant reduction of the blood potassium level after the course (5.2±0.9 vs 4.7±0.7mEq/L; p=0.029, before and after the course, respectively), but other laboratory variables were not modified. The feed questionnaire and the interdialytic weight gain were similar in both moments: pre and post course. The evaluation of the course by the patients was extremely positive. Conclusions: The educational nutrition program promoted a gain of knowledge in nutritional aspects for dialysis patients, but it did not foster significant changes in the quality or amount of food intake, interdialytic weight gain, and laboratorial levels. A positive assessment of the program was observed. It is possible that changes in the nutritional aspects and laboratorial levels demand more monitoring time.