Lizanka Paola Figueiredo Marinheiro

Comparative analysis of risk for falls in patients with and without type 2 diabetes mellitus

OBJECTIVE: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. METHODS: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) - with DM2 diagnosis for 200 mg/dL; and group 2 (G2) - no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go - TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium- and high-risk range. RESULTS: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). CONCLUSION: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.

Prevalência de fraturas vertebrais e fatores de risco em mulheres com mais de 60 anos de idade na cidade de Chapecó, Santa Catarina, Brasil

Fractures are the main problems related to bone fragility in postmenopausal women and account for the increase in the risk of new fractures, mortality, and costs. This studys objective was to verify the occurrence of vertebral fragility fracture and correlate it with demographic, behavioral, and clinical factors in a Brazilian population. The cross-sectional study was based on a random sample of elderly women living in Chapecó, Santa Catarina State, Brazil. The sample consisted of 186 white women over 60 years of age. Of these, 48.9% had asymptomatic vertebral fractures, with higher prevalence in T11-12 and L4-5. Adjusted analysis showed a gradient between age and vertebral fracture, while fracture prevalence was 2.3 times higher in women over 80 years. Fracture prevalence was 1.44 times higher in sedentary as compared to non-sedentary women. Due to the high prevalence of asymptomatic vertebral fractures, the authors suggest the use of spinal x-rays in elderly women for fracture screening and prevention.

Are skeletally mature female rats a suitable model to study osteoporosis

OBJECTIVE To analyze if female Wistar rats at 56 weeks of age are a suitable model to study osteoporosis. MATERIALS AND METHODS Female rats with 6 and 36 weeks of age (n = 8 per group) were kept over a 20-week period and fed a diet for mature rodents complete in terms of Ca, phosphorous, and vitamin D. Excised femurs were measured for bone mass using dual-energy x-ray absorptiometry, morphometry, and biomechanical properties. The following serum markers of bone metabolism were analyzed: parathyroid hormone (PTH), osteocalcin (OC), osteoprotegerin (OPG), receptor activator of nuclear factor Κappa B ligand (RANKL), C-terminal peptides of type I collagen (CTX-I), total calcium, and alkaline phosphatase (ALP) activity. RESULTS Rats at 56 weeks of age showed important bone metabolism differences when compared with the younger group, such as, highest diaphysis energy to failure, lowest levels of OC, CTX-I, and ALP, and elevated PTH, even with adequate dietary Ca. CONCLUSION Rats at 26-week-old rats may be too young to study age-related bone loss, whereas the 56-week-old rats may be good models to represent the early stages of age-related changes in bone metabolism.

Diabetes melito como fator associado às disfunções do trato urinário inferior em mulheres atendidas em serviço de referência

PURPOSE to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients. CONCLUSIONS Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).OBJETIVO: Descrever as disfuncoes do trato urinario inferior e as caracteristicas demograficas e clinicas de mulheres com queixas urinarias, estimando a prevalencia de diabetes melito e de alteracoes urodinâmicas nestas mulheres. METODOS: Estudo observacional, transversal, retrospectivo, com analise de 578 prontuarios. As prevalencias de diabetes melito e de cada diagnostico urodinâmico nas pacientes com disfuncoes do trato urinario inferior foram estimadas, com seus respectivos intervalos de confianca de 95%. Foram calculadas as razoes de prevalencia das alteracoes urodinâmicas segundo o diagnostico de diabetes. RESULTADOS: Setenta e sete pacientes (13,3%) eram diabeticas e a maioria (96,1%) tinha diabetes tipo 2. O diagnostico urodinâmico mais frequente nas pacientes diabeticas foi o de incontinencia urinaria de esforco (39%), seguido de hiperatividade do detrusor (23,4%). A prevalencia de urodinâmica alterada foi associada a de diabetes melito (RP=1,31; IC95%=1,17-1,48). As alteracoes de contratilidade do detrusor (hiper ou hipoatividade) estiveram presentes em 42,8% das pacientes diabeticas e em 31,5% das nao diabeticas. CONCLUSOES: As mulheres diabeticas apresentaram maior prevalencia de alteracoes urodinâmicas do que as nao diabeticas. Nao houve associacao entre o diabetes e as alteracoes de contratilidade do detrusor (p=0,80).

Metabolic syndrome and sexual function in postmenopausal women

Objective The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women. Subjects and methods This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participants sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data. Results The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01). Conclusion We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.

Quantitative ultrasound and risk of fractures in elderly women

OBJECTIVE To verify the prevalence of women with risk of fractures estimated by ultrasonometry of the calcaneus (UOC) in a population of elderly women and its association with clinical risk factors. METHODS Cross-sectional study of which sample was randomly selected and submitted to a structured questionnaire about risk factors for fractures. All women underwent UOC. RESULTS We studied 168 Caucasian postmenopausal women, with a mean age of 69.56 ± 6.27 years; 81% of these women had abnormal test results and 41% of the abnormal results were considered higher risk. Women with abnormal test results had lower weight, height and BMI, and had lower values of SOS, BUA, BQI and T-score. After adjustment, BMI remained significant for abnormal UOC (OR = 3.37, 95% CI: 1.19 9.56, p = 0.02), and history of previous fractures for UOC of the higher risk range (OR = 4.44, 95% CI: 1.16-16.96, p = 0.03). CONCLUSION We observed a high prevalence of risk of fractures determined by the UOC. Our prevalence was higher than those in other Brazilian studies. There was an association between UOC and BMI and previous history of fractures.

Resposta à carta: terapia hormonal da menopausa baseada em evidências

Arq Bras Endocrinol Metab vol 50 no 1 Fevereiro 2006 POSICIONAMENTOS SÃO REALIZADOS com o objetivo de sistematizar conceitos e orientar condutas, sendo particularmente úteis em temas polêmicos como a “Terapia Hormonal da Menopausa” (THM). Estes se fundamentam na revisão das evidências disponíveis, levando em consideração a experiência clínica na área. A medicina baseada em evidências tem sido cada vez mais utilizada na estruturação do conhecimento médico, porém somente a experiência clínica permite avaliar se as conclusões dos estudos grau I são extrapoláveis para a prática na população-alvo. Recentemente, assistimos à generalização das conclusões de estudos prospectivos randomizados, quando, a nosso ver, estas deveriam permanecer restritas aos grupos estudados: mulheres americanas com sobrepeso, hipertensão, diabetes mellitus e hiperlipemia, que iniciaram um mesmo tipo de THM aos 63 anos de idade em média, ou seja, 13 anos após a instalação da menopausa (1,2). Esta não é a prática habitual da THM, que usualmente é instituída ao início da menopausa e individualizada, conforme recomendado em nosso posicionamento. Por esses motivos optamos por não pautar nosso posicionamento em graus de evidência e sim descrever e apontar, na primeira parte do documento, algumas críticas aos principais estudos, fundamentais para a compreensão e discernimento de especialistas e não especialistas na área. As recomendações contidas na seqüência se apoiaram na análise detalhada da experiência clínica, dos estudos controlados e observacionais disponíveis na época (2004) e, certamente, poderão ser alteradas no caso do surgimento de novas evidências. Em resposta às dúvidas levantadas vale ressaltar: 1. Não dispomos de trabalhos bem controlados para avaliar a prevenção primária de eventos cardiovasculares em mulheres que iniciam a THM na peri-menopausa. Portanto, até que estes demonstrem o contrário, é importante considerar os grandes estudos observacionais nos quais se verifica redução no risco para doença cardiovascular entre as usuárias de estrogênio isolado ou associado a progesterona, que iniciam a terapia na peri-menopausa e a utilizam por período superior a 10 anos (3-8). Além disso, foram demonstrados em ensaios clínicos, múltiplos efeitos protetores do estrogênio no sistema vascular, tais como ativação da sintetase endotelial de óxido nítrico, que leva à vasodilatação arterial e modulação da resposta ao trauma e aterosclerose (9); diminuição dos níveis séricos de fibrinogênio e do inibidor de ativação do plasminogênio (PAI-1) (10); efeitos favoráveis em lipídios (11) e no metabolismo glicídico (12). Lobo e col. (13) conduziram dois grandes estudos clínicos controlados avaliando 4.064 mulheres com tempo de menopausa inferior a 5 anos, peso inferior a 35% do peso corporal ideal, sem hipertensão arterial ou diabetes, nas quais não se constatou aumento de doença coronariana ou acidente vascular cerebral no primeiro ano de terapia hormonal da menopausa quando comparado ao grupo com placebo. cartas ao editor Resposta à Carta: Terapia Hormonal da Menopausa Baseada em Evidências