Margô Gomes de Oliveira Karnikowski

Association between the -174 G/C promoter polymorphism of the interleukin-6 gene and cardiovascular disease risk factors in Brazilian older women

In worldwide studies, interleukin-6 (IL-6) is implicated in age-related disturbances. The aim of the present report was to determine the possible association of IL-6 -174 C/G promoter polymorphism with the cytokine profile as well as with the presence of selected cardiovascular risk features. This was a cross-sectional study on Brazilian women aged 60 years or older. A sample of 193 subjects was investigated for impaired glucose regulation, diabetes, hypertension, and dyslipidemia. Genotyping was done by direct sequencing of PCR products. IL-6 and C-reactive protein were quantified by high-sensitivity assays. General linear regression models or the Student t-test were used to compare continuous variables among genotypes, followed by adjustments for confounding variables. The chi-square test was used to compare categorical variables. The genotypes were consistent with Hardy-Weinberg equilibrium proportions. In a recessive model, mean waist-to-hip ratio, serum glycated hemoglobin and serum glucose were markedly lower in C homozygotes (P = 0.001, 0.028, and 0.047, respectively). In a dominant hypothesis, G homozygotes displayed a trend towards higher levels of circulating IL-6 (P = 0.092). Non-parametric analysis revealed that impaired fasting glucose and hypertension were findings approximately 2-fold more frequent among G homozygous subjects (P = 0.042 and 0.043, respectively). Taken together, our results show that the IL-6 -174 G-allele is implicated in a greater cardiovascular risk. To our knowledge, this is the first investigation of IL-6 promoter variants and age-related disturbances in the Brazilian elderly population.

Análise do perfil de automedicação em mulheres idosas brasileiras

The elderly consume more medications than other age groups, being susceptible to irrational use of therapeutic drugs. This work describes a cross-sectional study that evaluated self-medication practiced by elderly women, who were assisted at the Elderly Care Facility of the hospital of the Catholic University of Brasilia. The socio-economical variables analyzed were age group, educational level and monthly family income. The pharmaceuticals were evaluated according to prevalence, suitability for the age group and possible drug interactions. Among the 218 patients interviewed, 26% declared self-medication practices, part of them (40%) were prescription drugs. Anti-inflammatory, analgesic and antipyretic drugs were the most frequently consumed without professional orientation, followed by phytotherapeutic/natural and cardiovascular agents. Among the self-medicated patients 65% had incomplete or no formal basic education whereas 32% had earnings equal to or inferior to one minimum wage. The mean consumption of drugs by self-medication was not influenced by socio-economical variables. The practice of self-medication involves potentially harmful drug interactions and use of agents inappropriate for the age group.

Non-alcoholic fatty liver disease and metabolic syndrome in Brazilian middle-aged and older adults

CONTEXT AND OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is a complex clinicopathological entity characterized by diffuse or focal fat accumulation in the hepatic parenchyma of patients who deny abusive alcohol consumption. This study aimed to assess idiopathic NAFLD in community-dwelling, middle-aged and older adults living in the Brazilian Federal District. Associations between NAFLD and components of metabolic syndrome and the whole syndrome were investigated. DESIGN AND SETTINGS This was a cross-sectional study on 139 subjects aged 55 years or older. METHODS NAFLD was diagnosed by means of clinical procedures, to exclude subjects with signs of liver disorders, abusive alcohol consumption and influence from hepatotoxic drugs. Phenotypes were graded based on ultrasound examination. Metabolic syndrome was defined using the NCEP ATP III criteria. Laboratory tests were performed to assist clinical examinations and define the syndrome. RESULTS NAFLD was present in 35.2% of the subjects. Taken together, the two most intense phenotypes correlated with increased serum fasting glucose, triglyceride and VLDL cholesterol levels. Metabolic syndrome was diagnosed in 25.9% of the sample. In addition to associating NAFLD with specific traits of metabolic syndrome, non-parametric analysis confirmed the existence of a relationship (p < 0.05) between the steatotic manifestation and the syndromic condition. CONCLUSION Compared with the literature, this study reveals greater frequency of idiopathic NAFLD among Brazilian middle-aged and older adults than is described elsewhere. The findings also suggest that impaired glycemic metabolism coupled with increased fat delivery and/or sustained endogenous biosynthesis is the most likely physiopathogenic mechanisms underlying the onset of NAFLD in this population.

Retail prices of essential drugs in Brazil: an international comparison

OBJECTIVES Price is a key obstacle for consumer access to essential drugs, especially in developing countries. This study sought to compare the retail prices of essential drugs on the private market in Brazil with that of two international pricing standards. METHODS The retail price of all drugs on Brazils Essential Drugs List, July 2000 edition, were compared to the retail price of the same drugs on the Swedish market and on a referential bulk-price indicator from low-cost suppliers on the international market. Ratios of Brazils prices to Swedens prices and Brazils prices to the international bulk mean price-per-unit for each drug were calculated. Using linear regression analysis, the ratios were also studied in relation to the number of manufacturers. RESULTS For the 132 drugs that were listed on both Brazils and Swedens lists, unitary retail prices in Brazil were 1.9 times higher. Of the 94 drugs found on both Brazils list and the international unit-price indicator, Brazils national mean unit prices were 13.1 more expensive. No relationship was found between the number of manufacturers for each product and the ratios of prices. CONCLUSIONS Average retail prices of essential drugs in Brazil are significantly higher than in Sweden. Furthermore, international bulk prices indicate that drugs are brought to market by Brazils private pharmacies at prices that may be excessively high in relation to production costs, creating high profit margins. The expected price-lowering effects of competition were not identified.

A common polymorphism in the renin angiotensin system is associated with differential outcome of antihypertensive pharmacotherapy prescribed to Brazilian older women

BACKGROUND Since variations on the renin angiotensin (RA) system tend to exert effects on blood pressure, we investigated the association of the common ACE and AT1R polymorphisms with response to a multivariate pharmacotherapy. METHODS This prospective study involved 169 hypertensive, community-dwelling older women. Genotypes were obtained by length analysis or direct sequencing of PCR products. Blood pressure-lowering pharmacotherapy was conducted according to current Brazilian Guidelines on Hypertension. RESULTS Genotype frequencies were in agreement to the Hardy-Weinberg equilibrium. Interventions were found to represent actual hypertension-management practices in Brazil, and accounted for a significant reduction in both systolic (P<0.001) and diastolic (P<0.001) blood pressure. Concerning the effect of polymorphisms, no influence of the ACE and AT1R genotypes were found on the magnitude of the treatment-induced blood pressure reduction (P>0.05). Nonetheless, the clinical result varied according to the ACE alleles since mean systolic pressure was roughly 10 mm Hg higher in insertion (I) homozygotes than in the deletion (D) counterparts either in baseline (P=0.001) and endpoint (P=0.010). CONCLUSION The outcome of the antihypertensive pharmacotherapy advocated by national guidelines was significantly influenced by the ACE I/D polymorphism but not by the AT1R 1166 A/C polymorphism among postmenopausal women.

Pattern of drugs prescribed for community-residing middle-aged and older adults from the outskirts of Brasília

O escopo deste estudo consistiu em avaliar a medicacao prescrita para um grupo composto por individuos de meia-idade e idosos que reside na periferia de Brasilia e pratica exercicios fisicos regulares em uma Universidade local. Este estudo considerou aspectos qualitativos e quantitativos das medicacoes prescritas para individuos com idades entre 54 e 81 anos, incluindo sua adequacao e sua concordância com a Relacao Nacional de Medicamentos Essenciais (RENAME). As unidades de analise consistiram em cada medicamento e em cada individuo. Entre os cento e vinte e um individuos investigados, 19,7% declararam nao fazer uso de medicamento, enquanto os demais 80,3% revelaram fazer uso de media de 3,2 medicamentos. Entre os medicamentos sendo consumidos, 98,1% eram prescritos por medicos, sendo anti-hipertensivos, antiinflamatorios e analgesicos as classes terapeuticas mais frequentes. O consumo de medicamentos que devem ser evitados por idosos nao mostrou variar significativamente com a progressao das faixas etarias, tendo, no entanto, exibido aumento marcante (P < 0.05) conforme a quantidade de medicamentos prescritos. O grupo investigado exibiu perfil homogeneo de uso de medicamentos, uma vez que tanto o consumo geral quanto o consumo de determinados grupos de medicamentos nao mostraram variacao significativa em funcao do genero, faixa etaria, grau de escolaridade ou renda. Nossos resultados tambem sinalizam para a falta de concordância entre os medicamentos prescritos e aqueles pertencentes a RENAME.

A influência da composição corporal na força de homens idosos brasileiros

INTRODUCCION: La poblacion de ancianos representa el 10% de la poblacion total de brasilenos. La disminucion de la musculatura esqueletica es probablemente el cambio mas significativo, asociado al envejecimiento y a algunas enfermedades, y es determinante en la perdida de la fuerza muscular. OBJETIVO: Evaluar la relacion de la composicion corporal sobre la fuerza de agarre de los hombres ancianos brasilenos. METODO: 46 hombres de edad igual o superior a 60 anos, fueron divididos en 4 grupos segun el porcentaje de grasa y el valor de masa magra. Las medianas se establecieron a G = 28,65% y la masa magra = 54,35 kg. Para las evaluaciones se utilizo el testeo de bioimpedancia electrica y dinamometro de fuerza de agarre. RESULTADOS: Se observan diferencias significativas entre los 4 grupos cuanto a la masa magra y percentil de masa gorda (p≥0,05) caracterizando las especificidades de cada grupo en cuanto a las variables analizadas. CONCLUSION: Los resultados demuestran que los niveles de fuerza de agarre no dependen unicamente de la masa corporal magra, sino que tambien %G, en que la correlacion entre la masa magra y el porcentual de grasa pueden indicar una mejor o peor condicion para realizar el esfuerzo isometrico de fuerza de agarre.

Polymyositis: clinical investigation in two sisters

We present an investigation of a case of polymyositis affecting two sisters of one same parenthood. Their cases have been documented for almost two decades, being investigated by means of a diagnostic protocol which combined clinical findings as well as laboratorial, histopathological and image tests. In both cases, clinical manifestations started in childhood, without signs of involvement of the central and peripheral nervous system. Both patients proved to respond to a therapeutics based on corticosteroids. The degree of relatedness between their parents corroborate the notion that genetic factors may contribute to the development of the disease.

The influence of body composition in the strength of elderly Brazilian men

INTRODUCCION: La poblacion de ancianos representa el 10% de la poblacion total de brasilenos. La disminucion de la musculatura esqueletica es probablemente el cambio mas significativo, asociado al envejecimiento y a algunas enfermedades, y es determinante en la perdida de la fuerza muscular. OBJETIVO: Evaluar la relacion de la composicion corporal sobre la fuerza de agarre de los hombres ancianos brasilenos. METODO: 46 hombres de edad igual o superior a 60 anos, fueron divididos en 4 grupos segun el porcentaje de grasa y el valor de masa magra. Las medianas se establecieron a G = 28,65% y la masa magra = 54,35 kg. Para las evaluaciones se utilizo el testeo de bioimpedancia electrica y dinamometro de fuerza de agarre. RESULTADOS: Se observan diferencias significativas entre los 4 grupos cuanto a la masa magra y percentil de masa gorda (p≥0,05) caracterizando las especificidades de cada grupo en cuanto a las variables analizadas. CONCLUSION: Los resultados demuestran que los niveles de fuerza de agarre no dependen unicamente de la masa corporal magra, sino que tambien %G, en que la correlacion entre la masa magra y el porcentual de grasa pueden indicar una mejor o peor condicion para realizar el esfuerzo isometrico de fuerza de agarre.

La influencia de la composición corporal en la fuerza de hombres ancianos Brasileños

INTRODUCCION: La poblacion de ancianos representa el 10% de la poblacion total de brasilenos. La disminucion de la musculatura esqueletica es probablemente el cambio mas significativo, asociado al envejecimiento y a algunas enfermedades, y es determinante en la perdida de la fuerza muscular. OBJETIVO: Evaluar la relacion de la composicion corporal sobre la fuerza de agarre de los hombres ancianos brasilenos. METODO: 46 hombres de edad igual o superior a 60 anos, fueron divididos en 4 grupos segun el porcentaje de grasa y el valor de masa magra. Las medianas se establecieron a G = 28,65% y la masa magra = 54,35 kg. Para las evaluaciones se utilizo el testeo de bioimpedancia electrica y dinamometro de fuerza de agarre. RESULTADOS: Se observan diferencias significativas entre los 4 grupos cuanto a la masa magra y percentil de masa gorda (p≥0,05) caracterizando las especificidades de cada grupo en cuanto a las variables analizadas. CONCLUSION: Los resultados demuestran que los niveles de fuerza de agarre no dependen unicamente de la masa corporal magra, sino que tambien %G, en que la correlacion entre la masa magra y el porcentual de grasa pueden indicar una mejor o peor condicion para realizar el esfuerzo isometrico de fuerza de agarre.