Mônica Barros Costa

Efeitos da maturação sexual na composição corporal, nos dermatóglifos, no somatótipo e nas qualidades físicas básicas de adolescentes

OBJECTIVES Describe the characteristics of body composition, somatotype, basic physical qualities, dermatoglyphics and bone age regarding sexual maturation stages of boys. METHODS A transversal study was carried out in 136 boys, between 10 and 14 years of age. Clinical assessment, physical examination and radiography of wrists and hands to calculate bone age were performed. RESULTS A tendency of increasing total body mass, stature, body mass index, body bone diameters and muscle circumferences and basic physical qualities was found with the advancing of puberty. No differences were found in dermatoglyphics and somatotype between different stages of puberty maturation. CONCLUSIONS Due to the changes in important parameters of physical training that occur during puberty, it can be concluded that the selection of children and adolescents for sport training and competitions should be based not only on chronological age but also, and mainly on sexual maturation, for better physical assessment and appropriate training for this population.

Aldosterone Antagonist Decreases Blood Pressure and Improves Metabolic Parameters in Obese Patients With the Metabolic Syndrome

To the Editor: The association between obesity and hypertension is well established. Epidemiologic studies have reported that up to 75% of the risk for human essential hypertension is attributable to excess weight. Experimental and clinical studies have shown that excess weight raises blood pressure (BP) and that weight loss is the most effective nonpharmacologic strategy for lowering BP in obese hypertensive patients. The mechanisms that link excessive weight gain and increased BP are poorly understood, however. Proposed mechanisms include impairment of renalpressure natriuresis, sympathetic nervous system activation, functional and structural renal abnormalities, and activation of the renin-angiotensinaldosterone system (RAAS). Studies in experimental animals and humans have shown that obesity activates most components of the RAAS. It has been established that the treatment of obese patients with an angiotensinconverting enzyme inhibitor attenuates sodium retention and volume expansion as well as high BP. These findings support the hypothesis that angiotensin II plays a significant role in stimulating renal sodium reabsorption and thus contributes to obesity-induced hypertension. The involvement of aldosterone (ALDO) in sodium retention and hypertension in obesity has only recently been proposed. In a model of chronic dietary-induced obesity in dogs, ALDO blockade decreased glomerular hyperfiltration and sodium retention and attenuated hypertension, indicating that ALDO plays a role in the pathogenesis of obesity-induced hypertension. ALDO has also been implicated in the development of certain deleterious effects on the cardiovascular system. Some studies have demonstrated that ALDO induces endothelial lesions and cardiac and renal fibrosis, and that these effects can be attenuated by ALDO antagonism. Furthermore, ALDO blockade has been shown to be associated with improved BP control in patients with refractory hypertension, a disorder affecting a population that includes a high percentage of obese individuals. To the best of our knowledge, no previous study has been designed to specifically evaluate the BP response to ALDO blockade in obese and hypertensive patients with the metabolic syndrome (MetS). The primary goal of the present study was to determine whether ALDO blockade, achieved through the use of the antagonist spironolactone, attenuates hypertension in obese and hypertensive patients with MetS.

Efeito da perda de peso sobre a hemodinâmica renal em portadores da síndrome metabólica

Danielle Guedes Andrade Ezequiel Fundacao IMEPEN Rua Jose Lourenco Kelmer, 1.300/SL – Sao Pedro Juiz de Fora – MG – Brazil Zip code 36036-330 E-mail: daniezequiel@hotmail.comThis study was undertaken at Nucleo Interdisciplinar de Estudos e Pesquisas em Nefrologia – NIEPEN of UFJF.The authors report no conflicts of interest.

Espironolactona melhora a vasodilatação fluxo mediada em indivíduos com síndrome metabólica

INTRODUCTION The role of aldosterone in the pathophysiology of the metabolic syndrome (MS)-related endothelial dysfunction has been the subject of recent research. OBJECTIVE To evaluate the effects of aldosterone blockade on flow-mediated vasodilation (FMD) and on renal and metabolic parameters of patients with the MS. METHODS 19 MS subjects underwent clinical examination, laboratory work-up (serum lipid profile, glucose and insulin; creatinine clearance; microalbuminuria investigation), ambulatory blood pressure monitoring (ABPM), and FMD analysis before and after 16 weeks of aldosterone blockade with spironolactone. RESULTS After the treatment period, FMD increased from 7.6 ± 5.63% to 15.0 ± 6.10% (p < 0.001), associated with a non-significant decrease of blood pressure (from 142.2 ± 16.37 mmHg to 138.8 ± 16.67 mmHg, and from 84.3 ± 10.91 mmHg to 82.7 ± 9.90 mmHg, respectively). HDL-cholesterol significantly increased, microalbuminuria showed a decreasing trend and creatinine clearance did not change after treatment. CONCLUSION Aldosterone blockade in patients with the MS improved FMD without interfering with metabolic and renal parameters.

Are platelet indices useful in the evaluation of type 2 diabetic patients

Introduction: Long-term complications of diabetes mellitus are a leading cause of death in people with diabetes. Recent studies suggest that platelets with altered morphology could be associated with an increased risk for developing vascular complications in diabetes. Objective: To evaluate the platelet parameters in diabetic patients and correlate these indices with microvascular and macrovascular complications of the disease. Materials and methods: We analyzed platelet parameters and biochemical data of patients seen in outpatient clinics of a university hospital. Individuals aged between 30 and 60 years were included, 100 patients with type 2 diabetes mellitus (T2DM) (DM group) and 100 non-diabetic patients (control group). Results: We observed increase in plateletcrit (PCT): 0.21 ± 0.054% vs 0.20 ± 0.045% (p = 0.020); in mean platelet volume (MPV): 8.69 ± 1.288 fl vs 8.27 ± 1.244 fl (p = 0.018); and in platelet distribution width (PDW): 17.8 ± 1.06 fl vs 17.5 ± 0.87 fl (p = 0.039) in the DM and control groups, respectively. Values of MPV, PCT, and PDW were higher among patients with complications of T2DM (p < 0.001). In those with macrovascular disease, we observed a correlation between glycated hemoglobin (A1C) and MPV (p = 0.015) and PDW (p = 0.009) levels. Among patients with microvascular complications, there was a correlation between platelet count and MPV with A1C levels (p < 0.001). Conclusion: The study findings point to significant differences in platelet parameters in patients with T2DM, suggesting the presence of more reactive and aggregatable platelets in this group of individuals. These results suggest that platelet evaluation may be useful in the early detection of long-term complications in diabetic patients, considering that it is a simple and low-cost tool.

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

Background Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators. Methods In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs). Clinical and laboratory data of diabetic patients attending the PHCUs and from patients referred to a secondary health care (SHC) center were collected. Results There was a shortage of professionals in 53.8% of the PHCUs besides a high proportion of problems regarding referrals to SHC. At the PHCU, glycated hemoglobin results were available only in half of the medical records. A low rate of adequate glycemic control was also observed. An association between structure and process indicators and the outcomes analyzed was not found. Conclusion Major deficiencies were found in the structure and processes of the PHCUs, in addition to unsatisfactory diabetes care outcomes. However, no association between structure, process, and outcomes was found.

Strengths of primary healthcare regarding care provided for chronic kidney disease

Objetivo: avaliar estrutura, processo e resultado do “Programa de Atenção a Doentes Renais Crônicos” em um município brasileiro. Método: estudo epidemiológico, transversal, realizado em 14 unidades de atenção primária e um centro de atenção secundária, no período de 2010-2013. Utilizou-se o referencial metodológico de Donabedian. Para avaliação de estrutura e processo, foram entrevistados 14 médicos, 13 supervisores e 11 agentes comunitários de saúde da atenção primária. Para avaliação de resultado, foram utilizados 1.534 prontuários de saúde na atenção primária e 282 na atenção secundária. Resultados: na maioria das unidades faltam consultórios para atendimento médico e de enfermagem, as equipes estavam incompletas e a maioria dos profissionais não participou de capacitação para atenção à doença renal crônica. Médicos das unidades primárias, classificadas como capacitadas, encaminharam usuários à atenção secundária em estágios mais precoces da doença renal crônica (estágio 3B) quando comparados aos médicos das unidades não capacitadas (58% vs 36%) (p=0,049). As unidades de atenção primária, classificadas como capacitadas, apresentaram melhores taxas de estabilização da filtração glomerular (51%) quando comparadas às unidades parcialmente capacitadas (36%) e não capacitadas (44%) (p=0,046). Conclusão: usuários atendidos nas unidades de atenção primária com pontuação mais elevada em critérios de estrutura e processo apresentaram melhores resultados clínicos.

Avaliação da hipercalcemia assintomática em pacientes ambulatoriais

INTRODUCTION: Indiscriminate serum calcium measurement may lead to the identification of asymptomatic patients with hypercalcaemia, which is caused mostly by primary hyperparathyroidism. OBJECTIVE: To discuss the frequency of hypercalcaemia and the type of assessment of this condition in an outpatient population, with emphasis on the investigation of primary hyperparathyroidism. MATERIAL AND METHODS: In a prospective study 1,049 subjects (age range: 40 to 60 years old) underwent serum calcium and albumin determination and the corrected calcium values were calculated. When there was a rise in the corrected calcium level, ionized calcium, phosphate, parathyroid hormone (PTH) and urinary calcium were measured. RESULTS: The average age was 49.7 ± 13.7 years old, and 188 subjects (17.9%) had elevated corrected calcium levels. Among these, 90 patients underwent the second investigation and 19 (2%) remained hypercalcemic. Ionized calcium levels (average: 1.2 ± 0.01 mmol/L) were normal in all subjects. Urinary calcium was 185.8 ± 111.8 mg/24 hours. PTH levels (average: 46 ± 11.8 pg/mL) were elevated in three subjects whose parathyroid scintigraphies were normal. DISCUSSION: The fall in the frequency of hypercalcaemia based on corrected serum calcium levels and mostly after determination of serum ionized calcium suggests that determinations of serum free calcium are a better screening test. No subject was diagnosed with hyperparathyroidism, what suggests an uneven distribution of the disease in different populations. CONCLUSION: Routine serum calcium determinations in asymptomatic patients must be questioned. When serum calcium determination is thought necessary, ionized calcium levels should be favored.