>Magister Scientiae - MSc / About 180 million people have been estimated to suffer from type 2 diabetes (T2DM) in 2006 and the annual death rate due to this disease was 3 million by that time. More than 400 medicinal plants used for the treatment of diabetes mellitus have been recorded, but only a small number of these plants have received scientific and medical evaluation to assess their efficacy. The most common plant used to treat diabetes mellitus is Hypoxis hemerocallidea (HH). The present study was undertaken to investigate the effects of Hypoxis hemerocallidea (HH) on T2DM in rats. Male Wistar rats weighing 200-250 g were used in this experiment. Hypoxis hemerocallidea (HH) corm was used as plant material in the experiment. The study was based on three parts, an acute diabetes study, chronic diabetes study and insulin secretion study. In the acute study, the rats were randomly divided into 2 groups (control and diabetes). The saline solution was added to different concentrations of HH corm to produce concentration of (50, 200, 400, 800 mg/ml). Diabetes was induced by intraperitoneal injections of STZ (65mg/kg). Two weeks after the injection (STZ 65 mg/kg), different concentrations of HHS was administered intraperitoneally after an overnight fast. The blood glucose levels were monitored in the diabetic and control rats at, 30, 60, 120, 180 and 240 minutes post injection. In the chronic study, the rats were randomly divided into 6 different groups (control, HFD, DM, DM-HH, DM-PTHH, and HH). Diabetes mellitus was then induced in the groups of diabetic rats by intraperitoneal injections of STZ (40 mg/kg) and rats were fed a high fat diet (HFD). The body weight of the rats were measured weekly for 7 weeks. An intraperitoneal glucose tolerance test (IPGTT) was performed at the end of week 6. At the end of week 7, rats were killed and serum sample were collected for determination of fatty acid and insulin. Liver and pancreatic tissue was collected for histological evaluation. In the insulin secretion study, Hypoxis hemerocallidea was tested for its effects on insulin secretion by pancreatic islet cells exposed to low (3mM) and high (20mM) glucose medium. Results of the acute study indicated that HHS at a dose 800 mg/ml decreased blood glucose levels fastest in both normal and diabetic rats reaching significance after 30 minutes and 60 minutes respectively and remained below the baseline value until 240 minutes. In the chronic study, it was illustrated that HH had no effect in normal rats on any of the parameters evaluated. Animals in the DM group gained weight the first two weeks, but thereafter began to lose weight. At the end of seven weeks the animals gained significantly less weight than the rest. Animals fed a HFD have more visceral fat compared to the control group. The visceral fat gain occurred in the absence of a significant increase in body weight. We found a markedly lower fasting glucose level in HH treated diabetic animals compared to untreated DM animals. At time zero the blood glucose level of the HFD group (5.8±0.5mmol/l) and the HH group (4.9±0.7mmol/l) were in the normal range, and were not significantly different (P > 0.05) from the control group (5.0±0.2mmol/l). After glucose load peak blood glucose levels was measured after 30 minutes in the control group (9.0±0.6mmol/l), the HFD group (9.8±0.4 mmol/l), the DM-HH group (21±5.7 mmol/l) and the DM-HHPT group (27.8±5.3 mmol/l). In the HH group the blood glucose level reached a peak at 60 minutes (7.6±0.6 mmol/l). In the DM group two peaks were recorded one after 10 minutes (27.2±7.1mmol/l) and another after 60 minutes (31±5.2 mmol/l). In the groups control, HFD, DMHH, DM-HHPT and HH groups the blood glucose level after 120 minutes were not significantly different from the time zero value. The blood glucose level after 120 minutes in the DM group (28.2±7.1 mmol/L) was significantly higher (P ≤ 0.01) than from the time zero value. Serum fatty acid levels were increased in all groups fed a high fat diet. The serum insulin levels in the HFD group (6.2 ± 0.76 μUI/ml protein; P ≤ 0.05 ), the DM group (2.0 ± 0.9 μUI/ml protein; P ≤ 0.001), the DMHH group (3.4 ± 0.7 μUI/ml protein; P ≤ 0.001) and the DM-HHPT group (3.0 ± 1.1 μUI/ml protein; P ≤ 0.001) were significantly lower than the control group. The β-cell function in the HFD group (62 ± 8 %; P ≤ 0.001), the DM group (3 ± 1 %; P ≤ 0.001), the DM-HH (11 ± 9 %; P ≤ 0.001) group and the DM-HHPT group (4 ± 2 %; P ≤ 0.001) were significantly lower than the control group. The histological observation of the liver and the pancreas in rats after 7 weeks on different dietary regimes showed some morphological changes within the liver and pancreas parenchyma of some rats. In the insulin secretion study, glucose stimulated insulin secretion in low (3mM) and high (2mM) glucose concentration. Furthermore, insulin secretion was significantly higher when the glucose concentration was increased from 3mM to 20 mM (1.10 ± 0.13 μUI/ml protein and 1.5 ± 0.17 mIU/mg protein respectively P≤ 0.01). In the presence of low HH (100 µg/ml), there was a marked increase in insulin secretion when exposure to high glucose compared to low glucose concentration, while in the presence of high HH (500 µg/ml), there was no significant different in insulin secretion in the presence of low or high glucose. In conclusion, the results of this experimental study indicate that a concentration 800 mg/kg of HHS produces maximal hypoglycaemic effect in fasted normal and diabetic rats. HH has an antidiabetic activity as it lowers serum glucose levels in T2DM rats and significantly increases glucose tolerance. It also increases body weight of diabetic rats. HH treatment was found to improve insulin secretion in pancreatic islet cells.

Bakgrund: Diabetes Mellitus typ 1 debuterar under barn- och ungdomsåren. Behandlingen är egenvård som innebär blodglukoskontroller, läkemedelsbehandling och att följa rekommendationer om kost och motion. Sjuksköterskans yrkesområde innefattar barn- och ungdomar. Avvikande från egenvårdsaktiviteter och hemlighetsmakeri kring sjukdomen påverkar vårdkvaliteten för ungdomar. Syfte: Att beskriva ungdomars upplevelse av att leva med Diabetes Mellitus typ 1 samt att beskriva de granskade studiernas undersökningsgrupper. Metod: Deskriptiv litteraturstudie med tolv vetenskapliga artiklar med kvalitativ samt kvalitativ- och kvantitativ ansats. Samstämmigheter och olikheter i artiklarnas resultat har kategoriserats och teman och subteman har identifierats. Huvudresultat: En del ungdomar upplevde svårigheter att acceptera sin sjukdom och önskade ha kontroll över och ta eget ansvar för sin sjukdom och öka oberoendet. Ungdomar upplevde känslan av att vara annorlunda och undvek att utföra egenvård i sociala sammanhang. Svårigheter att följa kostrekommendationer varierade och att utföra blodglukoskontroller upplevdes ansträngande. Stöd från vänner och jämnåriga underlättade utförandet av egenvård. Det upplevdes positivt att sjuksköterskor visade intresse för ungdomarnas liv utöver deras DMT1. Sjuksköterskor upplevdes brista i att kunna sätta sig in i ungdomarnas situation och vara ett känslomässigt stöd. Slutsats: Det finns ett behov av ökat stöd och förståelse från sjuksköterskor. Genom ökad förståelse kan sjuksköterskan bidra med stöd för att underlätta överföringen av ansvar. Detta kan leda till en ökad trygghet och känsla av kontroll hos ungdomarna, vilket kan bidra till att de vågar dela med sig av sin sjukdom till omgivningen. / Background: Diabetes Mellitus Type 1 debuts in childhood and adolescence. The treatment is self-care that involves blood glucose control, drug treatment and following recommendations on diet and exercise. Nursing's professional area includes children and adolescents. Deviating from self-care activities and secrecy around the disease affects the quality of care for young people. Purpose: To describe the young people's experience of living with Diabetes Mellitus type 1 as well as describing the study groups of the studies examined. Method: Descriptive literature study with twelve scientific articles with qualitative as well as qualitative and quantitative approach. Consequences and differences in the results of the articles have been categorized and themes and subthemes have been identified. Results: Young people experienced difficulties in accepting their illness and wanted to have control over and take responsibility for their illness and increase independence. Young people experienced the feeling of being different and avoiding self-care in social contexts. Difficulties to follow dietary recommendations varied and blood glucose controls were exerted. Support from friends and peers facilitated the performance of self-care. It was positive that nurses showed interest in the lives of adolescents in addition to their DMT1. Nurses were found to fail to get into the situation of young people and to be an emotional support. Conclusion: There is a need for increased support and understanding from nurses. Through increased understanding, the nurse can help to facilitate the transfer of responsibility. This can lead to increased safety and sense of control among adolescents, which may help them dare to share their illness with the environment.

The extent to which endogenous free radical-scavenging defense mechanisms are involved in experimental and human diabetes was investigated in various tissues of animals with chemically-induced or spontaneous diabetes (BB Wistar rats) and in erythrocytes of patients with either Type I or Type II diabetes. Diabetes was induced in female Wistar rats using alloxan (ALX) or streptozotocin (STZ), each administered in a dose of 50 mg/kg body wt., intravenously. The present study also included a group -of animals in which body wt. loss was induced by food-deprivation for 72 h. The effects of pharmacological interventions (insulin or allopurinol (ALP)), on these processes were also investigated in chemically-induced diabetes., The activities of catalase (CAT), CuZn-superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-PX) and glutathione reductase (GSSG-RD) as well as levels of reduced glutathione (GSH) were examined in heart, pancreas, liver and kidney as well as in erythrocytes. Erythrocytes were also examined for their susceptibility to in vitro oxidative stress induced by hydrogen peroxide (H₂0₂). Criteria studied in this regard were GSH-depletion and malondi-aldehyde (MDA) production (an index of lipid peroxidation). The results obtained showed that tissue antioxidant systems are altered in experimental diabetes and that the magnitude of the alterations increased with the degree of body weight loss. Furthermore, the duration of hypoinsulinemia might contribute to the nature of alterations in antioxidant mechanisms. The complex patterns of the alterations observed varied from one tissue to another and may be the result of compensatory increases, usually involving enzymes whose activity in the particular tissue may be limiting, and direct inhibitory effects of endogenous oxidants on the enzymatic components of tissue antioxidant systems. The ability of insulin (9-12 U/kg body wt., subcutaneously) to reverse the many similar alterations of tissue antioxidant enzymes in diabetes induced by either STZ or ALX suggests that these changes are more likely attributable to hypoinsulinemia rather than to direct effects of either diabetogenic drug. The above-mentioned effects indicate that insulin can markedly influence tissue antioxidant status. However, the reason for the persistence of decreased CuZn-SOD activity in both liver and kidney of ALX-diabetic rats after 12 wk of treatment with insulin is not clear at present, and requires further investigation to determine whether this reflects the presence of a residual deficit in tissue antioxidant processes in liver and kidney despite insulin treatment, or whether it is the result of a direct effect exerted by ALX. Acute ALP administration (50 mg/kg body wt., intraperitoneally) was associated with reductions in ketonuria and early mortality among ALX-diabetic rats, and long-term ALP treatment (1.9 mg/day in drinking water) resulted in a normalization of renal CuZn-SOD activity in these animals. Comparable (although not identical) changes in tissue antioxidant status are present in insulin-dependent spontaneously diabetic BB (ISDBB) rats and in animals made diabetic by STZ or ALX administration. Our data also demonstate that the alterations in tissue GSH levels characterizing ALX-diabetes more closely paralleled changes seen in the ISDBB rat than did those in the diabetic state induced by STZ. If the alterations in antioxidant status in uncontrolled chemically-induced diabetes are attributable to a lack of insulin, the observed changes in ISDBB rats are suggestive of sub-optimal insulin therapy in these animals. The results obtained from BB rats demonstrate two types of alterations in antioxidant status: strain-related differences (increased CAT activity in pancreas and decreased GSH levels in pancreas and liver of both ISDBB and their non-diabetic littermates (NDLM)) and diabetes-related changes (mani- fested by an increase in cardiac GSH content and increases in activities of cardiac CAT and GSSG-RD, pancreatic CuZn-SOD and GSSG-RD, and renal GSH-PX). Whether or not these "strain-related" alterations in antioxidant status increase the susceptibility of these animals to developing diabetes remains unknown. Certain alterations were observed in red cells from diabetic patients and from animals with experimental diabetes suggesting that these alterations are more likely to be diabetes-related than species-dependent. Red cells in chemically-induced and clinical diabetes showed an increased resistance to peroxide-induced depletion of GSH, an effect attributed to hyperglycemia, which results in an increased supply of NADPH through the hexose monophosphate shunt for regeneration of GSH from GSSG via the GSSG-RD system. However, the susceptibility of red cells from diabetic patients and animals to lipid peroxidative damage was increased as reflected in augmented MDA production. In addition, insulin treatment did not normalize MDA production in red cells subjected to oxidative challenge and vigorous insulin treatment in both ALX- and STZ-diabetic rats resulted in a markedly decreased MDA production in response to H₂0₂. Moreover, GSSG-RD activity of red cells was increased in both uncontrolled and insulin-treated diabetic animals as well as in diabetic patients. However, some differences in erythrocyte antioxidant enzymes were also observed in erythrocytes from diabetic subjects and animals. For example, diabetic patients showed an increased activity of CuZn-SOD, while erythrocytes from diabetic animals showed no alterations in the activity of this enzyme. Erythrocyte membrane NADH-dehydrogenase activity was increased only in diabetic patients with Type I diabetes, but not in Type II diabetes or in diabetic animals. Erythrocytes from ALX- and STZ-diabetic animals showed an increase in the activity of GSH-PX and those from NDLM BB rats showed a decrease in CAT activity, alterations that were not observed in human diabetes. Finally, as far as antioxidant defense mechanisms are concerned, our results suggest that diabetes is associated with some common alterations in these mechanisms regardless of the model (chemically-induced versus the spontaneous type of diabetes) or the species used (animal versus human diabetes). Some of these alterations seem to be influenced by the degree of diabetic control, while others are apparently independent of it. Future studies will focus on the extent to which alterations in red cells of human diabetics can be used to predict the development of long-term sequelae of the disease. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

Background: In Sweden type 1-diabetes is the most common chronic disease among children. When a child suffers from type 1-diabetes the parents gets affected as well. The children’s need of support from the parents depends on the child’s age, maturity and individual needs. Aim: The purpose of this study was to describe the parents’ experience of living with a child that suffers from type 1-diabetes, as well as describe the articles research groups. Method: A descriptive literature study that’s based on 11 articles, nine of qualitative approach and two of qualitative- and quantitative approach. Result: Parents to children with type 1-diabetes experienced fear, grief, anxiety and frustration. Type 1-diabetes among children influences parents’ life in many ways. The disease required planning, attention and adjustment. Parents experienced that type 1-diabetes affected school, work, sleep, diet and physical activity. Conclusion: Parents of children with type 1 diabetes experiences that the disease required a great commitment and responsibility. The majority of the care and treatment is handled by the parents, due to the children's lack of self-care. The nurse therefore has an important role to provide information, support and encourage both to patients and their families regarding care and treatment. / Bakgrund: I Sverige är typ 1-diabetes den kroniska sjukdomen som är vanligast förekommande hos barn. När ett barn drabbas av typ 1-diabetes berörs även föräldrarna. Barns behov av stöd från föräldrar varierar efter barnets ålder, mognad och individuella behov. Syfte: Syftet med studien var att beskriva hur föräldrar upplever att det är att leva med ett barn med typ 1-diabetes samt att beskriva artiklarnas undersökningsgrupper. Metod: En beskrivande litteraturstudie som baserats på 11 artiklar, nio av kvalitativ ansats och två av kvalitativ- och kvantitativ ansats. Resultat: Föräldrar till barn med typ 1-diabetes upplevde rädsla, sorg, oro och frustration. Typ 1-diabetes hos ett barn påverkade föräldrarnas liv på många olika sätt. Sjukdomen krävde planering, uppmärksamhet och anpassning. Föräldrarna upplevde att typ 1-diabetes påverkade skola, jobb, sömn, kost och fysisk aktivitet. Slutsats: Föräldrar till barn med typ 1-diabetes upplevde att sjukdomen krävde ett stort engagemang och ansvar. Vård och behandling hanterades till större del av föräldrarna vilket berodde på barnens bristande egenvård. Sjuksköterskan har därmed en viktig roll att ge information, stötta och uppmuntra både patient samt dess anhöriga vad gäller vård och behandling.

Orientador: Nelson Filice de Barros / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T03:01:02Z (GMT). No. of bitstreams: 1 Castro_CeciliaMuzettide_M.pdf: 7007277 bytes, checksum: 4f258102c081367c0496070833d99f1f (MD5) Previous issue date: 2013 / Resumo: As doenças crônicas apresentam longa duração, lenta progressão e estão entre as principais causas de mortalidade atualmente. As bases terapêuticas medicamentosas para o tratamento destas doenças não tem sido exitosa e, por isso, a Organização Mundial de Saúde propôs a introdução de inovações no cuidado, que extrapolam o modelo biomédico. No Brasil, o Yoga e outras práticas corporais foram introduzidas no Sistema Único de Saúde por meio da Portaria 719, de 7 de abril de 2011, com a criação do Programa da Academia de Saúde, pelo Ministério da Saúde. A expansão do uso do Yoga como prática terapêutica motivou o crescimento do número de pesquisas sobre o tema. O objetivo do presente trabalho foi analisar sistematicamente a literatura científica sobre a aplicação do yoga no cuidados de pessoas portadoras de câncer e diabetes. As buscas foram conduzidas nas bases de dados "PubMed", "Embase", "Web of Science" e "Ebsco Host" para o período de vinte anos (1991 a 2011), utilizando as descritores "yoga and cancer" e "yoga and diabetes". Foram analisados 36 e 22 artigos respectivamente referentes ao câncer e diabetes segundo o país de desenvolvimento das pesquisas, os periódicos de publicação, as tradições e técnicas de yoga empregadas, objetos dos estudos e os resultados e conclusões obtidas pelos mesmos. Os artigos analisados indicaram que o yoga é um recurso terapêutico viável e favorável ao cuidado de pessoas com câncer e diabetes. É possível verificar avanço das investigações na área, embora haja carência de trabalhos que aprofundem de forma conceitual e filosófica a relação do Yoga com o cuidado de pacientes oncológicos e diabéticos. Desse modo, torna se evidente que, em futuros estudos, é importante considerar metodologias mais adequadas que explorem tal relação / Abstract: Chronic diseases have long-lasting, slow progression and are among the main causes of mortality. Therapies based exclusively on drugs for the treatment of these diseases have not been successful and, therefore, the World Health Organization proposed the introduction of innovations in care that go beyond the biomedical model. In Brazil, yoga and other body practices were introduced in the public health system through the 719 Ordinance of April 7, 2011, with the creation of the "academy of health program", by the ministry of health. The expansion of the use of yoga as therapeutic practice led to the growth of researches on the topic. The aim of this study was to systematically review the scientific literature on the application of yoga in the care of people with cancer and diabetes. The searches were conducted in the databases "PubMed", "Embase", "Web of Science" and "Ebsco Host" for the period of twenty years (1991 to 2011), using the keywords "yoga and cancer" and "yoga and diabetes ". Were analyzed 36 and 22 articles respectively regarding cancer and diabetes by country of research development, periodicals publishing, traditions and yoga techniques employed, objects of studies, results and conclusions obtained by them. Papers analyzed indicated that yoga is a therapeutic resource feasible and favorable to the care of people with cancer and diabetes. It is possible check advance of research in the area, although there are few studies that deepen the conceptual and philosophical form on the relationship of yoga in the cancer and diabetics patients care. Thus, it becomes apparent that, in future studies, it is important to consider the most appropriate methodologies that exploit this relationship / Mestrado / Ciências Sociais em Saúde / Mestra em Saúde Coletiva

Orientador: Rejane Maira Góes / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-26T11:01:26Z (GMT). No. of bitstreams: 1 Costa_CarolinaFrandsenPereirada_M.pdf: 27859071 bytes, checksum: f28a294dc38f78fd1d16827f7aee8c54 (MD5) Previous issue date: 2014 / Resumo: Existem inúmeras evidências de que o diabetes afeta a função reprodutiva masculina, provocando danos aos parâmetros espermáticos, e portanto, influenciando a fertilidade dos indivíduos afetados. A melatonina é um hormônio secretado pela glândula pineal que apresenta uma extensa gama de atuações, dentre elas um papel fundamental no controle da esteroidogênese e na proteção contra radicais livres. O objetivo deste estudo foi avaliar se a melatonina oferecida oralmente, em baixas doses, concomitante à maturação sexual, afeta os parâmetros reprodutivos de ratos saudáveis na idade adulta, e se interfere nos danos reprodutivos induzidos pelo diabetes experimental. Ratos Wistar machos com 4 semanas de idade foram divididos em oito grupos (n=15/grupo): os quatro primeiros foram eutanaziados com 14 semanas de idade, sendo respectivamente - controle (CS), tratados com melatonina (MS), diabéticos (DS) e tratados com melatonina submetidos ao diabetes (MDS); por sua vez, os quatro últimos foram eutanasiados na 21ª semana de vida- controle (CL), tratados com melatonina (ML), diabéticos não tratados (DL) e diabéticos tratados com melatonina (MDL). A melatonina foi disponibilizada na água de beber (10 µg/Kg p.c. em 0,001% etanol/dia) diariamente à partir da 5ª semana de idade, enquanto o diabetes foi induzido na 13a semana de vida com uma dose única de estreptozotocina (4,5mg/100g p.c., i.p.) nos grupos DS, DL, MDS e MDL. No primeiro conjunto de subgrupos (Grupos S), o período diabético correspondeu a uma semana, enquanto no segundo conjunto (Grupos L), este período se referiu a dois meses. Ratos diabéticos apresentaram hiperglicemia, redução marcante no peso corpóreo, queda acentuada nos níveis circulantes de testosterona, e em condições tardias da doença, atrofia do epidídimo. Análises histológicas e estereológicas indicaram alterações no compartimento intersticial do testículo, descolamento prematuro de células germinativas e vacuolização de células de Sertoli, porém lesões mais severas, como a depleção do epitélio germinativo, foram observadas em apenas um animal após dois meses de doença. Além disso, não houve prejuízos à produção diária de espermatozoides. Por outro lado, as contagens espermáticas foram reduzidas na cauda do epidídimo, e o tempo de trânsito foi acelerado em todos os seus segmentos à longo termo. A motilidade espermática foi prejudicada, e o número de células aberrantes no lúmen dos duetos do epidídimo foi acentuadamente maior do que em animais saudáveis. Houve um espessamento do tecido estromal em alguns segmentos, com aumento da frequência de fibras colágenas e musculatura lisa. O diabetes levou a um aumento sistêmico nos níveis de glutationa peroxidase (GPx) e níveis de malonaldeído (MDA), os quais não foram restaurados pela ingestão de melatonina. A atividade da glutationa transferase (GST), por sua vez, foi reduzida no sangue de animais diabéticos, independente do tratamento com melatonina. No testículo, houveram alterações marginais no sistema antioxidante relacionadas à condição diabética, o que não ocorreu no epidídimo. O tratamento de animais saudáveis com melatonina desde a idade pré-púbere não provocou disfunções reprodutivas na idade adulta, apesar de levar à uma redução na testosterona sérica, e não alterou os biomarcadores relacionados à resposta antioxidante. Porém, o tratamento com melatonina anterior e concomitante à condição diabética evitou alguns danos associados a esta desordem, particularmente ao que se refere ao epidídimo, pois à curto prazo impediu a redução da reserva espermática, e atenuou os danos à motilidade espermática em ambos os períodos, apesar de não impedir a atrofia observada no segmento distal. Em relação à histologia do órgão, a melatonina pareceu evitar o desenvolvimento de fibrose no estroma do epidídimo, embora esta resposta tenha sido confinada à sub-regiões particulares. A ingestão de melatonina também evitou lesões severas ao epitélio germinativo, e preveniu alterações morfológicas nas células de Leydig. A esteroidogênese não foi tão prejudicada quanto nos diabéticos não-tratados, e este padrão foi acompanhado por um aumento expressivo de células AR-positivas no testículo de diabéticos tratados à longo termo. Portanto, nossas evidências permitem sugerir que a ingestão diária de 10 µg/Kg p.c. de melatonina oferecida desde a fase pré-púbere não compromete a função testicular ou do epidídimo, mas apresenta um efeito positivo sobre a secreção de testosterona, que é afetada pelo diabetes. Como a redução na esteroidogênese provocada pela ingestão de melatonina foi permanente, nossos dados sugerem que seu consumo prolongado leva a uma reprogramação das células de Leydig ou do eixo hipotálamo-hipófise-gônada. A ingestão de melatonina também preserva a motilidade espermática, porém sem restaurar a atrofia epididimal ou a reserva espermática nos animais diabéticos. Comparando os efeitos de longo termo aos efeitos agudos do diabetes experimental de uma semana, infere-se que a melatonina age de maneira diferencial de acordo com o desenvolvimento da doença / Abstract: There are numerous evidence that diabetes affects male reproductive function, causing damage to sperm parameters, and thus influencing the fertility of the affected individuais. Melatonin is a hormone secreted by the pineal gland and presents a wide range of actions, among them a key role in the control of steroidogenesis and in the protection against free radicais. The aim of this study was to evaluate whether melatonin offered orally at low doses, concomitant with sexual maturity, affects the reproductive parameters in healthy adult rats, and interfere with reproductive damage induced by experimental diabetes. Male Wistar rats were divided into eight groups (n = 15/group) at their fourth week of age: the first four were euthanized when they were 14 weeks old, being respectively- Control (CS) treated with melatonin (MS), diabetic (DS) and treated with melatonin subjected to diabetes (MDS); in turn, the last four were studied until they were 21 weeks-old - control (CL), treated with melatonin (ML), untreated diabetics (DL) and diabetics treated with melatonin (MDL). Melatonin was provided daily in drinking water (10 mg/kg b.w. in 0.001o/o ethanol/day) since the 5th week of age, while diabetes was induced at 13 weeks of age with a single dose of streptozotocin (4.5 mg I 100g bw, ip) in groups DS, DL, MDS and MDL. Subgroups from the first experimental design(Groups S) had a diabetic period accounting for one week, while subgroups from the second one (Groups L) were submitted to two months of the disease. Diabetic rats presented hyperglycemia, marked reduction in body weight, strongly decreased circulating levels of testosterone, and at late disease conditions, epididymal atrophy. Histological and stereological analysis indicated alterations in the interstitial compartment of the testis, premature germ cell detachment and vacuolization of Sertoli cells, but more severe injuries, such as depletion of the germinal epithelium were observed in only one animal after two months of illness. Furthermore, there was no damage to the daily sperm production. Sperm counts were reduced at the epididymis distal segment, and transit time was accelerated in all segments after the progression of the disease. Sperm motility was impaired, and the number of aberrant cells in the lumen of the epididymal duct was markedly higher than in healthy animais. There was a thickening of the stromal tissue in some segments, with increased frequency of collagen fibers and smooth muscle. Diabetes has led to an increase in systemic leveis of glutathione peroxidase (GPx) and malondialdehyde (MDA) levels, which were not restored by melatonin supplementation. The activity of glutathione transferase (GST), in turn, was reduced in the blood of diabetic animais regardless of the treatment with melatonin. ln the testis, there were marginal changes in antioxidant systems related to diabetic condition, which did not occur in the epididymis. Treatment of healthy animais with melatonin from pre-pubertal age did not cause reproductive disorders in adulthood, although it lead to a reduction in serum testosterone levels, and did not alter biomarkers related to antioxidant response. However, melatonin treatment previous and concomitant with the diabetic condition prevented some damages associated with this disorder, particularly in what refers to the epididymis, since the short-term ingestion prevented sperm reserve impaiments, and attenuated damage to sperm motility in both periods, although it did not prevent the atrophy observed in the distal segment. Regarding the histology of the organ, melatonin seemed to prevent the development of flbrosis in its stroma, although this response was conflned to particular sub-regions. The ingestion of melatonin also avoided severe injury to the germinal epithelium, and prevented morphological changes in Leydig cells. Steroidogenesis was not as impaired as in untreated diabetics, and this pattern was accompanied by a signiflcant increase of AR-positive cells in the testis of diabetic individuais treated in long term. Therefore, our evidence suggests that the daily intake of 10 mg/kg b.w. melatonin offered from pubertal period on does not impair testicular or epididymal functions, but has a positive effect on the secretion of testosterone, which is affected by diabetes. The reduction in steroidogenesis caused by ingestion of melatonin was permanent, therefore our data suggest that prolonged MLT consumption leads to a reprogramming of Leydig cells or hypothalamic-pituitarygonadal axis. The ingestion of melatonin also preserves sperm motility, but nor epididymal atrophy or restores sperm reserves. Comparing the long term effects with the acute experimental diabetes, it appears that melatonin acts differentially in accordance with the development of the disease / Mestrado / Biologia Celular / Mestra em Biologia Celular e Estrutural

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-20T13:01:25Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE FINAL keila.pdf: 532756 bytes, checksum: c49aa0e3efc358990d4c25a3cdffcf32 (MD5) / Made available in DSpace on 2017-07-20T13:01:25Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) TESE FINAL keila.pdf: 532756 bytes, checksum: c49aa0e3efc358990d4c25a3cdffcf32 (MD5) Previous issue date: 2015-02-10 / CNPQ / OBJETIVO:este estudo avaliou os efeitos clínicos e metabólicos, além da avaliação polimórfica da Il-1ß, IL-12 e IL-10, de pacientes com periodontite crônica e diabetes tipo 2, comparando a terapia periodontal convencional e a terapia cirúrgica no tratamento de bolsas residuais nos períodos de 0, 3 e 6 meses. MATERIAL E MÉTODOS:este ensaio clínico randomizado controlado foi conduzido em 30 pacientes com bolsas residuais contralaterais, alocados randomicamente em dois grupos: G1 (n=16) - terapia cirúrgica – e G2 (n=14) – terapia convencional. Os parâmetros clínicos periodontaise metabólicos foram avaliados nos meses 0, 3 e 6. Também foi avaliada a distribuição de genótipos polimórficos das interleucinas IL-1, IL-10 e IL-12. RESULTADOS:houve uma melhora significativa nos níveis de Hb1Ac no G1 quando comparada ao G2 nos meses 3 e 6 (p<0,05). As médias da profundidade de sondagem (PS) e do nível de inserção clínica (NIC) foram reduzidas no G1 no tempo (0-6) (p<0,05) sem diferença estatisticamente significante quando comparado ao G2 nos tempo avaliados. Houve uma redução significativa no G2 quanto ao NIC no tempo (3-6) (p<0,05). Não houve diferença significativa quando avaliada e comparada a distribuição dos polimorfismos no G1 e G2 com os parâmetros clínicos avaliados (p>0,05). CONCLUSAO:a terapia cirúrgica periodontal trouxe melhorias no controle da Hb1Ac de pacientes diabéticos tipo 2 embora quando avaliados os parâmetros clínicos periodontais PS , NIC, as duas modalidades terapêuticas comportaram-se de forma semelhante. A presença de polimorfismos não influenciou a resposta ao tratamento periodontal nos dois grupos estudados. / OBJECTIVES: this study evaluated the effects clinical and metabolic moreover evaluated polimorphisms of IL-1ß, IL-12 and IL-10 inpacients with chronic periodontitis and diabetes type 2 comparing surgical and non surgical therapies on residual pockets over at baseline, 3 and 6 months post-therapy. MATERIAL AND METHODS:this randomized controlled trial was conduzed in 30 subjects presents contralateral residual pockets randomicaly allocated in 2 groups: G1 (n=16) – surgical therapy – and G2 (n=14) – non surgical therapy. Metabolics and periodontal clinical parameters were assessed at baseline, 3 and 6 months post-therapy. Distribution of polymorphic genotypes of IL-1, Il-10 and IL-12 was assessed. RESULTS:there was a significant improvement in Hb1Ac levels in G1 compared to G2 in the months 3 and 6 (p<0,05). The mean number, PD and CAL improved significantly after therapy in G1 (0-6) (p<0,05) without differences between groups at any timepoint(p>0,05).CAL was improved significantlyin G2 ate (3-6) (p<0,05). There was no significant difference when evaluated and compared the distribution of polymorphisms of interleukins in the G1 and G2 with clinical parameters evaluated (p>0,05). CONCLUSION: periodontal surgical therapy improves Hb1Ac levels in diabetics type 2 although when evaluated PD and CALboth therapisbehaved similarly.The presence of polymorphisms did not influence the response to periodontal treatment in both groups.

Orientador: Edison Bueno / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T07:06:07Z (GMT). No. of bitstreams: 1 Baade_RosileiTeresinhaWeiss_M.pdf: 3802500 bytes, checksum: 349fc4223b13900af582dd28ceb7b55c (MD5) Previous issue date: 2015 / Resumo: Este estudo tem como objetivo analisar o processo de coconstrução da autonomia no cuidado em diabetes mellitus, através das reflexões de pessoas com diabetes e profissionais de saúde de um ambulatório público especializado, localizado em um município de médio porte, no estado de SC, através de uma pesquisa qualitativa. Os referenciais teóricos buscaram ampliar o entendimento sobre temas e contextos de vida como autonomia, doenças crônicas, diabetes, adoecimento, viver com diabetes, clínica do sujeito, autocuidado, cuidado, trabalho em saúde, coconstrução e cogestão. Os dados foram coletados através de entrevistas individuais semiestruturadas com as pessoas com diabetes e os profissionais de saúde deste ambulatório, além da realização de uma Roda de Conversa com os profissionais de saúde sobre as falas dos usuários nas entrevistas. As falas foram transcritas e analisadas através dos referenciais da análise de conteúdo, especificamente pela análise temática (Bardin apud Minayo, 2014), destacando-se a compreensão sobre como as pessoas com diabetes e profissionais de saúde entendem o processo de coconstrução da autonomia das pessoas com diabetes, reforçando o protagonismo dos sujeitos e privilegiando meios que possam levar ao cuidado integral e singular. A escuta, a clínica ampliada e a cogestão se afirmam como importantes estratégias para compreender o processo de vivência com diabetes e possibilita perceber o outro com um sujeito singular, funcionando como disparador da criação de estratégias compartilhadas entre adoecidos e profissionais de saúde, na construção da autonomia do cuidado, onde a doença faz parte da vida e não a vida parte da doença / Abstract: This study aims to analyze the process of co-construction of autonomy in care in diabetes mellitus, through the reflections of people with diabetes and health professionals from a specialized public clinic, located in a medium-sized municipality in the state of SC, through a qualitative research. Theoretical frameworks attempted to increase the understanding of issues and contexts of life as autonomy, chronic diseases, diabetes, illness, living with diabetes, the subject of clinical, self-care, care, health work, co-construction and co-management. Data were collected through individual semi-structured interviews with people with diabetes and healthcare professionals of this clinic, in addition to holding a Chat wheel with health professionals about the speeches of the users in the interviews. The discussions were transcribed and analyzed through content analysis of reference, specifically the thematic analysis (Bardin apud Minayo, 2014), highlighting the understanding of how people with diabetes and healthcare professionals understand the co-construction process of people's autonomy with diabetes, reinforcing the role of the subject and focusing means that can lead to the full and meticulous care. Listening states, the clinic expanded and the co-management if claim as important strategy to understand the process of living with diabetes and allows perceive the other with a singular subject, functioning as trigger the creation of strategies shared between diseased and health professionals in the construction of autonomy of care, where the disease is part of life and not the life of the disease / Mestrado / Política, Planejamento e Gestão em Saúde / Mestra em Saúde Coletiva

Orientador: Lício Augusto Velloso / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T15:03:00Z (GMT). No. of bitstreams: 1 Silva_CarinaSolon_D.pdf: 1769268 bytes, checksum: b8a449a504bd2aa54bb737ba42860093 (MD5) Previous issue date: 2015 / Resumo: / Resumo: A interleucina-17 (IL17) está envolvida na resposta imune contra agentes patogénicos intestinais, e a sua expressão anómala no intestino pode ocorrer em condições tais como diabetes do tipo 1 (DM1), encefalomielite auto-imune e doença de Crohn. Fatores dietéticos podem alterar a microbiota intestinal desencadeando doenças metabólicas. Nossa hipótese é de que IL17 poderia ser diretamente modulada por nutrientes e pode desempenhar um papel na obesidade e diabetes tipo 2 (DM2). Aqui, nós demonstramos que as gorduras da dieta induzem a expressão IL17, predominantemente no íleo. In vivo, ilhotas pancreáticas isoladas estimuladas com IL17 apresentaram um aumento na secreção de insulina quando comparado a ilhotas não estimuladas, enquanto que a sua inibição sistémica resultou em intolerância à glicose. Animais knockout para o receptor de IL17 (IL17RA) eram intolerantes à glucose devido ao desenvolvimento embrionário anómalo das ilhotas pancreáticos, que eram menores e foram depletados de células produtoras de insulina. Nos seres humanos, os níveis circulantes de IL17 aumentaram após uma refeição. Este aumento foi significativamente maior nos indivíduos obesos normoglicêmicos do que em indivíduos obesos com diabetes. Semelhantes aos roedores, as ilhotas humanos também foram estimulados a secretarem insulina na presença de IL17. Assim nós identificamos a IL17 como um sensor intestinal de gorduras alimentares, que exerceram um efeito semelhante a hormônios incretínicos. Além disso, a presença IL17RA é importante para o desenvolvimento normal das ilhotas pancreáticas. / Abstract: / Abstract: Interleukin-17 (IL17) is involved in the immune response against intestinal pathogens, and its anomalous expression in the gut can occur in conditions such as type 1 diabetes (T1D) 1, autoimmune encephalomyelitis 2 and Crohn¿sdisease 3. Because dietary factors can change the gut microbiota, impacting metabolic diseases 4, we hypothesized that IL17 could be directly modulated by nutrients and might play a role in obesity and type 2 diabetes (T2D). Here, we show that dietary fats induced IL17 expression, predominantly in the ileum. Both in vivo and in isolated pancreatic islets, IL17 stimulated insulin secretion, while its systemic inhibition resulted in glucose intolerance. Mice KO for the main IL17 receptor (IL17RA) were glucose intolerant due to anomalous embryonic development of the pancreatic islets, which were smaller and were depleted of insulin-producing cells. In humans, blood IL17 increased following a meal. This increase was significantly higher in obese normoglycemic individuals than in obese subjects with diabetes. Similar to those of rodents, human islets were also stimulated to secrete insulin in the presence of IL17. Thus, we identified IL17 as a gut sensor of dietary fats, which exerted an incretin-like effect. In addition, the presence IL17RA was important for normal development of the pancreatic islets / Doutorado / Fisiopatologia Médica / Doutora em Ciências

Orientador: Letícia de Las Mercedes Marín-León / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T21:41:12Z (GMT). No. of bitstreams: 1 White_HarrietJane_D.pdf: 2077224 bytes, checksum: 00cc57ec7743150ef044b91043e24621 (MD5) Previous issue date: 2015 / Resumo: O objetivo do estudo foi investigar as variáveis socioeconômicas, condições de saúde, hábitos alimentares, estado nutricional, aconselhamento nutricional e qualidade de vida em idosos portadores de diabetes mellitus e hipertensão arterial, em relação aos idosos sem estas doenças. A amostra foi de conveniência e composta por idosos de ambos os sexos, de 60 anos e mais e residentes em Campinas. Os idosos portadores de diabetes e hipertensão foram recrutados em um Hospital Universitário e o grupo dos idosos, sem estas doenças foram selecionados em centros esportivos, onde são realizadas atividades físicas direcionadas à população idosa. Os dados obtidos foram avaliados por meio de um questionário estruturado, e aferido peso, altura e circunferência da cintura. Nos artigos 1 e 2, o delineamento do estudo epidemiológico foi caso-controle e no artigo 3, desenho transversal. No primeiro artigo, deste trabalho "Condições de saúde de idosos diabéticos e hipertensos: estudo caso-controle", o objetivo foi comparar idosos portadores de diabetes e hipertensão (casos; n=150), com idosos sem essas doenças (controles; n=300), quanto às características sociodemográficas, comportamentos de saúde, estado nutricional e capacidade funcional. Idosos portadores de hipertensão e diabetes apresentaram maior percepção de limitações econômicas e físicas, piores condições de saúde e obesidade, quando comparados aos idosos sem essas doenças. No segundo artigo, "A importância da Síndrome Metabólica em idosos", o objetivo foi comparar idosos portadores de Síndrome Metabólica (casos; n=103), com idosos sem Síndrome Metabólica (controles; n=206), quanto às características sociodemográficas, estilo de vida, e hábitos alimentares. Para a seleção dos casos, foi utilizado o critério proposto pela NCEP-ATPIII (2001), e para o grupo dos controles foram selecionados os idosos que não apresentaram o conjunto de fatores de risco para Síndrome Metabólica. Reforça-se a importância das modificações no estilo de vida, incluindo perda de peso e abstenção do tabagismo, e intervenções dietéticas que possam contribuir para a redução da circunferência da cintura, além da prática de atividade física regular e cuidados com a alimentação na prevenção e no controle da Síndrome Metabólica. No terceiro artigo "Orientações nutricionais em serviços de saúde - a percepção de idosos portadores de hipertensão e diabetes", o objetivo foi descrever os aspectos do atendimento nutricional e das práticas alimentares entre idosos, em face das orientações nutricionais recebidas. Realizado estudo transversal com idosos portadores de diabetes e hipertensão, de ambos os sexos. Participaram 150 idosos e disseram ter recebido material educativo contendo orientações nutricionais, 80% dos homens e 64% das mulheres, porém, estas não eram seguidas por uma parcela dos entrevistados, e 50% das mulheres e 62% dos homens relataram dúvidas sobre as orientações recebidas. O expressivo número de idosos com sobrepeso e obesidade, e aumento da circunferência da cintura, reflete a baixa adoção das recomendações nutricionais, e aponta para a necessidade de aprimorar a capacitação dos profissionais de saúde quanto às orientações de alimentação e atividade física / Abstract: The objective of the study was to investigate socioeconomic, health, eating habits, nutritional status, nutrition counseling, and quality of life among elderly patients with diabetes mellitus and hypertension and elderly without these diseases. A convenience sample composed of elderly men and women, 60 years and more, and living in Campinas-SP. Elderly diabetic and hypertensive patients, were recruited at the University Hospital and the group without these diseases, was selected in sports centers, which offer physical activities for the elderly. Elderly were evaluated through a questionnaire, and mesured weight, height and waist circumference. Article 1 and 2, are case-control study, and article 3, cross-sectional study. In the first article of this thesis "Health conditions of diabetic and hypertensive elderly: Case-control study", the objective was to compare elderly patients with diabetes and hypertension (cases, n=150), with older people without these diseases (controls, n=300), regarding sociodemographic characteristics, health behaviors, nutritional status and functional capacity. Elderly patients with hypertension and diabetes had more physical and economic limitations, worse health status, and obesity, when compared to subjects without hypertension and diabetes. In the second article, "The importance of metabolic syndrome in the elderly", the objective was to compare elderly patients with metabolic syndrome (cases, n=103), or without metabolic syndrome (controls, n=206), regarding sociodemographic characteristics, lifestyle, eating habits and eating disorders. To select the cases, we used the criteria proposed by the NCEP-ATPIII (2001), and the control group, were selected who did not have the set of risk factors for metabolic syndrome. Reinforces the importance of changes in lifestyle, including loss of weight and smoking abstention, and dietary interventions that can contribute to the reduction of waist circumference, in addition to regular physical activity and nutritional care, in the prevention and control of Metabolic Syndrome. The third article "nutritional guidelines in health services - the perception of elderly patients with hypertension and diabetes", aims to describe aspects of nutritional care and feeding practices among the elderly in face of nutritional guidelines received. A cross-sectional study of elderly patients with diabetes and hypertension of both sexes was carried out with 150 elderly, and 80% of men and 64% of women, informed they had received educational materials containing nutritional guidelines, but these were not followed by part of them and 50% of women and 62% of men reported having doubts about the guidelines received. The significant number of overweight or obese elderly, and the increased waist circumference reflects the limited use of nutritional recommendations and indicates the need to improve the training of health professionals as to food guidelines and physical activity / Doutorado / Epidemiologia / Doutora em Saúde Coletiva