A neuropatia periférica diabética é caracterizada por hiperalgesia e alodínia. O receptor CB1 é o principal responsável pelo efeito dos canabinóides na via nociceptiva. A Hemopressina (Hp), é um agonista inverso do CB1, que induz antinocicepção. Neste trabalho investigamos o efeito do tratamento com Hp (2,5 mg/Kg, por 28 dias) sobre a neuropatia diabética de camundongos, induzido por estreptozotocina (200mg/kg). A Hp reverte a hipersensibilidade mecânica em camundongos com neuropatia diabética, sendo que este efeito é específico para o tratamento da nocicepção e envolve a participação de receptores CB1, astrócitos e microglia em nível espinal. A Hp também previne a desmielinização do nervo isquiático dos animais diabéticos, e auxilia na manutenção dos níveis do NGF. Ainda, a Hp participa no controle da sensibilidade ao estímulo térmico quente em animais KO MOR e participa do controle da sensibilidade mecânica de animais KO MOR diabéticos pelo aumento da dimerização de CB1-DOR na medula espinal. Revelando a Hp um candidato para fins terapêuticos. / Diabetic peripheral neuropathy is characterized by hyperalgesia and allodynia. CB1 receptors are primarily responsible for the effect of cannabinoids in nociceptive pathways. Hemopressin (Hp) is an inverse agonist of CB1, which induces antinociception. In this study we investigated the effects of treatment with Hp (2.5 mg / kg for 28 days) on mice subjected to diabetic neuropathy by streptozotocin (STZ - 200 mg/kg). Hp treatement reversed the mechanical hypersensitivity in mice with neuropathy diabetic, and this effect is specific for the treatment of nociception and involves the participation of CB1 receptors, astrocytes and microglia at the spinal level. Hp prevented demyelination of the sciatic nerve in diabetic animals, and assisted in mantaining the levels of NGF. Also, Hp participates in the control of heat sensitivity to thermal stimulus in KO MOR animals and participates in the control of mechanical sensitivity in KO MOR diabetics animals by the increase in CB1-DOR dimerization in the spinal cord. Revealing Hp as a candidate for therapeutic purposes.

A eletromiografia de superfície (EMGs) é atualmente muito utilizada para diversos fins, em especial por ser um método não invasivo, com o objetivo de verificar a atividade elétrica neuromuscular em diversas doenças e/ou lesões que venham afetar esse sistema. E também as modificações, os efeitos e a especificidade do exercício e/ou treinamento físico na função neuromuscular. Em relação às diversas doenças potencialmente capazes de causar alterações nas propriedades teciduais e fisiológicas do sistema neuromuscular, destaca-se o Diabetes Mellitus Tipo II (DM tipo II). O principal objetivo do presente estudo foi estudar a resposta do sinal eletromiográfico frente ao exercício resistido agudo do tipo Leg Press 45° dos músculos reto femoral (RF), vasto medial (VM), vasto lateral (VL) e bíceps femoral (BF), em indivíduos portadores de DM tipo II. Participaram deste estudo 10 indivíduos portadores de DM tipo II (GD) e 10 indivíduos saudáveis (GC), na faixa etária de 50 a 60 anos. Não foram observadas diferenças significativas (p \'< OU =\' 0,05) para idade (55,3±6,1 vs 55,5±5,7) e estatura (1,7±0,1 vs 1,7±0,1) entre o GD e GC. Entretanto houve diferenças estatística significativas entre GD e GC para os valores de massa corporal (92,9±7,6 vs 84,2±13,8) e Índice de Massa Corpórea (IMC) (32,07±1,7 vs 27,8±2,5). Em relação à análise do sinal eletromiográfico foram observadas diferenças em relação ao recrutamento muscular ao longo do movimento de \"Leg Press\" destacando-se que para o GD o músculo mais ativo foi o RF seguido do VL, já para o GC foi o VL seguido do VM, e quanto aos valores de slope do RMS não houve diferença quanto ao músculo BF para ambos os grupos demonstrando valores positivos, porém para os músculos RF, VM e VL houve diferença entre os GC e GD. Resultados estes que podem estar associados a alterações do sistema neuromuscular, desencadeadas pela resistência insulínica ao tecido muscular e modificações metabólicas causadas pelo DM tipo II. / Surface electromyography (sEMG) is currently widely used for various purposes, especially for being a noninvasive method, in order to check the electrical activity in various neuromuscular diseases and / or injuries that may affect this system. And also changes the effects and specificity of exercise and / or exercise training on neuromuscular function. Regarding the various diseases that can potentially cause changes in tissue properties and physiological neuromuscular system, there is the Type II Diabetes Mellitus (DM type II). The main objective of this study was to study the response of the electromyographic signal against acute resistance exercise like \"Leg Press\" 45 ° of the rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL) and biceps femoris (BF), in individuals with type II DM. The study included 10 individuals with type II DM (GD) and 10 healthy individuals (CG), aged 50-60 years. There were no significant differences (p \'< OU =\' 0.05) for age (55.5±5.7 vs 55.3±6.1) and height (1.7±0.1 vs 1.7±0.1) between the GC and GD. However there were statistically significant differences between GC and GD values for body mass (84.2±13.8 vs 92.9±7.6) and body mass index (BMI) (27.8±2.5 vs 32,0±1.7). Regarding the analysis of the electromyographic signal differences were observed in relation to muscle recruitment during the movement \"Leg Press\" highlighting that for GD muscle was the most active followed by VL RF, since the CG was followed VL VM, and the values of the RMS slope there was no difference in BF for both groups demonstrating positive values, but to the muscles RF, VM and VL was no difference between the GC and GD. These results that may be associated with changes in the neuromuscular system, triggered by insulin resistance to muscle tissue and metabolic changes caused by diabetes mellitus type II.

Diabetic symmetrical polyneuropathy is the most common secondary complication of diabetes, with no effective treatment, apart from maintaining tight glycemic control. It is therefore essential to understand the mechanisms underlying the pathogenesis of the disease in order to develop new therapeutic strategies. Biochemical and structural changes are observed in the extracellular matrix (ECM) of the peripheral nerve in diabetes: including increased endoneurial collagen; reduplication of basement membranes around endoneurial capillaries; a thickening of basal lamina; and accumulation of advanced glycation end-products (AGEs). In normal nerves, ischaemic or other damage to distal axons provokes a regenerative response; in diabetes this is abortive and failure of axonal regeneration is a hallmark of clinical and experimental diabetic neuropathy. Matrix metalloproteinases (MMPs) are a large family of zinc-dependent proteolytic enzymes that cleave the protein components of the ECM. MMP-2 and MMP-9 play a central role in Wallerian degeneration and regeneration following nerve injury. This thesis investigates whether MMP-2 and -9 expression and/or activity were altered in the peripheral nerve in diabetes, and could contribute to regenerative failure in diabetic neuropathy. Using an experimental model of diabetes, we have demonstrated that MMP-2, but not MMP-9, is upregulated at gene, protein and activity levels in the rat sciatic nerve 8 weeks post-streptozotocin (STZ). This upregulation was not maintained at later time-points of diabetes. In vitro sciatic nerve cryoculture studies showed that peripheral nerve from STZ-diabetic rats was less supportive for neurite outgrowth from dissociated adult rat sensory neurons than nerve obtained from age-matched control rats. Cyrocultures were pre-treated with either MMP-2 or chondroitinase ABC, remodelling the peripheral nerve ECM, via the removal of inhibitory chondroitin sulfate proteoglycans from the sciatic nerve, and significantly enhanced its ability to support axonal regeneration, and partially restored the diabetes-associated regenerative deficit. However, exogenous MMP-2 or MMP-9 did not directly affect neurite outgrowth of dissociated adult rat sensory neurons. Finally, we assessed the neuroprotective effects of the AGE inhibitors LR90 and pyridoxamine in experimental diabetes, using a number of electrophysiological, behavioural and biochemical endpoints. These inhibitors were effective at preventing the development of some of the functional deficits observed in STZ-diabetes. Sensory nerve conduction velocity deficits and lipid peroxidation in the sciatic nerve were prevented by both LR90 and pyridoxamine. These agents have potential for the treatment of diabetic neuropathy.

Diabetic foot ulceration (DFU) is a known major complication of diabetes mellitus which contributes to lower extremities amputation. This study aimed to investigate the use of interventional devices either as a preventative or therapeutic strategy to improve clinical management of this pathology, as well as investigating the impaired function of endothelial progenitor cells in the diabetic condition. The first element targeted plantar callus formation among diabetic neuropathic (NRP) patients through the use of a SurroSenseRxTM biofeedback device. Reducing foot pressure with improved walking strategy in the 6 months study in diabetic neuropathy patients (n=20) appeared to minimise the size of non-ulcerative plantar callus (p < 0.05), potentially reducing future ulcer recurrence. The 2nd study focused on the use of a GekoTM electrical stimulation device to enhance DFU healing in 24 patients. Wounds were characterised as being neuroischaemic (NRI) or neuropathic (NRP) based on standard parameters adopted in the Manchester diabetes clinic. The device was worn by 11 intervention subjects and compared to 13 controls without any electrical stimulus. Results suggested healing and wound closure have potentially increased in participants with electrical stimulation. In addition, Neuropathy Disability Score (NDS) was improved among intervention patients compared to control (p < 0.0001). The 3rd, in vitro and mechanistic study focuses on the outgrowth of endothelial cells (OECs), abnormal angiogenic responses and inflammatory microenvironment which could contribute to impaired wound healing in diabetic patients. OECs were isolated from diabetic patients and healthy controls (HCs), characterised by immunohistochemistry and Polymerase Chain Reaction (PCR). The functions of the three OEC groups from NRI, NRP diabetic patients and healthy controls respectively were compared using in vitro proliferation, transwell migration and wound healing scratch assays, together with matrigel tube formation assays. Scratch assays showed 100% closure in HCs over 24 hours, while 86.6% closure was apparent in NRI vs 38.1% in NRP. Seahorse mitochondrial stress test was conducted and demonstrated mitochondrial dysfunction in NRP vs NRI vs HCs (p < 0.05). Western blot analysis showed a lack of ERK phosphorylation by NRP OECs and an up-regulation of plasma inflammatory cytokines (TNFa and IL-6) in diabetic samples vs HC (p < 0.0001), while the angiogenic factors ang-2, FGF-2, VEGF-D, HGF and IL-8, and nitric oxide bioavailability were all significantly reduced in diabetic samples vs HC (p < 0.05). The functional defects of the diabetic OECs were partially restored through glycomimetic (synthesis compounds for endothelial damage protection) treatment (p < 0.05). In summary, this study has highlighted areas worthy of future development both in terms of preventative and therapeutic strategies. With improvements in digital technology and the need to empower patients to take responsibility of their health and well-being as well as greater understanding of the cellular and molecular biological repair processes that may be exploited, there may be potentials to reduce the risk of future ulceration among patients using these novel approaches in the future.

Background/aim. The incidence of microvascular complications has been reported to be unchanged the last decades. However, in randomized clinical trials it has been shown that improved metabolic control can reduce the development of long term complications. It has been debated whether it is possible to achieve the same results in an unselected population. In a previous study we found a decreased incidence of overt nephropathy, but unchanged incidence of severe laser treated retinopathy in a population of patients with type 1 diabetes diagnosed in childhood. The aim of the present study was to investigate the incidence 10 years later in the same population and to analyse the importance of possible risk factors. In another previous study we found a high prevalence of subclinical neuropathy among young diabetic patients despite intensive insulin therapy since diagnosis. The aim of the present study was to examine if intensive treatment is more effective in preventing early diabetic complications other than neuropathy. The incidence of type 1 diabetes has doubled in Sweden the last decades. The reason must be environmental factors. These, as well as more intensive insulin regimens from onset of diabetes, might also lead to different disease process. We wanted to analyse if clinical characteristics at onset had changed the last 25 years and if there was any secular trend of C-peptide secretion. We also intended to investigate if longer persistence of C-peptide secretion could be of importance for prevention of long term complications. Methods. The whole study population consisted of all 478 patients with type 1 diabetes diagnosed before the age of 15 during the years 1961 - 2000, living in the catchment area of the Paediatric Clinic, University Hospital, Linköping, Sweden. For the statistical analysis the population was divided into five–year cohorts according to time of onset of diabetes. The cumulative proportion of severe retinopathy and overt nephropathy in 269 patients with onset of diabetes 1961 - 1985 was computed with survival analysis. Multivariable regression models were used to analyse the importance of metabolic control, diabetes duration, blood pressure, smoking, BMI, lipids and persisting C-peptide secretion. The prevalence of all grades of retinal changes, nephropathy and neuropathy, defined as abnormal nerve conduction, was estimated in the late 1990s in a subgroup of 80 children and adolescents with mean 13 years of diabetes duration. Clinical characteristics at onset, duration of partial remission and regularly measurements of fasting and stimulated C-peptide secretion the first five years after onset were analysed in 316 patients with onset of diabetes 1976 - 2000. Results. The cumulative proportion of severe laser treated retinopathy showed a significant declining trend the last decades. The decrease was significant between the oldest cohort with diabetes onset 1961 - 1965 and the cohorts with diabetes onset 1971 - 1975 and 1976 - 1980. The cumulative proportion of overt nephropathy also declined with a significant decrease between the oldest cohorts and all the following cohorts. After 25 years of diabetes duration it was 30% and 8% in the two oldest cohorts respectively and remained largely unchanged after 30 years. Diabetes duration and long term HbA1c were the only significant independent risk factors for both retinopathy and nephropathy. The risk of overt nephropathy increased substantially when HbA1c was above 8.5%, while the risk of severe retinopathy increased already when HbA1c exceeded 7.5%. The prevalence of neuropathy was 59%, of retinopathy 27% and of nephropathy 5% in the population of young patients after mean 13 years of diabetes duration. During the last 25 years the clinical characteristics at onset were unchanged as well as duration of partial remission and magnitude and persistence of C-peptide secretion. Conclusions. In this unselected population the cumulative proportion of severe retinopathy and overt nephropathy decreased over the last decades. Diabetic nephropathy has probably been prevented and not just postponed. Good glycaemic control was the most important factor to avoid complications, with the necessity of a lower level of HbA1c to escape retinopathy than nephropathy. Intensive insulin regimens from diabetes onset was not sufficient to entirely escape early diabetic complications after mean 13 years of diabetes duration, even if the prevalence of retinopathy and especially nephropathy was lower than usually reported. The clinical picture at onset of diabetes was unchanged the last 25 years. There was no secular trend of partial diabetes remission or C-peptide secretion during the first years after diagnosis.

Diabetinė neuropatija yra viena dažniausių cukrinio diabeto komplikacijų. Ši komplikacija išsivysto po 5-20 metų cukrinio diabeto ligos trukmės. Tačiau yra žinoma, kad 2 tipo cukrinio diabeto diagnozavimo data dažniausiai nesutampa su ligos pradžia. 2 tipo cukrinis diabetas pasireiškia palaipsniui, be ryškių simptomų, todėl diagnozė nustatoma pavėluotai, praėjus vidutiniškai 6-9 metams nuo ligos pradžios. Jutimų praradimas, pėdų opos, galūnių amputacijos didina mirtingumą nuo šios ligos. Mirtingumą taip pat įtakoja ir kardiovaskulinė autonominė neuropatija, padidėja mirčių rizika dėl širdies kraujagyslių ligų. Uždaviniai: 1. Nustatyti lėtinės sensomotorinės diabetinės neuropatijos dažnį sergantiesiems 2 tipo cukriniu diabetu. 2. Nustatyti autonominės neuropatijos dažnį ir ypatumus sergantiesiems 2 tipo cukriniu diabetu. 3. Įvertinti Mičigano klausimyno informatyvumą diabetinės neuropatijos diagnostikoje. 4. Įvertinti kiekybinių tyrimų informatyvumą diabetinės neuropatijos diagnostikoje. 5. Įvertinti sergančiųjų 2 tipo cukriniu diabetu, kuriems diagnozuota diabetinė neuropatija, gyvenimo kokybę. Atliktas darbas paskatins sudaryti diabetinės neuropatijos ištyrimo algoritmą, kad ir šeimos gydytojas, ir specialistas, kuo anksčiau nustatytų šią klastingą komplikaciją. / Diabetic neuropathy is one of the most prevalent complications of diabetes mellitus. It usually develops over 10 - 20 years of disease. However, it is known that the timing of disease diagnosis and the actual disease onset often differs. Since type 2 diabetes mellitus manifests gradually without obvious symptoms, the diagnosis is usually clarified only 6 - 9 years after the actual onset. Numbness, foot ulcers and amputation of the extremities increase this disease related mortality. Mortality is also affected by autonomic cardiovascular neuropathy and other cardiovascular diseases. The goals of the study: 1. Estimate a frequency of chronic sensory diabetic neuropathy in type 2 diabetes patients. 2. Estimate a frequency and characteristics of autonomic neuropathy in type 2 diabetes patients. 3. Evaluate a value of Michigan questionnaire in diagnostic of diabetic neuropathy. 4. Evaluate a value of quantitative methods in diagnostic of diabetic neuropathy. 5. Assess a life quality of patients with diabetic neuropathy. The study results stimulate to draft the recommendations and methods for the evaluation of diabetic neuropathy enabling family physicians and specialists to diagnose this complication early.

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Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / O diabetes é uma doença de alta prevalência que, frequentemente, induz o comprometimento do sistema nervoso periférico. Na neuropatia diabética periférica, os sintomas mais encontrados são os sensitivos, no qual a dor neuropática, condição crônica caracterizada por alodinia e hiperalgesia, é a mais debilitante. Esta, prejudica a qualidade de vida do paciente, sendo muitas vezes não responsiva aos métodos farmacológicos convencionais de tratamento. Diante desse panorama, o desenvolvimento de novas abordagens terapêuticas que possuam ação efetiva neste tipo de dor é de grande relevância. O uso da terapia celular no tratamento de lesões do sistema nervoso tem demonstrado resultados promissores e o potencial terapêutico de células-tronco na neuropatia experimental tem sido proposto. Neste estudo, avaliou-se o efeito de células-tronco mesenquimais derivadas da medula óssea (CMsMO) na neuropatia diabética periférica estabelecida em modelo experimental de diabetes induzido por estreptozotocina (ETZ). Quatro semanas após a indução do modelo por ETZ (80 mg/kg; ip; 3 dias consecutivos), os animais receberam uma administração endovenosa de CMsMO (1 x 106) ou veículo. O tratamento com gabapentina (30 mg/kg; v.o. a cada 12 horas durante seis dias consecutivos) foi usado como padrão ouro. Os limiares nociceptivos térmico e mecânico foram avaliados durante todo o período experimental (90 dias), pelos métodos de hargreaves e von Frey. A avaliação da função motora foi realizada pelo teste de rota-rod. Em diferentes tempos e para todos os grupos experimentais, foram realizadas coletas de segmentos da medula espinal (L4-L5) para dosagem de citocinas por ELISA e segmentos do nervo isquiático foram também coletados para avaliação de alterações morfológicas por microscopia óptica e eletrônica de transmissão. Os dados comportamentais demonstraram que o tratamento com CMsMO reduziu a mecanoalodinia e a hipoalgesia térmica, levando os limiares nociceptivos de animais neuropáticos a níveis similares aos de animais não neuropáticos. Do mesmo modo, a administração de CMsMO normalizou a função motora dos animais neuropáticos. Dados de microscopia mostraram que animais neuropáticos apresentaram atrofia axonal, redução do número de fibras mielínicas e aparente redução do numero de fibras amielínicas no nervo isquiático. Animais neuropáticos tratados com CMsMO tiveram menor ocorrência de atrofia axonal e não apresentaram redução do numero de fibras mielínicas ou amielínicas, em relação aos neuropáticos tratados com salina. Além disso, animais neuropáticos tratados com CMsMO apresentaram menores níveis espinais de IL-1β e TNF-α, e maiores de IL-10 e TGF-β, em relação aos animais neuropáticos não tratados. Esse conjunto de resultados indica que CMsMO produzem efeito antinociceptivo duradouro na neuropatia diabética, seguido de modificações no padrão fisiopatológico da doença, o que aponta a terapia celular como uma interessante alternativa para o controle da neuropatia diabética periférica dolorosa. / Diabetes is a highly prevalent disease which frequently compromises the peripheral nervous system. In peripheral diabetic neuropathy, the most frequent symptoms are sensitive, in which the neuropathic pain, chronic condition characterized by allodynia and hyperalgesia, is the most debilitating. Neuropathic pain affects the quality of patients’ lives, and is often not responsive to pharmacological conventional treatment methods. Against this background, the development of new therapeutic approaches that have an effective action in this type of pain is of great importance. The use of cell therapy in the treatment of lesions in the nervous system has shown promising results and the therapeutic potential of stem cells in experimental neuropathy has been proposed. In this study, we evaluated the effect of mesenchymal stem cells derived from bone marrow (CMsMO) in peripheral diabetic neuropathy established in experimental model of streptozotocin (STZ) induced diabetes in mice. Four weeks after the induction of the model by administration of STZ (80 mg/kg, ip; 3 days) the animals received an CMsMO by intravenous administration (1x106) or vehicle. The treatment with gabapentin (30 mg/kg, orally every 12 hours for six days) was used as the gold standard. The thermal and mechanical nociceptive thresholds were assessed throughout the entire experimental period (90 days), using Hargreaves and von Frey methods, respectively. Motor function evaluation of was conducted using the rotarod test. At different times, were analyzes conducted in spinal cord segments (L4-L5) to determine cytokines profile by ELISA. Sciatic nerve segments were also collected for evaluation of morphological changes by optical and electron transmission microscopy. According to the behavioral data, the CMsMO treatment reduced the mecanoalodinia and the thermal hypoalgesia, leading nociceptive thresholds of neuropathic animals to levels similar to those of non-neuropathic animals. Similarly, CMsMO administration normalized motor function of neuropathic animals. Microscopy data demonstrated that neuropathic animals had axonal atrophy and an apparent decrease of the number of myelinated fibers as well a reduction in the number of unmyelinated fibers in the sciatic nerve, but neuropathic animals treated with CMsMO had a lower incidence of axonal atrophy, showed no decrease in the number of myelinated fibers and no apparent decrease in the amount of unmyelinated fibers in relation to neuropathics treated with saline. Furthermore, neuropathic animals treated with CMsMO presented lower levels of spinal IL-1β and higher levels of TNF-α, and IL-10 and TGF-β compared to neuropathic animals that received saline. These data indicate that CMsMO produces a lasting analgesic effect in diabetic neuropathy, followed by changes in the pathophysiological disease pattern, which indicates cell therapy as an interesting alternative for the control of painful peripheral diabetic neuropathy.

Orientador: Cristina Elena Prado Teles Fregonesi / Banca: Dalva Mininroze Albuquerque Ferreira / Banca: Marli Aparecida Defani / Resumo: O estudo teve por objetivo avaliar as pressões e áreas de superfícies plantares e os componentes vásculo-sensório-motores dos pés de portadores de neuropatia diabética. Sessenta e oito indivíduos divididos em dois grupos: 28 no grupo neuropata e 40 no grupo controle, participaram do estudo. Os voluntários foram submetidos às avaliações da circulação e perfusão periférica de membros inferiores, por meio do índice tornozelo/braço e oximetria; sensibilidade somatossensitiva, pela estesiometria; força muscular do tornozelo, por dinamômetro digital portátil; e pressões e superfícies plantares com um baropodometro eletrônico. Os grupos foram comparados por meio dos testes Mann-Withney e análises de variâncias (ANOVA e MANOVA) (p<0,05). A sensibilidade tátil, o índice tornozelo/braço e a força muscular de dorsiflexores e plantiflexores de tornozelo estiveram diminuídas no grupo neuropata em relação aos controles. Nos picos de pressões plantares não foram verificadas diferenças entre os grupos, mas ocorreu diferença nos locais onde essas pressões foram impostas. Na condição estática, a área de superfície plantar foi maior no grupo neuropata, quando comparado ao controle... (resumo completo, clicar acesso eletrônico abaixo) / Abstract: The objective of this study was to analyze the postural control, using baropodometry, in patients with diabetic neuropathic and relate with loss in the sensorimotor system. Twenty-eight healthy subjects and 25 patients with diabetic neuropathic were evaluated with baropodometry in two conditions: static (for measure the center of pressure displacement) and dynamics (for measure the stance phase of gait cycle - total period of support, double support and single support). The tactile sensitivity of the feet was measured with a Semmes-Weinstein pressure esthesiometer and the isometric muscle strength of ankle was measured with dinamometry. The MANOVA and ANOVA indicated lower performance in tactile and force muscle in diabetic neuropathy. In the dynamic condition the diabetic neuropathy group showed more time in the gait parameters. With this study, by regression analysis, we can say that the differences of balance in the neuropathy diabetic gait may result from decreased of sensitivity tactile and strength / Mestre

Made available in DSpace on 2014-06-11T19:22:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-08Bitstream added on 2014-06-13T19:49:05Z : No. of bitstreams: 1 codogno_js_me_rcla.pdf: 551723 bytes, checksum: 7289c811872adb9358d081f132ed9cf5 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / A hipótese inicial do trabalho é a de que a maior prática de atividades físicas entre indivíduos diabéticos pode diminuir o custo total do tratamento do DM2 e suas complicações. Objetivo: Avaliar se pacientes diabéticos e com maior envolvimento com a prática de atividades físicas apresentam menor custo com medicamentos, consultas e exames médicos. Métodos: Trabalho transversal realizado junto a dois núcleos de saúde, na cidade de Bauru-SP. A casuística foi composta por 121 diabéticos tipo 2, de ambos os sexos, e com idade inferior a 75 anos. Foram analisados os prontuários clínicos dos pacientes (cálculo do custo), avaliada a presença de neuropatia, o estado nutricional, aferida a pressão arterial e aplicados questionários (atividade física, condição econômica e risco coronariano). A análise dos dados foi realizada após a divisão dos indivíduos em grupos de atividade física: Ativo, Moderadamente ativo e Sedentário. ANOVA one-way e ANOVA two-way avaliaram a interação da prática de atividades físicas e indicadores de custo médico. Para as variáveis categóricas, o teste qui-quadrado foi utilizado para verificar a existência de associações. As regressões linear e logística também foram aplicadas. Resultados: Neuropatia diabética aproximou-se dos 30% e diabéticos não acometidos representaram maiores custos para a saúde no que se refere às consultas com clínico geral. Diabéticos sedentários, quando comparados com ativos, apresentaram custo com clínico geral 63% maior (P= 0,012). Quando comparados com os não insulino-dependentes, os doentes que utilizam insulina apresentaram custos mais elevados para medicamentos (R$40.554,9±2976 vs R$2.454,4±216; p= 0,001) e consultas de enfermagem (R$8.064,8±487 vs R$6.147,9±208; p= 0,001). Entre os insulino-dependentes, a atividade física não exerceu efeito aparente sobre nenhuma das variáveis de custo... / The initial hypothesis of this work is that the higher physical activity level among diabetic individuals may reduce the total cost treatment of DM2 and its complications. Objective: To analyze whether diabetics patients and with increased physical activity levels show lower cost with medicines, medical consultations and examination. Methods: A cross-sectional research conducted at two health centers in the city of Bauru - SP, Brazil. The sample consisted of 121 type 2 diabetic patients of both sexes and aged below 75 years. For this research we analyzed the clinical records of patients (calculating cost), evaluated the presence of neuropathy, assessed the nutritional status, measured blood pressure and applied questionnaires (physical activity, status economical and coronary risk). Data analysis was performed after the division of individuals into groups for physical activity: Active, Moderately active and Sedentary. One-way ANOVA and two-way ANOVA evaluated the interaction between practice of physical activities and indicators of medical cost. For categorical variables, the chi-square was used to verify the existence of associations. Logistic and linear regressions were also applied. Results: Diabetic neuropathy rate was approximately 30% and diabetic patients without its diagnosis presented higher costs for the health regarding consultations with the general practitioner. Sedentary diabetic subjects had 63% higher cost for general practitioner than active ones (p = 0.012). Diabetics insulin-dependent had higher costs for drugs (R$40.554,9±2976 vs R$2.454,4±216; p= 0,001) and nursing visits (R$8.064,8±487 vs R$6.147,9±208; p= 0,001) than those ones non-insulin-dependent. Among those using insulin, physical activity had no apparent effect on cost. The therapeutic scheme also influenced the cost, and diet increased the cost of treatment and exercise reduced it. Conclusion:... (Complete abstract click electronic access below)

Made available in DSpace on 2016-12-12T17:32:57Z (GMT). No. of bitstreams: 1 Resumo Patricia Parizotto.pdf: 161091 bytes, checksum: d059e0a75ccc3e787d2e5905df36bb01 (MD5) Previous issue date: 2015-07-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Diabetes is considered a rising public health problem and a social and economic aggravation due to the high cost of its treatment, complications and disabilities of the disease. The main complication of the disease is peripheral neuropathy, characterized by reduction of temperature, pain and tactile sensitivity, joint destruction and fractures, the increase in postural oscillation, reaction time and abnormal neuromuscular response in the face of disturbance. This study aims to investigate the relationship between plantar sensitivity, plantar pressure distribution and balance score in diabetic patients with and without peripheral neuropathy. This study aims to investigate the association between plantar sensitivity, plantar pressure distribution and balance score in diabetic patients with and without peripheral neuropathy. The sample consisted of 80 volunteer adults from both sexes, between 20 and 65, divided into three groups: 29 subjects in the diabetic group without Peripheral Neuropathy; 11 subjects in the diabetic group with peripheral neuropathy and 40 individuals in the control group. This study was performed evaluation of sensitivity (Sorri Bauru® esthesiometer, Brazil), the plantar pressure distribution (Emed-AT System, Novel) and postural balance (SMART EquiTest® the Neurocom Internacional Inc®). The characterization of the sample was used in descriptive statistics and independent t test. To verify the differences in sensitivity, plantar pressure distribution and balance between the groups we used the test Univariate ANOVA or Kruskal-Wallis test, with post hoc analysis with Bonferroni correction. The relationship between plantar sensitivity, peak pressure and balance score was performed by Spearman correlation test. For all the results, a significance level of p&#8804;0,05 was adopted. The result showed moderate negative correlation between the peak pressure and balance score only in the diabetic patients with peripheral neuropathy group. It was also possible to observe reduction of plantar sensitivity in diabetic patients compared to the control group and diabetic patients with neuropathy had greater contact area and peak pressure. Additionally, the findings show that diabetic subjects present reduced values on the balance score and directional control, but with increased levels of latency. In conclusion, diabetes subjects have reduced plantar sensitivity and balance, as well as changes in the distribution of plantar pressure compared the control group and the presence of peripheral neuropathy can directly affect the quality of life of this population. / O diabetes é considerado um problema ascendente de saúde pública e um agravante social e econômico devido ao elevado custo em seu tratamento, complicações e incapacidades da doença. A principal complicação da patologia é a neuropatia periférica, caracterizada por redução da sensibilidade tátil, térmica e dolorosa, elevação das lesões e infecções cutâneas, fratura e destruição articular, elevação da oscilação postural, do tempo de reação e anormalidade da resposta neuromuscular diante de perturbações. Este estudo tem por objetivo investigar a relação entre sensibilidade cutânea plantar, distribuição de pressão plantar e escore de equilíbrio em indivíduos diabéticos com e sem neuropatia periférica. A amostra foi composta por 80 adultos voluntários, de ambos os sexos, com idade entre 20 e 65 anos divididos em três grupos: 29 indivíduos no grupo de diabéticos sem neuropatia periférica; 11 indivíduos no grupo de diabéticos com neuropatia periférica e 40 indivíduos no grupo controle. Neste estudo foi realizada avaliação da sensibilidade (estesiômetro Sorri Bauru®, Brasil); da distribuição de pressão plantar (Sistema Emed-AT, Novel) e do equilíbrio postural (SMART EquiTest® da Neurocom Internacional Inc®). A caracterização da amostra foi utilizada estatística descritiva e teste t independente. Para verificar a diferença na sensibilidade, distribuição de pressão plantar e equilíbrio entre os grupos foram utilizados o teste ANOVA univariada ou o teste de Kruskal-Wallis, com análise post hoc com correção de Bonferroni. A relação entre sensibilidade cutânea plantar, pico de pressão e escore de equilíbrio foi realizado pelo teste de Correlação de Spearman. Para todos os resultados foi adotado um nível de significância de p&#8804;0,05. Os resultados evidenciaram correlação moderada e negativa entre o pico de pressão e o escore de equilíbrio apenas no grupo de diabéticos com neuropatia. Também foi possível observar redução da sensibilidade plantar nos indivíduos diabéticos em comparação ao grupo controle e que indivíduos diabéticos com neuropatia apresentaram maior área de contato e pico de pressão. Adicionalmente, os achados mostram que os indivíduos diabéticos apresentam valores reduzidos no escore de equilíbrio e controle direcional, porém com aumento nos valores da latência. Em conclusão, os indivíduos diabéticos apresentam redução da sensibilidade cutânea plantar e do equilíbrio, assim como alterações na distribuição de pressão plantar em comparação ao grupo controle e que a presença de neuropatia periférica pode afetar diretamente a qualidade de vida dessa população.