A influência do conhecimento de estudantes de medicina sobre o manejo com o fim da vida, considerando teorias éticas e aplicabilidade clínica, permanece controversa. Objetivamos investigar o conhecimento de estudantes de medicina sobre conceitos bioéticos a respeito dos tipos morais de morte (Eutanásia, Distanásia e Ortotanásia) e analisar a influência de suas experiências clínicas para praticá-los, em um hospital terciário do estado de São Paulo, Brasil. Nós entrevistamos 180 estudantes de medicina [distribuídos em Grupo 1 (G1) - estudantes do primeiro ao terceiro ano de graduação em medicina e Grupo 2 (G2) - estudantes do quarto ao sexto ano] para avaliar a influência do "curso de ética médica" em teorias éticas e prática clínica, utilizando um questionário fechado. O "curso de ética médica" não diferiu os grupos (P=0.704) sobre os conceitos bioéticos. Neologismos como Cacotanásia e Idiotanásia foram erroneamente considerados como conceitos bioéticos por 28% dos indivíduos. Além disso, 45.3% da amostra consideraram os profissionais de saúde inaptos ao manejo de pacientes terminais, principalmente G2 (29%) comparado a G1 (16.5%, P=0.031). O conceito de Eutanásia foi aceito por 41% da amostra, enquanto Ortotanásia por 98.2%. Dentre os estudantes de medicina que aceitaram maneiras para abreviar a vida (22.9%), 30.1% deles pertenciam a G1 enquanto somente 16.1% a G2 (P=0.049). Estudantes de medicina mostram desconhecimento sobre conceitos clássicos em Bioética. Além disso, consideram os profissionais de saúde inaptos ao manejo de pacientes terminais. O ideal ético considerando a "boa morte" reflete melhor aceitação dos estudantes de medicina pela Ortotanásia, sugerindo tendência em aplicá-la em sua futura prática clínica.

The influence of medical students' knowledge concerning end-of-life care, considering ethical theories and clinical practice, remains controversial. We aimed to investigate medical students' knowledge of bioethical concepts related to moral kinds of death (euthanasia, disthanasia, and orthothanasia) and to analyze the influence of their clinical experience on practicing such approaches in a tertiary hospital in the state of São Paulo, Brazil. We interviewed 180 medical students [distributed in Group 1 (G1) - first to third- year students, and Group 2 (G2) - fourth to sixth-year students] to evaluate the influence of the course on "medical ethics" on ethical theories and clinical practice, using a closed questionnaire. The course on "medical ethics" did not distinguish the groups (P=0.704) in relation to bioethical concepts. Neologisms such as "cacothanasia" and "idiothanasia" were incorrectly viewed as bioethical concepts by 28% of the interviewees. Moreover, 45.3% of the sample considered health care professionals incapable of managing terminally ill patients, especially G2 (29%) as compared to G1 (16.5%, P=0.031). The concept of euthanasia was accepted by 41% of sample, as compared to 98.2% for orthothanasia. Among medical students that accepted ways to abbreviate life (22.9%), 30.1% belonged to G1, and only 16.1% to G2 (P=0.049). These medical students were unfamiliar with common bioethical concepts. Moreover, they considered healthcare professionals incapable of managing terminally ill patients. The ethical ideal of the "good death" reflects better acceptance of orthothanasia by medical students, suggesting a tendency to apply it in their future clinical practice.

Resistência insulínica consiste em reduzida resposta celular a esse hormônio e, portanto, disfunção do transporte de glicose para o meio intracelular. Esse fenômeno associa-se a fatores genéticos e principalmente comportamentais relacionados a obesidade e comorbidades a ela associadas como diabetes melito tipo 2, hipertensão arterial e dislipidemia. Entretanto, fatores clínicos de resistência insulínica também estão presentes em diabéticos tipo 1 não obesos na conhecida síndrome de extrema resistência à insulina subcutânea e intramuscular (DRIASM). Condição rara que consiste em resistência à ação da insulina no tecido subcutâneo e muscular e sensibilidade normal, ou próxima do normal, quando administrada via intravenosa. Tratamentos propostos até o momento mostram-se pouco efetivos e se relacionam a complicações e falhas frequentes. Descrevemos dois casos de pacientes femininas de 45 e 46 anos com DRIASM que se diferenciam dos demais já descritos por apresentar diagnóstico de diabetes melito tipo 1 tardio, hiperglicemia constante associada a complicações catabólicas, microvasculares (retinopatia) e neuropáticas sem, no entanto, nenhum episódio de cetoacidose diabética. Os tratamentos propostos variaram desde aplicação de insulina intramuscular e intravenosa até listagem para possível realização de transplante de pâncreas como tentativa de tratamento definitivo. Este trabalho teve aprovação do Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto.

Insulin resistance signs reduced cellular response to this hormone and dysfunction of glucose transport to intracellular compartment. This phenomenon is associated to genetic factors and principally behavior factors correlating to obesity and its comorbidities, as type 2 diabetes mellitus, hypertension and dyslipidemia. However clinical factors of insulin resistance are still present at not obese type 1 diabetes in a known syndrome called type 1 diabetes mellitus with resistance to insulin administered subcutaneously and intramuscularly (DRIASM). This is a rare condition that consists into insulin resistance at subcutaneously and intramuscularly use and normal or near to normal sensitivity at intravenously way. Treatments until now proposed are ineffective and are related to frequent fails and complications. We report here two cases of DRIASM in 45 and 46 female patients that are different from others yet related because they have late diabetes type 1, sustained hyperglycemia associated to catabolic, microangiopathy and neuropathic complications without any ketoacidosis episode. The treatment vary from alternative ways for insulin infusion to inscription to a possible performance of pancreas transplantation like a experiment of definitive treatment. This report was approved by Research Ethic Committee from São José do Rio Preto medical school.

Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95% = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95% = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95% = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68%) with elevated serum triglyceride levels, compared to patients (48%, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors.

Objetivos. Analisar perfil bioquímico e caracterizar síndrome metabólica (SM) em pacientes com acompanhamento cardiológico, conforme critérios de NCEP-ATPIII e IDF. MÉTODOS: Foram estudados 200 pacientes e 140 controles, considerando colesterol total (CT), fração de colesterol de lipoproteína de alta (HDLc), baixa (LDLc) e muito baixa densidade (VLDLc), triglicérides (TG), glicemia de jejum, cintura abdominal e hipertensão arterial sistêmica (HAS). Admitiu-se nível de significância P<0,05. RESULTADOS: Pacientes apresentaram níveis elevados de glicemia (103±31,4mg/dL) e reduzidos de HDLc (48±13,4mg/dL) comparado aos controles (88±29,7mg/dL, P<0,0001; 53±15,9mg/dL, P=0,0075; respectivamente). Controles do sexo masculino, entre 31 e 50 anos, mostraram níveis aumentados de CT (215±40,4mg/dL), LDLc (134±34mg/dL), VLDLc (30±11,8mg/dL) e TG (150±59,4mg/dL) comparado às mulheres (185±38,2mg/dL, P=0,0137; 111±35,8mg/dL; P=0,0324; 19±9,7mg/dL; P=0,0009; 93±49mg/dL, P=0,0010; respectivamente). Mulheres acima dos 50 anos mostraram aumento de CT (216±35,9mg/dL), HDLc (54±12,8mg/dL) e LDLc (138±30,8mg/dL) comparado aos homens (190±44,7mg/dL, P=0,0103; 47±14,5mg/dL, P=0,0229; 119±33,3mg/dL; P=0,0176; respectivamente). Os critérios NCEP-ATPIII e IDF caracterizaram SM em 35,5% e 46% dos pacientes, respectivamente, com destaque para glicemia, TG e HAS. CONCLUSÃO: Níveis elevados de glicemia e reduzidos de HDLc destacam-se nos pacientes. Perfil lipídico alterado, em homens entre 31 e 50 anos, confere maior risco para doenças cardiovasculares em adulto jovem, enquanto padrão semelhante nas mulheres, após essa faixa etária, pode refletir alterações hormonais fisiológicas. Ambos os critérios para diagnóstico de SM distinguem pacientes de controles, destacando-se IDF, com parâmetros, no entanto, nem sempre associados a alto risco. Alta prevalência de SM em pacientes, mesmo com acompanhamento cardiológico, sugere predisposição para manifestações cardiovasculares em indivíduos brasileiros.

OBJECTIVE: To analyze the biochemical profile and to characterize metabolic syndrome (MS) in patients with cardiologic medical assistance using NCEP-ATPIII and IDF definitions. METHODS: Two hundred patients and 140 controls were studied, considering total cholesterol (TC), HDL-cholesterol (HDLc), LDL-cholesterol (LDLc), VLDL-cholesterol (VLDLc), triglycerides (TG), fasting glycemia, abdominal waist and hypertension. Significance level was defined as P<0.05. RESULTS: Patients showed increased glycemia levels (103±31.4mg/dL) and reduced HDLc levels (48±13.4mg/dL) when compared to controls (88±29.7mg/dL, P<0.0001 and 53±15.9mg/dL, P=0.0075; respectively). Male controls 31-50 years old showed increased TC levels (215±40.4mg/dL), LDL-cholesterol (134±34mg/dL), VLDL-cholesterol (30±11.8mg/dL) and TG (150±59.4mg/dL) when compared to women (185±38.2mg/dL, P=0.0137; 111±35.8mg/dL; P=0.0324; 19±9.7mg/dL; P=0.0009; 93±49mg/dL, P=0.0010; respectively). Women over 50 years of age showed increased TC concentrations (216±35.9mg/dL), HDL-cholesterol (54±12.8mg/dL) and LDL-cholesterol (138±30.8mg/dL) when compared to men (190±44.7mg/dL, P=0.0103; 47±14.5mg/dL, P=0.0229; 119±33.3mg/dL; P=0.0176; respectively). NCEP-ATPIII and IDF definitions had characterized MS in 35.5% and 46% of patients, respectively, bolding glycemia, TG and hypertension. CONCLUSION: Elevated glycemia levels and reduced HDLc levels were detected in patients. Altered lipid profile observed in men 31-50 years old signals higher risk for cardiovascular diseases in young adults, while a similar profile in aged women can reflect hormonal physiological changes. Both definitions for MS diagnosis discriminate patients from controls, especially IDF, sometimes with lower capacity to determine high risk for cardiovascular complications. The high prevalence of MS in patients, even with cardiologic medical assistance, suggests predisposition for cardiovascular manifestations in Brazilian individuals.