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OBJECTIVE: The aim of this study was to evaluate the prevalence and risk factors related to metabolic dysfunction-associated steatotic liver disease in inflammatory bowel disease patients. METHODS: This is a cross-sectional study conducted on adults with inflammatory bowel disease from 2019 to 2021. Metabolic dysfunction-associated steatotic liver disease encompasses patients with steatosis and at least one cardiometabolic risk factor. Patients with alcohol consumption ≥20 g/day, chronic liver diseases, or methotrexate use were excluded. RESULTS: Almost 140 patients were included: 67.1% were female, with a mean age of 49.7±13.7 years, and 63.6% had Crohn's disease. The mean duration of inflammatory bowel disease was 9.7±7.9 years. Metabolic dysfunction-associated steatotic liver disease was observed in 44.3% and advanced liver fibrosis was excluded in 63.5% by Fibrosis-4. Patients with metabolic dysfunction-associated steatotic liver disease were older (p = 0.003) and had a higher number of metabolic syndrome components (2.9±1.1 versus 1.6±1.0; p<0.001), greater abdominal circumference (p<0.001), and body mass index (p<0.001). The only factor related to inflammatory bowel disease associated with metabolic dysfunction-associated steatotic liver disease was disease duration (11.6±9.5 versus 8.3±6.2; p = 0.017). A higher number of metabolic syndrome components and obesity increase by 2.2 times and an altered waist circumference by 2.6 times the occurrence of metabolic dysfunction-associated steatotic liver disease. CONCLUSION: A high prevalence of metabolic dysfunction-associated steatotic liver disease was observed in patients with inflammatory bowel disease, with the main risk factors being associated with metabolic syndrome predicting it, but not with inflammatory bowel disease features and/or its treatment.
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Doenças Inflamatórias Intestinais , Síndrome Metabólica , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Prevalência , Adulto , Fatores de Risco , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/complicações , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Centros de Atenção Terciária , Brasil/epidemiologia , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/complicações , Índice de Massa Corporal , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/complicaçõesRESUMO
SUMMARY OBJECTIVE: The aim of this study was to evaluate the prevalence and risk factors related to metabolic dysfunction-associated steatotic liver disease in inflammatory bowel disease patients. METHODS: This is a cross-sectional study conducted on adults with inflammatory bowel disease from 2019 to 2021. Metabolic dysfunction-associated steatotic liver disease encompasses patients with steatosis and at least one cardiometabolic risk factor. Patients with alcohol consumption ≥20 g/day, chronic liver diseases, or methotrexate use were excluded. RESULTS: Almost 140 patients were included: 67.1% were female, with a mean age of 49.7±13.7 years, and 63.6% had Crohn's disease. The mean duration of inflammatory bowel disease was 9.7±7.9 years. Metabolic dysfunction-associated steatotic liver disease was observed in 44.3% and advanced liver fibrosis was excluded in 63.5% by Fibrosis-4. Patients with metabolic dysfunction-associated steatotic liver disease were older (p = 0.003) and had a higher number of metabolic syndrome components (2.9±1.1 versus 1.6±1.0; p<0.001), greater abdominal circumference (p<0.001), and body mass index (p<0.001). The only factor related to inflammatory bowel disease associated with metabolic dysfunction-associated steatotic liver disease was disease duration (11.6±9.5 versus 8.3±6.2; p = 0.017). A higher number of metabolic syndrome components and obesity increase by 2.2 times and an altered waist circumference by 2.6 times the occurrence of metabolic dysfunction-associated steatotic liver disease. CONCLUSION: A high prevalence of metabolic dysfunction-associated steatotic liver disease was observed in patients with inflammatory bowel disease, with the main risk factors being associated with metabolic syndrome predicting it, but not with inflammatory bowel disease features and/or its treatment.
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Our purpose in this study was to analyze perceptual and cardiovascular responses in low-load resistance training (RT) sessions associated with a fixed non-elastic band compressed to the proximal region of the arms (p-BFR) versus a pneumatic cuff inflated to a pressure of 150 mmHg (t-BFR). Participants (16 healthy trained men) were randomly assigned to two conditions of low-load RT (20% one repetition maximum [1RM]) with BFR (p-BFR or t-BFR). In both conditions, the participants performed five exercises (4 sets/30-15-15-15) for the upper-limbs, but in one of the conditions, the exercises were performed with a p-BFR induced by a non-elastic band, while in the other, the exercises were performed with a t-BFR using a device with similar width. The devices used to generate the BFR had similar widths (5 cm). Brachial blood pressure (bBP) and heart rate (HR) were measured before, after each exercise and after the experimental session (5-, 10-, 15-, and 20 min post-session). Rating of perceived exertion (RPE) and rating of pain perception (RPP) were reported after each exercise and 15 minutes post-session. HR increased during the training session in both conditions, with no differences between p-BFR and t-BFR. Neither intervention increased diastolic BP (DBP) during training, but there was a significant post-session reduction in DBP in the p-BFR, with no differences observed between conditions. There were no significant differences in RPE and RPP in the two training conditions, with both conditions associated with higher RPE and RPP at the end versus beginning of the experimental session. We conclude that when BFR device width and material are similar, low-load training with t-BFR and p-BFR promotes similar acute perceptual and cardiovascular responses in healthy trained men.
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Treinamento Resistido , Masculino , Humanos , Músculo Esquelético/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Hemodinâmica , Pressão SanguíneaRESUMO
This study evaluates the association of anthropometric indexes and the incidence of type 2 diabetes mellitus (T2DM) after a 5-year follow-up. This analysis included 1091 middle-aged participants (57% women, mean age 47 ± 15 years) who were free of T2DM at baseline and attended two health examinations cycles [cycle 1 (2005-2006) and cycle 2 (2010-2013)]. As expected, the participants who developed T2DM after five years (3.8%) had the worst metabolic profile with higher hypertension, dyslipidemia, and obesity rates. Besides, using mixed-effects logistic regression and adjustment for sex, age, and glucose, we found that one unit increase in body adiposity index (BAI) was associated with an 8% increase in their risk of developing T2DM (odds ratio [OR] = 1.08 [95% CI, 1.02-1.14]) and visceral adiposity index (VAI) was associated with a risk increase of 11% (OR = 1.11 [95% CI, 1.00-1.22]). Moreover, a one-unit increase in the triglycerides-glucose index (TyG) was associated with more than four times the risk of developing T2DM (OR = 4.27 [95% CI, 1.01-17.97]). The interquartile range odds ratio for the continuous predictors showed that TyG had the best discriminating performance. However, when any of them were additionally adjusted for waist circumference (WC) or even body mass index (BMI), all adiposity indexes lost the effect in predicting T2DM. In conclusion, TyG had the most substantial predictive power among all three indexes. However, neither BAI, VAI, nor TyG were superior to WC or BMI for predicting the risk of developing T2DM in a middle-aged normoglycemic sample in this rural Brazilian population.
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Diabetes Mellitus Tipo 2 , Adiposidade , Adulto , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Glucose , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade Abdominal/complicações , Fatores de Risco , Triglicerídeos , Circunferência da CinturaRESUMO
Use of the six-minute walk test has been proposed as a prognostic marker in liver cirrhosis. In the Letter to the Editor presented here, the authors highlight some important points, which were raised after the article was published in the November issue of the World Journal of Hepatology.
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Hypertension is the leading cause of overall mortality in low- and middle-income countries. In Brazil, there is paucity of data on the determinants of incident hypertension and related risk factors. We aimed to determine the incidence of hypertension in a sample from the Brazilian population and investigate possible relationships with body adiposity indexes. We assessed risk factors associated with cardiovascular disease, including adiposity body indexes and biochemical analysis, in a sample from the Baependi Heart Study before and after a 10-year follow-up. Hypertension was defined by the presence of systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or the use of antihypertensive drugs. From an initial sample of 1693 participants, 498 (56% women; mean age 38 ± 13 years) were eligible to be included. The overall hypertension incidence was 24.3% (22.3% in men and 25.6% in women). Persons who developed hypertension had higher prevalence of obesity, higher levels for blood pressure, higher frequency of dyslipidemia, and higher body adiposity indexes at baseline. The best prediction model for incident hypertension includes age, sex, HDL-c, SBP, and Body Mass Index (BMI) [AUC = 0.823, OR = 1.58 (95% CI 1.23-2.04)]. BMI was superior in its predictive capacity when compared to Body Adiposity Index (BAI), Body Roundness Index (BRI), and Visceral Adiposity Index (VAI). Incident hypertension in a sample from the Brazilian population was 24.3% after 10-year follow-up and BMI, albeit the simpler index to be calculated, is the best anthropometric index to predict incident hypertension.
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Adiposidade , Hipertensão , Adiposidade/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Fatores de Risco , Circunferência da Cintura/fisiologiaRESUMO
The conversion of azathioprine (AZA) to active 6-thioguanine nucleotides (6-TGN) is essential for its clinical efficacy; however, another metabolite formed, 6-methylmercaptopurine (6-MMP), is related to hepatotoxicity. Blood samples were collected from 37 patients under AZA's treatment, and a new HPLC-UV method was validated and applied for simultaneous quantification of 6-TGN and 6-MMP in erythrocytes of Crohn's disease (CD) patients. The concentration of 6-TGN and 6-MMP found ranged from 4.5 to 2,456 ρmol/8 × 108 red blood cells (RBCs) for 6-TGN and from 170 to 53,951 ρmol/8 × 108 RBCs for 6-MMP. Reduced levels of 6-MMP in patients into combo therapy with AZA and allopurinol (2,031 ρmol/8 × 108 RBCs) have been observed when compared to patients undergoing monotherapy with AZA (9,098 ρmol/8 × 108 RBCs). Additionally, there was a negative correlation (r = -83.7%, P < 0.05) between lymphocyte count and 6-TGN levels. The method developed is reliable, accurate and reproducible and can be used as an important tool in the monitoring routine of patients with CD under AZA treatment, allowing the individualization of the dose, monitoring adherence to the treatment and the evaluation of the clinical outcome of these patients.
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Azatioprina , Doença de Crohn , Azatioprina/efeitos adversos , Azatioprina/uso terapêutico , Cromatografia Líquida de Alta Pressão , Doença de Crohn/tratamento farmacológico , Doença de Crohn/metabolismo , Eritrócitos/metabolismo , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêuticoRESUMO
O movimento do ar do ambiente para os alvéolos é um fenômeno vital e complexo que ocorre devido às variações nas pressões intratorácicas e nas vias aéreas em relação à atmosfera. A construção de protótipos didáticos pode minimizar a abstração necessária nestes fenômenos in vivo. Neste estudo, automatizamos um protótipo didático de ventilação pulmonar já descrito na literatura para simular e exibir variações na pressão intratorácica durante a função diafragmática. Um protótipo de ventilação pulmonar (PV) foi produzido com materiais recicláveis, e automatizado adaptando um sensor de pressão no sistema para gerar curvas de pressão em função do tempo durante a simulação da função diafragmática. A tração descendente do êmbolo automatizado induzida pelo servomotor (como o diafragmático) reduziu a pressão dentro da garrafa (intratorácica), e esta variação pode ser observada graficamente em uma interface de computador enquanto o balão foi expandido, e o ar atmosférico invadiu seu interior. Conclusão: A incorporação da tecnologia em um protótipo PV simples permitiu uma demonstração segura e simulada de como o diafragma induz a variação da pressão intratorácica em relação à atmosfera concomitantemente com a deformação pulmonar que ocorre durante a inspiração e a exalação.
The movement of air from the environment to the alveoli is a vital and complex phenomenon that occurs due to variations in intrathoracic and airway pressures in relation to the atmosphere. The construction of didactic prototypes can minimize the abstraction required in these in vivo phenomena. In this study, we automated a didactic prototype of pulmonary ventilation already described in literature to simulate and exhibit variations in intrathoracic pressure during diaphragmatic function. A pulmonary ventilation (PV) prototype was produced with recyclable materials, and automated by adapting a pressure sensor in the system to generate pressure curves as a function of time during the simulation of diaphragmatic function. The automated plunger's downward traction induced by the servomotor (such as diaphragmatic) reduced the pressure inside the bottle (intrathoracic), and this variation can be observed graphically on a computer interface while the balloon was expanded, and atmospheric air invaded its interior. Conclusion: The incorporation of technology into a simple PV prototype allowed a safe and simulated demonstration of how the diaphragm induces the variation of the intrathoracic pressure in relation to the atmosphere concomitantly with the pulmonary deformation that occurs during inspiration and exhalation.
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BACKGROUND AND AIMS: The 6-minute walk test (6MWT) is a measure of the overall functional capacity and is associated with the risk of mortality in patients with liver cirrhosis and in those listed for liver transplantation. Nevertheless, physical performance has not yet been established as a predictor of the risk of clinical decompensation in patients with cirrhosis. We aimed to determine the capacity of the 6MWT to predict the clinical decompensation in patients with cirrhosis after 1 year of follow-up. METHODS: This prospective cohort study included patients with compensated cirrhosis of several etiologies. All participants had stable clinical conditions for at least 6 months prior to baseline. At baseline, patients performed the 6MWT and were followed up for 1 year to detect the decompensation outcomes. RESULTS: A total of 55 participants completed the evaluation and follow-up. The mean age was 56.3±10.5 years, and 65% were men. Around 65.4% were classified as Child-Pugh class A. In the receiver operating characteristic analysis, a walking distance ≤ 401.8 m during the 6MWT was set as the threshold for predicting clinical decompensation with 64% sensitivity and 82% specificity. Kaplan-Meier curve analysis revealed that patients who covered a distance of < 401.8 m during the test had a decompensation-free outcome rate of 30% as compared to the rate of 75% of those who walked > 401.8 m (p<0.001). CONCLUSIONS: The 6MWT was a significant predictor of clinical decompensation in patients with cirrhosis. A cutoff of 401.8 m was related to an increased risk of clinical decompensation in cirrhotic patients with a stable clinical condition at baseline. The 6MWT should be added to the clinical assessment of the cirrhotic population.
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Cirrose Hepática/fisiopatologia , Teste de Caminhada , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
O magnésio é um cátion de localização predominantemente intracelular e de grande importância em várias funções metabólicas. É possível que tenha uma participação importante em processos álgicos e inflamatórios. Sua dosagem sérica possivelmente não representa a realidade de sua concentração corporal. A mensuração do magnésio eritrocitário talvez possa representar um avanço na sua melhor avaliação
Magnesium is a cation with location predominantly intracellular and of great importance in several metabolic functions. It is possible that it plays an important role in pain and inflammatory processes. It's serum dosage possibly does not represent the reality of it's body concentration. The measurement of erythrocyte magnesium may represent an advance in its better evaluation.
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Humanos , Eritrócitos , Dosagem , Magnésio , Osteoartrite , Dor , Artrite Reumatoide , Cátions , InflamaçãoRESUMO
Considering that the incidence of type 2 diabetes mellitus (T2DM) has been increasing especially in developing countries and becoming a global public health problem, this study aims to evaluate the association between triglyceride glucose index (TyG) - which is a mathematical product of the fasting blood glucose and triglyceride levels - and incident T2DM in an adult sample in the Baependi Heart Study (BHS). The data were from the BHS cohort consisting of two periods: cycle 1 (2005-2006; n = 1712; 119 families) and cycle 2 (2010-2013; n = 3017; 127 families). A total of 1121 individuals (both sexes, 18-100 years) were selected if they were assessed in both cycles and not diagnosed with T2DM at baseline (cycle 1). Our findings showed that a participant's risk of developing T2DM increased almost 10 times for a one-unit increase in the TyG (odds ratio OR = 10.17, 95% CI, 7.51-13.93). The association when stratified by age was OR = 28.13 [95% CI, 14.03-56.41] for young adults, meaning that the risk of developing T2DM increased more than 28 times for a one-unit increase in the TyG. For the other groups, young middle-aged adults, old middle-aged adults, and seniors, we found OR = 4.84 [95% CI, 2.91-8.06], OR = 28.73 [95% CI, 10.63-77.65, and OR = 9.88 [95% CI, 3.16-30.90], respectively. A higher TyG implies a significant increase in the risk of developing T2DM, which could be an important screening tool to target early lifestyle intervention in Brazil.
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Esse ensaio busca caracterizar a crise que assola a neurociência, bem como tenta mapear suas possíveis causas. No final, são propostas possíveis soluções que passam por mudança na maneira de se avaliar os projetos de pesquisa, o abandono da questão mente-corpo, a extinção do termo neurociência e a proposta de que a ciência que estuda o sistema nervoso retome suas origens, seu objeto de estudo e volte a ser uma ciência natural.
This essay both defines the challenges neuroscience is currently facing and sheds light on the causes of these challenges. Furthermore, possible solutions are proposed. These include changes in the ways resarch projects are evaluated, extinction of the mind-body problem as well as the term neuroscience, and the proposal that science that studies the nervous system returns to its origins focusing on its study object, becoming a natural science again.
Este ensayo busca caracterizar la crisis que afecta a la neurociencia, así como tratar de mapear sus posibles causas. Al final, se proponen posibles soluciones, que experimentan un cambio en la forma de evaluar los proyectos de investigación, abandonando la pregunta mente-cuerpo, la extinción del término neurociencia y la propuesta de que la ciencia que estudia el sistema nervioso reanude sus orígenes, su objeto de estudio y volver a ser una ciencia natural.
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BACKGROUND: The association between diabetes and obesity is very well established. Faced with this, several anthropometric indices of adiposity are often involved in studies on diabetes. Our main goal in this paper is to evaluate the association between body adiposity index (BAI) and type 2 diabetes mellitus (T2DM) in a sample of the Brazilian population after 5-year follow-up. METHODS: The data used come from the Baependi Heart Study cohort, which consists of two periods: cycle 1 (2005-2006) and cycle 2 (2010-2013). Individuals of both sexes (n = 1121) were selected by excluding participants with type 2 diabetes mellitus at baseline or those that were lost to follow-up. RESULTS: The diabetic subjects showed higher systolic blood pressure, BAI, body mass index, waist circumference and fasting glucose levels. In addition, using mixed-effects logistic regression, we found that the elevation of a single unit of BAI represented an increase of 8.4% in the risk of a patient developing T2DM (OR = 1.084 [95% CI 1.045-1.124]). CONCLUSIONS: Obesity is recognised as one of the most important risk factors for T2DM and BAI has proven to be a useful tool in estimating the risk of a patient developing T2DM in a Brazilian population.
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OBJECTIVE: To estimate whether the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is biologically accurate for the diagnosis of Attention Deficit/ Hyperactivity Disorder (ADHD) using a biological-based classifier built by a special method of multivariate analysis of a large dataset of a small sample (much more variables than subjects), holding neurophysiological, behavioral, and psychological variables. METHODS: Twenty typically developing boys and 19 boys diagnosed with ADHD, aged 10-13 years, were examined using the Attentional Network Test (ANT) with recordings of event-related potentials (ERPs). From 774 variables, a reduced number of latent variables (LVs) were extracted with a clustering of variables method (CLV), for further reclassification of subjects using the k-means method. This approach allowed a multivariate analysis to be applied to a significantly larger number of variables than the number of cases. RESULTS: From datasets including ERPs from the mid-frontal, mid-parietal, right frontal, and central scalp areas, we found 82% of agreement between DSM and biological-based classifications. The kappa index between DSM and behavioral/psychological/neurophysiological data was 0.75, which is regarded as a "substantial level of agreement". DISCUSSION: The CLV is a useful method for multivariate analysis of datasets with much less subjects than variables. In this study, a correlation is found between the biological-based classifier and the DSM outputs for the classification of subjects as either ADHD or not. This result suggests that DSM clinically describes a biological condition, supporting its validity for ADHD diagnostics.
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Resumo Este ensaio lança um olhar crítico sobre as consequências, na prática do profissional de saúde, da produção de verdades científicas com base em modelos estatísticos. A estatística nos oferece visão probabilística de eventos naturais observados sistematicamente, e vários são os limites intrínsecos a seus métodos. Mas, no senso comum do meio científico, criou-se o imaginário da estatística como meio para obter verdades a respeito de sistemas complexos, da mesma forma que cientistas postulam princípios para a órbita dos planetas. Nesse contexto, as expectativas de sucesso ou fracasso em intervenções e a avaliação dos riscos e benefícios da aplicação de resultados experimentais podem ser perigosamente comprometidas no dia a dia da prática biomédica.
Abstract This essay aims to raise critical awareness about the bioethical risk of the understanding of statistics, as the production of scientific truths, within the practical life of the health professional. Statistics give us a probabilistic view of the natural events observed systematically, with innumerable limits intrinsic to their methods. But the scientific milieu also has its degree of non scientific perception, which created in the collective imagination of the scientific milieu the idea that statistics obtain truths about the complex systems of nature, truths as solid as the scientist's predictions about the orbits of the planets. Thus, the construction of expectations of success and failure in interventions, as well as the careful evaluation of the risks and benefits of the application of experimental results in human life, can be dangerously compromised in the day to day of the biomedical practices.
Resumen Este ensayo tiene el objetivo de suscitar la conciencia crítica acerca del riesgo bioético de la comprensión de la estadística como producción de verdades científicas en la vida práctica del profesional de salud. La estadística nos ofrece una visión probabilística de los eventos naturales observados sistemáticamente, con innumerables límites intrínsecos a sus métodos. Pero el medio científico también tiene su sentido común. Se creó en el imaginario colectivo del medio científico la idea de que la estadística obtiene verdades respecto de los sistemas complejos de la naturaleza, verdades tan sólidas como las predicciones del científico acerca de las órbitas de los planetas. Así, la construcción de expectativas de éxito y fracaso en intervenciones, así como la evaluación criteriosa de los riesgos y beneficios de la aplicación de resultados experimentales en la vida humana, pueden verse peligrosamente comprometidos en el día a día de las prácticas biomédicas.
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Prática Profissional , Gestão de Riscos , Interpretação Estatística de Dados , Pessoal de SaúdeRESUMO
AIMS: This self-report presents the case of a physician and university professor affected by amyotrophic lateral sclerosis, and his experience in adjusting his occupational activities through communication technologies, as a distance education lecturer. It is a personal communication written by the reported patient/professor. CASE DESCRIPTION: The Neurophysiology Subject at the Federal University of the Juiz de Fora Medical School includes clinical case discussions at an online teaching platform. The reported patient has been collaborating as a lecturer of this discipline following the amyotrophic lateral sclerosis diagnosis. His professional experience as a physician and personal experience as a patient with a neuromuscular disease enriches the virtual clinical discussions. Through distance education, the lecturer overcome the physical limitations imposed by his underlying condition. He is able to deepen the discussion, highlighting psychosocial aspects, doctor-patient relationship, and humanization in neurodegenerative diseases. CONCLUSIONS: The interaction with the students, through distance learning, of this neurophysiology lecturer suffering with advanced amyotrophic lateral sclerosis, resulted in greater interest, better commitment to patients' care, and better student performance in the subject. It also improved the professor's self-reported quality of life and satisfaction, as he overcame his physical and social limitations, "feeling useful" again.
OBJETIVO: Este autorrelato apresenta o caso de um médico e professor universitário, portador de esclerose lateral amiotrófica avançada, e sua experiência em ajustar as atividades ocupacionais por meio de tecnologias de comunicação, como professor de ensino à distância. Trata-se de uma comunicação pessoal escrita pelo próprio paciente/professor. DESCRIÇÃO DO CASO: A disciplina de Neurofisiologia do Curso de Medicina da Universidade Federal de Juiz de Fora dinamiza as aulas presenciais com discussões de casos clínicos à distância, via plataforma de ensino virtual. Surgiu a possibilidade do professor atuar como colaborador dessa disciplina, na qual pode aproveitar sua experiência enquanto médico e sua vivência como paciente vítima de doença neuromuscular nas discussões de casos com os estudantes. Através da educação à distância, esse médico e professor supera as limitações físicas impostas pela doença. Ele tem condições de aprofundar a discussão, evidenciando os aspectos biopsicossociais, relação médico-paciente e humanização nas doenças neurodegenerativas. CONCLUSÕES: A interação com os alunos, por meio do ensino à distância, desse professor de neurofisiologia acometido por esclerose lateral amiotrófica avançada, resultou em maior interesse, maior comprometimento com o atendimento aos pacientes e melhor desempenho dos estudantes na disciplina. Também melhorou a qualidade de vida e a satisfação autorrrelatadas pelo professor, ao superar suas limitações físicas e sociais e "sentir-se útil" novamente.
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Esclerose Lateral Amiotrófica , Reabilitação , Doenças NeuromuscularesRESUMO
OBJECTIVES:: Increased arterial stiffness is an important determinant of the risk of cardiovascular disease. Lipid profile impairment, especially hypercholesterolemia, is associated with stiffer blood vessels. Thus, the aim of this study was to determine which of the five circulating lipid components (high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL), total cholesterol (TC) and triglycerides) is the best predictor of increased arterial stiffness in an urban Brazilian population. METHODS:: A random sample of 1,662 individuals from the general population of Vitoria, Brazil (25-64 years), was selected, and lipid components were measured using standard methods. Pulse wave velocity was measured using a non-invasive automatic device, and increased arterial stiffness was defined as a pulse wave velocity ≥10 m/s. RESULTS:: In men, only total cholesterol (OR=1.59; CI=1.02 to 2.48, p=0.04) was associated with the risk of increased arterial stiffness. In women, HDL-C (OR=1.99; CI=1.18 to 3.35, p=0.01) and non-HDL-C (OR=1.61; CI=1.01 to 2.56, p=0.04) were good predictors of the risk of increased arterial stiffness. However, these associations were only found in postmenopausal women (OR=2.06; CI=1.00 to 4.26, p=0.05 for HDL-C and OR=1.83; CI=1.01 to 3.33, p=0.04 for non-HDL-C). CONCLUSION:: Our findings indicate that both HDL-C and non-HDL-C are good predictors of the risk of increased arterial stiffness in postmenopausal women in an urban Brazilian population and may be useful tools for assessing the risk of arterial stiffness.