Effects of chronic oral exposure to insecticide teflubenzuron on the midgut of the honey bee Apis mellifera workers: histopathological insights into pesticide toxicity.

The honey bee Apis mellifera plays a significant role as a pollinator of native and cultivated plants, by increasing the productivity of several cultures, preserving the flora, and producing forest seeds. However, bee populations are declining worldwide, including A. mellifera, due to Colony Collapse Disorder, mainly resulting from the constant use of pesticides in the crops. Teflubenzuron is a physiological insecticide that belongs to the benzoylurea group, which inhibits chitin synthesis, the main component of the insect integument classified as safe for non-target insects, including bees. However, its effect on non-target organs of insects remains unknown. The midgut is the main organ of the digestive tract, which works in digestion and absorption and may be exposed to pesticides that contaminate food resources. The present work aimed to verify if the insecticide teflubenzuron is toxic and has histopathological effects on the midgut of A. mellifera adult workers. Workers exposed orally and chronically to the field-realistic concentration of teflubenzuron present 81.54% mortality. The epithelium of the midgut of these bees presents high vacuolization, spherocrystals, cell fragments released to the organ lumen, apocrine secretion, nuclear pyknosis, loss of cell-cell contact, and damage to regenerative cell nests and to the peritrophic matrix. These results indicate that the chitin synthesis-inhibiting insecticide teflubenzuron is toxic to A. mellifera after chronic oral exposure, at realistic field concentration, although it is classified as non-toxic to adult and non-target insects.

Cananga odorata L., Illicium verum, and Foeniculum vulgare essential oils impair the reproduction of the cattle tick Rhipicephalus microplus (Acari: Ixodidae).

This study aimed to evaluate the acaricidal potential of the essential oils of Cananga odorata L. (ylang-ylang), Illicium verum (star anise), and Foeniculum vulgare (sweet fennel) in Rhipicephalus microplus engorged females. The essential oils were extracted by hydrodistillation, and the females were immersed in each essential oil at concentrations ranging from 10 µL/mL to 50 µL/mL, using 10% dimethyl sulfoxide as a solvent. Tick mortality was evaluated after seven and 14 days, and the following parameters were determined: female weight before oviposition, preoviposition period, egg mass weight, egg production index, incubation period, hatching rate, fecundity, percentage of reduction in oviposition, percentage of reduction in hatching and product efficacy. Lethal concentration (LC50) values were 34.42 µL/mL (28.34-40.86) for C. odorata and 40.60 µL/mL (32.58-58.21) for F. vulgare. This parameter was not calculated for I. verum because there was insufficient mortality at the concentrations evaluated. The greatest efficacy was observed in the group treated with 40 µL/mL F. vulgare essential oil (97.17%), followed by I. verum (91.35%) and C. odorata (86.19%) at the same concentration. Efficacy results were associated with a greater reduction in egg mass weight and lower hatching rates. Although the essential oils caused a slight acaricidal impact, they showed significant effects on the reproductive performance of R. microplus engorged females. Thus, the results of this study indicate that these essential oils can be used in the development of new acaricidal formulations.

Exploring the effects of the acaricide cyflumetofen on the vital organs of the honey bee Apis mellifera (Hymenoptera: Apidae) workers.

Bees are important for maintaining ecosystems, pollinating crops and producing marketable products. In recent years, a decline in bee populations has been reported, with multifactorial causes, including the intensification of pesticide use in agriculture. Among pesticides, cyflumetofen is an insecticide and acaricide used in apple, coffee and citrus crops, whose main pollinator is the honey bee Apis mellifera. Therefore, this bee is a potential target of cyflumetofen during foraging. This study evaluated the histopathological and cytological damage in the midgut, hypopharyngeal glands and fat body of A. mellifera workers exposed to LC50 of cyflumetofen. The midgut epithelium of exposed bees presented cytoplasmic vacuolization, release of vesicles and cell fragments, which indicate autophagy, increased production of digestive enzymes and cell death, respectively. The cytological analysis of the midgut revealed the dilation of the basal labyrinth and the presence of spherocrystals in the digestive cells. The hypopharyngeal glands produced greater amounts of secretion in treated bees, whereas no changes were observed in the fat body. The results indicate that acute exposure to cyflumetofen negatively affect A. mellifera, causing damage to the midgut and changes in the hypopharyngeal glands, which may compromise the survival and foraging of this pollinator.

Alpha- and beta-pinene isomers act differently to control Rhipicephalus microplus (Acari: Ixodidae).

The cattle tick Rhipicephalus microplus is an ectoparasite of high importance in veterinary medicine and public health. Since synthetic chemicals used to control these ticks can select resistant strains and cause toxic effects in their hosts, there is a need to identify effective substances with fewer adverse effects. For this reason, we investigated the effects of alpha- and beta-pinene, known for their various biological effects, on the mortality and reproductive performance of R. microplus engorged female ticks. The products were diluted in a 2% Tween 80 aqueous solution. The ticks were first weighed and then immersed in the test solutions for five minutes. Then, they were dried with paper towels and fixed dorsoventrally in Petri dishes, totalling five treatment groups for each pinene and a control group treated with the solvent alone. The ticks were monitored daily for mortality, and their eggs were collected and weighed. The larval hatching rate was estimated, and the pre-oviposition and incubation periods were determined. From these data, the following parameters were calculated: egg production index, fertility rate, estimated reproduction rate, percentages of reduction in oviposition and hatching, and product efficacy. Alpha-pinene showed better results at higher concentrations, unlike beta-pinene, which was more effective at lower concentrations. The effectiveness of alpha-pinene was 74% at a concentration of 14.0 µL/mL, while beta-pinene showed 78% efficacy at 2.0 µL/mL. The results indicated for the first time different effects of two isomers in ticks, suggesting that these compounds act on R. microplus females in different ways.

Association among 25-hydroxyvitamin D levels, hypertriglyceridemic-waist phenotype, and cardiometabolic markers in individuals with type 2 diabetes mellitus from regions with high solar incidence.

OBJECTIVE: To evaluate the relationship between vitamin D status and hypertriglyceridemic-waist (HTW) phenotype and cardiometabolic markers in individuals with type 2 diabetes mellitus (T2DM) living in regions with high solar incidence (10° south). METHODS: An observational, cross-sectional study, with 122 individuals with T2DM, of both sexes, aged between 19 and 59 years, residing in Sergipe/Brazil. Measurements included serum 25-hydroxyvitamin D (25[OH]D), glucose, insulin, total cholesterol, LDL-c, HDL-c, triacylglycerols, blood pressure, body mass index, %body fat, and waist circumference. Participants were classified by the presence or absence of the HTW phenotype, according to increased waist circumference and triacylglycerols concentrations. Logistic and linear regression models were applied to verify the association among the concentration of 25(OH)D, HTW phenotype, and lipid profile variables. RESULTS: Triacylglycerols concentrations (p = .013) and %body fat (p = .011) were higher in women with serum 25(OH)D insufficient/deficient than in those with adequate 25(OH)D levels. Individuals with serum 25(OH)D insufficiency/deficiency were 2.595 times more likely to present the HTW phenotype than those with adequate 25(OH)D levels (p = .021). Additionally, a negative association was observed between the concentration of 25(OH)D and total cholesterol (Beta = -0.204, p = .049). CONCLUSION: Insufficiency/deficiency of serum 25(OH)D in individuals with T2DM increases the chances of developing the HTW phenotype.

Supplementation of vitamin D isolated or calcium-associated with bone remodeling and fracture risk in postmenopausal women without osteoporosis: A systematic review of randomized clinical trials.

Menopause and vitamin D deficiency increase bone reabsorption and bone fracture risk in women in postmenopause, and vitamin D supplementation may improve bone health and decrease bone fracture risk. This study aims to discuss the effect of vitamin D supplementation, isolated or calcium-associated, on remodeling and fracture risk bone in women in postmenopause without osteoporosis. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO database registration: CRD42022359796). A search was conducted in four databases and gray literature using MeSH and similar terms related to supplements, vitamin D, calcium, remodeling, and fracture bone, without the restriction of language and year of publication. A total of 3460 studies were identified, and nine were selected. Vitamin D supplementation increased 25-hydroxyvitamin D levels ≥10 ng/mL and decreased parathyroid hormone secretion dependent on baseline levels. The doses of 400 IU of vitamin D improved the percentage of carboxylated osteocalcin, whereas 800 to 1000 IU combined with calcium resulted in reduced, improved, or maintained bone mineral density and reduced alkaline phosphatase levels. However, 4000 IU alone or combined with calcium for 6 mo did not improve C-telopeptide and procollagen type 1 peptide levels. Additionally, 15 000 IU/wk increased the cortical area of metacarpal bone, whereas 500 000 IU of vitamin D annually for 5 y did not contribute to reducing the fracture risk and falls. Only one study found a reduction in fracture risk (dose of 800 IU of vitamin D plus 1200 mg of calcium). Thus, the vitamin D supplementation, alone or calcium-associated, improved the status of 25-hydroxyvitamin D and bone remodeling, but it was not possible to assert that it reduced fracture bone risk in postmenopausal women.

Adherence to Online Nutritional Monitoring Was Associated with Better Food Habits in People with T1DM during the COVID-19 Pandemic in Brazil.

Until this moment, no research has been found that has assessed adherence to online nutritional monitoring by adults with Diabetes Mellitus Type 1 (T1DM) during the pandemic. This article aims to analyze the association between eating habits and adherence to nutritional online care by adults with T1DM during social distancing because of the COVID-19 pandemic in Brazil. A cross-sectional study was carried out in July 2020. An online form was used to collect sociodemographic data, financial status, eating habits, carrying out online nutritional monitoring, and adherence to social distancing. Pearson's chi-squared test was performed with adjusted residual analysis and binomial logistic regression analysis (p < 0.05). Out of the 472 adults, only 8.9% had consulted with a nutritionist. Doing nutritional monitoring online during social distancing was associated with a reduction in the consumption of ultra-processed foods (p = 0.021), eating more servings of fruit (p = 0.036), and doing carbohydrate counting (CC) more frequently (p = 0.000). Doing nutritional monitoring online increased adherence to carbohydrate counting by 2.57 times and increased the consumption of fruits by 0.423 times. Therefore, nutritional monitoring, even if performed remotely, can influence the acquisition and maintenance of healthier eating habits, in addition to assisting adherence to the practice of CC.

Toxic effect of Callistemon viminalis essential oil on the ovary of engorged Rhipicephalus microplus female ticks (Acari: Ixodidae).

Rhipicephalus microplus is the main ectoparasite of cattle and its parasitism can reduce weight gain of hosts, in addition to causing anemia, increasing the risk of myiasis, and resulting in the transmission of Babesia bovis and Anaplasma marginale, among other pathogens. The use of synthetic chemicals plays an important role in controlling these ticks. However, its frequent and indiscriminate use has contributed to the selection of resistant strains, resulting in greater interest in the search for natural-origin products. The shrub Callistemon viminalis (Myrtaceae), also known as weeping bottlebrush, is known for its antibacterial, acaricidal, repellent, and antifungal activities, but there are no reports in the literature about its effects on the internal morphology of ticks. This study aimed to extract and characterize the essential oil obtained from the leaves of C. viminalis. Additionally, its effects on the ovary morphology of engorged R. microplus were assessed through histological, histochemical, and morphometric techniques. Exposure to C. viminalis caused dose-dependent morphological changes, such as cellular alterations in the epithelial layer lining the ovary lumen and the pedicel, irregularity of the chorion and oocyte shape, changes in protein and carbohydrate content, decrease in oocyte size, reduction in the size of the nucleus as well as cytoplasmic and nucleolar vacuolation. Thus, C. viminalis essential oil exhibited a toxic effect on the reproductive system of R. microplus, which may result in the reproductive impairment of this tick species.

Magnesium Status and Dietary Patterns Associated with Glycemic Control in Individuals with Type 2 Diabetes Mellitus.

Hypomagnesemia and unhealthy eating patterns are associated with poor glycemic control in individuals with type 2 diabetes mellitus (T2DM). This study aimed to associate magnesium status and dietary patterns with glycemic control in T2DM individuals. This cross-sectional study included 147 individuals with T2DM, aged between 19 and 59 years, of both sexes, residents in Sergipe/Brazil. The BMI, waist circumference, %body fat, plasma magnesium, serum glucose, insulin, %HbA1c, triacylglycerol, total cholesterol, LDL-c, and HDL-c were analyzed. Eating patterns were identified using a 24-h recall method. Logistic regression models were used to verify the association of magnesium status and dietary patterns with markers of glycemic control by adjusting for sex, age, time of T2DM diagnosis, and BMI. A P value < 0.05 was considered significant. Magnesium deficiency increased the chance of elevated %HbA1c by 5.893-fold (P = 0.041). Three main dietary patterns were identified: mixed (MDP), unhealthy (UDP), and healthy (HDP). UDP also increased the chance of elevated %HbA1c levels (P = 0.034). T2DM individuals' who presented magnesium deficiency had a higher chance of elevated %HbA1c levels (8.312-fold) and those in the lowest quartile (Q) of the UDP (Q1: P = 0.007; Q2: P = 0.043) had a lower chance of elevated %HbA1c levels. However, the lower quartiles of the HDP were associated with a greater chance of alterations in the %HbA1c level (Q1: P = 0.050; Q2: P = 0.044). No association was observed between MDP and the variables studied. Magnesium deficiency and UDP were associated with a higher chance of inadequate glycemic control in T2DM individuals.

Comparative toxicological evaluation of carvacrol, acetylcarvacrol anda fipronil-based pesticide in human blood cells.

Plant-derived chemicals are promising substances to control arthropod pests, although synthetic ones are still the most frequently used. Thus, comparative toxicological studies are needed to determine if natural substances are safe alternatives to replace the use of synthetic chemicals. This study aimed to compare the toxicity of carvacrol (natural origin), acetylcarvacrol (semi-synthetic) and a fipronil-based pesticide (synthetic). We assessed the effects of these chemicals on hemolytic activity, erythrocytes morphology and leucocyte viability using whole blood from human subjects. Additionally, DNA damage was evaluated through comet and DNA fragmentation assays. Fipronil and carvacrol caused hemolysis at concentrations ranging from 0.5 to 2.0%, whereas acetylcarvacrol did not cause hemolysis at 0.5 and 0.75%. Fipronil and carvacrol caused severe alterations in erythrocytes' morphology at 2%, such as ghost erythrocytes, elliptocyte-like shape and rouleau-like shape, presenting only 3.3 and 8.3% normal cells, respectively, at this concentration. However, 73.3% erythrocytes incubated with 2% acetylcarvacrol exhibited normal morphology. Fipronil considerably reduced leucocytes viability, decreasing it to 78% at 2%. Carvacrol and acetylcarvacrol showed no differences in leucocyte viability for 0.5 to 1.0%, but a decrease was observed for 2% carvacrol. The comet assay showed similar DNA damage for fipronil and carvacrol, but it was significantly lower for 1 and 2% acetylcarvacrol. Incubation with genomic DNA showed that only fipronil caused fragmentation of this molecule. Thus, we conclude that carvacrol and fipronil can present similar toxicity at higher concentrations. However, acetylation of carvacrol significantly reduced its toxicity to human blood cells compared with the other chemicals.

Adherence to Carbohydrate Counting Improved Diet Quality of Adults with Type 1 Diabetes Mellitus during Social Distancing Due to COVID-19.

To control glycemic variability in people with Type 1 diabetes mellitus (T1DM), it is essential to perform carbohydrate counting (CC), a strategy that ensures better quality of life for these patients. Thus, this study aims to analyze potential factors associated with adherence to CC in adults with T1DM during social distancing due to COVID-19 in Brazil. This was a single cross-sectional study carried out in July 2020. An online form was used to collect sociodemographic and economic data on the purchasing of supplies and food, as well as social distancing. The Chi-square test was performed with adjusted residuals analysis and a binomial logistic regression analysis (p < 0.05). Of 472 adults, 37.71% reported performing CC in the same frequency as before social distancing. There was an association between performance of CC and the type of city (p = 0.027), family income (p = 0.000), use of financial emergency aid (p = 0.045), type of insulin administration and glycemic monitoring (p < 0.000), and cooking more (p = 0.012). Participants who maintained or reduced consumption of ultra-processed foods were 0.62 times more likely to adhere to CC (OR 0.626, 95% IC: 0.419−0.935) and participants who cooked more were 1.67 times more likely to adhere to CC (OR 1.67, 95% CI: 1.146−2.447). There are still people with T1DM who did not know about and did not use CC method, which highlights the need for diabetes education.

Relationship between Eating Behavior, Quality of Life and Weight Regain in Women after Bariatric Surgery.

Individuals undergoing bariatric Surgery (BS) may have long-term weight regain. There is a need to investigate factors that may be related to this and if they can interfere with Quality of Life (QOL). This study aims to evaluate the relationship between eating behavior, perception of QOL, and weight regain in women after 24 months of bariatric surgery. This was a transversal study with 50 adult women residents in the city of Belém, Brazil. Sociodemographic, anthropometric, eating behavior (Three-Factor Eating Questionnaire­TFEQ-21) and perception of QOL (Item Short Form Healthy Survey­SF-36) data were collected. In 60% (n = 30) there was weight regain (≥15%), with a mean weight regain of 23.3% (±18.4). Emotional eating was the most frequent pattern (p = 0.047). Regarding QOL, the functional capacity and limitation due to physical aspects domains had a better perception (p < 0.0001). Women without weight regain showed a better perception of the functional capacity aspects (p = 0.007), limitation due to physical aspects (p = 0.044), social aspects (p = 0.048), and general physical components (p = 0.016) and also had an inverse association with the perception of QOL in physical components (p = 0.008). Patterns of eating behavior and weight regain can damage the perception of QOL, especially physical capacity. Long-term follow-up is essential to evaluate the behavior of people who have undergone BS in order to prevent weight regain and QOL damage.

Neutrophil-lymphocyte Ratio and C-Reactive Protein Levels are not Associated with Strength, Muscle Mass, and Functional Capacity in Kidney Transplant Patients.

Chronic inflammation has been associated with components of sarcopenia; however, these associations are unknown in kidney transplant patients (KTPs). The aim of this study was to associate neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) with strength, muscle mass, and functional capacity in KTPs. A cross-sectional study evaluating 108 KTPs was performed. Strength was evaluated by handgrip strength and five-times-sit-to-stand test (5STS), and appendicular skeletal muscle mass (ASM) was estimated by bioelectrical impedance analysis. The ASM index (ASMI) was calculated using the ASM (kg)/height (m2). Functional capacity was assessed by the 4-m gait speed test and short physical performance battery (SPPB). The electrochemiluminescence method was used for analyzing CRP levels, and the cytometric method XN-3000 Sysmex was used for obtaining leukogram values to calculate the NLR. Linear regression analysis was used to assess the association between systemic inflammation and sarcopenia components, adjusting for confounders. NLR and CRP levels were not associated with handgrip strength (ß = - 0.231, p = 0.389; ß = - 0.291, p = 0.577), 5STS (ß = - 0.114, p = 0.288; ß = - 0.202, p = 0.334), ASM (ß = - 0.027, p = 0.813; ß = 0.062, p = 0.788), ASMI (ß = - 0.036, p = 0.242; ß = 0.040, p = 0.505), 4-m gait speed (ß = 0.013, p = 0.082; ß = 0.004, p = 0.769), and SPPB (ß = 0.076, p = 0.170; ß = 0.152, p = 0.157), respectively. In conclusion, NLR and CRP levels were not associated with muscle mass, strength, and functional capacity in KTPs.

Role of food fortification with vitamin D and calcium in the bone remodeling process in postmenopausal women: a systematic review of randomized controlled trials.

CONTEXT: Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover. OBJECTIVE: To discuss effects of the intake of vitamin D-fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women. DATA SOURCES: PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as "grey literature". Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used. DATA EXTRACTION: Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations. DATA ANALYSIS: Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (-0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL. CONCLUSIONS: The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women. PROSPERO REGISTRATION NUMBER: CRD42019131976.

Variation of dipteran ectoparasites (Streblidae) on Anoura geoffroyi Gray, 1838 (Phyllostomidae) in two caves in southeastern Brazil.

Bats are parasitized by many different arthropods, among which the dipteran families Nycteribiidae and Streblidae are exclusive to bats. Researches that relate the ecology of ectoparasites with their hosts are fundamental for understanding issues related to the interactions between these two groups, in addition to epidemiological aspects of pathogen transmission. The present study evaluated the rate of infestation by dipteran (Streblidae) ectoparasites in two colonies of Anoura geoffroyi associated with caves in the southeastern Brazil. It also evaluated whether parasitological indices differ significantly with regard to host sex and reproductive condition. A total of 1377 bats were captured, of which 84% were parasitized. From these, a total of 5047 streblid bat flies belonging to three species of three genera were collected and identified. The most abundant was Exastinion clovisi (57%), followed by Anastrebla modestini (30%) and Trichobius propinquus (13%). In general, the populations of ectoparasites fluctuated throughout the year, with peaks of abundance during the rainy season. The sex ratios for the species of ectoparasites were close to one, which differs from what is reported in the literature. In addition, there were significant differences in parasitism rates in relation to host sex and reproductive condition. In both populations, ectoparasite infestation of pregnant or lactating females was significantly higher than for non-reproductive females. New studies aimed at assessing whether these higher rates of infestation have any effect on female bat reproduction are needed.

Insumos para manejo do Diabetes Tipo 1 durante o distanciamento social por COVID-19 no Brasil / Supplies for Type 1 Diabetes management during COVID-19 social distancing in Brazil

O estudo analisou fatores socioeconômicos associados à aquisição de insumos para manejo da glicemia por pessoas com Diabetes Mellitus tipo 1 durante o distanciamento social pela Pandemia de COVID-19 no Brasil. Pesquisa transversal com coleta de dados realizada durante 21 dias do mês de julho de 2020, com um formulário online sobre dados socioeconômicos e aquisição de insumos para monitorização glicêmica. Foi aplicado o teste Qui-Quadrado de Pearson com análise de resíduos ajustados (p<0,05). Participaram 472 adultos de ambos os sexos. Foram encontradas associações entre o tipo de aparelho utilizado para monitorização glicêmica (glicosímetro ou sistema Flash) e renda (p<0,000), escolaridade (p=0,007), macrorregiões (p=0,049) e tipo de cidade (p=0,043); entre aquisição de insulinas e renda (p<0,000), macrorregião (p=0,027) e tipo de bairro (p=0,003); entre aquisição de fitas reagentes e renda (p<0,000); entre aquisição de lancetas e renda (p=0,001), tipo de cidade (p=0,035) e de bairro (p=0,010); entre o uso de Sistema Flash e renda (p<0,000) e tipo de bairro (p=0,006). Os resultados expõem as desigualdades sociais na aquisição de insumos para manejo da glicemia por pessoas com Diabetes Tipo 1 durante a Pandemia no Brasil.

This study analyzed socioeconomic factors related with the acquisition of supplies for blood glucose management by people with Type 1 Diabetes Mellitus during social distancing due to the COVID-19 Pandemic in Brazil. This was a cross-sectional study with data collected during 21 days in July 2020, by an online form on socioeconomic data and acquisition of supplies for glycemic monitoring. This research applied Pearson's Chi-Squared test with adjusted residual analysis (p<0.05). 472 adults of both sexes participated. Relationships were found between the type of device used for blood glucose monitoring (glucometer or Flash system) and income (p<0.000), education (p=0.007), macro-regions (p=0.049), and type of city (p=0.043); between insulin acquisition and income (p<0.000), macro-region (p=0.027) and type of neighborhood (p=0.003); between acquisition of reagent strips and income (p<0.000); between acquisition of lancets and income (p=0.001), type of city (p=0.035) and neighborhood (p=0.010); between the use of Flash System and income (p<0.000) and type of neighborhood (p=0.006). The results expose the social inequalities in the acquisition of supplies for blood glucose management by people with Type 1 Diabetes during the Pandemic in Brazil.

Evaluation of the Relationships between Simple Anthropometric Measures and Bioelectrical Impedance Assessment Variables with Multivariate Linear Regression Models to Estimate Body Composition and Fat Distribution in Adults: Preliminary Results.

BACKGROUND: Overweight and obesity are conditions associated with sedentary lifestyle and accumulation of abdominal fat, determining increased mortality, favoring chronic diseases, and increasing cardiovascular risk. Although the evaluation of body composition and fat distribution are highly relevant, the high cost of the gold standard techniques limits their wide utilization. Therefore, the aim of this work was to explore the relationships between simple anthropometric measures and BIA variables using multivariate linear regression models to estimate body composition and fat distribution in adults. METHODS: In this cross-sectional study, sixty-eight adult individuals (20 males and 48 females) were subjected to bioelectrical impedance analysis (BIA), anthropometric measurements (waist circumference (WC), neck circumference (NC), mid-arm circumference (MAC)), allowing the calculation of conicity index (C-index), fat mass/fat-free mass (FM/FFM) ratios, body mass index (BMI) and body shape index (ABSI). Statistical analyzes were performed with the R program. Nonparametric Statistical tests were applied to compare the characteristics of participants of the groups (normal weight, overweight and obese). For qualitative variables, the Fisher's exact test was applied, and for quantitative variables, the paired Wilcoxon signed-rank test. To evaluate the linear association between each pair of variables, the Pearson correlation coefficient was calculated, and Multivariate linear regression models were adjusted using the stepwise variable selection method, with Akaike Information Criterion (p ≤ 0.05). RESULTS: BIA variables with the highest correlations with anthropometric measures were total body water (TBW), body fat percentage (BFP), FM, FFM and FM/FFM. The multiple linear regression analysis showed, in general, that the same variables can be estimated through simple anthropometric measures. CONCLUSIONS: The assessment of fat distribution in the body is desirable for the diagnosis and definition of obesity severity. However, the high cost of the instruments (dual energy X-ray absorptiometry, hydrostatic weighing, air displacement plethysmography, computed tomography, magnetic resonance) to assess it, favors the use of BMI in the clinical practice. Nevertheless, BMI does not represent a real fat distribution and body fat percentage. This highlights the relevance of the findings of the current study, since simple anthropometric variables can be used to estimate important BIA variables that are related to fat distribution and body composition.

Effect of spontaneous breathing on ventilator-free days in critically ill patients-an analysis of patients in a large observational cohort.

BACKGROUND: Mechanical ventilation can injure lung tissue and respiratory muscles. The aim of the present study is to assess the effect of the amount of spontaneous breathing during mechanical ventilation on patient outcomes. METHODS: This is an analysis of the database of the 'Medical Information Mart for Intensive Care (MIMIC)'-III, considering intensive care units (ICUs) of the Beth Israel Deaconess Medical Center (BIDMC), Boston, MA. Adult patients who received invasive ventilation for at least 48 hours were included. Patients were categorized according to the amount of spontaneous breathing, i.e., ≥50% ('high spontaneous breathing') and <50% ('low spontaneous breathing') of time during first 48 hours of ventilation. The primary outcome was the number of ventilator-free days. RESULTS: In total, the analysis included 3,380 patients; 70.2% were classified as 'high spontaneous breathing', and 29.8% as 'low spontaneous breathing'. Patients in the 'high spontaneous breathing' group were older, had more comorbidities, and lower severity scores. In adjusted analysis, the amount of spontaneous breathing was not associated with the number of ventilator-free days [20.0 (0.0-24.2) vs. 19.0 (0.0-23.7) in high vs. low; absolute difference, 0.54 (95% CI, -0.10 to 1.19); P=0.101]. However, 'high spontaneous breathing' was associated with shorter duration of ventilation in survivors [6.5 (3.6 to 12.2) vs. 7.6 (4.1 to 13.9); absolute difference, -0.91 (95% CI, -1.80 to -0.02); P=0.046]. CONCLUSIONS: In patients surviving and receiving ventilation for at least 48 hours, the amount of spontaneous breathing during this period was not associated with an increased number of ventilator-free days.

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS. / Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS.

OBJECTIVE: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. METHODS: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. RESULTS: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. CONCLUSION: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

OBJETIVO: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. MÉTODOS: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. RESULTADOS: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. CONCLUSÃO: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.