"Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

BACKGROUND: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. METHODS: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. RESULTS: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. CONCLUSIONS: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

Correction to: When Might Heterosexual Men Be Passive or Compassionate Toward Gay Victims of Hate Crime? Integrating the Bystander and Social Loafing Explanations.

The following errors were present in this article as originally published.

When Might Heterosexual Men Be Passive or Compassionate Toward Gay Victims of Hate Crime? Integrating the Bystander and Social Loafing Explanations.

Compassionate feelings for people who are victimized because of their perceived sexual deviance (e.g., gay men) may be incompatible with support for heterosexual norms among heterosexual men. But, indifference (or passivity) toward such victims could raise concern over heterosexual men's gay-tolerance attitude. Two classic social psychological theories offer competing explanations on when heterosexual men might be passive or compassionate toward gay victims of hate crime. The bystander model proposes passivity toward victims in an emergency situation if other bystanders are similarly passive, but compassionate reactions if bystanders are responsive to the victims. Conversely, the social loafing model proposes compassionate reactions toward victims when bystanders are passive, but passivity when other bystanders are already responsive toward the victims' predicament. We tested and found supportive evidence for both models across two experiments (Ntotal = 501) in which passivity and compassionate reactions to gay victims of a purported hate crime were recorded after heterosexual men's concern for social evaluation was either accentuated or relaxed. We found that the bystander explanation was visible only when the potential for social evaluation was strong, while the social loafing account occurred only when the potential for social evaluation was relaxed. Hence, we unite both models by showing that the bystander explanation prevails in situations where cues to social evaluation are strong, whereas the social loafing effect operates when concern over social judgement is somewhat muted.

Pregnancy after 24 Postoperative Months of Roux-En-Y Gastric Bypass Presents Risk of Pregnancy Complications Similar to Pregnancy within the First Postoperative Year.

BACKGROUND: To assess the influence of the time interval between pregnancy and the Roux-en-Y gastric bypass (RYGB) on maternal-infant complications. METHODS: This is an analytical, longitudinal and retrospective study comprising 42 pregnant women who had previously undergone RYGB, subdivided according to the time interval between pregnancy and bariatric surgery: ≤12 months (G1), >12 and <24 months (G2) and ≥24 months (G3). Anthropometric variables of mothers, newborns and information on pregnancy complications were collected. RESULTS: G1 was the group more likely to develop urinary tract infection, dumping syndrome and inadequacy of birth weight than G2. Pregnancy complications were similar and >80.0% both in the first 12 months and after 24 months of the RYGB and the smallest percentages occurred in the time interval of 12-24 months after it. In addition, the percentage of neonatal complications was the highest in G1 when compared to the other times studied. CONCLUSION: Our findings indicate less predisposition to maternal-infant complications in pregnancies occurring in the time interval of >12 and <24 months and suggest that pregnancy after 24 months can be as harmful as pregnancies occurring before the first 12 postoperative months, since a great catabolism occurs at this time as it has been shown in the literature.

Vitamin D and its relation with ionic calcium, parathyroid hormone, maternal and neonatal characteristics in pregnancy after roux-en-Y gastric bypass.

PURPOSE: The objective of this study was to evaluate vitamin D nutritional status and its relation with ionic calcium, parathyroid hormone (PTH), maternal anthropometry and perinatal outcomes in pregnant women who previously underwent Roux-en-Y gastric bypass (RYGB) surgery. METHODS: In a clinic specialized in obesity control located in the city of Rio de Janeiro (Brazil), the following information were collected for adult women who underwent RYGB before pregnancy: serum concentrations of vitamin D [25(OH)D], calcium and PTH per gestational trimester and data on maternal anthropometry, gestational intercurrences and perinatal outcomes. RESULTS: The present study included 46 post-RYGB pregnant women. The prevalence of pregnant women with deficiency (≤20 ng/mL) or insufficiency (≥21 and 29 ng/mL) of vitamin D was above 70% in all trimesters. The prevalence of calcium deficiency was 15.2% in the first and in the second trimesters and 20% in the third trimester, while the prevalence of excess PTH was 19.6, 30.4 and 32.6% in the first, the second and the third trimesters, respectively. In the second and the third trimesters, a significant difference was observed between concentrations of 25(OH)D, and a negative correlation was observed between concentrations of calcium and PTH. Association of 25(OH)D with urinary tract infection (UTI) was found, but there was no association with calcium, PTH, maternal anthropometry, type of delivery and weight and gestational age at birth CONCLUSIONS: The post-RYGB pregnant women showed an elevated serum inadequacy (deficiency or insufficiency) of 25(OH)D during pregnancy. Maternal vitamin D status showed no association with maternal variables, except UTI, and the neonatal variables analyzed.

Vitamin A concentration in human milk and its relationship with liver reserve formation and compliance with the recommended daily intake of vitamin A in pre-term and term infants in exclusive breastfeeding.

PURPOSE: To evaluate vitamin A concentration in mature breast milk of nursing mothers aiming to meet the daily needs and the formation of liver reserve in pre-term (PT) and term infants (T) in comparison with the recommended intake for this nutrient in this group. METHODS: We analyzed the retinol concentration in the milk of 120 nursing mothers (40 of PT infants and 80 of T infants) by collecting 10 mL of mature breast milk, held by a hand spray of one of the breasts 2 h after the last feeding in the morning. The cutoff points adopted for identification of vitamin A deficiency (VAD) and the liver reserve were <1.05 and >2.3 µmol/L, respectively. RESULTS: The concentrations of retinol in the human milk of T infants were superior to concentrations in the milk of PT infants (1.87 + 0.81 > 1.38 + 0.67 µmol/L, p < 0.0001). They were higher in T compared to PT (352.64 + 152.72 > 217.65 + 105.65 µg, p < 0.0001), but both were below the recommendation. VAD was 20.0 % (T) and 27.5 % (PT). Only 40.0 % (T) and 22.5 % (PT) of the mothers had retinol concentrations in milk above 2.3 mmol/L. CONCLUSION: The milk of the nursing mothers studied did not have enough retinol to meet the daily needs and to form liver reserve in both groups, especially in PT newborns. This finding reinforces the idea that supplementation with massive doses of vitamin A in the immediate postpartum period can be used as a protective device of the infant against VAD.

Changes to its peptidoglycan-remodeling enzyme repertoire modulate ß-lactam resistance in Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a leading cause of hospital-acquired infections and is resistant to many antibiotics. Among its primary mechanisms of resistance is expression of a chromosomally encoded AmpC ß-lactamase that inactivates ß-lactams. The mechanisms leading to AmpC expression in P. aeruginosa remain incompletely understood but are intricately linked to cell wall metabolism. To better understand the roles of peptidoglycan-active enzymes in AmpC expression-and consequent ß-lactam resistance-a phenotypic screen of P. aeruginosa mutants lacking such enzymes was performed. Mutants lacking one of four lytic transglycosylases (LTs) or the nonessential penicillin-binding protein PBP4 (dacB) had altered ß-lactam resistance. mltF and slt mutants with reduced ß-lactam resistance were designated WIMPs (wall-impaired mutant phenotypes), while highly resistant dacB, sltB1, and mltB mutants were designated HARMs (high-level AmpC resistant mutants). Double mutants lacking dacB and sltB1 had extreme piperacillin resistance (>256 µg/ml) compared to either of the single knockouts (64 µg/ml for a dacB mutant and 12 µg/ml for an sltB1 mutant). Inactivation of ampC reverted these mutants to wild-type susceptibility, confirming that AmpC expression underlies resistance. dacB mutants had constitutively elevated AmpC expression, but the LT mutants had wild-type levels of AmpC in the absence of antibiotic exposure. These data suggest that there are at least two different pathways leading to AmpC expression in P. aeruginosa and that their simultaneous activation leads to extreme ß-lactam resistance.

Irisin and Cardiometabolic Disorders in Obesity: A Systematic Review.

Background: Overweight and obesity are global health issues, impacting a significant portion of young adults. Obesity is a complex condition influenced by genetics and environmental factors, leading to increased susceptibility to cardiovascular diseases (CVDs), hypertension, dyslipidemia, and insulin resistance. Irisin, a protein derived from the cleavage of fibronectin type III domain-containing protein 5, may have relationship with these cardiometabolic diseases. Objective: This systematic review aims to examine the relationship between serum irisin levels and obesity, particularly in individuals predisposed to cardiovascular risk factors. Methods: A thorough literature search was conducted in multiple databases, including "Science Direct," "Scopus," "PubMed," and "Lilacs," from July 2020. Inclusion criteria encompassed subjects with metabolic disorders (with or without obesity, BMI ≥30 kg/m2), clinical trials, and observational studies published between 2010 and June 2020. Exclusion criteria were animal studies, meta-analyses, systematic reviews, studies evaluating only healthy subjects, and those investigating disorders beyond cardiometabolic diseases. Results: Out of 151 identified articles, 30 met the inclusion criteria. These studies, published between 2013 and 2020, assessed adults (≥21 years) and included 26 observational studies and 4 clinical trials (n = 7585 subjects). All studies examined irisin's role in obesity and CVDs, often including associated diseases such as type 2 diabetes and hypertension. Despite varying sample sizes, the samples within the articles were homogeneous. Observational studies exhibited a low risk of bias in at least 60% of the evaluated domains. Clinical trials demonstrated a low risk of bias in at least 50% of the domains. Limitations. Although the systematic review provides valuable insights, it is limited by the available literature and the varying methodologies used across studies. Conclusion: The review suggests that irisin plays a significant role as both a preventive measure and a biomarker for comorbidities linked to obesity and cardiometabolic disorders. Future research should focus on standardized irisin measurement methods and diverse populations to further elucidate its mechanisms of action.

"Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

Background: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, in order for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

Body Composition, Basal Metabolic Rate and Leptin in Long-Term Weight Regain After Roux-en-Y Gastric Bypass Are Similar to Pre-surgical Obesity.

PURPOSE: The purpose of this study is to evaluate the relationship between body composition, basal metabolic rate (BMR), and serum concentrations of leptin with long-term weight regain after Roux-en-Y gastric bypass (RYGB) and compare it with obesity before surgery. MATERIALS AND METHODS: Prospective longitudinal analytical study. Three groups were formed: individuals 60 months post RYGB, with weight regain (G1) and without it (G2), and individuals with obesity who had not undergone bariatric surgery (G3). Body fat (BF), body fat mass (BFM), visceral fat (VF), fat-free mass (FFM), skeletal muscle mass (SMM), and BMR were assessed by octapolar and multi-frequency electrical bioimpedance. Fasting serum concentrations of leptin were measured. RESULTS: Seventy-two individuals were included, 24 in each group. Higher means of BF, BFM, VF, and leptin levels were observed in G1, when compared to G2 (BF: 47.5 ± 5.6 vs. 32.0 ± 8.0, p < 0.05; FBM: 47.8 ± 11.6 vs. 23.9 ± 7.0, p < 0.05; VF: 156.8 ± 30.2 vs. 96.1 ± 23.8, p < 0.05; leptin: 45,251.2 pg/mL ± 20,071.8 vs. 11,525.7 pg/mL ± 9177.5, p < 0.000). G1 and G2 did not differ in FFM, SMM, and BMR. G1 and G3 were similar according to BF, FFM, BMR, and leptin levels. Body composition, but not leptin, was correlated with %weight regain in G1 (FBM: r = 0.666, p < 0.000; BF: r = 0.428, p = 0.037; VF: r = 0.544, p = 0.006). CONCLUSION: Long-term weight regain after RYGB is similar to pre-surgical obesity in body composition, BMR, and leptin concentrations, indicating relapse of metabolic and hormonal impairments associated with excessive body fat.

Inadequacy of Vitamin D Does Not Interfere with Body Weight Loss in Women of Reproductive Age after Roux-en-Y Gastric Bypass.

Objective: To assess the influence of vitamin D on body weight loss in women who had previously undergone Roux-en-Y gastric bypass (RYGB). Methodology: This is an analytical, longitudinal and retrospective study comprising 40 women of reproductive age who had previously undergone RYGB. To investigate the influence of the serum concentrations of vitamin D on body weight reduction, the variables were analyzed in the pre-operative period (T0), in the first (T1) and in the second postoperative year (T2) and were stratified according to the BMI measured in T1 and T2. In addition, in the pre-operative period, participants were subdivided into groups based on adequacy (G1), deficiency (G2) and insufficiency (G3), according to their serum concentrations of vitamin D. Results: Although weight loss occurred in a substantial way in T1, it continued to decrease in T2 (p = 0.017). The women who reached normal weight within two years of surgery showed the lowest vitamin D concentrations preoperatively when compared to those who were overweight (p = 0.011). Women with preoperative vitamin D deficiency showed increased concentrations in the assessed times (p < 0.001), while the opposite (p = 0.001) occurred in women with adequacy. Conclusion: The study showed that inadequacy of vitamin D does not interfere with weight loss in the two-year-follow-up after RYGB and highlights that vitamin D can present a differentiated response postoperatively, to the detriment of the pre-operative period.

Ultrasonographic evaluation of deep vein thrombosis related to the central catheter in hemodialytic patients.

BACKGROUND: Point of care ultrasound (PoCUS) is a useful tool for the early diagnosis of thrombosis related to the central venous catheter for dialysis (TR-CVCd). However, the application of PoCUS is still not common as a bedside imaging examination and TR-CVCd remains often underdiagnosed in the routine practice. The aim of this study was to investigate if a compression technique for the diagnosis of TR-CVCd blindly performed by PoCUS experts and medical students is accurate when compared to a Doppler study. METHODS: Two medical students without prior knowledge in PoCUS received a short theoretical-practical training to evaluate TR-CVCd of the internal jugular vein by means of the ultrasound compression technique. After the training phase, patients with central venous catheter for dialysis (CVCd) were evaluated by the students in a private hemodialysis clinic. The results were compared to those obtained on the same population by doctors with solid experience in PoCUS, using both the compression technique and the color Doppler. RESULTS: Eighty-one patients were eligible for the study and the prevalence of TR-CVCd diagnosed by Doppler was 28.4%. The compression technique performed by the students and by experts presented, respectively, a sensitivity of 59.2% (CI 51.6-66.8) vs 100% and a specificity of 89.6% (CI 84.9-94.3) vs 94.8% (CI 91.4-98.2). CONCLUSION: The compression technique in the hands of PoCUS experts demonstrated high accuracy in the diagnosis of TR-CVCd and should represent a standard in the routine examination of dialytic patients. The training of PoCUS inexperienced students for the diagnosis of TR-CVCd is feasible but did not lead to a sufficient level of sensitivity.

Serum retinol and ß-carotene levels and risk factors for cardiovascular disease in morbid obesity.

OBJECTIVE: to evaluate retinol and ß-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro. METHODOLOGY: blood serum concentrations of retinol and ß-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and ß-carotene serum levels were evaluated. RESULTS: metabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of ß-carotene were significantly lower when body mass index increased. Serum retinol didn't show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, ß-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average ß-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome. CONCLUSION: considering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.

Serum concentration of vitamin A and its relationship with body adiposity, oxidative stress, and cardiovascular risk in women with recommended dietary intake of vitamin A.

INTRODUCTION: Background: evidence indicates a role of vitamin A in the regulation of fat mass influencing obesity and cardiovascular diseases. Material and methods: a cross-sectional study in 200 women, paired by age and by the recommended dietary intake of vitamin A. Subjects were divided into four groups according to body mass index (BMI): 80 eutrophic (E), 40 overweight (OW), 40 class I obesity (OI) and 40 class II obesity (OII). Lipid and glycemic profiles were measured and oxidative stress was evaluated through serum concentrations of uric acid, glutathione peroxidase (GSH-Px), and thiobarbituric acid reactive substances (TBARS). Results: the cutoff points for deficiency of serum retinol and ß-carotene levels were < 1.05 µmol/L and 40 µg/dL, respectively. For the recommended dietary intake of vitamin A it was 700 µg/day. Retinol and ß-carotene deficiency was found in the E group at 5 % and 15 %, respectively, reaching 77.5 % and 82.5 % in the OII group. Conclusions: a correlation was observed between serum concentrations of retinol and ß-carotene and glycemic, lipid, and markers of oxidative stress profiles in the groups studied. It was observed that OI and OII subjects who had retinol and ß-carotene deficiency presented a risk that was 16 and 20.7 times greater, respectively, of having a diagnosis with DM2 as compared to E subjects with adequate concentrations of vitamin A. Increased demand of vitamin A may be related to increased BMI, body adiposity, and oxidative stress even when a recommended intake of vitamin A is reached.

INTRODUCCIÓN: Introducción: la evidencia indica un papel de la vitamina A en la regulación de la masa grasa que influye en la obesidad y las enfermedades cardiovasculares. Material y métodos: estudio transversal con 200 mujeres emparejadas por edad y por la ingesta dietética de vitamina A recomendada. Se dividieron en cuatro grupos según el índice de masa corporal (IMC): 80 eutróficas (E), 40 con sobrepeso (OW), 40 con obesidad de clase I (OI) y 40 con obesidad de clase II (OII). Se midieron los perfiles lipídicos y glucémicos y se evaluó el estrés oxidativo a través de las concentraciones séricas de ácido úrico, glutatión-peroxidasa (GSH-Px) y sustancias reactivas del ácido tiobarbitúrico (TBARS). Resultados: los puntos de corte para la deficiencia de las concentraciones séricas de retinol y caroteno fueron de 1,05 µmol/L y 40 g/dL, respectivamente. Para la ingesta dietética recomendada de vitamina A fue de 700 g/día. Se encontró deficiencia de retinol y caroteno en el grupo E, del 5 % y 15 %, respectivamente, alcanzando un 77,5 % y 82,5 % en el grupo OII. Conclusiones: se observó correlación entre las concentraciones séricas de retinol y caroteno y los perfiles glucémico, lipídico y de marcadores de perfiles de estrés oxidativo en los grupos estudiados. Se observó que los sujetos con OI y OII que tenían deficiencia de retinol y caroteno presentaban un riesgo 16 y 20,7 veces mayor, respectivamente, de ser diagnosticados de DM2 en comparación con los E con concentraciones adecuadas de vitamina A. El aumento de la demanda de vitamina A puede estar relacionado con el aumento del IMC, la adiposidad corporal y el estrés oxidativo, incluso cuando se alcanza la ingesta recomendada de vitamina A.

Non-pregnant Women Have a Lower Vitamin D than Pregnant Women After Gastric Bypass.

OBJECTIVE: To compare the nutritional status of vitamin D, calcium, and serum concentrations of parathyroid hormone (PTH) between women undergoing Roux-en-Y gastric bypass (RYGB) who became pregnant and women who did not become pregnant during the same postoperative period, as well as the impact of these changes on maternal and child health. METHODS: This is a longitudinal and retrospective study of women who previously underwent RYGB, paired by age and preoperative body mass index (BMI), divided into two groups: group 1 (G1), comprising 79 women who did not become pregnant, and group 2 (G2), comprising 40 pregnant women assessed in the overall trimesters. Both groups were analyzed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or greater than 1 year (T2), with a 2-year period at the most. Serum concentrations of vitamin D, calcium, parathyroid hormone (PTH), and gestational and neonatal complications were investigated. Statistical analysis was performed by the Statistical Package for the Social Sciences 21.0 (p < 0.05). RESULTS: Despite the additional nutritional demands at pregnancy, women evaluated after 1 year of RYGB had the highest demands of vitamin D when compared with pregnant women in the second trimester(p = 0.04). Women who became pregnant within 1 year of bariatric surgery were more likely to develop a urinary tract infection which, in turn, was associated with vitamin D inadequacy (p = 0.02).In the same period, the concentrations of calcium in the second and third trimesters showed a strong correlation with the number of pregnancies (R = 0.8, p = 0.008, R = 0.8, p = 0.003) and deliveries (R = 0.7, p = 0.013, R = 0.8, p = 0.006) and its nutritional status in the first trimester also showed a strong correlation with the occurrence of small newborns for gestational age/large for gestational age (SGA/LGA) (R = 0.8, p = 0.007). CONCLUSION: Since the highest vitamin D depletions occurred in G1 when compared with G2, the study suggests that a period of time for supplementation and its adjustments in post-bariatric pregnancy may be beneficial. It also encourages further investigation on the number of pregnancies/deliveries during prenatal care, due to vitamin D influence on the nutritional status of calcium, and it points out that changes in concentrations of this vitamin in pregnant women may lead to SGA/LGA newborns' births.

[Analysis of the biochemical, anthropometric profile, and of antioxidant micronutrient ingestion in patients with resistant arterial hypertension]. / Análisis del perfil bioquímico y antropométrico, y de la ingesta de micronutrientes antioxidantes en pacientes con hipertensión arterial resistente.

INTRODUCTION: Introduction: resistant arterial hypertension (HAR) is associated with a high risk for cardiovascular events due to oxidative stress. Research has shown the beneficial effects of dietary antioxidants on cardiovascular health. Objective: to analyze and correlate the biochemical, anthropometric profile and intake of antioxidant micronutrients of patients with HAR. Material and methods: the patients underwent a biochemical assessment, and an anthropometric assessment to calculate body mass index (IMC), waist circumference (PCI), hip circumference (PCA), waist-to-hip ratio (ICC), and micronutrient intake assessment: vitamin A, vitamin C, vitamin E, selenium and zinc, estimated by a semi-quantitative food frequency questionnaire and 24-hour recall. The statistical analysis was performed using the SPSS Statistics 20 software. A p-value < 0.05 was considered significant. Results: sixty individuals with HAR were studied, with a mean age of 62.83 ± 10.73 years. Mean IMC was 31.01 ± 5.60 kg/m², PCI, 98.12 ± 15.04 cm, PCA, 110.55 ± 13.16 cm, and ICC, 0.879 ± 0.084. Regarding the biochemical profile, mean total colesterol was 187.65 ± 48.29 mg/dL, triglycerides, 136.38 ± 99.91 mg/dL; HDL-col, 49.00 ± 10.99 mg/dL; LDL-col, 112.01 ± 41.89 mg/dL; glucose, 105.37 ± 14.81 mg/dL, and glycated hemoglobin, 6.29 ± 1.76 %. The average daily intake of antioxidants was: vitamin A, 241.47 ± 191.87 µg/d; vitamin C, 147.02 ± 192.94 mg/d; vitamin E, 1.99 ± 1.82 mg/d; selenium, 36.80 ± 34.56 µg/d, and zinc, 99.91 ± 6.64 mg/d, where 91.38 %, 46.55 %, 93.10 %, 67.24 %, and 46.55 % of the sample were below the recommended intakes, respectively. Conclusion: inadequate antioxidant intake was observed in these patients with HAR, with a high prevalence of obesity, especially visceral adiposity and alterations in lipid profile, conditions that require a greater usage of these micronutrients. We suggest there is a need for dietary planning for these patients to improve their quality of life and their response to antihypertensive treatment.

INTRODUCCIÓN: Introducción: la hipertensión arterial resistente (HAR) se asocia a un alto riesgo de eventos cardiovasculares debido al estrés oxidativo. Los estudios han demostrado los efectos beneficiosos de los antioxidantes dietéticos sobre la salud cardiovascular. Objetivo: analizar y correlacionar el perfil bioquímico y antropométrico, y la ingesta de micronutrientes antioxidantes en pacientes con HAR. Material y métodos: los pacientes se sometieron a una evaluación bioquímica y antropométrica para calcular el índice de masa corporal (IMC), el perímetro de la cintura (PCI), el perímetro de la cadera (PCA), el índice cintura-cadera (ICC) y la ingesta de micronutrientes ­vitaminas A, C y E, selenio y zinc­ utilizando una encuesta de frecuencia de consumo alimentario y el recordatorio de 24 horas. El análisis estadístico se realizó utilizando el software SPSS Statistics 20, con un valor de p < 0,05 como significativo. Resultados: estudiamos a 60 individuos con HAR de 62,83 ± 10,73 años. El IMC medio fue de 31,01 ± 5,60 kg/m²; el PCI de 98,12 ± 15,04 cm, el PCA de 110,55 ± 13,16 cm y el ICC de 0,879 ± 0,084. Respecto al perfil bioquímico, el colesterol total medio fue de 187,65 ± 48,29 mg/dL, los triglicéridos de 136,38 ± 99,91 mg/dL, el HDL-col de 49,00 ± 10,99 mg/dL, el LDL-col de 112,01 ± 41,89 mg/dL, la glucemia de 105,37 ± 14,81 mg/dL y la hemoglobina glucosilada del 6,29 ± 1,76 %. La ingesta de antioxidantes fue: vitamina A: 241,47 ± 191,87 µg/d; vitamina C: 147,02 ± 192,94 mg/d; vitamina E: 1,99 ± 1,82 mg/d; selenio: 36,80 ± 34,56 µg/d, y zinc: 9,91 ± 6,64 mg/d, y el 91,38 %, 46,55 %, 93,10 %, 67,24 % y 46,55 % de la muestra se encontraron por debajo de lo recomendado, respectivamente. Conclusión: se observó una ingesta insuficiente de antioxidantes en los pacientes con HAR, que presentan una alta prevalencia de obesidad, especialmente de adiposidad visceral y alteraciones del perfil lipídico, afecciones que requieren un mayor uso de estos micronutrientes. Se sugiere la necesidad de una planificación dietética dirigida a estos pacientes para mejorar la calidad de vida y la respuesta al tratamiento antihipertensivo.

Vitamin A deficiency is associated with body mass index and body adiposity in women with recommended intake of vitamin A.

INTRODUCTION: evidence indicates that vitamin A is involved in regulating fat mass. A low consumption of vitamin A has been reported in individuals with obesity, as have lower concentrations of this vitamin, than in eutrophic individuals when their dietary intake of vitamin A is not significantly different. OBJECTIVE: to investigate vitamin A nutritional status and its association with body mass index (BMI) and body fat in women who have the recommended dietary intake of vitamin A. METHODS: cross-sectional study with 200 women, paired by age and by the dietary intake of vitamin A recommended. Participants were divided into four groups, according to BMI. Anthropometric data were evaluated (weight, BMI and waist circumference [WC]), as well as the diagnosis of night blindness (NB). Lipid and glycemic profiles were measured. The cut-off points for deficiency of serum concentrations of retinol and ß-carotene were < 1.05 µmol/l and 40 µg/dl, respectively. The recommended dietary intake of vitamin A was 700 µg/day. RESULTS: there was a significant drop in retinol concentrations according to BMI (p < 0.001) and WC (p < 0.001). We found ß-carotene to behave similarly (p = 0.005; p < 0.001). We found NB in 7.5% of overweight (OW) cases and 20.0% of obesity class II (OII), and no functional alteration was found in the eutrophic group (EU). Inadequate levels of retinol and ß-carotene increased the odds ratio for the occurrence of OW, obesity class I (OI) and OII, as well as inadequate WC. CONCLUSION: even with recommended intake of vitamin A, we found a biochemical and functional inadequacy of vitamin A nutritional status,associated with overweight, obesity and body adiposity.

Vitamin A supplementation according to zinc status on oxidative stress levels in cardiac surgery patients.

INTRODUCTION: it is widely reported that oxidative stress increases in patients undergoing cardiovascular surgery and causes negative outcomes, such as reduced immunological responses and postoperative complications. In this context, vitamin A and zinc serves an important function in the immunological system because it plays a role in fighting oxidative stress. OBJECTIVES: to evaluate the effect of vitamin A supplementation on oxidative stress levels in cardiac surgery patients based on zinc nutritional status. METHODS: a control group (G1) and a vitamin A intervention group (G2- 5,000 IU of vitamin A daily) were subdivided based on their zinc nutritional status. The patients' serum concentrations of retinol, ß-carotene, zinc and malondialdehyde were assessed before surgery (T0), on the 3rd (T1) and 21st postoperative day (T2). RESULTS: in the individuals with adequate zinc concentrations, the retinol concentrations were significantly higher in G2 than in G1 at T1 and T2. In G2, the ß-carotene concentrations were significantly higher in individuals with adequate zinc concentrations compared to those who had inadequate concentrations at T1 (p = 0.024) and T2 (p = 0.043). After surgery, malondialdehyde levels were significantly higher in individuals who had inadequate zinc concentrations, compared to those who had adequate zinc concentrations. Analyzing the clinical evolution, operative mortality, hospitalization time and length of stay in Intensive Care Unit (ICU) were lower in G2. CONCLUSION: vitamin A has contributed to the reduction of oxidative stress, particularly in patients with adequate zinc concentrations and, this way, may help decrease the risk of postoperative complications.

Vitamin A nutritional status in patients with coronary artery disease and its correlation with the severity of the disease.

INTRODUCTION: the purpose of this study was to assess the vitamin A (VA) nutritional status of patients with coronary artery disease (CAD) and its correlation with the severity of the disease, taking into consideration zinc concentration and oxidative stress. METHODS: the patients were preoperative inpatients awaiting myocardial revascularization surgery. The serum concentrations of retinol, ß-carotene, zinc, malondialdehyde (MDA) and C-reactive protein (CRP) were quantified. CAD severity was assessed by cineangiography, observing the parameters of severity, extent and occlusion. An echocardiogram was performed to assess the ejection fraction. RESULTS: ninety individuals were studied (64.5 ± 9.6 years). Zinc did not correlate with retinol (r = -0.009/p = 0.40), ß-carotene (r = -0.06/p = 0.73) or MDA (r = 0.03/p = 0.70), but zinc deficiency was more frequent amongst the patients with high MDA (quartiles 50 and 75). CRP was found to be associated with retinol (x2 = 3.95/p = 0.04). The individuals with retinol deficiency had more severe CAD, and ß-carotene diminished as the extent score rose, although this was not statistically significant (p = 0.12). The degree of severity was associated to extent (x2 = 67.9)/(p < 0.001), occlusion (x2 = 34.5/p < 0.001) and CRP (x2 = 5.9/p = 0.05), while extent was associated with MDA (x2 = 42.1)/(p < 0.001). There was a positive correlation between the ejection fraction and ß-carotene (r = 0.42/p = 0.02). CONCLUSION: findings from this study indicate that chronic inflammation resulting from atherosclerosis is related to disease severity and consequent influence on nutritional status of VA.

Roux-en-Y Gastric Bypass Aggravates Vitamin A Deficiency in the Mother-Child Group.

OBJECTIVE: The objectives of this study are to compare the nutritional status of vitamin A in women who previously underwent Roux-en-Y gastric bypass (RYGB) who became pregnant or did not, in the same period after surgery, and to assess its effects on mother and child health. METHODOLOGY: A retrospective longitudinal study conducted with women who previously underwent RYGB, paired by age and BMI measured before surgery, divided into group 1 (G1) comprising 77 women who did not become pregnant and group 2 (G2) with 39 women in their third gestational trimester. Both groups were assessed before surgery (T0) and in the same interval after surgery: less than or equal to 1 year (T1) or over 1 year (T2), during a maximum of 2 years. Serum concentrations of retinol and ß-carotene, night blindness (NB), and gestational and neonatal complications were investigated [urinary tract infection, iron deficiency anemia, hypertensive syndrome of pregnancy, dumping syndrome, birth weight, gestational age at birth (GAB), and correlation between weight and GAB]. Data were analyzed by the Statistical Package for Social Sciences 21.0 (p < 0.05). RESULTS: RYGB reduced the serum levels of retinol and ß-carotene, especially before the first postsurgical year. When associated with pregnancy, inadequacy rate was 55% higher in T1 and T2. Comparing G1 to G2, we noted that pregnancy in women undergoing RYGB can contribute to increased inadequacy of retinol and ß-carotene, reaching a higher percentage of women with NB after 1 postsurgical year. High prevalence of pregnancy/neonatal complications was found in T1 and T2. NB was correlated with inadequacy of ß-carotene. CONCLUSION: Pregnancy after RYGB aggravates vitamin A deficiency, increases the percentage of NB cases, and can contribute to pregnancy and neonatal complications even in 1 postsurgical year.