Early-life nutrition and adult-life outcomes.

OBJECTIVES: To verify the association between early-life nutrition and chronic adult diseases. DATA SOURCES: Medline, Embase, Cochrane Database, and Lilacs. SUMMARY OF FINDS: The Developmental Origins of Health and Disease (DOHaD) hypothesis postulates that a mismatch between early-life circumstances and later-life situations may have an impact on chronic diseases. In this review, the authors emphasize the research supporting the impact of early nutrition on the origins of adult height, obesity and metabolic syndrome, type 2 diabetes mellitus, cardiovascular diseases, and reproductive outcomes. CONCLUSION: Even though this is a new topic and there are still many research questions to be answered, there is strong evidence that both deficiency and excess nutrition in early life can cause epigenetic changes that have effects that last a lifetime and contribute to the development of chronic diseases. Public health efforts to protect adults from getting chronic diseases should focus on nutrition in the first 1000 days of life, from conception to the end of the second year of life.

Patterns of physical activity and SARS-CoV-2 severe pneumonia: A case-control study.

BACKGROUND: Regular physical activity is associated with a low risk of severe community-acquired infections. However, the hypothesis that a physical inactivity pattern is associated with a higher risk for severe COVID-19 has not been completely proven, especially with severe pneumonia. OBJECTIVE: The goal of this study was to confirm the link between physical activity patterns and severe SARS-CoV-2 pneumonia. DESIGN: Case-control study. METHODS: This study involved 307 patients who developed SARS-CoV-2 severe pneumonia and were hospitalized in an intensive care unit. Age- and sex-matched controls (307) were selected from the same population: patients with mild to moderate forms of COVID-19 who were not hospitalized. Physical activity patterns were assessed using the short version of the International Physical Activity Questionnaire. RESULTS: The mean physical activity levels were lower in the SARS-CoV-2 severe pneumonia group as compared to the control group: 1576±2939 vs 2438±2999, metabolic equivalent of task (MET-min/week), p<0.001. A high or moderate physical activity level was more common in the control group, and a low physical activity level was more observed in the case group (p<0.001). Obesity was also associated with severe SARS-CoV-2 pneumonia (p<0.001). Multivariable analysis showed that a low physical activity level was associated with a higher risk for severe SARS-CoV-2 pneumonia, independent of nutritional status (CI 3.7; 2.24-5.99), p<0.001). CONCLUSION: A higher and moderate level of physical activity is linked to a lower risk of SARS-CoV-2 severe pneumonia.

Effects of exergaming on the microcirculation of adolescents with overweight or obesity-a clinical trial efficacy.

To assess the effect of exergaming on the microcirculation function of adolescents with overweight or obesity, this non-randomized clinical trial efficacy was conducted with 61 adolescents aged between 10 and 16 years. The intervention group (n = 31) performed exergaming three times per week for 8 weeks. Both groups received guidelines for a healthy diet and staying physically active. Microcirculation was assessed using a laser Doppler flowmetry (LDF) at baseline and after intervention. Primary outcomes derived from LDF assessment included resting flow, maximum flow, maximum/resting flow ratio, area under hyperemia, and post-occlusive reactive hyperemia (PORH). Secondary outcomes were body mass index and systemic blood pressure. Unpaired Student's t test compared intergroup analyses, and paired Student's t test compared intragroup analyses. The significance was set at 5%. Statistical analysis intergroup and intragroup was done by fitting a two-way mixed effects model. Microcirculation was similar between groups. Maximum flow (109.0 ± 38.3 versus 124.6 ± 43.0, P = 0.022), area under hyperemia (1614 ± 472 versus. 1755 ± 461, P = 0.023), and PORH (2.18 ± 0.49 versus 2.01 ± 0.52, P = 0.031) were statistically different after intervention. Body mass index decreased in intervention (24.5 ± 3.8-24.1 ± 4.0 kg/m2, P = 0.002) and control (25.2 ± 3.2-25.1 ± 3.3 kg/m2, P = 0.031) groups. Systolic blood pressure decreased significantly in the intervention group (110 ± 10-106 ± 9 mm Hg; P = 0.041) but not diastolic blood pressure (66.0 ± 7-68.8 ± 8 mm Hg; P = 0.089). Exergaming for 8 weeks led to improvements in the microcirculation function in adolescents with overweighed or obesity. Clinical trials: NTC03532659.

Effect of Kangaroo Position on microcirculation of preterm newborns: a controlled randomized clinical trial

Abstract Objective: The objective of this study was to evaluate the effect of Kangaroo Position (KP) in microcirculation (MC) of the flexor muscles of preterm newborns. Method: A controlled clinical trial was conducted in the city of Recife, Brazil, with 26 preterm children randomized in the Kangaroo Group (13) and in the Control Group (13). Assessments of blood flow, temperature, and tissue oxygen saturation (SO2) were made at two different times and in the biceps brachii muscle and hamstrings muscle group: before the KP and after 24 h of KP. In the Control Group, the registrations were performed at the times corresponding to those of the Kangaroo Group. The mean values among the times were analyzed by paired t-test for repeated measures. The clinical trial was recorded in Clinical Trials (NCT03611088). Results: In the Kangaroo Group there was an increase in tissue temperature and blood flow at the time evaluation periods (p < 0.05). In the control group, there was no statistical difference between the recording moments hamstring muscles group, but in the biceps brachii, there was a reduction in mean blood flow (p = 0.023). Conclusion: In conclusion, the KP has effects on the microcirculation of the flexor muscles of preterm newborns.

Effect of Kangaroo Position on microcirculation of preterm newborns: a controlled randomized clinical trial.

OBJECTIVE: The objective of this study was to evaluate the effect of Kangaroo Position (KP) in microcirculation (MC) of the flexor muscles of preterm newborns. METHOD: A controlled clinical trial was conducted in the city of Recife, Brazil, with 26 preterm children randomized in the Kangaroo Group (13) and in the Control Group (13). Assessments of blood flow, temperature, and tissue oxygen saturation (SO2) were made at two different times and in the biceps brachii muscle and hamstrings muscle group: before the KP and after 24 h of KP. In the Control Group, the registrations were performed at the times corresponding to those of the Kangaroo Group. The mean values among the times were analyzed by paired t-test for repeated measures. The clinical trial was recorded in Clinical Trials (NCT03611088). RESULTS: In the Kangaroo Group there was an increase in tissue temperature and blood flow at the time evaluation periods (p < 0.05). In the control group, there was no statistical difference between the recording moments hamstring muscles group, but in the biceps brachii, there was a reduction in mean blood flow (p = 0.023). CONCLUSION: In conclusion, the KP has effects on the microcirculation of the flexor muscles of preterm newborns.

Neuroimaging in Children Born With Congenital Zika Syndrome: A Cohort Study.

BACKGROUND AND PURPOSE: Neuroimaging findings have been associated with adverse neurologic outcomes in children with congenital Zika virus infection. Our purpose is to describe the brain magnetic resonance imaging (MRI) of children around 3 years of age, born with congenital Zika syndrome. METHODS: This cohort study followed 62 children born with congenital Zika syndrome who had head computed tomography (CT) performed during the first months of life. All these children had clinical, neuroimaging, and serological confirmation of congenital Zika. Around 3 years of age, these children received a brain MRI. RESULTS: In 35 children, we could perform an MRI. All these children had severe impairment in neuromotor development. In general, the examinations showed the same alterations of the CT examinations: delayed myelination (82.8%), intracranial calcification (71.4%) although with decreased intensity and size as compared with previously CT examinations, ventriculomegaly (91.4%), cerebellar hypoplasia (68.5%), and cortical development abnormalities (85.8%). CONCLUSION: The serious brain alterations observed through head CT examinations in children born with congenital Zika syndrome continued to be detected through an MRI examination carried out at around 3 years of age. This indicates a poor prognosis for these children who had a severe neuromotor development delay.

Prevalence and clinical significance of fetal tricuspid regurgitation during the third trimester of pregnancy / Prevalência e significado clínico da regurgitação tricúspide em fetos no terceiro trimestre da gestação

Abstract Objectives: the aim of this study was to determine the prevalence of fetal tricuspid valve regurgitation (TR) during the third trimester of low-risk pregnancies and to assess its clinical significance on neonates. Methods: this is a cross-sectional study including 330 singleton fetuses referred for routine fetal echocardiography during 3rd trimester in a fetal medicine center in Recife, Brazil. The presence and degree of tricuspid regurgitation were analyzed. Whenever TR was identified on fetal echocardiography, postnatal data, including the results of postnatal echocardiography were reviewed. Results: the prevalence of tricuspid regurgitation was 10.0% (n=33) in the study population. Regarding regurgitation degree, 90.9% (n=30) presented mild regurgitation and none presented important TR. Postnatal data was obtained from 21 neonates. Twenty of them were discharged without any complications, and one presented respiratory distress due to prematurity. Transthoracic echocardiography was performed in 66.7% (n=14) of the neonates and it was normal in 92.9% (n=13) of them. One neonate, 7.1%, persisted with tricuspid regurgitation, but had no other findings. Conclusions: tricuspid regurgitation in fetuses with normal cardiac anatomy during the 3rd trimester is a common condition in low-risk pregnancies, and is not associated with cardiac abnormalities or need for neonatal intervention.

Resumo Objetivos: determinar a prevalência da regurgitação tricúspide (RT) em fetos no terceiro trimestre de gestações de baixo risco e investigar sua repercussão clínica nos recémnascidos. Métodos: trata-se de um estudo transversal incluindo 330 fetos encaminhados para realização de ecocardiograma fetal de rotina no terceiro trimestre da gestação num centro de medicina fetal em Recife, Brasil. A presença e o grau de insuficiência tricúspide foram estudados. Quando RT estava presente ao ecocardiograma fetal dados pós-natais, incluindo ecocardiograma, também foram analisados. Resultados: a prevalência de RT foi de 10,0% na população estudada, sendo que 90,9% (n=30) dos casos foram classificados como RT leve, e nenhum caso de RT importante foi identificado. Foram obtidos dados pós-natais de 21 recém-nascidos. Destes, 20 receberam alta hospitalar sem nenhuma complicação, enquanto 1 apresentou desconforto respiratório associado à prematuridade. Ecocardiograma transtorácico foi realizado em 66.7% (n=14) dos recém-nascidos avaliados, e foi normal em 92.9% (n=13) deles. Apenas 1 recém-nascido, 7.1%, persistiu com RT mas sem outros achados significativos. Conclusões: a RT em fetos com anatomia cardíaca normal é comum no terceiro trimestre de gestações de baixo risco e não parece associar-se a anomalias cardíacas ou necessidade de intervenção no período neonatal.

Zika virus seroprevalence in women who gave birth during Zika virus outbreak in Brazil - a prospective observational study.

BACKGROUND: The recent Zika virus (ZIKV) outbreak in Brazil started in August 2015 and ended in May 2017 without effective public health measures for its control have been taken. The immunological status of a community may not only predict future outbreaks as well to answer questions regarding ZIKV not known yet. OBJECTIVE: To verify the seroprevalence of ZIKV in a group of women who were pregnant during the Zika virus outbreak in Recife, three to nine months after the delivery, and to evaluate the neurodevelopment of their children. METHODS: A cross-sectional study enrolled participants of a cohort study held at Instituto de Medicina Integral Professor Fernando Figueira (IMIP) during the ZIKV outbreak in Recife. Mothers who gave birth between the last trimester of 2015 and the first semester of 2016, period of the peak of microcephaly outbreak in Recife, were invited. All participants had the serum tested by the anti-ZIKV IgG/IgM enzyme-liked immunosorbent assays, ELISA kit (Euroimmun, Lübeck, Germany). All children whose mothers presented positive serology for ZIKV performed the IgG/IgM ELISA test for ZIKV. These children were also evaluated by a neuropediatrician and the Denver II development screening test was applied. RESULTS: Among the 132 studied pregnant women who gave birth at the peak of ZIKV outbreak in Recife, all were ZIKV IgM negative and 81 (61,3%) had ZIKV IgG positive. Mothers ZIKV IgG positive had more fever and rash during the pregnancy as compared with mothers negative for ZIKV; respectively 27/81 (33,3%) vs 6/51 (11,7%), p = 0.005 and 22/81 (27,2%) vs 4 (7,8%), p = 0.016. Only one child had IgG positive serology for ZIKV. No children had neurodevelopment defect for the age group and the Denver II normal scores. CONCLUSIONS: A high ZIKV IgG seroprevalence in pregnant women at the end of the ZIKV outbreak in Recife was found. This finding suggests that community protective immunity may have contributed to the end of ZIKV outbreak in Recife, Brazil.

Magnesium supplementation and preeclampsia in low-income pregnant women - a randomized double-blind clinical trial.

BACKGROUND: Preeclampsia is the major cause of maternal morbidity and mortality in developing countries. Magnesium sulfate is considered first-line therapy against eclampsia and magnesium deficiency in pregnancy has been associated with unfavourable perinatal outcomes. However there are doubts if magnesium supplementation during pregnancy can previne preeclampsia especially in population with high nutritional risk. This trial aims to verify the effect of oral magnesium supplmentation on preeclampsia incidence in low income pregnant women. METHODS: This randomized, double-blind, placebo-controlled trial investigated the effect of oral magnesium citrate supplementation for preeclampsia in low-income Brazilian pregnant women, i.e. annual per capita income of US$ 1025 or less. Participants were admitted to the study with gestational age between 12 and 20 weeks. Magnesium serum level was measured pre-randomization and participants with hypermagnesemia were excluded. After randomizationg participants received magnesium citrate capsule (300 mg magnesium citrate) or a daily placebo capsule, until delivery. Intent-to-treat analysis was performed. RESULTS: A total of 416 pregnant women were screened and 318 enrolled according to the inclusion criteria; 159 for each arm. Twenty-eight pregnant women were lost to follow-up. 55/290 (18.9%) of pregnant women developed preeclampsia; 26/143 (18.1%) in magnesium group and 29/147 (19.7%) in the control group; OR 0.90 (CI 95% 0.48-1.69), p = 0.747. No cases of eclampsia were registered. CONCLUSION: Oral magnesium supplementation did not reduce preeclampsia incidence in low-income and low-risk pregnant women. TRIAL REGISTRATION: Registered at ClinicalTrials.gov (Identifier NCT02032186), December 19, 2013.

Doze semanas de exercício físico domiciliar melhora amplitude de movimento do ombro de idosas mastectomizadas em tratamento para câncer de mama / Twelve weeks of home physical exercise improves shoulder range of motion in elderly mastectomized women undergoing treatment for breast cancer

Introdução: A realização de exercícios físicos domiciliares é uma metodologia segura e eficiente. Entretanto, poucos estudos abordam idosas com câncer de mama mastectomizadas. Objetivo: Verificar o impacto de 12 semanas de um programa de exercícios físicos domiciliares na amplitude de movimento do ombro de idosas sobre- viventes de câncer de mama em tratamento. Métodos: Ensaio clínico randomizado, com idosas mastectomizadas (n=33), 18 idosas para Grupo Controle e 15 para o Grupo Intervenção, realizado de abril a novembro de 2015. Foi ofertado ao Grupo Intervenção um manual de exercícios físicos e DVD previamente desenvolvido. Para o estudo, foram analisados os dados referentes ao teste "Alcançar as Costas" da bateria Senior Fitness Test. As idosas foram avaliadas no início da pesquisa e ao término da 12a semana. Foi realizada análise estatística descritiva através do programa estatístico STATA versão 12, com nível de significância de <0,05. Resultados: Após 12 semanas, foram observadas melhora significativa da flexibilidade no grupo de exercícios físicos domiciliares, de acordo com o teste "Alcançar as Costas" da Senior Fitness Test, medido em centímetros (-7.93 ± 11.54 a 0.533 ± 7.9, p <0,02), e tendência de piora do Grupo Controle (-12.5 ± 9.16 a -18.33 ± 9.12, p <0,06). Além disso, alterações referentes à classificação da flexibilidade das idosas de acordo com a idade foram observadas com ganhos para o Grupo Intervenção (p<0.01). Conclusão: A realização de um programa de exercícios físicos domiciliares parece ser sensível para a melhora da amplitude de movimento de idosas mastectomizadas em tratamento de hormonioterapia.(AU)

Introduction: Home-based exercise is a safe and efficient methodology. However, few studies address older women with mastectomized breast cancer. Purpose: To verify the 12-week impact of a home-based exercise program on shoulder range of motion of older women with breast cancer undergoing treatment. Methods: Randomized clinical trial with mastectomized older women (n = 33), 18 for the Control Group and 15 for the Intervention Group, conducted from April to November 2015. A previously developed exercise manual and DVD were offered to the Intervention Group. For the study, data r the "Reaching the Back" test of the Senior Fitness Test battery were analyzed. The older women were evaluated at the beginning of the research and at the end of week 12. Descriptive statistical analysis was performed using the statistical program STATA version 12, with a significance level of <0.05. Results: After 12 weeks, a significant improvement in flexibility was observed in the home-based exercise group according to the Senior Fitness Test Back Scratch test, measured in centimeters (-7.93 ± 11.54 to 0.533 ± 7.9, p <0.02 ), and worsening trend of the Control Group (-12.5 ± 9.16 to -18.33 ± 9.12, p <0.06). In addition, changes regarding the flexibility classification of older women according to age were observed with gains for the Intervention Group (p <0.01). Conclusion: The implementation of a home-based exercise program seems to be sensitive to the improvement of the range of motion of mastectomized older women undergoing hormone therapy.(AU)

A Digital Health Platform to Deliver Tailored Early Stimulation Programs for Children with Developmental Delays.

Developmental delay is a deviation from the regular development of normative milestones during childhood. Early stimulation is a standardized and straightforward technique to support children with developmental delays (aged 0-3 years) in reaching basic motor skills, which are essential for the execution of everyday activities, such as playing, feeding and locomotion. In doing so, early stimulation reduces the chances of permanent motor impairment, thus allowing the child to live a more functional life. However, outcomes of this treatment depend heavily on the involvement of the family, who are required to continue the early stimulation activities at home on a daily basis. To empower and educate families to administer standardized early stimulation programs at home, we developed an electronic early stimulation program, which provides personalized guidance to parents to administer early stimulation; together with evidence-based clinical decision support to therapists in tailoring ESP to observed needs.

Efeito de 12 semanas de exercício físico domiciliar na aptidão física de idosas com câncer de mama em hormonioterapia: ensaio clínico randomizado / Effect of 12 weeks of home-based physical exercise in the fitness of elderly women with breast cancer: a randomized clinical trial

Objetivo: Avaliar os efeitos de um programa de exercícios físicos domiciliares na aptidão física de idosas com câncer de mama em tratamento. Métodos: Ensaio clínico randomizado com 75 idosas com câncer de mama, realizado em um Hospital Geral do Recife, Brasil, de abril a novembro de 2015. 38 foram alocadas para um programa de exercícios físicos domiciliares, durante 12 semanas, e 37 para o Grupo Controle, o qual recebeu palestras mensais sobre a importância da manutenção de um estilo de vida ativo. Um manual de exercícios físicos e DVD foi previamente desenvolvido e distribuído para o Grupo Intervenção. Foi utilizada a bateria Senior Fitness Test para avaliar a aptidão física. Resultados: Foi observada melhora significativa da força muscular, flexibilidade, equilíbrio e resistência aeróbica no Grupo Intervenção, de acordo com os itens da SFT; Flexão de Antebraço (13,74 - 17,10 repetições, p <0,01); Levantar e Sentar (12,03 - 14,55 repetições, p <0,01); Ir e Vir (6,85 - 6,00 segundos, p <0,01), marcha estacionária de 2 minutos (79,08 - 123,37 duplas passadas, p <0,01); Alcançar as Costas (-8,74 a -0,42 centímetros, p <0,01); e Sentar e Alcançar (-6,76 a 4,76 centímetros, p <0,01). Não foram observadas melhoras com relação ao IMC e força de preensão manual. Conclusão: O programa de exercícios físicos domiciliares mostrou eficácia para melhorar a aptidão física em idosas com câncer de mama em tratamento.

Objective: To evaluate the effects of a home-based physical exercise program on fitness of elderly women with breast cancer. Methods: A randomized clinical trial with 75 elderly patients receiving treatment of breast cancer was developed in a General Hospital of Recife, Brazil, from April to November 2015. 38 were randomized for a home­based physical exercise program during 12 weeks and 37 were Control Group, which received monthly lectures on the importance of maintaining an active lifestyle. An instructional material of physical exercise with a brochure and DVD was previously developed and distributed to the Intervention Group. The Senior Fitness Test was used to evaluated physical fitness. Results: A significant improvement in muscle strength, flexibility, balance and aerobic resistance was observed in the Group Intervention according to the Senior Fitness Test items; 30-s arm curl (13.74 ­ 17.10 repetitions, p<0.01); 30-s chair stand (12.03 ­ 14.55 repetitions, p<0.01); 8-foot up-and-go (6.85 ­ 6.00 seconds, p<0.01); 2-min step test (79.08 ­ 123.37 past doubles, p<0.01); Back scratch (-8.74 to -0.42 centimeters, p<0.01); Chair sit-and-reach (-6.76 to 4.76 centimeters, p<0.01). However, BMI and manual grip strength did not show any change in both groups. Conclusion: A home-based physical exercise program showed efficacy to improve physical fitness in elderly patients receiving treatment of breast cancer.

Effects of physical activity on children's growth.

OBJECTIVE: To describe the current scientific knowledge on the effects of physical exercise on the growth of children and adolescents since intrauterine life. SOURCE OF DATA: A search was carried out in the Medline, Embase, Scielo, and Cochrane databases of studies published from 1990 to 2018. The authors included studies with different designs: clinical trials, cohort, cross-sectional and review studies. SYNTHESIS OF DATA: Studies that addressed the subject of physical exercise or physical activity, and weight-height growth or bone or muscle tissue growth were identified. These studies were analyzed, classified, and presented by age group: fetuses, preterm newborns, preschoolers, schoolchildren, and adolescents. It was observed that almost all studies indicated the safety of physical exercises, of mild to moderate intensity, for pregnant women, as well as children and adolescents, including both aerobic and anaerobic exercises. The retrieve studies did not demonstrate that the practice of physical exercises or certain sports, especially basketball and floor gymnastics, influenced the linear growth of children or adolescents. Some studies showed an increase in bone and muscle tissue growth in child and adolescent athletes. CONCLUSIONS: Despite the small number of studies with adequate methodology, especially randomized clinical trials, evidence appears to indicate that physical exercise is safe for both the pregnant woman and the child, from fetal life to adolescence. Physical exercise does not appear to impair the child's linear growth and contributes to the ideal shaping of bone and muscle tissues, ensuring possible beneficial effects throughout life.

Effects of physical activity on children's growth / Efeitos da atividade física sobre o crescimento de crianças

Abstract Objective: To describe the current scientific knowledge on the effects of physical exercise on the growth of children and adolescents since intrauterine life. Source of data: A search was carried out in the Medline, Embase, Scielo, and Cochrane databases of studies published from 1990 to 2018. The authors included studies with different designs: clinical trials, cohort, cross-sectional and review studies. Synthesis of data: Studies that addressed the subject of physical exercise or physical activity, and weight-height growth or bone or muscle tissue growth were identified. These studies were analyzed, classified, and presented by age group: fetuses, preterm newborns, preschoolers, schoolchildren, and adolescents. It was observed that almost all studies indicated the safety of physical exercises, of mild to moderate intensity, for pregnant women, as well as children and adolescents, including both aerobic and anaerobic exercises. The retrieve studies did not demonstrate that the practice of physical exercises or certain sports, especially basketball and floor gymnastics, influenced the linear growth of children or adolescents. Some studies showed an increase in bone and muscle tissue growth in child and adolescent athletes. Conclusions: Despite the small number of studies with adequate methodology, especially randomized clinical trials, evidence appears to indicate that physical exercise is safe for both the pregnant woman and the child, from fetal life to adolescence. Physical exercise does not appear to impair the child's linear growth and contributes to the ideal shaping of bone and muscle tissues, ensuring possible beneficial effects throughout life.

Resumo Objetivo: Descrever o conhecimento científico atual sobre os efeitos do exercício físico no crescimento das crianças e adolescentes desde a vida intrauterina. Fonte dos dados: Pesquisa nas bases de dados Medline, Embase, Scielo e Cochrane que envolveu estudos publicados desde 1990 até 2018. Foram incluídos estudos com diferentes desenhos: ensaios clínicos, coorte, transversais e revisões. Síntese dos dados: Foram identificados estudos que abordaram o tema, exercício físico ou atividade física e crescimento pondero-estatural ou dos tecidos ósseo ou muscular. Os estudos foram analisados, classificados e apresentados por faixa etária: fetos, recém-nascidos pré-termos, pré-escolares, escolares e adolescentes. Observou-se que quase todos os estudos apontaram para a segurança do exercício físico de leve a moderada intensidade, tanto para a gestante como para a criança e o adolescente, inclusive tanto os exercícios aeróbicos como os anaeróbicos. Os estudos identificados não comprovaram que a prática de exercícios físicos ou determinados esportes, em especial o basquete e a ginástica de solo, exerciam influência no crescimento linear das crianças ou adolescentes. Alguns estudos demonstraram um maior crescimento do tecido ósseo e muscular em crianças e adolescentes atletas. Conclusões: Apesar do pequeno número de estudos com metodologia adequada, em especial ensaios clínicos randomizados, as evidências parecem indicar que o exercício físico seja seguro, tanto para a gestante como para a criança, desde a vida fetal até adolescência. O exercício físico não parece comprometer o crescimento linear da criança e contribui para moldar de forma ideal os tecidos ósseo e muscular e assegurar possíveis efeitos benéficos ao longo da vida.

Congenital Zika Syndrome and Infantile Spasms: Case Series Study.

Recently described, the congenital Zika syndrome caused by the Zika virus has many features of other congenital infections. This case series study reports 22 infants with congenital Zika syndrome in Brazil who developed infantile spasms during their first year of life. The median age of infantile spasms onset was 4.3 (±1.4) months and ranged from 1 to 7 months. Neurologic evaluation showed that all 22 children presented severe impairment of neuropsychomotor development. A total of 18 infants had an interictal hypsarrhythmia electroencephalogram (EEG) pattern. Vigabatrin was prescribed as first-line treatment; however, only 5 patients were controlled. Steroid regimes were started for children who did not respond to vigabatrin and they are being followed. In conclusion, congenital Zika syndrome may be considered as an etiological agent of infantile spasms.

A Mobile Early Stimulation Program to Support Children with Developmental Delays in Brazil.

Developmental delay is a deviation development from the normative milestones during the childhood and it may be caused by neurological disorders. Early stimulation is a standardized and simple technique to treat developmental delays in children (aged 0-3 years), allowing them to reach the best development possible and to mitigate neuropsychomotor sequelae. However, the outcomes of the treatment depending on the involvement of the family, to continue the activities at home on a daily basis. To empower and educate parents of children with neurodevelopmental delays to administer standardized early stimulation programs at home, we developed a mobile early stimulation program that provides timely and evidence-based clinical decision support to health professionals and a personalized guidance to parents about how to administer early stimulation to their child at home.

Impaired neurovascular reactivity in the microvasculature of pregnant women with preeclampsia.

INTRODUCTION: PE is associated with maternal vascular dysfunction, leading to serious cardiovascular risk both during and following pregnancy. OBJECTIVE: To assess microvascular reactivity in pregnant women with PE. METHODS: A cross-sectional study was performed in 36 pregnant women with PE and 36 normotensive pregnant women (C) in the third trimester. Skin microvascular blood flow was measured using LDF at rest (RF), during the maximum hyperemic response to brief arterial occlusion (MF) and during the sympathetically mediated constrictor response to deep IBH. RESULTS: In pregnant women with PE, RF was higher [C, 8.1 (4.6); PE, 12.0 (7.6), P<.001; PU perfusion units; median (IQR)] and MF/RF [C, 6.1 (3.7); PE, 3. 9 (4.9) P<.001] and peak CVC lower (P=.009) compared to normotensive controls. The constrictor response to IBH [C, 62.4% (27.9); PE, 33.0% (50.6), P=.008] was reduced in women with PE. In univariate analysis, MF/RF was associated with PE status (r=-.417, P=.0001), systolic (r=-.385, P=.001), and diastolic (r=-.388, P=.001) blood pressure, but not BMI (r=.077, P=.536). CONCLUSIONS: Women with PE are more than three times more likely to exhibit a reduced microvascular reactivity in the third trimester of pregnancy than normotensive pregnant controls. These differences may be attributable in part to an altered sympathetic neural microvascular tone in PE.

Visceral Adiposity in the First Half of Pregnancy in Association with Glucose, Lipid and Insulin Profiles in Later Pregnancy: A Cohort Study.

Background Obesity is the most common risk factor in pregnancy but few studies have assessed the association of between visceral adiposity (VAT) depth in early to mild pregnancy and insulin resistance (IR), dysglycemia and dyslipidemia in later pregnancy. Objective To assess the association between VAT depth in early to mid pregnancy and IR [homeostatic model assessment of IR (HOMA-IR)], dysglycemia and dyslipidemia in later pregnancy. Methods We completed a prospective cohort study of 344 pregnant women at a single large hospital in Recife, Brazil. VAT depth was measured by ultrasound at 15-20 weeks gestation. Serum glucose, insulin and lipids were evaluated at 32-37 weeks gestation. Results In contrast to pre-pregnancy body mass index (BMI), VAT depth at 15-20 weeks was generally inferior in explaining the variation in the biochemical measures at 32-37 weeks gestation. This was the case for fasting HOMA-IR (adjusted r(2): 0.21 vs. 0.11, respectively), fasting insulin (adjusted r(2): 0.27 vs. 0.09, respectively), and lipids. Only for fasting glucose was the opposite true, but marginally (adjusted r(2) 0.03 vs. 0.06, respectively). Conclusion VAT depth measured in the first half of pregnancy is not better than pre-pregnancy BMI in predicting IR and related biochemical measures in later pregnancy.