Effectiveness and Safety of Ustekinumab for Ulcerative Colitis: A Brazilian Multicentric Observational Study.

Background: Real-world data on the effectiveness and safety of ustekinumab (UST) in ulcerative colitis (UC) are lacking in Latin America. In this study, we aimed to describe the effectiveness and safety of UST in a real-world multicenter cohort of Brazilian patients with UC. Methods: We conducted a multicenter retrospective observational cohort study, including patients with moderate-to-severe UC (total Mayo score 6-12, with an endoscopic subscore of 2 or 3) who received UST. The co-primary endpoints were clinical remission, defined as a total Mayo score ≤2 at 1 year, with a combined rectal bleeding and stool frequency subscore of ≤1, and endoscopic remission (endoscopic Mayo subscore of 0) within 1 year from baseline. Secondary endpoints included clinical response between weeks 12 and 16, endoscopic response within 1 year of starting UST, steroid-free clinical remission at week 52, and biochemical remission at week 52. We also evaluated UST treatment persistence and safety. Results: A total of 50 patients were included (female, n = 36, 72.0%), with a median disease duration of 9.2 years (1-27). Most patients had extensive colitis (n = 38, 76.0%), and 43 (86.0%) were steroid dependent at baseline. Forty patients (80.0%) were previously exposed to biologics (anti-TNF drugs, n = 31; vedolizumab [VDZ], n = 27). The co-primary endpoints of clinical remission at 1 year and endoscopic remission within 1 year were achieved by 50.0% and 36.0% of patients, respectively. Clinical response at weeks 12-16 was 56.0%, and endoscopic response, steroid-free clinical remission, and biochemical remission at week 52 were 68.0%, 46.5%, and 50.0%, respectively. The UST treatment persistence rate at 24 months was 73.7%. During the follow-up, 10 patients (20.0%) were hospitalized, mostly due to disease progression, and 3 patients required colectomy. Nine patients (18.0%) discontinued the drug mainly due to a lack of effectiveness. Twenty-seven adverse events (AEs) were reported, 16 of which were considered as serious AEs. Conclusions: In this real-world cohort of difficult-to-treat UC patients, UST was associated with improvements in clinical, biochemical, and endoscopic outcomes. The safety profile was favorable, consistent with the known profile of UST.

Recovery markers in elite climbers after the national boulder climbing championship.

This study aimed to investigate recovery markers among elite climbers following the National Boulder Championship. We assessed maximum isometric hand grip strength (HS), forearm swelling (circumference), delayed soreness in forearm muscles, tiredness, and exercise readiness at several time points: pre-competition, immediately post-competition (within 4 min after their last effort), and 12, 24, 48, and 60 h post-competition. Maximum isometric hand grip strength decreased by 6.38 ± 1.32% (p = 0.006) post-12 h, returning to pre-competition values post-24 h (all p > 0.05). Forearm circumference (FC) increased 1.78 ± 1.77% (p < 0.001) post-competition, returning to pre-competition values post-12 h (all p > 0.05). Forearm pain (FP) increased post-competition (p = 0.002) and post-12 h (p < 0.001), returning to pre-competition values post-24 h (all p > 0.05). Tiredness increased post-competition (p < 0.001), post-12 h (p < 0.001), and post-24 h (p < 0.001), returning to pre-competition values post-48 h (all p > 0.05). Climbing readiness was reduced post-competition (p < 0.001), post-12 h (p < 0.001), post-24 h (p < 0.001), and post-48 h (p = 0.005), only returning to pre-competition values post-60 h (p = 0.189). Visual analysis of individual data pointed out a relatively small variability in the HS and FC markers, while FP, tiredness, and readiness exhibited larger individual variations. These findings indicate that different recovery patterns exist for the analyzed markers, suggesting that athletes may require up to 60 h after a competition to fully recover and regain their ability to face new competitive challenges.

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S DISEASE AND COLITIS (GEDIIB).

BACKGROUND: Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. OBJECTIVE: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. METHODS: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. RESULTS AND CONCLUSION: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF CROHN'S DISEASE IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S DISEASE AND COLITIS (GEDIIB).

BACKGROUND: Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn's disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. OBJECTIVE: To guide the safest and effective medical treatments of adults with CD. METHODS: This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. RESULTS AND CONCLUSION: The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.

Effectiveness and Safety of Ustekinumab for Moderate to Severely Active Crohn's Disease: Results from an Early Access Program in Brazil.

This prospective, observational, open-label study aimed to provide access to ustekinumab prior to market authorization and assess its safety and effectiveness in patients with Crohn's disease (CD) refractory to anti-tumor necrosis factor-α and conventional drugs in Brazil. Patients with a diagnosis of moderate-to-severe active CD for ≥3 months before screening received ustekinumab in a single intravenous induction dose (~6 mg/kg) at week 0, and a 90 mg maintenance dose, subcutaneously, every 8 or 12 weeks, from week 8 through to 80. Serious adverse events (SAE), adverse drug reactions (ADR), clinical response (per CD Activity Index and Harvey Bradshaw Index (HBI) scores), remission (per HBI scores), biomarkers (C-reactive protein (CRP) and fecal calprotectin (FC)) and endoscopic improvement rate over 80 weeks were assessed. Patients with a mean age of 39.9 years were assessed. Discontinuation rate was low (23%) and most adverse events were mild (68.7%). The SAE rate was 21% (mostly infections/infestations or gastrointestinal disorder), and ADR rate was 44%. The CD Activity Index and HBI scores decreased (by 74% and 81%, respectively) with 50% of patients showing normalized CRP and FC, and 63% achieved endoscopic improvement. Ustekinumab was fairly safe, well tolerated and effective in a Brazilian cohort of CD patients.

Anti-TNF therapy for ulcerative colitis in Brazil: a comparative real-world national retrospective multicentric study from the Brazilian study group of IBD (GEDIIB).

BACKGROUND: Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment. METHODS: A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ2 or Fisher's exact test when appropriated, and Kaplan Meier analysis. RESULTS: Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p < 0.0001) and 52 (65.24% vs. 51.35%, p < 0.0001) when compared to ADA. According to Kaplan-Meier survival curve loss of response was less frequent in the Infliximab compared to Adalimumab group (p = 0.001). Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the groups (p = 0.114). Colectomy was performed in 23 patients (5.99%). Age, non-prior exposure to biological therapy, use of IFX and endoscopic remission at week 26 were associated with clinical remission after 52 weeks. Variables associated with endoscopic remission were non-prior exposure to biological therapy, and clinical and endoscopic remission at week 26. CONCLUSIONS: IFX was associated with higher rates of clinical remission after 1 year in comparison to ADA. Non-prior exposure to biological therapy and early response to anti-TNF treatment were associated with higher rates of clinical and endoscopic remission.

Segundo Consenso Brasileiro de Manejo da Doença de Crohn em adultos: um consenso da Organização Brasileira de Doença de Crohn e Colite (GEDIIB) / Second brazilian consensus on the management of crohn's disease in adults: a consensus of the brazilian organization for crohn's disease and colitis (gediib)

ABSTRACT Background: Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn's disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. Objective: To guide the safest and effective medical treatments of adults with CD. Methods: This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.

RESUMO Contexto: A doença inflamatória intestinal (DII) é uma doença imunomediada que inclui a doença de Crohn (DC) e a retocolite ulcerativa. A DC é caracterizada por um envolvimento intestinal transmural da boca ao ânus com sintomas recorrentes e remitentes que podem levar a danos intestinais progressivos e incapacidade ao longo do tempo. Objetivo: Orientar os tratamentos médicos mais seguros e eficazes de adultos com DC. Métodos: Este consenso foi desenvolvido por autores que representam gastroenterologistas e cirurgiões brasileiros especialistas em doenças colorretais (GEDIIB, Organização Brasileira de Doença de Crohn e Colite). Uma revisão sistemática das evidências mais recentes foi realizada para apoiar as recomendações/declarações. Todas as recomendações e declarações incluídas foram endossadas em um painel Delphi modificado pelas partes interessadas e especialistas em DII com uma concordância de pelo menos 80% ou mais. Resultados e conclusão: As recomendações médicas (intervenções farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso é direcionado a clínicos gerais, gastroenterologistas e cirurgiões interessados em tratar e gerenciar adultos com DC e apoia a tomada de decisões de companhias de seguro de saúde, agências reguladoras e líderes ou administradores de instituições de saúde.

Segundo Consenso Brasileiro no manejo da retocolite ulcerativa em adultos: um consenso da Organização Brasileira para Doença de Crohn e Colite (GEDIIB) / Second brazilian consensus on the management of ulcerative colitis in adults: a consensus of the brazilian organization for crohn's disease and colitis (gediib)

ABSTRACT Background: Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. Objective: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. Methods: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

RESUMO Contexto: As doenças inflamatórias intestinais são doenças imunomediadas que incluem a doença de Crohn (DC) e a retocolite ulcerativa (RCU). A RCU é uma doença progressiva que acomete a mucosa colorretal causando sintomas debilitantes levando a alta morbidade e incapacidade laboral. Como consequência da inflamação crônica do cólon, a RCU também está associada a um risco aumentado de câncer colorretal. Objetivo: Este consenso visa fornecer orientações sobre o manejo médico mais eficaz de pacientes adultos com RCU. Métodos: As recomendações do consenso foram desenvolvidas por gastroenterologistas e cirurgiões colorretais referências no Brasil (membros da Organização Brasileira para Doença de Crohn e Colite [GEDIIB]). Uma revisão sistemática, incluindo as evidências mais recentes, foi conduzida para apoiar as recomendações. Todas as recomendações foram endossadas pelas partes interessadas/especialistas em doença inflamatória intestinal usando um Painel Delphi modificado. O nível de concordância para alcançar consenso foi de 80% ou mais. Resultados e conclus ão: As recomendações médicas (farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso foi direcionado a clínicos gerais, gastroenterologistas e cirurgiões que tratam pacientes com RCU e apoia os processos de tomada de decisão por companhias de seguro de saúde, agências reguladoras, líderes institucionais de saúde e administradores.

Gravidez na adolescência: uma análise do perfil das adolescentes assistidas em hospital escola na cidade de maceió-al / Pregnancy in adolescence: An analysis of the profile ofadolescents assisted in a school hospital in the city of Maceió-AL / Embarazo em adolescencia: Um análisis del perfil de adolescentes assistidas em um hospital escolar de la ciudad de Maceió-AL

Introdução:Aadolescência é um período curto, porém é nela que ocorrem mudanças biológicas, físicas e psicológicas determinantes na busca da autoafirmação e que podem acarretar complicações no ciclo de vida. A gravidez vista nesta etapa é uma realidade no Brasil e, apesar de susceptível em qualquer classe social,os fatores econômico e social são determinantesnos índices estatísticos. Objetivo:Analisar o perfil das adolescentes que utilizam os serviços do ambulatório e enfermaria de obstetrícia do Hospital Veredas, identificar os fatores que levaram a uma maternidade precoce, as relações sociais, familiares e escolares das adolescentes, além das suas expectativas futuras na construção afetiva da relação mãe-filho e dos possíveis riscos gerados à saúde de ambos. Metodologia:Pesquisa analítica, individual, transversal e observacional, com dados coletados através de análise de prontuários para seleção da amostra e entrevistas com as gestantes do ambulatório e enfermaria de obstetrícia do Hospital Veredas, Maceió-Alagoas, entre janeirode 2020enovembro de 2020. Resultadose Discussão:Das adolescentes analisadas, 52,3% eram menores de idade, dadosignificativo que demonstraa natureza social destas gestações. Quando questionadas sobre sua percepção quanto a gestação, 57,5% declararamque se tratava de uma gravidez indesejada,informação que associadaa narrativa dessas mulheres, demonstra que a gravidez associada a ausência de uma rede de apoio, agrava sua rejeição, refletindo em um isolamento e dificuldade de aceitação. Pode-se constatar através de análise inferencial que uma tendência dasadolescentes etilistas evoluírem com gestações pré-termo (tempo de gestação < 37 semanas) e recém-nascidos prematuros. Conclusões:Através da análise dos dados e da bibliografia analisada, nota-se que a gravidez na adolescência é uma realidade no município de Maceió, e permanece um importante problema de saúde pública gerando impactos negativos nos aspectos sociais, econômicos e nos indicadores de saúde dessas jovens (AU).

Introduction:Adolescence is a short period, but it is when biological, physical and psycological changes happen and those are decisive in the search for self-affirmation and can cause complications in the life cycle. Teenage pregnancy is a reality in Brazil and, although susceptible in any social class, the economic and social factors are determinant in the statistical indexes. Objective:To analyze the profile of adolescents who use the services of the ambulatory and obstetric ward of Hospital Veredas, identifying thefactors that led to an early motherhood, the social, family and school relationships of the adolescents, in addition to their future expectations in the affective construction the mother-child relationship and the possible risks to their health. Methodology:Analytical, individual, cross-sectional and observational research, with data collected through analysis of medical records for sample selection and interviews with pregnant women from the outpatient clinic and obstetrics ward of Hospital Veredas, Maceió-Alagoas, between January2020toNovember 2020. Resultsand Discussion:Of the adolescents analyzed, 52.3% were minors, a significant figure that reflects the social nature of these pregnancies. When asked about their perception of pregnancy, 57.5% stated that it was an unwanted pregnancy, given that associated with the narrative of these women, demonstrates that pregnancy associated with the absence of a support network, aggravates their rejection, reflecting on a isolation and difficulty of acceptance. It can be seen through inferential analysis that a tendency for alcooholic teenagers to evolve with preterm pregnancies (gestation time <37 weeks) and premature newborns. Conclusions:Through the analysis of the data and the analyzed bibliography, it is noted that teenage pregnancy is a reality in the city of Maceió andremains an important public health,problem generating negative impacts on the social, economic and health indicators of these young women (AU).

Introducción: La adolescencia es un período corto, donde ocurren los cambios biológicos, físicos y psicológicos que son determinantes en la búsqueda de la autoafirmación y que pueden derivar en complicaciones en el ciclo vital. El embarazo visto en esta etapa es una realidad en Brasil y, aunque susceptible en cualquier clase social, los factores económicos y sociales son determinantes. Objetivo: Analizar el perfil de las adolescentes que utilizan los servicios del ambulatorioy obstétrico del Hospital Veredas, para identificar los factores que llevaron a una maternidad temprana, las relaciones sociales, familiares y escolares de las adolescentes, además de sus expectativas futuras en la construcción afectiva. Metodología: Investigación analítica, individual, transversal y observacional, con datos recolectados mediante análisis de historias clínicas para selección de muestras y entrevistas a gestantes del ambulatorio y sala de ginecología y obstetricia del Hospital Veredas, Maceió-Alagoas, entre el Enerode 2020al Noviembre 2020.Resultadosy Discussión:De las analizadas, el 52,3% fueron menores de edad, cifra significativa que refleja el carácter social de estos embarazos. Sobre su percepción del embarazo, el 57,5% afirmó que se trató de un embarazo no deseado, informaciónque,asociadaa la narrativa de estas mujeres, demuestra que el embarazo asociado a la ausencia de una red de apoyo, agrava su rechazo, reflejándose en una aislamiento y dificultad de aceptación. Se puede vera través del análisis inferencial que una tendencia de los adolescentes bebedores a evolucionar con los embarazos pretérmino (tiempo de gestación <37 semanas) y los recién nacidos prematuros.Conclusiones: A través del análisis de los datos y la bibliografía analizada, se constata que el embarazo adolescente es una realidad en la ciudad de Maceió, y sigue siendo un importante problema de salud pública generando impactos negativos en los indicadores sociales, económicos y de salud de estos jóvenes (AU).

The Relative Age Effect on Anthropometry, Body Composition, Biological Maturation and Motor Performance in Young Brazilian Soccer Players.

The present study aimed to investigate the influence of months of birth on anthropometry, body composition, biological maturation, and motor performance in young Brazilian soccer players. Young Brazilian soccer players from the Under-13 (n = 50; 13.6 ± 0.3 years), Under-15 (n = 50; 15.5 ± 0.4 years), and Under-17 categories (n = 46; 17.7 ± 0.3 years) took part in this study. Athletes were divided according to chronological age, 1st tertile (January to April); 2nd tertile (May to August); and 3rd tertile (September to December). Anthropometry, body composition, biological maturation, and motor performance variables were evaluated for all participants. There were no differences between the U-13, U-15, and U-17 categories regarding birth tertiles (p > 0.05). Differences between the ages and birth tertiles were observed for the stature, body mass, and lean body mass (p < 0.05). Moreover, differences were found in maturational status between the ages and birth tertiles (p < 0.05). In general, U-13 players showed lower values compared to U-15 and U-17 players in tests of motor performance. In addition, there was a difference in motor performance between the birth tertiles only for RSA variables. The months of birth influenced the stature, body mass, lean body mass, and repeated sprint ability in the U-13 and U-15 categories. Thus, care should be taken during the process of talent selection, as many young players could be underestimated due to their date of birth.

Ensaio sobre a aderência ao modelo nacional de bengala eletrônica Smart Mobb® como recurso auxiliar à mobilidade de pessoas com cegueira ou baixa visão / Essay on adherence to the national model of electronic walking stick Smart Mobb® as a resource to assist the mobility of people with blindness or low vision

Objetivo: O objetivo deste trabalho foi identificar, por meio da interposição de questionário, pontos favoráveis e pontos potencialmente impeditivos à compra da Smart Mobb® como tecnologia assistiva auxiliar à mobilidade de pessoas com deficiência visual. Métodos: A aplicação do questionário foi realizada na Fundação Dorina Nowill para Cegos, instituição especializada no atendimento e reabilitação de pessoas com deficiência visual. A entrevista consistiu em perguntas sobre o perfil socioeconômico, social, tecnológico, sob o contexto das tecnologias assistivas, e de saúde, relativas ao indivíduo e às dificuldades que ele enfrenta no dia a dia por causa do seu quadro de deficiência visual. Resultados: Foram entrevistados oito candidatos. Os resultados indicaram que a Smart Mobb® possui características que apresentam identidade com as preferências relatadas pelas pessoas que participaram do estudo, apresentando inconsistência apenas quanto ao valor médio mensal estimado para venda e ao que esses indivíduos estão dispostos a pagar. Conclusão: Verificou-se que existe o desejo, por parte dos potenciais demandantes, quanto a soluções em tecnologias assistivas que carreguem maior teor tecnológico e que surjam como proposta de solução para o problema da mobilidade urbana. Com relação ao preço, a maioria dos entrevistados está disposta a pagar um percentual médio mensal abaixo do mínimo estipulado para a aquisição da bengala eletrônica Smart Mobb® , o que configura um potencial fator impeditivo à adesão

Objective: The objective of this work was to identify, through the questionnaire, favorable points and potentially impeding points for the purchase of Smart Mobb® as an auxiliary mobility technology for people with visual impairments. Methods: The questionnaire was applied at the Dorina Nowill Foundation for the Blind, an institution specialized in the care and rehabilitation of visually impaired people. The interview consisted of questions about the socioeconomic profile; Social; technological, in the context of assistive technologies; and health, including the individual and the difficulties he faces on a daily basis using his visual impairment. Results: Eight candidates were interviewed. The results indicate that Smart Mobb® has features that display the identity with respect to the people who study, showing inconsistency only in terms of the estimated average monthly value for sale and that these items are available for payment. Conclusion: It was found that it exists or desires, on the part of users who demand as much solutions in assisted technologies that carry greater technological content, and that appear as a solution proposal for the problem of urban mobility. With regard to price, most respondents are willing to pay an average monthly percentage below the minimum stipulated for the purchase of the Smart Mobb® electronic cane, or to set up a potential impediment to adherence

The effects of lifting straps in maximum strength, number of repetitions and muscle activation during lat pull-down.

The objective of the study was to investigate the effects of using lifting straps on the lat pull-down exercise on maximal strength, number of repetitions, and muscle activation. Twelve resistance-trained men participated (age 27 ± 4 years, body mass 84 ± 10 kg, height 177 ± 6 cm, resistance training experience 6.6 ± 2.4 years). All participants performed the 1RM tests and training protocols either with the lifting straps (WS) or without (WOS). Exercise sessions for both conditions (WS and WOS) consisted of 3 sets to concentric failure with a load of 70% of one repetition maximum (1RM) and rest intervals of 60 s. For the 1RM test, no difference was observed between WS and WOS conditions (96.5 ± 12.7 kg and 96.6 ± 11.9 kg, respectively). There were no differences between the WS and WOS conditions in the number of repetitions per set, total repetitions and latissimus dorsi muscle activation. In conclusion, the findings of this study demonstrate that the use of lifting straps in the lat pull-down exercise by resistance-trained individuals does not promote beneficial effect in the 1RM value, the number of repetitions performed with 70% of 1RM, and muscle activation.

INFLAMMATORY BOWEL DISEASE CARE IN BRAZIL: HOW IT IS PERFORMED, OBSTACLES AND DEMANDS FROM THE PHYSICIANS' PERSPECTIVE.

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Atendimento da doença inflamatória intestinal no Brasil: como é feito, os entraves e as demandas sob a ótica dos médicos / Inflammatory bowel disease care in brazil: how it is performed, obstacles and demands from the physicians' perspective

ABSTRACT BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

RESUMO CONTEXTO: As doenças inflamatórias intestinais (DII) são afecções inflamatórias crônicas de caráter recorrente, cujas taxas de incidência e prevalência têm aumentado, inclusive no Brasil. A longo prazo, são responsáveis por danos estruturais que impactam na qualidade de vida, morbidade e mortalidade dos pacientes. OBJETIVO: Avaliar o perfil dos médicos que atendem pacientes com DII, assim como as características deste atendimento, demandas não atendidas e dificuldades. MÉTODOS: Um questionário contendo 17 variáveis foi elaborado e enviado para médicos, selecionados a partir do cadastro da Comissão das Estaduais do Grupo de Estudos da Doença Inflamatória Intestinal do Brasil (GEDIIB), totalizando 286 médicos de 101 cidades brasileiras distribuídas por 21 estados e Distrito Federal. RESULTADOS: A maioria dos médicos que respondeu o questionário foram Gastroenterologistas e Coloproctologistas. Mais de 60% tinham até 20 anos de atuação na especialidade e 53,14% trabalhavam em três locais ou mais. A dificuldade no acesso ou liberação de medicamentos ficou evidenciada neste questionário, assim como a dificuldade no encaminhamento para profissionais não médicos que atuam em DII. Mais de 75% dos médicos relataram dificuldades para realização de enteroscopia por duplo balão e cápsula endoscópica, e 67,8% para realização da calprotectina. Em relação ao número de pacientes atendidos por cada médico, foi evidenciado que não há uma concentração de pacientes sob a responsabilidade de poucos médicos. O infliximabe e o adalimumabe foram os biológicos mais utilizados e ficou evidenciada prescrição maior de derivados de 5-ASA para retocolite ulcerativa quando comparada à doença de Crohn. Os corticoides foram prescritos para uma parcela menor de pacientes em ambas doenças. Os temas "falha a terapia biológica" e "novas drogas" foram referidos como aqueles com maior prioridade para discussão em eventos científicos. Em relação às possíveis diferenças entre cada região e o restante do país, os médicos da região Norte relataram maior dificuldade no acesso a exames complementares e os médicos da região Nordeste, maior dificuldade no acesso ou liberação de medicamentos. CONCLUSÃO: Os dados obtidos por meio deste estudo mostram o perfil do atendimento médico especializado em DII e podem se constituir em ferramenta útil para para elaboração de políticas governamentais e para sociedade brasileira como um todo.

The effect of an airflow restriction mask (ARM) on metabolic, ventilatory, and electromyographic responses to continuous cycling exercise.

This study analyzed the physiological adjustments caused by the use of the Elevation training mask® (2.0), an airflow restriction mask (ARM) during continuous exercise. Eighteen physically active participants (12 men and 6 women) were randomized to two protocols: continuous exercise with mask (CE-ARM) and continuous exercise without mask (CE). Exercise consisted of cycling for 20 minutes at 60% of maximum power. Metabolic variables, lactate, and gas concentration were obtained from arterialized blood samples at pre and post exercise. Continuous expired gases and myoelectric activity of the quadriceps were performed at rest and during the test. We observed no reduction in oxygen saturation in CE-ARM, leading to lower pH, higher carbon dioxide, and greater hematocrit (all p <0.05). The expired gas analysis shows that the CE-ARM condition presented higher oxygen uptake and expired carbon dioxide concentrations (p <0.05). The CE-ARM condition also presented lower ventilatory volume, ventilatory frequency, and expired oxygen pressure (p <0.05). No changes in electromyography activity and lactate concentrations were identified. We conclude that using ARM does not induce hypoxia and represents an additional challenge for the control of acid-base balance, and we suggest the use of ARM as being suitable for respiratory muscle training.

VEDOLIZUMAB IN THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASES: A BRAZILIAN OBSERVATIONAL MULTICENTRIC STUDY.

BACKGROUND: There is scarce data regarding efficacy and safety of vedolizumab in inflammatory bowel diseases in Latin America. OBJECTIVE: To describe the first observational real-world experience with vedolizumab in Latin American inflammatory bowel diseases patients. METHODS: Retrospective observational multicentric study of patients with Crohn's disease (CD) and ulcerative colitis (UC) who used vedolizumab at any phase of their treatment. Clinical remission and response (according to Harvey-Bradshaw index for CD and Mayo score for UC), mucosal healing, need for surgery and adverse events were evaluated. RESULTS: A total of 90 patients were included (52 with CD and 38 with UC), the majority with previous exposure to anti-TNF agents (88.46% in CD and 76.31% in UC). In CD (as observed analysis) remission rates at weeks 12, 26 and 52 were 42.89% (21/49), 61.9% (26/42) and 46.15% (12/26), respectively. In UC, remission rates at weeks 12, 26 and 52 were 28.94% (11/38), 36.66% (11/30) and 41.17% (7/17). Mucosal healing rates were 36.11% in CD and 43.4% in UC. During the study period, 7/52 CD patients underwent major abdominal surgery and 4/38 UC patients needed colectomy. CONCLUSION: Vedolizumab was effective in induction and maintenance of clinical response and remission in CD and UC, with no new safety signs.

Vedolizumabe no manejo das doenças inflamatórias intestinais: um estudo multicentrico observacional brasileiro / Vedolizumab in the management of inflammatory bowel diseases: a brazilian observational multicentric study

ABSTRACT BACKGROUND: There is scarce data regarding efficacy and safety of vedolizumab in inflammatory bowel diseases in Latin America. OBJECTIVE: To describe the first observational real-world experience with vedolizumab in Latin American inflammatory bowel diseases patients. METHODS: Retrospective observational multicentric study of patients with Crohn's disease (CD) and ulcerative colitis (UC) who used vedolizumab at any phase of their treatment. Clinical remission and response (according to Harvey-Bradshaw index for CD and Mayo score for UC), mucosal healing, need for surgery and adverse events were evaluated. RESULTS: A total of 90 patients were included (52 with CD and 38 with UC), the majority with previous exposure to anti-TNF agents (88.46% in CD and 76.31% in UC). In CD (as observed analysis) remission rates at weeks 12, 26 and 52 were 42.89% (21/49), 61.9% (26/42) and 46.15% (12/26), respectively. In UC, remission rates at weeks 12, 26 and 52 were 28.94% (11/38), 36.66% (11/30) and 41.17% (7/17). Mucosal healing rates were 36.11% in CD and 43.4% in UC. During the study period, 7/52 CD patients underwent major abdominal surgery and 4/38 UC patients needed colectomy. CONCLUSION: Vedolizumab was effective in induction and maintenance of clinical response and remission in CD and UC, with no new safety signs.

RESUMO CONTEXTO: Há escassez de dados sobre a eficácia e segurança do vedolizumabe nas doenças inflamatórias intestinais na América Latina. OBJETIVO: Descrever a primeira experiência observacional de mundo real com vedolizumabe em pacientes latino-americanos com doenças inflamatórias intestinais. MÉTODOS: Estudo retrospectivo multicêntrico observacional de pacientes com doença de Crohn (DC) e retocolite ulcerativa inespecífica (RCUI) que utilizaram vedolizumabe em qualquer fase de seu tratamento. Foram avaliadas a remissão e resposta clínicas (de acordo com o índice de Harvey-Bradshaw para DC e escore de Mayo para RCUI), cicatrização da mucosa, necessidade de cirurgia e eventos adversos. RESULTADOS: Foram incluídos 90 pacientes (52 com DC e 38 com RCUI), a maioria com exposição prévia a agentes anti-TNF (88,46% na DC e 76,31% na RCUI). Na DC (em análise conforme observado), as taxas de remissão nas semanas 12, 26 e 52 foram 42,89% (21/49), 61,9% (26/42) e 46,15% (12/26), respectivamente. Na RCUI, as taxas de remissão nas semanas 12, 26 e 52 foram de 28,94% (11/38), 36,66% (11/30) e 41,17% (7/17). As taxas de cicatrização da mucosa foram 36,11% na DC e 43,4% na RCUI. Durante o período do estudo, 7/52 pacientes com DC foram submetidos a cirurgia abdominal maior e 4/38 pacientes com RCUI necessitaram de colectomia. CONCLUSÃO: O vedolizumabe foi eficaz na indução e manutenção da resposta e remissão clínicas em população refratária na DC e RCUI, com perfil de segurança favorável.

Abdominal ultrasonography with color Doppler analysis in the assessment of ileal Crohn's disease: comparison with magnetic resonance enterography.

BACKGROUND/AIMS: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn's disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. METHODS: Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. RESULTS: Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. CONCLUSIONS: USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.

Birth month distribution and anthropometric measures of U-15 national elite soccer players / Distribuição do mês de nascimento e medidas antropométricas de jogadores de futebol de elite nacional sub-15

Abstract The aim of this study was to analyze the birth month distribution and anthropometric measurements of U-15 elite soccer players. The sample consisted of 400 athletes (15.4 ± 0.4 years, 171.0 ± 10.6 cm and 63.0 ± 8.8 kg) participants of the 11th edition of the Brazil U-15 Soccer Cup, who had their birth month information and height and body mass measures obtained from data available on the organization's website. Athletes were separated according to the categorization of chronological age into four-month periods: 1st quarter (1st QDT), athletes born between January and April; 2nd quarter (2nd QDT), those born between May and August, and 3rd quarter (3rd QDT), those born between September and December. The non-parametric chi-square test (X2) was used to analyze the possible differences between observed and expected birth date distributions in the four-month periods. The significance level was P<0.05. The results show that the number of players born in 1st QDT was higher when compared to 2nd QDT and 3rd QDT (P<0.05), and higher when compared to 2nd QDT with 3rd QDT (P<0.05). For variables height and body mass, it was observed that players born in 1st QDT presented values significantly higher than those born in 2nd QDT and 3rd QDT (P<0.05). In the same way, players born in 2nd QDT presented higher values than those born in 3rd QDT (P<0.05). It could be concluded that the relative age effect exerts an influence on the selection of Brazilian U-15 soccer players because it is associated with differences in the anthropometric characteristics of these young players.

Resumo O propósito deste estudo foi analisar a distribuição do mês de nascimento e a influência do efeito relativo da idade (ERI) sobre as medidas antropométricas de jogadores de futebol de elite nacional sub-15. Para tanto, a amostra foi composta por 400 atletas (15,4 ± 0,4 anos; 171.0 ± 10,6 cm e 63,0 ± 8,8 kg) participantes da 11ª edição da Copa Brasil de Futebol Sub-15, e que tiveram suas informações de datas de nascimento e medidas de estatura e massa corporal, obtidas a partir de dados disponíveis no site da organização do evento. Os atletas foram separados de acordo com a categorização de idade cronológica em quadrimestres: 1˚ quadrimestre (1˚ QDT) jovens nascidos entre janeiro e abril; 2˚ quadrimestre (2˚ QDT) os nascidos entre maio e agosto, e o terceiro quadrimestre (3˚ QDT) os nascidos entre setembro e dezembro. Os resultados demonstraram diferença estatisticamente significativas entre as frequências de datas de nascimento dos jogadores nos quadrimestres. Da mesma forma, as variáveis antropométricas estatura e massa corporal, apresentaram diferenças significativas entre os quadrimestres. Pode-se concluir que o ERI exerce influência na seleção de jovens jogadores brasileiros de elite por estar associado à diferenças nas características antropométricas.

Adalimumabe no manejo da retocolite ulcerativa inespecífica: resultados de um estudo multicêntrico observacional brasileiro / Adalimumab for ulcerative colitis: results of a brazilian multicenter observational study

ABSTRACT BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.

RESUMO CONTEXTO: O adalimumabe é um anticorpo monoclonal, inibidor do TNF alfa, que tem eficácia comprovada na indução e manutenção da remissão na retocolite ulcerativa inespecífica moderada à severa. Há escassez de dados sobre o uso do adalimumabe na retocolite ulcerativa inespecífica em pacientes latino-americanos. OBJETIVO: Analisar as taxas de remissão clínica na indução e manutenção do tratamento da retocolite ulcerativa inespecífica com adalimumabe. MÉTODOS: Estudo observacional, multicêntrico e retrospectivo de uma série de casos de portadores de retocolite ulcerativa inespecífica moderada à grave que utilizaram adalimumabe. Variáveis analisadas: dados demográficos, uso prévio de infliximabe, medicações concomitantes, Classificação de Montreal, atividade da doença (escore parcial de Mayo) nas semanas 0, 8, 26 e 52, ou até o maior tempo de seguimento atingido. Remissão clínica foi definida como escore parcial de Mayo ≤2 e foi avaliada pelos métodos. Abordagem com base na observação mais recente (LOCF) e Imputação de não respondedores (NRI). RESULTADOS: Trinta e seis pacientes foram incluídos no estudo. Pela análise LOCF, as taxas de remissão nas semanas 8, 26 e 52 foram de 41,7%, 47,2% e 47,2%, respectivamente. Pela análise NRI, as taxas nas semanas 8, 26 e 52 foram de 41,7%, 41,7% e 27,8%, respectivamente. CONCLUSÃO: Adalimumabe foi eficaz no manejo da retocolite ulcerativa inespecífica moderada a grave. A remissão clínica foi observada em cerca de 40% dos pacientes nas semanas 8 e 26, e em cerca de 1/4 dos pacientes após 1 ano de seguimento.