Study of auditory pathways in type 1 diabetes mellitus through brainstem auditory evoked potentials and contralateral acoustic reflex / Estudo das vias auditivas em diabetes mellitus tipo 1 através dos potenciais auditivos evocados de tronco encefálico e reflexo acústico contralateral

ABSTRACT Purpose To investigate the functionalities of the neural pathways through the auditory evoked potentials of the brainstem and the contralateral stapedial acoustic reflexes in normal-hearing individuals with type 1 diabetes mellitus, in order to detect possible alterations in the central auditory pathways. Methods This is a cross-sectional study with a comparison group and a convenience sample, consisting of 32 individuals with type 1 diabetes mellitus and 20 controls without the disease. All subjects had hearing thresholds within normal limits and type A tympanometric curves. The acoustic reflex arc and brainstem auditory potentials were investigated. Statistical analyses were performed using the SPSS 17.0. The Chi-square test, Student´s t-test, and Multiple linear regression were used. Results The auditory thresholds of the acoustic reflex were statistically lower in the group with the disease at frequencies of 0.5 kHz and 1.0 kHz in the left ear (p=0.01 and p=0.01, respectively). The absolute latencies III and V of the auditory potentials of the brainstem in the right ear and V in the left ear were increased in subjects with type 1 diabetes mellitus (p=0.03, p=0.02 and p=0.03, respectively). Conclusion The findings suggest that subjects with type 1 diabetes mellitus are more likely to present alterations in the central auditory pathways, even with auditory thresholds within normal limits.

RESUMO Objetivo Investigar a funcionalidade das vias neurais por meio dos potenciais evocados auditivos de tronco encefálico e os reflexos acústicos estapedianos contralaterais em sujeitos com diabetes mellitus tipo 1 normo-ouvintes, a fim de detectar possíveis alterações nas vias auditivas centrais. Método Trata-se de um estudo transversal com grupo de comparação, e amostra de conveniência, composta por 32 sujeitos com diabetes mellitus tipo 1 e 20 controles sem a doença. Todos os sujeitos apresentavam limiares auditivos dentro dos padrões de normalidade e curva timpanométrica tipo A. Foram investigados o arco-reflexo acústico e os potenciais auditivos de tronco encefálico. As análises dos resultados foram realizadas no SPSS 17.0. Utilizou-se o Teste Qui Quadrado, Teste T de Studant e Regressão linear múltipla. Resultados Os limiares auditivos do reflexo acústico foram estatisticamente menores no grupo com a doença nas frequências de 0,5 kHz e 1,0 kHz na orelha esquerda (p=0,01 e p=0,01, respectivamente). As latências absolutas III e V dos potenciais auditivos de tronco encefálico da orelha direita e V da orelha esquerda estavam aumentadas em sujeitos com diabetes mellitus tipo 1 (p=0,03, p=0.02 e p=0,03, respectivamente). Conclusão Os achados sugerem que sujeitos com diabetes mellitus tipo 1 estão mais propensos a apresentar alterações nas vias auditivas centrais, mesmo com limiares auditivos dentro dos padrões de normalidade.

Espiritualidade, Ganho Funcional e Qualidade de Vida em Reabilitação Cardiovascular / Spirituality, Functional Gain, and Quality of Life in Cardiovascular Rehabilitation

Resumo Fundamento Religiosidade e espiritualidade têm sido associadas a maiores taxas de recuperação, maior adesão a tratamentos e melhores níveis de qualidade de vida em pacientes cardiopatas. Objetivos Avaliar a associação entre espiritualidade, ganho funcional e melhoria de qualidade de vida em pacientes de um programa de reabilitação cardiovascular. Métodos Estudo de coorte prospectiva, no qual foi avaliada a associação entre os ganhos funcional e em qualidade de vida obtidos durante um programa de reabilitação cardiovascular e o índice de religiosidade/espiritualidade a partir de escala validada. Sintomas de depressão, ansiedade e estresse foram rastreados, para fins de controle. Um p < 0,05 foi adotado como padrão significante para todas as análises. Resultados Foram acompanhados 57 pacientes (66 ± 12 anos; 71,7% masculinos, 76% com doença arterial coronariana). O cálculo do coeficiente de correlação de Spearman não evidenciou associações entre incrementos na capacidade funcional e religiosidade organizacional (rs = 0,110; p = 0,421), não organizacional (rs = −0,007; p = 0,421) ou intrínseca (rs = −0,083; p = 0,543). Também não foram detectadas associações entre os resultados de um escore de qualidade de vida e religiosidade organizacional (rs = 0,22; p = 0,871), não organizacional (rs = 0,191; p = 0,159) ou intrínseca (rs = 0,108; p = 0,429). Conclusão Não foi detectada associação entre ganho funcional ou em qualidade de vida e religiosidade organizacional, não organizacional ou intrínseca, nesta amostra de pacientes em reabilitação cardiovascular.

Abstract Background Religiosity and spirituality have been associated with higher recovery rates, greater adherence to treatments, and better levels of quality of life in patients with heart disease. Objectives To evaluate the association between spirituality, functional gain, and improved quality of life in patients in a cardiovascular rehabilitation program. Methods This prospective cohort study evaluated the association between functional and quality of life gains during a cardiovascular rehabilitation program and a religiosity/spirituality index based on a validated scale. Depression, anxiety, and stress symptoms were screened for control purposes. P values < 0.05 were considered significant for all analyses. Results The study followed 57 patients (66 ± 12 years old; 71.7% male; 76% with coronary artery disease). The Spearman correlation coefficient did not show any associations between increases in functional capacity and organizational (rs = 0.110; p = 0.421), non-organizational (rs = −0.007; p = 0.421), or intrinsic (rs = −0.083; p = 0.543) religiosity. Furthermore, no associations were detected between the results of a quality of life score and organizational (rs = 0.22; p = 0.871), non-organizational (rs = 0.191; p = 0.159), or intrinsic (rs = 0.108; p = 0.429) religiosity. Conclusion No association was detected between functional and quality of life gains and organizational, non-organizational, or intrinsic religiosity in this sample of patients undergoing cardiovascular rehabilitation.

Association Between Lipid Profile and Clinical Manifestations in Sickle Cell Anemia: A Systematic Review

Abstract Introduction Sickle cell anemia (SCA) is a genetic disease associated with frequent episodes of acute illness. Changes in the lipid profile and a chronic inflammatory process make up the molecular aspects observed in this disease. Associations between these mechanisms and clinical manifestations could thus define severity profiles and therapeutic strategies. Objectives To verify whether there is an association between lipid profile and clinical manifestations in patients with SCA and if there is a correlation between lipid profile and laboratory markers in this disease. Methodology According to the PRISMA guidelines, a systematic review of the literature was conducted by searching the MEDLINE/PubMed, LILACS, SciELO, Scopus, and Cochrane databases. Articles were screened by reading the titles and abstracts, reaching those selected for full-text reading. The included studies were published between 2010 and 2020, were fully available in the databases, and addressed the proposed theme. The risk of individual bias was assessed by using the Joanna Briggs Institute checklist and the Newcastle-Ottawa scale. Results Out of the 144 identified articles, 15 were selected for analysis, resulting in a sample size of 2,230 individuals. HDL-C, LDL-C, total cholesterol , and triglycerides were the main variables analyzed in the lipid profiles. A correlation was observed between these variables and some of the most relevant clinical events in the disease, including vaso-occlusive seizures and acute thoracic syndrome. Conclusion Lipid metabolism disorders, especially hypocholesterolemia and hypertriglyceridemia, are linked to clinical events observed in SCA, suggesting they play a relevant role in the multifactorial pathogenesis of this disease.

Prevalência das Complicações Cardiovasculares nos Indivíduos com Anemia Falciforme e Outras Hemoglobinopatias: Uma Revisão Sistemática / Prevalence of Cardiovascular Complications in Individuals with Sickle Cell Anemia and Other Hemoglobinopathies: A Systematic Review

Resumo Fundamento A anemia falciforme (AF) é uma doença hereditária cujas complicações cardiovasculares são a principal causa de morte, o mesmo sendo observado em outras hemoglobinopatias. A identificação precoce dessas alterações pode modificar favoravelmente o curso da doença. Objetivo Comparar a prevalência de complicações cardiovasculares entre indivíduos com AF e indivíduos com outras hemoglobinopatias. Métodos Seguindo recomendações do protocolo PRISMA, realizou-se revisão sistemática da literatura com buscas nas bases de dados PubMed/Medline, associadas à busca manual. Incluídos estudos que analisaram a prevalência das alterações cardiovasculares nas hemoglobinopatias (AF, traço falciforme, hemoglobinopatia SC, alfatalassemia e betatalassemia). A qualidade metodológica dos artigos foi realizada pela escala de Newcastle-Ottawa. Resultados Foram selecionados para análise quatro estudos, resultando em um tamanho amostral de 582 participantes: 289 portadores de AF, 133 possuem hemoglobinopatia SC, 40 com betatalassemia, 100 indivíduos saudáveis e nenhum com alfatalassemia ou traço falcêmico. Dilatação das câmaras cardíacas, hipertrofia ventricular esquerda e direita, hipertensão pulmonar, disfunção diastólica, insuficiência mitral e insuficiência tricúspide são mais prevalentes na AF do que nas demais hemoglobinopatias consideradas. A sobrecarga miocárdica de ferro é mais frequente na talassemia maior do que na AF. A função sistólica foi similar entre as hemoglobinopatias. Conclusão Verificou-se maior comprometimento cardiovascular nos indivíduos com AF do que naqueles com as demais hemoglobinopatias, reforçando a necessidade de acompanhamento cardiovascular regular e frequente nos pacientes falcêmicos.

Abstract Background Sickle cell anemia (SCA) is a hereditary disease whose cardiovascular complications are the main cause of death, the same being observed in other hemoglobinopathies. Early identification of these changes can favorably modify the course of the disease. Objective To compare the prevalence of cardiovascular complications between individuals with SCA and individuals with other hemoglobinopathies. Method Following the recommendations of the PRISMA protocol, a systematic literature review was carried out with searches in PubMed/Medline databases, associated with a manual search. Studies that analyzed the prevalence of cardiovascular alterations in hemoglobinopathies (SCA, sickle cell trait, SC hemoglobinopathy, alpha-thalassemia and beta-thalassemia) were included. The methodological quality of the articles was assessed using the Newcastle-Ottawa scale. Results Four studies were selected for analysis, resulting in a sample size of 582 participants: 289 with SCA, 133 with SC hemoglobinopathy, 40 with beta-thalassemia, 100 healthy individuals and none with alpha-thalassemia or sickle cell trait. Dilatation of the cardiac chambers, left and right ventricular hypertrophy, pulmonary hypertension, diastolic dysfunction, mitral regurgitation and tricuspid regurgitation are more prevalent in SCA than in the other hemoglobinopathies considered. Myocardial iron overload is more frequent in thalassemia major than in sickle cell anemia. Systolic function is similar between different hemoglobinopathies. Conclusion There is greater cardiovascular impairment in individuals with SCA than in those with other hemoglobinopathies, reinforcing the necessity for regular cardiovascular follow-up in sickle cell patients.

Renin-Angiotensin-Aldosterone System in Women Using Combined Oral Contraceptive: A Systematic Review / Sistema renina-angiotensina-aldosterona em mulheres usuárias de contraceptivo oral combinado: Revisão sistemática

Abstract Objective To describe the effects of combined oral contraceptives (COC) on the renin-angiotensin-aldosterone system (RAAS). Data sourcesThis is a systematic review according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registered in PROSPERO under the ID: CRD42020200019. Searches were performed between August 2020 and December 2021, in the following databases: Medline via Pubmed, Cochrane Central Library, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences via Virtual Health Library. The effects of the combined oral contraceptive on plasma renin activity values, plasma renin values, angiotensinogen values— also known as plasma renin substrate— angiotensin, and/or aldosterone values. Study selectionA total of 877 studies were selected and, of these, 10 articles met the eligibility criteria and were included in this review. Data collectionData were combined through qualitative synthesis and included in a spreadsheet previously prepared by the authors. Data synthesisThe collected samples ranged from 18 to 137 participants, totaling 501 women aged between 18 and 49 years throughout all studies. The studies showed increased activity of plasma renin, plasma renin substrate, angiotensin II, and aldosterone in this population. Conclusion The findings of this study suggest that the COC promotes greater activation of the RAAS. Supporting the idea that its use is related to an increased risk of cardiovascular events, including systemic arterial hypertension.

Resumo Objetivo Descrever os efeitos do contraceptivo oral combinado (COC) no sistema renina-angiotensina-aldosterona (SRAA). Fontes dos dadosTrata-se de uma revisão sistemática de acordo com os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada no PROSPERO sob ID: CRD42020200019. As buscas foram realizadas entre agosto de 2020 e dezembro de 2021 nas bases de dados: Medline via Pubmed, Biblioteca Cochrane Central, Scientific Electronic Library Online, e Literatura Latino-americana e do Caribe em Ciências da Saúde via Biblioteca Virtual em Saúde. Consultado os artigos sobre os efeitos do contraceptivo oral combinado nos valores da atividade da renina plasmática, valores plasmáticos da renina, valores do angiotensinogênio - também conhecido como substrato da renina plasmática -, valores da angiotensina e/ou aldosterona. Seleção dos estudosForam selecionados 877 estudos e, destes, 10 artigos preencheram os critérios de elegibilidade e foram incluídos nesta revisão. Coleta de dadosOs dados foram combinados por meio de síntese qualitativa e inclusos em uma planilha elaborada previamente pelos autores. Síntese dos dadosAs amostras coletadas variavam entre 18 e 137 participantes, totalizando 501 mulheres com idade entre 18 e 49 anos em todos os estudos. Os estudos apresentaram aumento da atividade da renina plasmática, do substrato da renina plasmática, da angiotensina II e da aldosterona nessa população. Conclusão Os achados deste estudo sugerem que o COC promove maior ativação do SRAA. Apoiando a ideia de que o seu uso esteja relacionado ao aumento do risco de eventos cardiovasculares, incluindo a hipertensão arterial sistêmica.

Physical exercise in sickle cell anemia: a systematic review

Introduction and objective: Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. Methodology: We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. Results: Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. Conclusion: Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.

Moderate and severe periodontitis are positively associated with metabolic syndrome.

OBJECTIVE: This study investigated the association between periodontitis severity (exposure) and metabolic syndrome (MetS - outcome), using two criteria for diagnosis of the outcome, since this relationship remains unexplored. MATERIALS AND METHODS: A case-control study was conducted with 870 individuals: 408 with first MetS diagnosis (cases) and 462 without MetS (controls). Participants' general information was obtained using a questionnaire and laboratory data was collected from medical records. Periodontitis severity criteria followed the Center for Disease Control and Prevention: none, mild, moderate, and severe. Odds ratios (OR) and 95% confidence intervals (95% CI) were determined by logistic regression analysis. RESULTS: Findings showed a positive association between moderate and severe periodontitis and MetS: ORadjusted = 1.64 (95% CI: 1.01 to 2.68) and ORadjusted = 1.94 (95% CI: 1.19 to 3.16), respectively, after adjustment for age, sex, schooling level, smoking habit, and cardiovascular disease. The adjusted measurements showed that among individuals with moderate or severe periodontitis, the probability of having MetS was around two times greater than among those without periodontitis, and that the chance was greater among participants with severe periodontitis than those with moderate periodontitis. CONCLUSION: An association between the severity of periodontal status and MetS was found, suggesting a possible relationship between the two diseases. CLINICAL RELEVANCE: MetS influences the etiology of cardiovascular diseases, one of the leading causes of mortality worldwide. The findings suggest that the greater the severity of periodontitis, the greater is the association magnitude with MetS. The health professional needs to recognize that the importance of periodontal disease may play in MetS.

Ecocardiografia e Análise de Doenças Cardiovasculares Subclínicas em Povos Indígenas que Vivem em Diferentes Graus de Urbanização: Projeto de Aterosclerose nas Populações Indígenas (Pai) / Echocardiography and Analysis of Subclinical Cardiovascular Diseases in Indigenous People Living in Different Degrees of Urbanization: Project of Atherosclerosis Among Indigenous Populations (Pai

Fundamento: O processo de urbanização tem impacto na carga de doenças cardiovasculares. As populações indígenas podem sofrer uma transição epidemiológica devastadora. Objetivos: Descrever o protocolo de estudo do Projeto de Aterosclerose nas Populações Indígenas (PAI) para avaliar a análise ecocardiográfica e as doenças cardiovasculares (CV) subclínicas em populações indígenas de acordo com o grau de urbanização e mostrar resultados preliminares do estudo piloto. Métodos: O PAI é um estudo transversal, com voluntários com idade entre 30 e 70 anos, em grupos indígenas brasileiros expostos a estágios baixos e avançados de urbanização (Fulni-ô e Truká, respectivamente) e um grupo controle urbano, excluindo indivíduos com doenças CV conhecidas ou em hemodiálise. O estudo piloto começou no território de Fulni-ô em setembro de 2016. Os participantes foram submetidos a avaliação clínica e laboratorial, eletrocardiograma (ECG), ultrassonografia de carótidas e um protocolo ecocardiográfico abrangente, incluindo strain longitudinal global (SLG) avaliado por speckle tracking. Os resultados preliminares são descritos de acordo com o sexo em uma análise univariada. Resultados: O estudo piloto avaliou o protocolo descrito em 55 indivíduos do grupo indígena Fulni-ô (48,7 ± 12,0 anos, 80% mulheres). Foram encontrados fatores de risco tradicionais como hipertensão, diabetes e dislipidemia em 40%, 36% e 54%, respectivamente, sem diferenças estatísticas significativas entre os sexos. O uso de tabaco mostrou-se extremamente prevalente, referido em 91% dos participantes. Os parâmetros derivados da ecocardiografia estavam, em média, dentro da faixa normal. No entanto, a média do SLG foi de 17,3 ± 3,4% (p 0,73 por sexo). Conclusão: Descrevemos o protocolo do estudo PAI para avaliar doenças cardiovasculares subclínicas e fatores de risco em populações indígenas de acordo com o estágio de urbanização. Resultados preliminares sugerem alta prevalência desses na população indígena em menor grau de urbanização.

Background: The urbanization process impacts the burden of cardiovascular disease (CVD). Indigenous populations can undergo a devastating epidemiological transition. Objective: The present study aimed to describe the Project of Atherosclerosis among Indigenous Populations (PAI) study protocol for assessing echocardiographic images and subclinical CVD in indigenous populations according to the degree of urbanization and report its preliminary results. Methods: The PAI is a cross-sectional study that includes volunteers aged 30­70 years among Brazilian indigenous groups exposed to low and advanced stages of urbanization (Fulni-ô and Truká, respectively) and an urban control group. Individuals with known CVD or who were on hemodialysis were excluded. The pilot study began in Fulni-ô territory in September 2016. The participants underwent clinical and laboratory

Perfil epidemiológico e social de crianças e adolescentes com Anemia Falciforme e sua relação com a cárie dentária / Epidemiological and social profile of children and adolescents with sickle cell anemia and association with dental caries

Introdução: a Anemia Falciforme (AF) é a patologia hereditária monogênica mais prevalente associada à presença de hemoglobina SS no mundo. Pode provocar alterações no corpo, face e dentes dos indivíduos afetados, que podem levar a uma maior predisposição ao desenvolvimento da cárie dentária. Objetivo: avaliar o perfil epidemiológico e social de crianças e adolescentes com AF, a prevalência de cárie e influência da dieta. Metodologia: estudo de corte transversal com 124 indivíduos de 5 a 18 anos provenientes do ambulatório de referência em AF para o grupo AF (n=61) e sem hemoglobinopatias matriculados em colégio público da Bahia (n=63) para o grupo comparação. Anamnese, exame dos dentes e aplicação de questionários sobre a condição de saúde, história da doença e dieta foram realizados. Resultados: a maioria era da raça parda, cursava o 1º grau, a renda era de um salário mínimo, mas em relação à procedência, a maioria das crianças com AF era do interior. Estas também frequentavam mais as consultas odontológicas, apesar de o CPO-D ter sido maior (CPO-D=2,1) que o grupo comparação (CPO-D=1,1), bem como o ceo-d de 2,3 e 0,88, respectivamente. Crianças e adolescentes com AF consumiam menos carboidratos e tiveram um índice de cárie mais alto (ceo-d=2,0; CPO-D=4,2) que os do grupo comparação (ceo-d=0,9; CPO-D=1,0). O grupo com AF apresentou nível socioeconômico baixo e maior índice de cárie em ambas as dentições, apesar da dieta ter sido menos cariogênica. Conclusão: é possível que a prevalência maior de cárie para indivíduos com AF esteja associada a outros fatores inerentes à doença.

Introdution: sickle cell anemia (SCA) is the most prevalent hereditary monogenic pathology associated with the presence of SS hemoglobin in the world. It can affect ibody, face and teeth, which can lead to a higher predisposition to the development of dental caries. Objective: evaluate the epidemiological and social profile of children and adolescents with Sickle Cell Anemia (SCA), prevalence of caries and influence of diet. Methodology: a cross-sectional study was realized with 124 individuals ages of 5 to 18 years originated from the reference ambulatory in SCA for the SCA group (n=61) and without SCA matriculate in a public school in Bahia (n=63) for the comparation group. Anamnesis, teeth examination and application of questionnaires about health condition, disease and diet history were realized. Results: most of them were brown, was in elementary school, income of a minimum wage, but in relation to provenance, most children with SCA were from the countryside. These ones also attended more dental consultations, although the DMFT was higher than the comparation group, 2.1 and 1.1, as well as the dmft 2.3. and 0.88, respectively. Children and adolescents with SCA consumed less carbohydrates and had a higher caries index (dmft = 2.0; DMFT = 4.2) than those in the comparation group (dmft = 0.9; DMFT = 1.0). The group with SCA presented low socioeconomic level and higher caries index in both dentitions, even if the diet was less cariogenic. Conclusion: it is possible that higher prevalence of caries for individuals with SCA may be associated with other factors inherent to the disease.

Palmilhas de reprogramação postural na diminuição da pressão arterial e do desalinhamento postural em indivíduos hipertensos: ensaio clínico randomizado / Postural reprogramming insoles for blood pressure fall and posture misalignment in hypertensive individuals: randomized clinical trial

Testar a hipótese que Palmilhas de Reprogramação Postural (PRP) melhoram a postura e podem modificar média e picos de pressão arterial (PA) em indivíduos hipertensos. DESENHO DE ESTUDO: ECR, registrado no Clinical Trials (NCT02401516), com 24 indivíduos hipertensos. CONFIGURAÇÃO: Todos foram submetidos à Monitorização Ambulatorial da Pressão Arterial (MAPA) e avaliação da postura (SAPO) no início e após seis semanas. INTERVENÇÃO: grupo intervenção (GI) utilizou PRP e grupo controle (GC) SHAM. DESFECHO PRIMÁRIO: Médias da PA. DESFECHOS SECUNDÁRIOS: Picos de PA, durante vigília e sono e ângulo posturais. A melhora da postura ocorreu quando valores angulares diminuíram ou chegaram a zero. Para comparar a PA, foram utilizados os testes t de Student, pareado e não-pareado, com nível de significância de 5%. O tamanho do efeito (TDE) foi avaliado com D de Cohen. Para postura, Wilcoxon e Mann-Whitney. Variáveis categóricas, através do teste do Qui-quadrado. RESULTADOS: As variáveis de linha de base não diferiram entre grupos. Foram obtidos os seguintes deltas: pico da PAS em vigília (+9,3mmHgVs-7,5mmHg) (p<0,05, grande TDE); pico da PAS no sono (+2,3mmHgVs-6,8mmHg) (p<0,05, TDE moderado); e pico da PAD durante vigília (+3,2mmHgVs-4,7mmHg) (p<0,05, grande TDE), GC e GI respectivamente. Para os ângulos posturais, 33% da PAS foram explicados pelo deslocamento anterior do corpo. Para a PAD, 46% e 55%, pelos ângulos de Joelho e Tornozelo, respectivamente. CONCLUSÕES: A PRP reduziu picos de PAS e PAD durante vigília, sem efeito na média da PA. Embora PRP não tenha mostrado melhora na postura geral, o deslocamento anterior do corpo e os ângulos de joelho e tornozelo explicaram 33-55% da PA mais alta.

To test the hypothesis that Postural Reprogramming Insoles (PRI) improves posture and the effect of PRI on average and peaks of blood pressure (BP) in hypertensive individuals. DESIGN: RCT, registered at the Clinical Trials (NCT02401516), with 24 hypertensive individuals. SETTING: All patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and posture assessment (PAS/SAPO software) at the beginning and the end of six weeks. INTERVENTION: intervention group (IG) used PRI and control group (CG) SHAM. MAIN OUTCOME MEASURES: BP averages. SECONDARY OUTCOMES: BP peaks, during awake and asleep periods. Improvement of posture was determined when the angle values assessed decreased or reached zero (perfect alignment). To compare BP, paired, and unpaired Student's t-tests were used, significance level of 5%. Effect size (ES) was assessed with Cohen's D. For posture assessment, Wilcoxon and Mann-Whitney were applied to analysis. Categorical variables, through Chi-square test. RESULTS: Baseline variables did not differ between groups. The following deltas were obtained-SBP peak in awake period (+9.3mmHgVs-7.5mmHg) (p<0.05, great ES); SBP peak during sleeping period (+2.3mmHgVs-6.8mmHg) (p<0.05, moderate ES); and DBP peak during awake period (+3.2mmHgVs-4.7mmHg) (p<0.05, great ES), in control and intervention groups, respectively. For postural angles, 33% of SBP were explained by anterior body shift. For DBP, 46% and 55% were explained by Knee and Ankle Angles, respectively. CONCLUSIONS: PRI reduced SBP and DBP peaks during awake period, with no effect on BP average. Even though PRI has not shown any improvement in overall posture, anterior body displacement and knee and ankle angles would solely explain 33-55% of the highest BP.

Knowledge of academics and health professionals on Basic Life Support / Conhecimento de acadêmicos e profissionais de saúde sobre Suporte Básico de Vida

INTRODUCTION: Inadequate assessment and lack of knowledge of the applicable procedures in emergencies are factors that can result in greater population morbidity and mortality. OBJECTIVE: To systematically review studies in the national literature on the knowledge of academics and health professionals in basic life support and cardiorespiratory arrest. METHODS: Systematic review of studies published in journals indexed in SciELO and LILACS databases. Search terms: "Cardiopulmonary Resuscitation", "Basic Life Support", "Cardiac Arrest", "Health Education" and "Knowledge". Complete articles published until December 2018 were included. They analyzed the knowledge of students and/or graduated health professionals about basic life support and its procedures, as well as teaching strategies. Studies with undergraduate health professionals and/or with hospital conduct and/or advanced life support were excluded. RESULTS: Searches identified 60 articles, 16 of which were included. Of these, eleven were observational and five were intervention studies. The observational studies identified the lack of knowledge of 1,178 academics and 335 professionals about the identification of cardiorespiratory arrest, the sequence of basic life support, ventilation/compression ratio, interruption of compressions and use of the automatic external defibrillator. The intervention studies, involving 24 students and 189 professionals, indicated that active learning strategies can improve knowledge. CONCLUSION: Results indicate that students and graduated health professionals have limitations in their knowledge about the cardiopulmonary arrest and basic life support, which may result in great damage and short survival to emergency patients.

INTRODUÇÃO: Avaliação inadequada e desconhecimento dos procedimentos aplicáveis em emergências são fatores que podem resultar maior morbidade e mortalidade. OBJETIVO: Revisar sistematicamente estudos da literatura nacional sobre o conhecimento de acadêmicos e profissionais da saúde em suporte básico de vida e parada cardiorrespiratória. MÉTODOS: Revisão sistemática de estudos publicados em periódicos indexados nas bases SciELO e LILACS. Descritores: "Reanimação Cardiopulmonar", "Suporte Básico de Vida", "Parada Cardíaca", "Educação em Saúde" e "Conhecimento". Foram incluídos artigos completos publicados até dezembro de 2018. Esses analisaram o conhecimento de acadêmicos e/ou profissionais da saúde sobre suporte básico de vida e seus procedimentos, assim como, estratégias de ensino. Foram excluídos estudos com profissionais de nível técnico e/ou, com condutas hospitalares e/ou suporte avançado de vida. RESULTADOS: As buscas identificaram 60 artigos, sendo 16 incluídos. Desses, onze eram observacionais e cinco de intervenção. Os estudos observacionais identificaram o desconhecimento de 1.178 acadêmicos e 335 profissionais sobre a identificação da parada cardiorrespiratória, sequência do suporte básico de vida, relação ventilação/compressão, interrupção das compressões e uso do desfibrilador externo automático. Os estudos de intervenção, envolvendo 24 estudantes e 189 profissionais, indicaram que estratégias de aprendizagem ativas podem melhorar o conhecimento. CONCLUSÃO: Os resultados indicam que acadêmicos e profissionais da saúde apresentam limitações no conhecimento sobre parada cardiorrespiratória e suporte básico de vida, o que pode implicar em maiores agravos e menor sobrevida para pacientes em emergência.

Plasma Renin in Women Using and not Using Combined Oral Contraceptive

Abstract Backgroud: Recent studies show that women on combined oral contraceptives (COC) present abnormal fasting lipid profile, increased postprandial lipemia, plasma C-reactive protein (CRP) and blood pressure (BP) compared to women not on combined oral contraceptives. Plasma renin is one of the factors responsible for abnormal BP. Objectives: To assess plasma renin levels in women using or not using COC, the correlation between renin and CRP, as well as divergences in lipid profile. Methods: A cross-sectional study with apparently healthy women aged 20 to 30, eutrophic, irregularly active, and with fasting triglycerides < 150 mg/dL. The sample was stratified into two groups: the No Combined Oral Contraceptive Group (NCOCG), comprised of women who did not use any type of hormone contraceptive, and the Combined Oral Contraceptive Group (COCG) comprised of women on low-dose COC for at least one year. After a 12-hour fast, 5 ml of blood was collected for renin dosing and PCR. Data were analyzed by the t-Test and bidirectional Mann-Whitney Test, both with significance < 0.05. Results: We evaluated 44 women equally distributed between the groups, age 23 ± 1.2 years, BMI 21.0 ± 3.2 kg/m2. Median and interquartile deviation of renin in the NCOCG and the COCG were, respectively, 0.5 (0.1-1.0) and 3.0 (2-6) (p < 0.01). A positive correlation between PCR and renin (p < 0.01 and r = 0.68) was found. Conclusion: The plasma renin levels of women using COC were higher, with a strong correlation with CRP.

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease / Preditores de Desfecho Desfavorável em Crianças e Adolescentes Submetidos à Valvoplastia Mitral Cirúrgica Secundária a Cardiopatia Reumática Crônica

Abstract Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.

Resumo Fundamento: A plastia da valva mitral, em pacientes pediátricos com cardiopatia reumática crônica, é superior à troca valvar e vem sendo utilizada com bons resultados. Objetivo: Identificar variáveis preditoras de desfecho desfavorável em crianças e adolescentes submetidos à valvoplastia mitral cirúrgica secundária à cardiopatia reumática. Métodos: Estudo retrospectivo em 54 pacientes menores de 16 anos, operados em um hospital pediátrico terciário entre março de 2011 e janeiro de 2017. As variáveis preditoras de risco para desfecho desfavorável foram: idade, fração de ejeção, grau de insuficiência mitral, grau de hipertensão pulmonar, presença de insuficiência tricúspide, dilatação de câmaras esquerdas, classe funcional no pré-operatório, tempo de circulação extracorpórea, tempo de anóxia, presença de fibrilação atrial e tempo de uso de droga vasoativa. Os desfechos avaliados foram: morte, insuficiência cardíaca congestiva, reoperação, insuficiência mitral residual, estenose mitral residual, acidente vascular cerebral, sangramento e troca valvar. Para todas as análises foi estabelecido valor de p < 0,05 como significante. Resultados: Dos pacientes avaliados, 29 (53,7%) eram do sexo feminino, com média de idade de 10,5 ± 3,2 anos. A classe funcional de 13 pacientes (25%) foi 4. Não houve morte na amostra estudada. O tempo médio de circulação extracorpórea foi de 62,7 ± 17,8 minutos e de anóxia 50 ± 15,7 minutos. O tempo de uso de droga vasoativa no pós-operatório imediato teve mediana de 1 dia (intervalo interquartil 1-2 dias). O modelo de regressão logística foi utilizado para avaliar as variáveis preditoras para o desfecho desfavorável. O tempo de uso de droga vasoativa foi o único preditor independente para os desfechos estudados (p = 0,007). A insuficiência mitral residual foi associada à reoperação (p = 0,044), enquanto a insuficiência tricúspide (p = 0,012) e a hipertensão pulmonar (p = 0,012) se associaram à presença de desfechos desfavoráveis. Conclusão: O tempo de uso de droga vasoativa é um preditor independente para desfechos desfavoráveis no pós-operatório imediato e tardio, enquanto insuficiência mitral residual se associou à reoperação e tanto a insuficiência tricúspide quanto a hipertensão pulmonar foram associadas a desfechos desfavoráveis.

Comparison of the energy and metabolic nutritional profile of women with central obesity of socioeconomic classes A/B vs C/D/E.

INTRODUCTION: Objective: to describe the characteristics of food consumption and energy intake of women with central obesity of socioeconomic classes A/B vs C/D/E. Methodology: a cross-sectional study in which a structured questionnaire was answered containing data on socioeconomics and physical activities. Weight and waist circumference (WC) were measured and the 24-hour recall was assessed (24hR) in relation to food consumption. Biochemical exams were analyzed. The dietary analysis was performed on the Nutwin software and statistical analysis on the SPSS 23.0. Results: there were 89 women assessed in each group and no significant differences were observed in relation to age, with averages of 51.2 ± 12.2 years vs 49 ± 14.4 years for classes C/D/E vs A/B, respectively. A sedentary lifestyle was predominant for class C/D/E 82 (92.13%) vs 22 (24.71%) (p < 0.001).Significant differences were observed between the groups for variables of hypertriglyceridemia (p < 0.001), predominant in the C/D/E socioeconomic group, and HDL-C (p < 0.001), predominant in the A/B socioeconomic group. Total energy consumption of women from class C/D/E vs A/B presented mean values of 1,528.72 kcal (1,128.8-1,697.3) vs 2,267.48 kcal (1,670.3-2,625.84), respectively. Significant differences were observed in the consumption of fiber between groups C/D/E vs A/B (p < 0.001), with less consumption in class C/D/E. With reference to income and schooling levels, we observed heterogeneity in the results and emphasize the marked contrast between low and high income that could influence the choice of food, contributing in the lower income to monotonous diets, less energy consumption and, furthermore, low quality in the ingested food. Conclusion: in this study, all of the women presented metabolic profiles in different manners among the groups and, also, women of class C/D/E, who presented insufficient fiber consumption, directly contributing to this condition of obesity, also presented worse lipid (total cholesterol and triglycerides) and glycemic profiles.

INTRODUCCIÓN: Objetivo: describir las características del consumo alimentario e ingestión energética de mujeres con obesidad central de clase socioeconómica A/B vs C/D/E. Metodología: estudio transversal en el que respondieron a un cuestionario estructurado que contenía datos socioeconómicos y actividad física. Se evaluaron el peso, circunferencia de la cintura (CC), y se hizo un recordatorio de 24 horas (R24h) en relación al consumo alimentario y los exámenes bioquímicos. Los análisis dietéticos se realizaron en el software Nutwin y los análisis estadísticos en el SPSS 23.0. Resultados: se valoraron 89 mujeres en cada grupo y no se observó diferencia significativa para la edad, con una media de 51,2 ± 12,2 años frente a 49 ± 14,4 años clase C/D/E vs A/B, respectivamente. El sedentarismo fue predominante en la clase C/D/E 82 (92,13%) vs 22 (24,71%), (p < 0,001). Se observaron diferencias significativas entre los grupos para las variables de hipertrigliceridemia (p < 0,001), predominantes en el grupo de clase socioeconómico C/D/E y HDL-C (p < 0,001), predominante en el grupo de clase socioeconómico A/B. El consumo energético total de las mujeres de clase C/D/E vs A / B, presentó medianas de 1528,72 kcal (1128,8-1697,3) frente a 2267,48 kcal (1670,3-2625,84), respectivamente. Se observó una diferencia significativa del consumo de fibra entre los grupos C/D/E vs A/B (p < 0,001), siendo el consumo menor en la clase C / D / E. En lo que se refiere a la renta y escolaridad, observamos la heterogeneidad de los resultados y destacamos el marcado contraste entre la baja y elevada renta lo que podría influir en la elección de los alimentos, contribuyendo en la menor renta para la monotonía alimentaria, menor consumo energético y, además, baja calidad de los alimentos ingeridos. Conclusión: en este estudio, todas las mujeres presentaron perfiles metabólicos de maneras distintas entre los grupos. Las mujeres de la clase C/D/E presentaron consumo insuficiente de fibra, lo que ciertamente contribuyó al cuadro de obesidad encontrado y paralelamente presentan peor perfil lipídico (colesterol total y triglicéridos) y glucémico.

Effect of remote nursing monitoring on overweight in women: clinical trial / Efeito do monitoramento remoto de enfermagem sobre o excesso de peso de mulheres: ensaio clínico / Efecto del monitoreo remoto de enfermería sobre el sobrepeso de mujeres: ensayo clínico

ABSTRACT Objective: to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. Method: controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. Results: in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. Conclusion: the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.

RESUMO Objetivo: avaliar o efeito do monitoramento remoto de enfermagem na melhora das medidas antropométricas de mulheres com excesso de peso. Método: ensaio clínico controlado, randomizado, realizado em ambulatório de referência em obesidade. Constituíram o baseline 101 mulheres, alocadas aleatoriamente em dois grupos, 51 no grupo de intervenção (GI) e 50 no grupo controle (GC). O GI recebeu o monitoramento remoto por telefone e acompanhamento convencional e o GC acompanhamento convencional. A avaliação das mulheres ocorreu no baseline e após três meses de intervenção. Para avaliar as diferenças das medidas antropométricas intragrupos, utilizou-se o teste t pareado e, intergrupos, a análise de covariância, adotando-se significância estatística de 5%. Completaram o estudo 81 mulheres. Resultados: na comparação intergrupos após a intervenção, verificou-se redução de 1,66 kg na média do peso (p = 0,017) e redução de 0,66 kg/m2 na média do IMC (p = 0,015) para o grupo intervenção. Houve redução de 2,5 cm na CC no grupo intervenção com diferença estatística boderline (p=0,055). Conclusão: o efeito do monitoramento remoto foi benéfico na redução das medidas antropométricas. RBR-3hzdgv.

RESUMEN Objetivo: evaluar el efecto del monitoreo remoto de enfermería en la mejora de las medidas antropométricas de mujeres con sobrepeso. Método: ensayo clínico controlado, aleatorio, realizado en ambulatorio de referencia en obesidad. Constituyeron el baseline 110 mujeres, colocadas aleatoriamente en dos grupos, 51 en el grupo de intervención (GI) y 50 en el grupo control (GC). El GI recibió el monitoreo remoto por teléfono y el seguimiento convencional y el GC tuvo seguimiento convencional. La evaluación de las mujeres ocurrió en el baseline y después de tres meses de intervención. Para evaluar las diferencias de las medidas antropométricas intragrupos se utilizó el test t pareado y, intergrupos, el análisis de covariancia, adoptando significancia estadística del 5%. Completaron el estudio 81 mujeres. Resultados: en la comparación intergrupos después de la intervención se verificó reducción de 1,66 Kg en la media del peso (p=0,017) y reducción de 0,66 Kg m2 en la media del IMC (p=0,015) para el grupo intervención. Hubo reducción de 2,5 cm en la CC en el grupo intervención con diferencia estadística boderline (p=0,055). Conclusión: el efecto del monitoreo remoto fue benéfico en la reducción de las medidas antropométricas. RBR-3hzdgv.

Influence of subacute physical exercise on medium- and long-chain fatty acid profile in serum of individuals with overweight.

OBJECTIVE: to test the hypothesis that acute physical exercise would change the fatty acids in the serum of individuals with increased body weight. METHOD: sixty-six sedentary women with excess weight were included in the sample (BMI = 29.6 ± 4.2). They were aged 24.4 ± 3.6 years and were randomly divided into control and exercise groups. After 12 hours fasting, basal blood collection was performed. Twelve hours after the first collection, the exercise group was submitted to a physical exercise session with energy expenditure of 250 kcal. The volunteers underwent a second blood collection 24 hours after the first one and dosed the fatty acids: pelargonic, azelaic, elaidic and oleic. RESULTS: physical exercise did not change the fatty acid profile response for both the intragroup analysis and intergroup analysis. Exercise group: pelargonic (before = 0.12 ± 0.06% vs after = 0.15 ± 0.14%, p = 0.507); azelaic (before = 20.3 ± 10.5% vs after = 27.7 ± 25.4%, p = 0.295); elaidic (before = 0.03 ± 0.01% vs after = 0.04 ± 0.01%, p = 0.328); oleic (before = 16.1 ± 7.4% vs after = 20.3 ± 14.6%, p = 0.236). CONTROL GROUP: pelargonic (before = 0.70 ± 0.45% vs after = 0.71 ± 0.51%, p = 0.776); azelaic (before = 62.1 ± 26% vs after = 57.1 ± 27%, p = 0.197); elaidic (before = 0.05 ± 0.02% mg/dl vs after = 0.05 ± 0.03%, p = 0.530); oleic (before = 26.8 ± 22.7% mg/dl vs after = 29.0 ± 22.4%, p = 0.525). CONCLUSION: in women with overweight, low intensity physical exercise is not capable of changing the medium-chain fatty acids in the first 12 hours.

Elevation of Oxidized Lipoprotein of Low Density in Users of Combined Oral Contraceptives / Elevação da Lipoproteína de Baixa Densidade Oxidada em Usuárias de Contraceptivo Oral Combinado

Abstract Background: The use of combined oral contraceptive (COC) has been related to changes in glycemic, lipid metabolism, increased oxidative stress, and systemic blood pressure, which could suggest a higher oxidation of low-density lipoprotein cholesterol (LDL-cholesterol) in women on use of COC. Objective: To test the hypothesis that there is a difference in the plasma values of oxidized LDL among women who use and do not use COC, as well as to evaluate the correlation between it and the lipid profile and high-sensitivity C-reactive protein (hs-CRP). Methods: Forty-two women with ages between 18 and 35 years old, who were eutrophic, irregularly active, with triglycerides < 150 mg/dL, blood glucose < 100 mg/dL, and who used or did not use COC were selected. These women were allocated in the COC group, formed by 21 women on COC use for at least 1 year; and a control group (CG), consisting of 21 women who had not used any type of hormonal contraceptive for at least 1 year. A significance level of 5% was adopted for statistical analyses. Results: It was observed that GCOC showed higher values of oxidized LDL than the CG, respectively 384 mU/mL versus 283 mU/mL (p < 0.01). A positive correlation between oxidized LDL and LDL-cholesterol (r = 0.3, p < 0.05), with total cholesterol (r = 0.47, p < 0.01) and with triglycerides (r = 0.32, p < 0.03) was observed, and there was no correlation with the hs-CRP. In the categorized analysis of oxidized LDL, 71.4% of GCOC women, and 28.6% of the CG remained above the established cutoff point. Conclusion: Women who use COC have higher plasma levels of oxidized LDL, and there is a positive correlation between oxidized LDL and other lipid variables.

Resumo Fundamento: O uso de contraceptivo oral combinado (COC) tem sido relacionado com alterações no metabolismo glicêmico, lipídico, maior estresse oxidativo e pressão arterial sistêmica, o que poderia sugerir maior oxidação da lipoproteína de baixa densidade colesterol (LDL-colesterol) em mulheres que utilizam COC. Objetivo: Testar a hipótese de que existe diferença nos valores plasmáticos da LDL-oxidada entre mulheres que utilizam e não utilizam COC, bem como avaliar a correlação entre ela e o perfil lipídico e proteína C reativa de alta sensibilidade (PCR-as). Métodos: Foram selecionadas 42 mulheres com idade entre 18 e 35 anos, eutróficas, irregularmente ativas, com triglicerídeos < 150 mg/dL, glicemia < 100 mg/dL e que utilizavam ou não COC. Essas foram alocadas no grupo COC, formado por 21 mulheres em uso COC há pelo menos 1 ano; e grupo controle (GC), composto por 21 mulheres que não utilizavam nenhum tipo de contraceptivo hormonal há pelo menos 1 ano. Adotado um nível de significância de 5% para as análises estatísticas. Resultados: Foi observado que o GCOC apresenta valores mais elevados da LDL-oxidada que o GC, respectivamente 384 mU/mL versus 283 mU/mL (p < 0,01). Também foi observado correlação positiva entre a LDL-oxidada e a LDL-colesterol (r = 0,3, p < 0,05), com o colesterol total (r = 0,47, p < 0,01) e com os triglicerídeos (r = 0,32, p < 0,03), não havendo correlação com a PCR-as. Na análise categorizada da LDL-oxidada, 71,4% das mulheres do GCOC e 28,6% do GC mantiveram-se acima do ponto de corte estabelecido. Conclusão: Mulheres que utilizam COC apresentam valores plasmáticos mais elevados da LDL-oxidada, existindo, correlação positiva entre a LDL-oxidada e outras variáveis lipídicas.

Mutation screening in the genes PAX-8, NKX2-5, TSH-R, HES-1 in cohort of 63 Brazilian children with thyroid dysgenesis

ABSTRACT Objective: To evaluate the candidate genes PAX-8, NKX2-5, TSH-R and HES-1 in 63 confirmed cases of thyroid dysgenesis. Subjects and methods: Characterization of patients with congenital hypothyroidism into specific subtypes of thyroid dysgenesis with hormone levels (TT4 and TSH), thyroid ultrasound and scintigraphy. DNA was extracted from peripheral blood leukocytes and the genetic analysis was realized by investigating the presence of mutations in the transcription factor genes involved in thyroid development. Results: No mutations were detected in any of the candidate genes. In situ thyroid gland represented 71.1% of all cases of permanent primary congenital hypothyroidism, followed by hypoplasia (9.6%), ectopia (78%), hemiagenesis (6.0%) and agenesis (5.5%). The highest neonatal screening TSH levels were in the agenesis group (p < 0.001). Conclusions: Thyroid dysgenesis is possibly a polygenic disorder and epigenetic factors could to be implicated in these pathogeneses.

Exercício físico e redução da lipemia pós-prandial: a influência do gasto calórico / Physical exercise and reduction of postprandial lipemia: the influence of caloric expenditure

INTRODUÇÃO: Embora o efeito redutor de uma única sessão de exercício físico (EF) sobre a lipemia pós-prandial (LPP) seja controverso, estudos apontam que o gasto calórico é o principal determinante de redução da LPP. OBJETIVO: Testar a hipótese de que uma sessão de EF, baseado no gasto calórico modifica a LPP. MÉTODOS: Estudo de intervenção prospectivo controlado, tendo como população 18 homens com idade média de 22±1,3 anos e IMC de 21±4,2kg/m². Todos eram estudantes irregularmente ativos, com valores de triglicerídeos (TG) de jejum menor ou igual a 150mg/dl. Foram submetidos a dois testes de LPP: Basal (LPPB) e Exercício (LPPE). Amostras sanguíneas foram coletadas nos tempos 0(jejum) e após a ingestão de um composto lipídico (25g) em 180 e 240 minutos para a dosagem dos TG. No teste da LPPE foi aplicado logo após a coleta de 120 minutos, uma sessão de EF em esteira ergométrica alcançando um gasto energético de 500kcal. ESTATÍSTICA: Foram comparadas as medianas da variação (delta) entre os valores dos TG dosados entre o jejum e 120min (∆1), jejum e 240min (∆2) e entre 120 e 240min (∆3). Utilizou-se o teste de Wilcoxon bidirecional para comparação dos deltas. RESULTADOS: As medianas dos TG do ∆1 respectivamente para LPPB e LPPE foram de 63 Vs 60 (p=0,95); ∆2 102 Vs 25 (p=0,02) e ∆3 32 Vs -10 (p˂0,01). CONCLUSÃO: Neste estudo, uma sessão de exercício físico baseado no gasto calórico de 500kcal, após a ingestão lipídica, reduziu o pico da LPP em jovens sadios. [AU]

INTRODUCTION: Although the reductive effect of a single physical exercise (PE) session on postprandial lipemia (PPL) is controversial, studies indicate that caloric expenditure is the main determinant of PPL reduction. OBJECTIVE: Test the hypothesis that a PE session based on caloric expenditure modifies PPL. METHODS: This is a prospective controlled intervention study, including a cohort of 18 men with average age of 22 ± 1.3 years and BMI of 21 ± 4.2 kg/m². All were irregularly active students, with fasting triglyceride (TG) values of less than or equal to 150mg/dL. They were submitted to two PPL tests: Basal (PPLB) and Exercise (PPLE). Blood samples were collected at time 0 (fasting) and after ingestion of a lipid compound (25g) at 180 and 240 minutes for TG dosing. In the PPLE test, a PE session on treadmill was applied shortly after the collection at 120 minutes, achieving an energy expenditure of 500kcal. STATISTICS: The medians of the variation (delta) between the TG values between fasting and 120min (Δ1), fasting and 240min (Δ2) and between 120 and 240min (Δ3) were compared. The bi-directional Wilcoxon test was used to compare deltas. RESULTS: The TG medians of Δ1 respectively for PPLB and PPLE were 63 Vs.60 (p=0.95); Δ2 102 Vs. 25 (p=0.02) and Δ3 32 Vs. -10 (p<0.01). CONCLUSION: In this study, a physical exercise session based on caloric expenditure of 500kcal, after lipid intake, reduced the PPL peak in healthy youngsters. [AU]