Pathological Complete Response After Neoadjuvant Imatinib in a Recurrent Duodenal Gastrointestinal Stromal Tumor (GIST).

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal (GI) tract. Although surgery is the treatment of choice in resectable disease, neoadjuvant therapy is indicated in advanced, metastatic, and recurrent tumors. Decreasing tumor burden may facilitate resection and reduce surgical morbidity. We describe a case of a 66-year-old male with a recurrent duodenal GIST, after surgery and adjuvant imatinib five years before. Following neoadjuvant therapy with imatinib for 12 months, the patient underwent a cephalic pancreaticoduodenectomy, without complications. The final histopathology showed a pathological complete response (pCR) with no residual neoplasm. A pathological complete response to imatinib in a recurrent disease is extremely rare. Molecular testing should be performed before neoadjuvant therapy to identify response-predictive mutations. In recurrent/metastatic disease, systemic therapy is the standard treatment for all patients. Surgery should be considered in a tailored approach in patients with good responses to systemic therapy before developing therapeutic resistance.

Vitamin D and the Metabolic Phenotype in Weight Loss After Bariatric Surgery: A Longitudinal Study.

PURPOSE: To evaluate the influence of vitamin D (VD) concentrations coupled with metabolic phenotypes preoperatively and 6 months after Roux-en-Y gastric bypass (RYGB) on body variables and weight loss. MATERIALS AND METHODS: A longitudinal, retrospective, analytical study comprising 30 adult individuals assessed preoperatively (T0) and 6 months (T1) after undergoing Roux-en-Y gastric bypass. The participants were distributed preoperatively into metabolically healthy obese (MHO) and metabolically unhealthy obese individuals (MUHO) according to the HOMA-IR classification, as well as the adequacy and inadequacy of vitamin D concentrations in the form of 25(OH)D. All participants were assessed for weight, height, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), visceral adiposity index (VAI), body circularity index (BCI), body adiposity index (BAI), weight loss, and assessment of 25(OH)D and 1,25(OH)2D concentrations using high-performance liquid chromatography with an ultraviolet detector (HPLC-UV). The statistical program used was SPSS version 21. RESULTS: VD adequacy and a healthy phenotype in the preoperative period may play an important role concerning body fat distribution, as the body averages for WHtR (0.020*) and BCI (0.020*) were lower in MHO participants. In comparison, those with VD inadequacy and MUHOs had higher BAI averages (0.000*) in the postoperative period. Furthermore, it is possible that VD inadequacy before and after RYGB, even in the presence of an unhealthy phenotype, may contribute to the increase in VAI values (0.029*) after this surgery. Only those with inadequate VD and MUHOs had higher 25(OH)D concentrations. Besides, this unhealthy phenotype had a greater reduction in BMI in the early postoperative period (p < 0.001). CONCLUSION: This study suggests that VD adequacy and the presence of a healthy phenotype appear to have a positive impact on the reduction of visceral fat in the context of pre- and postoperative obesity. In addition, there was a greater weight reduction in those with VD inadequacy and in MUHO, which suggests that the volumetric dilution effect of VD and catabolism after bariatric surgery is more pronounced in this specific metabolic phenotype.

Educação Interprofissional nos cursos da área da saúde de uma universidade pública / Interprofessional Education in health courses at a public university

RESUMO Visto que a Educação Interprofissional tem sido apontada para a reorientação da formação e do trabalho em saúde, objetivou-se analisar sua inserção nos Projetos Pedagógicos dos Cursos de graduação em saúde de uma universidade pública. Trata-se de uma pesquisa pautada na análise documental, dividida em três etapas: leitura exploratória, pré-análise e análise dos documentos. Todos os documentos dos cursos analisados referem-se ao trabalho em equipe como competência importante para a formação, ainda que façam apenas algumas menções pontuais e específicas à interprofissionalidade. Os documentos não apresentam projetos para a implementação da Educação Interprofissional nos currículos regulares, apenas delegam a inserção da interprofissionalidade à extensão universitária. Assim, observou-se que os projetos pedagógicos inserem a Educação Interprofissional de forma restrita nos cursos da área da saúde.

ABSTRACT Since Interprofessional Education has been identified as a means of reorientation health training and work, the objective was to analyze its insertion in the pedagogical projects of undergraduate health courses at a public university. This research is based on document analysis, divided into three stages: exploratory reading, pre-analysis and document analysis. All documents of the analyzed courses refers to teamwork as an important skill for training, even though they only make a few punctual and specific mentions of interprofessionality. The documents do not present projects for the implementation of Interprofessional Education in regular curriculum, they just delegate the insertion of interprofessionality to university extension. Thus, it was observed that pedagogical projects include Interprofessional Education in a restricted way in health courses.

The Effect of Vitamin D Adequacy on Thyroid Hormones and Inflammatory Markers after Bariatric Surgery.

Vitamin D status affects the clinical and corporal outcomes of postoperative patients who undergo a Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the effect of adequate vitamin D serum concentrations on thyroid hormones, body weight, blood cell count, and inflammation after an RYGB. A prospective observational study was conducted with eighty-eight patients from whom we collected blood samples before and 6 months after surgery to evaluate their levels of 25-hydroxyvitamin D 25(OH)D, thyroid hormones, and their blood cell count. Their body weight, body mass index (BMI), total weight loss, and excess weight loss were also evaluated 6 and 12 months after surgery. After 6 months, 58% of the patients achieved an adequate vitamin D nutritional status. Patients in the adequate group showed a decrease in the concentration of thyroid-stimulating hormone (TSH) (3.01 vs. 2.22 µUI/mL, p = 0.017) with lower concentrations than the inadequate group at 6 months (2.22 vs. 2.84 µUI/mL, p = 0.020). Six months after surgery, the group with vitamin D adequacy showed a significantly lower BMI compared with the inadequate group at 12 months (31.51 vs. 35.04 kg/m2, p = 0.018). An adequate vitamin D nutritional status seems to favor a significant improvement in one's thyroid hormone levels, immune inflammatory profile, and weight loss performance after an RYGB.

Brazilian guide to nutrition in bariatric and metabolic surgery.

PURPOSE: Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS: A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS: The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION: We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

Vitamin D Supplementation and Its Relationship with Loss of Visceral Adiposity.

PURPOSE: An inverse relationship between vitamin D (VD) nutritional status and obesity is frequent, and the distribution of body fat is an important aspect to assess the risks of obesity-related metabolic dysfunction. The purpose of the study was to evaluate the relationship between serum VD concentrations and body fat reduction after 12 months of bariatric surgery, using two different vitamin D3 (VD3) supplementation protocols. MATERIAL AND METHODS: A randomized controlled trial consisted of 41 patients divided into G1 (800 IU/day) and G2 (1800 IU/day) according to the VD3 supplementation. At baseline (T0) and follow-up (T1), 25(OH)D, waist circumference (WC), visceral adiposity index (VAI), body adiposity index (BAI), and waist/height ratio (WHtR) were evaluated. RESULTS: In T0, the mean of 25(OH)D was lower in G2 compared to that in G1 (22.6 vs 23.6 ng/mL; p = 0.000). At T1, it had a significant increase in G2 (32.1 vs 29.9 ng/mL; p = 0.000), with 60% sufficiency. A significant negative correlation was observed between VAI, BAI, and WHtR with 25(OH)D in G2 (r = - 0.746, p = 0.024; r = - 0.411, p = 0.036; r = - 0.441, p = 0.032) after surgery. Higher mean changes from baseline of visceral fat loss, represented by VAI, were observed in G2 (176.2 ± 149.0-75.5 ± 55.0, p = 0.000). CONCLUSION: Patients submitted to the 1800 IU/day protocol, 12 months after the surgical procedure, had a higher percentage of sufficient vitamin D levels compared to those submitted to the 800 IU/day protocol. Additionally, higher dose supplementation promoted a significant improvement in VAI.

Adequacy and Vitamin D in the Preoperative Period of Roux-en-Y Gastric Bypass, Bariatric Surgery, Can Protect Metabolic Health in Metabolically Healthy and Unhealthy Individuals.

Evaluating the influence of vitamin D concentrations together with preoperative metabolic phenotypes on remission of chronic noncommunicable diseases (CNCDs) after 6 months of Roux-en-Y gastric bypass (RYGB). Cross-sectional analytical study comprising 30 adult individuals who were assessed preoperatively (T0) and 6 months (T1) after undergoing RYGB. Participants were distributed preoperatively into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) individuals according to HOMA-IR classification and to the adequacy and inadequacy of vitamin D concentrations in the form of 25(OH)D. All participants were assessed for anthropometric characteristics, biochemical variables, and presence of CNCDs. The statistical program used was the SPSS version 21. In face of vitamin D adequacy and regardless of the metabolic phenotype classification in the preoperative period, the means found for HOMA-IR allowed us to define them as metabolically healthy 6 months after RYGB. Only those with vitamin D inadequacy with the MUHO phenotype showed better results regarding the reduction of glucose that accompanied the shift in serum 25(OH)D concentrations from deficient to insufficient. It is possible that preoperative vitamin D adequacy, even in the presence of an unhealthy phenotype, may contribute to the reduction of dyslipidemia and improvement in cholesterol. It is suggested that preoperative vitamin D adequacy in both phenotypes may have a protective effect on metabolic health.

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

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

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

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

Concepções em disputa no uso da suplementação e/ou fortificação de micronutrientes na alimentação escolar para prevenção da anemia / Conceptions in dispute in the use of micronutrient supplementation and/or fortification in school programs for prevention of anemia / Concepciones en disputa en el uso del uso de suplementos y/o enriquecimiento de micronutrientes en la alimentación escolar para la prevención de la anemia

Resumo: A anemia por deficiência de ferro afeta, mundialmente, diferentes populações e, no Brasil, é uma das principais carências nutricionais na infância. Diferentes estratégias são propostas por organismos internacionais e pelo Ministério da Saúde para sua prevenção. O objetivo do estudo foi analisar as ideias em disputa, presentes em documentos oficiais e narrativas dos profissionais da saúde e educação acerca do uso da suplementação e/ou fortificação nutricional como medida de prevenção da anemia no âmbito escolar. Baseou-se na análise de documentos governamentais e entrevistas semiestruturadas com profissionais atuantes em municípios que implementaram a estratégia de fortificação da alimentação escolar (NutriSUS) no Estado do Rio de Janeiro. As ideias disseminadas nos documentos governamentais ressaltam a eficiência da suplementação e da fortificação caseira para prevenção de anemia, com base em pesquisas científicas e se adequa aos objetivos das políticas públicas neles formalizados. As ideias presentes nas narrativas dos profissionais são, por vezes, críticas à necessidade desse tipo de intervenção e, por outras, favoráveis, indicando as controvérsias presentes no próprio processo de operacionalização local das políticas federais. Observaram-se tensões em torno dos conceitos de promoção, prevenção e tratamento por meio do NutriSUS, da dosagem e da forma de administração. As críticas à suplementação ressaltam as práticas alimentares saudáveis como estratégia preferencial. A medicalização em detrimento de ações de promoção da saúde pode tencionar a perspectiva pedagógica no contexto escolar e produzir ideias contraditórias sobre as melhores estratégias de promoção de alimentação saudável.

Abstract: Iron deficiency anemia affects different populations worldwide, and in Brazil it is one of the principal childhood nutritional deficiencies. Different strategies have been proposed by international agencies and the Brazilian Ministry of Health for its prevention. The study aimed to analyze the ideas in dispute, expressed in official documents and narratives by health and education workers concerning the use of nutritional supplementation and/or fortification as a measure in schools to prevent anemia. The study was based on government documents and semi-structured interviews with workers in municipalities that implemented the school food fortification strategy (NutriSUS) in the state of Rio de Janeiro. The ideas expressed in the government documents highlight the efficiency of home supplementation and fortification for prevention of anemia, based on scientific studies and adjusted to the objectives of the public policies set out in them. Some ideas in the workers' narratives are critical of the need for this type of intervention, others they favor them, indicating controversies in the process of local operationalization of federal policies. Tensions were observed in the concepts of promotion, prevention, and treatment through NutriSUS, dosage, and form of administration. Criticisms of supplementation highlight healthy eating practices as the best strategy. Medicalization rather than health promotion measures can strain the pedagogical perspective in schools and produce contradictory ideas on the best strategies for the promotion of healthy eating.

Resumen: La anemia por deficiencia de hierro afecta mundialmente a diferentes poblaciones y, en Brasil, es una de las principales carencias nutricionales durante la infancia. Se proponen diferentes estrategias por parte de organismos internacionales y el Ministerio de Salud para su prevención. El objetivo del estudio fue analizar las ideas en disputa, presentes en documentos oficiales y narraciones de los profesionales de salud y educación, acerca del uso de los suplementos y/o enriquecimientos nutricionales, como medida de prevención de la anemia en el ámbito escolar. Se basó en el análisis de documentos gubernamentales y entrevistas semiestructuradas con profesionales que actuaban en municipios que implementaron la estrategia de fortificación de la alimentación escolar (NutriSUS) en el estado de Río de Janeiro. Las ideas difundidas en los documentos gubernamentales resaltan la eficiencia de la suplementación y del enriquecimiento alimenticio casero para la prevención de anemia, basadas investigaciones científicas, y se adecua a los objetivos de las políticas públicas en ellos formalizados. Las ideas presentes en las narraciones de los profesionales son, a veces, críticas con la necesidad de este tipo de intervención y, otras veces, favorables, indicando las controversias presentes en el propio proceso de operacionalización local de las políticas federales. Se observaron tensiones en torno a los conceptos de promoción, prevención y tratamiento mediante NutriSUS, así como sobre la dosificación y la forma de administración. Las críticas a los suplementos resaltan las prácticas alimentarias saludables como estrategia preferente. La medicalización en detrimento de acciones de promoción de la salud puede tensionar la perspectiva pedagógica en el contexto escolar y producir ideas contradictorias sobre las mejores estrategias de promoción de alimentación saludable.

Deficiência e transferência de renda diante da síndrome congênita do Zika vírus: um estudo sobre a Medida Provisória 894/2019 / Discapacidad y transferencia de renta ante el síndrome congénito del zika virus: un estudio sobre la medida provisional 894/2019 / Disability and income transfer in relation to congenital Zika syndrome: a study of provisional measure 894/2019

Desde 2015, a Síndrome Congênita do Zika Vírus (SCZV) marca o cenário brasileiro, extrapolando o campo da Saúde Pública com demandas da proteção social. Considerando a intersecção entre pobreza, deficiência e marcos da seguridade social, examina-se a Medida Provisória 894, que prevê renda mensal vitalícia para as crianças acometidas. Com o objetivo discutir o instrumento à luz dos marcos da seguridade social no recorte da transferência de renda não condicionada para as pessoas com deficiência (PcD) no Brasil, realizou-se um estudo qualitativo mediante análise de documentos públicos e revisão de literatura. As respostas estatais não produziram impacto na insuficiência de renda porque voltaram-se inicialmente para atender à situação emergencial, recorrendo às políticas preexistentes, e culminaram na substituição entre modalidades de transferência de renda - o Benefício de Prestação Continuada para Pensão Vitalícia -, revelando fragilização da proteção social integral. (AU)

Desde 2015 el Síndrome Congénito del Zika Virus (SCZV) marca el escenario brasileño, extrapolando el campo de la salud pública con demandas de la protección social. Considerando la intersección entre pobreza, discapacidad y marcos de la seguridad social, se examina la Medida Provisional 894 que prevé renta mensual vitalicia para los niños afectados. Con el objetivo de discutir el instrumento a la luz de los marcos de la seguridad social en el recorte de la transferencia de renta no condicionada para las Personas con Discapacidad (PcD) en Brasil, se realizó un estudio cualitativo mediante análisis de documentos públicos y revisión de literatura. Las respuestas estatales no causaron impacto en la insuficiencia de renta porque inicialmente se enfocaron para atender la situación de emergencia recurriendo a las políticas preexistentes y que culminaron en la substitución entre modalidades de transferencia de renta, el Beneficio de Prestación Continua para Pensión Vitalicia, revelando la fragilización de la protección social integral. (AU)

Since 2015, Congenital Zika Syndrome (CZS) has been a feature of the Brazilian context and has moved beyond public health to demands for social protection. Given the intersection between poverty, disability and the social security framework, we examine Provisional Measure 894, which provides a lifetime monthly income for affected children. We conduct a qualitative study, analysing public documents and reviewing the literature, in order to discuss this instrument in the light of social security frameworks for unconditional cash transfers for People with Disabilities (PwD) in Brazil. State responses did not have an impact on income insufficiencies, since they were initially intended to respond to emergency situations and referred to pre-existing policies; this culminated in an income transfer modality, the Continuous Cash Benefit, being replaced by a Lifetime Pension, demonstrating a weakening of comprehensive social protection. (AU)

Nitrogen coated fertilizer with controlled release for the maize crop / Fertilizante revestido com nitrogênio com liberação controlada para a cultura do milho

Maize represents one of the most cultivated crops of cereals in the world, being used as a source of grain, silage and biofuel. Nitrogen is very required in the maize crop, making nitrogen fertilization a significant part of the production cost. The objective of this study was to evaluate the response of two sources of N, urea and coated urea of controlled release, regarding the productivity and the cost/benefit ratio in maize for 2nd harvest. The experiment was carried out in the field in soil classified as dystroferric Red Latosol and treatments distributed in experimental plots, following the randomized block design with four replications. The treatments were 40 kg N ha-1 of common urea; 60 kg N ha-1 of common urea; 40 kg N ha-1 of coated urea; 60 kg of N-coated urea and the control without application of N broadcast application in planting. The maize crop responded to the application of nitrogen at planting. However, the use of coated urea did not increase the grain yield in relation to the use of common urea. The economic analysis demonstrated a better efficiency of use of N and the best net revenues with the application of the dose of 40 kg N ha -1 of common urea in the planting of the crop.

O milho representa uma das culturas de cereais mais cultivadas no mundo, sendo utilizado como fonte de grãos, silagem e biocombustível. O nitrogênio é muito necessário na cultura do milho, tornando a fertilização nitrogenada uma parte significativa do custo de produção. Este trabalho teve como objetivo avaliar o fertilizante nitrogenado revestido de liberação controlada para a cultura do milho de 2ª safra. O trabalho foi desenvolvido na Fazenda Estância Maracaju, localizada no município de Maracaju ­ Mato Grosso do Sul. As parcelas experimentais foram constituídas por 48 linhas com espaçamento de 0,5 metros por 1000 metros de comprimento entre si. Como área útil considerou-se as 30 linhas centrais (1,5 ha). Os tratamentos utilizados foram T1: 40 kg ha-1 de N de ureia comum; T2: 60 kg ha-1 de N de ureia comum; T3: 40 kg ha-1 de N de ureia revestida; T4: 60 kg de N de ureia revestida e T5: sem aplicação de N. Os tratamentos foram distribuídos nas unidades experimentais segundo delineamento de blocos ao acaso com quatro repetições. A cultura de milho, respondeu aplicação de nitrogênio no plantio. O uso de ureia revestida não influenciou na produtividade de grãos em relação a ureia comum no milho de 2ª safra. A melhor eficiência de uso de N e a melhor receita líquida é com a dose de 40 kg de N ureia ha-1, de ureia comum aplicado no plantio da cultura.

Higher cut-off values of non-invasive methods might be needed to detect moderate-to-severe steatosis in morbid obese patients: a pilot study.

To evaluate the diagnostic value of described thresholds of controlled attenuation parameter (CAP) and biomarker scores for liver steatosis and to evaluate new cut-offs to detect moderate-to-severe steatosis (S2-3) in patients with morbid obesity. In this prospective study, 32 patients with morbid obesity with indications for bariatric surgery (15 women and 17 men, mean age = 36 years, median BMI = 40.2 kg/m2) underwent CAP, magnetic resonance spectroscopy (MRS), three biomarker scores (Steato-ELSA, Fatty Liver Index (FLI), and Hepatic Steatosis Index (HSI)), and liver biopsy. Subjects were divided into an exploratory cohort (reliable CAP and liver biopsy) and a confirmatory cohort (reliable CAP and MRS) to evaluate new thresholds for CAP and biomarker scores to detect S2-3. Receiver operator characteristic (ROC) curves analyses were performed and the optimal cut-off points were identified using the maximal Youden index. A total of 22 patients had CAP measure and liver biopsy (exploratory cohort) and 24 patients had CAP measure with MRS (confirmatory cohort). New cut-offs were identified for detection of S2-3 by the non-invasive tests using liver biopsy as the reference standard (exploratory cohort). Considering the new proposed cut-offs for detection of S2-3 for CAP (≥ 314 dB/m), Steato-ELSA (≥ 0.832), FLI (≥ 96), and HSI (≥ 53), for the exploratory and confirmatory cohorts sensitivities were: 71-75%, 86-81%, 85-81%, and 71-69% and specificities were: 94-89%, 75-63%, 63-63%, and 75-88%, respectively. Higher cut-offs for CAP and biomarker scores may be better to diagnose moderate-to-severe steatosis in patients with morbid obesity.

Vertical Sleeve Gastrectomy Has Better Weight Evolution and Serum Concentrations of Vitamin D when Compared with Roux-Y Gastric Bypass.

OBJECTIVE: The objective of this study is to compare the weight evolution and serum concentrations of vitamin D in individuals undergoing Roux-en-Y Gastric Bypass (RYGB) and Sleeve after 1 follow-up year. METHODOLOGY: Descriptive, prospective, and longitudinal study, with 108 individuals divided into 2 groups: RYGB (55 patients) and Sleeve (53), evaluated preoperatively, and at 6 and 12 postoperatively months. Anthropometric data, serum concentrations of 25(OH)D, calcium, and parathyroid hormone were analyzed. RESULTS: The Sleeve group showed greater reductions in excess weight and excess body mass index (BMI) when compared with the RYGB group at both times (p < 0.001). Besides, after 12 months, those who had undergone the Sleeve procedure also had higher percentages of surgical success (84.4% versus 65.0%, p = 0.038). The prevalence of preoperative inadequacy of 25(HO)D in both groups was 78.7%. After 6 months, there was an increase in serum concentrations of 25(HO)D in both groups (p < 0.001), but without significant differences between the groups (p = 0.154). In the comparison between 6 and 12 months, there was only a reduction for the RYGB group (p = 0.001). Also, when comparing both groups, the means of vitamin D in patients undergoing RYGB were also lower after 12 months (p = 0.003). There was a negative correlation between vitamin D and parathyroid hormone (r = - 0.235 p = 0.030). The mean serum concentrations of calcium were adequate at all times. CONCLUSION: Patients undergoing the Sleeve procedure had a better evolution in weight loss and are at a lower risk of vitamin D inadequacy than those undergoing RYGB.

Baixo peso ao nascer e fatores associados ao prénatal: estudo seccional em uma maternidade de referência de Macaé

Objetivos: Estimar a associação entre o baixo peso ao nascer (BPN) e os fatores socioeconômicos, demográficos e assistência pré-natal de puérperas atendidas em uma maternidade de referência de Macaé. Métodos: Realizou-se um estudo seccional, descritivo, de bases primária e secundária na maternidade de um hospital público do município, entre agosto e dezembro de 2014. Realizou-se uma análise múltipla de correspondências para descrição e elaboração de perfil multivariado entre as variáveis socioeconômicas, demográficas e assistência pré-natal com o BPN. Resultados: Foram entrevistadas 105 puérperas, com idade média de 25,5 anos e observou-se 8,6% de BPN. O perfil multivariado sinalizou que recém-nascidos com BPN tendem a ser aqueles cuja mãe apresentou baixo peso pré-gestacional, renda inferior a um salário mínimo, realizou menos de 6 consultas de pré-natal e idade gestacional a termo. Conclusão: O BPN foi associado ao baixo peso pré-gestacional materno, baixa renda familiar (inferior a 1 salário mínimo) e o número de consultas pré-natal (<6).

Objectives: To estimate the association between low birth weight (LBW) and socioeconomic, demographic factors and prenatal care of postpartum women attended in a reference maternity in Macaé. Methods: A descriptive, sectional study of primary and secondary bases in the maternity hospital of a public hospital in the municipality was carried out between August and December 2014. A multiple correspondence analysis was performed to describe and elaborate a multivariate profile among socioeconomic variables, and prenatal care with LBW. Results: 105 postpartum women were interviewed, with an average age of 25.5 years. LBW was 8.6%. In the first group, it was detected that newborns with LBW tend to be those whose mothers had low pre- gestational weight, income less than a minimum wage, performed less than 6 prenatal consultations and full term gestational age. Conclusion: The LBW was associated with low maternal pre - gestational weight, low family income (less than 1 minimum wage) and the number of prenatal consultations (<6).

IRON DEFICIENCY ANEMIA AND ITS RELATIONSHIP WITH SOCIOECONOMIC VULNERABILITY.

OBJECTIVE: To analyze the association of anemia with the socioeconomic vulnerability of preschoolers in public day care centers, in the city of Taubaté, SP, Brazil. METHODS: This is a cross-sectional study with a probabilistic sample that analyzed 363 children assisted in public day care centres in low-income and high-income areas of Taubaté, SP, Brazil. The hemoglobin concentration (Hb), dependent variable, was obtained by digital puncture, considering anemic children with Hb concentration <11.0 g/dL. The independent variables such as socioeconomic and demographic conditions were collected by a semi-structured questionnaire. RESULTS: The prevalence of iron deficiency anemia was 19.3% among preschoolers. Children from day care centers with high socioeconomic vulnerability had lower Hb concentration than those from a non-vulnerable area (p<0.05). CONCLUSIONS: The lower concentration of hemoglobin in preschoolers is associated with the location of day care centers in an area of socioeconomic vulnerability. Children attending these day care centers face adverse family conditions such as low income, working mothers, and mothers with low schooling, though they receive social benefits and monitoring by public health services.

Phytochemistry and antifungal potential of Datura inoxia Mill. on soil phytopathogen control / Fitoquímica e potencial antifúngico de Datura inoxia Mill. no controle de fitopatógenos do solo

The application of chemical pesticides for the control of fungal diseases results in impacts on the environment and human health. The use of vegetal extracts with antifungal properties for the proper management of crops becomes a viable alternative, mainly for organic and family farming. The objective of this study was to carry out the phytochemical evaluation of Datura inoxia, evaluating its antifungal potential against the mycelial growth of Fusarium solani and Sclerotinia sclerotiorum. The extracts, aqueous and ethanolic, obtained from the leaves of the plant collected in areas of the municipality of Campo Grande, Mato Grosso do Sul, were submitted to phytochemical prospecting and quantification of flavonoids and total phenols. It was evaluated its antifungal activity at concentrations of 800, 1200, 1600, 2000, and 2400 µg 100 mL-1. Each concentration was separately incorporated into BDA agar, poured into Petri dishes, and inoculated with the mycelial disc of the fungus. The diameter of the colonies were measured daily. Two solutions were prepared as control, one containing the solvent added to PDA medium (ethanol solution), and another with only PDA medium (without D. inoxia extract, control). In both extracts were found the same diversity of secondary metabolites (nine classes). The ethanolic extract, a solvent of lower polarity than water, was more efficient in the extraction of these constituents. Alkaloids and phenolic compounds were the most frequent compounds (100%). In relation to antifungal activity, the ethanolic extract provided 100% inhibition of mycelial growth ofSclerotinia sclerotitorum in all concentrations, relative to the control. On the other hand, the growth ofFusarium solani was only negatively affected at the highest concentrations of 800 and 1200 µmL-1 100 mL-1. The antifungal potential of Datura inoxia was probably related to the abundance of alkaloids and phenolic compounds in its chemical constitution that negatively effects the development of the vegetative mycelium.

A aplicação de defensivos químicos para o controle de doenças fúngicas tem por consequência impactos sobre o ambiente e a saúde humana. Desta forma, a utilização de extratos vegetais com propriedades antifúngicas associado ao manejo adequado de culturas, torna-se uma proposta viável de controle alternativo, principalmente na agricultura orgânica e familiar. Neste sentido, objetivou-se realizar a avaliação fitoquímica das folhas de Datura inoxia, avaliando seu potencial antifúngico frente ao crescimento micelial de Fusarium solani e Sclerotinia sclerotiorum. Os extratos, aquoso e etanólico, obtidos das folhas da planta coletadas em áreas do município de Campo Grande, Mato Grosso do Sul, foram submetidos à prospecção fitoquímica e quantificação flavonoides e fenóis totais, avaliando-se sua atividade antifúngica em concentrações de 800, 1200, 1600, 2000 e 2400 µg 100 mL-1. Cada concentração foi incorporada, separadamente, em ágar BDA, vertida em placas de petri, seguida da colocação do disco de micélio do fungo, com diâmetro das colônias sendo medido diariamente. Utilizou-se como controle negativo, ágar sem extrato e ágar com solução etanólica. Nos dois extratos ocorreu a mesma diversidade de metabólitos secundários (nove classes); porém o extrato etanólico, um solvente de menor polaridade que a água, foi mais eficiente na extração destes constituintes, com destaque aos alcaloides e compostos fenólicos com maior frequência (100%). Em relação a atividade antifúngica, o extrato etanólico proporcionou inibição de 100% do crescimento micelial de Sclerotinia sclerotitorum, em todas as concentrações, em relação a testemunha. Por outro lado, o crescimento de Fusarium solani foi afetado negativamente apenas nas maiores concentrações, 800 e 1200 µmL-1 100 mL-1.O potencial antifúngico da planta provavelmente está relacionado a sua constituição química, com abundância de alcaloides e compostos fenólicos, afetando negativamente o desenvolvimento do micélio vegetativo.

Evolução do excesso de peso em gestantes usuárias da Atenção Primária à Saúde do município de Macaé-RJ entre 2010-2018 / Evolution of overweight pregnant women in the Primary Health Care in the city of Macaé-RJ between 2010-2018

Introdução: O estudo visa investigar a taxa de prevalência e a tendência temporal do excesso de peso em gestantes usuárias da Atenção Primária à Saúde de Macaé, entre 2010 e 2018. Método: Realizou-se estudo quantitativo, de série temporal, com a base de dados do Sistema de Vigilância Alimentar e Nutricional (Sisvan WEB), de acesso público, referente ao diagnóstico nutricional de gestantes ≥20 anos usuárias da Atenção Primária à Saúde do município de Macaé, no período de 2010 a 2018. Analisaram-se 4.279 registros de gestantes no período de nove anos. As variáveis estudadas foram: ano de coleta e registro dos dados; baixo peso; peso adequado; sobrepeso; obesidade; excesso de peso (sobrepeso e obesidade). A análise de tendência do excesso de peso foi realizada por meio de modelos de regressão linear simples, considerando-se o nível de significância de 5%. Resultados: As prevalências do excesso de peso em gestantes foram elevadas e ascendentes: 2010 (40,2%), 2011 (37,5%), 2012 (46,8%), 2013 (48,8%), 2014 (50,9%), 2015 (51,8%), 2016 (54,4%), 2017 (57,6%) e 2018 (55,8%). Em todas as análises, detectou-se a tendência significativa e crescente, podendo-se destacar o desfecho do excesso de peso, que apresentou velocidade de incremento anual (ß1=2,35; p-valor<0,001) superior aos demais desfechos analisados em separado. Conclusão: Conclui-se que é elevada e crescente a prevalência do excesso de peso em gestantes usuárias da Atenção Primária à Saúde do município de Macaé no período estudado. (AU)

Introduction The study aims to investigate the prevalence rate and the time trend of excess weight in pregnant women receiving Primary Health Care in Macaé, between 2010 and 2018. Method: A quantitative, time series study was conducted with the open access database of the Food and Nutritional Surveillance System (Sisvan WEB), relative to the nutritional diagnosis of pregnant women> 20 years old, receiving Primary Health Care in the city of Macaé, between 2010 and 2018. Analyses were made of 4,279 records of pregnant women over a nine-year period. The study variables were: year of data collection and registration; low weight; adequate weight; overweight; obesity; excess weight (overweight and obesity). Trend analysis of excess weight was performed using simple linear regression models, considering the significance level of 5%. Results: Prevalence of overweight in pregnant women was high and rising: 2010 (40.2%), 2011 (37.5%), 2012 (46.8%), 2013 (48.8%), 2014 (50.9%), 2015 (51.8%), 2016 (54.4%), 2017 (57.6%) and 2018 (55.8%). All analyses showed a significant and growing trend, especially for the excess weight outcome, whose annual increase speed (£ 1 = 2.35; p-value <0.001) was higher than the other outcomes, when analyzed separately. Conclusion: Prevalence of excess weight in pregnant women receiving Primary Health Care in the city of Macaé was high and growing during the study period. (AU)

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

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