Serum α-Carotene, but Not Other Antioxidants, Is Positively Associated with Muscle Strength in Older Adults: NHANES 2001-2002.

Aging is associated with an increased reactive oxygen species that can decrease muscle strength. Thus, antioxidant substances could be positively associated with muscle strength in older adults. To investigate the association between serum antioxidants and muscle strength in older adults. A cross-sectional study evaluating 1172 individuals (627 men and 545 women), aged 50 to 85 years from NHANES 2001-2002, was performed. Carotenoids (α-carotene, trans-ß-carotene, cis-ß-carotene, ß-cryptoxanthin, lutein/zeaxanthin combination, trans-lycopene), vitamin E, and retinol were analyzed via the high-performance liquid chromatography method. Muscle strength was evaluated by the isokinetic knee extension test. Linear regression was performed to evaluate the association between tertiles of serum antioxidant levels and strength, adjusted for confounders (energy and protein intake, body mass index, sex, age, C-reactive protein, uric acid, race/ethnicity, marital status, annual household income, educational level, physical activity, smoking, hypertension, arthritis, and diabetes). Alpha-carotene levels (p-trend = 0.027) were positively associated with muscle strength. However, serum vitamin E, trans-ß-carotene, cis-ß-carotene, ß-cryptoxanthin, carotenoids, and retinol levels were not associated with strength. Serum α-carotene, but not other antioxidants, was positively associated with muscle strength in older adults.

Síndrome de Parsonage Turner: um relato de caso / Parsonage-Turner Syndrome: a case report

A Síndrome de Parsonage-Turner (SPT) é uma doença rara que acomete a musculatura da cintura escapular, acarretando hipotrofia muscular e grande limitação funcional. A etiologia ainda é indeterminada; acredita-se que existam fatores autoimunes e infecciosos envolvidos. No presente caso foi aventada possível relação com a vacina da influenza. Os sintomas da SPT incluem dor abrupta de um lado da cintura escapular, sendo característico o despertar noturno. É uma condição de difícil diagnóstico, podendo ser confundida inicialmente com espondilose cervical, capsulite adesiva, radiculopatia cervical e bursite. Na investigação diagnóstica, foram realizados exames laboratoriais e ressonâncias magnéticas e eletroneuromiografia que auxiliou na definição diagnóstica. O tratamento envolve a abordagem da dor neuropática e reabilitação visando a recuperacao da força e da função muscular. O objetivo dessa descrição é revisar o assunto através de um relato de caso típico mas que, no entanto, não foi inicialmente considerado, servindo de alerta para que diante de quadros de dor aguda em membros superiors seja ponderado o diagnóstico de Parsonage Turner. Dessa forma o assunto se torna mais habitual no ofício médico, facilitando o diagnóstico precoce e oferecendo o prognóstico ao paciente, evitando exames e medicações desnecessárias.

Parsonage-Turner Syndrome (SPT) is a rare disease that affects the musculature of the shoulder girdle, resulting in muscle hypotrophy and functional limitation. The etiology is still undertermined: It is believed that exist autoimune disorders and infections involved. In this case a possible relationship with the influenza vacinne was suggest. The symptoms of SPT include acute onset pain in one side of the shoulder girdle and frequently awakens pacients from sleep, fact that occurred in this report. This disease has difficult diagnostic and can be confused initially with cervical spondylosis, adhesive capsulitis, cervical radiculopathy and bursitis. In the diagnostic investigation, laboratory exams, magnetic resonances and electroneuromyography were performed, of the latter deserves mention for assisting in the definitive diagnosis and determining the extent of the lesion. There is still no protocol for specific treatment, but it should be focused on reducing neuropathic pain and recovering muscle strength and function. The purpose of this description is to review the subject through a typical case report, which, however, was not initially considered, serving as a warning so that in the face of acute pain in upper limbs, the diagnosis of Parsonage Turner should be considered. Thus, the subject becomes more usual in the medical craft making the clinical evaluation more careful so that the diagnosis is early and offers a better prognosis to the patient, avoiding unnecessary exams and medications.

Endoscopic evaluation of pharyngeal and laryngeal sensation in patients with chronic obstructive pulmonary disease (COPD): A cross-sectional study.

OBJECTIVE: To describe and compare the findings of endoscopic sensory assessment in COPD patients and healthy controls. DESIGN: A prospective cross-sectional study. SETTING: Otorhinolaryngology outpatient clinic at a university hospital. PARTICIPANTS: 27 adults with COPD and 11 age-matched healthy controls. MAIN OUTCOME MEASURES: Group differences in light touch endoscopic tests of pharyngeal and laryngeal sensation, controlling for pooled salivary secretions in the pharynx and laryngo-pharyngeal reflux as measured by the Reflux Finding Score (RFS). RESULTS: A significant difference in laryngeal sensation was found between the study groups (P = .047), with reduced laryngeal sensation in the COPD patients. Additionally, a significant relationship was found between impaired oropharyngeal sensation and the presence of pooled salivary secretions in the pharynx (P = .018), especially in the pyriform sinuses (P = .012). No differences in the frequency of abnormal RFSs were found between groups. CONCLUSION: Individuals with COPD were significantly more likely to present with impaired laryngeal sensation. Additionally, impaired sensation in the oropharynx was associated with pooled salivary secretions in the pharynx.

Efficient synthesis and antitumor evaluation of 4-aminomethyl-N-arylpyrazoles: Discovery of potent and selective agents for ovarian cancer.

A new one-pot two-step sequential methodology for synthesis of novel 3-carboxyethyl 4-[(tert-butylamino)methyl]-N-arylpyrazole derivatives is reported. One-pot transformation of ß-enamino diketones and arylhydrazines generated 4-iminium-N-arylpyrazole salt intermediates in situ, which were easily transformed into 4-[(tert-butylamino)methyl]-N-arylpyrazole derivatives by NaBH3CN. The products could be isolated in the free or hydrochloride salt forms. Also, it was possible to obtain the products in the zwitterionic form by ester group hydrolysis. Furthermore, all synthesised compounds were evaluated in vitro against a panel of eight human tumor cell lines. The 4-[(tert-butylamino)methyl]-N-arylpyrazole derivatives were much more powerful than the hydrochloride and zwitterionic forms. Moreover, the results suggest that the N-aryl group at the pyrazole ring is vital for modulating antiproliferative activity. The 3-carboxyethyl 4-[(tert-butylamino)methyl]-N-phenylpyrazoles 3a-g exhibited higher inhibitory activities against OVCAR-3, with GI50 values of 0.013-8.78 µM, and lower inhibitory activities against normal human cell lines. Molecular docking was performed to evaluate the probable binding mode of 3a into active site of CDK2.

Relação do tempo de trânsito faríngeo e presença de resíduo com dispneia e função pulmonar na doença pulmonar obstrutiva crônica / Relationship of pharyngeal transition time and presence of residue with dyspnea and lung function in chronic obstructive pulmonary disease

RESUMO Objetivo Relacionar o tempo de trânsito faríngeo e a presença de resíduos com a dispneia e a função pulmonar em indivíduos com Doença Pulmonar Obstrutiva Crônica DPOC. Método Estudo realizado com 19 adultos (11 homens e 8 mulheres) com diagnóstico clínico e espirométrico de DPOC e idade média de 63,8 (±9,3) anos. A coleta de dados foi realizada utilizando o questionário COPD Assessment Test (CAT, Teste de Avaliação da DPOC) a escala de dispneia do Medical Research Council modificada (mMRC) e um manovacuômetro digital, para caracterizar o impacto da doença no indivíduo, a dispneia e a função pulmonar. Os dados referentes ao tempo de trânsito faríngeo e resíduo faríngeo foram coletados por meio de análise das imagens videofluoroscópicas realizada por três juízes cegados. Resultados Não foram encontradas relações significativas entre tempo de trânsito faríngeo (TTF) com função pulmonar (r = -0,71), e entre presença de resíduo faríngeo com a dispneia (r= -0,06). O TTF, quando comparado com a normalidade, apresentou-se aumentado. Conclusão Os indivíduos com DPOC, independente da gravidade da doença, não manifestaram associação entre alterações no TTF e resíduo faríngeo e dispneia e função pulmonar.

ABSTRACT Purpose To relate pharyngeal transit time and the presence of residues with dyspnea and lung function in individuals with Chronic Obstructive Pulmonary Disease COPD. Methods Study conducted with 19 adults (11 men, 8 women) with a clinical and spirometric diagnosis of COPD and a mean age of 63.8 years (SD = 9.3). Data collection was performed using the COPD Assessment Test (CAT) questionnaire, the modified Medical Research Council scale (mMRC) and a digital manovacuometer, to characterize the impact of the disease on the individual, dyspnea and lung function. The data related to pharyngeal transit time and pharyngeal residue were collected through the analysis of videofluoroscopic images performed by three blinded judges. Results No significant relationship was found between pharyngeal transit time (PTT) with lung function (r = -0.71), pharyngeal residue and dyspnea (r = -0.06). PTT, when compared to normality, was increased. Conclusion Individuals with COPD, regardless of the severity of the disease, showed no association between PTT and pharyngeal residue and dyspnea and lung function.

Quantitative determination of histone methylation via fluorescence resonance energy transfer (FRET) technology in immortalized bovine mammary alveolar epithelial cells supplemented with methionine.

Methionine (Met) is an essential precursor of S-adenosylmethionine (SAM), which is the primary methyl donor required for biological processes such as DNA and histone methylation, which alter gene expression. In dairy cows, dietary Met has been observed to exert transcriptional alterations with beneficial effects on milk biosynthesis; however, the extent of these effects via SAM remains unknown. Therefore, we evaluated the effect of Met supply on histone methylation in lysine residues K9 and K27 in the histone tail H3 via a fluorescence resonance energy transfer (FRET) system in immortalized bovine mammary alveolar epithelial cells (MACT) incubated varying concentration of Met. The histone methylation data was complemented with global DNA methylation, cellular protein synthesis, and RT-qPCR analysis of genes related to Met cycle, DNA and histone methylation, AA transporters, and protein synthesis. The histone methylation data was performed on MACT cells seeded at 30,000 cells/well in 96-well plates 24 h prior to transfection. The transfections of FRET gene reporter plasmids H3K9 and H3K27 was performed with 0.3 µL/well of Lipofectamine® 3000 and 50 ng of plasmid DNA per well. At 24 h post-transfection, cells were treated with 0, 125, 250, and 500 µM of Met, and quantification of histone methylation was performed at 0, 12, and 24 h post-treatment as well as cell viability at 24 h using CellProfiler software. An inverted microscope for live imagining (EVOS® FL Auto) equipped with a motorized scanning stage, and an environment-controlled chamber at 37˚C and 5.0% of CO2 was used to take 4 pictures/well at 4x magnification. A more defined response on histone methylation was observed in H3K9 than H3K27 to Met supply, where maximal histone methylation in H3K9 was observed with 125 µM of Met. This greater histone methylation in H3K9 at 125 µM was accompanied by greater cellular protein concentration. The linear increase in Met supply causes a linear decrease in global DNA methylation, while linearly upregulating genes related to the Met cycle (i.e., MAT1A, PEMT, SAHH, and MTR). The histone methylation data suggest that, to some extent, methyl-donors such as Met may affect the methylation sites, H3K9 and H3K27, and consequently causing a different epigenetic alteration. In the context of the dairy cow, further refinement to this FRET assay to study histone methylation could lead to establishing novel potential mechanisms of how dietary methyl donors may control the structural conformation of the bovine genome and, by extension, gene expression.

Early Infant Formula Feeding Impacts Urinary Metabolite Profile at 3 Months of Age.

There is a growing consensus that nutritional programming may persist and influence risk for several chronic diseases in adulthood. In the present study, we used urinary metabolic analysis in assessing diet effects on early-life metabolism. Urine samples from healthy three-month-old infants fed human milk (HM; n = 93), cow's milk-based infant formula [MF; n = 80], or soy protein-based infant formula (SF; n = 76) were analyzed with an untargeted metabolomics approach using GC-TOF MS. PLS-DA and ANOVA analyses were performed using MetaboAnalyst (v4.0). A total of 150 metabolites differed significantly among the feeding groups, including dietary-specific patterns of urinary metabolites of sugars, sugar alcohols, amino acids, and polyphenols. Urinary metabolites may mirror the infant's overall metabolism and serve as a noninvasive tool to examine the neonatal effects of diet on early-infant metabolism.

Escolarização de pessoas com Transtornos do Espectro Autista (TEA) em idade adulta: relatos e perspectivas de pais e cuidadores de adultos com TEA / Schooling of people with Autism Spectrum Disorder (ASD) in adulthood: reports and perspectives of parents and caregivers of adults with ASD

Resumo A Política Nacional da Educação, dentro da perspectiva da educação inclusiva, orienta que os sistemas de ensino e aprendizagem garantam o acesso desde a educação infantil até o ensino superior/profissionalizante. A literatura da área revela a necessidade de uma maior compreensão acerca dos processos de escolarização para pessoas com TEA nas diversas etapas da vida. Este trabalho teve como objetivo identificar perspectivas de familiares de adultos com TEA em relação às instituições que se propõem a atenção aos autistas na vida adulta. Objetivou também identificar como foi o percurso escolar, os aspectos positivos e desafios, sob o ponto de vista de seus familiares. O método incluiu a administração de dois questionários, analisados através de estatística descritiva e da técnica do Discurso do Sujeito Coletivo (DSC). Participaram do estudo 67 pais/cuidadores de adultos com TEA residentes em 14 estados brasileiros. Os resultados evidenciam exclusão vivenciada por esses adultos em seu processo de escolarização desde o período da infância/adolescência até a idade adulta. Verifica-se que a maior parte destes autistas esteve inserida somente em instituições educacionais especiais, sendo que somente oito chegaram a instituições regulares de ensino na idade adulta. As dificuldades relatadas estavam relacionadas à inserção, qualidade dos serviços e permanência nas instituições escolares. Foram apresentados como pontos positivos a ampliação da socialização e o ganho de habilidades. Por fim estes familiares apresentam suas perspectivas sobre como deveriam ser as instituições aptas a receberem a pessoa com TEA, já em idade adulta, englobando atendimentos individualizados e de forma integral.

Abstract The Educational National Policy, within the perspective of inclusive education, orients teaching and learning systems to guarantee access since preschool until high school/vocational school. The literature on the field reviews the need for a greater understanding of schooling processes for people with ASD in the different stages of life. This study has aimed to identify the perspective of families of adults with ASD regarding the institutions that offer care to autistic people during adulthood. The study has also aimed to identify the educational trajectory, its positive aspects/challenges, under the outlook of their family members. The research methodology includes the provision of two questionnaires, subsequently analyzed under descriptive statistics and Collective Subject Discourse Methodology (CSD). In total, 67 parents/caregivers of adults with ASD, residents in 14 Brazilian states, were part of the study. The results reveal the exclusion experienced by these adults in their educational trajectories, since their childhood/adolescence, until their adulthood. Moreover, it is noted that most of them have been inserted only in special education institutions, with only eight reaching regular teaching institutions within adulthood. The reported challenges were related to inclusion, service quality and permanence in the educational institutions. As for positive aspects, the expansion of socialization and the gain of new skills have been highlighted. Ultimately, these family members showed their perspectives on characteristics institutions should have, in order to be considered suitable to care for people with ASD during adulthood, comprising individual and comprehensive care.

Caffeine and cannabinoid receptors modulate impulsive behavior in an animal model of attentional deficit and hyperactivity disorder.

Attention deficit and hyperactivity disorder (ADHD) is characterized by impaired levels of hyperactivity, impulsivity, and inattention. Adenosine and endocannabinoid systems tightly interact in the modulation of dopamine signaling, involved in the neurobiology of ADHD. In this study, we evaluated the modulating effects of the cannabinoid and adenosine systems in a tolerance to delay of reward task using the most widely used animal model of ADHD. Spontaneous Hypertensive Rats (SHR) and Wistar-Kyoto rats were treated chronically or acutely with caffeine, a non-selective adenosine receptor antagonist, or acutely with a cannabinoid agonist (WIN55212-2, WIN) or antagonist (AM251). Subsequently, animals were tested in the tolerance to delay of reward task, in which they had to choose between a small, but immediate, or a large, but delayed, reward. Treatment with WIN decreased, whereas treatment with AM251 increased the choices of the large reward, selectively in SHR rats, indicating a CB1 receptor-mediated increase in impulsive behavior. An acute pre-treatment with caffeine blocked WIN effects. Conversely, a chronic treatment with caffeine increased the impulsive phenotype and potentiated the WIN effects. The results indicate that both cannabinoid and adenosine receptors modulate impulsive behavior in SHR: the antagonism of cannabinoid receptors might be effective in reducing impulsive symptoms present in ADHD; in addition, caffeine showed the opposite effects on impulsive behavior depending on the length of treatment. These observations are of particular importance to consider when therapeutic manipulation of CB1 receptors is applied to ADHD patients who consume coffee.

Cuidados paliativos em cardiologia / Palliative care in cardiology / Cuidados paliativos en cardiología

Este estudo tem como objetivo analisar a produção cientifica acerca do tema cuidados paliativos em cardiologia. Para tanto foi realizado uma pesquisa bibliográfica na literatura nacional e internacional. A partir da aplicação dos critérios de inclusão e exclusão resultou na seleção de 25 artigos analisados. Como resultado a pesquisa mostra a pouca oferta de médicos especializados em cuidados paliativos; a oferta do cuidado paliativo no tratamento de pacientes com insuficiência cardíaca ainda incipiente e restrita no Brasil; a insuficiência cardíaca como a enfermidade com maior prevalência e incidência na aplicação dos cuidados paliativos em cardiopatas; a percepção errônea de que este cuidado só deva ocorrer no processo final de vida; as barreiras na implementação deste modelo de cuidado em cardiologia; e por fim, o quanto o cuidado paliativo reflete melhor as necessidades dos pacientes em situação terminal, além do baixo custo. A conclusão referência a demanda da implementação do tema no currículo da graduação do curso de medicina e a possibilidade de clínicos serem treinados a utilizar os domínios paliativos essenciais, como algumas sugestões de estratégias para ampliação deste cuidado. (AU)

This study aims to analyze the scientific production on the topic of palliative care in cardiology. For this purpose a bibliographical research was carried out in the national and international literature. From the application of inclusion and exclusion criteria, 25 articles were nalyzed. As a result research shows the limited supply of physicians specializing in palliative care; the offer of palliative care in the treatment of patients with heart failure still incipient and restricted in Brazil; heart failure as the most prevalent disease and incidence in the application of palliative care in patients with heart disease; the erroneous perception that this care should only occur in the final process of life; the barriers in the implementation of this cardiology care model; and finally, how palliative care better reflects the needs of patients in a terminal situation, in addition to the low cost. The conclusion refers to the demand for implementation of the topic in the undergraduate curriculum of the medical course and the possibility of clinicians being trained to use the essential palliative domains as some suggestions of strategies to extend this care. (AU)

Este estudiotiene como objetivo analizarlaproducción científica acerca del tema cuidados paliativos encardiología. Para ello se realizó una investigación bibliográfica enla literatura nacional e internacional. A partir de laaplicación de loscriterios de inclusión y exclusiónresultóenlaselección de 25 artículos analizados. Como resultado lainvestigaciónmuestralapoca oferta de médicos especializados en cuidados paliativos; la oferta del cuidado paliativo eneltratamiento de pacientes coninsuficiencia cardíaca aún incipiente y restringida en Brasil; lainsuficiencia cardíaca como laenfermedadconmayorprevalencia e incidenciaenlaaplicación de los cuidados paliativos en cardiopatas; lapercepción errónea de que este cuidado sólodebeocurrirenelproceso final de vida; lasbarrerasenlaimplementación de este modelo de cuidado encardiología; y por último, cuantoel cuidado paliativo reflejamejorlasnecesidades de los pacientes ensituación terminal, ademásdel bajo costo. La conclusión se refiere a la demanda de laaplicacióndel tema enel currículo de lagraduacióndel curso de medicina y laposibilidad de que los médicos seanentrenados para utilizar losdominios paliativos esenciales, como algunassugerencias de estrategias para ampliar este cuidado. (AU)

Relato de Experiência de um Grupo de Apoio à Proatividade e ao Envelhecimento / Experience Report of a Proactivity and Aging Group / Informe de experiencia de un grupo de apoyo de proactividad y envejecimiento

O estudo da proatividade mostra-se relevante no atual quadro de envelhecimento populacional, pois pode auxiliar, de algum modo, para uma melhor compreensão do que se define como uma velhice bem-sucedida. O presente estudo relata uma intervenção com base na Terapia Cognitiva (TC), em um Grupo de Apoio à Proatividade e ao Envelhecimento, o GAPSI. Participaram, desta vez, cinco mulheres, com idades variando entre 45 e 60 anos de idade. O GAPSI traz contribuições para a TC em grupo, no que tange à utilização de práticas preventivas aos problemas de avanço da idade, e também na ampliação da discussão sobre a temática da proatividade.

The study of proactivity is relevant in the current population aging scenario, as it may help, in some way, to a better understanding of what is defined as a successful old age. The present study reports an intervention based on Cognitive Therapy (TC) in a Proactive and Aging Support Group, GAPSI. This time five women participated, with ages ranging from 45 to 60 years old. The GAPSI brings contributions to group CT, regarding the use of preventive practices to the problems of advancing age, and also to broaden the discussion on the theme of proactivity.

El estudio de la proactividad es relevante en el escenario actual de envejecimiento de la población, ya que puede ayudar, de alguna manera, a una mejor comprensión de lo que se define como una vejez exitosa. El presente estudio informa una intervención basada en la terapia cognitiva (TC) en un grupo de apoyo proactivo y de envejecimiento, GAPSI. Esta vez participaron cinco mujeres, con edades comprendidas entre 45 y 60 años. El GAPSI aporta contribuciones al grupo CT, con respecto al uso de prácticas preventivas a los problemas de la edad avanzada, y también para ampliar la discusión sobre el tema de la proactividad.

Avaliação de sintomas psicofuncionais em bebês: revisão crítica da literatura sobre o uso do symptom checklist / Evaluation of psychofunctional symptoms in infants: a critical review of the literature on the use of the symptom checklist / Evaluación de síntomas psicofuncionales en los bebés: revisión crítica de la literatura sobre el uso de symptom checklist

Esse trabalho objetivou apresentar os estudos que utilizaram o Symptom Checklist (SCL) para avaliar sintomas psicofuncionais em bebês. Foram detalhados os países em que os trabalhos foram realizados, o delineamento dos estudos e as principais variáveis associadas. Para tanto, foi realizada uma revisão crítica da literatura, considerando trabalhos que utilizaram o SCL. Identificou-se que a prevalência de sintomas psicofuncionais em bebês ainda é um dado desconhecido tanto no Brasil quanto no exterior, ainda que exista um predomínio de estudos europeus. Embora o SCL possa ser usado em pesquisas com diversos tipos de delineamentos, destacaramse estudos longitudinais. Os achados também permitiram problematizar as propriedades psicométricas do instrumento. Sugere-se a realização de novos estudos, bem como uma ampliação no uso e na divulgação do SCL, uma vez que o instrumento permite uma avaliação compreensiva e detalhada da saúde e do desenvolvimento infantil.

This study aimed to present the studies that used the Symptom Checklist (SCL) to evaluate psychofunctional symptoms infants. Were detailed the countries that the studies were carried out, the design of the articles and the main variables associated. Therefore, a critical review of the literature was performed, considering works that used the SCL instrument. It was found that the prevalence of symptoms of infants, is still unknown in Brazil and abroad, although there is a predominance of studies in the European context. Although the SCL can be used in various types of research designs, longitudinal studies were predominant. The findings also allowed to question the psychometric properties of the instrument. It is suggested to carry out new studies, as well as an expansion in the use and divulgation of SCL, since the instrument allows a comprehensive and detailed assessment of health and child development.

Esta investigación tuvo como objetivo presentar los estudios que utilizaron el Symptom Checklist (SCL) para evaluar los síntomas psicofuncionales en bebés. Fueron detallados los países en los que el trabajo se lleva a cabo, el diseño de los estudios y las principales variables asociada. Por lo tanto, se realizó una revisión crítica de la literatura, teniendo en cuenta los estudios que utilizaron el SCL. Se encontró que la prevalencia de síntomas en los bebés psicofuncionales sigue siendo una incógnita tanto en Brasil como en el extranjero, aunque hay un predominio de los estudios europeos. Aunque el SCL se puede utilizar en la investigación de varios tipos de diseños, se destacaron estudios longitudinales. Los resultados también permiten a cuestionar las propiedades psicométricas del instrumento. Se sugiere conducir nuevos estudios, así como una expansión en el uso y divulgación de SCL, ya que el instrumento permite una evaluación completa y detallada de salud y desarrollo infantil

Frequência da síndrome de burnout em uma amostra de fisioterapeutas intensivistas / Frequency of burnout syndrome in a sample of intensivists physiotherapists

INTRODUÇÃO: A síndrome de Burnout é uma condição que envolve basicamente três dimensões: a exaustão emocional, a despersonalização e a redução da realização profissional. Apresenta-se hoje, como um dos grandes problemas psicossociais no Brasil, sendo recordista em afastamento e incapacidades para o trabalho. OBJETIVO: estimar a frequência de Síndrome de Burnout em uma amostra de fisioterapeutas intensivistas na cidade de Salvador, Bahia, Brasil. Método: estudo transversal, utilizando-se o Maslach Burnout Inventory para avaliar a síndrome e suas dimensões e o Inventário de Sintomas para avaliar a frequência com que alguns sintomas são sentidos no cotidiano dos fisioterapeutas intensivistas. RESULTADOS: foram incluídos dados de 45 fisioterapeutas intensivistas, sendo que nove (20%) apresentaram alto nível de exaustão emocional, 1 (2,2%) alto nível para despersonalização e 6 (13,3%) com alta reduzida realização profissional. A frequência da síndrome de Burmout apresentou um percentual relevante: 31,1% (14 participantes). CONCLUSÃO: o número de pacientes, assim como o número de atendimento destes, por plantão contribui para uma sobrecarga física e mental do profissional, caracterizando o trabalho da fisioterapia como fator de risco para a incidência da SB. [AU]

INTRODUCTION: Burnout syndrome is a condition that basically involves three dimensions: emotional exhaustion, depersonalization and reduction of professional achievement. He presents himself today as one of the great psychosocial problems in Brazil, being a record holder in his absence and incapacities for work. OBJECTIVE: To estimate the frequency of burnout syndrome in a sample of intensive physical therapists in the city of Salvador, Bahia, Brazil. METHODS: Cross-sectional, descriptive study using the Maslach Burnout Inventory to assess the syndrome and its dimensions and Symptoms Inventory to assess the frequency with which some symptoms are felt in the daily lives of intensive physical therapists. RESULTS: were included in the survey data for 45 intensive physical therapists, and 20% had high levels of emotional exhaustion, 1 (2.2%) high level to depersonalization and 6 (13.3%) with high reduced professional accomplishment. The frequency of the Burnout syndrome showed a significant percentage 31.1% (14 participants). CONCLUSION: The number of patients, as well as the number of these services, per shift contributes to physical and mental overload professional, featuring the work of physical therapy as a risk factor for the incidence of SB. [AU]

Grau de dispneia em pacientes com linfoma não Hodgkin / Degree of dyspnea in patients with non-Hodgkin's lymphoma

Introdução: Linfomas são transformações neoplásicas de células linfóides normais que residem predominantemente em tecidos linfóides. Em alguns casos de pacientes com LNH, eles apresentam grandes massas mediastinais, podendo haver sinais de compressão da veia cava superior, tosse e dispneia. Metodologia: Foi realizado um estudo transversal descritivo, onde foi aplicado a Escala de Borg Modificada. Resultados: A amostra contem 10 pacientes, onde a media de dispneia antes do diagnostico foi de 3 na escala de Borg e após diagnostico e pacientes em tratamento foi de 1,6. Conclusão: O numero da amostra foi limitado, não sendo encontrada nenhuma relevância estatística. (AU)

Odontopediatria digital: avaliação diagnóstica com o teste do dentinho / Digital dentistry: diagnostic evaluation with dental test

Introdução: diante da dificuldade observada pelos cirurgiões- -dentistas, relacionada a compreensão dos responsáveis do paciente quanto a real condição da saúde bucal e a importância de realizar os tratamentos que são definidos pelos profissionais, foi criado o Teste do Dentinho. Objetivo: a proposta deste estudo, foi realizar por meio de um interpretador digital dos dados da saúde bucal com base em um exame odontológico, um instrumento para oferecer aos responsáveis dos pacientes uma visão individualizada, detalhada e de fácil compreensão. Método: a amostra constituiu-se de 50 pacientes, com idade entre 0 e 7 anos, atendidos na clínica de odontope diatria, acompanhados de um responsável. Foi realizada a coleta de dados pessoais e o exame clínico no paciente por meio da utilização de um odontograma digital para os cálculos do Índice de Funcionalidade dos Dentes (IFD) e do Nível de Risco (NR). O paciente e os responsáveis puderam acompanhar a coleta e inserção dos dados, bem como os resultados no momento da execução do exame. Resultados e Discussão: foi observado que 90% dos entrevistados responderam que a apresentação dos resultados do instrumento foi ótima e 10% responderam que é boa. Conclusão: a compreensão diagnóstica se torna facilitada com o Teste do Dentinho. Gerando estes dados, aos Cirurgiões Dentistas e os responsáveis, poderão realizar juntos os comparativos de dados coletados a cada consulta odontológica, proporcionando uma visão educativa e assertiva da saúde bucal do paciente.

Introduction: because of patient´s difficulties on understanding their responsibility on oral health conditions, as well as difficulties about the importance of having treatments suggested by the professionals, the Tooth Test was created. Objective: the purpose of this study was to perform, through a data digital interpreter based on a dental examination, an instrument to offer the patients´ tutors a detailed and individual view with easy understanding. Method: the sample consisted of 50 patients, aged between 0 and 07 years, seen at the Pediatric Dentistry Clinic, accompanied by a tutor. Personal data collection and clinical examination were performed on the patient using a digital Odontogram to calculate the teeth functionality index and the risk level. The patients and tutors could observe and follow the collection and insertion of data, as well as the results at the moment of the examination. Results: it was observed that 90% of the interviewed considered the results of the instrument excellent and 10% considered good. Thus, the diagnostic comprehension becomes easier with the tooth test. Conclusion: the dental surgeon and those in charge, will be able to compare collected data in every dental appointment, providing an educative and assertive view of the patient´s oral health.

Decanulação: atuação fonoaudiológica e fisioterapêutica / Decannulation: speech therapy and physiotherapy approach / Desentubación: actuación fonoaudiologica y fisioterapéutica

Foi realizada uma revisão narrativa e compreensiva de estudos e pesquisas sobre o processo de decanulação em pacientes traqueostomizados. Objetivo: analisar a atuação fonoaudiológica e fisioterapêutica no processo de decanulação de pacientes traqueostomizados, bem como as possíveis complicações ao longo deste processo a partir da literatura indexada em bases de dados nacionais e internacionais. Métodos: Foram pesquisadas as seguintes bases de dados: Scopus, SciELO e PubMed, referentes ao período de 1996 a 2015. Foram selecionadas e analisadas 26 referências, que mostraram serem escassos os estudos que estabelecem critérios específicos para a decanulação, mantendo a decisão a respeito deste procedimento ainda baseada em avaliações subjetivas em oposição a protocolos padronizados. Conclusão: O desmame da traqueostomia e a consequente decanulação dependem de muitos fatores e podem ser um processo complexo, sendo necessárias pesquisas, não somente sobre quais os fatores que estão mais significativamente envolvidos, mas também sobre sua avaliação e a interação entre eles, levando sempre em consideração a importância da atuação em equipe multidisciplinar, a fim de tornar o processo mais eficaz e seguro.

It was undertaken a narrative and comprehensive review of studies and research about the decannulation process in patients undergoing tracheostomy. Objective: to analyze the speech therapy and physiotherapy approach on decannulation of tracheostomy patients, as well as possible complications throughout this process, from the literature indexed in national and international databases. Methods: The following databases were searched: Scopus, SciELO and PubMed, from 1996 to 2015. There were selected and analyzed 26 references, which showed the existence of few studies that establish specific criteria for decannulation, keeping the decision regarding this procedure still based on subjective judgments, in opposition to standardized protocols. Conclusion: The removal of the tracheostomy and the consequent decannulation depend on many factors and may be a complex process, being necessary others research not only about the most significant factors involved, but also on their evaluation and the interaction between them, taking into account the importance of the performance in multidisciplinary team in order to make the most effective and safe process.

Se realizó una revisión narrativa y comprehensiva de los estudios y investigaciónes sobre el proceso de desentubación en pacientes traqueotomisados. Objetivo: analizar la acctuación fonoaudiológica y fisioterapica en la desentubación de los pacientes traqueotomizados, así como las posibles complicaciones a lo largo de este proceso a partir de la literatura indexada en bases de datos nacionales e internacionales. Métodos: Fueron investigadas las siguientes bases de datos: Scopus, SciELO y PubMed, para el período 1996-2015. Se seleccionaron y analizaron 26 referencias, que mostraron ser escasos los estudios que establecen criterios específicos para desentubación. Todavia se manteniene la decisión con respecto a este procedimiento con base en juicios subjetivos, en oposición a los protocolos estándar. Conclusión: La eliminación de la traqueotomía y la consiguiente desentubación dependen de muchos factores y puede ser un proceso complejo, siendo necesarias investigaciones no sólo sobre qué factores estan mas significativamente implicados, sino también sobre su evaluación y la interacción entre ellos, teniendo siempre en cuenta la importancia de la actuación en un equipo multidisciplinario, con el fin de hacer el proceso más efectivo y seguro.

Insulin Sensitivity in Adipose and Skeletal Muscle Tissue of Dairy Cows in Response to Dietary Energy Level and 2,4-Thiazolidinedione (TZD).

The effects of dietary energy level and 2,4-thiazolidinedione (TZD) injection on feed intake, body fatness, blood biomarkers and TZD concentrations, genes related to insulin sensitivity in adipose tissue (AT) and skeletal muscle, and peroxisome proliferator-activated receptor gamma (PPARG) protein in subcutaneous AT (SAT) were evaluated in Holstein cows. Fourteen nonpregnant nonlactating cows were fed a control low-energy (CON, 1.30 Mcal/kg) diet to meet 100% of estimated nutrient requirements for 3 weeks, after which half of the cows were assigned to a higher-energy diet (OVE, 1.60 Mcal/kg) and half of the cows continued on CON for 6 weeks. All cows received an intravenous injection of TZD starting 2 weeks after initiation of dietary treatments and for an additional 2 weeks, which served as the washout period. Cows fed OVE had greater energy intake and body mass than CON, and TZD had no effect during the administration period. The OVE cows had greater TZD clearance rate than CON cows. The lower concentration of nonesterified fatty acids (NEFA) and greater concentration of insulin in blood of OVE cows before TZD injection indicated positive energy balance and higher insulin sensitivity. Administration of TZD increased blood concentrations of glucose, insulin, and beta-hydroxybutyrate (BHBA) at 2 to 4 weeks after diet initiation, while the concentration of NEFA and adiponectin (ADIPOQ) remained unchanged during TZD. The TZD upregulated the mRNA expression of PPARG and its targets FASN and SREBF1 in SAT, but also SUMO1 and UBC9 which encode sumoylation proteins known to down-regulate PPARG expression and curtail adipogenesis. Therefore, a post-translational response to control PPARG gene expression in SAT could be a counteregulatory mechanism to restrain adipogenesis. The OVE cows had greater expression of the insulin sensitivity-related genes IRS1, SLC2A4, INSR, SCD, INSIG1, DGAT2, and ADIPOQ in SAT. In skeletal muscle, where PPARA and its targets orchestrate carbohydrate metabolism and fatty acid oxidation, the OVE cows had greater glyceroneogenesis (higher mRNA expression of PC and PCK1), whereas CON cows had greater glucose transport (SLC2A4). Administration of TZD increased triacylglycerol concentration and altered expression of carbohydrate- and fatty acid oxidation-related genes in skeletal muscle. Results indicate that overfeeding did not affect insulin sensitivity in nonpregnant, nonlactating dairy cows. The bovine PPARG receptor appears TZD-responsive, with its activation potentially leading to greater adipogenesis and lipogenesis in SAT, while differentially regulating glucose homeostasis and fatty acid oxidation in skeletal muscle. Targeting PPARG via dietary nutraceuticals while avoiding excessive fat deposition might improve insulin sensitivity in dairy cows during times such as the peripartal period when the onset of lactation naturally decreases systemic insulin release and sensitivity in tissues such as AT.

Segurança do teste de caminhada de seis minutos em cardiopatas hospitalizados / Safety of the Six-Minute Walk Test in Hospitalized Cardiac Patients

Fundamentos: Não há respaldo na literatura para atestar a segurança da aplicação do teste de caminhada deseis minutos (TC6M) em cardiopatas hospitalizados. Objetivo: Identificar os efeitos adversos ocorridos durante a realização do TC6M em cardiopatas hospitalizados. Métodos: Trata-se de estudo observacional, transversal, realizado em 30 portadores de cardiopatia que se encontravam hospitalizados. Neles foram realizadas duas práticas do TC6M em um corredor de 20 metros. Foram coletados a distância percorrida, os parâmetros cardiorrespiratórios e os sinais de intolerância ao esforço físico. Os efeitos adversos identificados em ambas as práticas foram classificados em: não cardiopulmonares e cardiopulmonares, sendo neste último grupo, subdivididos em não graves e graves. Resultados: Observaram-se efeitos adversos nas duas práticas do TC6M em 15 (50,0%) pacientes, sendo identificados: artralgia em membros inferiores (MMII), palpitação dispneia, dessaturação, tontura, náusea, hipotensão, bradicardia e dormência em membro superior esquerdo. Dos 30 pacientes, identificou-se em 4 (13,3%) pacientes efeitos adversos do tipo grave, sendo os 4 (100%) portadores de hipertensão arterial sistêmica (HAS) e 3 (75,0%) também com diagnóstico de insuficiência coronariana (ICO) e dislipidemia (DLP).Conclusão: No TC6M, foi identificada uma baixa frequência de eventos adversos graves em pacientes cardiopatassob condição de hospitalização a partir de dois dias da sua admissão.

Background: There is no evidence in the literature to attest the safety of the six-minute walk test (6MWT) in hospitalized cardiac patients. Objective: To identify adverse events during the course of the 6MWT in hospitalized cardiac patients.Methods: This is an observational, cross-sectional, conducted in 30 patients with heart disease who were hospitalized. Two 6MWT practices were carried along a 20-meter corridor. The distance traveled, the cardiorespiratory parameters and signs of intoleranceto physical exertion were collected. The adverse effects identified in both practices were classified as non-cardiopulmonary and cardiopulmonary, and in the latter group, divided into non-serious and serious. Results: Adverse effects were observed in both 6MWT practices in 15 (50.0%) patients, and the following were identified: lowerlimb (LL) arthralgia, palpitation, dyspnea, desaturation, dizziness, nausea, hypotension, bradycardia, and numbness in the left arm. Of the 30 patients, 4 (13.3%) patients presented severely adverse effects. All of the 4 (100%) patients had hypertension (SAH) and 3 (75%) were diagnosed with coronary artery disease (ICO) and dyslipidemia (DLP). Conclusion: In the 6MWT, a low frequency of serious adverse events was found in cardiac patients hospitalized two days afteradmission.

Association between magnesium status, oxidative stress and inflammation in preeclampsia: A case-control study.

BACKGROUND & AIMS: Preeclampsia is responsible for more than one-third of all maternal deaths in Brazil. The objectives of the present study were to evaluate magnesium status and its association with oxidative stress and inflammation in preeclamptic women, and to identify the predictor variables of the disorder. METHODS: The study population consisted of 36 women divided into preeclamptic (n = 18) and control groups (n = 18). The preeclamptic group included women (≥20 weeks of pregnancy) with arterial pressure ≥ 140/90 mmHg and proteinuria >0.3 g/24 h, while the control group comprised pregnant women with no clinical/obstetric complications. Magnesium intake was assessed via a food frequency questionnaire validated for pregnant women in Brazil. Plasma, erythrocyte and urinary magnesium levels were determined by flame atomic absorption spectroscopy, while oxidative stress and inflammatory markers were assessed using standard protocols. Logistic regression analysis was used to identify the predictors of preeclampsia. RESULTS: Preeclamptic and control groups were similar with respect to magnesium intake and urinary excretion, while plasma and erythrocyte magnesium concentrations were higher in the former group. Plasma magnesium was positively correlated with catalase and glutathione peroxidase activities and with concentrations of interleukin-6 and tumor necrosis factor alpha. Regression analysis showed that plasma magnesium and urinary 8-isoprostane were associated with preeclampsia. CONCLUSION: Magnesium status appears to result from homeostatic imbalance and physiological alterations typical of preeclampsia. Increased plasma magnesium and decreased urinary 8-isoprostane were considered predictors of preeclampsia.