Microparticles: potential new contributors to the pathogenesis of systemic sclerosis?

Abstract Background Microparticles (MPs) are membrane-derived vesicles released from cells undergoing activation or apoptosis with diverse proinflammatory and prothrombotic activities, that have been implicated in the pathogenesis of systemic sclerosis (SSc). We aimed to evaluate the plasma levels of platelet-derived microparticles (PMPs), endothelial cell-derived microparticles (EMPs), and monocyte-derived microparticles (MMPs) in SSc patients, and the association between MPs and the clinical features of SSc. Methods In this cross-sectional study, 70 patients with SSc and 35 age- and sex-matched healthy controls were evaluated. Clinical and nailfold capillaroscopy (NFC) data were obtained from all patients. Plasma levels of PMPs (CD42+/31+), EMPs (CD105+), and MMPs (CD14+) were quantified by flow cytometry. Results Patients were mainly females (90%), with a mean age of 48.9 years old. PMP, EMP, and MMP levels were significantly increased in SSc patients compared to controls (79.2% ± 17.3% vs. 71.0% ± 19.8%, p = 0.033; 43.5% ± 8.7% vs. 37.8% ± 10.4%, p = 0.004; and 3.5% ± 1.3% vs. 1.1% ± 0.5%, p < 0.0001, respectively). PMP levels were significantly higher in patients with positive anti-topoisomerase-I antibodies (p = 0.030) and in patients with a disease duration > 3 years (p = 0.038). EMP levels were lower in patients with a higher modified Rodnan skin score (p = 0.015), and in those with an avascular score > 1.5 in NFC (p = 0.042). Conclusion The increased levels of PMPs, EMPs and MMPs in scleroderma patients might indicate a possible role for these agents in the pathogenesis of this challenging disease.

Three-dimensional cell culture for the study of nasal polyps

Abstract Objectives: Three-dimensional (3D) cell cultures have many applications such as stem cell biology research, new drug discovery, cancer, and Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). This disease is characterized by a significant impact on quality of life and productivity. The diversity of factors that act in the progression of CRSwNP point to the creation of a cell culture model that allows the integration of different cell types with extracellular matrix. This work aimed to create a cell culture model in 3 dimensions (spheroids) for the study of Nasal Polyposis. Methods: Nasal polyp tissue from patients diagnosed with CRSwNP was mechanically dissociated using tweezers and a scalpel and the solution containing cells and small aggregates of nasal polyps was transferred to a Petri dish containing 5 mL of culture medium at the concentration of 106 cells/mL. Results: The spheroids were cultivated for 20 days, fixed and analyzed using confocal microscopy. In a 3D culture environment, the spheroids were formed both by clustering cells and from small tissue fragments. In the cultures analyzed, the ciliary beat was present from the dissociation of the cells up to 20 days in culture. Conclusion: Our findings also point to these characteristics showing the environment generated in our study, the cells remained differentiated for a longer time and with ciliary beating. Thus, this work shows that nasal polyp-derived cells can be maintained in a 3D environment, enabling better strategies for understanding CRSwNP in situations similar to those found in vivo. Level of evidence: Laboratory studies.

Newborns at high risk for brain injury: the role of the amplitude-integrated electroencephalography

Abstract Objective: Amplitude-integrated electroencephalography (aEEG) is a simplified bedside neurophysiology tool that has been implemented in the neonatal intensive care unit and studied in an extensive range of clinical applications in the past decade. This critical review aimed to evaluate a variety of clinical applications of aEEG monitoring in diagnosis, clinical management, and prognosis assessment in critically ill neonates. Sources: The databases of Pubmed, SciELO, Lilacs, and Cochrane, books, and other online resources were consulted, as well as sources of professional experiences. Summary of findings: The clinical use of aEEG to access real-time brain function, background activity, and utility in seizures detection has been described. A critical review was realized considering the authors' professional experience. Newborns with hypoxic-ischemic encephalopathy and seizures screening represent the most common studied population. However, several studies have shown interesting applications on preterm infants, newborns with congenital heart disease, and other clinical situations of high risk of injury to the developing brain. Conclusion: The aEEG has shown to be a useful non-invasive bedside monitor that aids in evaluating brain function, background activity, and cyclicity. aEEG findings have also demonstrated good prognostic value in a group of critically ill neonates. The aEEG seizure diagnosis capability has limitations, which have been already well established. The use of neonatal brain monitoring such as aEEG was shown to give valuable information in several high-risk clinical situations.

Creches são ambientes saudáveis quando se trata de saúde bucal? / Are day care centers healthy environments, when it comes to oral health? / ¿Son saludables los jardines de infancia en lo que respecta a la salud bucal?

Creches são consideradas ambientes saudáveis, pois, para além de cumprir uma missão de educação, exercem influência em cuidados básicos de saúde, responsabilizando-se pela integridade física e emocional da criança, bem como orientando hábitos de higiene, alimentação e socialização interpessoal. Neste contexto, o objetivo deste estudo foi avaliar ambientes de creches, compreendendo melhor os fatores de risco presentes e os padrões de comportamento ensinados, assim como sua associação com cárie dentária, traumatismo dentário e presença de biofilme. Trata-se de estudo transversal com utilização da Infant/Toddler Environment Rating Scale Revised (ITERS-R), escala de avaliação de ambientes, conduzido em dois municípios do interior do estado do Rio de Janeiro, em creches públicas e particulares. Para avaliação das lesões de cárie, seguiu-se o critério do Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS ­ International Caries Detection and Assessment System); para a presença de biofilme, o critério de Alaluusua e Malmivirta; e o critério descrito por O'Brien para lesões traumáticas. A associação entre ambiente e desfechos foi verificada através da comparação de médias para as variáveis numéricas, via teste t de Student e, para variáveis categóricas binárias, empregou-se a regressão logística. Foi verificada uma baixa qualidade dos ambientes das creches em relação à saúde bucal, ficando os escores médios de ambiente no valor mais baixo da escala (entre 1,2 e 1,4), e houve associação estatisticamente significante entre ambientes e cárie (RC: 0,51; IC: 0,29-0,88) e com biofilme (RC: 0,27; IC: 0,17-0,42). Conclui-se que existe uma inadequação do ambiente das creches que não contribui para a construção de conhecimentos relativos à educação para saúde bucal, que se associa com desfechos de saúde bucal. Pode-se, assim, considerar creches como ambientes não saudáveis em relação à saúde bucal.

Child Day Care Centers are considered healthy environments since, beyond the educational role, they still influence basic health care, taking responsibility for the physical and emotional integrity of the child, as well as guiding hygiene habits, feeding habits, and interpersonal socialization. Objectives: In this context, this study aimed to evaluate daycare environments, better understanding the health determinants present and the behavior patterns taught, as well as their association with dental caries, dental trauma, and the presence of biofilm. This is a cross-sectional study using the Infant/Toddler Environment Rating Scale Revised (ITERS-R) for assessing environments, carried out in two municipalities in the interior of the state of Rio de Janeiro, in public and private day care centers. To evaluate caries lesions, the International Caries Detection and Assessment System (ICDAS) criterion was followed; for the presence of biofilm, the Alaluusua and Malmivirta criteria; and for traumatic injuries, the criterion described by O'Brien. The association between environment and outcomes was verified by comparing means for numerical variables, via Student's t-test and, for binary categorical variables, logistic regression was used. A low quality of day care centers regarding oral health was verified, with the average environment scores at the lowest value of the scale (between 1.2 and 1.4), and there was a statistically significant association between environments and caries (RC: 0.51; CI: 0.29-0.88) and with biofilm (RC: 0.27; CI: 0.17-0.42). In conclusion, there is an inadequacy of the day care environment that does not contribute to the construction of knowledge related to oral health education, which is associated with oral health outcomes. Therefore, day cares can be considered unhealthy environments regarding oral health.

Los jardines de infancia se consideran un ambiente saludable porque, además de cumplir una misión educativa, influyen en los cuidados básicos de la salud, se responsabilizan de la integridad física y emocional del niño, y orientan los hábitos de higiene, alimentación y socialización interpersonal. Por tanto, este estudio tuvo por objetivo evaluar ambientes de jardines de infancia para comprender mejor los factores de riesgo presentes y padrones de comportamiento enseñados, así como su asociación con la caries dental, traumatismo dental y presencia de biopelícula. Este es un estudio transversal con utilización de escala Infant/Toddler Environment Rating Scale Revised (ITERS-R), la evaluación de ambientes en guarderías públicas y particulares en dos municipios del estado de Río de Janeiro. Para la evaluación de las lesiones de caries, se siguieron los criterios del International Caries Detection and Assessment System (ICDAS); para una presencia de biopelícula se utilizó el criterio de Alaluusua y Malmivirta, y el descrito por O'Brien para lesiones traumáticas. La asociación entre el ambiente y los resultados se observó por medio de la comparación de medias para las variables numéricas, mediante la prueba t de Student, y para las variables categóricas binarias, se utilizó la Regresión Logística. Se constató una baja calidad de los ambientes con relación a la salud bucal, con puntajes promedio de ambiente en el valor más bajo de la escala (entre 1,2 y 1,4) y hubo asociación estadísticamente significativa entre ambientes y caries (OR: 0,51; IC: 0,29-0,88) y con biopelícula (OR 0,27; IC: 0,17-0,42). Se concluye que las guarderías son inadecuadas, porque no contribuyen a la construcción de conocimientos relacionados con la educación en salud bucal y esto se asocia a resultados de salud oral. Se puede, de esa forma, considerarlos ambientes no saludables relacionados a la salud bucal.

Aspects of trauma related to violence, accidents and falls before and during the COVID-19 pandemic / Aspectos del trauma relacionados con la violencia, accidentes y caídas antes y durante la pandemia COVID-19

Abstract Introduction: Trauma is the second leading cause of mortality and the sixth leading cause of hospitalization in the country, with violence, accidents, and falls being the most prevalent. However, the country is experiencing reflexes of the COVID-19 pandemic, together with a lack of studies on trauma, as well as on clinical care. Objective: To analyze the clinical and epidemiological characteristics of trauma related to violence, accidents, and falls among the years 2019, 2020, and 2021, considered as before and during the COVID-19 pandemic. Material and Methods: Retrospective cohort study, with adults aged 25-55 years, who suffered trauma related to violence, falls, and other accidents, in the period between March and June of 2019, 2020, and 2021, in the city of São Paulo. Data surveys were carried out using the TABNET system, of the Municipal Health Department. Within this system, the search was carried out through the Information System for the Surveillance of Accidents, of the Coordination of Health Surveillance, in which situations of violence were notified and recorded by the National Information System for Notifiable Diseases. Subsequently, the Information System for Surveillance of Violence and Accidents was accessed, focusing on notifications and records of falls and other accidents. Results: Trauma remained more prevalent for males, with complete primary education, and ethnicity predominantly between white or brown. When analyzing the different types of violence: physical, torture, and sexual, there was a prevalence of higher percentages during the year 2019, the pre-pandemic period of COVID-19, except for psychological/moral violence, which was higher in 2021. It should also be noted that the different mechanisms of violence were significantly more prevalent in 2019, as well as the different causes of violence, falls, and car trauma involving pedestrians, occupants, drivers, and passengers. Outpatient care confirmed the higher trend in the pre-pandemic period; however, emergency hospital care showed a greater number of requests in 2020 and 2021. Conclusión: Trauma from violence, accidents, and falls was higher pre-pandemic compared to the period during the COVID-19 pandemic; as well as the search for health care in hospitals and outpatient clinics. These findings show a possible reduction in trauma reports and lower demand for assistance during the pandemic.

Resumen Introducción: El trauma es la segunda causa de mortalidad y la sexta de hospitalización en el país, siendo la violencia, los accidentes y las caídas las más prevalentes. Sin embargo, el país está experimentando reflejos de una pandemia de COVID-19, junto a una falta de estudios sobre el trauma, así como sobre la atención clínica. Objetivo: Analizar las características clínicas y epidemiológicas del trauma junto a la violencia, accidentes y caídas entre los años 2019, 2020 y 2021, considerados antes y durante la pandemia COVID-19. Materiales y métodos: Estudio de cohorte retrospectivo, con adultos de 25 a 55 años, que sufrieron trauma relacionado con violencia, caídas y otros accidentes, en el período comprendido entre marzo y junio de 2019, 2020 y 2021, en la ciudad de São Paulo. Las encuestas de datos fueron realizadas por el sistema TABNET, por el Departamento Municipal de Salud. Dentro de este sistema, la búsqueda se realizó a través del Sistema de Información para la Vigilancia de Accidentes, de la Coordinación de Vigilancia en Salud, en el cual las situaciones de violencia fueron notificadas y registradas por el Sistema Nacional de Información de Enfermedades Notificables. Posteriormente, se accedió al Sistema de Información de Vigilancia de Violencia y Accidentes, con enfoque en notificaciones y registro de caídas y otros accidentes. Resultados: El trauma siguió siendo más prevalente para los hombres, con educación primaria completa y raza predominantemente entre blancos y morenos. Al analizar los diferentes tipos de violencia: física, tortura y sexual, hubo mayores porcentajes de prevalencia durante el año 2019, período prepandémico de COVID-19, a excepción de la violencia psicológica / moral, que fue mayor en 2021. Nótese que los diferentes mecanismos de violencia fueron significativamente más prevalentes en 2019, así como las diferentes causas de violencia, caídas y traumatismos automovilísticos que involucran a peatones, ocupantes, conductores y pasajeros. La atención ambulatoria confirmó la tendencia de superioridad en el período prepandémico, sin embargo, la atención hospitalaria de emergencia mostró un mayor número de solicitudes en 2020 y 2021. Conclusión: Los traumas de violencia, accidentes y caídas son más prepandémico en comparación con el período durante la pandemia COVID-19; así como la búsqueda de asistencia sanitaria en hospitales y clínicas. Estos hallazgos muestran una posible reducción en los informes de trauma y una menor demanda de asistencia durante la pandemia.

Low frequency of SARS-CoV2 infection in daycare centers during the reopening of school activities in the Southeast's poor area of Brazil

ABSTRACT SARS-Cov2 has already infected over 482 million people and caused more than 6.1 million deaths. The beginning of the pandemic has led the health authorities of several countries to adopt non-pharmacological preventive measures such as daycare closures. The reopening took place when the country had the highest rates of infection and mortality (mainly due to the gamma variant (P.1) outbreak) and the beginning of the vaccination program. Therefore, we aimed to investigate the prevalence of SARS-CoV2 in daycare after educational activities resumed. The study was conducted in seven childcare facilities. Swab samples from the nasopharynx were collected from children and staff members. The viral RNA was obtained through PureLink RNA extraction kit purification and SARS-CoV2 presence was detected using the All plex SARS-CoV2 kit. The study population included 201 participants, including daycare workers and children. The average age of the workers and children is 40 and 3 years old, respectively. Among the children, 47.5% are female and among the workers, 91.4%. One (0.5%) test came out positive for the presence of SARS-CoV-2, which was from a sample of an asymptomatic childcare worker, and no secondary infections were detected. Considering that the return to daycare activities occurred during a period with a high number of deaths and a lack of vaccines throughout the country, the small number of cases indicates the effectiveness of the several preventive measures used by daycare centers in preventing SARS-CoV2 transmission.

Physical activity and symptoms of anxiety and depression among medical students during a pandemic / Actividad física, síntomas de ansiedad y depresión en estudiantes de medicina durante la pandemia / Atividade física e sintomas de ansiedade e depressão entre estudantes de medicina durante a pandemia

ABSTRACT Introduction: Decreased physical activity has been associated with poorer mental health and is a cause for concern during the COVID-19 pandemic. Objective: To compare groups of medical students (MS) who practiced different levels of moderate and vigorous physical activity (MVPA) during the COVID-19 pandemic, in relation to symptoms of anxiety and depression (BAI-BDI), sleep quality (PSQI), and physical activity (PA) - light, moderate, vigorous (LPA-MPA and VPA), and sedentary behavior (SB). Methods: This research is a cross-sectional study involving 218 MS. Data on the characteristics of the MS were collected through online forms: PA, SB, BAI, BDI, and PSQI. The Cohen's D (Effect Size - ES) and confidence interval (95% CI), Mann-Whitney test: Lower MVPA (Median=0 minute) and Higher MVPA (Median=390 minutes) were recorded. For the statistical analyses, we used: the Odds ratio (OR) for the presence of symptoms of high levels of anxiety and depression and poor sleep quality in the MS and MVPA. Results: We found a small ES for symptoms of depression (ES 0.26 95% CI 0.00 0.53 p=0.029), and significant differences (p<0.05) for symptoms of anxiety (ES 0.17 95% CI −0.09 0.44 p=0.037). There was also a significant tendency for sedentary behavior on weekdays (ES 0.27 95% CI 0.00 0.53 p = 0.051). The OR for MVPA and the presence of symptoms of high levels of anxiety was 0.407 (95% CI = 0.228 to 0.724). Conclusions: the MS who practiced higher MVPA presented less symptoms of anxiety and depression during the COVID-19 pandemic. Level of evidence III; Case-control study.

RESUMEN Introducción: La disminución de la actividad física se ha asociado con un empeoramiento de la salud mental y es motivo de preocupación durante la pandemia de COVID-19. Objetivo: Comparar grupos de estudiantes de medicina (EM) con diferentes momentos de actividad física moderada y vigorosa (AFMV) durante la pandemia COVID-19, en relación a los síntomas de ansiedad y depresión (BAI-BDI), calidad de sueño (PSQI) y actividad física (AF) - comportamiento leve, moderado, vigoroso (LPA-MPA y VPA) y sedentario (SB). Métodos: Esta encuesta transversal evaluó 218 EM. Los datos se recogieron mediante formularios online sobre las características del grupo PA, SB, BAI, BDI y PSQI. D de Cohen (ES) y el intervalo de confianza (IC del 95%), prueba de Mann-Whitney: AFMV baja (mediana = 0 minutos) y AFMV (mediana = 390 minutos); En el análisis estadístico se utilizó la razón de probabilidades (OR) para la presencia de síntomas de ansiedad alta y síntomas depresivos, la mala calidad del sueño de la EM y la MVPA. Resultados: Una pequeña EE para síntomas de depresión (ES 0.26 IC 95% 0.00 0.53 p = 0.029) y diferencias significativas (p <0.05) para síntomas de ansiedad (ES 0.17 IC 95% −0, 09 0.44 p = 0.037). Se verificó tendencia de significancia para el día de la semana SB (ES 0.27 IC 95% 0.00 0.53 p = 0.051). Se verificó la OR para AFMV y la presencia de síntomas de alta ansiedad de 0,407 (IC del 95% = 0,228 a 0,724). Conclusiones: La EM con un AFMV más alto tiene menos síntomas de ansiedad y síntomas de depresión durante la pandemia de COVID-19. Nivel de evidencia III; Estudio de casos y controles.

RESUMO Introdução: A diminuição da atividade física tem sido associada à piora da saúde mental e é motivo de preocupação durante a pandemia de COVID-19. Objetivo: Comparar grupos de estudantes de medicina (EM) que praticam diferentes níveis de atividade física moderada e vigorosa (AFMV) durante a pandemia de COVID-19, com relação aos sintomas de ansiedade e depressão (BAI-BDI), qualidade do sono (PSQI), e atividade física (AF) - leve, moderada, vigorosa (AFL, AFM, AFV) e comportamento sedentário (CS). Métodos: Esta pesquisa com desenho transversal avaliou 218 EM. Os dados das características dos EM foram coletados por meio de formulários on-line: AF, CS, BAI, BDI e PSQI. Para as análises estatísticas, utilizou-se odds ratio (OR) para a presença de sintomas elevados de ansiedade e depressão e má qualidade do sono de EM e AFMV. O D de Cohen (tamanho do efeito, TE) e o intervalo de confiança (IC de 95%), teste de Mann-Whitney: baixa MVPA (mediana = 0 minuto) e alta MVPA (Mediana = 390 minutos) foram registrados. Resultados: Encontramos um pequeno TE para sintomas de depressão (TE 0,26; IC de 95%; 0,00-0,53; p = 0,029) e diferenças significativas (p < 0,05) para sintomas de ansiedade (TE 0,17; IC de 95%; 0,09-0,44; p = 0,037). Também houve tendência de significância para o comportamento sedentário nos dias de semana (TE 0,27; IC de 95%; 0,00-0,53; p = 0,051). A OR para MVPA e a presença de sintomas de ansiedade elevada foi de 0,407 (IC de 95% = 0,228-0,724). Conclusões: Os EM que praticavam maior MVPA apresentaram menos sintomas de ansiedade e depressão durante a pandemia de COVID-19. Nível de evidência III; Estudo de caso-controle.

Concordância entre métodos antropométricos índice de massa corpórea e circunferência da cintura no diagnóstico de sobrepeso e obesidade em escolares / Agreement between anthropometric methods body mass index and waist circumference in diagnosis of overweight and obesity in schools

O objetivo deste trabalho foi avaliar a concordância entre o uso do índice de massa corporal (IMC) e a circunferência da cintura (CC), no diagnóstico de sobrepeso e obesidade em escolares. Estudo transversal e observacional, com avaliação antropométrica de 318 escolares, entre 6 e 10 anos matriculadas no 1o ao 5o ano do ensino fundamental de uma escola pública municipal de São Paulo. Realizou-se comparação entre os diagnósticos antropométricos dados pelo IMC e pela CC para verificar possível concordância de acordo com o gênero separadamente. Para análise dos resultados foram aplicados o teste Kappa e o teste de McNemar.Fixou-se em ambos os testes o nível de significância (p) de 0,05 ou 5%. A prevalência de sobrepeso e obesidade pelo IMC foi de 30,2% e 24.5% respectivamente. Por meio da CC, encontrou-se 33,3% de sobrepeso e 10,7% de obesidade. No sexo feminino, houve concordância de 89,0% entre os dois diagnósticos de IMC e CC, dado pelo Teste de Concordância de Kappa = 0,79 (p < 0,0001). Já com relação ao sexo masculino, houve concordâncias de 77,3% dada pelo mesmo Teste de Concordância de Kappa = 0,55 (p < 0,0001). Conclui-se que houve correlação significativa entre as variáveis antropométricas de IMC e CC no sexo masculino e feminino. Os resultados deste estudo mostram que é adequada a escolha do IMC como indicador-diagnóstico de sobrepeso e obesidade em escolares

This study aimed to evaluate the agreement between the use of body mass index (BMI) and waist circumference (WC), with no diagnosis of overweight and obesity in schoolchildren. Cross-sectional and observational study, with anthropometric assessment of 318 schoolchildren, aged between 6 and 10, enrolled in the 1st to 5th grade of elementary school in a municipal public school in São Paulo. A comparison was made between anthropometric data diagnoses by BMI and WC to verify possible agreement according to the gender used. For analysis of the results, the Kappa and McNemar tests were applied. It fixed in both tests or the significance level (p) of 0.05 or 5%. The prevalence of overweight and obesity by BMI was 30.2% and 24.5%, respectively. Through WC, 33.3% of obesity and 10.7% of obesity were found. In females, there was agreement of 89.0% between the two diagnoses of BMI and WC, given by the Kappa Agreement Test = 0.79 (p <0.0001). Regarding males, there were 77.3% agreement, given by the same Kappa Agreement Test = 0.55 (p <0.0001). It was concluded that there was a significant correlation between the anthropometric variables of BMI and WC in males and females. The results of this study show that it is appropriate to choose BMI as a diagnostic indicator of obesity and obesity in schoolchildren.

Survival prognosis of newborns from an intensive care unit through the SNAP-PE II risk score

OBJECTIVES: Although child mortality has declined significantly in recent decades, the reduction of neonatal mortality remains a major challenge as neonatal mortality represents 2/3 of the mortality rate in this population. The objective of this study was to evaluate the utility of the Score for Neonatal Acute Physiology Perinatal Extension II (SNAP-PE II) score for evaluating the survival prognosis of newborns admitted to a neonatal intensive care unit (NICU). METHODS: The study design involved an observational cross-sectional retrospective collection, as well as a prospective component. The sample included all newborns admitted to the NICU validated by the SNAP-PE II tool from January 1 to December 31, 2014. RESULTS: A predominance of young mothers (25.4 years), underwent prenatal care (86.2%), however a considerable percentage (49.4%) of mothers received insufficient medical consultation (less than six consults during their pregnancy). A prevalence of male admissions (62.4%) were noted in the NICU. Premature (61.7%) and underweight (weight <2,500 grams) newborns were also prevalent. The SNAP-PE II score showed an association between the infants who were discharged from the neonatal unit and the non-survivors. An increased prevalence of low birth weight and hypothermia was noted in the group of non-survivors. The mean arterial pressure appears to be a significant risk factor in the newborn group that progressed to death. Hypothermia, mean arterial pressure, and birth weight were the most significant variables associated with death. CONCLUSION: The SNAP-PE II was a beneficial indicator of neonatal mortality. The prevention of prematurity and hypothermia by improving maternity care and newborn care can decisively influence neonatal mortality.

Efeitos de exercícios físicos sobre fatores de risco cardiovascular em idosos hipertensos / Efectos de los ejercicios físicos en los factores de riesgo cardiovascular de mayores hipertensos / Effects of physical exercise on cardiovascular risk factors in hypertensive older adults

OBJETIVO: Avaliar os efeitos de um programa de exercícios na redução dos fatores de risco cardiovascular em idosos sedentários e hipertensos. MÉTODOS: Trata-se de ensaio clínico não randomizado, realizado em uma clínica escola de fisioterapia em São Paulo, em 2016, com amostra de 34 idosos que realizaram um programa de exercícios de noventa minutos, duas vezes por semana, durante o período de três meses. As variáveis avaliadas foram: pressão arterial, índice de massa corporal, frações de colesterol, colesterol total e triglicérides. Houve comparação dos dados em dois momentos, antes do início e ao término do programa de exercícios, considerando-se p<0,0001 em todos os casos pelo teste de Wilcoxon. RESULTADOS: Encontrou-se idade mediana dos avaliados (intervalo interquartis) de 63 (61-66) anos, sendo 25 (74%) do sexo feminino. Após três meses, houve redução estatisticamente significativa do peso, índice de massa corpórea, pressão arterial sistólica (PAS) e diastólica (PAD) dos idosos avaliados (p < 0,0001 em todos os casos). CONCLUSÃO: O efeito do programa de exercícios foi eficaz na redução dos fatores de risco cardiovascular dos idosos sedentários e hipertensos estudados. (AU)

OBJECTIVE: To assess the effects of an exercise program on the reduction of cardiovascular risk factors in sedentary hypertensive older adults. METHODS: This is a nonrandomized clinical trial carried out in a physical therapy teaching clinic in São Paulo in 2016 with a sample of 34 older adults who performed a ninety-minute exercise program twice a week for three months. The analyzed variables were: blood pressure, body mass index, cholesterol fractions, total cholesterol and triglycerides. Data were compared in two stages, before and after the exercise program, with p<0.0001 in all cases using the Wilcoxon test. RESULTS: The median age of the participants (interquartile range) was 63 (61-66) years, with 25 (74%) women. After three months, there was a statistically significant reduction in weight, body mass index, systolic (SBP) and diastolic blood pressure (DBP) in the analyzed older adults (p<0.0001 in all cases). CONCLUSION: The exercise program was effective in reducing cardiovascular risk factors in the sedentary hypertensive older adults analyzed. (AU)

OBJETIVO: Evaluar los efectos de un programa de ejercicios para la disminución de los factores de riesgo cardiovascular de mayores sedentarios e hipertensos. MÉTODOS: Se trata de un ensayo clínico no randomizado realizado en una clínica escuela de fisioterapia de São Paulo, en 2016, con una muestra de 34 mayores que realizaron un programa de ejercicios de noventa minutos, dos veces a la semana durante el período de tres meses. Las variables evaluadas fueron: la presión arterial, el índice de masa corporal, las fracciones de colesterol, el colesterol total y los triglicéridos. La comparación de los datos se dio en dos momentos: antes del inicio y al final del programa de ejercicios con p<0,0001 para todos los casos a través del test de Wilcoxon. RESULTADOS: La edad mediana de los evaluados (intervalo intercuartil) fue de 63 (61-66) años y 25 (74%) años para el sexo femenino. Tras tres meses hubo reducción estadísticamente significativa del peso, el índice de masa corporal y la presión arterial sistólica (PAS) y diastólica (PAD) de los mayores evaluados (p < 0,0001 para todos los casos). CONCLUSIÓN: El efecto del programa de ejercicios ha sido eficaz para la reducción de los factores de riesgo cardiovascular de los mayores sedentarios e hipertensos estudiados. (AU)

Effects of Chronic Exercise on Endothelial Progenitor Cells and Microparticles in Professional Runners / Efeitos de Exercício Crônico Sobre Células Progenitoras Endoteliais e Micropartículas em Corredores Profissionais

Abstract Background: The effects of chronic exposure to exercise training on vascular biomarkers have been poorly explored. Objective: Our study aimed to compare the amounts of endothelial progenitor cells (EPCs), and endothelial (EMP) and platelet (PMP) microparticles between professional runners and healthy controls. Methods: Twenty-five half-marathon runners and 24 age- and gender-matched healthy controls were included in the study. EPCs (CD34+/KDR+, CD133+/KDR+, and CD34+/CD133+), EMP (CD51+) and PMP (CD42+/CD31+) were quantified by flow-cytometry. All blood samples were obtained after 12 h of fasting and the athletes were encouraged to perform their routine exercises on the day before. Results: As compared with controls, the CD34+/KDR+ EPCs (p=0.038) and CD133+/KDR+ EPCs (p=0.018) were increased, whereas CD34+/CD133+ EPCs were not different (p=0.51) in athletes. In addition, there was no difference in MPs levels between the groups. Conclusion: Chronic exposure to exercise in professional runners was associated with higher percentage of EPCs. Taking into account the similar number of MPs in athletes and controls, the study suggests a favorable effect of exercise on these vascular biomarkers.

Resumo Fundamento: Os efeitos da exposição crônica ao exercício sobre biomarcadores vasculares foram pouco estudados. Objetivo: Nosso estudo teve como objetivo comparar as quantidades de células progenitoras endoteliais (CPEs), e de micropartículas endoteliais (MPEs) e plequetárias (MPPs) de corredores profissionais com controles sadios. Métodos: Vinte e cinco corredores de meia maratona e 24 controles pareados quanto à idade e ao sexo foram incluídos no estudo. CPEs (CD34+/KDR+, CD133+/KDR+ e CD34+/CD133+), MPE (CD51+) e MPPs (CD42+/CD31+) foram quantificadas por citometria de fluxo. Todas as amostras de sangue foram obtidas após 12 horas de jejum, e os atletas foram incentivados a realizar seus exercícios de rotina no dia anterior à coleta. Resultados: Em comparação aos controles, CPEs CD34+/KDR+ (p=0,038) e CD133+/KDR+ (p=0,018) estavam aumentados, e CPEs CD34+/CD133+ não foram diferentes (p=0,51) nos atletas. As concentrações de MP não diferiram entre os grupos. Conclusão: A exposição crônica ao exercício em corredores profissionais associou-se a uma maior porcentagem de CPEs. Considerando o número similar de MPs entre atletas e controles, o estudo sugere um efeito favorável do exercício sobre esses biomarcadores vasculares.

Performance of the dipstick screening test as a predictor of negative urine culture / Desempenho da fita de urina como resultado presuntivo para cultura de urina negativa

ABSTRACT Objective To investigate whether the urine dipstick screening test can be used to predict urine culture results. Methods A retrospective study conducted between January and December 2014 based on data from 8,587 patients with a medical order for urine dipstick test, urine sediment analysis and urine culture. Sensitivity, specificity, positive and negative predictive values were determined and ROC curve analysis was performed. Results The percentage of positive cultures was 17.5%. Nitrite had 28% sensitivity and 99% specificity, with positive and negative predictive values of 89% and 87%, respectively. Leukocyte esterase had 79% sensitivity and 84% specificity, with positive and negative predictive values of 51% and 95%, respectively. The combination of positive nitrite or positive leukocyte esterase tests had 85% sensitivity and 84% specificity, with positive and negative predictive values of 53% and 96%, respectively. Positive urinary sediment (more than ten leukocytes per microliter) had 92% sensitivity and 71% specificity, with positive and negative predictive values of 40% and 98%, respectively. The combination of nitrite positive test and positive urinary sediment had 82% sensitivity and 99% specificity, with positive and negative predictive values of 91% and 98%, respectively. The combination of nitrite or leukocyte esterase positive tests and positive urinary sediment had the highest sensitivity (94%) and specificity (84%), with positive and negative predictive values of 58% and 99%, respectively. Based on ROC curve analysis, the best indicator of positive urine culture was the combination of positives leukocyte esterase or nitrite tests and positive urinary sediment, followed by positives leukocyte and nitrite tests, positive urinary sediment alone, positive leukocyte esterase test alone, positive nitrite test alone and finally association of positives nitrite and urinary sediment (AUC: 0.845, 0.844, 0.817, 0.814, 0.635 and 0.626, respectively). Conclusion A negative urine culture can be predicted by negative dipstick test results. Therefore, this test may be a reliable predictor of negative urine culture.

RESUMO Objetivo Verificar se a triagem de urina por fitas reativas é capaz de predizer a cultura de urina. Métodos Estudo retrospectivo realizado entre janeiro e dezembro de 2014 com 8.587 pacientes, com solicitação médica de triagem de urina (fita), sedimento urinário e cultura de urina. Foram analisados sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e curva ROC. Resultados Foram positivas 17,5% das culturas. O nitrito apresentou sensibilidade de 28% e especificidade de 99%. O valor preditivo positivo foi de 89% e o valor preditivo negativo de 87%. Esterase apresentou sensibilidade de 79% e especificidade de 84%. Valor preditivo positivo e valor preditivo negativo foram de 51% e 95%, respectivamente. A combinação de nitrito ou esterase positivos apresentou sensibilidade de 85% e especificidade de 84%. Valor preditivo positivo e valor preditivo negativo foram, respectivamente, 53% e 96%. O sedimento positivo (mais de dez leucócitos por microlitro) apresentou sensibilidade de 92% e especificidade de 71%. O valor preditivo positivo foi 40% e o negativo, 98%. A combinação de nitrito e sedimento urinário positivos apresentou sensibilidade de 82% e especificidade de 99%. Os valores preditivos positivo e negativo foram 91% e 98%, respectivamente. Para o nitrito ou esterase positivos mais os leucócitos positivos, a sensibilidade foi de 94% e a especificidade de 84%. O valor preditivo positivo foi de 58% e o negativo foi de 99%. Com base na curva ROC, o melhor indicador de urocultura positiva foi a associação entre a esterase ou nitrito positivos na fita mais os leucócitos positivos no sedimento, seguido por nitrito e esterase positivos, sedimento urinário positivo isolado, esterase positiva isolada, nitrito positivo isolado e, finalmente, pela associação entre nitrito e sedimento urinário positivos (AUC: 0,845, 0,844, 0,817, 0,814, 0,635 e 0,626, respectivamente). Conclusão Uma urocultura negativa pode ser prevista com resultados negativos na fita. Portanto, este teste pode ser um preditor confiável de urocultura negativa.

Estresse em Estudantes do Quarto Ano de Graduação Expostos à Realização do Trabalho de Conclusão de Curso / Stress Among Fourth-Year Undergraduate Students in the Process of Developing Their Course Term Project

Objetivo: Avaliar o nível de estresse em alunos do quarto (último) ano de graduação, na fase de elaboração do Trabalho de Conclusão de Curso. Material e Métodos: Foram incluídos 51 alunos dos cursos de Graduação em Fisioterapia, Biologia e Sistemas de Informação de uma universidade de São Paulo - SP, que foram avaliados por meio de questionário de coleta de dados e pelo Inventário para Sintomas de Estresse em Adultos de Lipp. Resultados: Observou-se que o grupo Fisioterapia referiu com maior frequência (n= 10, 76,9%) que tem que fazer as atividades com muita rapidez e 69,2% (n= 9) do mesmo grupo afirmou que o trabalho exige frequentemente habilidades ou conhecimentos especializados (p = 0,002 e p = 0,02, respectivamente, Teste de Kruskal-Wallis). O grupo Biologia pareceu ter o pior relacionamento com os chefes e o melhor com os colegas e também referiu o maior número de sintomas associados ao estresse em 24 horas, uma semana e um mês (p < 0,0001, p < 0,0001 e p = 0,009, respectivamente, Teste de KruskalWallis). Conclusão: O grupo Sistemas de Informação apresentou menor número de sintomas associados ao estresse, sugerindo maior adaptabilidade às exigências e problemas do dia-a-dia por esse grupo, comparado à Fisioterapia e Biologia.(AU)

Objective: To evaluate the level of stress among fourthyear undergraduate students in preparation of their course term projects. Materials and Methods: 51 students of Physiotherapy, Biology and Information Systems from a university in São Paulo were included. The student were evaluated using a questionnaire and the Lipp's Stress Symptoms Inventory for adults. Results: The Physiotherapy group reported most frequently having to do the activities very quickly (n= 10, 76.9%). Of these, 69.2% (n=9) reported that the work often requires skill or specialized knowledge (p=0.002 and p=0.02, respectively, Kruskal-Wallis Test). The Biology group seemed to have the worst relationship with the bosses and the best with colleagues and also reported the highest number of symptoms associated with stress in 24 hours, one week and one month (p<0.0001, p<0.0001 and p=0.009 respectively, Kruskal-Wallis Test). Conclusion: The Information Systems group presented a lower number of symptoms related to stress, suggesting more adaptability to the demands and day-by-day problems as compared to Physiotherapy and Biology.(AU)

Microparticles as Potential Biomarkers of Cardiovascular Disease / Micropartículas como Possíveis Biomarcadores da Doença Cardiovascular

Primary prevention of cardiovascular disease is a choice of great relevance because of its impact on health. Some biomarkers, such as microparticles derived from different cell populations, have been considered useful in the assessment of cardiovascular disease. Microparticles are released by the membrane structures of different cell types upon activation or apoptosis, and are present in the plasma of healthy individuals (in levels considered physiological) and in patients with different pathologies. Many studies have suggested an association between microparticles and different pathological conditions, mainly the relationship with the development of cardiovascular diseases. Moreover, the effects of different lipid-lowering therapies have been described in regard to measurement of microparticles. The studies are still controversial regarding the levels of microparticles that can be considered pathological. In addition, the methodologies used still vary, suggesting the need for standardization of the different protocols applied, aiming at using microparticles as biomarkers in clinical practice.

A prevenção primária da doença cardiovascular constitui uma opção de grande relevância pelos seus impactos na saúde. Alguns biomarcadores têm sido considerados úteis na avaliação da doença cardiovascular, dentre eles micropartículas originadas de diferentes populações de células. Micropartículas são estruturas liberadas pela membrana de diferentes tipos celulares após ativação ou apoptose, presentes tanto no plasma de indivíduos saudáveis (níveis considerados fisiológicos) quanto em portadores de diferentes doenças. Muitos estudos têm sugerido uma associação entre micropartículas e diferentes condições patológicas, destacando-se a relação com o desenvolvimento das doenças cardiovasculares. Além disso, têm sido descritos os efeitos de diferentes terapias hipolipemiantes na mensuração de micropartículas. Os estudos ainda são controversos quanto aos níveis de micropartículas que possam ser considerados patológicos, e os métodos utilizados ainda são variados, o que sugere a necessidade da padronização dos diferentes protocolos utilizados, visando à utilização de micropartículas como biomarcadores úteis na prática clínica.

Micropartículas e células progenitoras: novos marcadores da disfunção endotelial / Microparticles and progenitor cells: new markers of endothelial dysfunction

O endotélio vascular compreende uma população altamente dinâmica decélulas com papel na proteção vascular contra inflamação, resposta imune,trombose e doenças cardiovasculares, Células progenitoras endoteliais(CPE) compreendem um grupo celular extremamente raro de células nãohematopoiéticas que podem ser recrutadas da medula óssea por váriosestímulos, como citocinas, fármacos, estrógenos, eritropoietina, atividadefísica,e participam na manutenção da integridade endotelial. Aregeneraçãovascular após dano endotelial ocorre tanto pela proliferação de célulasendoteliais maduras, residentes na parede dos vasos (angiogênese), comopor migração e diferenciação de CPE da medula óssea para áreas deisquemia, com a formação de novos vasos sanguíneos (vasculogênese).As CPE podem ser identificadas por citometria de fluxo por meio daexpressão dos marcadores de superfície celular CD34, CD309 (KDR) eCD133. Micropartículas (MP) são pequenas vesículas liberadas por diferentestipos celulares após ativação ou apoptose, contendo material celularcomo proteínas, mRNA, lipoproteínas e debris. Têm papel relacionado àresposta imune adaptativa, sendo utilizados também como biomarcadoresde disfunção endotelial e de algumas afecções como diabetes, infarto, HIV,além de promoverem a transferência de material e comunicação entrecélulas. CPE associadas às MP podem ser consideradas biomarcadoresúteis da doença cardiovascular por estarem diretamente relacionadas àhomeostase endotelial. O recrutamento de CPE sugere um mecanismocompensatório de reparo vascular que contribui para a restauração daintegridade endotelial. Aumento de MP associa-se à disfunção endoteliale à progressão da aterosclerose. Assim, a relação MP/CPE pode indicar ograu de desequilíbrio entre dano endotelial e capacidade de reparo...

The vascular endothelium comprises a highly dinamic population of cellswith a role in vascular protection against inflammation, imune response,thrombosis and cardiovascular diseases. Endothelial progenitor cells(EPC) are an extremely rare population of non-hematopoietic cells thatcan be recruited from bone marrow by many stimuli, such as cytokines,drugs, estrogens, erithropoetin, physical activity and can participate inthe manteinance of endothelium integrity. Vascular repair after injury ofthe endothelium can occur by both proliferation of mature adjacent cells(angiogenesis), or by EPC migration and proliferation from bone marrowto ischemic areas, forming new vessels (vasculogenesis). EPC can beidentified by flow citometry by using surface markers CD34, CD309(KDR) and CDl33. Microparticles (MP) are small vesicles released bydiferent cell types after acti vation or apoptosis, and contain cell materialsuch as proteins, mRNA, lipoproteins and debris. Their role is related tothe adaptive immune responses, and are also potential biomarkers of endotelialdysfunction in diabetes, myocardial infarction and in HIV infection.Further, MP can promote transfer of cell material and cell communication.EPC and MP can be used as useful biomarkers in cardiovascular diseasefor being associated with endothelial homeostasis. EPC mobilization is acompensatory mechanisrn for vascular repair that contributes to restoreendothelial integrity. Conversely, increase in circulating MP is associatedwith endotelial dysfunction and atherosclerosis progression. Though, theassessment of the MPIEPC ratio can indicate the degree of disbalancebetween endothelial damage and repair...

Células endoteliais circulantes, progenitoras endoteliais e micropartículas / Circulating endothelial cells, endothelial progenitor cells and microparticles

A disfunção endotelial está associada ao desenvolvimento e às complicações da aterosclerose e pode ser um marcador do risco cardiovascular. Em situação fisiológica, ocorre equilíbrio entre a erosão da monocamada de células endoteliais e a capacidade de reposição dessas células para a manutenção da homeostase vascular; porém, quando a perda do endotélio, quer por erosão quer por apoptose, superar a capacidade de reposição celular ou se as células endoteliais não preservarem suas propriedades características, ocorre disfunção endotelial. Biomarcadores de função endotelial prompreendem características das células endotelial que possam ser mensuradas. Entre os novos biomarcadores da função endotelial, um grupo de marcadores do turnover dessas células tem sido proposto: células progenitoras endoteliais, células endoteliais circulantes e micropartículas de diferentes populações celulares, células progenitoras endoteliais, células endoteliais circulantes e micropartículas oferecem um meio não-invasivo para estimar a competência vascular. Níveis de células progenitoras endoteliais podem aumentar em eventos agudos, como o infarto...

Endothelial dysfunction is associated with the development of atherosclerosis complications and may be a marker of cardiovascular risk. In physiological conditions there is a balance between the erosion of the endothelial cell monolayer and the ability of the regenerated endothelium to maintain vascular homeostasis; however, when there is loss of endothelial cells, due to erosion or to apoptosis, surpassing the capacity of endothelial regrowth, or if these cells do not preserve their protective characteristics, the endothelium becomes dysfunctional. Endothelial function biomarkers comprise measurable characteristics of endothelial cells. Among new biomarkers of endothelial function, a group of markers of the turnover of these cells has been proposed: endothelial progenitor cells, circulating endothelial cells, and microparticles of different cell populations. As mediators of endothelial homeostasis, endothelial progenitor cells, circulating endothelial cells and microparticles are non-invasive means to estimate vascular competence. Endothelial progenitor cell levels may increase in acute events, such as in acute myocardial infarction or in vascular injury. However, cardiovascular risk factors reduce the number of endothelial progenitor cells. Microparticles are small fragments released by activated or apoptotic cells (endothelial cells, platelets, etc.) found in healthy individuals and among those with cardiovascular diseases. Platelets are the cells that release the greatest amount of microparticles in the blood, although other cell populations also produce microparticles. Higher levels of endothelial microparticles have been found in acute coronary syndrome, peripheral arterial disease and in patients with cardiovascular risk factors...

Efeitos da terapia combinada atorvastatina e clopidogrel na biodisponibilidade da estatina e na função plaquetária em pacientes com doença coronária estável / Effects of the artovastatin and clopidogrel combination therapy on station bioavailability and platelet function of patients with stable coronary disease

Introdução: Atorvastatina 80 mg é recomendada a pacientes portadores de doença coronária para redução de eventos cardiovasculares, havendo controvérsia sobre as interações farmacocinéticas entre doses elevadas das estatinas e uso concomitante de clopidogrel, por compartilharem a mesma via de biotransformação. Este estudo avaliou os efeitos da terapia combinada atorvastatina/clopidogrel na farmacocinética da estatina e função plaquetária em pacientes com doença coronária estável, sob uso crônico e efetivo de estatina. Método: Os pacientes foram admitidos quatro vezes para internação (V1 a V4) em leito-dia. Sete dias (D) antes da primeira internação a estatina em uso foi suspensa. A seguir, receberam atorvastatina 80 mg (D1 a D22) e clopidogrel 75 mg/dia (D8 a D29). Em todas as V foram obtidas amostras de sangue em jejum para dosagens lipídicas, avaliação da função plaquetária (técnica da placa e cone) e quantificação dos níveis plasmáticos de atorvastatina (cromatografia líquida e espectrometria de massa). Resultados: A suspensão por uma semana da estatina modificou o perfil lipídico (P < 0,05 vs. basal), ocorrendo rápida melhora de todas as frações lipídicas após atorvastatina 80 mg (P < 0,005; V1 > V2, V3 e V4). A adesão plaquetária foi menor com clopidogrel isolado (P = 0,003; V4 < V1, V2 e V3), enquanto para a agregação houve menor valor com tratamento combinado atorvastatina/clopidogrel ou clopidogrel isolado comparado aos demais períodos (P < 0,0001; V3 e V4 < V1 e V2). O clopidogrel não modificou as concentrações de atorvastatina. Conclusão: Atorvastatina em alta dose não afetou as meias respostas plaquetárias ao clopidogrel; entretanto, curto período de suspensão da estatina piorou o perfil lipídico e a função plaquetária.

Background: Atorvastatin 80 mg is recommended in patientswith coronary artery disease to reduce cardiovascular events, however, there is controversy regarding the pharmacokinetic interactions between high doses of statins and the concomitant use of clopidogrel, since they share the same biotransformation pathway. This study evaluated theeffects of the atorvastatin/clopidogrel combination therapy on the pharmacokinetics of statins and on platelet function of patients with stable coronary artery disease receivingchronic statins. Method: Patients were admitted four times (V1 to V4) to a day-clinic. Statin was discontinued sevendays (D) before the first admission. Patients then received atorvastatin 80 mg (D1 to D22) and clopidogrel 75 mg/day (D8 to D29). Fasting blood samples were obtained at all time points for lipid measurements, platelet function tests (cone and plate technique), and quantification of atorvastatin plasma levels (liquid chromatography and mass spectrometry). Results: The discontinuation of statins for one weekchanged the lipid profile (P < 0.05 vs. baseline), with an early improvement of all lipid parameters after the administration of atorvastatin 80 mg (P < 0.005; V1 > V2, V3 and V4). Platelet adhesion was lower with clopidogrel alone (P = 0.003; V4 < V1, V2 and V3), whereas platelet aggregation values were lower following the atorvastatin/clopidogrel combination therapy or clopidogrel alone when compared to the other time points (P < 0.0001; V3 and V4 < V1 and V2). The use of clopidogrel did not affect atorvastatin serum levels. Conclusion: High-dose atorvastatin did not affectplatelet responses to clopidogrel, however the short-term statindiscontinuation worsened the lipid profile and platelet function.