Cannabis sativa: A look at protozoa, helminths, insect vectors, and pests.

Active principles extracted from plants, such as essential oils, have been commonly described in the literature as therapeutic targets for numerous pathological conditions. Cannabis sativa, which has an ancient and peculiar history, has been used for various purposes, from recreational to compounds of pharmacotherapeutic and industrial importance, such as pesticides based on this plant. It is a plant that contains approximately 500 described cannabinoid compounds and is the target of in vitro and in vivo studies at different locations. This review clarifies the role of cannabinoid compounds in parasitic infections caused by helminths and protozoa. In addition, this study briefly presented the use of C. sativa constituents in the formulation of pesticides for vector control, as the latter topic is justified by the economic burden faced by several regions where vector-borne diseases are a troubling reality. Studies involving cannabis compounds with pesticidal potential should be encouraged, especially those that evaluate their effectiveness against the different life cycles of insects, seeking to interrupt vector proliferation after egg laying. Actions aimed at the management and cultivation of plant species with ecologically correct pharmacotherapeutic and pesticide potentials are becoming urgent.

Effects of protein source and lipid supplementation on conservation and feed value of total mixed ration silages for finishing beef cattle.

The objective of this study was to examine the conservation process and feed value of total mixed ration (TMR) silages. In exp. 1, we evaluated the fermentation pattern and aerobic stability of TMR silages containing different protein and lipid supplementations. In exp. 2, we compared the performance of finishing beef heifers fed those TMR silages. In both experiments, treatments were as follows: ensiled TMR with urea (U); ensiled TMR without a protein supplement at ensiling, but soybean meal supplemented at feeding to balance diet crude protein (CP) in exp. 2 (SMnf; where the acronym nf indicates nonfermented); ensiled TMR with soybean meal (SM); and ensiled TMR with rolled soybean grain (SG). Thirty-two Nellore heifers (313 ± 8.8 kg shrunk body weight [SBW]) were blocked by initial SBW, housed in individual pens, and enrolled in exp. 2 for 82 d. In exp. 1, treatment without a protein supplement (SMnf) had a lower content of CP, soluble CP, NH3-N, pH, and Clostridium count compared with U (P ≤ 0.03). Lactic acid concentrations tended to be reduced for SMnf compared with U (P = 0.09). Ethanol concentration was reduced in SG compared with SM (P < 0.01). 1,2-Propanediol concentration was increased in SMnf compared with U (P < 0.01), reduced in SM compared with SMnf (P = 0.02), and increased in SG compared with SM (P = 0.02). Dry matter (DM) loss during fermentation was low and similar among treatments (~3.7%). All silages remained stable during 10 d of aerobic exposure after feed out. Considering fermentation traits, such as pH (≤4.72), NH3-N (<10% of N, except for U treatment), butyric acid (<0.05 % DM), and DM losses (<3.70% DM), all silages can be considered well conserved. In exp. 2, diets were isonitrogenous because soybean meal was added to SMnf before feeding. Compared with SM, cattle fed SG made more meals per day (P = 0.04) and tended to have a decreased intermeal interval (P = 0.09). DM intake, average daily gain, final SBW, hot carcass weight, Biceps femoris fat thickness, and serum levels of triglycerides and cholesterol were increased for SG compared with SM (P ≤ 0.05). In brief, TMR silages exhibited an adequate fermentation pattern and high aerobic stability. The supplementation of true protein did not improve animal performance, whereas the addition of soybean grain as a lipid source improved the performance of finishing cattle fed TMR silages.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort.

BACKGROUND: optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority. METHODS: we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox's proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values. RESULTS: Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39-5.12), serum iron (HR = 8.396, 95% CI: 2.02-34.96), serum calcium (HR = 4.102, 95% CI: 1.35-12.46) and serum protein (HR = 4.630, 95% CI: 2.07-10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01-0.74), high ferritin values (HR = 0.392, 95% CI: 0.19-0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19-0.61) and serum albumin (HR = 0.230, 95% CI: 0.10-0.54) were less risk to die. CONCLUSION: survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Pre-colonial Amerindian legacies in forest composition of southern Brazil.

Past human societies have left persistent marks on forests worldwide. However, the degree to which pre-colonial Amerindian societies have affected forest structure is still not fully understood, especially in southern Brazil. This study investigated the influence of two distinct Amerindian groups (Southern-Jê and Guarani) over tree composition of forest fragments in the State of Santa Catarina. Vegetation data was obtained from the Santa Catarina Forest and Floristic Inventory (SCFFI): a statewide systematic vegetation sampling project. Archaeological data was collated from literature reviews as well as existing databases for archaeological sites occupied by Guarani and Southern-Jê groups. Using these sites of known Amerindian occupation, and corresponding environmental variables, ecological niche models were developed for each Amerindian group, predicting potential archaeological sites occupied by these groups across southern Brazil. Maps of these potential occupation sites of pre-colonial Amerindian groups were compared with 417 corresponding floristic inventory plots. Redundancy analysis (RDA) was used to identify floristic composition patterns linked to areas with a high probability of Southern-Jê or Guarani presence. Southern-Jê and Guarani pre-colonial occupations overlapped near main rivers; however, Southern-Jê groups generally occupied elevated areas whereas Guarani occupied mostly coastal areas. We observed differences in forest composition associated with the predicted occurrence of these pre-colonial Amerindian groups. Based on these results, we argue there is a relationship between tree species distribution and pre-colonial human occupation by these two Amerindian groups.

Catechins as Model Bioactive Compounds for Biomedical Applications.

Research regarding polyphenols has gained prominence over the years because of their potential as pharmacological nutrients. Most polyphenols are flavanols, commonly known as catechins, which are present in high amounts in green tea. Catechins are promising candidates in the field of biomedicine. The health benefits of catechins, notably their antioxidant effects, are related to their chemical structure and the total number of hydroxyl groups. In addition, catechins possess strong activities against several pathogens, including bacteria, viruses, parasites, and fungi. One major limitation of these compounds is low bioavailability. Catechins are poorly absorbed by intestinal barriers. Some protective mechanisms may be required to maintain or even increase the stability and bioavailability of these molecules within living organisms. Moreover, novel delivery systems, such as scaffolds, fibers, sponges, and capsules, have been proposed. This review focuses on the unique structures and bioactive properties of catechins and their role in inflammatory responses as well as provides a perspective on their use in future human health applications.

O fenômeno da conspiração do silêncio em pacientes em cuidados paliativos: uma revisão integrativa / El fenomeno de la conspiración del silencio en pacientes en cuidados paliativos: una revisión integrativa / The phenomenon of the conspiracy of silence in patients in palliative care: an integrative review

Resumo Objetivou identificar o fenômeno da conspiração do silêncio navivência de pacientes em cuidados paliativos, familiares e profissionais de saúde. Trata-se de uma revisão integrativa, realizada a partir de buscas na Biblioteca Virtual de Saúde (BVS) primeiramente por meio dos descritores "Cuidados Paliativos", "Cuidados Paliativos na terminalidade da vida" e "Conspiración de silencio", sendo AND o operador booleano utilizado. Em seguida utilizou-se uni-termos "conspiración de silencio" e "pacto de silencio". Os critérios de incluso foram: ano de publicação, últimos 10 (dez) anos (2008 a 2017); idiomas: português, inglês e espanhol; e texto na íntegra. Assim selecionou 9 artigos, sendo 7 (77,8%) indexados no BDENF e 2 (22,2%) na LILACS. Os resultados demonstraram alta incidência da conspiração do silêncio em pacientes sob cuidados paliativos, a comunicação ineficaz contribui para a falta de informação entre profissionais de saúde, pacientes e familiares sobre o diagnóstico e prognóstico da enfermidade. Sentimentos de medo, angústia e ansiedade são vivenciados por pacientes e familiares. Conclui-se que há necessidade de aprender a ouvir os pacientes e familiares como objetivo de perceber como direcionar da melhor forma a comunicação sobre a terminalidade de vida, fornecendo autonomía ao paciente na condução das suas atitudes frente ao processo que está vivenciando.

Resumen Objetivo identificar el fenómeno de la conspiración del silencio en la vivencia de pacientes en cuidados paliativos, familiares y profesionales de salud. Se trata de una revisión integrativa, realizada a partir de búsquedas en la Biblioteca Virtual de Salud (BVS) primero por medio de los descriptores "Cuidados Paliativos", "Cuidados Paliativos en la terminalidad de la vida" y "Conspiración de silencio", siendo AND el operador boleano utilizado. En seguida se utilizó uni-términos "conspiración de silencio" y "pacto de silencio". Los criterios de inclusión fueron: año de publicación, últimos 10 (diez) años (2008 a 2017); Idiomas: portugués, inglés y español; y el texto en su totalidad. Así seleccionó 9 artículos, siendo 7 (77,8%) indexados en el BDENF y 2 (22,2%) en la LILACS. Los resultados demostraron alta incidencia de la conspiración del silencio en pacientes bajo cuidados paliativos, la comunicación ineficaz contribuye a la falta de información entre profesionales de salud, pacientes y familiares sobre el diagnóstico y pronóstico de la enfermedad. Los sentimientos de miedo, angustia y ansiedad son experimentados por pacientes y familiares. Se concluye que hay necesidad de aprender oír a los pacientes y familiares con el objetivo de percibir cómo dirigir de la mejor forma la comunicación sobre la terminalidad de vida, proporcionando autonomía al paciente en la conducción de sus actitudes frente al proceso que está viviendo.

Abstract The objective was to identify the phenomenon of the conspiracy of silence in the experience of patients in palliative care, family and health professionals. This is anintegrative review, carried out based on searches in the Virtual Health Library (VHL), firstly by means of the descriptors "Palliative Care", "Palliative Care in the terminality of life" and "Conspiracy of silence", being AND the operator boolean used. Then we used the terms "conspiracy of silence" and "pact of silence". The inclusión criteria were: year of publication, last 10 (ten) years (2008 to 2017); languages: Portuguese, English and Spanish; and text in full. Thus, 9 articles were selected, 7 (77.8%) indexed in the BDENF and 2 (22.2%) in LILACS. The results showed a high incidence of the conspiracy of silence in patients undergoing palliative care, ineffective communication contributes to the lack of information among health professionals, patients and families about the diagnosis and prognosis of the disease. Feelings of fear, anguish and anxiety are experienced by patients and family members. It is concluded that there is a need to learn to listen to patients and their families with the objective of understanding how to best communicate the communication about the terminality of life, providing autonomy to the patient in the conduct of their attitudes towards the process they are experiencing.

Fish Oil Supplementation Reduces Inflammation but Does Not Restore Renal Function and Klotho Expression in an Adenine-Induced CKD Model.

BACKGROUND: Chronic kidney disease and inflammation promote loss of Klotho expression. Given the well-established anti-inflammatory effects of omega-3 fatty acids, we aimed to investigate the effect of fish oil supplementation in a model of CKD. METHODS: Male C57BL/6 mice received supplementation with an adenine-enriched diet (AD, n = 5) or standard diet (CTL, n = 5) for 10 days. Two other experimental groups were kept under the adenine diet for 10 days. Following adenine withdrawal on the 11th day, the animals returned to a standard diet supplemented with fish oil (Post AD-Fish oil, n = 9) or not (Post AD-CTL, n = 9) for an additional period of 7 days. RESULTS: Adenine mice exhibited significantly higher mean serum urea, creatinine, and renal expression of the pro-inflammatory markers Interleukin-6 (IL-6), C-X-C motif chemokine 10 (CXCL10), and Interleukin-1ß (IL-1ß), in addition to prominent renal fibrosis and reduced renal Klotho gene expression compared to the control. Post AD-Fish oil animals demonstrated a significant reduction of IL-6, C-X-C motif chemokine 9 (CXCL9), and IL-1ß compared to Post AD-CTL animals. However, serum creatinine, renal fibrosis, and Klotho were not significantly different in the fish oil-treated group. Furthermore, renal histomorphological changes such as tubular dilatation and interstitial infiltration persisted despite treatment. CONCLUSIONS: Fish oil supplementation reduced renal pro-inflammatory markers but was not able to restore renal function nor Klotho expression in an adenine-induced CKD model.

Morinda citrifolia (Noni) Fruit Juice Reduces Inflammatory Cytokines Expression and Contributes to the Maintenance of Intestinal Mucosal Integrity in DSS Experimental Colitis.

Morinda citrifolia L. (noni) has been shown to treat different disorders. However, data concerning its role in the treatment of intestinal inflammation still require clarification. In the current study, we investigated the effects of noni fruit juice (NFJ) in the treatment of C57BL/6 mice, which were continuously exposed to dextran sulfate sodium (DSS) for 9 consecutive days. NFJ consumption had no impact on the reduction of the clinical signs of the disease or on weight loss. Nonetheless, when a dilution of 1 : 10 was used, the intestinal architecture of the mice was preserved, accompanied by a reduction in the inflammatory infiltrate. Regardless of the concentration of NFJ, a decrease in both the activity of myeloperoxidase and the key inflammatory cytokines, TNF-α and IFN-γ, was also observed in the intestine. Furthermore, when NFJ was diluted 1 : 10 and 1 : 100, a reduction in the production of nitric oxide and IL-17 was detected in gut homogenates. Overall, the treatment with NFJ was effective in different aspects associated with disease progression and worsening. These results may point to noni fruit as an important source of anti-inflammatory molecules with a great potential to inhibit the progression of inflammatory diseases, such as inflammatory bowel disease.

Public-private settlement and hospital mortality per sources of payment.

OBJECTIVE: To analyze if the adjusted hospital mortality varies according to source of payment of hospital admissions, legal nature, and financing settlement of hospitals. METHODS: Cros-ssectional study with information source in administrative databases. Specific hospital admission reasons were selected considering the volume of hospital admissions and the list of quality indicators proposed by the North-American Agency for Healthcare Research and Quality (AHRQ). Were analyzed 852,864 hospital admissions of adults, occurred in 789 hospitals between 2008 and 2010, in Sao Paulo and Rio Grande do Sul, applying multilevel logistic regression. RESULTS: At hospital admission level, showed higher chances of death male patients in more advanced age groups, with comorbidity, who used intensive care unit, and had the Brazilian Unified Health System as source of payment. At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System. This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%. CONCLUSIONS: In addition to structural characteristics of the hospitals and the profile of the patients, interventions aimed at improving care should also consider the coverage of the population by health plans, the network shared between beneficiaries of plans and users of the Brazilian Unified Health System, the standard of care to the various sources of payment by hospitals and, most importantly, how these factors influence the clinical performance. OBJETIVO: Analisar se a mortalidade hospitalar ajustada varia segundo fonte de pagamento das internações, natureza jurídica e arranjo de financiamento dos hospitais. MÉTODOS: Estudo observacional transversal com fonte de informações em bases de dados administrativos. Motivos de internação específicos foram selecionados considerando o volume de internações e a lista de indicadores de qualidade propostos pela agência norte-americana de pesquisa em saúde e qualidade (AHRQ). Foram analisadas 852.864 internações em adultos, ocorridas em 789 hospitais entre 2008 e 2010, em São Paulo e Rio Grande do Sul, aplicando regressão logística multinível. RESULTADOS: No nível da internação, apresentaram maiores chances de óbito pacientes do sexo masculino, em faixas etárias mais avançadas, com comorbidade, que utilizaram unidade de terapia intensiva, e tinham o Sistema Único de Saúde como fonte de pagamento. No nível dos hospitais, naqueles situados na média da distribuição, a probabilidade de morte ajustada nas internações financiadas por plano ou particular foi de 5,0%, contra 9,0% quando reembolsadas pelo Sistema Único de Saúde. Essa probabilidade aumentou nas internações financiadas pelo Sistema Único de Saúde em hospitais a dois desvios padrão acima da média, passando para 29,0%. CONCLUSÕES: Além das características estruturais dos hospitais e do perfil dos pacientes, intervenções voltadas para a melhoria do cuidado deveriam considerar também a cobertura da população por planos de saúde, a rede compartilhada entre beneficiários de planos e usuários do Sistema Único de Saúde, o padrão de atendimento às diversas fontes de pagamento pelos hospitais e, fundamentalmente, como esses fatores influenciam o desempenho clínico.

Assistência de profissionais de saúde à mulher em situação de violência sexual: revisão integrativa / Health professionals' assistance to women in situation of sexual violence: an integrative review / Asistencia de los profesionales de la salud a la mujer en situación de violencia sexual: una revisión integradora

Objetivo: analisar as publicações científicas entre 2003 a 2013 sobre a assistência à saúde às mulheres em situação de violência sexual. Método: revisão integrativa a partir da questão de pesquisa << Como ocorre a assistência à saúde da mulher em situação de violência sexual? >>. Foram empregados os descritores violência contra a mulher, violência sexual, assistência nas Bases de Dados MEDLINE, LILACS e biblioteca virtual Scielo. Os estudos selecionados foram analisados e criticados, considerando o rigor e as características dos mesmos. Resultados: os 16 estudos destacaram a valorização do modelo biomédico na atenção às mulheres em situação de violência, a falta de articulação intersetorial, o despreparo dos profissionais na assistência e as consequências para a saúde da mulher violentada que procura os serviços de saúde e da rede de atenção. Conclusão: torna-se necessária a construção de redes de atenção com foco na atenção primária à saúde e capacitação dos profissionais para o atendimento às mulheres em situação de violência sexual, na perspectiva da integralidade do cuidado.(AU)

Objective: to analyze the scientific publications between 2003 and 2013 about health care to women in situation of sexual violence. Method: an integrative review from the research question << How does health care of women in situations of sexual violence happen? >>. There were used the descriptors violence against women, sexual violence and assistance, in MEDLINE, LILACS and Scielo virtual library databases. The selected studies were analyzed and criticized, considering the accuracy and characteristics. Results: the 16 studies highlighted the appreciation of the biomedical model in care to women in situations of violence, the lack of inter-agency coordination, the unpreparedness of the professionals in attendance and the consequences for the health of abused women seeking health services and network attention. Conclusion: it becomes necessary to build focused attention networks in primary health care and training of professionals to take care of women in situations of sexual violence in a comprehensive care perspective.(AU)

Objetivo: analizar las publicaciones científicas entre 2003 a 2013 acerca del cuidado de la salud de las mujeres en situación de violencia sexual. Método: una revisión integradora a partir de la pregunta de investigación << ¿Cómo es la medida que se da la atención de la salud a las mujeres en situación de violencia sexual? >>. Fueron utilizados los descriptores de la violencia contra las mujeres, la violencia sexual, la asistencia en las bases de datos MEDLINE, LILACS y biblioteca virtual Scielo. Se analizaron y criticaron los estudios seleccionados, teniendo en cuenta la precisión y características. Resultados: los 16 estudios pusieron de relieve la apreciación del modelo biomédico en la atención a las mujeres en situación de violencia, la falta de coordinación entre organismos, la falta de preparación de los profesionales de la asistencia y las consecuencias para la salud de las mujeres maltratadas que buscan los servicios de salud y la red atención. Conclusión: se hace necesaria la construcción de redes de atención centrada en la Atención Primaria de Salud y la formación de profesionales para atender a mujeres en situación de violencia sexual en la perspectiva de la atención integral.(AU)

Adherence to non-pharmacological treatment: Analysis of the impact of three health educational and nutritional strategies in hypertensive patients / Adesão ao tratamento não farmacológico: análise do impacto de três estratégias de educação em saúde e nutrição em portadores de hipertensão arterial

ABSTRACT Objective: To evaluate adherence to non-pharmacological treatment of hypertension by comparing biochemical, clinical, anthropometric, and dietary parameters before and after three health educational and nutritional strategies. Methods: This longitudinal clinical trial included 212 hypertensive individuals who met the inclusion criteria. The participants were allocated to three groups to assess the impact of monthly intervention methods over twelve months. Results: Waist circumference decreased significantly in all groups. Weight and body mass index decreased significantly in Groups 2 and 3. Blood glucose, total cholesterol, and low-density lipoprotein cholesterol decreased significantly in Groups 1 and 2. The interventions also reduced the mean per capita intakes of oil, sugar, and salt in all groups. Conclusion: Educational interventions promoted adherence to non-pharmacological treatment of treatment of hypertension evidenced by anthropometric (weight, body mass index, and waist circumference), biochemical (blood glucose, total cholesterol, and low-density lipoprotein cholesterol), and dietary (meanper capita intake of oil, sugar, and salt) parameters.

RESUMO Objetivo: Avaliar a adesão ao tratamento não farmacológico da hipertensão arterial sistêmica por meio de parâmetros antropométricos, bioquímicos, clínicos e dietéticos antes e após três estratégias de educação em saúde e nutrição. Métodos: Trata-se de um estudo de intervenção longitudinal, do tipo ensaio comunitário, comparativo, de abordagem quantitativa. A amostra foi constituída de 212 indivíduos com diagnóstico de hipertensão arterial sistêmica que atenderam aos critérios de inclusão/exclusão. Os participantes foram alocados em três grupos de forma a avaliar o impacto das modalidades de intervenção realizadas mensalmente durante 12 meses. Resultados: No grupo 1, houve redução estatisticamente significante da circunferência da cintura. Nos grupos 2 e 3, os resultados foram estatisticamente significantes para o peso, índice de massa corporal e circunferência da cintura. Foram verificadas reduções estatisticamente significantes na glicemia, no colesterol total e lipoproteína de baixa densidade nos grupos 1 e 2. As intervenções também foram capazes de promover alterações favoráveis no consumo médio per capita de óleo, açúcar e sal em todos os grupos. Conclusão: As intervenções educativas propiciaram resultados positivos sobre a adesão ao tratamento não farmacológico da hipertensão arterial sistêmica, considerando os parâmetros antropométricos (peso, índice de massa corporal e circunferência da cintura), bioquímicos (glicemia, colesterol total e lipoproteína de baixa densidade), e dietéticos (consumo médio per capita de óleo, açúcar e sal).

Effects of transcutaneous electrical nerve stimulation on fetal and placental development in an experimental model of placental insufficiency.

OBJECTIVE: To elucidate the effects of transcutaneous electrical nerve stimulation (TENS) in pregnancies with placental insufficiency. METHODS: Pregnant rats were subjected to uterine artery ligation and to TENS according to the following groups: ligated stimulated (LS); ligated non-stimulated (LN), control stimulated (CS); and control non-stimulated (CN). Fetal external measurements, such as crown-rump length (CRL), fronto-occipital distance (FOD), thoracic ventral-dorsal (TVDD) and abdominal ventral-dorsal (AVDD) distances were analyzed together with the area occupied by fetal internal organs. Glucose transporter 1 (GLUT-1) expression was evaluated by immunohistochemistry in fetal organs. Thickness of junctional, labyrinth and intermediate placental zones was analyzed by morphometric evaluation in HE-stained slides, and placental hypoxia-inducible factor 1 alfa expression was measured by real-time polymerase chain reaction. RESULTS: In LN and CS groups compared to the CN group, CRL was reduced (27.51/28.95 versus 30.16 mm), as well as FOD (6.63/6.63 versus 7.36 mm), AVDD (7.38/8.00 versus 8.61 mm) and TVDD (6.46/6.87 versus 7.23 mm). Brain GLUT-1 expression was higher in LS (1.3%) and CS (1.8%). The area occupied by placental vessels in the labyrinth zone (29.67 ± 3.51 versus 20.83 ± 7.63) and intermediate zone (26.46 ± 10.21 versus 10.86 ± 8.94) was larger in the LS group than in the LN group. CONCLUSIONS: Our results suggest a negative effect of TENS on placental development, thus compromising the maintenance of adequate blood flow to the fetus.

O efeito anti-obesidade da Garcinia cambogia em humanos / The effect anti-obesity of Garcinia cambogia in human

Tema: O excesso de peso acomete mais de um bilhão de pessoas no mundo e o fitoterápico Garcinia cambogia é citado como uma ferramenta coadjuvante para o tratamento da obesidade. Entretanto, ainda existem lacunas sobre dosagens e efeitos colaterais. Objetivo: Realizar um levantamento bibliográfico sobre os efeitos da Garcinia cambogia no tratamento da obesidade. Metodologia: Foi realizada uma revisão da literatura através de buscas aos bancos de dados de duas plataformas, PubMed e SciELO, sendo selecionados somente artigos completos e com acesso livre, dos últimos dez anos na língua inglesa e portuguesa. Resultados e Discussão: nove artigos foram considerados para discussão, todos indexados na PubMed nos últimos anos, sendo cinco de revisão e quatro de ensaios clínicos, não havendo consenso sobre os efeitos benéficos da Garcinia cambogia sobre obesidade e comorbidades em humanos. Conclusão: Os estudos mostram tendência de um efeito positivo da Garcinia cambogia sobre o controle da obesidade e comorbidades com pouca possibilidade de efeitos colaterais, porém ainda não existe consenso sobre esse efeito, dosagem e efeitos colaterais.(AU)

Theme: Overweight affects more than one billion people in the world and the Garcinia cambogia´s phytotherapy is cited as a supporting tool for the treatment of obesity, but there are still gaps on dosage effects and side effects. Objective: To review the literature on the effects of Garcinia cambogia in the treatment of obesity. Methodology: A literature´s review was performed through searches in databases from two platforms: PubMed and SciELO, being selected only complete and free full text articles, from last ten years in English or Portuguese. Results and Discussion: There were considered nine articles for discussion, all indexed in PubMed in last years, including five reviews and four clinical trials. There was no consensus about beneficial effect of Garcinia cambogia regarding obesity and comorbidities in Humans. Conclusion: Studies show a positive effect from Garcinia cambogia on obesity control and comorbidity with low possibility to side effect. However there is still no consensus about this effect, dosage or side effect.(AU)

Public-private settlement and hospital mortality per sources of payment / O arranjo público privado e a mortalidade hospitalar por fontes de pagamento

ABSTRACT OBJECTIVE To analyze if the adjusted hospital mortality varies according to source of payment of hospital admissions, legal nature, and financing settlement of hospitals. METHODS Cros-ssectional study with information source in administrative databases. Specific hospital admission reasons were selected considering the volume of hospital admissions and the list of quality indicators proposed by the North-American Agency for Healthcare Research and Quality (AHRQ). Were analyzed 852,864 hospital admissions of adults, occurred in 789 hospitals between 2008 and 2010, in Sao Paulo and Rio Grande do Sul, applying multilevel logistic regression. RESULTS At hospital admission level, showed higher chances of death male patients in more advanced age groups, with comorbidity, who used intensive care unit, and had the Brazilian Unified Health System as source of payment. At the level of hospitals, in those located in the mean of the distribution, the adjusted probability of death in hospital admissions financed by plan or private was 5.0%, against 9.0% when reimbursed by the Brazilian Unified Health System. This probability increased in hospital admissions financed by the Brazilian Unified Health System in hospitals to two standard deviations above the mean, reaching 29.0%. CONCLUSIONS In addition to structural characteristics of the hospitals and the profile of the patients, interventions aimed at improving care should also consider the coverage of the population by health plans, the network shared between beneficiaries of plans and users of the Brazilian Unified Health System, the standard of care to the various sources of payment by hospitals and, most importantly, how these factors influence the clinical performance.

RESUMO OBJETIVO Analisar se a mortalidade hospitalar ajustada varia segundo fonte de pagamento das internações, natureza jurídica e arranjo de financiamento dos hospitais. MÉTODOS Estudo observacional transversal com fonte de informações em bases de dados administrativos. Motivos de internação específicos foram selecionados considerando o volume de internações e a lista de indicadores de qualidade propostos pela agência norte-americana de pesquisa em saúde e qualidade (AHRQ). Foram analisadas 852.864 internações em adultos, ocorridas em 789 hospitais entre 2008 e 2010, em São Paulo e Rio Grande do Sul, aplicando regressão logística multinível. RESULTADOS No nível da internação, apresentaram maiores chances de óbito pacientes do sexo masculino, em faixas etárias mais avançadas, com comorbidade, que utilizaram unidade de terapia intensiva, e tinham o Sistema Único de Saúde como fonte de pagamento. No nível dos hospitais, naqueles situados na média da distribuição, a probabilidade de morte ajustada nas internações financiadas por plano ou particular foi de 5,0%, contra 9,0% quando reembolsadas pelo Sistema Único de Saúde. Essa probabilidade aumentou nas internações financiadas pelo Sistema Único de Saúde em hospitais a dois desvios padrão acima da média, passando para 29,0%. CONCLUSÕES Além das características estruturais dos hospitais e do perfil dos pacientes, intervenções voltadas para a melhoria do cuidado deveriam considerar também a cobertura da população por planos de saúde, a rede compartilhada entre beneficiários de planos e usuários do Sistema Único de Saúde, o padrão de atendimento às diversas fontes de pagamento pelos hospitais e, fundamentalmente, como esses fatores influenciam o desempenho clínico.

Evaluation of human polymorphonuclear behavior on textured titanium and calcium-phosphate coated surfaces.

Few studies have evaluated the effects of titanium (Ti) surface modifications on polymorphonuclear neutrophils (PMNs). Human PMNs' viability and release of key mediators-such as IL1ß, IL6, TNFα, IL12, IL10, IL4, TGFß1, IL8, IP-10, and Mig-were evaluated on three different Ti surface treatments: (1) machined Ti; (2) alumina-blasted and acid-etched Ti (AB/AE); and (3) calcium phosphate coating of 300-500 nm by ion beam onto the AB/AE Ti surface (CaP). A polystyrene surface was used as a negative control. The PMNs were purified from whole human blood and cultured for 6 h. Cell viability was determined by flow cytometry, and the supernatant was evaluated to determine the levels of cytokines and chemokines. Results showed that the percentage of viable cells was significantly lower on the CaP surface compared to the control (p < 0.05) relative to the other groups. No differences in the levels of IL8, MIG, and IP10 were detected between groups. Significantly higher levels of IL1ß (p = 0.046) and TNFα (p = 0.016) were detected for the CaP surfaces compared to AB/AE surface only. The levels of IL4, IL10, and TGFß1 secreted from the PMNs in the CaP group were significantly lower than in the control and machined groups (p < 0.05) that were statistically comparable to AB/AE. Overall, the addition of a thin CaP coating to the AB/AE Ti surface influenced the secretion profile of pro-inflammatory cytokines due to the higher release of pro-inflammatory cytokines (IL1ß and TNFα) on these surfaces.

O efeito agudo do café na pressão arterial: uma revisão integrativa / El efecto agudo del café en la presión arterial: una revisión integrativa / The acute effects of coffe on blood pressure: an integrative review

Revisão integrativa de literatura que objetivou buscar as evidências sobre o efeito agudo docafé nos valores da pressão arterial, no período de1993 a 2010, em três bases de dados.Obteve-se quatro estudos quantitativos com nível deevidência II, com delineamentoexperimental de amostras randomizadas. Em dois deles, o café elevou os níveis pressóricosapenas em consumidores não habituais da bebida. Emum, evidenciou-se aumento nos níveispressóricos após a ingestão do café, em hipertensos, tanto em consumidores habituais, comonaqueles que se mantiveram em abstinência de café.Outro estudo demonstrou o efeito agudodo café sobre o aumento dos valores pressóricos e aumento da resistência vascular. Conclui-sea partir de estudos de alto nível de evidência necessidade de abster-se da ingestão de caféantes da medida da pressão arterial, conforme as recomendações das Diretrizes Brasileiras deHipertensão (2010) .

An integrative literature review that aimed to findevidence of the acute effects of coffee onblood pressure, taken from three databases between1993 and 2010. Four quantitative studieswere taken with level of evidence II and with a trial design of random samples. In two ofthem, coffee raised blood pressure only in occasional consumers. In another one, an increase of blood pressure after coffee ingestion was seen in hypertensive individuals, both in regularconsumers and those who had not drunk for some time. Another study showed the acuteeffects of coffee on blood pressure increase and vascular resistance increase. Based on studieswith high level of evidence, the need to refrain from drinking coffee before measuring bloodpressure is clear, as recommended by the Brazilianhypertension guidelines (2010) .

Revisión integrativa de literatura que objetivó buscar las evidencias sobre el efecto agudo delcafé en los valores de presión arterial, en períodode 1993 a 2010, revisándose tres bases dedatos. Se obtuvieron cuatro estudios cuantitativoscon nivel de evidencia II, condelineamiento experimental de muestras randomizadas. En dos de ellos, el café elevó losniveles presóricos sólo en consumidores no habituales. En uno, se evidenció aumento de losniveles presóricos luego de la ingesta del café enhipertensos, tanto en consumidoreshabituales como en aquellos en abstinencia de la bebida. Otro estudio demostró el efectoagudo del café sobre el aumento de los valores presóricos y aumento de la resistenciavascular. Se concluye, a partir de estudios de altonivel de evidencia, en la necesidad deabstenerse de ingerir café antes de la medición dela presión arterial, conforme lasrecomendaciones de las Directivas Brasileñas de Hipertensión (2010) .

Investigação em material de autópsias sobre a hipótese de associação entre obesidade e neurocisticercose / Investigation in autopsy material on the hypothesis of the association between obesity and neurocysticercosis

Introdução: A Neurocisticercose (NCC) é uma infecção no sistema nervoso central que pode ser associada à obesidade quando o cisticerco afeta os centros hipotalâmicos relacionados ao controle da fome e da saciedade. Objetivo: Comparar o Índice de Massa Corporal (IMC) dos pacientesautopsiados com NCC (exceto hipotalâmica) com um grupo sem cisticercose. Métodos: Foram revistos 2.629 protocolos de autópsias realizadas no período de 1970 a 2004, avaliando-se as seguintes variáveis: índice de massa corporal, diagnóstico e localização da NCC. Resultados: A ocorrência de NCC foi de 2,7por cento e a mediana do IMC do grupo com NCC (19,06 kg/m2) foi significativamente menor (p igual 0,001) que a do grupo sem cisticercose (20,76 kg/m2). Conclusão: A NCC, por si só, não está relacionada à obesidade, exceto quando o cisticerco apresenta localização hipotalâmica.

Introduction: Neurocysticercosis (NCC) is an infection of the Central NervousSystem that may be associated with obesity when the cysticercus affectshypothalamic centers associated to the appetite and satiety. Aim: to compare the Body Mass Index (BMI) of autopsied patients with NCC (except hypothalamic) with an autopsied group without cysticercosis. Methods: 2,629 protocols from autopsies from 1970 until 2004 were revised and the following variables evaluated: BMI, positive diagnosis, and localization of neurocysticercosis. NCC was found in71 autopsies (2.7%). The median BMI of the group with NCC, which was 19.06kg/m2, was significantly lower (p=0.001) in comparison with the group without cysticercosis with a BMI of 20.76 kg/m2. Conclusion: NCC itself is not related to obesity, except when the cysticercus has hypothalamic localization.

Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral / Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

OBJETIVO: Avaliar a freqüência de infecção relacionada ao cateter venoso central em pacientes submetidos a terapia nutricional parenteral. MÉTODOS: Foram analisados os cateteres venosos centrais de pacientes em terapia nutricional parenteral que tiveram a indicação de retirada do cateter venoso central por infecção, alta hospitalar, ou trombose. Os pacientes com infecção foram denominados de Grupo 1 e os demais de Grupo 2. RESULTADOS: Não houve diferença estatisticamente significante quanto ao estado nutricional dos 18 pacientes analisados. Foram analisados 28 cateteres e destes 68 por cento estavam infectados, sendo 72 por cento do Grupo 1 e 28 por cento do Grupo 2 (assintomáticos). No Grupo 1, houve infecção sistêmica em 70 por cento dos casos, já no Grupo 2 a hemocultura foi positiva em 17 por cento dos casos. A colonização por Staphylococcus sp. ocorreu em 48 por cento dos casos, seguida de Candida sp. (21 por cento), Enterococcus faecalis (16 por cento), Pseudomonas aerurginosa (10 por cento) e Proteus sp.(5 por cento). CONCLUSÃO: A contaminação de cateter venoso central utilizado para terapia nutricional parenteral é freqüente. Mesmo pacientes assintomáticos recebendo nutrição parenteral têm uma incidência maior de infecção por Candida sp. Portanto é necessária a criação de barreiras que impeçam a colonização destes cateteres venosos centrais, a fim de diminuir a morbimortalidade de pacientes dependentes deste tipo de terapia.

OBJECTIVE: The aim of this study was to evaluate the frequency of central venous catheter-related infections in hospitalized patients receiving total parenteral nutrition. METHODS: Central venous catheters were analyzed immediately after removal due to infection, hospital discharge or thrombosis. The patients with catheter-related infection were named Group 1 and the other patients were named Group 2. RESULTS: Eighteen patients were studied. There was no statistically significant difference in nutritional status between the two groups. A total of 28 catheters were analyzed. Sixty-eight percent of the catheters were infected: 72 percent of them were from Group 1 and 28 percent from Group 2 (asymptomatic patients). Systemic infection was diagnosed in 70 percent of the patients from Group 1. Positive blood culture was found in 17 percent of the patients from Group 2. The microorganisms found were: Staphylococcus sp. (48 percent), Candida sp. (21 percent), Enterococcus faecalis (16 percent), Pseudomonas aerurginosa (10 percent) and Proteus sp. (5 percent). CONCLUSION: Central venous catheter infection is common in hospitalized asymptomatic patients. Patients receiving total parenteral nutrition are most frequently infected with Candida sp. Therefore, the creation of barriers that block colonization in the central venous catheter is essential to decrease the morbidity and mortality among patients that depend on total parenteral nutrition.

Biofilms, infection, and parenteral nutrition therapy.

Parenteral nutrition therapy is used in patients with a contraindication to the use of the gastrointestinal tract, and infection is one of its frequent and severe complications. The objective of the present study was to detect the presence of biofilms and microorganisms adhering to the central venous catheters used for parenteral nutrition therapy by scanning electron microscopy. Thirty-nine central venous catheters belonging to patients with clinical signs of infection (G1) and asymptomatic patients (G2) and patients receiving central venous catheters for clinical monitoring (G3) were analyzed by semiquantitative culture and scanning electron microscopy. The central venous catheters of G1 presented more positive cultures than those of G2 and G3 (81% vs 50% and 0%, respectively). However, biofilms were observed in all catheters used and 55% of them showed structures that suggested central venous catheters colonization by microorganisms. Approximately 53% of the catheter infections evolved with systemic infection confirmed by blood culture. The authors conclude that the presence of a biofilm is frequent and is an indicator of predisposition to infection, which may even occur in patients who are still asymptomatic.

Is oral nutritional therapy effective for the treatment of chylothorax? A case report.

We report a case of a female patient who underwent corrective aortic coarctation surgery that progressed to chylothorax on the fifth postoperative day. Because the patient was clinically stable and had a functioning digestive tract, the nutritional team decided to treat her by oral nutritional support with a low-lipid diet, rich in medium-chain triacylglycerols. After 20 d, the patient returned to her habitual home diet and did not develop pleural spilling, showing full healing of the thoracic duct.