An elderly man with gastric cancer, Saint's triad and Heyde's syndrome.

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.

Freeze-Dried Banana Slices Carrying Probiotic Bacteria.

Findings on diet-health relationships have induced many people to adopt healthier diets, including the substitution of energy-dense snacks with healthier items, e.g., those containing probiotic microorganisms. The aim of this research was to compare two methods to produce probiotic freeze-dried banana slices-one of them consisting of impregnating slices with a suspension of probiotic Bacillus coagulans, the other based on coating the slices with a starch dispersion containing the bacteria. Both processes resulted in viable cell counts above 7 log ufc.g-1, although the presence of the starch coating prevented a significant loss in viability during freeze-drying. The coated slices were less crispy than the impregnated ones, according to the shear force test results. However, the sensory panel (with more than 100 panelists) did not perceive significant texture differences. Both methods presented good results in terms of probiotic cell viability and sensory acceptability (the coated slices being significantly more accepted than the non-probiotic control slices).

Validation of a protocol to evaluate maximal expiratory pressure using a pressure transducer and a signal conditioner.

The respiratory muscles can present fatigue and even chronic inability to generate force. So, reliable devices are necessary to their evaluation. The aim of this study is to evaluate the MEP (Maximal Expiratory Pressure) values of individuals between 20 and 25 years old and to validate a protocol using a pressure transducer and a signal conditioner comparing it with the digital manometer. We evaluated the MEP of 10 participants. They remained seated and made six respiratory maneuvers from Total Lung Capacity (TLC) to Residual Volume (RV). The results in the study showed no statistically significant differences when compared to values reported in the literature, and that the pressure transducer provides reliable values for MEP.

Optimizing the microstructure of a new machinable bioactive glass-ceramic.

OBJECTIVES: This study aimed to optimize the crystallization process and the microstructure of a new bioactive glass-ceramic (GC) previously developed by our research group to obtain machinable glass-ceramics. METHODS: Differential scanning calorimetry (DSC) analyses were conducted to explore the characteristic temperatures and construct a semi-quantitative nucleation curve. The GC specimens were characterized by X-ray diffraction (XRD) and Rietveld refinement. Their brittleness index (B) and machinability were characterized and compared with IPS e.max-CAD®. Their Young's modulus, fracture toughness, and hardness were assessed. RESULTS: We found that the maximum crystal nucleation rate temperature of this GC is ~470 °C. Treatments were designed based on the 1st DSC peak onset (570 °C), 1st peak offset (650 °C), and 2nd peak offset (705 °C) crystallization temperatures of lithium metasilicate (LS, LiSi2O3) and lithium disilicate (LS2, Li2Si2O5). Rietveld refinement indicated an increase in LS2 and a reduction in LS and amorphous phase for increased temperatures and longer treatment times. Their B values indicate good machinability compared with that of the control group based on statistical analyses. As expected, lower levels of LS2 increase the machinability regardless of the rotation speed adopted, leading to a greater depth of cut and reduced Edge Chipping Damage Depth (ECDD). CONCLUSION: This bioactive GC with optimized microstructure presents high machinability. For treatment temperatures above 570 °C, the number of elongated LS2 crystals increases and decreases the amorphous phase content, which reduce the machinability of the GC, and should therefore be avoided. The best results were obtained using heat treatment at 570 °C, which produces LS crystals embedded in a glassy matrix (67%) with small contents of secondary phases.

Rating of Perceived Exertion in Three-Minute Step Test in Children with Cystic Fibrosis.

The purpose of the study was to assess whether there are differences in cardiorespiratory fitness between children with and without cystic fibrosis (CF). Ten children with CF attended at a referral center for the treatment of CF and 13 children without CF were evaluated. The average age of the children with CF was 10.40 (3.13) years and those without CF was 9.39 (3.25) years. The children performed the three-minute step test with monitoring of hemodynamic parameters and the rating of perceived exertion (RPE) every minute. Oxygen desaturation of 4% during the test occurred in three children with CF and none of the children reached a SatO2 percentage < 75%. After the step test, the findings showed that children with CF presented higher RPE scores during the test (p = 0.002) when compared to children without CF (p < 0.001). The RPE was the only parameter that changed during the test and demonstrated that children with cystic fibrosis tired more during the test when compared to children without CF despite the lack of changes in hemodynamic variables.

Mechanical and Chemical Changes in the Adhesive-Dentin Interface after Remineralization.

PURPOSE: To evaluate the remineralization effects of Bioglass 45S5 (BAG) on dentin composition, adhesive-dentin bond strength, as well as interface and diffusion zone thickness. MATERIALS AND METHODS: Dentin specimens were assigned to a control group (CG), in which the adhesive was applied following the manufacturer's instructions, and a remineralized group (RG), in which remineralization treatment was carried out by rubbing a remineralization solution (0.015 g of BAG with 1.35 ml of distilled water) on the etched dentin surface for 30 s before applying the adhesive. For bioactive analysis (n = 10), control and remineralized dentin were investigated using micro-Raman spectroscopy (mRS) and scanning electron microscopy (SEM). Stick specimens prepared with a three-step etch-and-rinse adhesive were submitted to a microtensile bond strength (µTBS) test (n = 10) after 24 h (24 h) and eight months (8 m). Micro-RS 3D-maps (n = 10) characterized the adhesive-dentin interface composition and diffusion zone thickness, and SEM images (n = 10) evaluated interface thickness. Data were analyzed using Student's t-test or two-way ANOVA and Tukey-Kramer's post-hoc test (α = 0.05). RESULTS: Remineralization treatment increased the mineral content of dentin. Mean µTBSs were statistically different at 24 h, with RG higher than CG; however, this difference was not significant at 8 m. When the adhesive was applied on remineralized dentin, its penetration was reduced, its physical interaction with phosphate was improved, and its degree of conversion increased. The diffusion zone in the CG did not differ from that of the RG, and interface thickness values of the CG did not differ from that of the RG. CONCLUSION: Remineralization treatment promoted mineral growth on the dentin surface, improved the interaction of dentin with adhesive monomers, and consequently resulted in higher immediate bond strengths.

Acute Changes in Interleukin-6 Level During Four Days of Long-Distance Walking.

BACKGROUND: Interleukin 6 (IL-6) has an inflammatory effect, and its concentration in serum increases during exercise. However, no studies have assessed acute changes in IL-6 concentration after consecutive days of extreme and long-term exercise. OBJECTIVE: This study aimed to assess acute changes in serum IL-6 concentration during four days of long-distance walking. METHODS: This prospective observational study assessed 25 athletes (aged 44.8 ± 9.1 years), who covered a total of 251 km in four days. Blood samples were collected daily to assess serum IL-6 concentrations. Repeated-measures analysis of variance (with Bonferroni's post hoc test) and the Kruskal-Wallis H-test (with Dunn's post hoc test) were used to investigate the differences between the measures. RESULTS: The serum IL-6 concentrations were higher on the four days of walking (1st day: 26.8 ± 14.8; 2nd day: 14 ± 7.4; 3rd day: 9.4 ± 10.8; 4th day: 4.5 ± 0.2 pg/mL) when compared to pre-walk values (pre-walk: 2.2 ± 2.1 pg/mL; p < 0.001). On the first day, there was a tenfold increase compared to the pre-walk value. CONCLUSION: The inflammatory response increased the serum concentration of IL-6 after four days of exercise. With the passing of days, there were reductions but not to baseline values.

BIOELECTRICAL VECTOR ANALYSIS IN OBESE ADOLESCENTS.

OBJECTIVE: To evaluate the hydration of obese and non-obese adolescents by vectorial bioimpedance analysis, in addition to verifying the associations between obesity and bioelectrical impedance vectorial analysis (BIVA) parameters. METHODS: A cross-sectional study with adolescents between 14 and 18 years old (n=489, 300 boys and 189 girls). Electric bioimpedance (BIA; Quantum_II, RJL system, Rome, Italy) provided resistance and reactance parameters to calculate phase angle (PA), fat-free mass (FFM) and body fat (%BF). The confidence ellipses were compared, and the construction of the tolerance ellipses allowed individual and qualitative evaluation of the vectors and classification in dehydrated, normohydrated and hyperhydrated. RESULTS: 78 obese and 411 eutrophic adolescents participated. Resistance (p<0.001) and reactance (p<0.001) and their normalization by stature (p<0.001) were reduced in the obese, whereas the PA was higher (p=0.003). %BF was 11.3% higher in obese adolescents. The main vector of the obese, both male (D=1.38; p<0.001) and female (D=1.49; p<0.001), indicated greater hydration. The ellipse of tolerance of the total sample showed that 25 (32.1%) were hyperhydrated and 02 (2.6%) vectors positioned in the sense of dehydration. A total of 17 (53.2%) girls and 16 (34.8%) boys were hyperhydrated. Logistic regression showed an inverse relation of BMI with resistance (p<0.001), reactance (p<0.001) and both normalized by stature. Adolescents with increased PA (p<0.001) were twice as likely to present obesity. CONCLUSIONS: Obese adolescents were hyperhydrated and there was an inverse relationship of BMI with resistance and direct with PA.

Metabolic syndrome impact on pulmonary function of women.

BACKGROUND: The presence of metabolic syndrome (MetS) and its components may induce structural and physiological changes that exacerbate the impairment of the respiratory function. The aim of the study is to evaluate the impact of metabolic syndrome and its components on lung function in women. METHODS: This is cross-sectional study. A total of 121 women aged 20-75 years were assisted in two primary health centers of Brazil. These women were divided into two groups according to the presence of metabolic syndrome. Waist circumference and blood pressure measurements, high density low-cholesterol (HDL-c) and triglycerides analysis and pulmonary function tests by spirometry were performed. RESULTS: Metabolic syndrome prevalence was 46.3%. Systemic arterial pressure (BP) and waist circumference (WC) were identified with higher eigenvalues in the main components explaining 26.78% of the variance. The multiple regression analysis showed an inverse relationship between forced expiratory volume in the first second predicted (FEV1%) (ß = -6.0, p = 0.03) and predicted forced vital capacity (FVC%) (ß = -7, 02, p = 0.004) with the presence of MetS. PA (ß = -8.50, p = 0.003) and WC (ß = -0.24, p = 0.001) it presented an inverse relationship with FVC% when was adjusted for age, smoking history, menopausal BMI. CONCLUSIONS: WC and PA were considered the parameters most related to MetS by principals components analysis. The diagnosis of MetS presented an inverse relation with the spirometrics parameters. Elevation of BP and WC were the predictors of the CFV% reduction.

Associação da percepção do nível de estresse com marcadores de obesidade e funcionalidade em idosos / Association of perceived stress level with obesity and functionality markers in elderly / Asociación del nivel de estrés percibido con marcadores de obesidad y funcionalidad en ancianos

O estresse é um grave problema de saúde pública e sua gravidade e suscetibilidade se relacionam com uma série de fatores como a idade, a obesidade e a funcionalidade. As mudanças na saúde física, na saúde mental, na vida social e na capacidade cognitiva no envelhecimento predispõem o estresse. Assim, saber manejar o estresse do cotidiano é necessário, principalmente durante a velhice. O presente estudo teve como objetivo avaliar a percepção de estresse, presença de obesidade, funcionalidade e histórico de tabagismo em idosos de uma Universidade Aberta a Pessoa Idosa (UniAPI). Trata-se de um transversal. Foram coletados dados sociodemográficos, aplicado o questionário de percepção de estresse (EPS-10), medidas antropométricas (índice de massa corporal e circunferência de cintura), Escala de Brody e Lawton e histórico de tabagismo de 63 idosos. A comparação entre dois grupos foi realizada com o teste t- Student ou o Teste de Mann-Whitney. Para variáveis categóricas, o teste Qui-quadrado de Pearson e também, regressão linear múltipla ajustados por sexo e idade. A maioria dos idosos eram do sexo feminino (85,7%). Em relação ao estresse, 34% dos idosos apresentaram maior percepção de estresse. O IMC (∆= 3,57 kg/m²) foi maior no grupo com maior percepção de estresse, enquanto o score da escala de Lawton e Brody (∆= 0,47) foi maior no grupo sem percepção. Houve associação entre a presença de percepção de estresse com o IMC (p= 0,031). 100% dos idosos com baixa funcionalidade apresentaram maior percepção de estresse. O IMC (ß= 0,28; p=0,038) e a circunferência de cintura (ß=0,13; p=0,028) tiveram relação direta com o escore de percepção subjetiva de estresse. Em conclusão, a presença de estresse está associada a altos valores de IMC e CC e menor funcionalidade em idosos.

Stress is a serious public health problem and its severity and susceptibility are related to a number of factors such as age, obesity and functionality. Changes in physical health, mental health, social life, and cognitive ability in aging predispose to stress. Thus, knowing how to manage everyday stress is necessary, especially during old age. The present study aimed to evaluate the perception of stress, presence of obesity, functionality and smoking history in elderly people from an Open University for the Elderly (UniAPI). This is a cross-sectional study. We collected sociodemographic data, applied the questionnaire of perceived stress (EPS-10), anthropometric measurements (body mass index and waist circumference), Brody and Lawton Scale and smoking history of 63 elderly. Comparison between two groups was performed with the t-Student test or the Mann-Whitney test. For categorical variables, Pearson's chi-square test and also, multiple linear regression adjusted for gender and age. Most of the elderly were female (85.7%). Regarding stress, 34% of the elderly showed higher perception of stress. The BMI (∆= 3.57 kg/m²) was higher in the group with higher perception of stress, while the Lawton and Brody scale score (∆= 0.47) was higher in the group with no perception. There was an association between the presence of perceived stress and BMI (p= 0.031). 100% of the elderly with low functionality had higher perceived stress. BMI (ß= 0.28; p=0.038) and waist circumference (ß=0.13; p=0.028) had a direct relationship with the score of subjective perception of stress. In conclusion, the presence of stress is associated with high BMI and WC values and lower functionality in the elderly.

El estrés es un grave problema de salud pública y su gravedad y susceptibilidad están relacionadas con una serie de factores como la edad, la obesidad y la funcionalidad. Los cambios en la salud física, la salud mental, la vida social y la capacidad cognitiva en el envejecimiento predisponen al estrés. Por ello, es necesario saber cómo gestionar el estrés cotidiano, especialmente durante la vejez. El presente estudio tuvo como objetivo evaluar la percepción del estrés, la presencia de obesidad, la funcionalidad y los antecedentes de tabaquismo en ancianos de una Universidad Abierta para Ancianos (UniAPI). Se trata de un estudio transversal. Se recogieron datos sociodemográficos, se aplicó el cuestionario de estrés percibido (EPS-10), medidas antropométricas (índice de masa corporal y perímetro de cintura), Escala de Brody y Lawton e historia de tabaquismo a 63 ancianos. La comparación entre dos grupos se realizó con la prueba t-Student o la prueba de Mann-Whitney. Para las variables categóricas, se utilizó la prueba de chi-cuadrado de Pearson y también la regresión lineal múltiple ajustada por sexo y edad. La mayoría de los ancianos eran mujeres (85,7%). En cuanto al estrés, el 34% de los ancianos mostró una mayor percepción de estrés. El IMC (∆= 3,57 kg/m²) fue mayor en el grupo con mayor percepción de estrés, mientras que la puntuación de la escala de Lawton y Brody (∆= 0,47) fue mayor en el grupo sin percepción. Hubo asociación entre la presencia de estrés percibido y el IMC (p= 0,031). El 100% de los ancianos con baja funcionalidad tenían mayor estrés percibido. El IMC (ß= 0,28; p=0,038) y el perímetro de cintura (ß=0,13; p=0,028) tuvieron una relación directa con la puntuación de percepción subjetiva de estrés. En conclusión, la presencia de estrés se asocia a valores elevados de IMC y CC y a una menor funcionalidad en los ancianos.

Relação do etilismo e do nível de atividade física com fatores de risco para doenças cardiovasculares em estudantes universitários / Relationship between alcohol consumption and physical activity level with risk factors for cardiovascular diseases in college students / Relación del consumo de alcohol y el nivel de actividad física con los factores de riesgo de enfermedades cardiovasculares en estudiantes universitarios

O consumo de bebidas alcoólicas, principalmente em jovens, acarreta uma série de efeitos negativos no sistema cardiovascular. Tal uso exacerbado e precoce pode predispor à calcificações coronarianas, aumento na pressão arterial, arritmias cardíacas e insuficiências coronarianas à longo prazo. Em contrapartida, a prática de atividades físicas é uma grande aliada na saúde cardiovascular. Assim, objetiva-se com o presente estudo associar o consumo de bebidas alcoólicas e a prática de atividade física com fatores de risco para doenças cardiovasculares em estudantes universitários. É um estudo observacional transversal. Foram coletados dados de consumo de bebidas alcoólicas (questionário AUDIT), nível de atividade física (IPAQ), índice de massa corporal (IMC), circunferência de cintura (CC), relação cintura quadril (RCQ), pressão arterial sistêmica e histórico de tabagismo. A comparação entre os grupos realizada pelo teste t-Student ou Mann-Whitney. A correlação entre as variáveis pelo Coeficiente de Spearman. Dessa forma, os resultados encontrados foram que os estudantes universitários que consumiam bebida alcóolica e que tiveram risco de dependência (n=40) tiveram maior IMC (Δ=+1,18kg/m2, p=0,049), CC (Δ=+5,77cm, p=0,005) e RCQ (Δ=+0,003, p=0,027). O score da dieta (Δ=+6,39, p=0,056) do grupo ativo foi maior em relação ao sedentário. Houve correlação direta do score do questionário AUDIT com tabagismo (p<0,001), IMC (p=0,010), CC (p=0,005), RCQ (0,045) e atividade física vigorosa (p=0,027) e, desta com tabagismo (p=0,021). Com o estudo, foi perceptível que há alto consumo de bebidas alcoólicas entre os estudantes universitários, mas, baixo o risco de dependência ao álcool. Os estudantes que são etilistas e com risco de dependência tem maiores valores para parâmetros de obesidade incluindo a RCQ que está diretamente relacionada com evento cardiovascular.

The consumption of alcoholic beverages, especially among young people, has a series of negative effects on the cardiovascular system. Such exacerbated and early use may predispose to coronary calcification, increased blood pressure, cardiac arrhythmias, and long-term coronary insufficiency. On the other hand, the practice of physical activities is a great ally in cardiovascular health. Thus, this study aims to associate the consumption of alcoholic beverages and the practice of physical activity with risk factors for cardiovascular diseases in college students. This is a cross-sectional observational study. We collected data on alcohol consumption (AUDIT questionnaire), physical activity level (IPAQ), body mass index (BMI), waist circumference (WC), waist- to-hip ratio (WHR), systemic blood pressure, and smoking history. The comparison between groups was done by the t-Student or Mann-Whitney test. The correlation between variables was done by Spearman's Coefficient. Thus, the results found were that college students who consumed alcoholic beverages and had a risk of addiction (n=40) had higher BMI (Δ= +1.18kg/m2, p=0.049), WC (Δ=+5.77cm, p=0.005) and WHR (Δ=+0.003, p=0.027). The diet score (Δ=+6.39, p=0.056) of the active group was higher compared to the sedentary group. There was direct correlation of AUDIT questionnaire score with smoking (p<0.001), BMI (p=0.010), WC (p=0.005), WHR (0.045) and vigorous physical activity (p=0.027) and, of this with smoking (p=0.021). With the study, it was noticeable that there is high alcohol consumption among college students, but, low risk of alcohol dependence. Students who are alcohol drinkers and at risk of addiction have higher values for obesity parameters including WHR which is directly related to cardiovascular event. KEYWORDS: Alcohol Consumption in College; Physical Exercise; Heart Disease; Risk Factors; Students.

El consumo de bebidas alcohólicas, especialmente entre los jóvenes, tiene una serie de efectos negativos sobre el sistema cardiovascular. Este consumo exacerbado y precoz puede predisponer a la calcificación coronaria, aumento de la presión arterial, arritmias cardiacas e insuficiencia coronaria a largo plazo. Por otro lado, la práctica de actividades físicas es un gran aliado en la salud cardiovascular. Así, este estudio pretende asociar el consumo de bebidas alcohólicas y la práctica de actividad física con factores de riesgo de enfermedades cardiovasculares en estudiantes universitarios. Se trata de un estudio observacional transversal. Se recogieron datos sobre el consumo de alcohol (cuestionario AUDIT), el nivel de actividad física (IPAQ), el índice de masa corporal (IMC), el perímetro de cintura (CC), la relación cintura-cadera (RCC), la presión arterial sistémica y los antecedentes de tabaquismo. La comparación entre los grupos se realizó mediante la prueba t-Student o Mann-Whitney. La correlación entre las variables por el Coeficiente de Spearman. Así, los resultados encontrados fueron que los universitarios que consumían bebidas alcohólicas y tenían riesgo de dependencia (n=40) presentaban mayor IMC (Δ= +1,18kg/m2, p=0,049), CC (Δ=+5,77cm, p=0,005) y RH (Δ=+0,003, p=0,027). La puntuación de la dieta (Δ=+6,39, p=0,056) del grupo activo fue mayor en comparación con el grupo sedentario. Hubo correlación directa de la puntuación del cuestionario AUDIT con el tabaquismo (p<0,001), el IMC (p=0,010), la CC (p=0,005), el RH (0,045) y la actividad física vigorosa (p=0,027) y, de ésta, con el tabaquismo (p=0,021). Con el estudio, se notó que hay alto consumo de bebidas alcohólicas entre los universitarios, pero, bajo riesgo de dependencia del alcohol. Los estudiantes bebedores de alcohol y con riesgo de dependencia presentan valores más elevados en los parámetros de obesidad, incluyendo el WHR que está directamente relacionado con el evento cardiovascular.

Assessment of attitudes related to humanization of assistance by medical students / Avaliação de atitudes relacionadas ao atendimento humanizado pelos estudantes de Medicina

Abstract: Introduction: Typical medical care has been characterized by professional and disease-centered attitudes, with little concern for focusing on the patient's psychosocial context and expectations. However, the medical care that seeks to more globally encompass the patient's perspective has shown to bring greater benefits. Objective: To evaluate the attitudes of medical students regarding the physician-patient relationship. Methods: This is a cross-sectional study that evaluated the attitudes of students in the 4th semester of the medical course in relation to patient care based on the application of the Patient-Practitioner Orientation Scale and a questionnaire with sociodemographic and curricular characteristics. Data were analyzed using the Statistical Package for Social Science (SPSS) software and the Mann-Whitney test, Kruskal-Wallis test with Dunn's post hoc, and Chi-square test. Results: A total of 83 medical students participated in the study, with a prevalence of female students (74.7%), and those who declared a family income of less than US$ 2,140 (43.0%), as well as those who professed the Catholic religion (53.0%). The majority of students (85.5%) had attitudes centered on the physician and the disease (mean PPOS scores <4.57), with scores in the caring domain higher than those in the sharing domain. The variables gender, family income, student financial aid, and religion showed a positive association (p≤0.05) with PPOS scores related to patient-centered attitudes. There were no statistically significant associations of PPOS scores with the variables age group, city of origin, undergraduate research activities, extracurricular internships, artistic activities, personal and family history of serious illness, and parental level of schooling. Conclusion: The present study showed that the assessed medical students had attitudes centered on the physician and on the disease, with mean PPOS scores below the range related to attitudes of humanized medicine.

Resumo: Introdução: O atendimento médico usual tem sido caracterizado por atitudes centradas no profissional e na doença, pouco se preocupando em focar o contexto psicossocial e as expectativas do paciente. Entretanto, o atendimento médico que procura abranger mais globalmente a perspectiva do paciente tem se mostrado mais eficiente ao promover maiores benefícios. Objetivo: Este estudo teve como objetivo avaliar as atitudes de estudantes de Medicina a respeito da relação médico-paciente. Método: Trata-se de um estudo transversal que avaliou as atitudes de acadêmicos do quarto período de Medicina em relação à atenção aos pacientes a partir da aplicação da Escala de Orientação Médico-Paciente (EOMP) e de questionário com características sociodemográficas e curriculares. Os dados foram analisados no software Statistical Package for Social Science (SPSS), e utilizaram-se o teste de Mann-Whitney, o teste de Kruskall-Wallis com post hoc de Dunn e o teste de qui-quadrado. Resultado: Participaram do estudo 83 estudantes de Medicina, com prevalência maior de alunos do sexo feminino (74,7%) e que declararam renda familiar inferior a dez salários mínimos (43,0%), bem como a religião católica (53,0%). A maioria dos acadêmicos (85,5%) apresentou atitudes centradas no médico e na doença (média de escores da EOMP < 4,57), com escores do domínio cuidar superiores aos do domínio compartilhar. As variáveis sexo, renda familiar, bolsa de auxílio financeiro estudantil e religião apresentaram associação positiva (p ≤ 0,05) com os escores da EOMP relacionados às atitudes centradas no paciente. Não foram observadas associações estatisticamente significativas dos escores da EOMP entre as variáveis faixa etária, cidade de procedência, realização de atividades de iniciação científica, estágios extracurriculares, atividades artísticas, antecedentes pessoais e familiares de doença grave, e escolaridade dos pais. Conclusão: O presente estudo demonstrou que os acadêmicos de Medicina avaliados apresentaram atitudes centradas no médico e na doença, com média de escores da EOMP abaixo do intervalo relacionado às atitudes da medicina humanizada.

The In Vitro Bioactivity, Degradation, and Cytotoxicity of Polymer-Derived Wollastonite-Diopside Glass-Ceramics.

Ca-Mg silicates are receiving a growing interest in the field of bioceramics. In a previous study, wollastonite-diopside (WD) glass-ceramics were successfully prepared by a new processing route, consisting of the heat treatment of a silicone resin embedding reactive oxide particles and a Ca/Mg-rich glass. The in vitro degradation, bioactivity, and cell response of these new WD glass-ceramics, fired at 900-1100 °C for 1 h, as a function of the Ca/Mg-rich glass content, are the aim of this investigation The results showed that WD glass-ceramics from formulations comprising different glass contents (70-100% at 900 °C, 30% at 1100 °C) exhibit the formation of an apatite-like layer on their surface after immersion in SBF for seven days, thus confirming their surface bioactivity. The XRD results showed that these samples crystallized, mainly forming wollastonite (CaSiO3) and diopside (CaMgSi2O6), but combeite (Na2Ca2Si3O9) crystalline phase was also detected. Besides in vitro bioactivity, cytotoxicity and osteoblast adhesion and proliferation tests were applied after all characterizations, and the formulation comprising 70% glass was demonstrated to be promising for further in vivo studies.

A 52-year-old man with gouty arthritis and erosive lesion in the hip.

The case study of peripheral and axial gouty arthritis is described in a 52-year-old man without concomitant clinical evidence of tophaceus gout on physical evaluation on admission. Gout is a metabolic disorder related to excess of uric acid in the extracellular compartment, and deposition of monosodium urate crystals in the joints and other sites. Arthritis and tophi are major manifestations, which more often involve the peripheral joints asymmetrically. Chronic tophaceous gout commonly develops after a decade of recurrent polyarticular gout. With lower frequency, the axial skeleton (spine and sacroiliac region) may be affected, condition sometimes associated with additional concerns, diagnostic challenges and pitfalls. Higher suspicion index and utilization of novel radiographic tools can settle these matters. Radiographic imaging exams include plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy to show bone erosion and joint lesions characterizing the spectrum of gouty osteoarthropathy.

Cardiac Autonomic Modulation and the Kinetics of Heart Rate Responses in the On- and Off-Transient during Exercise in Women with Metabolic Syndrome.

Objective: To test whether women with metabolic syndrome (MS) have impairments in the on- and off-transients during an incremental test and to study whether any of the MS components are independently associated with the observed responses. Research Design and Methods: Thirty-six women aged 35-55 years were divided into a group with MS (MSG, n = 19) and a control group (CG, n = 17). R-R intervals (RRi) and heart rate variability (HRV) were calculated on a beat-to-beat basis and the heart rate (HR) at the on- and off-transient were analyzed during an incremental cardiopulmonary exercise test (CPET). Results: MSG showed lower aerobic capacity and lower parasympathetic cardiac modulation at rest compared with CG. HR values in on-transient phase were significantly lower in MSG compared with CG. The exponential amplitudes "amp" and the parameters "τ" [speed of heart rate recovery (HRR)] were lower in MSG. MSG exhibited higher HR values in comparison to CG during the off-transient indicating a slower HRR. In MSG, there was an inverse and significant correlation between fasting plasma vs. ΔF and glucose vs. exponential "τ" of HRR dynamics. Conclusion: MS is associated with poor heart rate kinetics. The altered HR kinetics seems to be related to alterations in cardiac parasympathetic modulation, and glucose metabolism seems to be the major determinant.

Radiofrequency for the treatment of skin laxity: mith or truth.

The nonablative radiofrequency is a procedure commonly used for the treatment of skin laxity from an increase in tissue temperature. The goal is to induce thermal damage to thus stimulate neocollagenesis in deep layers of the skin and subcutaneous tissue. However, many of these devices haven't been tested and their parameters are still not accepted by the scientific community. Because of this, it is necessary to review the literature regarding the physiological effects and parameters for application of radiofrequency and methodological quality and level of evidence of studies. A literature search was performed in MEDLINE, PEDro, SciELO, PubMed, LILACS and CAPES and experimental studies in humans, which used radiofrequency devices as treatment for facial or body laxity, were selected. The results showed that the main physiological effect is to stimulate collagen synthesis. There was no homogeneity between studies in relation to most of the parameters used and the methodological quality of studies and level of evidence for using radiofrequency are low. This fact complicates the determination of effective parameters for clinical use of this device in the treatment of skin laxity. The analyzed studies suggest that radiofrequency is effective, however the physiological mechanisms and the required parameters are not clear in the literature.

Effects of four days hiking on postural control.

Hiking is a demanding form of exercise that may cause delayed responses of the postural muscles and a loss of somatosensory information, particularly when repeatedly performed for several days. These effects may negatively influence the postural control of hikers. Therefore, the aim of this study was to investigate the effects of a four-day hike on postural control. Twenty-six adults of both sexes travelled 262 kilometers, stopping for lunch and resting in the early evening each day. Force platforms were used to collect center of pressure (COP) data at 100 Hz for 70 seconds before hiking started and immediately after arriving at the rest station each day. The COP time course data were analyzed according to global stabilometric descriptors, spectral analysis and structural descriptors using sway density curve (SDC) and stabilometric diffusion analysis (SDA). Significant increases were found for global variables in both the anterior-posterior and medial-lateral directions (COP sway area, COP total sway path, COP mean velocity, COP root mean square value and COP range). In the spectral analysis, only the 80% power frequency (F80) in the anterior-posterior direction showed a significant increase, reflecting the increase of the sway frequencies. The SDC revealed a significant increase in the mean distance between peaks (MD) and a significant decrease in the mean peak amplitudes (MP), suggesting that a larger torque amplitude is required for stabilization and that the postural stability is reduced. The SDA revealed a decrease in the long-term slope (Hl) and increases in the short-term (Ks) and the long-term (Kl) intercepts. We considered the likelihood that the presence of local and general fatigue, pain and related neuromuscular adaptations and somatosensory deficits may have contributed to these postural responses. Together, these results demonstrated that four days of hiking increased sway frequencies and deteriorated postural control in the standing position.

Bioelectrical vector analysis in obese adolescents / Análise vetorial por bioimpedância em adolescentes obesos

ABSTRACT Objective: To evaluate the hydration of obese and non-obese adolescents by vectorial bioimpedance analysis, in addition to verifying the associations between obesity and bioelectrical impedance vectorial analysis (BIVA) parameters. Methods: A cross-sectional study with adolescents between 14 and 18 years old (n=489, 300 boys and 189 girls). Electric bioimpedance (BIA; Quantum_II, RJL system, Rome, Italy) provided resistance and reactance parameters to calculate phase angle (PA), fat-free mass (FFM) and body fat (%BF). The confidence ellipses were compared, and the construction of the tolerance ellipses allowed individual and qualitative evaluation of the vectors and classification in dehydrated, normohydrated and hyperhydrated. Results: 78 obese and 411 eutrophic adolescents participated. Resistance (p<0.001) and reactance (p<0.001) and their normalization by stature (p<0.001) were reduced in the obese, whereas the PA was higher (p=0.003). %BF was 11.3% higher in obese adolescents. The main vector of the obese, both male (D=1.38; p<0.001) and female (D=1.49; p<0.001), indicated greater hydration. The ellipse of tolerance of the total sample showed that 25 (32.1%) were hyperhydrated and 02 (2.6%) vectors positioned in the sense of dehydration. A total of 17 (53.2%) girls and 16 (34.8%) boys were hyperhydrated. Logistic regression showed an inverse relation of BMI with resistance (p<0.001), reactance (p<0.001) and both normalized by stature. Adolescents with increased PA (p<0.001) were twice as likely to present obesity. Conclusions: Obese adolescents were hyperhydrated and there was an inverse relationship of BMI with resistance and direct with PA.

RESUMO Objetivo: Avaliar a hidratação de adolescentes obesos e não obesos por meio dos gráficos da análise vetorial por bioimpedância (BIVA), além de verificar as associações entre a obesidade e os parâmetros da BIVA. Métodos: Estudo transversal realizado com adolescentes entre 14 e 18 anos (n=489, 300 meninos e 189 meninas). A bioimpedância elétrica (BIA; Quantum_II, RJL system, Roma, Itália) ofereceu os parâmetros de resistência e reactância para calcular o ângulo de fase (AF), a massa livre de gordura (MLG) e a gordura corporal (GC). As elipses de confiança foram comparadas e a construção das elipses de tolerância permitiu a avaliação individual e a qualitativa dos vetores e, ainda, a classificação em desidratados, normohidratados e hiper-hidratados. Resultados: Participaram do estudo 78 adolescentes obesos e 411 eutróficos. A resistência (p<0,001), a reactância (p<0,001) e a normalização desses pela estatura (p<0,001) estavam reduzidas nos obesos, enquanto o AF foi superior (p=0,003). O percentual de gordura corporal (%GC) foi 11,3% maior nos adolescentes obesos. O vetor principal dos obesos, tanto masculino (Distância de Mahalanobis (D)=1,38; p<0,001) quanto feminino (D=1,49; p<0,001), indicou maior hidratação. A elipse de tolerância da amostra total mostrou que 25 adolescentes (32,1%) estavam hiper-hidratados e dois (2,6%) vetores posicionados no sentido de desidratação. Dezessete (53,2%) meninas e 16 (34,8%) meninos estavam hiper-hidratados. A regressão logística mostrou relação inversa do índice de massa corpórea (IMC) com a resistência (p<0,001) e a reactância (p<0,001), ambas normalizadas pela estatura. Os adolescentes com aumento do AF (p<0,001) apresentaram duas vezes mais chances de serem classificados como obesos. Conclusões: Os adolescentes obesos estavam hiper-hidratados e houve relação inversa do IMC com a resistência e direta com o AF.

Body composition of chronic renal patients: anthropometry and bioimpedance vector analysis.

OBJECTIVE: to compare the body composition of patients undergoing hemodialysis with that of healthy individuals using different methods. METHOD: cross-sectional study assessing male individuals using anthropometric markers, electrical bioimpedance and vector analysis. RESULTS: the healthy individuals presented larger triceps skinfold and arm circumference (p<0.001). The bioimpedance variables also presented significant higher values in this group. Significant difference was found in the confidence interval of the vector analysis performed for both the patients and healthy individuals (p<0.0001). The tolerance intervals showed that 55.20% of the patients were dehydrated, 10.30% presented visible edema, and 34.50% were within normal levels of hydration. Bioimpedance and vector analysis revealed that 52% of the patients presented decreased cell mass while 14.00% presented increased cell mass. CONCLUSIONS: the differences in the body composition of patients and healthy individuals were revealed through bioimpedance and vector analysis but not through their measures of arm circumference and arm muscle area.

An elderly man with gastric cancer, Saint's triad and Heyde's syndrome / Un anciano con cáncer gástrico, tríada de Saint y síndrome de Heyde

This case study describes a 71-year-old man with signet-ring cell gastric adenocarcinoma and malignant sigmoidal polyp; and typical features of Saint's triad and Heyde syndrome. He had digestive bleeding, two types of hernia, diverticulosis, arterial hypertension, malignant polyp, and antecedent of smoking, lung tuberculosis, and surgical correction of aortic valve stenosis. There is a hypothetical inverse relationship between herniosis and development of malignancy; however, the patient herein described presented gastric and sigmoidal cancers. Gastrointestinal malignancies are sometimes associated with paraneoplastic entities, isolated or manifested as syndromes, but neither Saint's triad or Heyde syndrome have been included. This patient persisted clinically stable during the preoperative period, but suddenly died; Trousseau's syndrome would be the most probable mechanism of sudden death in this setting. Case reports can stimulate further studies to get additional knowledge about unusual entities.

Este estudio de caso describe un hombre de 71 años de edad, con adenocarcinoma gástrico con células en anillo de sello y un pólipo maligno sigmoideo; y características típicas de la tríada de Saint y del síndrome de Heyde. Tuvo una hemorragia digestiva, dos tipos de hernias, divertículos, hipertensión arterial, y pólipo maligno; con antecedente de tabaquismo, tuberculosis pulmonar, y corrección quirúrgica de estenosis de la válvula aórtica. Hay una hipotética relación inversa entre hernioses y el desarrollo de malignidades; sin embargo, el paciente que se describe en el presente documento presentó cánceres gástrico y sigmoideo. Neoplasias gastrointestinales se asocian a veces con entidades para neoplásicas aisladas o manifiestan síndromes, pero ni la tríada de Saint ni el síndrome de Heyde se ha incluido. Este paciente persistió clínicamente estable durante el período preoperatorio, pero de repente murió; síndrome de Trousseau sería el mecanismo más probable de muerte súbita en esta situación. Los informes de casos pueden estimular más estudios para obtener un conocimiento adicional sobre esas entidades inusuales.