Lignans Isolated from Piper truncatum Act as New Potent Antitrypanosomal Compounds.

The hexane extract from twigs of Piper truncatum Vell (Piperaceae) displayed activity against Trypanosoma cruzi and was subjected to chromatographic steps to afford six dibenzylbutyrolactolic lignans, being four knowns: cubebin (1), (-)-9α-O-methylcubebin (2), (+)-9ß-O-methylcubebinin (3) and 3,4-dimethoxy-3,4-demethylenedioxycubebin (4) as well as two new, named truncatin A (5) and B (6). Initially, in vitro activity against trypomastigotes was evaluated and compounds 1, 4 and 6 exhibited EC50 values of 41.6, 21.0 and 39.6 µM, respectively. However, when tested against amastigotes, the relevant clinical form in the chronic phase of Chagas disease, compounds 1-6 displayed activities with EC50 values ranging from 1.6 to 13.7 µM. In addition, the mammalian cytotoxicity of compounds 1-6 was evaluated against murine fibroblasts (NCTC). Compounds 2, 3 and 4 exhibited reduced toxicity against NCTC cells (CC50>200 µM), resulting in SI values of>21.9,>14.5 and>121.9, respectively. Compound 4 showed the highest potency with an SI value twice superior to that determined by the standard drug benznidazole (SI>54.6) against the intracellular amastigotes. These data suggest that lignan 4 can be considered a possible scaffold for designing a new drug candidate for Chagas disease.

Lignans isolated from Piper truncatum act as new potent Antitrypanosomal compounds

The hexane extract from twigs of Piper truncatum Vell (Piperaceae) displayed activity against Trypanosoma cruzi and was subjected to chromatographic steps to afford six dibenzylbutyrolactolic lignans, being four knowns: cubebin (1), (−)-9α-O-methylcubebin (2), (+)-9β-O-methylcubebinin (3) and 3,4-dimethoxy-3,4-demethylenedioxycubebin (4) as well as two new, named truncatin A (5) and B (6). Initially, in vitro activity against trypomastigotes was evaluated and compounds 1, 4 and 6 exhibited EC50 values of 41.6, 21.0 and 39.6 μM, respectively. However, when tested against amastigotes, the relevant clinical form in the chronic phase of Chagas disease, compounds 1–6 displayed activities with EC50 values ranging from 1.6 to 13.7 μM. In addition, the mammalian cytotoxicity of compounds 1–6 was evaluated against murine fibroblasts (NCTC). Compounds 2, 3 and 4 exhibited reduced toxicity against NCTC cells (CC50>200 μM), resulting in SI values of>21.9,>14.5 and>121.9, respectively. Compound 4 showed the highest potency with an SI value twice superior to that determined by the standard drug benznidazole (SI>54.6) against the intracellular amastigotes. These data suggest that lignan 4 can be considered a possible scaffold for designing a new drug candidate for Chagas disease.

Abdominal and Diaphragmatic Mobility in Adults With Chronic Gastritis: A Cross-Sectional Study.

Objective: The purpose of this study was to assess abdominal and diaphragmatic mobility in adults with chronic gastritis compared with healthy individuals and to analyze the impact of chronic gastritis on musculoskeletal signs and symptoms of the cervical and thoracic spine. Methods: This was a cross-sectional study conducted by the physiotherapy department at the Universidade Federal de Pernambuco in Brazil. Fifty-seven individuals participated, 28 with chronic gastritis (gastritis group [GG]) and 29 healthy individuals (control group [CG]). We assessed the following: restricted abdominal mobility in the transverse, coronal, and sagittal planes; diaphragmatic mobility; restricted cervical vertebral segmental mobility; restricted thoracic vertebral segmental mobility; and pain on palpation, asymmetry, and density and texture of the soft tissues on the cervical and thoracic spine. The measure of diaphragmatic mobility was assessed with ultrasound imaging. The Fisher exact and χ2 tests were applied to compare the groups (GG and CG) in relation to the restricted mobility of the abdominal tissues near the stomach on all planes and diaphragm, and the independent samples t test to compare the mobility measurements of the diaphragm. A significance level of 5% was considered for all tests. Results: Restricted abdominal mobility in all directions (P < .05) was greater in GG when compared with CG except for the counterclockwise direction (P = .09). In GG, 93% of the individuals presented restricted diaphragmatic mobility, with a mean mobility of 3.1 ± 1.9 cm, and in the CG, 36.8% with a mean of 6.9 + 1.7 cm (P < .001). The GG presented a higher occurrence of restricted rotation and lateral glide mobility of the cervical vertebrae, pain to palpation, and density and texture dysfunction of the adjacent tissues when compared with CG (P < .05). In the thoracic region, there was no difference between GG and CG regarding musculoskeletal signs and symptoms. Conclusion: Individuals with chronic gastritis presented greater abdominal restriction and lower diaphragmatic mobility, in addition to a higher occurrence of musculoskeletal dysfunction in the cervical spine when compared with healthy individuals.

Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study / Valores normativos e equação de referência para o teste do degrau de seis minutos para avaliar a capacidade funcional de exercício: um estudo multicêntrico

ABSTRACT Objective: To establish normative values and a reference equation for the number of steps climbed during the six-minute step test (6MST) in healthy adults, and to assess the reliability of the test and of the equation. Methods: This was a multicenter cross-sectional study involving 468 healthy volunteers (age range: 18-79 years) recruited from the general community in six research laboratories across different regions of Brazil, which is a country with continental dimensions. The 6MST was performed twice (30-min interval), and clinical, demographic, and functional variables were evaluated. An independent sample of 24 volunteers was evaluated to test the reference equation a posteriori. Results: The number of steps had excellent test-retest reliability (intraclass correlation coefficient = 0.96 [95%CI: 0.95-0.97]), and the mean number of steps was 175 ± 45, the number being 14% greater in males than in females. The best performance on the test was correlated with age (r = −0.60), sex (r = 0.28), weight (r = 0.13), height (r = 0.41), BMI (r = −0.22), waist circumference (r = −0.22), thigh circumference (r = 0.15), FVC (r = 0.54), and physical activity level (r = 0.17; p < 0.05 for all). In the regression analysis, age, sex, height, and weight explained 42% of the variability of the 6MST. Normative values were established for the 6MST according to age and sex. There was no difference between the 6MST values from the independent sample and its predicted values (157 ± 29 steps vs. 161 ± 25 steps; p = 0.47; 97% of predicted values). Conclusions: The normative values and the reference equation for the 6MST in this study seem adequate to accurately predict the physical functional performance in adults in Brazil.

RESUMO Objetivo: Estabelecer valores normativos e uma equação de referência para o número de degraus subidos no teste do degrau de seis minutos (TD6) em adultos saudáveis, bem como avaliar a confiabilidade do teste e da equação. Métodos: Estudo transversal multicêntrico com 468 voluntários saudáveis (faixa etária: 18-79 anos) recrutados na comunidade geral em seis laboratórios de pesquisa em diferentes regiões do Brasil, um país de dimensões continentais. O TD6 foi realizado duas vezes (com 30 min de intervalo entre uma e outra), e foram avaliadas variáveis clínicas, demográficas e funcionais. Uma amostra independente composta por 24 voluntários foi avaliada para testar a equação de referência a posteriori. Resultados: O número de degraus subidos apresentou excelente confiabilidade teste-reteste [coeficiente de correlação intraclasse = 0,96 (IC95%: 0,95-0,97)], e a média de degraus subidos foi de 175 ± 45, sendo 14% maior no sexo masculino. O melhor desempenho no teste correlacionou-se com as seguintes variáveis: idade (r = −0,60), sexo (r = 0,28), peso (r = 0,13), estatura (r = 0,41), IMC (r = −0,22), circunferência da cintura (r = −0,22), circunferência da coxa (r = 0,15), CVF (r = 0,54) e nível de atividade física (r = 0,17; p < 0,05 para todos). Na análise de regressão, idade, sexo, estatura e peso explicaram 42% da variabilidade do TD6. Foram estabelecidos valores normativos para o TD6 de acordo com a idade e o sexo. Não houve diferença entre os valores do TD6 na amostra independente e os valores previstos (157 ± 29 vs. 161 ± 25 degraus subidos; p = 0,47; 97% dos valores previstos). Conclusões: Os valores normativos e a equação de referência para o TD6 neste estudo parecem adequados para predizer com precisão o desempenho físico funcional em adultos no Brasil.

Individualized in-hospital exercise training program for people undergoing hematopoietic stem cell transplantation: a feasibility study.

PURPOSE: The purpose of this study is to evaluate the feasibility of an individualized exercise program for people undergoing hematopoietic stem cell transplantation. METHODS: This is a feasibility study of an individualized in-hospital exercise training program for people undergoing hematopoietic stem cell transplantation. Participants performed the exercise program based on daily clinical, hemodynamic and hematological assessment. The program was carried out on a daily basis for 20-40 min during their hospital admission. The primary outcome was feasibility (recruitment, adherence and attrition rates) of the exercise program. The secondary outcomes were functional capacity, peripheral muscle strength, and health-related quality of life evaluated on admission and prior to hospital discharge. The adverse events rate was recorded during the intervention. RESULTS: Twenty-six participants (58% female), aged 40 ± 15 (mean ± SD) years were included. The exercise program feasibility was demonstrated by 100% recruitment, 86% exercise adherence and 12% attrition rates with no adverse events recorded. Significant differences were observed in functional capacity (p = 0.03), upper and lower-limb muscle strength (p = 0.01) from admission to discharge (23 ± 7 d). CONCLUSIONS: An individualized exercise training program based on daily clinical parameters is feasible for hospitalized patients undergoing hematopoietic stem cell transplantation. This intervention warrants further investigation in a randomized controlled trial. Implications for rehabilitation The individualized in-hospital exercise training program guided by daily clinical, hemodynamic and hematologic parameters is feasible, safe and with good adherence in people undergoing hematopoietic stem cell transplantation. People undergoing hematopoietic stem cell transplantation may improve functional capacity and upper and lower limb muscle strength following in-hospital exercise training program. The individualized in-hospital exercise training program could tentatively be introduced as part of the rehabilitation process in people undergoing hematopoietic stem cell transplantation.

Performance, metabolic, hemodynamic, and perceived exertion in the six-minute step test at different heights in a healthy population of different age groups

Abstract Aim: This study aimed to compare the performance, metabolic, hemodynamic, and perceived exertion during the 6-minute step test (6MST) conducted with different step heights in healthy subjects and also to compare the performance between different age groups for each step height. The association between age, body mass index, level of physical activity, and lower limb measurements with performance were also evaluated. Methods: This is a cross-sectional study. Anthropometric measures, physical performance, and cardiovascular stress were evaluated during a self-paced 6MST with different step heights in healthy subjects in the age group of 18-59. All the participants underwent three-step tests (15 cm, 20 cm, and 30 cm) on the same day, in a randomized order. Results: Forty participants (20 men and 20 women) performed the tests. The performance in the test for the highest step was significantly lower compared to the step with the lowest height (152 ± 24 vs. 173 ± 27 and 184 ± 33; p < 0,05). The estimated peak oxygen consumption (VO2peak) increased by ∼2.5 mL.kg−1·min−1 with the increase in step height. Hemodynamic variables, such as percent of maximum heart rate (%HRmáx), and systolic blood pressure increased as the step height increased. There was a fair correlation between performance and the level of physical activity in the test with a step height of 15 cm and 20 cm. Conclusion: A higher step height caused greater cardiovascular stress, without exceeding the submaximal levels of the test, indicating that the 6MST can be used as an accurate instrument for evaluating aerobic capacity in healthy individuals.

Exame preventivo do câncer de colo do útero: conhecimento de mulheres / Preventive cervical cancer tests: women's knowledge / Examen preventivo de cáncer de cuello uterino: conocimiento de mujeres

Objetivo: analisar o conhecimento de mulheres acerca do exame preventivo do câncer de colo do útero (CCU), bem como verificar a prática do exame. Método: estudo exploratório descritivo, de abordagem quantiqualitativa entre as usuárias da Unidade de Saúde da Família (USF) Cuiá no município de João PessoaPB. Para delimitar a amostra, foi utilizada a técnica de amostragem não probabilística e, para a coleta de dados, realizou-se uma entrevista estruturada. A amostra foi composta por 30 mulheres. Resultados: as mulheres pesquisadas possuíam algum conhecimento acerca do exame preventivo do CCU sendo, este conhecimento, superficial. Apresentaram esclarecimento satisfatório sobre os cuidados antes da realização desse exame (93,3%). A maioria (86,67%) declarou já ter recebido informações sobre o exame e todas consideraram necessária a realização do mesmo. Conclusão: conclui-se que projetos educativos devem ser direcionados a esta clientela para que exista um maior entendimento da finalidade, importância e frequência do exame.(AU)

Objective: to analyze the knowledge of women about preventive cervical cancer (CC) tests and verify the practical exam. Method: a descriptive exploratory study of a quantitative and qualitative approach among users of the Cuiá Family Health Unit (FHU) in the city of João Pessoa-PB. To delimit the sample, a nonprobability sampling technique was used and, data collection, took place with a structured interview. The sample consisted of 30 women. Results: the women surveyed had some knowledge about the preventive examinations for cervical cancer, superficial knowledge. They have a satisfactory clarification of care before this test(93.3%). The majority (86.67%) reported having received information about the exam and all considered it necessary to have this test done. Conclusion: it is concluded that educational programs should be directed to this clientele so that there is greater understanding of the purpose, importance and frequency of the test.(AU)

Objetivo: analizar el conocimiento de mujeres sobre el examen preventivo de cáncer de cuello uterino (CCU), así como verificar la práctica del examen. Método: estudio exploratorio descriptivo, de abordaje canticualitativa entre las usuarias de la unidad de salud de la familia (USF) Cuiá en la ciudad de João Pessoa-PB. Para delimitar la muestra, se utilizó la técnica de no probabilístico, muestreo y para la recogida de datos, fue una entrevista estructurada. La muestra fue compuesta por 30 mujeres. Resultados: las mujeres encuestadas tenían algún conocimiento sobre el examen preventivo de la CCU siendo este conocimiento, superficial. Presentó aclaración satisfactoria acerca del cuidado antes de realizar este examen (93,3%). La mayoría (86.67%) declaró ya haber recibido información sobre el examen y todos consideraron necesarios para lograr el mismo. Conclusión: se concluye que los proyectos educativos deben ser dirigidos a esta clientela para mayor comprensión de la finalidad, importancia y frecuencia del examen.(AU)

Um olhar sobre a peregrinação anteparto: reflexões sobre o acesso ao pré-natal e ao parto / Una mirada a la peregrinación antes del parto: reflexiones sobre el acceso a la atención prenatal y el parto / A look at the antenatal peregrination: reflections on access to prenatal care and childbirth

Analisar as situações do acesso das gestantes a assistência pré-natal e ao parto de baixo risco. Métodos: Trata de uma revisão sistemática de literatura, realizada na Biblioteca Virtual de Saúde, selecionando 12 referências bibliográficas. Resultados: Foram dispostos em duas categorias: 1) o acesso, a escolha e assistência ao pré-natal e; 2) a peregrinação anteparto e a assistência a parturição. Conclusão: Percebeu-se que a peregrinação anteparto nas maternidades de baixo risco, geralmente, ocorre devido ao baixo número de leitos obstétricos existentes. Para que o sistema de referência e conta-referência de gestantes funcione plenamente é necessário que haja uma comunicação entre os profissionais da rede básica de saúde com as maternidades. É necessário também que haja uma expansão da rede de Atenção Básica, a fim de capilarizar cada vez mais a assistência pré-natal e, por sua vez, promover melhorias na organização deste sistema.

Analyze situations of pregnant women access to prenatal care and delivery of low risk. Method: Is a systematic literature review carried out in the Virtual Health Library, selecting 12 bibliographies. Results: Were placed into two categories, with access, choice and assistance to prenatal care and antenatal peregrination and the parturition assistance. Conclusion: Realized that the antenatal peregrination in low-risk maternities, usually, due to the low number of beds in these units. For the reference and counter reference of pregnant women works fully, there must be communication between professionals in primary health care with the maternities. It is also necessary to have an expansion network of Basic Attention, in order to expand access to prenatal care and, in turn, encourage improvements in the organization of this system.

Analizar la situación de las mujeres embarazadas el acceso a la atención prenatal y el parto de bajo riesgo. Métodos: Se trata de una revisión sistemática de literatura realizado en la Biblioteca Virtual en Salud, la selección de 12 bibliografías. Resultados: Se colocaron en dos categorías, con acceso, la elección y la asistencia a la atención prenatal y de la peregrinación antes del parto y de atención para el parto. Conclusión: se observó que la peregrinación antes del parto en las maternidades de bajo riesgo por lo general se produce debido al bajonúmero de camas existentes en estas unidades. Para el sistema de referencia y la cuenta de la remisión de las mujeres embarazadas a funcionar plenamente, tiene que haber comunicación entre los profesionales en la red de atención primaria en las maternidades. También es necesario contar con una red en expansión de la atención primaria con el fin de universalizar la atención prenatal y cada vez más, a su vez, promover mejoras en la organización de este sistema.

Caso para diagnóstico / Case for diagnosis

Relata-se caso de erythema gyratum repens em paciente do sexo masculino, de 40 anos, com eritema disseminado, pruriginoso, bizarro, figurado, com fina descamação nas bordas. Na primeira consulta, os exames laboratoriais e a radiografia do tórax foram normais. Durante acompanhamento clínico foi diagnosticado câncer de pulmão por tomografia computadorizada de tórax, tendo a imuno-histoquímica da biópsia da linfonodomegalia inguinal confirmado o pulmão como sítio primário.

A case of erythema gyratum repens is described in a 40-year-old man with a generalized, bizarre, figurated and pruritic erythema with fine scaling borders. Laboratorial exams and radiography of the thorax were normal in the first visit. A tomographic study of the thorax showed a lobulated pulmonary nodule and the immunohistochemistry on the biopsy of an inguinal lymph node confirmed the lung cancer as the primary site of the neoplasia.