Polymyxin Resistance in Salmonella: exploring mutations and genetic dDeterminants of non-human isolates

Until 2015, polymyxin resistance was primarily attributed to chromosomal mutations. However, with the first report of mobile colistin resistance (mcr-1) in commensal Escherichia coli from food animals in China, the landscape has changed. To evaluate the presence of polymyxin resistance in Salmonella spp., a drop screening test for colistin and polymyxin B was carried out on 1156 isolates of non-human origin (animals, food, and the environment), received in Brazil, between 2016 and 2021. Subsequently, 210 isolates with resistant results in the drop test were subjected to the gold-standard test (broth microdilution) for both colistin and polymyxin B. Whole-genome sequencing (WGS) of 102 resistant isolates was performed for a comprehensive analysis of associated genes. Surprisingly, none of the isolates resistant to colistin in the drop test harbored any of the mcr variants (mcr-1 to mcr-10). WGS identified that the most common mutations were found in pmrA (n= 22; T89S) and pmrB (n = 24; M15T, G73S, V74I, I83A, A111V). Other resistance determinants were also detected, such as the aac(6′)-Iaa gene in 72 isolates, while others carried beta-lactamase genes (blaTEM-1 blaCTX-M-2, blaCMY-2). Additionally, genes associated with fluoroquinolone resistance (qnrB19, qnrS1, oqxA/B) were detected in 11 isolates. Colistin and polymyxin B resistance were identified among Salmonella from non-human sources, but not associated with the mcr genes. Furthermore, the already-described mutations associated with polymyxin resistance were detected in only a small number of isolates, underscoring the need to explore and characterize unknown genes that contribute to resistance.

The bitter side of teas: Pesticide residues and their impact on human health.

Tea (Camellia sinensis) is one of the most widely consumed non-alcoholic beverages globally, known for its rich composition of bioactive compounds that offer various health benefits to humans. However, the cultivation of tea plants often faces challenges due to their high vulnerability to pests and diseases, resulting in the heavy use of pesticides. Consequently, pesticide residues can be transferred to tea leaves, compromising their quality and safety and potentially posing risks to human health, including hormonal and reproductive disorders and cancer development. In light of these concerns, this review aims to: (I) present the maximum limits of pesticide residues established by different international regulatory agencies; (II) explore the characteristics of pesticides commonly employed in tea cultivation, encompassing aspects such as digestion, bioaccessibility, and the behavior of pesticide transfer; and (III) discuss the effectiveness of detection and removal methods for pesticides, the impacts of pesticides on both tea plants and human health and investigate emerging alternatives to replace these substances. By addressing these critical aspects, this review provides valuable insights into the management of pesticide residues in tea production, with the goal of ensuring the production of safe, high-quality tea while minimizing adverse effects on human health.

Bioprinting: From Technique to Application in Tissue Engineering and Regenerative Medicine.

Among the different approaches present in regenerative medicine and tissue engineering, the one that has attracted the most interest in recent years is the possibility of printing functional biological tissues. Bioprinting is a technique that has been applied to create cellularized three-dimensional structures that mimic biological tissues and thus allow their replacement. Hydrogels are interesting materials for this type of technique. Hydrogels based on natural polymers are known due to their biocompatible properties, in addition to being attractive biomaterials for cell encapsulation. They provide a threedimensional aqueous environment with biologically relevant chemical and physical signals, mimicking the natural environment of the extracellular matrix (ECM). Bioinks are ink formulations that allow the printing of living cells. The controlled deposition of biomaterials by bioinks needs to maintain cell viability and offer specific biochemical and physical stimuli capable of guiding cell migration, proliferation, and differentiation. In this work, we analyze the theoretical and practical issues of bioprinting, citing currently used methods, their advantages, and limitations. We present some important molecules that have been used to compose bioinks, as well as the cellular responses that have been observed in different tissues. Finally, we indicate future perspectives of the method.

The Importance of Antioxidant Biomaterials in Human Health and Technological Innovation: A Review.

Biomaterials come from natural sources such as animals, plants, fungi, algae, and bacteria, composed mainly of protein, lipid, and carbohydrate molecules. The great diversity of biomaterials makes these compounds promising for developing new products for technological applications. In this sense, antioxidant biomaterials have been developed to exert biological and active functions in the human body and industrial formulations. Furthermore, antioxidant biomaterials come from natural sources, whose components can inhibit reactive oxygen species (ROS). Thus, these materials incorporated with antioxidants, mainly from plant sources, have important effects, such as anti-inflammatory, wound healing, antitumor, and anti-aging, in addition to increasing the shelf-life of products. Aiming at the importance of antioxidant biomaterials in different technological segments as biodegradable, economic, and promising sources, this review presents the main available biomaterials, antioxidant sources, and assigned biological activities. In addition, potential applications in the biomedical and industrial fields are described with a focus on innovative publications found in the literature in the last five years.

Investigation on brewer's spent yeast as a bio-vehicle for encapsulation of natural colorants from pumpkin (Cucurbita moschata) peels.

Brewer's spent yeast (BSY) Saccharomyces cerevisiae has been explored as a bio-vehicle for the encapsulation of bioactive compounds and as a delivery system. The main objectives of this work were to encapsulate carotenoids from pumpkin peel extract using BSY as an encapsulating agent and to evaluate the influence of ultrasound treatment on the carotenoid incorporation, stability and release. The powders produced by atomization of the suspension of BSY in the extract from pumpkin peels showed physical and microbiological stability during storage, presenting low values of water activity (<0.406), moisture content (<7.0%) and hygroscopicity (<6.8 g per 100 g), characteristics of greatest importance for powder formulations. Regarding the chemical stability of the incorporated carotenoids, there was a decline in carotenoid content in the first 30 days (p ≤ 0.01), although stabilization was achieved up to the 75th day. The best retention of carotenoids (273.3 µg g-1 of particles) was obtained by applying ultrasound treatment before atomization, which probably led to the adsorption of carotenoids onto yeasts. Ultrasound also showed a positive effect on the color protection of powders during storage and on the protection of compounds under simulated gastrointestinal digestion. BSY released the carotenoids gradually during the digestion and higher carotenoid release occurred in the intestinal phase with bioaccessibility values of 26.9 and 30.3%. Yeasts are a suitable carrier material and show promising characteristics for technological application.

Functional properties of bioactive compounds from Spirulina spp.: Current status and future trends.

Functional foods show non-toxic bioactive compounds that offer health benefits beyond their nutritional value and beneficially modulate one or more target functions in the body. In recent decades, there has been an increase in the trend toward consuming foods rich in bioactive compounds, less industrialized, and with functional properties. Spirulina, a cyanobacterium considered blue microalgae, widely found in South America, stands out for its rich composition of bioactive compounds, as well as unsaturated fatty acids and essential amino acids, which contribute to basic human nutrition and can be used as a protein source for diets free from animal products. In addition, they have colored compounds, such as chlorophylls, carotenoids, phycocyanins, and phenolic compounds which can be used as corants and natural antioxidants. In this context, this review article presents the main biological activities of spirulina as an anticancer, neuroprotective, probiotic, anti-inflammatory, and immune system stimulating effect. Furthermore, an overview of the composition of spirulina, its potential for different applications in functional foods, and its emerging technologies are covered in this review.

Políticas de saúde do trabalhador no Brasil: contradições históricas e possibilidades de desenvolvimento / Workers' health policies in Brazil: historical contradictions and possibilities for development

Resumo A abordagem de Saúde do Trabalhador entende que é necessário ampliar o objeto das políticas públicas para transformar os processos de trabalho que determinam a relação saúde-doença. Essa ampliação traz desafios que impulsionam o desenvolvimento da formulação e implementação das políticas para a vigilância e prevenção de agravos. O objetivo deste artigo é analisar o desenvolvimento das políticas brasileiras em saúde do trabalhador a partir das contradições históricas. Para este fim, foi usado o conceito analítico de contradição da teoria da atividade histórico-cultural. Trata-se de uma revisão de escopo que inclui 64 estudos teóricos, empíricos e literatura cinza publicados entre 1991 e 2019. Os resultados da análise mostraram que: a partir da mudança de objeto da prevenção inserida pela abordagem da Saúde do Trabalhador, emergiram cinco novas contradições que estão relacionadas ao predomínio de instrumentos do modelo de atividade anterior, instrumentos normativos e de formação, divisão do trabalho para as ações de assistência e vigilância, articulações intra e intersetoriais e controle social. Essas contradições permitiram impulsionar algumas mudanças, mas também existem limitações que persistem em torno de um objeto desafiante.

Abstract The Workers' Health (WH) approach understands that it is necessary to expand the object of public policies to transform the work processes that determine the health-disease relationship. This broadening brings challenges that drive the development of the formulation and implementation of policies for the surveillance and prevention of diseases. This article aimed to analyze the development of Brazilian policies on WH from the perspective of historical contradictions. To this end, the analytical concept of contradiction from Cultural-Historical Activity Theory was used. This is a scoping review, including 64 theoretical and empirical studies and gray literature published between 1991 and 2019. The results of the analysis showed that: from the change of the object of prevention inserted by the WH approach, five new contradictions emerged that are related to the predominance of instruments of the previous activity model, normative and training instruments, division of labor for assistance and surveillance actions, intra and intersectoral articulations. and social control. These contradictions have driven some changes, but some limitations persist around a challenging object.

Workers' health policies in Brazil: historical contradictions and possibilities for development. / Políticas de saúde do trabalhador no Brasil: contradições históricas e possibilidades de desenvolvimento.

The Workers' Health (WH) approach understands that it is necessary to expand the object of public policies to transform the work processes that determine the health-disease relationship. This broadening brings challenges that drive the development of the formulation and implementation of policies for the surveillance and prevention of diseases. This article aimed to analyze the development of Brazilian policies on WH from the perspective of historical contradictions. To this end, the analytical concept of contradiction from Cultural-Historical Activity Theory was used. This is a scoping review, including 64 theoretical and empirical studies and gray literature published between 1991 and 2019. The results of the analysis showed that: from the change of the object of prevention inserted by the WH approach, five new contradictions emerged that are related to the predominance of instruments of the previous activity model, normative and training instruments, division of labor for assistance and surveillance actions, intra and intersectoral articulations. and social control. These contradictions have driven some changes, but some limitations persist around a challenging object.

A abordagem de Saúde do Trabalhador entende que é necessário ampliar o objeto das políticas públicas para transformar os processos de trabalho que determinam a relação saúde-doença. Essa ampliação traz desafios que impulsionam o desenvolvimento da formulação e implementação das políticas para a vigilância e prevenção de agravos. O objetivo deste artigo é analisar o desenvolvimento das políticas brasileiras em saúde do trabalhador a partir das contradições históricas. Para este fim, foi usado o conceito analítico de contradição da teoria da atividade histórico-cultural. Trata-se de uma revisão de escopo que inclui 64 estudos teóricos, empíricos e literatura cinza publicados entre 1991 e 2019. Os resultados da análise mostraram que: a partir da mudança de objeto da prevenção inserida pela abordagem da Saúde do Trabalhador, emergiram cinco novas contradições que estão relacionadas ao predomínio de instrumentos do modelo de atividade anterior, instrumentos normativos e de formação, divisão do trabalho para as ações de assistência e vigilância, articulações intra e intersetoriais e controle social. Essas contradições permitiram impulsionar algumas mudanças, mas também existem limitações que persistem em torno de um objeto desafiante.

Different infective forms trigger distinct lesions in the colon during experimental Chagas disease.

With the control of vectorial transmission of Chagas disease caused by metacyclic trypomastigotes (MT) in endemic countries, other pathways of infection have become important. The infection caused by blood trypomastigotes (BT) is relevant in places where the blood transfusion and organ transplantation are poorly controlled. This study aimed to evaluate immunopathogenic parameters in the colon during the acute and chronic phases of experimental infection in Swiss mice infected with BT or MT forms of VL-10 strain of Trypanosoma cruzi. We have found that animals infected with MT forms presented lower survival rate, and higher tissue parasitism in the acute phase of the disease, which may be associated with the exacerbated activation of the immune system with the production of pro-inflammatory cytokines even in the chronic phase of infection. Taken together, these results can also be associated to the maintenance of the inflammatory process in chronic phase and an earlier denervation of myenteric plexus in colon. These findings emphasized the importance of the inoculum source and the strain, once different forms of different strains seem to promote distinct diseases.

Development of natural pigments microencapsulated in waste yeast Saccharomyces cerevisiae using spray drying technology and their application in yogurt.

Although Saccharomyces cerevisiae has shown potential utilization as a bio-vehicle for encapsulation, there are no reports about the functionality of natural colorants encapsulated using yeast cells. The main objectives of this study were to produce natural food coloring by encapsulating extracts from grape pomace (GP) and jabuticaba byproducts (JB) in brewery waste yeast and evaluate the functionality of the pigments by their incorporation into yogurts. Particles produced by the encapsulation of extracts from GP and JB in S. cerevisiae using 5% of yeast had the highest encapsulation efficiencies for both anthocyanins (11.1 and 47.3%) and phenolic compounds (67.5 and 63.6%), the highest concentration of both bioactives during storage and stable luminosity. Yogurts showed a pseudoplastic behavior and were considered weak gels. Colored yogurts had acceptance indexes between 73.9 and 81.4%. This work evidenced the utilization of enriched yeasts as coloring agents and interesting additives for the production of functional foods.

Microencapsulation of carotenoid-rich materials: A review.

Carotenoids are natural pigments that present several bioactive properties, including antioxidant, anticarcinogenic and provitamin A activities. However, these compounds are susceptible to degradation when exposed to a number of conditions (e.g. light, heat, oxygen), leading to loss of benefits and hampering their application in food products. Their hydrophobicity also makes incorporation into water-based foods more difficult. Microencapsulation techniques have been applied for decades to provide stability to carotenoid-rich extracts under typical conditions of processing and storage of foods, besides offering several other advantages to the use and application of these materials. This work reviews the recent advances in the microencapsulation of carotenoid-rich extracts, oils and oleoresins from varying sources, evidencing the technologies applied to encapsulate these materials, the effects of encapsulation on the obtained particles, and the impact of such processes on the bioaccessibility and release profile of carotenoids from microparticles. Moreover, recent applications of carotenoid-rich microparticles in food products are discussed. Most of the applied processes were effective in improving different aspects of the encapsulated materials, especially the stability of carotenoids during storage, resulting in microparticles with promising properties for future applications in food products. However, the lack of information about the effects of microencapsulation on carotenoids during processing of model foods, the sensory acceptance of enriched food products and the bioaccessibility and bioavailability of microencapsulated carotenoids reveals gaps that should be explored in the future.

Building new paths for responsible solid waste management.

The amount of solid waste produced across the planet in the past decade was 1.3 billion tons (1.2 kg/year per person). Also, the significant number of publications on solid waste management (SWM) draws attention to the importance of discussing the topic to improve public health and to mitigate environmental impacts. The objectives of this article are to identify the state of the art and the scientific gaps on SWM and to propose a framework to promote it in the coming years. For this, a content analysis was carried out with the support of a bibliometric study, considering articles published in the Scopus database. The field of SWM study was classified into 12 different themes, and from this division, it was sought to identify the evolution of each of them between the 2005 and 2018 period. Content analysis and bibliometric study indicate that thermal and biological treatments are a promising trend to improve the performance of SWM. Its most important applied contribution is the generation of qualified information about SWM that can support the decision-making of public and private managers to reduce environmental impacts and improve life in urban spaces. The main academic contribution of the paper is the articulation of the most important themes on SWM, identifying the individual impact of each one of them in this field of study and the indication of the scientific trends that should guide the development of future research.

Histopathological changes in the gastrointestinal tract and systemic alterations triggered by experimental oral infection with Trypanosoma cruzi.

Chagas disease, caused by the protozoan Trypanosoma cruzi, is endemic in almost all countries of Latin America. In Brazil, oral infection is becoming the most important mechanism of transmission of the disease in several regions of the country. The gastrointestinal tract is the gateway for the parasite through this route of infection, however, little is known about the involvement of these organs related to oral route. In this sense, the present study evaluated the impact of oral infection on the digestive tract in mice infected by Berenice-78 (Be-78) T. cruzi strain, in comparison with the intraperitoneal route of infection. In this work, the intraperitoneal route group showed a peak of parasitemia similar to the oral route group, however the mortality rate among the orally infected animals was higher when compared to intraperitoneal route. By analyzing the frequency of blood cell populations, differences were mainly observed in CD4+ T lymphocytes, and not in CD8+, presenting an earlier reduction in the number of CD4+ T cells, which persisted for a longer period, in the animals of the oral group when compared with the intraperitoneal group. Animals infected by oral route presented a higher tissue parasitism and inflammatory infiltrate in stomach, duodenum and colon on the 28th day after infection. Therefore, these data suggest that oral infection has a different profile of parasitological and immune responses compared to intraperitoneal route, being the oral route more virulent and with greater tissue parasitism in organs of the gastrointestinal tract evaluated during the acute phase.

Utilization of grape pomaces and brewery waste Saccharomyces cerevisiae for the production of bio-based microencapsulated pigments.

This research approaches the utilization of brewery waste yeast Saccharomyces cerevisiae as a vehicle for the encapsulation and protection of phenolic compounds from Cabernet Sauvignon and Bordeaux grape pomace extracts. The main purpose of this research was to enrich the biomass of yeast to investigate its potential as a novel vehicle for further application as pigment or functional ingredient. The obtained powders presented characteristics appropriated for storage, such as low water activity (<0.289), hygroscopicity (<13.71 g/100 g) and moisture (<7.10%) and particle sizes lower than the sensory perceptible (<11.45 µm). This work proved that yeasts were loaded after spray-drying, thus, they might be considered as biocapsules. Furthermore, the bioaccessibility of encapsulated phenolic compounds from Bordeaux and Cabernet Sauvignon extracts was 34.96% and 14.25% higher compared to their respective free extracts, proving that yeasts are not only biocapsules of easy application, but also a biological material capable of protecting and delivering the compounds during gastrointestinal digestion.

Insatisfação com a imagem corporal e fatores associados em estudantes universitários / Dissatisfaction with body image and associated factors in university students

RESUMO Objetivo Avaliar a prevalência de insatisfação com a imagem corporal e os fatores associados entre universitários da área da saúde. Métodos Trata-se de um estudo descritivo, de caráter transversal e abordagem quantitativa, com 364 acadêmicos matriculados em cinco cursos da área da saúde. Para a obtenção dos dados, foram utilizados seis instrumentos autoaplicáveis: questionário socioeconômico, demográfico e de hábitos de vida adaptado do Vigitel, o Body Shape Questionnaire (BSQ), o Eating Attitudes Test (EAT-26), o Questionário Internacional de Atividade Física (IPAQ), o Inventário de Ansiedade de Beck (BAI) e o Inventário de Depressão de Beck (BDI). Foram coletadas, ainda, as medidas antropométricas. A associação entre as variáveis estudadas e a insatisfação com a imagem corporal foi verificada por análise bivariada seguida de regressão logística, com variância robusta. Resultados Houve prevalência de insatisfação com a imagem corporal de 9,1% entre os universitários. As variáveis que, após análise múltipla, se mostraram associadas a maior prevalência de insatisfação com a imagem corporal foram: cor da pele não branca, realização de tratamento para perder peso, presença de atitudes para transtorno alimentar, estado de saúde regular/ruim, ansiedade moderada/grave e circunferência abdominal. Conclusão A prevalência com a insatisfação com a imagem corporal nos universitários foi baixa, entretanto fatores sociodemográficos, estilo de vida, estado de saúde e condições clínicas e antropométricas mostraram-se associados com a prevalência da insatisfação com a imagem corporal.

ABSTRACT Objective To assess the prevalence of dissatisfaction with body image and associated factors among university students in the health field. Methods This is a descriptive, cross-sectional study with a quantitative approach, with 364 students enrolled in five health courses. To obtain the data, six self-administered instruments were used: socioeconomic, demographic and lifestyle habits adapted from Vigitel, the Body Shape Questionnaire (BSQ), the Eating Attitudes Test (EAT-26), the International Physical Activity Questionnaire (IPAQ), the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). Anthropometric measurements were also collected. The association between the studied variables and dissatisfaction with body image was verified by bivariate analysis followed by logistic regression, with robust variance. Results There was a prevalence of body image dissatisfaction of 9.1% among university students. The variables that, after multiple analysis, were associated with a higher prevalence of dissatisfaction with body image were: non-white skin color, undergoing treatment to lose weight, presence of attitudes towards eating disorder, regular/poor health status, moderate/severe anxiety and waist circumference. Conclusion It is concluded that the prevalence of dissatisfaction with body image in university students was low, however, sociodemographic factors, lifestyle, health status and clinical and anthropometric conditions were shown to be associated with the prevalence of dissatisfaction with body image.

Low-dose of benznidazole promotes therapeutic cure in experimental chronic Chagas' disease with absence of parasitism in blood, heart and colon.

Studies suggest that the dose of the standard benznidazole (BNZ) treatment regimen might be too high. We investigated the efficacy of BNZ 20 and 40 mg/kg/day compared with standard dose (100 mg/kg/day) to induce cure in mice infected with Trypanosoma cruzi Y strain in the acute and chronic phases of Chagas' disease. Our findings indicate that an experimental treatment with a BNZ low-dose (40 mg/kg/day) is similarly effective as the usual dose in the chronic mice model (100% of cure). In addition, the treatment in the chronic model of Chagas' disease presented better results than the acute model and colon appears to be a key tissue when it comes to evaluating treatment efficacy compared to blood and heart. Therefore, our data suggest the reconsideration of the current therapy, mainly in the chronic phase of the disease.

Oxidative stability of crude palm oil after deep frying akara (Fried Bean Paste)

Abstract For this study 47 samples of crude palm oil (CPO) were collected, consisted of what had been used for 4 hours around the city of Salvador-Bahia. To evaluate the quality of CPO were analyzed: Total Polar Compound (TPC; %) by Adsorption Chromatography (AC), Testo 270 and Fricheck; Free fatty acids (FFA; % oleic acid), Color (CIELab); Total Carotenoids (TC; ppm), induction time (IT, h) and fatty acids composition (g 100 g-1). The TPC analysis by Testo 270 and Fricheck showed a poor linear correlation with AC (0.69 and 0.60 respectively). Otherwise 44.70% and 36.95% of samples were completely oxidized, according to CA and IT methods. All samples presented TC (11.01-331.45 ppm) and yellow color predominance. Trans fatty acids, C18:1t in 17.02% and C18:3t in 65.65% of the samples were identified. The results demonstrate the need in the deep frying control, respect to techniques used during process. As well the improvement of the quality of palm oil fresh, can minimize the degradation process during th deep frying.

Tendência do nível de atividade física ocupacional e estado nutricional de adultos ao longo de quatro décadas no Brasil / Trend of adults' occupational physical activity levels and nutritional status over four decades in Brazil

Resumo Objetivo: avaliar a tendência do nível de atividade física ocupacional (Nafo) e o estado nutricional (EN) de adultos (≥ 20 anos) em pesquisas nacionais brasileiras realizadas ao longo de quatro décadas. Métodos: os dados declarados da ocupação principal foram estratificados em três Nafo (leve, moderado e pesado) segundo as classificações vigentes à época das pesquisas. O EN foi determinado segundo a classificação da OMS baseada no índice de massa corporal (IMC, kg.m-2) como baixo peso (IMC < 18,5), adequado (18,5 ≤ IMC < 25) e sobrepeso (IMC ≥ 25). Todas as estimativas foram calculadas usando os pesos amostrais das pesquisas. Resultados: a população com ocupação declarada aumentou no período, com mais Nafo moderado nos anos 1970 e migrando para Nafo leve ao final dos anos 2000. A prevalência de baixo peso diminuiu e a de sobrepeso aumentou substancialmente para todas as categorias de Nafo. O sobrepeso variou de 27,6 a 49,7% no Nafo leve e de 12,7 a 43,3% no Nafo pesado. Conclusões: apesar da limitação do estudo (atividade física estimada pela ocupação declarada sem considerar a evolução/modificação dos processos de trabalho), conclui-se que os trabalhadores no Brasil apresentam balanço energético positivo independente do Nafo.

Abstract Objective: to evaluate the trend of adults' (≥ 20 years) occupational physical activity levels and nutritional status in Brazilian national surveys carried out over four decades. Methods: the declared data regarding main occupation was stratified in three physical activity levels (light, moderate, and heavy) according to the classifications in force when the surveys were conducted. The nutritional status was determined according to the World Health Organization classification based on the body mass index (BMI, kg.m-2) as underweight (BMI < 18.5), normal (18,5 ≤ IMC < 25) and overweight (BMI ≥ 25). All estimates were calculated using the sampling weights from the surveys. Results: the population with declared occupation increased in the period, with greater moderate physical activity levels in the 1970's and shifting to light in the 2000's. The prevalence of underweight decreased and of overweight increased substantially for all physical activity levels. Overweight ranged from 27.6 to 49.7% in light levels and from 12.7 to 43.3% in heavy levels. Conclusions: despite the limitations of the study (the physical activity levels were estimated by declared occupation and did not consider the development/modification of labor processes), we concluded that workers in Brazil present a positive energy balance regardless of their occupational physical activity levels.

Predictive factors of axillary metastasis in patients with breast cancer and positive sentinel lymph node biopsy. / Fatores preditivos de metástases axilares em pacientes com câncer de mama e biópsia de linfonodo sentinela positivo.

OBJECTIVE: to evaluate the risk factors for the presence of non-sentinel axillary metastatic disease in patients with breast cancer and positive sentinel node biopsy. Methods: retrospective cross-sectional study of women with breast cancer operated at the Cancer Institute of Ceará between 2002 and 2012 and submitted to sentinel lymph node biopsy. RESULTS: Among 946 breast cancer patients, 331 underwent sentinel lymph node biopsy, which was positive in 83. These patients underwent axillary lymphadenectomy and 39 (46%) had metastases in other axillary lymph nodes. The variables that were significant for additional axillary disease included Ki67>14 (p=0.043), angiolymphatic invasion (p=0.01) and tumor size (p=0.027). No association was observed with estrogen, progesterone, tumor grade and Her-2 receptors. DISCUSSION: the presence of angiolymphatic invasion and tumor size have also been related to additional axillary metastasis in other studies. In addition to these variables, the same predictive effect was observed when we evaluated Ki67. The validation of these results may allow the customization of breast cancer treatment, which may reduce its morbidity. CONCLUSION: angiolymphatic invasion, tumor size (T3/T4) and Ki67>14 were factors predictive of axillary metastasis involvement in addition to the sentinel lymph node.

OBJETIVO: avaliar os fatores de risco para presença de doença metastática axilar não sentinela em pacientes com câncer de mama e biópsia do linfonodo sentinela positiva. MÉTODOS: estudo transversal, retrospectivo, de mulheres com câncer mamário operadas no Instituto do Câncer do Ceará, entre os anos de 2002 e 2012 e submetidas à biópsia de linfonodo sentinela. RESULTADOS: de 946 pacientes com câncer de mama, 331 foram submetidas à biópsia de linfonodo sentinela, que foi positiva em 83. Estas foram submetidas à linfadenectomia axilar e 39 (46%) apresentaram metástases em outros linfonodos axilares. As variáveis que foram significantes para doença axilar adicional foram Ki67>14 (p=0,043), presença de invasão angiolinfática (p=0,01) e tamanho tumoral (p=0,027). Não foi observado associação com receptores de estrogênio, progesterona, grau tumoral e Her-2. DISCUSSÃO: a presença de invasão angiolinfática e tamanho tumoral tambémjáforam relacionados à metástase axilar adicional em outros estudos. Além destas variáveis observou-se o mesmo efeito preditivo quando avaliamos o Ki67. A validação destes resultados poderá permitira customização do tratamento do câncer de mama, podendo reduzir sua morbidade. CONCLUSÃO: invasão angiolinfática, tamanho tumoral (T3/T4) e Ki67>14 foram fatores preditivos de acometimento de metástase axilar além do linfonodo sentinela.