Study of auditory pathways in type 1 diabetes mellitus through brainstem auditory evoked potentials and contralateral acoustic reflex.

PURPOSE: To investigate the functionalities of the neural pathways through the auditory evoked potentials of the brainstem and the contralateral stapedial acoustic reflexes in normal-hearing individuals with type 1 diabetes mellitus, in order to detect possible alterations in the central auditory pathways. METHODS: This is a cross-sectional study with a comparison group and a convenience sample, consisting of 32 individuals with type 1 diabetes mellitus and 20 controls without the disease. All subjects had hearing thresholds within normal limits and type A tympanometric curves. The acoustic reflex arc and brainstem auditory potentials were investigated. Statistical analyses were performed using the SPSS 17.0. The Chi-square test, Student´s t-test, and Multiple linear regression were used. RESULTS: The auditory thresholds of the acoustic reflex were statistically lower in the group with the disease at frequencies of 0.5 kHz and 1.0 kHz in the left ear (p=0.01 and p=0.01, respectively). The absolute latencies III and V of the auditory potentials of the brainstem in the right ear and V in the left ear were increased in subjects with type 1 diabetes mellitus (p=0.03, p=0.02 and p=0.03, respectively). CONCLUSION: The findings suggest that subjects with type 1 diabetes mellitus are more likely to present alterations in the central auditory pathways, even with auditory thresholds within normal limits.

Ultra-Processed Food Consumption Is Related to Higher Trans Fatty Acids, Sugar Intake, and Micronutrient-Impaired Status in Schoolchildren of Bahia, Brazil.

Ultra-processed food (UPF) consumption impacts nutrient intake and plays an important role in non-communicable diseases (NCD), even among schoolchildren. This cross-sectional study aimed to characterize the food consumption of this population and its relationship with laboratory and anthropometric aspects. A sample of 190 subjects aged 5 to 19 y was randomly selected for dietary, laboratory, and anthropometric assessment. Statistical inference was calculated using Spearman's correlation. Excess weight was observed in 34%, a high Waist-to-Height Ratio in 9%, and hypertriglyceridemia in 17% of the subjects, higher among those from urban schools (45%, p = 0.011; 15%, p = 0.015; 24%, p = 0.026, respectively). UPF consumption represented 21% of caloric intake and showed a positive correlation with trans fatty acids (r = 0.70) and sugar (r = 0.59) intake. Unprocessed food consumption showed a weak, but significant, correlation with Body Mass Index (r = 0.22) and Waist Circumference (r = 0.23), while processed meat showed a negative correlation with serum ferritin (r = -0.16) and vitamins D (r = -0.20) and B12 (r = -0.15). These findings highlight the need for public policies to promote Food and Nutritional Security for schoolchildren to prevent NCD and nutritional deficiencies.

Study of auditory pathways in type 1 diabetes mellitus through brainstem auditory evoked potentials and contralateral acoustic reflex / Estudo das vias auditivas em diabetes mellitus tipo 1 através dos potenciais auditivos evocados de tronco encefálico e reflexo acústico contralateral

ABSTRACT Purpose To investigate the functionalities of the neural pathways through the auditory evoked potentials of the brainstem and the contralateral stapedial acoustic reflexes in normal-hearing individuals with type 1 diabetes mellitus, in order to detect possible alterations in the central auditory pathways. Methods This is a cross-sectional study with a comparison group and a convenience sample, consisting of 32 individuals with type 1 diabetes mellitus and 20 controls without the disease. All subjects had hearing thresholds within normal limits and type A tympanometric curves. The acoustic reflex arc and brainstem auditory potentials were investigated. Statistical analyses were performed using the SPSS 17.0. The Chi-square test, Student´s t-test, and Multiple linear regression were used. Results The auditory thresholds of the acoustic reflex were statistically lower in the group with the disease at frequencies of 0.5 kHz and 1.0 kHz in the left ear (p=0.01 and p=0.01, respectively). The absolute latencies III and V of the auditory potentials of the brainstem in the right ear and V in the left ear were increased in subjects with type 1 diabetes mellitus (p=0.03, p=0.02 and p=0.03, respectively). Conclusion The findings suggest that subjects with type 1 diabetes mellitus are more likely to present alterations in the central auditory pathways, even with auditory thresholds within normal limits.

RESUMO Objetivo Investigar a funcionalidade das vias neurais por meio dos potenciais evocados auditivos de tronco encefálico e os reflexos acústicos estapedianos contralaterais em sujeitos com diabetes mellitus tipo 1 normo-ouvintes, a fim de detectar possíveis alterações nas vias auditivas centrais. Método Trata-se de um estudo transversal com grupo de comparação, e amostra de conveniência, composta por 32 sujeitos com diabetes mellitus tipo 1 e 20 controles sem a doença. Todos os sujeitos apresentavam limiares auditivos dentro dos padrões de normalidade e curva timpanométrica tipo A. Foram investigados o arco-reflexo acústico e os potenciais auditivos de tronco encefálico. As análises dos resultados foram realizadas no SPSS 17.0. Utilizou-se o Teste Qui Quadrado, Teste T de Studant e Regressão linear múltipla. Resultados Os limiares auditivos do reflexo acústico foram estatisticamente menores no grupo com a doença nas frequências de 0,5 kHz e 1,0 kHz na orelha esquerda (p=0,01 e p=0,01, respectivamente). As latências absolutas III e V dos potenciais auditivos de tronco encefálico da orelha direita e V da orelha esquerda estavam aumentadas em sujeitos com diabetes mellitus tipo 1 (p=0,03, p=0.02 e p=0,03, respectivamente). Conclusão Os achados sugerem que sujeitos com diabetes mellitus tipo 1 estão mais propensos a apresentar alterações nas vias auditivas centrais, mesmo com limiares auditivos dentro dos padrões de normalidade.

Association Between Lipid Profile and Clinical Manifestations in Sickle Cell Anemia: A Systematic Review

Abstract Introduction Sickle cell anemia (SCA) is a genetic disease associated with frequent episodes of acute illness. Changes in the lipid profile and a chronic inflammatory process make up the molecular aspects observed in this disease. Associations between these mechanisms and clinical manifestations could thus define severity profiles and therapeutic strategies. Objectives To verify whether there is an association between lipid profile and clinical manifestations in patients with SCA and if there is a correlation between lipid profile and laboratory markers in this disease. Methodology According to the PRISMA guidelines, a systematic review of the literature was conducted by searching the MEDLINE/PubMed, LILACS, SciELO, Scopus, and Cochrane databases. Articles were screened by reading the titles and abstracts, reaching those selected for full-text reading. The included studies were published between 2010 and 2020, were fully available in the databases, and addressed the proposed theme. The risk of individual bias was assessed by using the Joanna Briggs Institute checklist and the Newcastle-Ottawa scale. Results Out of the 144 identified articles, 15 were selected for analysis, resulting in a sample size of 2,230 individuals. HDL-C, LDL-C, total cholesterol , and triglycerides were the main variables analyzed in the lipid profiles. A correlation was observed between these variables and some of the most relevant clinical events in the disease, including vaso-occlusive seizures and acute thoracic syndrome. Conclusion Lipid metabolism disorders, especially hypocholesterolemia and hypertriglyceridemia, are linked to clinical events observed in SCA, suggesting they play a relevant role in the multifactorial pathogenesis of this disease.

Prevalência das Complicações Cardiovasculares nos Indivíduos com Anemia Falciforme e Outras Hemoglobinopatias: Uma Revisão Sistemática / Prevalence of Cardiovascular Complications in Individuals with Sickle Cell Anemia and Other Hemoglobinopathies: A Systematic Review

Resumo Fundamento A anemia falciforme (AF) é uma doença hereditária cujas complicações cardiovasculares são a principal causa de morte, o mesmo sendo observado em outras hemoglobinopatias. A identificação precoce dessas alterações pode modificar favoravelmente o curso da doença. Objetivo Comparar a prevalência de complicações cardiovasculares entre indivíduos com AF e indivíduos com outras hemoglobinopatias. Métodos Seguindo recomendações do protocolo PRISMA, realizou-se revisão sistemática da literatura com buscas nas bases de dados PubMed/Medline, associadas à busca manual. Incluídos estudos que analisaram a prevalência das alterações cardiovasculares nas hemoglobinopatias (AF, traço falciforme, hemoglobinopatia SC, alfatalassemia e betatalassemia). A qualidade metodológica dos artigos foi realizada pela escala de Newcastle-Ottawa. Resultados Foram selecionados para análise quatro estudos, resultando em um tamanho amostral de 582 participantes: 289 portadores de AF, 133 possuem hemoglobinopatia SC, 40 com betatalassemia, 100 indivíduos saudáveis e nenhum com alfatalassemia ou traço falcêmico. Dilatação das câmaras cardíacas, hipertrofia ventricular esquerda e direita, hipertensão pulmonar, disfunção diastólica, insuficiência mitral e insuficiência tricúspide são mais prevalentes na AF do que nas demais hemoglobinopatias consideradas. A sobrecarga miocárdica de ferro é mais frequente na talassemia maior do que na AF. A função sistólica foi similar entre as hemoglobinopatias. Conclusão Verificou-se maior comprometimento cardiovascular nos indivíduos com AF do que naqueles com as demais hemoglobinopatias, reforçando a necessidade de acompanhamento cardiovascular regular e frequente nos pacientes falcêmicos.

Abstract Background Sickle cell anemia (SCA) is a hereditary disease whose cardiovascular complications are the main cause of death, the same being observed in other hemoglobinopathies. Early identification of these changes can favorably modify the course of the disease. Objective To compare the prevalence of cardiovascular complications between individuals with SCA and individuals with other hemoglobinopathies. Method Following the recommendations of the PRISMA protocol, a systematic literature review was carried out with searches in PubMed/Medline databases, associated with a manual search. Studies that analyzed the prevalence of cardiovascular alterations in hemoglobinopathies (SCA, sickle cell trait, SC hemoglobinopathy, alpha-thalassemia and beta-thalassemia) were included. The methodological quality of the articles was assessed using the Newcastle-Ottawa scale. Results Four studies were selected for analysis, resulting in a sample size of 582 participants: 289 with SCA, 133 with SC hemoglobinopathy, 40 with beta-thalassemia, 100 healthy individuals and none with alpha-thalassemia or sickle cell trait. Dilatation of the cardiac chambers, left and right ventricular hypertrophy, pulmonary hypertension, diastolic dysfunction, mitral regurgitation and tricuspid regurgitation are more prevalent in SCA than in the other hemoglobinopathies considered. Myocardial iron overload is more frequent in thalassemia major than in sickle cell anemia. Systolic function is similar between different hemoglobinopathies. Conclusion There is greater cardiovascular impairment in individuals with SCA than in those with other hemoglobinopathies, reinforcing the necessity for regular cardiovascular follow-up in sickle cell patients.

Prevalence of Cardiovascular Complications in Individuals with Sickle Cell Anemia and Other Hemoglobinopathies: A Systematic Review. / Prevalência das Complicações Cardiovasculares nos Indivíduos com Anemia Falciforme e Outras Hemoglobinopatias: Uma Revisão Sistemática.

BACKGROUND: Sickle cell anemia (SCA) is a hereditary disease whose cardiovascular complications are the main cause of death, the same being observed in other hemoglobinopathies. Early identification of these changes can favorably modify the course of the disease. OBJECTIVE: To compare the prevalence of cardiovascular complications between individuals with SCA and individuals with other hemoglobinopathies. METHOD: Following the recommendations of the PRISMA protocol, a systematic literature review was carried out with searches in PubMed/Medline databases, associated with a manual search. Studies that analyzed the prevalence of cardiovascular alterations in hemoglobinopathies (SCA, sickle cell trait, SC hemoglobinopathy, alpha-thalassemia and beta-thalassemia) were included. The methodological quality of the articles was assessed using the Newcastle-Ottawa scale. RESULTS: Four studies were selected for analysis, resulting in a sample size of 582 participants: 289 with SCA, 133 with SC hemoglobinopathy, 40 with beta-thalassemia, 100 healthy individuals and none with alpha-thalassemia or sickle cell trait. Dilatation of the cardiac chambers, left and right ventricular hypertrophy, pulmonary hypertension, diastolic dysfunction, mitral regurgitation and tricuspid regurgitation are more prevalent in SCA than in the other hemoglobinopathies considered. Myocardial iron overload is more frequent in thalassemia major than in sickle cell anemia. Systolic function is similar between different hemoglobinopathies. CONCLUSION: There is greater cardiovascular impairment in individuals with SCA than in those with other hemoglobinopathies, reinforcing the necessity for regular cardiovascular follow-up in sickle cell patients.

FUNDAMENTO: A anemia falciforme (AF) é uma doença hereditária cujas complicações cardiovasculares são a principal causa de morte, o mesmo sendo observado em outras hemoglobinopatias. A identificação precoce dessas alterações pode modificar favoravelmente o curso da doença. OBJETIVO: Comparar a prevalência de complicações cardiovasculares entre indivíduos com AF e indivíduos com outras hemoglobinopatias. MÉTODOS: Seguindo recomendações do protocolo PRISMA, realizou-se revisão sistemática da literatura com buscas nas bases de dados PubMed/Medline, associadas à busca manual. Incluídos estudos que analisaram a prevalência das alterações cardiovasculares nas hemoglobinopatias (AF, traço falciforme, hemoglobinopatia SC, alfatalassemia e betatalassemia). A qualidade metodológica dos artigos foi realizada pela escala de Newcastle-Ottawa. RESULTADOS: Foram selecionados para análise quatro estudos, resultando em um tamanho amostral de 582 participantes: 289 portadores de AF, 133 possuem hemoglobinopatia SC, 40 com betatalassemia, 100 indivíduos saudáveis e nenhum com alfatalassemia ou traço falcêmico. Dilatação das câmaras cardíacas, hipertrofia ventricular esquerda e direita, hipertensão pulmonar, disfunção diastólica, insuficiência mitral e insuficiência tricúspide são mais prevalentes na AF do que nas demais hemoglobinopatias consideradas. A sobrecarga miocárdica de ferro é mais frequente na talassemia maior do que na AF. A função sistólica foi similar entre as hemoglobinopatias. CONCLUSÃO: Verificou-se maior comprometimento cardiovascular nos indivíduos com AF do que naqueles com as demais hemoglobinopatias, reforçando a necessidade de acompanhamento cardiovascular regular e frequente nos pacientes falcêmicos.

Renin-Angiotensin-Aldosterone System in Women Using Combined Oral Contraceptive: A Systematic Review / Sistema renina-angiotensina-aldosterona em mulheres usuárias de contraceptivo oral combinado: Revisão sistemática

Abstract Objective To describe the effects of combined oral contraceptives (COC) on the renin-angiotensin-aldosterone system (RAAS). Data sourcesThis is a systematic review according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registered in PROSPERO under the ID: CRD42020200019. Searches were performed between August 2020 and December 2021, in the following databases: Medline via Pubmed, Cochrane Central Library, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences via Virtual Health Library. The effects of the combined oral contraceptive on plasma renin activity values, plasma renin values, angiotensinogen values— also known as plasma renin substrate— angiotensin, and/or aldosterone values. Study selectionA total of 877 studies were selected and, of these, 10 articles met the eligibility criteria and were included in this review. Data collectionData were combined through qualitative synthesis and included in a spreadsheet previously prepared by the authors. Data synthesisThe collected samples ranged from 18 to 137 participants, totaling 501 women aged between 18 and 49 years throughout all studies. The studies showed increased activity of plasma renin, plasma renin substrate, angiotensin II, and aldosterone in this population. Conclusion The findings of this study suggest that the COC promotes greater activation of the RAAS. Supporting the idea that its use is related to an increased risk of cardiovascular events, including systemic arterial hypertension.

Resumo Objetivo Descrever os efeitos do contraceptivo oral combinado (COC) no sistema renina-angiotensina-aldosterona (SRAA). Fontes dos dadosTrata-se de uma revisão sistemática de acordo com os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada no PROSPERO sob ID: CRD42020200019. As buscas foram realizadas entre agosto de 2020 e dezembro de 2021 nas bases de dados: Medline via Pubmed, Biblioteca Cochrane Central, Scientific Electronic Library Online, e Literatura Latino-americana e do Caribe em Ciências da Saúde via Biblioteca Virtual em Saúde. Consultado os artigos sobre os efeitos do contraceptivo oral combinado nos valores da atividade da renina plasmática, valores plasmáticos da renina, valores do angiotensinogênio - também conhecido como substrato da renina plasmática -, valores da angiotensina e/ou aldosterona. Seleção dos estudosForam selecionados 877 estudos e, destes, 10 artigos preencheram os critérios de elegibilidade e foram incluídos nesta revisão. Coleta de dadosOs dados foram combinados por meio de síntese qualitativa e inclusos em uma planilha elaborada previamente pelos autores. Síntese dos dadosAs amostras coletadas variavam entre 18 e 137 participantes, totalizando 501 mulheres com idade entre 18 e 49 anos em todos os estudos. Os estudos apresentaram aumento da atividade da renina plasmática, do substrato da renina plasmática, da angiotensina II e da aldosterona nessa população. Conclusão Os achados deste estudo sugerem que o COC promove maior ativação do SRAA. Apoiando a ideia de que o seu uso esteja relacionado ao aumento do risco de eventos cardiovasculares, incluindo a hipertensão arterial sistêmica.

Renin-Angiotensin-Aldosterone System in Women Using Combined Oral Contraceptive: A Systematic Review.

OBJECTIVE: To describe the effects of combined oral contraceptives (COC) on the renin-angiotensin-aldosterone system (RAAS). DATA SOURCES: This is a systematic review according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registered in PROSPERO under the ID: CRD42020200019. Searches were performed between August 2020 and December 2021, in the following databases: Medline via Pubmed, Cochrane Central Library, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences via Virtual Health Library. The effects of the combined oral contraceptive on plasma renin activity values, plasma renin values, angiotensinogen values- also known as plasma renin substrate- angiotensin, and/or aldosterone values. STUDY SELECTION: A total of 877 studies were selected and, of these, 10 articles met the eligibility criteria and were included in this review. DATA COLLECTION: Data were combined through qualitative synthesis and included in a spreadsheet previously prepared by the authors. DATA SYNTHESIS: The collected samples ranged from 18 to 137 participants, totaling 501 women aged between 18 and 49 years throughout all studies. The studies showed increased activity of plasma renin, plasma renin substrate, angiotensin II, and aldosterone in this population. CONCLUSION: The findings of this study suggest that the COC promotes greater activation of the RAAS. Supporting the idea that its use is related to an increased risk of cardiovascular events, including systemic arterial hypertension.

OBJETIVO: Descrever os efeitos do contraceptivo oral combinado (COC) no sistema renina-angiotensina-aldosterona (SRAA). FONTES DOS DADOS: Trata-se de uma revisão sistemática de acordo com os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada no PROSPERO sob ID: CRD42020200019. As buscas foram realizadas entre agosto de 2020 e dezembro de 2021 nas bases de dados: Medline via Pubmed, Biblioteca Cochrane Central, Scientific Electronic Library Online, e Literatura Latino-americana e do Caribe em Ciências da Saúde via Biblioteca Virtual em Saúde. Consultado os artigos sobre os efeitos do contraceptivo oral combinado nos valores da atividade da renina plasmática, valores plasmáticos da renina, valores do angiotensinogênio ­ também conhecido como substrato da renina plasmática ­, valores da angiotensina e/ou aldosterona. SELEçãO DOS ESTUDOS: Foram selecionados 877 estudos e, destes, 10 artigos preencheram os critérios de elegibilidade e foram incluídos nesta revisão. COLETA DE DADOS: Os dados foram combinados por meio de síntese qualitativa e inclusos em uma planilha elaborada previamente pelos autores. SíNTESE DOS DADOS: As amostras coletadas variavam entre 18 e 137 participantes, totalizando 501 mulheres com idade entre 18 e 49 anos em todos os estudos. Os estudos apresentaram aumento da atividade da renina plasmática, do substrato da renina plasmática, da angiotensina II e da aldosterona nessa população. CONCLUSãO: Os achados deste estudo sugerem que o COC promove maior ativação do SRAA. Apoiando a ideia de que o seu uso esteja relacionado ao aumento do risco de eventos cardiovasculares, incluindo a hipertensão arterial sistêmica.

Physical exercise in sickle cell anemia: a systematic review

Introduction and objective: Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. Methodology: We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. Results: Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. Conclusion: Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.

Anti-chikungunya virus seroprevalence in Indigenous groups in the São Francisco Valley, Brazil.

BACKGROUND: Chikungunya fever (CHIKF) is a serious public health problem with a high rate of infection and chronic disabling manifestations that has affected more than 2 million people worldwide since 2005. In spite of this, epidemiological data on vulnerable groups such as Indigenous people are scarce, making it difficult to implement public policies in order to prevent this disease and assist these populations. OBJECTIVE: To describe the serological and epidemiological profile of chikungunya virus (CHIKV) in two Indigenous populations in Northeast Brazil, as well as in an urbanized control community, and to explore associations between CHIKV and anthropometric variables in these populations. METHODOLOGY/PRINCIPAL FINDINGS: This is a cross-sectional ancillary study of the Project of Atherosclerosis among Indigenous Populations (PAI) that included people 30 to 70 years old, recruited from two Indigenous tribes (the less urbanized Fulni-ô and the more urbanized Truká people) and an urbanized non-Indigenous control group from the same area. Subjects underwent clinical evaluation and were tested for anti-CHIKV IgG by enzyme-linked immunosorbent assay. Serological profile was described according to ethnicity, sex, and age. The study population included 433 individuals distributed as follows: 109 (25·2%) Truká, 272 (62·8%) Fulni-ô, and 52 (12%) from the non-Indigenous urbanized control group. Overall prevalence of CHIKV IgG in the study sample was 49.9% (216; 95% CI: 45·1-54·7). When the sample was stratified, positive CHIKV IgG was distributed as follows: no individuals in the Truká group, 78·3% (213/272; 95% CI: 72·9-83·1) in the Fulni-ô group, and 5.8% (3/52; 95% CI: 1.21-16) in the control group. CONCLUSIONS/SIGNIFICANCE: Positive tests for CHIKV showed a very high prevalence in a traditional Indigenous population, in contrast to the absence of anti-CHIKV serology in the Truká people, who are more urbanized with respect to physical landscape, socio-cultural, and historical aspects, as well as a low prevalence in the non-Indigenous control group, although all groups are located in the same area.

Physical exercise in sickle cell anemia: a systematic review.

INTRODUCTION AND OBJECTIVE: Sickle cell anemia (SCA) is a genetic condition that alters the conformation of deoxygenated red blood cells, which results in their stiffening and the occurrence of vaso-occlusive crises, endothelium damage, organ dysfunction and systemic complications. Additionally, SCA limits the participation of individuals in physical and social activities. As we consider that physical exercise promotes the recovery of functional capacity and cardiorespiratory conditioning, we aim to verify the patterns of prescription, the effects and safety of exercise for individuals with SCA. METHODOLOGY: We systematically reviewed the published literature focusing on clinical trials that correlated physical exercise with SCA patients and cross-sectional studies that applied the stress test. The data research was based on the PRISMA recommendations and the following databases were used: Medline by PubMed, Cochrane, PEDro, Scielo. RESULTS: Six studies which were based on the evaluation of 212 patients aged between 13 and 40 years, were selected from 122 identified studies. Those studies associated the individual effort tolerance improvement, its inflammatory profile adjustment and the absence of alteration in the autonomic nervous system activity to physical exercise or stress test. CONCLUSION: Low-to-moderate intensity physical exercise increased the SCA individual tolerance without causing vaso-occlusive crises, nor changes in the hemorheological and inflammatory profiles.

Perfil epidemiológico e social de crianças e adolescentes com Anemia Falciforme e sua relação com a cárie dentária / Epidemiological and social profile of children and adolescents with sickle cell anemia and association with dental caries

Introdução: a Anemia Falciforme (AF) é a patologia hereditária monogênica mais prevalente associada à presença de hemoglobina SS no mundo. Pode provocar alterações no corpo, face e dentes dos indivíduos afetados, que podem levar a uma maior predisposição ao desenvolvimento da cárie dentária. Objetivo: avaliar o perfil epidemiológico e social de crianças e adolescentes com AF, a prevalência de cárie e influência da dieta. Metodologia: estudo de corte transversal com 124 indivíduos de 5 a 18 anos provenientes do ambulatório de referência em AF para o grupo AF (n=61) e sem hemoglobinopatias matriculados em colégio público da Bahia (n=63) para o grupo comparação. Anamnese, exame dos dentes e aplicação de questionários sobre a condição de saúde, história da doença e dieta foram realizados. Resultados: a maioria era da raça parda, cursava o 1º grau, a renda era de um salário mínimo, mas em relação à procedência, a maioria das crianças com AF era do interior. Estas também frequentavam mais as consultas odontológicas, apesar de o CPO-D ter sido maior (CPO-D=2,1) que o grupo comparação (CPO-D=1,1), bem como o ceo-d de 2,3 e 0,88, respectivamente. Crianças e adolescentes com AF consumiam menos carboidratos e tiveram um índice de cárie mais alto (ceo-d=2,0; CPO-D=4,2) que os do grupo comparação (ceo-d=0,9; CPO-D=1,0). O grupo com AF apresentou nível socioeconômico baixo e maior índice de cárie em ambas as dentições, apesar da dieta ter sido menos cariogênica. Conclusão: é possível que a prevalência maior de cárie para indivíduos com AF esteja associada a outros fatores inerentes à doença.

Introdution: sickle cell anemia (SCA) is the most prevalent hereditary monogenic pathology associated with the presence of SS hemoglobin in the world. It can affect ibody, face and teeth, which can lead to a higher predisposition to the development of dental caries. Objective: evaluate the epidemiological and social profile of children and adolescents with Sickle Cell Anemia (SCA), prevalence of caries and influence of diet. Methodology: a cross-sectional study was realized with 124 individuals ages of 5 to 18 years originated from the reference ambulatory in SCA for the SCA group (n=61) and without SCA matriculate in a public school in Bahia (n=63) for the comparation group. Anamnesis, teeth examination and application of questionnaires about health condition, disease and diet history were realized. Results: most of them were brown, was in elementary school, income of a minimum wage, but in relation to provenance, most children with SCA were from the countryside. These ones also attended more dental consultations, although the DMFT was higher than the comparation group, 2.1 and 1.1, as well as the dmft 2.3. and 0.88, respectively. Children and adolescents with SCA consumed less carbohydrates and had a higher caries index (dmft = 2.0; DMFT = 4.2) than those in the comparation group (dmft = 0.9; DMFT = 1.0). The group with SCA presented low socioeconomic level and higher caries index in both dentitions, even if the diet was less cariogenic. Conclusion: it is possible that higher prevalence of caries for individuals with SCA may be associated with other factors inherent to the disease.

Palmilhas de reprogramação postural na diminuição da pressão arterial e do desalinhamento postural em indivíduos hipertensos: ensaio clínico randomizado / Postural reprogramming insoles for blood pressure fall and posture misalignment in hypertensive individuals: randomized clinical trial

Testar a hipótese que Palmilhas de Reprogramação Postural (PRP) melhoram a postura e podem modificar média e picos de pressão arterial (PA) em indivíduos hipertensos. DESENHO DE ESTUDO: ECR, registrado no Clinical Trials (NCT02401516), com 24 indivíduos hipertensos. CONFIGURAÇÃO: Todos foram submetidos à Monitorização Ambulatorial da Pressão Arterial (MAPA) e avaliação da postura (SAPO) no início e após seis semanas. INTERVENÇÃO: grupo intervenção (GI) utilizou PRP e grupo controle (GC) SHAM. DESFECHO PRIMÁRIO: Médias da PA. DESFECHOS SECUNDÁRIOS: Picos de PA, durante vigília e sono e ângulo posturais. A melhora da postura ocorreu quando valores angulares diminuíram ou chegaram a zero. Para comparar a PA, foram utilizados os testes t de Student, pareado e não-pareado, com nível de significância de 5%. O tamanho do efeito (TDE) foi avaliado com D de Cohen. Para postura, Wilcoxon e Mann-Whitney. Variáveis categóricas, através do teste do Qui-quadrado. RESULTADOS: As variáveis de linha de base não diferiram entre grupos. Foram obtidos os seguintes deltas: pico da PAS em vigília (+9,3mmHgVs-7,5mmHg) (p<0,05, grande TDE); pico da PAS no sono (+2,3mmHgVs-6,8mmHg) (p<0,05, TDE moderado); e pico da PAD durante vigília (+3,2mmHgVs-4,7mmHg) (p<0,05, grande TDE), GC e GI respectivamente. Para os ângulos posturais, 33% da PAS foram explicados pelo deslocamento anterior do corpo. Para a PAD, 46% e 55%, pelos ângulos de Joelho e Tornozelo, respectivamente. CONCLUSÕES: A PRP reduziu picos de PAS e PAD durante vigília, sem efeito na média da PA. Embora PRP não tenha mostrado melhora na postura geral, o deslocamento anterior do corpo e os ângulos de joelho e tornozelo explicaram 33-55% da PA mais alta.

To test the hypothesis that Postural Reprogramming Insoles (PRI) improves posture and the effect of PRI on average and peaks of blood pressure (BP) in hypertensive individuals. DESIGN: RCT, registered at the Clinical Trials (NCT02401516), with 24 hypertensive individuals. SETTING: All patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and posture assessment (PAS/SAPO software) at the beginning and the end of six weeks. INTERVENTION: intervention group (IG) used PRI and control group (CG) SHAM. MAIN OUTCOME MEASURES: BP averages. SECONDARY OUTCOMES: BP peaks, during awake and asleep periods. Improvement of posture was determined when the angle values assessed decreased or reached zero (perfect alignment). To compare BP, paired, and unpaired Student's t-tests were used, significance level of 5%. Effect size (ES) was assessed with Cohen's D. For posture assessment, Wilcoxon and Mann-Whitney were applied to analysis. Categorical variables, through Chi-square test. RESULTS: Baseline variables did not differ between groups. The following deltas were obtained-SBP peak in awake period (+9.3mmHgVs-7.5mmHg) (p<0.05, great ES); SBP peak during sleeping period (+2.3mmHgVs-6.8mmHg) (p<0.05, moderate ES); and DBP peak during awake period (+3.2mmHgVs-4.7mmHg) (p<0.05, great ES), in control and intervention groups, respectively. For postural angles, 33% of SBP were explained by anterior body shift. For DBP, 46% and 55% were explained by Knee and Ankle Angles, respectively. CONCLUSIONS: PRI reduced SBP and DBP peaks during awake period, with no effect on BP average. Even though PRI has not shown any improvement in overall posture, anterior body displacement and knee and ankle angles would solely explain 33-55% of the highest BP.

Knowledge of academics and health professionals on Basic Life Support / Conhecimento de acadêmicos e profissionais de saúde sobre Suporte Básico de Vida

INTRODUCTION: Inadequate assessment and lack of knowledge of the applicable procedures in emergencies are factors that can result in greater population morbidity and mortality. OBJECTIVE: To systematically review studies in the national literature on the knowledge of academics and health professionals in basic life support and cardiorespiratory arrest. METHODS: Systematic review of studies published in journals indexed in SciELO and LILACS databases. Search terms: "Cardiopulmonary Resuscitation", "Basic Life Support", "Cardiac Arrest", "Health Education" and "Knowledge". Complete articles published until December 2018 were included. They analyzed the knowledge of students and/or graduated health professionals about basic life support and its procedures, as well as teaching strategies. Studies with undergraduate health professionals and/or with hospital conduct and/or advanced life support were excluded. RESULTS: Searches identified 60 articles, 16 of which were included. Of these, eleven were observational and five were intervention studies. The observational studies identified the lack of knowledge of 1,178 academics and 335 professionals about the identification of cardiorespiratory arrest, the sequence of basic life support, ventilation/compression ratio, interruption of compressions and use of the automatic external defibrillator. The intervention studies, involving 24 students and 189 professionals, indicated that active learning strategies can improve knowledge. CONCLUSION: Results indicate that students and graduated health professionals have limitations in their knowledge about the cardiopulmonary arrest and basic life support, which may result in great damage and short survival to emergency patients.

INTRODUÇÃO: Avaliação inadequada e desconhecimento dos procedimentos aplicáveis em emergências são fatores que podem resultar maior morbidade e mortalidade. OBJETIVO: Revisar sistematicamente estudos da literatura nacional sobre o conhecimento de acadêmicos e profissionais da saúde em suporte básico de vida e parada cardiorrespiratória. MÉTODOS: Revisão sistemática de estudos publicados em periódicos indexados nas bases SciELO e LILACS. Descritores: "Reanimação Cardiopulmonar", "Suporte Básico de Vida", "Parada Cardíaca", "Educação em Saúde" e "Conhecimento". Foram incluídos artigos completos publicados até dezembro de 2018. Esses analisaram o conhecimento de acadêmicos e/ou profissionais da saúde sobre suporte básico de vida e seus procedimentos, assim como, estratégias de ensino. Foram excluídos estudos com profissionais de nível técnico e/ou, com condutas hospitalares e/ou suporte avançado de vida. RESULTADOS: As buscas identificaram 60 artigos, sendo 16 incluídos. Desses, onze eram observacionais e cinco de intervenção. Os estudos observacionais identificaram o desconhecimento de 1.178 acadêmicos e 335 profissionais sobre a identificação da parada cardiorrespiratória, sequência do suporte básico de vida, relação ventilação/compressão, interrupção das compressões e uso do desfibrilador externo automático. Os estudos de intervenção, envolvendo 24 estudantes e 189 profissionais, indicaram que estratégias de aprendizagem ativas podem melhorar o conhecimento. CONCLUSÃO: Os resultados indicam que acadêmicos e profissionais da saúde apresentam limitações no conhecimento sobre parada cardiorrespiratória e suporte básico de vida, o que pode implicar em maiores agravos e menor sobrevida para pacientes em emergência.

Plasma Renin in Women Using and not Using Combined Oral Contraceptive

Abstract Backgroud: Recent studies show that women on combined oral contraceptives (COC) present abnormal fasting lipid profile, increased postprandial lipemia, plasma C-reactive protein (CRP) and blood pressure (BP) compared to women not on combined oral contraceptives. Plasma renin is one of the factors responsible for abnormal BP. Objectives: To assess plasma renin levels in women using or not using COC, the correlation between renin and CRP, as well as divergences in lipid profile. Methods: A cross-sectional study with apparently healthy women aged 20 to 30, eutrophic, irregularly active, and with fasting triglycerides < 150 mg/dL. The sample was stratified into two groups: the No Combined Oral Contraceptive Group (NCOCG), comprised of women who did not use any type of hormone contraceptive, and the Combined Oral Contraceptive Group (COCG) comprised of women on low-dose COC for at least one year. After a 12-hour fast, 5 ml of blood was collected for renin dosing and PCR. Data were analyzed by the t-Test and bidirectional Mann-Whitney Test, both with significance < 0.05. Results: We evaluated 44 women equally distributed between the groups, age 23 ± 1.2 years, BMI 21.0 ± 3.2 kg/m2. Median and interquartile deviation of renin in the NCOCG and the COCG were, respectively, 0.5 (0.1-1.0) and 3.0 (2-6) (p < 0.01). A positive correlation between PCR and renin (p < 0.01 and r = 0.68) was found. Conclusion: The plasma renin levels of women using COC were higher, with a strong correlation with CRP.

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease / Preditores de Desfecho Desfavorável em Crianças e Adolescentes Submetidos à Valvoplastia Mitral Cirúrgica Secundária a Cardiopatia Reumática Crônica

Abstract Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.

Resumo Fundamento: A plastia da valva mitral, em pacientes pediátricos com cardiopatia reumática crônica, é superior à troca valvar e vem sendo utilizada com bons resultados. Objetivo: Identificar variáveis preditoras de desfecho desfavorável em crianças e adolescentes submetidos à valvoplastia mitral cirúrgica secundária à cardiopatia reumática. Métodos: Estudo retrospectivo em 54 pacientes menores de 16 anos, operados em um hospital pediátrico terciário entre março de 2011 e janeiro de 2017. As variáveis preditoras de risco para desfecho desfavorável foram: idade, fração de ejeção, grau de insuficiência mitral, grau de hipertensão pulmonar, presença de insuficiência tricúspide, dilatação de câmaras esquerdas, classe funcional no pré-operatório, tempo de circulação extracorpórea, tempo de anóxia, presença de fibrilação atrial e tempo de uso de droga vasoativa. Os desfechos avaliados foram: morte, insuficiência cardíaca congestiva, reoperação, insuficiência mitral residual, estenose mitral residual, acidente vascular cerebral, sangramento e troca valvar. Para todas as análises foi estabelecido valor de p < 0,05 como significante. Resultados: Dos pacientes avaliados, 29 (53,7%) eram do sexo feminino, com média de idade de 10,5 ± 3,2 anos. A classe funcional de 13 pacientes (25%) foi 4. Não houve morte na amostra estudada. O tempo médio de circulação extracorpórea foi de 62,7 ± 17,8 minutos e de anóxia 50 ± 15,7 minutos. O tempo de uso de droga vasoativa no pós-operatório imediato teve mediana de 1 dia (intervalo interquartil 1-2 dias). O modelo de regressão logística foi utilizado para avaliar as variáveis preditoras para o desfecho desfavorável. O tempo de uso de droga vasoativa foi o único preditor independente para os desfechos estudados (p = 0,007). A insuficiência mitral residual foi associada à reoperação (p = 0,044), enquanto a insuficiência tricúspide (p = 0,012) e a hipertensão pulmonar (p = 0,012) se associaram à presença de desfechos desfavoráveis. Conclusão: O tempo de uso de droga vasoativa é um preditor independente para desfechos desfavoráveis no pós-operatório imediato e tardio, enquanto insuficiência mitral residual se associou à reoperação e tanto a insuficiência tricúspide quanto a hipertensão pulmonar foram associadas a desfechos desfavoráveis.

Dysfunction of the auditory system in sickle cell anaemia: a systematic review with meta-analysis.

OBJECTIVES: To describe the occurrence of both peripheral and central auditory system dysfunction in sickle cell anaemia (SCA) patients and discuss the different mechanisms hypothesised to be responsible for these alterations. METHODS: An electronic search was conducted using PubMed Central® (MEDLINE), LILACS® and Scopus® databases. This systematic review was performed in accordance with the PRISMA statement. Original observational studies that utilised audiological tests for auditory system evaluations in SCA were included. RESULTS: A total of 183 records were found in the databases searched. Twenty-one of these studies met the inclusion criteria. Pooled prevalence of sensorineural hearing loss (SNHL) was 20.5% (CI: 10.3-33%). Retrocochlear involvement was detected with the auditory brainstem response, which assesses integrity of the cochlea, 8th cranial nerve and brainstem structures. In addition, the increase in otoacoustic emission amplitudes in SCA patients indicates changes in cochlear micromechanics and precedes the expression of a detectable cochlear pathology. CONCLUSION: The prevalence of the SNHL is higher than in the general population. Dysfunction of the auditory system may be present in SCA patients, with the most probable mechanism being the presence of circulatory disturbances resulting from the chronic inflammatory state of the disease.

DYSFONCTIONNEMENT DU SYSTÈME AUDITIF DANS L'ANÉMIE FALCIFORME: REVUE SYSTÉMATIQUE ET MÉTA-ANALYSE: OBJECTIFS: Décrire l'apparition de dysfonctionnements du système auditif périphérique et central chez les patients atteints d'anémie falciforme (AF) et discuter des différents mécanismes supposés responsables de ces altérations. MÉTHODES: Une recherche électronique a été effectuée dans les bases de données PubMed Central® (MEDLINE), LILACS® et Scopus® . Cette revue systématique a été réalisée conformément au PRISMA Statement. Des études observationnelles originales utilisant des tests audiologiques pour évaluer le système auditif dans l'AF ont été incluses. RÉSULTATS: Un total de 183 enregistrements ont été trouvés dans les bases de données consultées. Vingt et une de ces études répondaient aux critères d'inclusion. La prévalence poolée de la perte auditive neurosensorielle (SNHL) était de 20,5% (IC: 10,3% à 33%). L'atteinte rétrocochléaire a été détectée avec la réponse du tronc cérébral auditif, qui évalue l'intégrité de la cochlée, du huitième nerf crânien et de la structure du tronc cérébral. De plus, l'augmentation des amplitudes des émissions otoacoustiques chez les patients atteints de l'AF indique des modifications de la micromécanique cochléaire et précède l'expression d'une pathologie cochléaire détectable. CONCLUSION: La prévalence de la SNHL est plus élevée que dans la population générale. Un dysfonctionnement du système auditif peut être présent chez les patients AF, le mécanisme le plus probable étant la présence de troubles circulatoires résultant de l'état inflammatoire chronique de la maladie.

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease.

BACKGROUND: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. OBJECTIVE: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. METHODS: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. RESULTS: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. CONCLUSION: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.