RESUMO
BACKGROUND: Progressive disseminated histoplasmosis is a significant issue in Latin America, particularly in Brazil, contributing to high mortality rates. OBJECTIVES: Our objectives were to comprehensively describe histoplasmosis treatment with various amphotericin B (AmB) formulations, including mortality rates, adverse effects and risk factors for mortality. METHODS: This multicentre retrospective cohort study (January 2014-December 2019) evaluated medical records of patients with proven or probable histoplasmosis treated with at least two doses of AmB in seven tertiary medical centres in Brazil. We assessed risk factors associated with death during hospitalization using univariate and multivariate analyses. RESULTS: The study included 215 patients, mostly male (nâ=â158, 73%) with HIV infection (nâ=â187, 87%), and a median age of 40 years. Only 11 (5%) patients initiated treatment with liposomal amphotericin B (L-AmB). Amphotericin B deoxycholate (D-AmB) was administered to 159 (74%) patients without changes in the treatment. The overall mortality during hospitalization was 23% (50/215). Variables independently associated with mortality were use of D-AmB (OR 4.93) and hospitalization in ICU (OR 9.46). There was a high incidence of anaemia (nâ=â19, 90%), acute kidney injury (nâ=â96, 59%), hypokalaemia (nâ=â73, 55%) and infusion reactions (nâ=â44, 20%) during treatment. CONCLUSIONS: We found that D-AmB was the main formulation, which was also associated with a higher mortality rate. Lipid formulations of AmB have become more readily available in the public health system in Brazil. Further studies to evaluate the effectiveness of L-AmB will likely show improvements in the treatment outcomes for patients with disseminated histoplasmosis.
Assuntos
Anfotericina B , Antifúngicos , Histoplasmose , Humanos , Anfotericina B/uso terapêutico , Anfotericina B/efeitos adversos , Masculino , Histoplasmose/tratamento farmacológico , Histoplasmose/mortalidade , Feminino , Estudos Retrospectivos , Adulto , Antifúngicos/uso terapêutico , Antifúngicos/efeitos adversos , Pessoa de Meia-Idade , Brasil/epidemiologia , Ácido Desoxicólico/uso terapêutico , Ácido Desoxicólico/efeitos adversos , Fatores de Risco , Combinação de Medicamentos , Adulto Jovem , Hospitalização/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Idoso , Hipopotassemia/induzido quimicamente , Hipopotassemia/mortalidadeRESUMO
Introduction: Obesity is a multifactorial disease associated with the development of many comorbidities. This disease is associated with several metabolic alterations; however, it has been shown that some individuals with obesity do not exhibit metabolic syndrome. Adipose tissue neutralizes the detrimental effects of circulating fatty acids, ectopic deposition, and inflammation, among others, through its esterification into neutral lipids that are stored in the adipocyte. However, when the adipocyte is overloaded, i.e., its expansion capacity is exceeded, this protection is lost, resulting in fatty acid toxicity with ectopic fat accumulation in peripheral tissues and inflammation. In this line, this study aimed to investigate whether polymorphisms in genes that control adipose tissue fat storage capacity are potential biomarkers for severe obesity susceptibility and also metabolic complications. Methods: This study enrolled 305 individuals with severe obesity (cases, BMI≥35 kg/m2) and 196 individuals with normal weight (controls, 18.5≤BMI≤24.9 kg/m2). Demographic, anthropometric, biochemical, and blood pressure variables were collected from the participants. Plasma levels of leptin, resistin, MCP1, and PAI1 were measured by Bio-Plex 200 Multiplexing Analyzer System. Genomic DNA was extracted and variants in DBC1 (rs17060940), SIRT1 (rs7895833 and rs1467568), UCP2 (rs660339), PPARG (rs1801282) and ADRB2 (rs1042713 and rs1042714) genes were genotyped by PCR allelic discrimination using TaqMan® assays. Results: Our findings indicated that SIRT1 rs7895833 polymorphism was a risk factor for severe obesity development in the overdominant model. SIRT1 rs1467568 and UCP2 rs660339 were associated with anthropometric traits. SIRT1 rs1467568 G allele was related to lower medians of body adipose index and hip circumference, while the UCP2 rs660339 AA genotype was associate with increased body mass index. Additionally, DBC1 rs17060940 influenced glycated hemoglobin. Regarding metabolic alterations, 27% of individuals with obesity presented balanced metabolic status in our cohort. Furthermore, SIRT1 rs1467568 AG genotype increased 2.5 times the risk of developing metabolic alterations. No statistically significant results were observed with Peroxisome Proliferator-Activated Receptor Gama and ADRB2 polymorphisms. Discussion/Conclusion: This study revealed that SIRT1 rs7895833 and rs1467568 are potential biomarkers for severe obesity susceptibility and the development of unbalanced metabolic status in obesity, respectively. UCP2 rs660339 and DBC1 rs17060940 also showed a significant role in obesity related-traits.
RESUMO
This systematic review aimed to answer the focused question: "What are the benefits of subgingival periodontal therapy on blood hematological and biochemical index, biomarkers of inflammation and oxidative stress, quality of life, and periodontal pathogen counts in patients with obesity and periodontitis?". A systematic literature search was performed in six databases: PubMed, Embase, LILACS, Web of Science, Cochrane and SCOPUS and other sources, and a manual search was conducted as well. Inclusion criteria were randomized and non-randomized clinical trials, and before-and-after studies on patients with obesity subjected to periodontal therapy. The results were synthesized qualitatively. Risk of bias within studies was assessed using RoB 2 and ROBINS-I tools. The certainty of evidence was evaluated following the GRADE approach. Three randomized controlled trials and 15 before-and-after studies were included. Randomized controlled trials were considered to have a low risk of bias, as compared to before-and-after studies assessed as having low, serious, and critical risks of bias. Non-surgical periodontal therapy plus azithromycin, chlorhexidine, and cetylpyridinium chloride reduced blood pressure and decreased serum levels of HbA1c, hsCRP, IL-1ß, and TNF-α. Salivary resistin level also decreased in patients with obesity and periodontitis after therapy and chlorhexidine mouth rinse. Before-and-after data suggest an improvement in total cholesterol, LDL, triglycerides, insulin resistance, C3, GCF levels of TNF-α, chemerin, vaspin, omentin-1, visfatin, 8-OHdG, and periodontal pathogen counts after therapy.
Assuntos
Periodontite Crônica , Periodontite , Humanos , Clorexidina , Fator de Necrose Tumoral alfa , Qualidade de Vida , Periodontite/complicações , Periodontite/terapia , Obesidade/complicações , Obesidade/terapia , Periodontite Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: Data on the real-life use of amphotericin B lipid complex (ABLC) compared with other available formulations are limited. This study aimed to evaluate the effectiveness, tolerability, and safety of different amphotericin B (AMB) intravenously administered in the context of hospital practice for the treatment of invasive fungal infections (IFI) and to provide new insights into the profile of ABLC. METHODS: This is a multicenter, retrospective, observational study conducted at 10 tertiary Brazilian hospitals. Patients first exposed to any formulation of AMB for treating endemic and opportunistic IFI who had received at least 2 intravenous doses were screened. Retrospective data (from January 2014 to December 2019) were extracted from the patients' medical records. Clinical parameters were examined pre- and post-treatment to determine effectiveness; acute infusion-related side effects (IRSE) and drug interruption to determine tolerability; and adverse events, toxicity, and treatment interruption were stated to analyze safety. FINDINGS: Overall, 1879 medical records of patients were identified. The median (interquartile rate) duration of treatment was 14 (7-21) days. The overall success rate (95% confidence interval [CI]) was 65% (95% CI 60-65). ABLC proved to be effective among AMB formulations with 59% (95% CI 55.6-62.5) within complete response. This was significantly higher in patients who received the drug for a longer period, ≥4 weeks compared to <1 week treatment (P < 0.001). IRSE was observed in 446 (23.7%) patients. Eight cases (1.4%) of severe IRSE in pediatrics and 14 (1.1%) in adults resulted in treatment discontinuation. Regarding safety, 637 (33.9%) patients presented some alteration in creatinine levels during AMB exposure, and 89 (4.74%) had to interrupt or discontinue the drug within the first 14 days of therapy because of renal dysfunction. Overall mortality was 34%. IMPLICATIONS: ABLC is an effective formulation for the treatment of invasive fungal infections, with few adverse events leading to drug discontinuation or lethal outcomes. Furthermore, this real-life study confirmed the comparative safety of AMB lipid formulations versus AMB deoxycholate.
Assuntos
Anfotericina B , Antifúngicos , Infecções Fúngicas Invasivas , Humanos , Estudos Retrospectivos , Infecções Fúngicas Invasivas/tratamento farmacológico , Anfotericina B/efeitos adversos , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Masculino , Feminino , Antifúngicos/efeitos adversos , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Pessoa de Meia-Idade , Adulto , Resultado do Tratamento , Idoso , Brasil , Adolescente , Adulto JovemRESUMO
Abstract This systematic review aimed to answer the focused question: "What are the benefits of subgingival periodontal therapy on blood hematological and biochemical index, biomarkers of inflammation and oxidative stress, quality of life, and periodontal pathogen counts in patients with obesity and periodontitis?". A systematic literature search was performed in six databases: PubMed, Embase, LILACS, Web of Science, Cochrane and SCOPUS and other sources, and a manual search was conducted as well. Inclusion criteria were randomized and non-randomized clinical trials, and before-and-after studies on patients with obesity subjected to periodontal therapy. The results were synthesized qualitatively. Risk of bias within studies was assessed using RoB 2 and ROBINS-I tools. The certainty of evidence was evaluated following the GRADE approach. Three randomized controlled trials and 15 before-and-after studies were included. Randomized controlled trials were considered to have a low risk of bias, as compared to before-and-after studies assessed as having low, serious, and critical risks of bias. Non-surgical periodontal therapy plus azithromycin, chlorhexidine, and cetylpyridinium chloride reduced blood pressure and decreased serum levels of HbA1c, hsCRP, IL-1β, and TNF-α. Salivary resistin level also decreased in patients with obesity and periodontitis after therapy and chlorhexidine mouth rinse. Before-and-after data suggest an improvement in total cholesterol, LDL, triglycerides, insulin resistance, C3, GCF levels of TNF-α, chemerin, vaspin, omentin-1, visfatin, 8-OHdG, and periodontal pathogen counts after therapy.
RESUMO
INTRODUCTION: Few studies have evaluated the impact of bariatric surgery (BS) on thyroid function and morphology, and how it correlates to inflammatory and metabolic markers. We aimed to evaluate all those parameters together. METHODS: A longitudinal study included 70 patients with severe obesity. The bariatric group (BG) enrolled 40 patients who underwent BS, and the control group (CG) enrolled 30 patients who did not undergo BS. Both were submitted (pre- and 2nd-year) to thyroid ultrasound and laboratory analyses to determine the levels of thyroid hormones, inflammatory, and metabolic markers. RESULTS: Thyroid volume (TV) decreased after BS (-1.5 cm3), differing significantly from the CG (+0.6 cm3; p = 0.003). ΔTV was independently and positively correlated with ΔHOMA-IR (0.41 (0.11/7.16) p = 0.007) and ΔIL6 (0.02 (0.01/0.3) p = 0.016). A nonsignificant correlation between ΔTV and ΔBMI was detected (0.38 (-0.01/0.09) p = 0.152). We also observed a negative correlation between ΔTV and ΔTSH (-2.03 (-2.87/-1.19) p = 0.000) and ΔT3/T4 ratio (-0.06 (-0.09/-0.02) p = 0.001). TSH had a nonsignificant reduction with BS (-0.3872 vs. -0.2483 p = 0.128). The conversion of T4 to T3 had a significant increase after BS, as demonstrated by the T3/T4 ratio (+5.16 p = 0.01). Despite an increase in the prevalence of thyroid nodules in the BG, it was not statistically significant (p = 0.340). CONCLUSION: BS was associated with a reduction in TV and a nonstatistically significant reduction in TSH. The variations in TV were related to the metabolic markers and inflammatory changes. An increase in the conversion of T4 to T3 with BS was detected, possibly related to inflammatory improvement.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Humanos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Estudos Longitudinais , Obesidade Mórbida/cirurgia , TireotropinaRESUMO
ABSTRACT Objective To develop and validate predictive equations to estimate the body composition of women with grade III obesity, using the body mass index (BMI) as a predictive variable. Methods This cross-sectional study involved 104 patients treated at the hospital of the Universidade Federal do Rio de Janeiro randomly divided into two groups, the Equation Group, used to generate regression equations, and the Validation Group, used to validate the equations. Body fat mass (BFM), body fat percentage (BFP), skeletal muscle mass (SMM), fat-free mass (FFM) and total body water content (TBW) were valuated employing the bioimpedance method (InBody® 230). Results Polynomial equations exhibited the best fit and a general trend of results normalized by height squared presenting higher coefficients of determination (r2) was noted, positively affecting equation validations. Only one exception was observed, since the body fat percentage index (BFPI) resulted in an even lower correlation with BMI. Only these variables exhibited low r2 (0.11 to 0.29), while r2 values ranged from 0.51 to 0.94 for the other results. Conclusion Except for the BFP and BFPI, body composition can be estimated by the application of predictive BMI-based models. The equations employed for the indices normalized by the square of height were better predictors, while the use of equations that do not employ this normalization should consider the caveat that individuals with extreme BMI values (40 to 76 kg/m2) present greater estimate deviations in relation to the measured values.
RESUMEN Objetivo Desarrollar y validar ecuaciones predictivas para estimar la composición corporal de mujeres con obesidad III, utilizando el índice de masa corporal (IMC) como variable predictiva. Métodos Este estudio transversal involucró a 104 pacientes atendidos por el Hospital Universitario de la Universidad Federal de Río de Janeiro, divididos aleatoriamente en dos grupos. La masa de grasa corporal (MGC), el porcentaje de grasa corporal (PGC), la masa musculoesquelética (MME), la masa libre de grasa (MLG) y el contenido de agua total (ACT) fueron valorados por el método de bioimpedancia (InBody® 230). Resultados Las ecuaciones polinómicas presentaron un mejor ajuste y se observó una tendencia general de resultados normalizados, con mayores coeficientes de determinación (r2), lo cual afectó positivamente las validaciones de las ecuaciones. Se observó apenas una excepción, en relación con el PGC, pues el índice de porcentaje de grasa corporal (IPGC) tuvo una correlación menor con el IMC. Estas variables exhibieron un r2 bajo (0,11 a 0,29). Los valores de r2 oscilaron entre 0,51 y 0,94 para los demás resultados. Conclusión Con excepción del PGC y el IPGC, la composición corporal puede estimarse por medio de la aplicación de modelos predictivos basados en el IMC. Las ecuaciones empleadas por los índices normalizados por el cuadrado de la estatura fueron mejores predictores, en tanto que el uso de las ecuaciones que no emplean esa normalización debe considerar la advertencia de que individuos con valores extremos de IMC (40 a 76 kg/m2) presentan una mayor estimación de las desviaciones en relación con los valores medidos.
RESUMO
Cryptococcosis is traditionally associated with immunocompromised patients but is increasingly being identified in those without the human immunodeficiency virus (HIV) or other immunocompetent individuals. We aim to describe the characteristics, mortality, and associated variables with death among hospitalized patients with cryptococcosis in Brazil. This is the first multicenter retrospective cohort study conducted in seven public tertiary Brazilian hospitals. A total of 384 patients were included; the median age was 39 years and 283 (73.7%) were men. In all, 304 HIV-positive were hosts (79.2%), 16 (4.2%) solid organ transplant (SOT), and 64 (16.7%) non-HIV-positive/non-transplant (NHNT). Central nervous system (CNS) cryptococcosis had a significantly higher number across disease categories, with 313 cases (81.5%). A total of 271 (70.6%) patients were discharged and 113 (29.4%) died during hospitalization. In-hospital mortality among HIV-positive, SOT, and NHNT was 30.3% (92/304), 12.5% (2/16), and 29.7% (19/64), respectively. Induction therapy with conventional amphotericin B (AMB) mainly in combination with fluconazole (234; 84.2%) was the most used. Only 80 (22.3%) patients received an AMB lipid formulation: liposomal (n = 35) and lipid complex (n = 45). Most patients who died belong to the CNS cryptococcosis category (83/113; 73.4%) when compared with the others (P = .017). Multivariate analysis showed that age and disseminated cryptococcosis had a higher risk of death (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = .008 and OR, 1.84; 95% CI, 1.01-3.53; P = .048, respectively). Understanding the epidemiology of cryptococcosis in our settings will help to recognize the burden and causes of mortality and identify strategies to improve this scenario.
This multicenter cohort study included 384 hospitalized individuals with cryptococcosis in Brazil. Most individuals were men (74%), HIV-positive (79%), had central nervous system involvement (82%), and received conventional amphotericin plus fluconazole (84%). In-hospital mortality was high (29%).
Assuntos
Criptococose , Transplante de Órgãos , Masculino , Animais , Humanos , Feminino , Brasil/epidemiologia , Estudos Retrospectivos , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Criptococose/complicações , Criptococose/veterinária , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/veterinária , Anfotericina B/uso terapêutico , Lipídeos/uso terapêutico , Antifúngicos/uso terapêuticoRESUMO
PURPOSE: SH2B1 gene encodes an important adaptor protein to receptor tyrosine kinases or cytokine receptors associated with Janus kinases. This gene has been associated with the structural and functional modulation of neurons and other cells, and impacts on energy and glucose homeostasis. Several studies suggested that alterations in this gene are strong candidates for the development of obesity. However, only a few studies have screened SH2B1 point variants in individuals with obesity. Therefore, the aim of this study was to investigate the prevalence of SH2B1 variants in a Brazilian cohort of patients with severe obesity and candidates to bariatric surgery. METHODS: The cohort comprised 122 individuals with severe obesity, who developed this phenotype during childhood. As controls, 100 normal-weight individuals were included. The coding region of SH2B1 gene was screened by Sanger sequencing. RESULTS: A total of eight variants were identified in SH2B1, of which p.(Val345Met) and p.(Arg630Gln) variants were rare and predicted as potentially pathogenic by the in the silico algorithms used in this study. The p.(Val345Met) was not found in either the control group or in publicly available databases. This variant was identified in a female patient with severe obesity, metabolic syndrome and hyperglycemia. The p.(Arg630Gln) was also absent in our control group, but it was reported in gnomAD with an extremely low frequency. This variant was observed in a female patient with morbid obesity, metabolic syndrome, hypertension and severe binge-eating disorder. CONCLUSION: Our study reported for the first time two rare and potentially pathogenic variants in Brazilian patients with severe obesity. Further functional studies will be necessary to confirm and elucidate the impact of these variants on SH2B1 protein function and stability, and their impact on energetic metabolism. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.
Assuntos
Síndrome Metabólica , Obesidade Mórbida , Humanos , Feminino , Obesidade Mórbida/genética , Brasil , Estudos Transversais , Proteínas Adaptadoras de Transdução de SinalRESUMO
BACKGROUND AND OBJECTIVE: Amphotericin B deoxycholate (AMB-D) remains an antifungal agent with great therapeutic value in pediatric patients. The currrent consensus is that its use in neonates is safer than in older children. However, childhood presents different periods of development that deserve to be evaluated more precisely. Our goal was to assess the usage profile of AMB-D in stratified pediatric age groups, adapted according to the National Institute of Child Health and Human Development classification. METHODS: This retrospective cross-sectional observational study was conducted at a Brazilian tertiary children's hospital between January 2014 and December 2019. Data of patients who received at least two doses of intravenous AMB-D while hospitalized were extracted from electronic health files. Information on patient demographics, underlying diseases and comorbidities, laboratory examinations, fungal infection diagnosis, and AMB-D use were gathered following specific criteria. Nonparametric tests were applied, such as the chi-square test to compare proportions and Fisher's exact test to assess the association between categorical variables or contingency tables. RESULTS: One hundred and twenty-seven (127) medical records were stratified as preterm neonatal (birth <37 weeks postmenstrual age), term neonatal (birth-27 days), infants (28 days-12 months), toddlers (13 months-2 years), early childhood (3-5 years), middle childhood (6-11 years), and early adolescence (12-18 years). The criteria for the indication of AMB-D followed empirical use as the main indication (n = 74; 58.26%), proven and probable fungal infection (n = 39; 30.71%), and medical suspicion (n = 14; 11.02%). Candida spp. was the main etiologic agent isolated in cultures, with the highest frequency of C. albicans (n = 18; 40%), followed by Candida parapsilosis (n = 14; 31.11%), and Candida tropicalis (n = 6; 13.33%). Very few acute infusion-related adverse effects were observed during the administration of AMB-D in pediatric patients. We found an unfavorable impact of AMB-D use in patients from 13 months of age onwards suggesting this group as a turning point for a greater chance of adverse events, and not soon after the neonatal period. CONCLUSIONS: Clinical or observational studies based on age stratification are essential to accurately elucidate whether potentially toxic drugs can be used safely in the pediatric population. Our search for a turning point was shown to contribute to the accuracy of the study, as it provided data on the impact of D-AMB in specific pediatric age groups.
Assuntos
Anfotericina B , Micoses , Adolescente , Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Criança , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Recém-Nascido , Micoses/induzido quimicamente , Micoses/tratamento farmacológico , Estudos RetrospectivosRESUMO
A insuficiência renal crônica compromete as funções fisiológicas dos rins, e leva o paciente à diálise como terapia; contudo, essa condição gera suscetibilidade à desnutrição. O objetivo deste estudo foi descrever o perfil epidemiológico e nutricional dos pacientes em hemodiálise e compará-los em relação à doença renal de base. É estudo retrospectivo, descritivo e transversal. Foram coletados dados demográficos, clínicos, antropométricos e laboratoriais de pacientes que estiveram em diálise. Foram incluídos pacientes com insuficiência renal crônica e excluídos menores de 18 anos, com dados insuficientes ou com comorbidades que alterassem processo nutricional. Em conclusão, observaram-se 4 principais causas para doença renal crônica: hipertensão arterial crônica, doença renal policística, doença renal terminal e nefropatia diabética, que foi a mais prevalente, com pouca evidência de desnutrição
Chronic renal failure compromises the physiological functions of the kidneys and leads the patient to dialysis as a therapy; however, this condition generates susceptibility to malnutrition. The aim of this study was to describe the epidemiological and nutritional profile of patients on hemodialysis and to compare them in relation to the underlying renal disease. It is a retrospective, descriptive and cross-sectional study. Demographic, clinical, anthropometric and laboratory data were collected from patients who were on dialysis. Patients with chronic renal failure were included and those under 18 years of age, with insufficient data or with comorbidities that altered the nutritional process, were excluded. In conclusion, 4 main causes of chronic kidney disease were observed: chronic arterial hypertension, polycystic kidney disease, end-stage renal disease and diabetic nephropathy, which was the most prevalent, with little evidence of malnutrition
Assuntos
Humanos , Perfil de Saúde , Estudos Transversais , Diálise , Insuficiência Renal Crônica , Rim , Deficiências Nutricionais , DesnutriçãoRESUMO
A insuficiência renal crônica compromete as funções fisiológicas dos rins, e leva o paciente à diálise como terapia; contudo, essa condição gera suscetibilidade àdesnutrição. O objetivo deste estudo foi descrever o perfil epidemiológico e nutricional dos pacientes em hemodiálise e compará-los em relação à doença renal de base. Éestudo retrospectivo, descritivo e transversal. Foram coletados dados demográficos, clínicos, antropométricos e laboratoriais de pacientes que estiveram em diálise. Foram incluídos pacientes com insuficiência renal crônica e excluídos menores de 18 anos, com dados insuficientes ou com comorbidades que alterassem processo nutricional. Em conclusão, observaram-se 4 principais causas para doença renal crônica: hipertensão arterial crônica, doença renal policística, doença renal terminal e nefropatia diabética, que foi a mais prevalente, com pouca evidência de desnutrição
Chronic renal failure compromises the physiological functions of the kidneys and leads the patient to dialysis as a therapy; however, this condition generates susceptibility to malnutrition. The aim of this study was to describe the epidemiological and nutritional profile of patients on hemodialysis and to compare them in relation to the underlying renal disease. It is a retrospective, descriptive and cross-sectional study. Demographic, clinical, anthropometric and laboratory data were collected from patients who were on dialysis. Patients with chronic renal failure were included and those under 18 years of age, with insufficient data or with comorbidities that altered the nutritional process, were excluded. In conclusion, 4 main causes of chronic kidney disease were observed: chronic arterial hypertension, polycystic kidney disease, end-stage renal disease and diabetic nephropathy, which was the most prevalent, with little evidence of malnutrition.
Assuntos
Humanos , Adulto , Diálise Renal , Desnutrição , Insuficiência Renal Crônica , EpidemiologiaRESUMO
The present study aimed to evaluate the nutrient profile of packaged foods marketed in Brazil, giving insights into healthiness of the Brazilian supermarket packaged food environment, considering different food categories and levels of industrial food processing and presence of nutrition and health claims and marketing strategies. A cross-sectional survey was conducted on the labels of pre-packed foods marketed in a home-shopping website. A stratified random sample (n = 335) was obtained to be analysed by four nutrient profile models: Food Standards Australia New Zealand's Nutrient Profiling Scoring Criterion, UK Nutrient Profile from the Food Standards Agency, Nutrient profile model from Pan American Health Organization, and Nutrition Score from Unilever Food & Health Research (Unilever). Overall, the models shown agreement, besides some differences in the levels of approval. Ultra-processed foods were less healthy. Pass rates for products carrying nutrition and/or health claims have evidenced the presence of these claims may be indicative of slightly better nutritional quality. This did not apply for products with and without marketing techniques. These findings highlight the need for improvement of the supermarket packaged food environment in scenarios like Brazil by increasing efforts to reformulate products to make them healthier, together with appropriate food labelling regulation.
RESUMO
The cocoa bean shell is a residue rich in bioactive compounds and its use as an ingredient in the food industry has been studied. This work had the objective of proposing the elaboration of chocolate cake with substitution of wheat flour by cocoa bean shell powder (CSp). Five formulations with different percentages of CSp were used: 25%, 50%, 75%, 100% and 0% (control). The cakes were evaluated by technological characteristics (volume, texture profile, firmness and colour), antioxidant profile (DPPH, ß-carotene/linoleic acid system, phenolic compounds, anthocyanins and tannins) and sensory tests (TDS and acceptance). The technological characteristics and antioxidant activity of the cakes were influenced by the different concentrations of CSp compared to the control sample. The cakes containing up to 75% CSp presented satisfactory sensory acceptance. Therefore, CSp has been revealed to be a prominent alternative substitute ingredient to be used promisingly in the food industry.
Assuntos
Cacau , Chocolate , Antocianinas , Cacau/química , Farinha , Pós , TriticumRESUMO
Sertraline hydrochloride is a first-line antidepressant with potential antineoplastic properties because of its structural similarity with other drugs capable to inhibit the translation-controlled tumor protein (TCTP), a biomolecule involved in cell proliferation. Recent studies suggest it could be repositioned for cancer treatment. In this review, we systematically map the findings that repurpose sertraline as an antitumoral agent, including the mechanisms of action that support this hypotesis. From experimental in vivo and in vitro tumor models of thirteen different types of neoplasms, three mechanisms of action are proposed: apoptosis, autophagy, and drug synergism. The antidepressant is able to inhibit TCTP, modulate chemotherapeutical resistance and exhibit proper cytotoxicity, resulting in reduced cell counting (in vitro) and shrunken tumor masses (in vivo). A mathematical equation determined possible doses to be used in human beings, supporting that sertraline could be explored in clinical trials as a TCTP-inhibitor.
RESUMO
Abstract The literature that links career development with reading skills is scarce. This study seeks to fill this gap, for which the reading fluency of college students was analyzed, taking into account the choice of more/less desirable courses. Desirability is based on the classifications for college access. 211 students participated in the study, 132 female, attending four courses: Mechanical Engineering, Health, Psychology, and Education, in three Portuguese Public Universities. The instruments used were the sociodemographic form and the Teste de Idade de Leitura (Reading Age Test - TIL). The results indicated that students attending less desirable courses (i.e., Education and Health) are significantly less fluent and; students who score lower on reading fluency are more likely to belong to the Education course. This study stresses the importance of the distribution of students by the different areas of studies should not reflect reading fluency asymmetries.
Resumo A literatura que articula o desenvolvimento de carreira com a leitura é escassa. Este estudo teve como objetivo analisar a fluência leitora de estudantes universitários, considerando a escolha de cursos mais/menos desejados. A desejabilidade tem por base as classificações de acesso ao Ensino Superior. Participaram 211 estudantes, 132 de sexo feminino, a frequentar quatro cursos: Engenharia Mecânica, Saúde, Psicologia e Educação, em três instituições públicas de ensino superior portuguesas. Os instrumentos utilizados foram ficha sociodemográfica e Teste da Idade de Leitura- TIL. Os resultados indicaram que estudantes de cursos menos desejados (i.e., Educação e Saúde) são significativamente menos fluentes e; estudantes com menor fluência leitora são mais prováveis de pertencerem à Educação. Este estudo destaca a importância da distribuição pelas diferentes áreas de estudo não ser um espelho de assimetrias ao nível de competências leitoras.
Resumen La literatura que vincula desarrollo profesional con habilidades lectoras es escasa. Este estudio busca llenar este vacío, analizando la fluidez lectora de estudiantes universitarios en cursos más/menos deseables. La deseabilidad de los cursos se basa en las clasificaciones de acceso a la Universidad. Participaron 211 estudiantes, 132 mujeres, de cuatro cursos: Ingeniería Mecánica, Salud, Psicología y Educación, en tres universidades públicas portuguesas. Los instrumentos utilizados fueron la ficha sociodemográfica y el Test de Edad Lectora - TIL. Los resultados indican que los estudiantes de cursos menos deseables (Educación y Salud) son significativamente menos fluentes y; estudiantes con puntuación más baja en fluidez tienen más probabilidades de pertenecer al curso de Educación. Este estudio destaca la importancia de que la distribución por las diferentes áreas de estudio en la universidad no sea un espejo de asimetrías en el nivel de habilidades lectoras.
Assuntos
Humanos , Masculino , Feminino , Leitura , Estudantes , Universidades , Escolha da ProfissãoRESUMO
Obesity is a pandemic condition of complex etiology, resulting from the increasing exposition to obesogenic environmental factors combined with genetic susceptibility. In the past two decades, advances in genetic research identified variants of the leptin-melanocortin pathway coding for genes, which are related to the potentiation of satiety and hunger, immune system, and fertility. Here, we review cases of congenital leptin deficiency and the possible beneficial effects of leptin replacement therapy. In summary, the cases presented here show clinical phenotypes of disrupted bodily energy homeostasis, biochemical and hormonal disorders, and abnormal immune response. Some phenotypes can be partially reversed by exogenous administration of leptin. With this review, we aim to contribute to the understanding of leptin gene mutations as targets for obesity diagnostics and treatment strategies.
Assuntos
Leptina/uso terapêutico , Obesidade/tratamento farmacológico , Obesidade/genética , Metabolismo Energético/genética , Terapia de Reposição Hormonal , Humanos , Leptina/deficiência , Leptina/genética , Mutação , Obesidade/congênito , FenótipoRESUMO
Abstract Background: Obesity has repercussions on functional capacity (FC). The six-minute walk test (6MWT) is a useful tool for assessing submaximal FC, and the distance reached at 6 minutes of walking (D6MW) is a relevant prognostic marker. Objective: This paper aims to establish a reference equation for the distance predicted in 6MWT in obese Brazilian subjects. Methods: This study included 460 patients (306 women), with a body mass index (BMI) > 30 kg/m2, 71% (328) of whom presented a grade III obesity (BMI ≥ 40 Kg/m²) and were evaluated with 6MWT. Heart rate, blood pressure, oxygen saturation and Borg scale perception of effort were recorded before and after the 6MWT. For statistical analysis, Kolmogorov-Smirnov tests, an unpaired T-Test, Pearson's correlation, and multiple linear regression were used, together with a significance level set at p<0.05. Results: Gender, age, and BMI were significantly correlated with D6MW and were identified by multiple linear regression as the best predictors of the D6MW. Together, they explain 48.7% of the D6MW variance for obese Brazilian subjects. Based on these findings, an equation was proposed - D6MW = 930.138 + (27.130 x Genderfemales = 0; males = 1) − (5.550 x BMI kg/m2) − (4.442 x Age years). When the average of the D6MW obtained with the above equation was compared to the average calculated with the equations described in medical literature for healthy and obese individuals, the latter tended to overestimate the D6MW. Conclusion: The proposed reference equation exhibited better assessment of FC in obese Brazilian patients, providing proper subsidies for the follow up ofinterventions in this population..
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Teste de Caminhada/métodos , Obesidade/diagnóstico , Valores de Referência , Tolerância ao Exercício , Aptidão Cardiorrespiratória , Obesidade/complicações , Obesidade/mortalidade , Obesidade/prevenção & controleRESUMO
Introduced in the late 1950s, polyenes represent the oldest family of antifungal drugs. The discovery of amphotericin B and its therapeutic uses is considered one of the most important scientific milestones of the twentieth century . Despite its toxic potential, it remains useful in the treatment of invasive fungal diseases owing to its broad spectrum of activity, low resistance rate, and excellent clinical and pharmacological action. The well-reported and defined toxicity of the conventional drug has meant that much attention has been paid to the development of new products that could minimize this effect. As a result, lipid-based formulations of amphotericin B have emerged and, even keeping the active principle in common, present distinct characteristics that may influence therapeutic results. This study presents an overview of the pharmacological properties of the different formulations for systemic use of amphotericin B available for the treatment of invasive fungal infections, highlighting the characteristics related to their chemical, pharmacokinetic structures, drug-target interactions, stability, and others, and points out the most relevant aspects for clinical practice.
RESUMO
The effect of the flavor enhancers monoammonium glutamate (MAG), monosodium glutamate (MSG), disodium guanylate (GMP), and disodium inosinate (IMP) on intensifying salty taste in food matrices (shoestring potatoes, requeijão cheese, and beef burgers) with a reduction in the amount of sodium chloride (NaCl) present was evaluated. Experiments were conducted using a central composite rotational design with two variables: the concentrations of flavor enhancer and NaCl added in the food matrix. The effect of IMP was not significant (P > 0.05) on the intensity of salty taste in any of the matrices analyzed. GMP presented lower performance compared to MAG and MSG in intensifying the salty taste of the treatments, regardless of the reduction of NaCl. Compared to MSG and GMP, MAG showed greater efficiency in intensifying the salty taste in requeijão cheese and beef burger with a reduction of 25%, 50%, 75%, and 100% of NaCl. MSG presented higher efficiency compared to MAG and GMP when applied in shoestring potatoes for all reductions of NaCl tested (25%, 50%, and 75%). The ability of flavor enhancers to improve the salty taste depends on the effect of the flavor enhancer, the complexity of the food matrix, and the reduction of NaCl in foods. PRACTICAL APPLICATIONS: The complexity of the food matrix plays a significant role in the perception of salty taste in sodium-reduced products. In these products, sodium reduction may affect the taste enhancer's effect of enhancing salty taste. Therefore, this study broadens the knowledge of the effects of flavor enhancers on different foods, as well as the ability to enhance salty taste in food matrices with NaCl reduction. Moreover, it provides information on how to reduce the sodium content in these matrices while maintaining the same perception of salty taste as a conventional matrix.