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RESUMO Objetivo identificar as evidências científicas sobre fitoterápicos utilizados no tratamento de pé diabético em pessoas idosas. Métodos revisão integrativa, realizada nas bases de dados Medical Literature Analysis and Retrieval System, SCOPUS, EMBASE, Web of Science e Latin American and Caribbean Health Sciences Literature. Utilizou-se a plataforma Rayyan, como ferramenta auxiliar para arquivamento, organização e seleção dos artigos. Resultados a busca resultou em 158 artigos. Após a estratégia de identificação, seleção, avaliação da elegibilidade, sistematização e leitura na íntegra, a amostra final foi de 10 artigos. Identificou-se fitoterápicos derivados de Calendula officinalis, Ageratina pichinchensis, Phellodendron chinense, Curcumin phytosome, Capsicum spp., Rehmannia Glutinosa e Astragalus membranaceus. Conclusão predominou a investigação de compostos fitoterápicos derivados de quatro plantas utilizados no tratamento do pé diabético em pessoas idosas. Considerações para a prática amparados pela legislação, os enfermeiros podem orientar usuários interessados em utilizar fitoterapia, como solução acessível e de eficácia comprovada.

ABSTRACT Objective to identify the scientific evidence on herbal medicines used in treating diabetic foot in older adults. Methods an integrative review conducted in the Medical Literature Analysis and Retrieval System, SCOPUS, EMBASE, Web of Science and Latin American and Caribbean Health Sciences Literature databases. The Rayyan platform was used as a supporting tool for archiving, organizing and selecting articles. Results the search resulted in 158 articles. After identifying, selecting, evaluating eligibility, systematization and performing a full reading of the articles, the final sample consisted of 10 articles. We identified herbal medicines derived from Calendula officinalis, Ageratina pichinchensis, Phellodendron chinense, Curcumin phytosome, Capsicum spp., Rehmannia Glutinosa and Astragalus membranaceus. Conclusion investigations of herbal compounds derived from four plants used in treating diabetic foot in older adults predominated. Considerations to practice supported by legislation, nurses can guide users interested in using phytotherapy as an accessible solution with proven efficacy.

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BACKGROUND: People living with HIV (PLHIV) present impaired muscle metaboreflex, which may lead to exercise intolerance and increased cardiovascular risk. The muscle metaboreflex adaptations to exercise training in these patients are unknown. The present study aims to investigate the effects of a supervised multimodal exercise training on hemodynamic and autonomic responses to muscle metaboreflex activation in PLHIV. METHODS AND DESIGN: In this randomized clinical trial protocol, 42 PLHIV aged 30-50 years will be randomly assigned at a ratio of 1:1 into an intervention or a control group. The intervention group will perform exercise training (3x/week during 12 weeks) and the control group will remain physically inactive. A reference group composed of 21 HIV-uninfected individuals will be included. Primary outcomes will be blood pressure and heart rate variability indices assessed during resting, mental stress, and activation of muscle metaboreflex by a digital sphygmomanometer and a heart rate monitor; respectively. Mental stress will be induced by the Stroop Color-Word test and muscle metaboreflex will be activated through a post-exercise circulatory arrest (PECA) protocol, being the latter performed without and with the application of a capsaicin-based analgesic balm in the exercised limb. Secondary outcomes will be heart rate, peripheral vascular resistance, stroke volume, cardiac output, blood lactate, anthropometric markers and handgrip maximal voluntary contraction. The intervention and control groups of PLHIV will be evaluated at baseline and after the intervention, while the HIV-uninfected reference group only at baseline. DISCUSSION: The findings of the present study may help to elucidate the muscle metaboreflex adaptations to exercise training in PLHIV. TRIAL REGISTRATION: This study will be performed at University of Rio de Janeiro State following registration at ClinicalTrials.gov as NCT04512456 on August 13, 2020.

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INTRODUCTION: Combination antiretroviral therapy (cART) substantially extended the life of people living with HIV (PLHIV). However, prolonged HIV infection and cART increase the risk of comorbidities accelerating age-related muscle, bone, and vascular disorders. This cross-sectional study compared muscle mass and strength, bone mineral density (BMD), and vascular function in middle-aged PLHIV treated with cART vs. non-infected age-matched and older controls. METHODS: After careful screening for secondary diseases and medications, body composition, muscular and vascular function were assessed in 12 PLHIV (43.9±8.7 yrs old; HIV-infection for 16.2±8.6 yrs; on cART for 11.6±9.2 yrs), 12 age-matched (CONT, 43.2±8.5 yrs old), and 12 older (OLDER, 74.4±8.3 yrs old) controls through dual x-ray absorptiometry, isokinetic dynamometry, and venous occlusion plethysmography, respectively. RESULTS: PLHIV and CONT showed similar relative muscle mass (65.3±8.0 vs. 66.9±7.3%, respectively; P= 0.88) and strength (160.7±53.9 vs. 152.0±52.9 N.m-1, respectively; P= 0.90), which were greater than OLDER (80.6±18.8 N.m-1; P= 0.001). Total BMD was similar in PLHIV (1.04±0.13 g.cm-2) and OLDER (1.00±0.15 g.cm-2, P= 0.86), and both groups presented lower values than CONT (1.20±0.13 g.cm-2, P< 0.01). No significant difference across groups was detected for macrovascular reactivity (P= 0.32). CONCLUSION: Age-related osteopenia might be accelerated in middle-aged PLHIV on prolonged cART, as their BMD approached values found in older adults. On the other hand, muscle mass, isokinetic strength, and vasodilation capacity were similar in PLHIV and age-matched uninfected controls.

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OBJECTIVE: Identify factors associated with the knowledge and attitude regarding male condom use in school adolescents. METHODS: Cross-sectional, quantitative, Knowledge, Attitude, and Practice survey, conducted with 114 adolescents from a public state high school from August to October 2017, in Fortaleza, Ceará, Brazil. RESULTS: The assumption of having sufficient knowledge regarding safe sex, not having a casual/dating partner, and having had three or more sexual partners in the last three months affected adequate knowledge. Higher education of the mother and not talking to the mother about sex were factors that influenced the inappropriate attitude of the participants. CONCLUSION: The knowledge and attitude of adolescents are influenced both by their previous sexual relations and by their relationship with their mother and the level of her schooling. Thus, it is essential that health institutions promote actions aimed at sex education, with support from schools and health professionals in general.

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BACKGROUND: Chagas heart disease (CHD) impairs the systemic microvascular function. We investigated the effects of exercise training on cutaneous microvascular function among patients with CHD. METHODS: Patients from the PEACH study were randomly assigned to a supervised exercise training 3 times/week for 6 months (Trained; n = 10) or a control group (Untrained; n = 8). Both groups underwent evaluation of microvascular function before, and at 3- and 6-months of follow-up. Cutaneous vascular conductance (CVC) was assessed in the skin of the forearm using laser speckle contrast imaging coupled with iontophoresis of acetylcholine (ACh), sodium nitroprusside (SNP) and during post-occlusive reactive hyperemia (PORH). RESULTS: At 3-months of follow-up, no difference was detected between groups in CVC responses to ACh (p = 0.50), SNP (p = 0.26) and HRPO (p = 0.65). However, at 6-months of follow-up, trained vs. untrained patients improved CVC induced by SNP-iontophoresis (0.19 ± 0.10 vs. 0.14 ± 0.15 APU.mmHg-1; p = 0.05) and PORH (0.63 ± 0.15 vs. 0.48 ± 0.18 APU.mmHg-1; p = 0.05). CVC response to ACh-iontophoresis was similar between groups (0.19 ± 0.11 vs. 0.22 ± 0.17 APU.mmHg-1; p = 0.38). CONCLUSION: Exercise training performed during 6 months improved the cutaneous microvascular function of CHD patients. Further studies evaluating the mechanism involved in this response are warranted.

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ABSTRACT Objective: Identify factors associated with the knowledge and attitude regarding male condom use in school adolescents. Methods: Cross-sectional, quantitative, Knowledge, Attitude, and Practice survey, conducted with 114 adolescents from a public state high school from August to October 2017, in Fortaleza, Ceará, Brazil. Results: The assumption of having sufficient knowledge regarding safe sex, not having a casual/dating partner, and having had three or more sexual partners in the last three months affected adequate knowledge. Higher education of the mother and not talking to the mother about sex were factors that influenced the inappropriate attitude of the participants. Conclusion: The knowledge and attitude of adolescents are influenced both by their previous sexual relations and by their relationship with their mother and the level of her schooling. Thus, it is essential that health institutions promote actions aimed at sex education, with support from schools and health professionals in general.

RESUMEN Objetivo: Identificar factores relacionados al conocimiento y conducta sobre el uso del preservativo masculino por adolescentes escolares. Métodos: Estudio cuantitativo, transversal, del tipo investigación Conocimiento, Conducta y Práctica, realizado con 114 adolescentes de escuela estatal de educación secundaria en el período de agosto a octubre de 2017, en Fortaleza, Ceará. Resultados: Considerar conocimiento sobre sexo seguro suficiente, no tener pareja ocasional y haber tenido tres o más parejas sexuales en los últimos tres meses, afectaron el conocimiento adecuado. Mayor escolaridad de la madre y no charlar con ella sobre sexo han sido factores que influenciaron la conducta inadecuada de los participantes. Conclusión: El conocimiento y la conducta de los adolescentes son influenciados tanto por sus relaciones sexuales previas como por la relación con la madre y por la escolaridad de ella. Así, se vuelve imprescindible que instituciones de salud promuevan acciones vueltas a la educación sexual, mediante apoyo de las escuelas y de profesionales de salud en general.

RESUMO Objetivo: Identificar fatores associados ao conhecimento e atitude sobre uso do preservativo masculino em adolescentes escolares. Método: Estudo quantitativo, transversal, do tipo inquérito Conhecimento, Atitude e Prática, realizado com 114 adolescentes de escola estadual de ensino médio no período de agosto a outubro de 2017, em Fortaleza, Ceará. Resultados: Considerar seu conhecimento sobre sexo seguro suficiente, não ter parceiro casual/ficante, e ter tido três ou mais parceiros sexuais nos últimos três meses afetaram o conhecimento adequado. Maior escolaridade da mãe e não conversar com a mãe sobre sexo foram fatores que influenciaram a atitude inadequada dos participantes. Conclusão: O conhecimento e a atitude dos adolescentes são influenciados tanto por suas relações sexuais prévias como pela relação com a mãe e pela escolaridade dela. Assim, torna-se imprescindível que as instituições de saúde promovam ações voltadas à educação sexual, mediante apoio das escolas e dos profissionais de saúde em geral.

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The present study describes and analyzes experimental results of a study performed with street vendors exposed to noise pollution by monitoring daily variations in cortisol levels taking into account the influence of variables such as age and body mass index (BMI). The study was conducted with 17 male street vendors, inhabitants of Uberlândia - Brazil, who work in the central region of the city. The levels of exposure to noise were assessed using an audio dosimeter and, every two hr, samples of saliva were collected for determination of salivary cortisol levels through an enzymatic immunoassay. The measured equivalent A-weighted sound level (LAeq) ranged from 70.2 to 76.6 dB (A) during the monitoring period of endogenous salivary cortisol levels. Morning levels of cortisol in street vendors were higher in older and overweight individuals. The noise levels to which the subjects were exposed were above the acoustic comfort threshold established by the World Health Organization and hence may be associated with severe discomfort and stress.

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Background: Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO2) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise ­ reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure

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This study compared macro- and microvascular endothelial function and redox status in active vs inactive HIV-infected patients (HIVP) under antiretroviral therapy. Using a cross-sectional design, macro- and microvascular reactivity, systemic microvascular density, and oxidative stress were compared between 19 HIVP (53.1 ± 6.1 year) enrolled in a multimodal training program (aerobic, strength and flexibility exercises) for at least 12 months (60-minutes sessions performed 3 times/wk with moderate intensity) vs 25 sedentary HIVP (51.2 ± 6.3 year). Forearm blood flow during reactive hyperemia (521.7 ± 241.9 vs 361.4% ± 125.0%; P = 0.04) and systemic microvascular density (120.8 ± 21.1 vs 105.6 ± 25.0 capillaries/mm2 ; P = 0.03) was greater in active than inactive patients. No significant difference between groups was detected for endothelium-dependent and independent skin microvascular vasodilation (P > 0.05). As for redox status, carbonyl groups (P = 0.22), lipid peroxidation (P = 0.86), catalase activity (P = 0.99), and nitric oxide levels (P = 0.72) were similar across groups. However, superoxide dismutase activity was greater in active vs inactive HIVP (0.118 ± 0.013 vs 0.111 ± 0.007 U/mL; P = 0.05). Immune function reflected by total T CD4 and T CD8 counts (cell/mm3 ) did not differ between active and inactive groups (P > 0.82). In conclusion, physically active HIVP exhibited similar immune function, but greater macrovascular reactivity, systemic microvascular density, and superoxide dismutase activity than inactive patients of similar age.

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Introduction: Combined antiretroviral therapy (cART) used to treat acquired immunodeficiency virus (HIV) induces a number of adverse effects, such as insulin resistance and dyslipidemia, which ultimately increases the cardiovascular risk. Advanced glycation end products (AGEs) have been implicated in the etiology of cardiovascular diseases, diabetes and other chronic diseases. It is known that physical exercise improves the lipid profile, insulin resistance and reduces the risk of cardiovascular diseases. However, the impact of physical exercise on AGE levels in HIV-infected patients has not been so far investigated. Therefore, this study compared AGEs levels in people with and without HIV and verified the effect of physical training on serum AGE levels. Methods: Participants were initially assigned into three groups: healthy control (CTL, n = 35), physically inactive HIV-infected (In-HIV, n = 33) and physically active HIV-infected (Ac-HIV, n = 19). The In-HIV group underwent physical training for 3 months, consisting of 60-min sessions of multimodal supervised exercise (aerobic, resistance and flexibility) with moderate intensity (50-80% heart rate reserve), performed 3 times/week. AGEs were measured in serum by fluorescence spectrometry. Results: At baseline, serum AGEs fluorescence level was significantly higher in inactive HIV-patients when compared to controls or active HIV-patients (In-HIV: 0.93 ± 0.08 vs. controls: 0.68 ± 0.13 and Ac-HIV: 0.59 ± 0.04 A.U.; P < 0.001). Triglycerides were also higher in In-HIV than CTL (182.8 ± 102 vs. 132.8 ± 52.3 mg/dL; P < 0.05). Waist circumference was lower in Ac-HIV, compared to In-HIV and controls (83.9 ± 10.4 vs. 92.9 ± 13.5 and 98.3 ± 12.4, respectively; P < 0.05). Body mass, fasting blood glucose, LDL, HDL, and total cholesterol were similar between groups. After training, AGE levels decreased (Baseline: 0.93 ± 0.08 vs. 3 months follow-up: 0.59 ± 0.04 AU; P < 0.001), no further difference being detected vs. CTL or Ac-HIV. Conclusion: HIV-infected patients under cART exhibited elevated AGEs levels compared to healthy individuals and physically active patients. Short-term aerobic training of moderate intensity counteracted this condition.

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OBJECTIVE: Adults with congenital heart disease share some features with those with chronic heart failure. Although microvascular endothelial dysfunction has been described in chronic heart failure, evaluation of the microcirculation in adults with congenital heart disease is lacking. The present study aimed to investigate systemic microvascular reactivity in adults with congenital heart disease. INTERVENTIONS: The patients initially underwent cardiopulmonary exercise testing. Then, the cutaneous microvascular reactivity was evaluated in these patients using a laser speckle contrast imaging system coupled with skin iontophoresis of endothelial-dependent (acetylcholine) or -independent (sodium nitroprusside) vasodilators and postocclusive reactive hyperemia (PORH) and compared with healthy controls matched for age and sex. RESULTS: Thirty-one patients and 29 healthy controls were evaluated. The basal microvascular flow (P < .0001) and area under the curve in response to acetylcholine (P < .0001) were higher in the patients than in the healthy volunteers. The increase in cutaneous vascular conductance in response to sodium nitroprusside was reduced in the patients compared to the healthy volunteers (P = .0031). No difference in the microvascular response was observed during postocclusive reactive hyperemia. The basal microvascular flow of patients with peak oxygen consumption below 16.0 mL kg-1 min-1 was superior to that of patients with values greater than 16.0 mL kg-1 min-1 (P = .0046). CONCLUSIONS: Adults with congenital heart disease present a higher baseline cutaneous microvascular blood flow than healthy controls and do not present systemic microvascular endothelial dysfunction. Nevertheless, endothelium-independent microvascular reactivity is blunted, suggesting an altered vascular smooth muscle response or vascular structural alterations. Finally, patients with a lower functional capacity presented a greater microvascular basal blood flow than subjects with a higher functional capacity.

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PURPOSE: This paper introduces a surgical technique for the sutureless management of zonular dialysis greater than 120° using a capsular tension segment (CTS) or a modified capsular tension ring (m-CTR; CTR with suturing eyelets) and a haptic removed from a 3-piece polypropylene IOL. METHODS: A CTR is used as normal. Cataract removal is followed by connection of the CTS or m-CTR to the single haptic and created using heat to make a flange in one haptic's extremity. The other extremity is placed in the CTS or m-CTR's central hole. The CTS or m-CTR/flanged-haptic complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 30-gauge needle guides the externalization of the free haptic extremity through the adjacent pars plana and creates a flange on the second haptic tip permitting intrascleral fixation of the CTS or m-CTR. RESULTS: The result is a successful IOL implantation with a sutureless technique. CONCLUSIONS: This double-flanged m-CTR/CTS technique allows suture-free option for managing zonular weakness or dialysis while performing cataract surgery.

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Farinatti, P, Paes, L, Harris, EA, Lopes, GO, and Borges, JP. A simple model to identify risk of sarcopenia and physical disability in HIV-infected patients. J Strength Cond Res 31(9): 2542-2551, 2017-Early detection of sarcopenia might help preventing muscle loss and disability in HIV-infected patients. This study proposed a model for estimating appendicular skeletal muscle mass (ASM) to calculate indices to identify "sarcopenia" (SA) and "risk for disability due to sarcopenia" (RSA) in patients with HIV. An equation to estimate ASM was developed in 56 patients (47.2 ± 6.9 years), with a cross-validation sample of 24 patients (48.1 ± 6.6 years). The model validity was determined by calculating, in both samples: (a) Concordance between actual vs. estimated ASM; (b) Correlations between actual/estimated ASM vs. peak torque (PT) and total work (TW) during isokinetic knee extension/flexion; (c) Agreement of patients classified with SA and RSA. The predictive equation was ASM (kg) = 7.77 (sex; F = 0/M = 1) + 0.26 (arm circumference; cm) + 0.38 (thigh circumference; cm) + 0.03 (Body Mass Index; kg·m) - 8.94 (R = 0.74; Radj = 0.72; SEE = 3.13 kg). Agreement between actual vs. estimated ASM was confirmed in validation (t = 0.081/p = 0.94; R = 0.86/p < 0.0001) and cross-validation (t = 0.12/p = 0.92; R = 0.87/p < 0.0001) samples. Regression characteristics in cross-validation sample (Radj = 0.80; SEE = 3.65) and PRESS (RPRESS = 0.69; SEEPRESS = 3.35) were compatible with the original model. Percent agreements for the classification of SA and RSA from indices calculated using actual and estimated ASM were of 87.5% and 77.2% (gamma correlations 0.72-1.0; p < 0.04) in validation, and 95.8% and 75.0% (gamma correlations 0.98-0.97; p < 0.001) in cross-validation sample, respectively. Correlations between actual/estimated ASM vs. PT (range 0.50-0.73, p ≤ 0.05) and TW (range 0.59-0.74, p ≤ 0.05) were similar in both samples. In conclusion, our model correctly estimated ASM to determine indices for identifying SA and RSA in HIV-infected patients.

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BACKGROUND: It remains unclear whether self-regulated exercise is sufficient to maintain the benefits acquired during formal cardiac rehabilitation (CR). This retrospective observational study investigated the effects of a home-based exercise intervention after discharge from CR upon anthropometric and aerobic capacity markers in clinically stable patients. METHODS: Fifty patients with cardiovascular disease were discharged after 6 months of CR and encouraged to maintain aerobic exercise without supervision. Subsequent to 6 months of follow-up, patients were assigned to compliant (n = 34) or noncompliant (n = 16) groups according to their compliance to the home-based program. Maximal aerobic capacity (VO2peak) and anthropometric data were assessed before CR, at discharge, and after 6 months of follow-up. RESULTS: No statistical differences between compliant and noncompliant groups were observed at baseline and at discharge from CR. At the end of the follow-up, statistical differences across groups were not found for body mass or body mass index, but increases in VO2peak (+3.6 vs. -0.6 ml/kg·min, P = 0.004) and oxygen pulse (+1.5 vs. +0.2 ml/bpm, P = .03) were greater in compliant than noncompliant group. CONCLUSIONS: Self-regulated exercising following CR discharge seems to be effective to maintain gains in exercise capacity acquired during supervised center-based programs.

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