Cross-sectional evaluation of socioeconomic and clinical factors and the impact of fibromyalgia on the quality of life of patients during the COVID-19 pandemic

Abstract BACKGROUND: The fibromyalgia impact questionnaire (FIQ) relates to the functional capacity, professional situation, psychological disorders, and physical symptoms, and can identify the factors that determine the impact of the syndrome and characteristics of its carriers; the higher the score, the greater the impact of fibromyalgia on the quality of life. OBJECTIVE: To evaluate the impact of fibromyalgia on the quality of life of individuals with fibromyalgia, who were categorized according to the FIQ during the coronavirus disease pandemic. DESIGN AND SETTING: A cross-sectional study was conducted at an institution of higher education in Taquara, RS, Brazil. METHODS: A quantitative study was carried out, with the application of a sociodemographic and clinical questionnaire, and the FIQ in 163 Brazilian individuals with a medical diagnosis of fibromyalgia. Data were collected using SurveyMonkey software. RESULTS: Of the female carriers, 98.2% were living in urban areas, working, and under pharmacological and complementary treatment. The FIQ results showed that seven of the 10 items had the maximum score. The items "physical function" and "feel good" had intermediate scores, and the item "missed work" had a low score. The average total score was 79.9 points, indicating that fibromyalgia had a severe impact on the participants' lives. A severe impact of fibromyalgia was observed in 61.3% of the participants, a moderate impact in 30.7%, and a low impact in 8%. CONCLUSION: The survey findings suggest a severe impact in the majority of the Brazilian fibromyalgic population.

Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

ABSTRACT Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2max (−5.84 mL.kg−1.min−1, 95% CI −6.93, −4.76 mL.kg−1.min−1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (−93.30 meters, 95% CI −141.2, −45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

Avaliação transversal dos indicadores de saúde do programa nacional de triagem neonatal de um município do Vale do Paranhana / Cross-sectional evaluation of health indicators of the national neonatal screening program in a city of Vale do Paranhana

Objetivo: avaliar indicadores do programa nacional de triagem neonatal (PNTN) e de saúde no município de Rolante, RS, Brasil. Método: estudo transversal, por meio dos prontuários eletrônicos cadastrados entre janeiro de 2017 e julho de 2020. Foi realizado o cálculo dos indicadores do PNTN dos anos de 2017 a 2019, e análise de outras variáveis de saúde como: período e local da coleta, peso e idade de nascimento, idade materna, realização de pré-natal, realização da consulta, resultado do exame e recoleta. Resultado: a cobertura variou entre 201 de 256 (78,5%) e 229 de 272 (84,2%). Das 734 coletas 544 (74,1%) foram realizadas no período de três a cinco dias de vida, preconizado pelo Ministério da Saúde. A mediana da idade do RN na primeira consulta foi superior a 15 dias em todas as doenças triadas, exceto fenilcetonúria e deficiência de biotinidase, no período avaliado. Conclusão: a partir dos resultados foi possível observar que a cobertura do município correspondeu aos dados nacionais e estaduais no período. E, ainda que o percentual de coletas realizadas na data ideal tenha sido alto, a idade preconizada na primeira consulta não foi cumprida na maior parte das patologias

Objective: to evaluate neonatal screening national program (PNTN) and health indicators in the Rolante city, RS, Brazil.Method: cross-sectional study, using electronic medical records registered between January 2017 and July 2020. The calculation of the PNTN indicators from 2017 to 2019 was carried out. And analysis of other health variables such as: period and place of collection, weight and age at birth, maternal age, prenatal care, consultation, test results and collection. Result: coverage ranged from 201 out of 256 (78.5%) to 229 out of 272 (84.2%). Of the 734 collections, 544 (74.1%) were performed within the period of 3 to 5 days of life, recommended by the Ministry of Health. The median age of the NB at the first consultation was greater than 15 days in all screened diseases, except for phenylketonuria and biotinidase deficiency, in the period evaluated.Conclusion: from the results it was possible to observe that the coverage of the municipality corresponded to the national and state data in the period. And even though the percentage of collections carried out on the ideal date was high, the recommended age at the first consultation was not met in most pathologies

Maintenance of plasma glucose variability after an acute session of aerobic exercise despite changes in insulin and glucagon-like peptide-1 levels in type 2 diabetes

ABSTRACT Objective: The present study aimed to evaluate glucose variability and hormonal responses during and after an aerobic exercise session performed after breakfast in type 2 diabetes patients treated with metformin. Materials and methods: In this quasi-experimental study individuals underwent clinical and laboratory evaluations and maximal exercise test. After two weeks an aerobic exercise session (30 minutes at 60%-70% of the peak heart rate) was performed. At rest, during and after the exercise session, glucose variability (mean amplitude glucose excursions, glucose coefficient of variation, and glucose standard deviation) and levels of plasma glucose, insulin, glucagon, and glucagon-like-peptide-1 were evaluated. Results: Thirteen patients were enrolled in the study. Plasma glucose increased at 15 minutes during the exercise session (244.6 ± 61.9 mg/dL), and decreased at 60 min after exercise (195.6 ± 50.0 mg/dL). Glucose variability did not show any difference before and after exercise. Insulin levels at 15 min [27.1 µU/mL (14.2-42.1)] and 30 min [26.3 µU/mL (14.6-37.4)] during the exercise were higher than those at fasting [11.2 µU/mL (6.7-14.9)] but decreased 60 minutes after exercise (90 minutes) [16.6 µU/mL (8.7-31.7)]. Glucagon levels did not show any difference. GLP-1 levels increased at 30 min [7.9 pmol/L (7.1-9.2)] during exercise and decreased 60 min after exercise (90 minutes) [7.7 pmol/L (6.8-8.5)]. Conclusion: Subjects with type 2 diabetes presented expected changes in insulin, glucagon and GLP-1 levels after breakfast and a single aerobic exercise session, not accompanied by glycemic variability changes.

Avaliação da atividade física e qualidade de vida da enfermagem / Physical activity assessment and quality of life in nursing

Objetivo:avaliar o nível de atividade física, índice de massa corporal e a qualidade de vida dos acadêmicos de enfermagem e enfermeiros do Rio Grande do Sul. Método: trata-se de um estudo transversal, com aplicação de questionários digitais de anamnese e para levantamento donível de atividade física, pelo International Physical Activity Questionnaire,e da qualidade de vida,por meio do Short Form-36. Os dados foram coletados e analisados pelossoftwaresSurveyMonkeye SPSS (teste de Mann-Whitney e qui-quadrado).Resultados: os resultados do questionário de atividade físicamostraram que um total de 22(25%) indivíduos apresentava nível de atividade física insuficiente, 33 (37%) eram suficientemente ativose 34 (38%) muito ativos. O índice de massa corporaldos enfermeiros e acadêmicos apresentou uma média de 24,7 (22-29) kg/m².Avaliando a qualidade devida segundo os domínios do questionário, observou-se que osenfermeiros e acadêmicosapresentam alta capacidade funcional (90% do máximo), porém osdemais domínios da qualidade de vida apresentam-se com valores abaixo de 75% do máximo possível. Conclusão: amaioria dos enfermeiros e acadêmicos possuem níveis satisfatórios de atividade física, índice de massa corporal dentro dos parâmetros recomendados e qualidade de vida parcialmente adequada.

Objective: evaluate the level of physical activity, body mass index and quality of life of nursing students and nurses in Rio Grande do Sul. Method:this was a cross-sectional study, with application of digital questionnaires for anamnesis and for survey of the level of physical activity, by the International Physical Activity Questionnaire, and of the quality of life, by means of the Short Form-36.Data were collected and analyzed by SurveyMonkey and SPSS software(Mann-Whitney and chi-square test). Results:the results of the physical activity questionnaire showed that a total of 22 (25%) individuals had insufficient level of physical activity, 33 (37%) were sufficiently active and 34(38%) were very active. The body massindex of the nurses and students had a mean of 24.7 (22-29) kg/m². Evaluating the quality of life according to the domains of the questionnaire, it was observed that the nurses and academics had high functional capacity (90% of the maximum), but the otherdomains of quality of life presented values below 75% of the maximum possible.Conclusion:most nurses and students have satisfactory levels of physical activity, body mass index within the recommended parameters and partially adequate quality of life

Biochemical and Molecular Mechanisms of Glucose Uptake Stimulated by Physical Exercise in Insulin Resistance State: Role of Inflammation / Mecanismos Bioquímicos e Moleculares da Captação da Glicose Estimulada pelo Exercício Físico no Estado de Resistência à Insulina: Papel da Inflamação

Abstract Obesity associated with systemic inflammation induces insulin resistance (IR), with consequent chronic hyperglycemia. A series of reactions are involved in this process, including increased release of proinflammatory cytokines, and activation of c-Jun N-terminal kinase (JNK), nuclear factor-kappa B (NF-κB) and toll-like receptor 4 (TLR4) receptors. Among the therapeutic tools available nowadays, physical exercise (PE) has a known hypoglycemic effect explained by complex molecular mechanisms, including an increase in insulin receptor phosphorylation, in AMP-activated protein kinase (AMPK) activity, in the Ca2+/calmodulin-dependent protein kinase kinase (CaMKK) pathway, with subsequent activation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), Rac1, TBC1 domain family member 1 and 4 (TBC1D1 and TBC1D4), in addition to a variety of signaling molecules, such as GTPases, Rab and soluble N-ethylmaleimide-sensitive factor attached protein receptor (SNARE) proteins. These pathways promote greater translocation of GLUT4 and consequent glucose uptake by the skeletal muscle. Phosphoinositide-dependent kinase (PDK), atypical protein kinase C (aPKC) and some of its isoforms, such as PKC-iota/lambda also seem to play a fundamental role in the transport of glucose. In this sense, the association between autophagy and exercise has also demonstrated a relevant role in the uptake of muscle glucose. Insulin, in turn, uses a phosphoinositide 3-kinase (PI3K)-dependent mechanism, while exercise signal may be triggered by the release of calcium from the sarcoplasmic reticulum. The objective of this review is to describe the main molecular mechanisms of IR and the relationship between PE and glucose uptake.

Resumo A obesidade associada à inflamação sistêmica induz resistência à insulina (RI), com consequente hiperglicemia crônica. Este processo envolve o aumento na liberação de citocinas pró-inflamatórias, ativação da enzima c-Jun N-terminal cinase (JNK), do fator nuclear kappa-B (NF-κB) e dos receptores do tipo Toll 4 (TLR4). Dentre as ferramentas terapêuticas disponíveis, o exercício físico (EF) tem efeito hipoglicemiante conhecido, explicado por mecanismos moleculares complexos. Dentre eles, ocorre aumento na fosforilação do receptor da insulina, na atividade da proteína quinase ativada por AMP (AMPK), na via da proteína cinase cinase dependente de Ca+2/calmodulina (CaMKK), com posterior ativação do coativador-1α do receptor ativado por proliferador do peroxissoma (PGC-1α), proteínas Rac1, TBC1 membro das famílias de domínio 1 e 4 (TBC1D1 e TBC1D4), além de uma variedade de moléculas de sinalização, como as proteínas GTPases, Rab e proteína solúvel de fusão sensível a N-etil-maleimida (SNARE); estas vias promovem maior translocação de transportador de glicose do tipo 4 (GLUT4) e consequente captação de glicose pelo músculo esquelético. A cinase fosfatidilinositol-dependente (PDK), proteína quinase C atípica (aPKC) e algumas das suas isoformas, como a PKC-iota/lambda também parecem desempenhar papel fundamental no transporte de glicose. Nesse sentido, a associação entre autofagia e EF também tem demonstrado papel relevante na captação de glicose muscular. A insulina, por sua vez, utiliza um mecanismo dependente da fosfatidilinositol-3-quinase (PI3K), enquanto que o sinal do EF pode ter início mediante liberação de cálcio pelo retículo sarcoplasmático e concomitante ativação da AMPK. O objetivo desta revisão é descrever os principais mecanismos moleculares da RI e da relação entre o EF e a captação de glicose.

O papel do fator nuclear eritroide 2 relacionado ao fator 2 (Nrf2) no diabetes mellitus / The role of factor 2 erythroid nuclear factor 2 (Nrf2) in diabetes mellitus

O diabetes mellitus (DM) é uma doença metabólica complexa. Sua etiologia é atribuída a uma combinação entre fatores genéticos, ambientais e de estilo de vida. Contudo, sabe-se que o estresse oxidativo desempenha papel crucial na patogênese do DM, acarretando em disfunção das células ß pancreáticas e resistência à insulina. Neste contexto, o fator nuclear eritroide 2 relacionado ao fator 2 (Nrf2) é considerado o regulador mestre da resposta antioxidante do organismo, sendo um mecanismo de importância crítica para a manutenção da homeostase e sobrevivência celular. Todavia, a função do Nrf2 não se limita somente à resposta antioxidante. Ao interagir com outras vias metabólicas, o Nrf2 possui importante papel na regulação do metabolismo, atuando no metabolismo dos lipídios, manutenção da glicemia, resposta inflamatória, entre outros. Entretanto, a exata relação do Nrf2 com outras vias metabólicas ainda não é totalmente conhecida. Contudo, sabe-se que o comprometimento da função do Nrf2 é evidente na fisiopatologia do DM bem como no desenvolvimento de suas complicações clínicas. A ativação do Nrf2 protege contra os danos mediados pelo DM, podendo ser adequada uma intervenção exógena para aumentar a sua atividade (AU)

Diabetes mellitus (DM) is a complex metabolic disease. Its etiology is attributed to a combination of genetic, environmental, and lifestyle factors. However, it is known that oxidative stress plays a crucial role in the pathogenesis of DM, leading to pancreatic ß-cell dysfunction and insulin resistance. In this context, the nuclear factor- erythroid 2-related factor 2 (Nrf2) is considered the main regulator of the body's antioxidant response, being a mechanism of critical importance in the maintenance of homeostasis and cell survival. However, the role of Nrf2 is not limited to the antioxidant response alone. When interacting with other metabolic pathways, Nrf2 plays an important role in regulating metabolism, acting on lipid metabolism, in the maintenance of glycemia, and in inflammatory response, among others. However, the exact relationship of Nrf2 with other metabolic pathways is not yet fully understood. Nevertheless, impairment of Nrf2 function is known to be evident in the pathophysiology of DM as well as in the development of its clinical complications. Activation of the Nrf2 protects against damage mediated by DM, and an exogenous intervention may be adequate to increase its activity (AU)

Perfil farmacoterapêutico de pacientes obesos no pós-operatório de cirurgia bariátrica / Pharmacotherapeutic profile of obese patients during the postoperative period after bariatric surgery

Resumo Contexto A obesidade pode estar relacionada a doenças como diabetes, hipertensão arterial e dislipidemia. A cirurgia bariátrica é um dos tratamentos mais eficazes, levando à diminuição de peso e comorbidades. Objetivo Avaliar o perfil metabólico e farmacoterapêutico de pacientes obesos após cirurgia bariátrica. Métodos Trata-se de um estudo observacional transversal retrospectivo, realizado em um hospital localizado na cidade de Porto Alegre, RS, Brasil. Foram avaliados 70 prontuários de pacientes que realizaram cirurgia bariátrica, nos períodos de antes de 2 meses e mais de 6 meses após a cirurgia bariátrica. A análise estatística foi realizada no programa SPSS 17.0®. Resultados A pressão arterial inicial foi de 130/85 mmHg, passando para 120/80 mmHg (p < 0,01). Com relação ao perfil metabólico antes de dois meses, o HDL foi de 34 mg/dL, o colesterol total foi de 195,07 ± 40,17 mg/dL, o LDL foi de 118,22 ± 41,28 mg/dL, os triglicerídeos foram de 141,09 ± 43,39 mg/dL, e a glicemia de jejum foi de 90 mg/dL. Após 6 meses de cirurgia, os valores passaram para 43 mg/dL, 133,67 ± 28,14 mg/dL, 65,53 ± 24,3 mg/dL, 104,41 ± 29,6 mg/dL, e 77 mg/dL, respectivamente (p < 0,01). Com relação ao uso de medicamentos, 41% utilizaram anti-hipertensivos, 39% utilizaram hipolipemiantes, 10% utilizaram hipoglicemiantes orais e 97% utilizaram suplementos antes dos 2 meses de cirurgia. Após os 6 meses, os percentuais foram alterados para 21%, 19%, 9% e 99%, respectivamente. Conclusões O estudo mostra o sucesso da cirurgia bariátrica em pacientes obesos com comorbidades, revelando melhora no perfil metabólico e redução na utilização de medicamentos para tratamento de comorbidades.

Abstract Background Obesity can be associated with diseases such as diabetes, arterial hypertension and dyslipidemia. Bariatric surgery is one of the most effective treatments available, reducing both weight and comorbidities. Objective To evaluate the metabolic and pharmacotherapeutic profile of obese patients after bariatric surgery. Methods This is a retrospective, cross-sectional, observational study conducted at a hospital located in the city of Porto Alegre, RS, Brazil, based on analysis of the medical records for 70 patients who underwent bariatric surgery covering periods spanning from 2 months prior to more than 6 months after their bariatric surgery. Statistical analysis was conducted using SPSS 17.0®. Results Initial arterial blood pressure was 130/85 mmHg, 6 months after surgery it was 120/80 mmHg (p < 0.01). The metabolic profile 2 months before surgery was as follows: HDL was 34 mg/dL, total cholesterol was 195.07 ± 40.17 mg/dL, LDL was 118.22 ± 41.28 mg/dL, triglycerides were 141.09 ± 43.39 mg/dL, and fasting glycemia was 90 mg/dL. The same figures 6 months after surgery were 43 mg/dL, 133.67 ± 28.14 mg/dL, 65.53 ± 24.3 mg/dL, 104.41 ± 29.6 mg/dL, and 77 mg/dL, respectively (p < 0.01). Use of medications 2 months before surgery was as follows: 41% were on antihypertensives, 39% on hypolipidemics, 10% on oral hypoglycemics, and 97% were on nutritional supplements. These percentages 6 months after surgery had changed to 21%, 19%, 9% and 99%, respectively. Conclusions This study illustrates that bariatric surgery for obese patients with comorbidities was successful, demonstrating improvements in their metabolic profile and reductions in use of medications used to treat comorbidities.

Consumo exacerbado de lipídeos provoca dano celular em algumas doenças metabólicas e cardiovasculares / Excessive consumption of fat provokes systemic cellular damage in some metabolic and cardiovascular diseases

OBJECTIVE: To review the deleterious biochemical mechanisms related to changes of oxidative stress and inflammation, provoked by excessive consumption and accumulation of lipids in different tissues, in cardiovascular diseases, diabetes and metabolic syndrome. Data source: This review article was based on papers selected for their relevance from databases such as Science Direct, PubMed and SciELO, published between 1995 and 2014. The search included the following keywords: High-fat diet, obesity, oxidative stress, inflammation. Data synthesis: Evidence suggests that the deleterious effects of lipotoxicity are related to ectopic deposition, activation of lipolysis, formation of lipid metabolites, generation of reactive oxygen species and oxidative stress, as well as to stimulation of inflammatory cascades. In this context, the simultaneous activation of these biochemical mechanisms interferes with intracellular signaling cascades, disrupting homeostasis, leading to systemic cellular damage or even lipoapoptosis. CONCLUSIONS: The identification of the biochemical cellular pathways involved in the process provides an understanding of the molecular mechanisms and, especially, may identify potential therapeutic targets

OBJETIVO: Revisar mecanismos bioquímicos deletérios relacionados com alterações de estresse oxidativo e inflamação ocasionados pelo consumo excessivo e acúmulo de lipídeos em diferentes tecidos, nas doenças cardiovasculares, diabetes e síndrome metabólica. Fonte de dados: Este artigo de revisão baseou-se em artigos científicos, selecionados por sua relevância e provenientes de bases de dados como Science Direct, Scielo e Pubmed, publicados entre 1995 e 2014. A busca contemplou as seguintes palavras-chave: dieta hiperlipídica, obesidade, estresse oxidativo, inflamação. Síntese dos dados: Evidências sugerem que os efeitos deletérios da lipotoxidade estão relacionados com a deposição ectópica, ativação da lipólise, formação de metabólitos lipídicos, geração de espécies reativas e estresse oxidativo, bem como estimulação de cascatas inflamatórias. Nesse contexto, a ativação simultânea desses mecanismos bioquímicos interfere em cascatas de sinalização intracelular, prejudicando a homeostase, levando ao dano celular sistêmico ou até mesmo à lipoapoptose. CONCLUSÕES: A identificação das vias bioquímicas celulares envolvidas proporciona a compreensão dos mecanismos moleculares e, principalmente, pode identificar possíveis alvos terapêuticos

Avaliação antropométrica e bioquímica em pacientes com esquizofrenia usuários de clozapina / Anthropometric and biochemical assessment of schizophrenic patients taking clozapine

OBJETIVO: Avaliar a proporção de sobrepeso/obesidade e alterações em parâmetros bioquímicos sangüíneos em pacientes com esquizofrenia do sexo masculino, usuários de medicação antipsicótica (clozapina). MÉTODOS: Estudo transversal com 40 pacientes do sexo masculino, diagnosticados com esquizofrenia, em uso de clozapina, atendidos no Hospital de Clínicas de Porto Alegre. Foram verificadas as relações entre o índice de massa corporal, a circunferência abdominal, o percentual de gordura corporal, o perfil lipídico e o exame de glicose de jejum e a dosagem da medicação, o acompanhamento dietoterápico e a monoterapia de clozapina. RESULTADOS: Os pacientes apresentaram freqüências de 71,8 por cento de sobrepeso/obesidade, 76,9 por cento de circunferência abdominal aumentada e 94,1 por cento de percentual de gordura elevada. Foram encontrados 56,8 por cento de pacientes com lipoproteína de baixa densidade-colesterol acima do normal e 64,1 por cento com triglicerídeos elevados. Quanto maior a dosagem de clozapina utilizada maiores foram os níveis de lipoproteína de baixa densidade-colesterol (p=0,01). CONCLUSÃO: Pacientes tratados com clozapina apresentam aumento de peso e significante anormalidade lipídica, necessitando de monitoramento freqüente dos níveis plasmáticos e intervenção nutricional precoce, visando à otimização do tratamento.

OBJECTIVE: The objective was to access the overweight/obesity rates and variations of biochemical blood parameters in male schizophrenic outpatients taking antipsychotic medication (clozapine), treated at the Schizophrenia and Dementia First Aid Station of the Clinics Hospital in Porto Alegre. METHODS: This is a cross-sectional study with 40 male outpatients diagnosed with schizophrenia and taking clozapine, from the Clinics Hospital in Porto Alegre. Associations between body mass index, waist circumference, body fat percentage, lipid levels and fasting glucose and medication dosage, diet therapy and clozapine monotherapy were verified. RESULTS: There was a rate of 71.8 percent of overweight/obesity, 76.9 percent of increased waist circumference and 94.1 percent of high body fat percentage. More than half of the patients (56.8 percent) had low density lipoprotein cholesterol levels above normal and 64.1 percent had high triglycerides. LDL-cholesterol levels increased with increasing clozapine dose (p=0.01). CONCLUSION: Patients on clozapine presented excess weight and significant lipid abnormality, needing frequent monitoring of the biochemical blood parameters and early nutritional intervention to optimize treatment.