A biocomplex to repair experimental critical size defects associated with photobiomodulation therapy

Abstract Background: The association of scaffolds to repair extensive bone defects can contribute to their evolution and morphophysiological recomposition. The incorporation of particulate biomaterials into three-dimensional fibrin bioproducts together with photobiomodulation therapy (PBM) has potential and can improve regenerative medicine procedures. The objective of this experiment was to evaluate the effects of PBM therapy on critical size defects filled with xenogenic bone substitute associated with fibrin biopolymer. Methods: A critical defect of 8 mm was performed in 36 Wistar male adult rats that were divided into four groups. Groups BC and BC-PBM were defined as controls with defects filled by a clot (without or with PBM, respectively) and groups XS and XS-PBM that comprised those filled with biocomplex Bio-OssTM in association with fibrin biopolymer. PBM was applied immediately after the surgery and three times a week every other day, with the parameters: wavelength of 830 nm, energy density 6.2 J/cm2, output power 30 mW, beam area of 0.116 cm2, irradiance 0.258,62 W/cm2, energy/point 0.72 J, total energy 2.88 J. Fourteen and 42 days after the surgery, animals were euthanatized and subjected to microtomography, qualitative and quantitative histological analysis. Results: The BC-PBM and XS-PBM groups had a similar evolution in the tissue repair process, with a higher density of the volume of new formed bone in relation to the groups without PBM (p = 0.04086; p = 0.07093, respectively). Intense vascular proliferation and bone deposition around the biomaterial particles were observed in the animals of the groups in which biocomplex was applied (XS and XS-PBM). Conclusion: PBM therapy allowed an improvement in the formation of new bone, with a more organized deposition of collagen fibers in the defect area. Biocomplex favored the insertion and permanence of the particulate material in bone defects, creating a favorable microenvironment for accelerate repair process.

A biocomplex to repair experimental critical size defects associated with photobiomodulation therapy

The association of scaffolds to repair extensive bone defects can contribute to their evolution and morphophysiological recomposition. The incorporation of particulate biomaterials into three-dimensional fibrin bioproducts together with photobiomodulation therapy (PBM) has potential and can improve regenerative medicine procedures. The objective of this experiment was to evaluate the effects of PBM therapy on critical size defects filled with xenogenic bone substitute associated with fibrin biopolymer. Methods: A critical defect of 8 mm was performed in 36 Wistar male adult rats that were divided into four groups. Groups BC and BC-PBM were defined as controls with defects filled by a clot (without or with PBM, respectively) and groups XS and XS-PBM that comprised those filled with biocomplex Bio-OssTM in association with fibrin biopolymer. PBM was applied immediately after the surgery and three times a week every other day, with the parameters: wavelength of 830 nm, energy density 6.2 J/cm2, output power 30 mW, beam area of 0.116 cm2, irradiance 0.258,62 W/cm2, energy/point 0.72 J, total energy 2.88 J. Fourteen and 42 days after the surgery, animals were euthanatized and subjected to microtomography, qualitative and quantitative histological analysis. Results: The BC-PBM and XS-PBM groups had a similar evolution in the tissue repair process, with a higher density of the volume of new formed bone in relation to the groups without PBM (p = 0.04086; p = 0.07093, respectively). Intense vascular proliferation and bone deposition around the biomaterial particles were observed in the animals of the groups in which biocomplex was applied (XS and XS-PBM). Conclusion: PBM therapy allowed an improvement in the formation of new bone, with a more organized deposition of collagen fibers in the defect area. Biocomplex favored the insertion and permanence of the particulate material in bone defects, creating a favorable microenvironment for accelerate repair process.(AU)

Relação entre espessura da artéria Carótida, Vitamina D, Perfil Glicêmico e Antropometria / Relationship between Carotid artery thickness, Vitamin D, Glycemic Profile and Anthropometry

O objetivo foi avaliar se a espessura íntima carotídea está associada à vitamina D, perfil glicêmico e antropométrico. Foram coletados dados pessoais, antropométricos, bioquímicos e laudo de ultrassonografia carotídea, o qual foi utilizado a fim de avaliar o espessamento em milímetros e constatar ou não placas ateroscleróticas. As variáveis estudadas foram tratadas com o coeficiente de correlação de Pearson, ANOVA e Kruskal-Wallis. A média do IMC dos 51 pacientes foi de 29,47±6,39 kg/m². A espessura carotídea foi ≥1 mm em 54,90%. Quanto à vitamina D, 41,18% apresentaram hipovitaminose. A correlação da espessura carotídea com dados antropométricos, glicemia de jejum e HbA1c foi diretamente proporcional e inversamente com os valores de vitamina D, embora sem diferença significativa. As variáveis estudadas não puderam ser associadas com diferença significativa à espessura da camada média intimal da carótida nesta amostra.

The aim of this study was to evaluate the association of carotid intima thickness with vitamin D, glycemia and anthropometry. Personal, anthropometric and biochemical data, and carotid ultrasound report (to check thickening in millimeters and for the presence of atherosclerotic plaques) were collected. The variables studied were treated with Pearson's correlation coefficient, ANOVA and Kruskal-Wallis. The mean BMI of the 51 patients was 29.47 ± 6.39kg/m². The carotid thickness was ≥1mm in 54.90%. Regarding vitamin D, 41.18% had hypovitaminosis. The carotid thickness was directly proportionally correlated with anthropometric data, fasting blood glucose and HbA1c, and inversely correlated with vitamin D values, although without significant difference. The studied variables were not significantly associated with carotid intima thickness in this sample.

May Obesity and Nutritional Knowledge Influence the Assessing Energy Intake Underreporting in Adults?.

Aims: Investigate the influence of the nutrition knowledge and nutritional status in the assessing energy intake underreporting. Methodology: It’s a cross-sectional study in 52 adults treated in an ambulatory. The nutritional knowledge was measured through the Nutritional Knowledge Scale. The anthropometric data analyzed were: waist circumference, height and weight. The food consumption was checked by three recalls of 24 hours. The resting metabolic rate was calculated by the Mifflin’s formula, and the assessing energy intake underreporting was calculated after Goldberg’s formula. Statistical analysis was performed by the “Bioestat 5.0” program and the Chi Square test for trend was used to evaluate the association between variables (p≤0,05). Results: The studied group showed an average age of 38,90±9,52. The assessing energy intake underreporting was noted in 92,3% of the sample. It was observed that the average energy intake related (1583,27±575,29 Kcal) was less than the average of the resting metabolic rate (1802,71±227,02 Kcal). Higher values of IMC (A = 0,153; p = 0,85) and in waist circumference (A = 2,769; p = 0,05) were associated with the increase of the assessing energy intake underreporting. In the other hand, there was a decreasing tendency (A = - 0,384; p = 0,750) in the association between energetic underreporting and nutritional knowledge. Conclusion: It was observed a higher tendency of assessing energy intake underreporting between individuals with higher IMC and waist circumference and lower nutritional knowledge.

Perfil socioeconômico e antropométrico de candidatas a cirurgia bariátrica pelo Sistema Único de Saúde / Socio-economic and anthropometric profile of candidates for bariatric surgery by the National Health Service

A cirurgia bariátrica é considerada eficaz no controle e tratamento da obesidade grave, tendo como principais benefícios a melhora no perfil das comorbidades e consequente melhora na qualidade de vida. O objetivo deste estudo foi avaliar o perfil socioeconômico e antropométrico de obesas candidatas a cirurgia bariátrica. Foram estudadas cem pacientes do sexo feminino, com idade entre 20 e 45 anos, cadastradas pelo Sistema Único de Saúde. Entrevista individual foi realizada para a coleta dos dados. O índice de massa corporal foi calculado e classificado segundo a Sociedade Americana de Cirurgia Bariátrica. A classificação econômica foi estabelecida de acordo com a Associação Brasileira de Empresas de Pesquisa. A amostra apresentou média de idade de 33,3±6,0 anos. Os dados antropométricos apresentaram valores médios±DP de índice de massa corporal de 45,75±6,05Kg/m², prevalecendo o diagnóstico de obesidade mórbida (68%). Segundo a classificação econômica, a maioria das mulheres pertence à classe C. Das entrevistadas, 45% são casadas e 66% têm escolaridade igual ou superior ao ensino médio completo, sendo que os trabalhos domésticos representam a atividade de maior frequência (28%). Quanto ao início da obesidade, 38% desenvolveram na infância. A hipertensão arterial foi a comorbidade de maior predomínio (48%). Conclui-se que, a maioria das candidatas à cirurgia bariátrica, encontra-se casadas, sua principal atividade é cuidado doméstico, estão com IMC entre 40 e 50 kg/m2, tiveram o início da obesidade ainda na infância, apresenta o segundo grau completo e pertence à classe econômica C.

Bariatric surgery is efficient in the control and treatment of serious obesity. Its great assets are the essening of co-morbidities and improvement in life quality. Current analysis evaluates the socioeconomical and anthropometric profile of obese candidates for bariatric surgery. One hundred female patients, aged between 20 and 45 years, were selected by the National Health Service and an individual interview was undertaken for data collection. Body mass index was calculated and classified according to the American Society of Bariatric Surgery. Economic classification was established according to the Brazilian Association of Research Firms. Results showed a mean age of 33.3±6.0 years; mean rates±SD of body mass index of 45.75±6.05Kg/m², predominantly diagnosis for morbid obesity (68%). According to economic classification, most females belong to class C, corresponding to a mean family earning of R$ 927.00. Further, 45% are married and 66% have a high school diploma, with house chores as their main activity (28%). Obesity started during childhood in 38% of the interviewed, with arterial hypertension as the predominant co-morbidity (48%). Results showed that, although most females were within surgery standards, a certain percentage decided early for such an alternative without reaching higher BMI. In some cases, surgery was done without the previous conservative treatments.

Subnotificação da ingestão alimentar e fatores associados / Food intake underreporting and associated factors

OBJETIVO: Avaliar a subnotificação da ingestão energética e fatores associados entre mulheres que aguardam a cirurgia bariátrica no serviço público de saúde de uma cidade do interior do estado de São Paulo-Brasil. MÉTODOS: A amostra foi composta por 100 obesas. A ingestão energética (IE) e o nível de atividade física (NAF) foram estimados por meio de três recordatórios de 24 horas. O gasto energético em repouso(GER) foi medido pela calorimetria indireta. A razão ingestão energética relatada e gasto energético de repouso (IErel: GER) foi usada para avaliar a subnotificação, sendo o resultado comparado com pontos de corte derivados da equação de Goldberg. A associação entre a subnotificação e as características das mulheres foi avaliada pelo teste Z e a comparação entre os dados não paramétricos foi feita pelo teste de Mann-Whitney. Resultados e Conclusões: Houve diferença significativa entre os grupos de subnotificadoras e não subnotificadoras para a razão IErel:GER (p<0,0001). A proporção de subnotificação da ingestão energética foi de 47%, sendo maior entre mulheres que relataram níveis maiores de atividade física (p=0,006) e menor entre as que relataram níveis menores de atividade física (p=0,001). Quanto à escolaridade a maior proporção de subnotificação foi entre mulheres com ensino fundamental (p=0,002) e menor entre aquelas com ensino médio (p=0,03). A proporção de subnotificação também foi maior entre mulheres da classe econômica C ou inferior (p=0,049). As candidatas à cirurgia bariátrica apresentaram altas taxas de subnotificação da ingestão energética, especialmente a parcela das mulheres com menor escolaridade, baixa classe econômica e/ou mais ativas

OBJECTIVE: To assess the energy intake underreporting and associated factors among women waiting for bariatric surgery at the public healthcare service of a city in the state of São Paulo-Brazil. Methods: The sample consisted of 100 obese women.Three 24-hour recalls were used to estimate energy intake (EI) and physical activity level (PAL). Resting metabolic rate (RMR) was determined by indirect calorimetry.The ratio between reported energy intake and resting metabolic rate (rEI:RMR) wasused to assess the underreporting and the results were compared with the cut-off points obtained by the Goldberg equation. The association between under reporting and the women's characteristics was assessed by the Z-test and the non-parametric data were compared by the Mann-Whitney test. Results and Conclusions: The ratiorEI:RMR differed significantly between the underreporting and non-under reporting groups (p<0.0001). Forty-seven percent of women underreported their energy intake being that, this proportion was higher among women who reported higher physical activity levels (p=0.006) and lower among women who reported lower physical activity levels (p<0.001). The proportion of underreporting was also higher among women who had only completed elementary school (p<0.002) and lower among those who completed high school (p <0.03). Women belonging to the socioeconomic class Cor below also presented a higher proportion of underreporting (p<0.049). Bariatric surgery candidates present high rates of energy intake underreporting, especially those with lower education levels, of low socioeconomic classes and/or higher physical activity levels

Qualidade das medidas de peso produzidas em unidades de atenção básica à saúde da região de Botucatu-SP, Brasil / The quality of weight measurements produced in primary health care centers located in the region of Botucatu-SP, Brazil

The aim of this study was to evaluate the quality of weight measurements produced in Primary Health Care Centers in Botucatu and surroundings.14 Health Care Centers were included, all of them located in four townsin the area of Botucatu (4,555; 5,656; 18,761 and 128,397 inhabitants). General conditions and scale calibration conditions found in those Health Care Centers were evaluated. In order to evaluate the weight accuracy obtained by the local team, 10 adult users of each Center were addressed by the rater during the service routine in order to get a new weight evaluation, immediately after the measurement made by the team. The statistic method applied for checking the weight measurement held in the Heath Care Center and the scales accuracy was the measurement error technique (MET). The results have showed that out of 19 scales, 6 of them over estimated the weight by 50 grams, 1 of them under estimated the weight by 200 grams and the others were accurate. Evaluated as a group, the result of the scale MET was 44.3g. Regarding the conformity of the measures obtained by the MET of the adults weighing in the Health Care Centers compared to the ones obtained by the researcher, the expected result was obtained in only one Center (< 100g). The results have showed data compromise, rather due tolack of health team training than due to the conditions of the equipment used for the measurement.

El objetivo del estudio fue evaluar la calidad delas medidas de peso producidas en la atención básica a la salud de la región de Botucatú(SP, Brasil). Fueron comprendidas en el estudio 14 unidades de salud, pertenecientes a cuatro municipios de la región de Botucatú(4.555, 5.656, 18.761 e 128.397 habitantes). Fueron evaluadas las condiciones generales y de calibración de las balanzas presentes en las unidades. Para evaluar la precisión del peso obtenido por el equipo local, 10 usuarios adultos de cada unidad fueron abordados por el investigador durante la rutina del servicio para una nueva evaluación comparativade la medición, inmediatamente después de la evaluación realizada por el equipo local. El método estadístico aplicado para inquirir la conformidad de las medidas de peso y la precisión de las balanzas fue la Técnica del Error de la Medida (TEM). Los resultados mostraron que de las 19 balanzas existentes, 6 super estimaban el peso en 50 gramos, 1 los ubestimaba en 200 gramos y las otras eran precisas. Evaluadas en conjunto, el resultado dela TEM de las balanzas fue de 44,3g. En relacióna la concordancia por la TEM de las medidas realizadas en las unidades con las medidas de control de los investigadores, solamente en una Unidad de Salud se obtuvo el resultado esperado (<100g). Los resultados mostraron falta de precisión de los datos producidos, más por la falta de entrenamiento del equipo de salud que por las condiciones de los instrumentos utilizados.

O objetivo do estudo foi avaliar a qualidade das medidas de peso produzidas na atenção básica à saúde da região de Botucatu-SP.A pesquisa incluiu 14 unidades de saúde, pertencentes a quatro municípios da região de Botucatu (4.555, 5.656, 18.761 e 128.397habitantes). Foram aferidas as condições gerais e de calibração das balanças presentes nessas unidades. Para avaliação da acurácia do peso obtido pela equipe local, 10 usuários adultos de cada unidade foram abordados pela avaliadora durante a rotina do serviço para uma nova avaliação do peso, imediatamente após a aferição feita pela equipe. O método estatístico utilizado para averiguação da concordância das medidas de peso produzidas na unidade e a curácia das balanças foi a Técnica do Erro da Medida (TEM). Os resultados mostraram que das19 balanças existentes, 6 superestimavam o peso em 50 gramas, 1 subestimava em 200 gramas e as demais apresentaram-se acuradas. Avaliadas no conjunto, o resultado da TEM da balança foi de 44,3g. Com relação à concordância das medidas pela TEM da pesagem de adultos realizadas nas unidades com àquelas da avaliadora, apenas em uma unidade obteve-se o resultado esperado (<100g). Os resultados mostraram comprometimento dos dados produzidos, mais em função da falta de treinamento da equipe de saúde, que das condições dos equipamentos utilizados para tal finalidade.

Projeto criança saudável, educação dez: resultados com e sem intervenção do nutricionista / Healthy child education project, the best education: results with and without the dietician's intervention

OBJETIVO: Planejar e aplicar um programa de orientação em nutrição, realizado por nutricionista e destinado a professores de 1ª a 4ª série do ensino fundamental, visando analisar a contribuição desse profissional no resultado do projeto "Criança Saudável, Educação Dez" quanto ao conhecimento dos escolares. MÉTODOS: O trabalho foi realizado em duas escolas públicas, A e B, nas quais foi desenvolvido o projeto educativo, sendo que na primeira os professores foram apoiados por um programa de orientação realizado por profissional nutricionista. Antes e depois do desenvolvimento do projeto educativo foi aplicado um instrumento para avaliar o conhecimento dos escolares sobre alimentação e nutrição. RESULTADOS: Os escolares da Escola A apresentaram mudança significante (p<0,01) no conhecimento de alimentação e nutrição após o desenvolvimento do projeto educativo, o que não ocorreu entre os estudantes da Escola B (p>0,05). CONCLUSÃO: Os resultados obtidos sugerem que a realização de programa de orientação, prestada por nutricionistas aos professores para desenvolverem o projeto educativo, maximizou os resultados, gerando mudança significante no conhecimento dos escolares sobre alimentação e nutrição. Tais resultados apontam a importância da capacitação do nutricionista para atuar em educação nutricional, indicando que o campo pedagógico merece aprofundamento nos cursos de graduação, de modo a permitir ao aluno e futuro profissional uma compreensão alicerçada e sólida do processo educativo.

OBJECTIVE: In this study, a dietician planned and implemented a nutrition counseling program for first through fourth grade elementary school teachers. The objective was to analyze the contribution of this professional to the result of the project "Healthy Child, Outstanding Education", regarding the students' knowledge. METHODS: The program was implemented in two public schools - A and B, in which an education project was developed. In School A, the teachers had the support of a counseling program provided by a dietician. The students' knowledge on food and nutrition was assessed before and after the implementation of the education project. RESULTS: Knowledge on food and nutrition among School A students changed significantly (p<0.01) after the implementation of the education program. This did not occur among School B students (p>0.05). CONCLUSION: The results suggest that the counseling program administered by a dietician for teachers to develop the education project maximized the results. The knowledge gained by the students on food and nutrition was significant. These results show the importance of training a dietician to provide nutrition education. The education field deserves more attention in undergraduate courses so that the student and future professional gain a solid and well-founded understanding of the education process.

Prática de dietas de emagrecimento por escolares adolescentes / Practical diets for weight loss teen

Objetivo - A cada ano, milhões de pessoas apresentam problemas relacionados a transtornos alimentares, sendo que mais de 90% destes ocorre na população adolescente do sexo feminino. Frente a tais considerações, este estudo busca identificar a frequência de práticas de dietas de emagrecimento em adolescentes de uma escola privada da cidade de Bauru, Estado de São Paulo. Métodos - A coleta de dados foi feita a partir de um questionário elaborado pelas pesquisadoras deste estudo. Este questionário autoaplicável é composto por 16 questões de múltipla escolha que buscou identificar a frequência do uso de dietas de emagrecimento, suas fontes de orientação, bem como a percepção de alterações físicas consequentes de tais dietas. Resultados - Responderam ao questionário 250 estudantes matriculados nas três séries do ensino médio, sendo 55% deles do sexo feminino. A média de idade dos adolescentes foi de 15,8 ± 0,4 anos. A realização de dieta para emagrecimento foi afirmada por 14% dos participantes, sendo que 44% destes apresentavam eutrofia segundo o IMC para idade.Quanto à fonte de orientações para as dietas praticadas, consulta com nutricionista e sugestões de amigos e familiares tiveram maior prevalência, 24% e 12%, respectivamente. Conclusões - Este estudo mostra alta prevalência de adolescentes eutróficos que informaram se achar acima do peso, assim como a prática de dietas para emagrecimento por estes, principalmente do sexo feminino. Esses dados indicam que atenção deve ser dada aos fatores que podem interferir na construção da imagem corporal, considerando sua influência nos hábitos alimentares e transtornos da alimentação.

Objective - Each year, millions of people have problems related to eating disorders, and more than 90% of this population occurs in adolescent females. In view of these considerations, this study seeks to identify the frequency of practice of weight loss diets among adolescentsin a private school in Bauru, São Paulo. Methods - Data collection was done from a questionnaire developed by the researchers in this study. This self-administered questionnaire consists of 16 multiple choice questions aimed at identifying the frequency of use of weight loss diets, sources of guidance as well as the perception of physical changes resulting from such diets. Results - Questionnaire answered by 250 students enrolled in three middle schools, 55% were female. The average age of adolescents was 15.8 ± 0.4 years. The dieting to lose weight was affirmed by 14% of participants, and 44% of them had normal weight according to BMI for age. As for the source of guidelines for diet practiced, consultation with a nutritionist and suggestions from friends and relatives had a higher prevalence, 24% and 12% respectively.Conclusions - This study shows high prevalence of eutrophic adolescents who reported find yourself overweight, and the practice of weight control diets by them, especially females. These data indicate that attention should be given to factors that may interfere with the construction of body image, given its influence on dietary habits and eating disorders.

Avaliação nutricional de pacientes em hemodiálise / Nutritional evaluation of patients on hemodialysis

Objetivo - A hemodiálise (HD) é uma terapia dialítica que se associa a complicações agudas e crônicas. Por ser um evento catabólico, é comum paciente em terapia hemodialítica apresentar desnutrição. Diante disto, o presente estudo tem como objetivo avaliar indicadores antropométricos do estado nutricional dos pacientes cadastrados junto ao programa de HD da Irmandade da Santa Casa de Misericórdia de Marília, bem como estabelecer a correlação entre tempo de realização do procedimento dialítico e estado nutricional dos mesmos. Métodos - Foram coletadas as medidas antropométricas peso seco, estatura, dobra cutânea tricipital (DCT) e circunferência braquial (CB). A circunferência muscular do braço (CMB) e o índice de massa corporal (IMC) foram calculados. Resultados - Os resultados indicam que, com base no IMC, a desnutrição esteve presente em 12% dos pacientes avaliados e que o excesso de peso foi encontrado em 34%. Foi encontrada maior adequação da massa muscular e maior comprometimento do tecido adiposo, considerando que segundo a CMB 55% dos pacientes apresentaram eutrofia, enquanto a DCT indicou que 59% dos pacientes apresentavam déficit de massa de gordura. A correlação entre tempo de diálise e indicadores antropométricos, no presente estudo, foi fraca negativa. Conclusões - Considerando que o estado nutricional é um importante preditor de resultados clínicos em pacientes com IRC, principalmente naqueles em HD, torna-se imperativo a realização do diagnóstico nutricional e da adequada intervenção. Entretanto, sugere-se a realização de novas pesquisas a fim de verificar fatores que estariam influenciando no estado nutricional desta população.

Objective - Hemodialysis (HD) is a dialysis that is associated with acute and chronic complications. Because it is a catabolic event, it is common in hemodialysis patients presenting malnutrition. Hence, the present study aims to evaluate anthropometric indicators of nutritional status of patients registered with the HD program of the Brotherhood of Santa Casa de Misericórdia de Marília, and establish the correlation between time of completion of the dialysis procedure and nutritional status of these. Methods - We collected anthropometric measures dry weight, height, triceps skinfold thickness (TSF) and arm circumference (MUAC). The arm muscle circumference (MAMC) and body mass index (BMI) were calculated. Results - The results indicate that, based on BMI, malnutrition was present in 12% of patients evaluated and that excess weight was found in 34%. Found increased compliance in muscle mass and greater involvement of adipose tissue, whereas according to CMB 55% of patients were eutrophic, while the DCT indicated that 59% of patients had a deficit of fat mass. The correlation between duration of dialysis and anthropometric indicators in the present study, weak negative. Conclusions - Considering that nutritional status is an important predictor of clinical outcomes in patients with CRF, especially those in HD, it is imperative to the diagnosis and appropriate nutritional intervention. However, it is suggested to conduct further research to identify factors that would influence the nutritional status of this population.