Eficácia e segurança do acetato de megestrol para o tratamento da anorexia nos cuidados paliativos: revisão rápida de evidências / Efficacy of the megestrol acetate in the treatment of anorexia in palliative care: a rapid response review of evidence

Acetato de Megestrol (AM). Indicação: Tratamento da Síndrome anorexia-caquexia (SAC) em doentes crônicos em fase de cuidados paliativos. Objetivo: Avaliar a eficácia e segurança do uso do AM em doentes crônicos sob cuidados paliativos. Métodos: Foi realizada uma revisão rápida de revisões sistemáticas, com levantamento bibliográfico nas bases de dados PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web Of Science e em registros de revisões sistemáticas e ensaios clínicos. A qualidade metodológica dos estudos incluídos foi avaliada com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: A busca recuperou um total de 2.370 após exclusão das duplicatas; 1003 estudos foram triados pelo título e resumo, de acordo com os critérios de inclusão previamente estabelecidos. Dezesseis RSs foram selecionadas para leitura completa, sendo que, destas, apenas 1 RS foi classificado com alta qualidade metodológica. Após a análise dos ECR das RSs excluídas, um ECR foi incluído considerando os critérios de inclusão. Dois estudos adicionais publicados posteriormente a RS de Ruiz-Garcia et al. Conclusão: Com base nas evidências disponíveis, o AM proporciona leve ganho de peso e melhora o apetite, porém esses resultados não refletem melhoria na qualidade de vida dos pacientes, além de haver risco considerável de desenvolver fenômenos tromboembólicos

Megestrol acetate (MA). Indication: treatment of anorexia-cachexia syndrome (ACS) in chronic diseases patients, under palliative care. Objective: Evaluate the efficacy and safety of the use of Megestrol Acetate to treat ACS in patients under palliative care. Methods: Rapid review protocol of Systematic Reviews and Clinical Trials. A literature Search was performed in PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web of Science databases and in clinical trials records, following a predefined strategy. The methodological quality of the selected articles was assessed through AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2) tool. Results: the search resulted in 2,370 articles, after the duplicates exclusion. 1003 were analyzed by tittle and abstracts according the inclusion criteria. 16 were selected for full text reading, and only one considered to have high methodological quality. After the analyses of the Randomized Clinical Trials of the excluded Systematic Reviews, one RCT was included. Two additional studies published after the SR of Ruiz-Garcia et al were also included. Conclusion: based on available evidence, the MA promoted a small gain in body weight and a slight appetite improvement, although these results did not imply an enhancement in their quality of life. Moreover, there is a considerable risk of causing thromboembolic disorders

Lisdexamfetamine to improve excessive daytime sleepiness and weight management in narcolepsy: a case series

Objective: To report the successful use of lisdexamfetamine in the management of narcolepsy. Methods: Five narcoleptic patients received lisdexamfetamine, at different dosages and for different periods, for management of excessive daytime sleepiness and weight control. Results: All patients experienced improvement of excessive daytime sleepiness and lost weight without side effects. Conclusion: Lisdexamfetamine appears promising for the treatment of two of the most common symptoms of narcolepsy: excessive daytime sleepiness and weight gain.

Sericin as treatment of obesity: morphophysiological effects in obese mice fed with high-fat diet / Sericina como tratamento da obesidade: efeitos morfofisiológicos de camundongos obesos por dieta hiperlipídica

ABSTRACT Objective To investigate the effects of sericin extracted from silkworm Bombyx mori cocoon on morphophysiological parameters in mice with obesity induced by high-fat diet. Methods Male C57Bl6 mice aged 9 weeks were allocated to one of two groups - Control and Obese, and fed a standard or high-fat diet for 10 weeks, respectively. Mice were then further subdivided into four groups with seven mice each, as follows: Control, Control-Sericin, Obese, and Obese-Sericin. The standard or high fat diet was given for 4 more weeks; sericin (1,000mg/kg body weight) was given orally to mice in the Control-Sericin and Obese-Sericin Groups during this period. Weight gain, food intake, fecal weight, fecal lipid content, gut motility and glucose tolerance were monitored. At the end of experimental period, plasma was collected for biochemical analysis. Samples of white adipose tissue, liver and jejunum were collected and processed for light microscopy analysis; liver fragments were used for lipid content determination. Results Obese mice experienced significantly greater weight gain and fat accumulation and had higher total cholesterol and glucose levels compared to controls. Retroperitoneal and periepididymal adipocyte hypertrophy, development of hepatic steatosis, increased cholesterol and triglyceride levels and morphometric changes in the jejunal wall were observed. Conclusion Physiological changes induced by obesity were not fully reverted by sericin; however, sericin treatment restored jejunal morphometry and increased lipid excretion in feces in obese mice, suggesting potential anti-obesity effects.

RESUMO Objetivo Investigar os efeitos da sericina extraída de casulos de Bombyx mori na morfofisiologia de camundongos com obesidade induzida por dieta hiperlipídica. Métodos Camundongos machos C57Bl6, com 9 semanas de idade, foram distribuídos em Grupos Controle e Obeso, que receberam ração padrão para roedores ou dieta hiperlipídica por 10 semanas, respectivamente. Posteriormente, os animais foram redistribuídos em quatro grupos, com sete animais cada: Controle, Controle-Sericina, Obeso e Obeso-Sericina. Os animais permaneceram recebendo ração padrão ou hiperlipídica por 4 semanas, período no qual a sericina foi administrada oralmente na dose de 1.000mg/kg de massa corporal aos Grupos Controle-Sericina e Obeso-Sericina. Parâmetros fisiológicos, como ganho de peso, consumo alimentar, peso das fezes em análise de lipídios fecais, motilidade intestinal e tolerância à glicose foram monitorados. Ao término do experimento, o plasma foi coletado para dosagens bioquímicas e fragmentos de tecido adiposo branco; fígado e jejuno foram processados para análises histológicas, e amostras hepáticas foram usadas para determinação lipídica. Resultados Camundongos obesos apresentaram ganho de peso e acúmulo de gordura significativamente maior que os controles, aumento do colesterol total e glicemia. Houve hipertrofia dos adipócitos retroperitoneais e periepididimais, instalação de esteatose e aumento do colesterol e triglicerídeos hepáticos, bem como alteração morfométrica da parede jejunal. Conclusão O tratamento com sericina não reverteu todas as alterações fisiológicas promovidas pela obesidade, mas restaurou a morfometria jejunal e aumentou a quantidade de lipídios eliminados nas fezes dos camundongos obesos, apresentando-se como potencial tratamento para a obesidade.

Efeitos adversos associados a uso de contraceptivos orais em discentes / Adverse effects associated with students' use of oral contraceptives

Objetivos: Investigar o número de mulheres, as causas que levam a fazer o uso e descrever os efeitos adversos mais comuns associados ao uso de contraceptivos orais de forma contínua. Métodos: Trata-se de estudo observacional, transversal ou de prevalência e quantitativo. A pesquisa teve população de 832 alunas do curso de Direito dos turnos matutino, vespertino e noturno, no período de agosto a setembro, tendo como amostra 248 participantes para esse estudo. O questionário versou sobre o uso de anticoncepcionais, o perfil das usuárias e os possíveis efeitos adversos observados ao longo do uso. Resultados: A prevalência de uso dos contraceptivos orais foi de 42,3%, justificada principalmente pelo desejo de evitar a concepção (42,9%), regular os níveis hormonais (25,7%) e tratar acne (15,2%). Cerca de 63,8% relataram que já sentiram algum desconforto associado ao uso destes medicamentos, sendo os mais frequentes aumento de peso corporal (32,4%), alterações de humor (24,3%), dor nas mamas (13,5%), cefaleia (4,1%), dor abdominal (2,7%). Conclusão: A prevalência de efeitos adversos decorrentes do uso contínuo de contraceptivos orais é alta, evidenciando-se a necessidade de conscientizar as usuárias a buscarem profissionais habilitados, para que elas façam uso do anticoncepcional mais adequado, minimizando o desconforto advindo dos efeitos adversos.

Objectives: To investigate the number of women, the causes that lead to making use, and to describe the most common adverse effects associated with oral contraceptive continuous use. Methods: This is an observational, cross-sectional, or prevalence and quantitative study. The research had a population of 832 students of the law course of the morning, afternoon and evening shifts, from August to September, with a sample of 248 participants for this study. The questionnaire was about contraceptive use, users' profile, and possible adverse effects observed during use. Results: The prevalence of oral contraceptive use was 42.3%, mainly explained by the desire to avoid conception (42.9%), regulate hormone levels (25.7%), and to treat acne (15.2%). About 63.8% reported already having some discomfort associated with the use of these medications, with the most frequent being body weight gain (32.4%), mood swings (24.3%), breast pain (13.5%), headache (4.1%), abdominal pain (2.7%). Conclusion: The prevalence of adverse effects resulting from the continued use of oral contraceptives is high, so there is a need to guide users to seek qualified professionals so that they make use of the most appropriate contraceptive, minimizing the discomfort arising from adverse effects.

Efectos adversos del implante anticonceptivo subdérmico en adolescentes / Adverse effects of the subdermal contraceptive implant in adolescents

Introducción: Los anticonceptivos subdérmicos deben ser seguros, con efectos colaterales mínimos, reversibles y de larga duración, sin embargo, se ha observado que ocasionan efectos adversos, fundamentalmente en los primeros meses de su uso. Objetivos: Describir efectos adversos, junto a antecedentes personales en adolescentes a quienes se realizó implante anticonceptivo subdérmico. Métodos: Se realizó un estudio descriptivo en 120 adolescentes a las que se les colocó implante subdérmico como método anticonceptivo. Fueron estudiadas las variables efectos adversos, edad y antecedente obstétrico. Resultados: El 36,6 por ciento de las pacientes tenía antecedentes de abortos provocados, y el 5 por ciento era menor de 15 años. Los efectos adversos más frecuentes fueron el aumento de peso (23,3 por ciento a los 6 meses y 21,6 por ciento al año), la cefalea (18,3 por ciento a los 6 meses y 8,3 por ciento al año) y la mastalgia (12,5 por ciento a los 6 meses y 15 por ciento al año). En el patrón de sangrado, se presentaron, sangrado infrecuente (36 por ciento a los 6 meses y 43,3 por ciento al año) y amenorrea (27,5 por ciento a los 6 meses y 35 por ciento al año). Conclusiones: Más de un tercio de las pacientes tenían abortos previos; los efectos adversos más frecuentes fueron: aumento de peso, cefalea y mastalgia, tanto a los 6 meses como al año y en el patrón de sangrado, el sangrado infrecuente y la amenorrea(AU)

Introduction: Subdermal contraceptives must be safe, with minimal side effects, reversible and long lasting, however, it has been observed that they cause adverse effects, mainly in the first months of its use. Objectives: To describe adverse effects, together with personal history in adolescents who underwent a subdermal contraceptive implant. Methods: A descriptive study was conducted in 120 adolescents who were placed as a subdermal implant as a contraceptive method. The variables adverse effects, age and obstetric history were studied. Results: 36.6 percent of the patients had a history of induced abortions, and 5 percent were younger than 15 years. The most frequent adverse effects were weight gain (23.3 percent at 6 months and 21.6 percent per year), headache (18.3 percent at 6 months and 8.3 percent per year) and mastalgia (12.5 percent at 6 months and 15 percent at year). In the pattern of bleeding, infrequent bleeding occurred (36 percent at 6 months and 43.3 percent per year) and amenorrhea (27.5 percent at 6 months and 35 percent per year). Conclusions: More than a third of the patients had previous abortions; The most frequent adverse effects were: weight gain, headache and mastalgia, both at 6 months and 1 year and in the pattern of bleeding, infrequent bleeding and amenorrhea(AU)

Sex-differential effects of olanzapine vs. aripiprazole on glucose and lipid metabolism in first-episode schizophrenia

Abstract Objective To compare sex difference in metabolic effect of olanzapine versus aripiprazole on schizophrenia. Methods A twelve-week prospective open-label cohort study to compare four subgroups according to first-episode schizophrenia patients' type of drug usage and sex: female aripiprazole (n = 11), male aripiprazole (n = 11), female olanzapine (n = 10), and male olanzapine (n = 11) for body mass index, fasting serum triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose. Results Aripiprazole may be associated with weight gain in female patients with low-baseline weight. Aripiprazole may have an adverse effect of weight and favorable effects of circulating glucose and lipid on female over male schizophrenia patients. The aripiprazole-induced changes in glucose and lipid may be independent of body fat storage, especially for female schizophrenia patients. Olanzapine may have adverse effects of weight, glucose and lipid profiles on female over male schizophrenic patients. Discussion Our findings fill the gap in knowledge and provide a sex-specific guidance to psychiatrist better tailoring treatment to individual sex-differential characteristics and a key clue to understand the sex-differential mechanism of antipsychotics-induced metabolic dysfunction.

Dietary intake and eating behavior in depot medroxyprogesterone acetate users: a systematic review

Because of weight gain, women often discontinue hormonal contraception, especially depot medroxyprogesterone acetate (DMPA). Our objective was to conduct a systematic review of studies describing dietary intake or eating behavior in DMPA users to understand whether the use of DMPA is associated with changes in dietary habits and behaviors leading to weight gain. We searched the PubMed, POPLINE, CENTRAL Cochrane, Web of Science, and EMBASE databases for reports published in English between 1980 and 2017 examining dietary intake or eating behavior in healthy women in reproductive age and adolescents using DMPA (150 mg/mL). Of the 749 publications screened, we excluded 742 due to duplicates (96), not addressing the key research question (638), not reporting dietary intake data (4), and not evaluating the relationship of body weight and dietary or eating behaviors (4). We identified seven relevant studies, including one randomized placebo-controlled trial, one non-randomized paired clinical trial, and five cohort studies. The randomized trial found no association and the other reports were inconsistent. Findings varied from no change in dietary intake or eating behavior with DMPA use to increased appetite in the first six months of DMPA use. Few studies report dietary intake and eating behavior in DMPA users and the available data are insufficient to conclude whether DMPA use is associated with changes in dietary habits or behavior leading to weight gain.

Use of ractopamine during compensatory gain of finishing pigs on carcass and meat performance and quality / Uso de ractopamina durante ganho compensatório de suínos em terminação sobre o desempenho e a qualidade da carcaça e de carne

The objective of this study was to evaluate the effects of compensatory gain associated with the use of 10ppm ractopamine after a period of feed restriction in finishing pigs on performance, carcass and meat quality. Twenty castrated males and 20 females, at 110 days of age and 66.137±6.13kg live weight, were submitted to four treatments using a 2 x 2 factorial design (fed ad libitum or with 20% restriction between 0(21 days of age and fed with or without 10ppm ractopamine for 22(42 days of experimentation), with 10 replicates (animals). There was no interaction between the factors for any of the evaluated parameters. Animals treated with ractopamine presented better weight gain (1.083 versus 1.259kg), feed conversion (2.910 versus 2.577), warm and cold carcass weight (86.08 versus 89.00 and 83.46 versus 87.20kg, respectively), loin depth (63.02 versus 68.40mm), loin eye area (41.43 versus 46.59mm2) and muscle fiber diameter (27.48 versus 35.85µm). Animals submitted to feed restriction followed by ad libitum feed presented compensatory gain without losses to carcass and meat characteristics, but with a reduction in the ethereal extract (2.19 versus 1.64%) and lower water loss due to thawing in the meat (11.35 versus 9.42%). The effects of compensatory gain after food restriction and ractopamine are independent of the parameters evaluated.(AU)

Objetivou-se avaliar os efeitos do ganho compensatório associado ao uso de 10ppm de ractopamina após um período de restrição alimentar, em suínos em terminação, sobre características de desempenho, carcaça e qualidade de carne. Foram utilizados 20 machos castrados e 20 fêmeas, com 110 dias de idade e 66,137±6,13kg de peso vivo, submetidos a quatro tratamentos, fatorial 2 x 2 (alimentação à vontade ou com 20% de restrição entre zero e 21 dias de experimentação; e alimentação à vontade, sem ou com 10ppm de ractopamina, durante 22 a 42 dias de experimentação), com 10 repetições, sendo o animal a repetição. Não houve interação entre os fatores para nenhum dos parâmetros avaliados. Animais tratados com ractopamina apresentaram melhor ganho de peso (1,083 versus 1,259kg), conversão alimentar (2,910 versus 2,577), peso da carcaça quente e fria (86,08 versus 89,00 e 83,46 versus 87,20kg, respectivamente), profundidade do lombo (63,02 versus 68,40mm), área de olho de lombo (41,43 versus 46,59mm2) e diâmetro de fibras musculares (27,48 versus 35,85µm). Animais submetidos à restrição alimentar seguida de arraçoamento ad libitum apresentaram ganho compensatório sem prejuízos às características de carcaça e à carne, mas com redução do extrato etéreo (2,19 versus 1,64%) e menor perda de água por descongelamento na carne (11,35 versus 9,42%) Os efeitos do ganho compensatório após a restrição alimentar e da ractopamina mostram-se independentes sobre os parâmetros avaliados.(AU)

Role of vitamin D in the development of obesity / Rol de la vitamina D en el desarrollo de la obesidad

SUMMARY: Antecedents in the literature suggest that vitamin D (VD) play a role in overweigh/obesity. The present study evaluated the effect of VD deficiency diet intake and fat hight on overweight/obesity about white adipose tissue (WAT) and body mass (BM) gain. Animals were divided into four experimental groups according to the lipid and VD content of their diets; G1: CVD+ (C: control diet with VD+; n=5), G2: CVD- (control diet without VD-; n=5), G3: HFVD+ (high fat diet, with VD+; n=5), G4: HFVD- (HF diet without VD-; n=5). The diets were administered for three months and BW was monitored weekly. At the end of this period all animals were euthanized. Epididymal (EFM), retroperitoneal (RFM) and subcutaneous (SFM) fat mass were removed, weighted. At 12 weeks the body mass of the animals that were fed without VD- diets; G2: 507.60±17.31 g, and G4: 528.50±13.50 g were significantly higher (p < 0.05), than the counterparts G1: 485.0±11.29 g and G3: 521.20±26.20 g respectively. Similarly, the animals fed with VDdiets had a greater EFM and SFM (p < 0.05) compared with the respective controls (VD+). Nevertheless, the animals fed with high fat diet had equal RFM (G3: 12.2±4.10 g, G4: 12.88±2.3 g, p > 0.05). The results demonstrate that the nutrition of rats with diet deficient in VD and high fat, promotes overweight by increasing fat deposits, suggestion a cause-effect relationship between VD deficiency and overweight. These results suggest that VD deficiency increases the risk of visceral fat obesity in males.

RESUMEN: Los antecedentes de la literatura sugieren una relación entre la vitamina D (VD) y el sobrepeso/obesidad, sin embargo, causalidad de la relación no está clara. El presente estudio evaluó el efecto de la ingesta dietética deficiente de VD y alta en grasa sobre el tejido adiposo (TA) y la masa corporal (MC). Los animales se dividieron en cuatro grupos experimentales de acuerdo con el contenido de VD y lípido en la dieta; G1: CVD+ (C: dieta control con VD+; n = 5), G2: CVD- (dieta control sin VD-; n = 5), G3: HFVD+ (dieta alta en grasa, con VD+; n = 5), G4: HFVD- (dieta HF sin VD-; n = 5). Las dietas se administraron durante tres meses y MC se controló semanalmente. Al final de este período, los animales fueron sacrificados. La masa grasa epididimaria (MGE), subcutánea abdominal (MGS) y retroperitoneal (MGR) fueron diseccionadas y pesadas individualmente. A las 12 semanas, la MC de los animales alimentados con dietas sin VD-; G2: 507,60 ± 17,31 g, y G4: 528,50 ± 13,50 g fue significativamente mayor (p < 0,05), que sus homólogos G1: 485,0 ± 11,29 g y G3: 521,20 ± 26,20 g respectivamente. De forma similar, los G2 y G4 tuvieron una mayor MGE y MGS (p < 0,05) en comparación con los controles respectivos (VD+). Sin embargo, los animales alimentados con dieta alta en grasas tuvieron igual MGR (G3: 12,2 ± 4,10 g; G4: 12,88 ± 2,3 g, p > 0,05). Los resultados demuestran que la nutrición de ratas con dieta deficiente en VD y alta en grasa, promueve el sobrepeso/obesidad al exacerbar la ganancia de masa grasa en los diferentes depósitos de grasa, sugiriendo una relación causa-efecto entre la deficiencia de VD y el sobrepeso/obesidad. Estos resultados sugieren que la deficiencia de VD aumenta el riesgo de obesidad de grasa visceral en machos.

Doppler velocimetry in fetal rats exposed to enoxaparin and unfractionated heparin (UFH) during pregnancy

Abstract Purpose: To evaluate the effects of enoxaparin and unfractionated heparin (UFH) administered in prophylactic and therapeutic doses on fetal vessels in healthy pregnant Wistar rats, according to Doppler velocimetry measurements. Methods: Fifty animals were assigned to one of five groups: controls (saline), prophylactic and therapeutic enoxaparin (1 and 2 mg/kg/day, respectively), and prophylactic and therapeutic UFH (72 and 400 UI/kg/day, respectively). Uterine horns were examined by ultrasound for identification of live fetuses. A sample of these fetuses underwent Doppler velocimetry. Spectral curves, peak systolic velocity (PSV), pulsatility index (PI), and resistance index (RI) of the middle cerebral artery, ductus venosus, and umbilical artery were investigated. Differences were considered statistically significant when p<0.05. Results: No significant differences in PSV, PI, or RI values were observed among the groups. Conclusion: Doppler velocimetry measurements revealed no significant effects of enoxaparin or unfractionated heparin on fetal vessels in pregnant Wistar rats.

Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up

ABSTRACT Objective The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. Subjects and methods Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI < 30 kg/m2, and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. Results After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group’s only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained < 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. Conclusion Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus.

Efeitos do uso de fortificante do leite humano em recém-nascidos pré-termo de muito baixo peso / Efectos del uso de fortificante de la leche humana en recién nacidos pretérmino de muy bajo peso / The effects of using the human breast milk fortifier in pre-term of very low weight newly born

RESUMO O leite materno é o alimento ideal para qualquer recém-nascido devido à sua composição nutricional balanceada e à sua capacidade de gerar imunidade. Seu uso tem sido muito incentivado nas Unidades de Terapia Intensiva (UTI) e Unidades Intermediárias (UI), sendo ofertados tanto o leite materno extraído diretamente do seio materno, quanto o proveniente de bancos de leite humano. Dessa forma, este estudo teve como propósito acompanhar e comparar recém-nascidos com e sem o uso de aditivo fortificante do leite materno, em UTI neonatal. O estudo foi observacional do tipo coorte, com grupo controle, realizado em uma maternidade pública, nas unidades de terapia intensiva e terapia intermediária neonatais. Foram acompanhados 26 recém-nascidos pré-termo, divididos em dois grupos, um deles constituído por 13 recém-nascidos em aleitamento materno exclusivo (grupo controle) e outro composto por 13 recém-nascidos em uso de leite materno, com aditivo fortificante. Para a análise de dados, foi utilizada estatística descritiva simples, calculando-se distribuições de frequências, cálculo das médias, desvio-padrão e realizações dos testes estatísticos. O ganho de peso médio no período do estudo foi significativamente maior no grupo que recebeu leite materno com aditivo. Em relação ao comprimento e ao perímetro cefálico não foram observadas diferenças estatísticas significativas entre os grupos. Constata-se que o uso de aditivo no leite materno humano cru ou processado proporciona melhor ganho de peso, favorecendo a recuperação do estado nutricional.

RESUMEN La leche materna es el alimento ideal para cualquier recién nacido debido a su composición nutricional balanceada y a su capacidad de generar inmunidad. Su uso ha sido muy fomentado en las Unidades de Cuidados Intensivos y Unidades Intermediarias, siendo ofertadas, tanto la leche materna, extraída directamente del seno materno, como la proveniente de bancos de leche humana. El propósito del estudio fue el de acompañar y comparar a los recién nacidos con y sin el uso de aditivo fortificante de la leche materna, en UCI neonatal. Este estudio fue observacional del tipo cohorte, con grupo control, realizado en una maternidad pública, en las unidades de cuidados intensivos y cuidados intermediarios neonatales. Fueron acompañados 26 recién nacidos pretérmino, divididos en dos grupos, uno de ellos constituido por 13 recién nacidos en lactancia materna exclusiva (grupo control) y otro compuesto por 13 recién nacidos en uso de leche materna, añadido de aditivo fortificante. Para el análisis de datos fue utilizada estadística descriptiva simple calculando distribuciones de frecuencias, cálculo de los promedios, desviación típica y realizaciones de las pruebas estadísticas. El aumento de peso promedio en el período del estudio fue significativamente mayor en el grupo que recibió leche materna con aditivo. En relación a la longitud y al perímetro cefálico no fueron observadas diferencias estadísticas significativas entre los grupos. Se constata que el uso de aditivo en la leche materna humana cruda o procesada proporciona mejor aumento de peso, favoreciendo la recuperación del estado nutricional.

ABSTRACT Breast milk is the ideal food for any newborn regarding the balanced nutritional composition and its ability to generate immunity. Its use has been greatly encouraged in intensive care units and Intermediate Unit, both the milk extracted directly from the mother's womb, as the one from the milk bank. The purpose of the study was to monitor and to compare infants with and without use of breast milk fortifier in neonatal intensive care unit. It was an observational cohort study with a control group, performed in a public hospital, in intensive care units and neonatal intermediate unit. They were followed 26 preterm infants, divided into two groups consisting of 13 preterm infants in exclusively breastfed (control group) and 13 preterm infants in use of breast milk fortifier with additive added. The average weight gain was significantly higher in the group receiving breast milk containing additive. In relation to the length and head circumference, significant differences were not observed. For data analysis, we used simple descriptive statistics by calculating frequency distributions, calculation of averages, standard deviation and achievements of the statistical tests. The average weight gain during the study period was significantly higher in the group receiving breast milk with additives. Regarding the length and head circumference, statistical differences were not significant between groups. It appears that the additive used in raw or processed human breast milk provides better weight gain, facilitating recovery of nutritional status.

Prenatal and developmental toxicity study of meclizine and caffeine combination in female albino wistar rats.

Meclizine and caffeine combination is used for the treatment of morning sickness. Both compounds are teratogenic and caffeine is known to possess anti-fertility activity also. The present study was undertaken to evaluate the reproductive toxic effect of meclizine and caffeine combination. Three doses were taken for the study; low dose (LD; meclizine 3.7 mg/kg and caffeine 3 mg/kg) was selected from commercially available formulation, middle dose (MD; meclizine 37 mg/kg and caffeine 30 mg/kg) and high dose (HD; meclizine 370 mg/kg and caffeine 300 mg/kg). The mixture was administered 1-7 days and 8-14 days for fertility and embryotoxic studies respectively. Laparotomy was done on 10th day of gestation period. Number of implants and corpora lutea were counted, pre and post-implantation losses were determined. In embryo toxicity study fetuses were evaluated for external, skeletal and visceral examination. High dose was removed from both fertility and embryotoxicity studies due to its severe toxicity to the dam. Significant anti-fertility activity was observed at middle dose. Embryotoxicity study showed significant reduction in fetal body weight, body length and body mass index, dam body weight gain on gestation day 14. Absolute kidney weight in MD and absolute and relative spleen weight in both LD and MD were significantly reduced. There was no increase in external or internal congenital anomalies at both LD and MD. The, results suggest that prescription of meclizine and caffeine for morning sickness in early pregnancy should be reviewed carefully.

Examining the side effects of sucrose for pain relief in preterm infants: a case-control study

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.

Recent evidence and potential mechanisms underlying weight gain and insulin resistance due to atypical antipsychotics

Objective: Atypical antipsychotics (AAPs) promote obesity and insulin resistance. In this regard, the main objective of this study was to present potential mechanisms and evidence concerning side effects of atypical antipsychotics in humans and rodents. Method: A systematic review of the literature was performed using the MEDLINE database. We checked the references of selected articles, review articles, and books on the subject. Results: This review provides consistent results concerning the side effects of olanzapine (OL) and clozapine (CLZ), whereas we found conflicting results related to other AAPs. Most studies involving humans describe the effects on body weight, adiposity, lipid profile, and blood glucose levels. However, it seems difficult to identify an animal model replicating the wide range of changes observed in humans. Animal lineage, route of administration, dose, and duration of treatment should be carefully chosen for the replication of the findings in humans. Conclusions: Patients undergoing treatment with AAPs are at higher risk of developing adverse metabolic changes. This increased risk must be taken into account when making decisions about treatment. The influence of AAPs on multiple systems is certainly the cause of such effects. Specifically, muscarinic and histaminergic pathways seem to play important roles. .

Somatic growth effects of intramuscular injection of growth hormone in androgen-treated juvenile Nile tilapia, Oreochromis niloticus (Perciformes: Cichlidae)

Little is known about the effects of the interaction of growth hormone (GH) with 17 a-methyltestosterone (17-MT) during fish growth. We evaluated this in the present study to assess the effect on fish growth. Fish in two batches of juvenile tilapia (Oreochromis niloticus) (approximately 5.0cm in length) were randomly assigned in triplicate to three treatments and a control group, distributed among 12 fiberglass tanks of 1 000L capacity (50 fish per tank) in an experiment covering a period of six weeks. The experimental groups were: a) fish treated with 17-MT and GH in mineral oil (RGH); b) fish treated with 17-MT and mineral oil without the addition of GH (R); c) fish treated with GH in mineral oil but not 17-MT (NGH); and d) fish of the control group, which were treated with mineral oil but not 17-MT or GH (N). The GH was injected into the fish at a rate of 0.625mg/g body weight. Morphometric data were recorded at the beginning of the experiment (T) and at 15, 30 and 45 days (T, T and T), and various indicators of growth were assessed: condition factor (K); survival percentage (S), feed conversion rate (FCR), percentage weight gain (WG) and (v) daily weight gain. The optimum dietary level was calculated assuming 5% food conversion to total weight in each group. During the experiment, the fish were provided with a commercial food containing 45% protein. The data showed that GH injection resulted in a greater weight gain in fish treated with 17-MT (the RGH treatment group), being particularly significant increase in weight during T and T (p<0.05). High values of K were found in the R and RGH treatments during the initial days of the experiment, which may have been a consequence of the better nutritional status affecting both weight gain and growth in body length, as a result of the additive effects of 17-MT and GH. The fish in groups not treated with 17-MT and treated with 17-MT and added GH showed greater increases in WG per day, higher K values and lower FCRs than fish in the other groups, which suggests that greater feed efficiency occurred in the hormone-treated fish. Fish in the RGH treatment showed the most growth, suggesting a possible interaction between 17-MT and injected GH.

Actualmente, durante el crecimiento de los peces existe poco conocimiento sobre los efectos de la interacción de la hormona del crecimiento (HC) con 17 α-metiltestosterona (17-MT). En el presente estudio los peces en dos lotes de tilapia (Oreochromis niloticus) (5.0cm de longitud), fueron asignados al azar por triplicado a tres tratamientos y un grupo control, distribuidos en 12 tanques de fibra de vidrio de 1 000 litros (50 peces por tanque), en un período de seis semanas. Los tratamientos fueron: a) peces tratados con 17-MT+HC en aceite mineral (RGH), b) peces tratados con 17-MT+aceite mineral sin la adición de HC (R), c) los peces que no fueron tratados con 17-MT-tratado+HC en aceite mineral (NGH), y d) los peces que no fueron tratados con 17-MT+aceite mineral (N). La hormona de crecimiento humano recombinante (Humatrope, Eli Lilly & Co., Windlesham, Inglaterra), se inyectó en el pez con una dosis de 0.625mg por gramo de peso corporal. Los datos morfométricos se registraron al comienzo del experimento (T) y en los días 15, 30 y 45 (T, T y T), Se registraron diversos indicadores de crecimiento: factor de condición (K), porcentaje de supervivencia (S), la tasa de conversión alimenticia (FCR), porcentaje de ganancia de peso (GP) y el aumento de peso al día. El nivel óptimo dietético fue calculado suponiendo 5% de conversión de alimentos al peso total de cada grupo. Durante el experimento fue usada una dieta comercial con el 45% de proteína. De los resultados presentados, es evidente que la inyección de HC dio lugar a una mayor ganancia de peso en el 17-MT-los peces tratados (el grupo de tratamiento RGH), y la diferencia fue significativa, tanto en T y T (p<0.05) para ambas comparaciones. De manera similar, los altos valores de K se presentaron en los tratamientos R y RGH durante los primeros días de cultivo. Esto puede haber sido asociado con un mejor estado nutricional que afectó tanto el desarrollo de peso y la longitud del cuerpo del pez, como resultado del efecto aditivo de 17-MT y GH. Los tratamientos no andrógenos y los grupos tratados con andrógenos y con HC mostraron un mayor incremento en la ganancia de peso por día, los mayores valores de K y menores tasas de conversión del alimento, lo que sugiere una mayor eficiencia de la alimentación en los peces tratados con hormonas. Peces en el tratamiento RGH mostraron el mayor crecimiento, lo que sugiere una posible interacción entre el 17 de α-metiltestosterona (17-MT) y hormona de crecimiento inyectada.

Régimen con insulina lispro mix 25 versus insulina glargina para la diabetes tipo 2 / Starting an insulin regimen with insulin lispro mix 25 versus glargine insulin for type 2 diabetes

La información sobre el inicio de regímenes de insulina en poblaciones específicas con diabetes tipo 2 (DT2) es limitada. Se comparó eficacia y seguridad de dos regímenes de inicio: insulina lispro mix 25 (LM25) e insulina glargina basal (GL). Se evaluaron 193 pacientes no tratados previamente con insulina, en la fase de iniciación de 24 semanas del ensayo DURABLE; edades: 30-79 años, DT2 controlada inadecuadamente (HbA1c > 7.0%) con = 2 medicaciones orales antidiabéticas (MOAs), aleatorizados para LM25 (25% de insulina lispro, 75% de insulina lispro protamina en suspensión) dos veces/día, o GL (insulina glargina basal) una vez/ día, a las MOAs previas. La eficacia primaria se midió por HbA1c a las 24 semanas. Se midió eficacia secundaria por: proporción de pacientes que alcanzaron HbA1c= 6.5% y= 7.0%, cambio en peso corporal, valores de automonitoreo glucémico e índices de hipoglucemia. LM25 demostró mayor reducción de la HbA1c (- 2.4% ± 0.16 vs. -2.0% ± 0.16, P = 0.002), mayor proporción de pacientes alcanzaron HbA1c= 7.0% (P = 0.012) y niveles de glucemia menores después del desayuno (P = 0.028) y de la cena (P = 0.011), y a las 3 a.m. (P = 0.005) comparada con GL. La glucemia en ayunas (GA) y la proporción de pacientes que alcanzaron una HbA1c= 6.5% fueron similares. En ambos grupos hubo aumento del peso corporal, mayor en la valoración final con LM25 (6.35 kg vs. 4.23 kg, P < 0.001). No hubieron diferencias en índices de hipoglucemia entre grupos, ni eventos adversos serios en ninguno. Con LM25 fue mejor el control de glucosa, riesgo de hipoglucemia similar y mayor aumento de peso que GL.

Information on starting insulin regimens in specific populations with type 2 diabetes (T2D) is limited. This analysis compared efficacy and safety of two starter insulin regimens: insulin lispro mix 25 (LM25) and basal insulin glargine (GL) in patients from Argentina. This post-hoc analysis evaluated 193 insulin-naïve patients who participated in the DURABLE trial 24-week initiation phase. Patients 30-79 years with T2D inadequately controlled (HbA1c > 7.0%) with = 2 oral antihyperglycemic medications (OAMs), were randomized to add LM25 (25% insulin lispro, 75% insulin lispro protamine suspension) twice daily or GL (basal insulin glargine) once daily to pre-study OAMs. Primary efficacy was measured by HbA1c at 24-week endpoint. Secondary measures included: proportion of patients achieving HbA1c= 6.5% and= 7.0%, body weight change, self-monitored blood glucose (BG) values, and hypoglycemia rates. LM25 demonstrated greater HbA1c reduction (- 2.4% ± 0.16 vs. -2.0% ± 0.16, P = 0.002), a higher proportion of patients achieving HbA1c= 7.0% (P = 0.012), and lower BG levels after the morning (P = 0.028) and evening (P = 0.011) meals, and at 3:00AM (P = 0.005) compared with GL. Fasting BG and proportion of patients achieving HbA1c= 6.5% were similar between groups. Both groups increased body weight, although the gain was higher at endpoint with LM25 (6.35 kg vs. 4.23 kg, P < 0.001). No differences in hypoglycemia rates were observed between groups, and no serious adverse events were reported for either group. In this subgroup from Argentina, LM25 demonstrated greater improvement in glucose control with similar risk of hypoglycemia and more weight gain than GL.

Energy metabolism, leptin, and biochemical parameters are altered in rats subjected to the chronic administration of olanzapine / Metabolismo calórico, leptina e parâmetros bioquímicos se alteram em ratos submetidos à administração crônica de olanzapina

OBJECTIVES: Olanzapine, an atypical antipsychotic drug with affinities for dopamine, serotonin, and histamine binding sites appears to be associated with substantial weight gain and metabolic alterations. The aim of this study was to evaluate weight gain and metabolic alterations in rats treated with olanzapine on a hypercaloric diet. METHODS: We used 40 rats divided into 4 groups: Group 1, standard food and water conditions (control); Group 2, standard diet plus olanzapine; Group 3, cafeteria diet (hypercaloric); and Group 4, olanzapine plus cafeteria diet. Olanzapine was administered by gavage at a dose of 3 mg/kg for 9 weeks. RESULTS There were no significant changes in the cholesterol levels in any group. Glucose levels increased in Group 3 by the fourth week. Triglyceride levels were altered in group 2 toward the end of the experiment. Leptin levels decreased in Groups 2 and 4. Complex II activity in the muscles and liver was altered in Group 2 (muscle), and Groups 2, 3, and 4 (liver). Complex IV activity was altered only in the liver in Group 2, without significant alterations within the muscles. CONCLUSION: These results suggest that olanzapine is correlated with weight gain and the risks associated with obesity.

OBJETIVOS: A olanzapina, uma droga antipsicótica atípica com afinidade por locais de ligação de dopamina, serotonina e histamina, parece se associar a um ganho de peso e a alterações metabólicas consideráveis. O objetivo desse estudo foi avaliar o ganho de peso e as alterações metabólicas em ratos tratados com olanzapina numa dieta hipercalórica. MÉTODOS: Usamos 40 ratos divididos em 4 grupos: Grupo 1, condições padrão de alimento e água (controle); Grupo 2, dieta padrão mais olanzapina; Grupo 3, dieta hipercalórica; e Grupo 4, olanzapina mais dieta hipercalórica. Olanzapina foi administrada por gavagem a uma dose de 3 mg/kg por 9 semanas. RESULTADOS: Não houve alterações significativas nos níveis de colesterol em qualquer um dos grupos. Os níveis de glicose aumentaram no Grupo 3 por volta da quarta semana. Os níveis de triglicerídeos estavam alterados no Grupo 2 ao final do experimento. Os níveis de leptina diminuíram nos Grupos 2 e 4. A atividade do complexo II nos músculos e no fígado se alterou no Grupo 2 (músculos) e nos Grupos 2, 3 e 4 (fígado). A atividade do complexo IV se alterou apenas no fígado no Grupo 2, sem alterações significativas nos músculos. CONCLUSÃO: Esses resultados sugerem que olanzapina se correlaciona ao ganho de peso e aos riscos associados à obesidade.

Ensaio clínico randomizado, duplo-cego e controlado por placebo de ciproheptadina para estímulo do apetite na fibrose cística / A randomized, double-blind, placebo-controlled trial of cyproheptadine for appetite stimulation in cystic fibrosis

OBJETIVO: O objetivo deste estudo foi determinar se a administração de ciproheptadina é capaz de induzir ganho de peso em pacientes com fibrose cística. MÉTODOS: Foi realizado um estudo duplo-cego, controlado com placebo em dois centros no Brasil. Vinte e cinco pacientes com fibrose cística entre 5 e 18 anos completaram o estudo. Os pacientes foram randomizados em dois grupos, para receber ciproheptadina 4 mg três vezes por dia durante 12 semanas ou placebo. Todos os dados foram coletados no início e no final do período de estudo e incluíram peso, altura e espirometria. RESULTADOS: O ganho de peso médio foi de 0,67 kg e 1,61 kg nos grupos placebo e ciproheptadina, respectivamente (p = 0,036). O índice de massa corporal (IMC) diminuiu 0,07 kg/m² no grupo placebo e aumentou 0,46 kg/m² no grupo intervenção (p = 0,027). A mudança no IMC para a idade (escore z) foi de -0,19 no grupo placebo e 0,20 no grupo ciproheptadina (p = 0,003). O IMC escore z diminuiu 0,19 no grupo placebo e aumentou 0,2 no grupo ciproheptadina (p = 0,003). Alterações na função pulmonar não foram estatisticamente diferentes. CONCLUSÃO: O uso de ciproheptadina em pacientes com fibrose cística foi bem tolerado, apresentando um ganho de peso significativo e um aumento no IMC após 12 semanas. Foi encontrado um tamanho de efeito clinicamente relevante para o peso/idade (escore z) e IMC para idade (escore z). Tais achados sugerem que a prescrição de ciproheptadina pode ser uma abordagem alternativa para pacientes que precisam de suporte nutricional por um curto período de tempo.

OBJECTIVE: To determine whether the administration of cyproheptadine was able to induce weight gain in patients with cystic fibrosis. METHODS: We performed a double-blind, placebo-controlled trial in two centers in Brazil. Twenty-five patients with cystic fibrosis between 5 and 18 years completed the study. Patients were randomized into two groups, to receive either cyproheptadine 4 mg three times per day for 12 weeks or placebo. All data were collected at the beginning and at the end of the study period and included weight, height and spirometry. RESULTS: Average weight gain was 0.67 kg in the placebo group and 1.61 kg in the cyproheptadine group (p = 0.036). Body mass index (BMI) decreased 0.07 kg/m² in the placebo group and increased 0.46 kg/m² in the intervention group (p = 0,027). The change in BMI for age (z score) was -0.19 in the placebo group and +0.20 in the cyproheptadine group (p = 0.003). BMI z score decreased 0.19 in the placebo group and increased 0.2 in the cyproheptadine group (p = 0.003). Changes in pulmonary function were not statistically different. CONCLUSION: Use of cyproheptadine in cystic fibrosis patients was well tolerated, showing a significant weight gain and a significant increase in BMI after 12 weeks. A clinically relevant effect size for weight/age (z score) and body mass index for age (z score) was found. Such findings suggest that the prescription of cyproheptadine can be an alternative approach for patients who need nutritional support for a short period of time.

Freeze-dried jaboticaba peel powder rich in anthocyanins did not reduce weight gain and lipid content in mice and rats

Jaboticaba, a native fruit from Brazilian Atlantic Forest, is an important source of anthocyanins. Anthocyanins have been recently identified as modulators of lipid metabolism and energy expenditure ‘in vivo’. The purpose of this study was to evaluate the effect of the freeze-dried jaboticaba peel powder on obesity treatment in different experimental models. Obese Swiss mice and obese Sprague- Dawley rats were fed a high-fat diet supplemented with 1, 2 and 4% freeze-dried jaboticaba peel powder for 6 weeks. Energy intake, weight gain and body composition were determined, and the results were analyzed using variance and Tukey's tests (p <0.05). The energy intake was higher in mice groups supplemented with 2% and 4% of jaboticaba peel. In relation to weight gain, the mice supplemented with 2% of jaboticaba peel had higher total weight gain than the other experimental groups, while no significant difference in the fat mass accumulation was observed among the groups. The rats did not show significant differences in the evaluated parameters. These results suggest that the supplementation with freeze-dried jaboticaba peel powder, at concentrations of 1, 2 and 4%, was not effective in the reduction of energy intake, weight gain and body fat both in mice and in rats.

La cáscara de jaboticaba liofilizada, una rica fuente de antocianinas, no influyó en la ganancia de peso ni en el contenido de lípidos en roedores La jaboticaba, una fruta nativa de la Selva Atlántica de Brasil, es una fuente importante de antocianinas. Las antocianinas han sido recientemente identificadas como moduladoras del metabolismo de lípidos y del gasto energético en vivo. Este estudio tuvo como objetivo evaluar el uso de la cáscara de jaboticaba liofilizada en polvo en el tratamiento de la obesidad, en distintos modelos experimentales. Ratones Swiss y ratas Sprague-Dawley obesos, recibieron dietas con alto contenido de grasas, a las que se añadió 1, 2 y 4% de cáscara de jaboticaba en polvo, durante 6 semanas. Se determinó el consumo de energía, el aumento de peso y la composición corporal de los animales, y los resultados fueron sometidos a análisis de varianza y prueba de Tukey, con p <0,05. El consumo de energía fue superior en los grupos de ratones Swiss de los grupos con 2% y 4% de cáscara de jaboticaba. En el aumento del peso, los ratones Swiss del grupo con 2% de piel de jaboticaba aumentaron más en peso total comparados a los otros grupos experimentales; mientras que no se observaron diferencias significativas entre los grupos respecto a la composición de la masa grasa. Entre los grupos de ratas Sprague-Dawley no se dieron diferencias significativas en ninguno de los parámetros evaluados. Por lo tanto, se concluye que la adición de 1, 2 y 4% de cáscara de jaboticaba liofilizada, a la dieta, no fue eficaz para el tratamiento de la obesidad, tanto en ratones Swiss como en ratas Sprague-Dawley.