O Papel dos Níveis Séricos de ANP na Perda de Peso, Risco Cardiometabólico e Composição Corporal de Adolescentes com Obesidade Submetidos a Terapia Interdisciplinar / The Role of ANP Level Response in Interdisciplinary Weight Loss Therapy on Cardiometabolic Risk and Body Composition in Adolescents with Obesity

Resumo Fundamento A ação do peptídeo natriurético atrial (ANP) na natriurese, diurese e vasodilatação, resistência à insulina, fígado, rim e tecido adiposo pode contribuir para o desenvolvimento metabólico e cardiovascular saudável. Embora o nível circulante de ANP seja reduzido em pacientes com obesidade, sua resposta à perda de peso ainda é pouco explorada em populações pediátricas. Objetivo Avaliar os efeitos das variações do ANP em resposta à intervenção interdisciplinar para perda de peso na Síndrome Metabólica (SMet) e nos riscos cardiometabólicos em adolescentes com obesidade. Métodos 73 adolescentes com obesidade participaram de uma terapia interdisciplinar para perda de peso de 20 semanas, incluindo uma abordagem clínica, nutricional, psicológica e de exercícios físicos. A composição corporal, análises bioquímicas e pressão sanguínea foram avaliadas. A SMet foi classificada de acordo com a Federação Internacional de Diabetes (IDF) (2007). Após o tratamento, os voluntários foram divididos de acordo com os níveis de plasma do ANP aumento (n=31) ou ANP redução (n=19). Resultados Ambos os grupos apresentaram redução significativa de peso corporal, índice de massa corporal (IMC) e circunferências de cintura, pescoço e quadril (CC, CP e CQ, respectivamente), e aumento da massa livre de gordura (MLG). É interessante observar que houve uma redução significativa na gordura corporal, na razão de TG/HDL-c e na prevalência de SMet (de 23% para 6%) somente no grupo com ANP aumento. Conclusão Este estudo sugere que o aumento nos níveis séricos de ANP após a terapia para perda de peso pode estar associado a melhorias nos riscos cardiometabólicos e na prevalência reduzida de SMet em adolescentes com obesidade.

Abstract Background The action of atrial natriuretic peptide (ANP) on natriuresis, diuresis and vasodilatation, insulin resistance, liver, kidney, and adipose tissue may contribute to the healthy metabolic and cardiovascular development. Even though the circulating level of ANP is reduced in patients with obesity, its response to weight loss remains poorly explored in pediatric populations. Objective To evaluate the effects of ANP variations in response to interdisciplinary weight loss intervention on metabolic syndrome (MetS) and cardiometabolic risks in adolescents with obesity. Methods 73 adolescents with obesity attended a 20-week clinical interdisciplinary weight loss therapy including clinical, nutritional, psychological and exercise training approach. Body composition, biochemical analyses and blood pressure were evaluated. MetS was classified according to the International Diabetes Federation (IDF) (2007). After the treatment, volunteers were divided according to Increasing (n=31) or Decreasing (n=19) ANP plasma levels. Results Both groups present significant reduction of body weight, Body Mass Index (BMI), waist, neck and hip circumferences (WC, NC and HC, respectively) and increasing fat-free mass (FFM). Interestingly, a significant reduction in body fat, TG/HDL-c ratio and MetS prevalence (from 23% to 6%) was observed in the Increased ANP group only. Conclusion This study suggests that an increase in ANP serum levels after weight loss therapy could be associated with improvements in cardiometabolic risks and the reduced prevalence of MetS in adolescents with obesity.

Aprender e ensinar semiologia médica em situações de deficiência auditiva: nossa experiência / Learn and teach medical semiology front hearing impairment: our report

Resumo: Introdução: Da população brasileira, 5% vivem com algum nível de deficiência auditiva. Apesar desse número, poucas pessoas têm acesso à educação superior. A legislação nacional defende a integração e, principalmente, a inclusão dessas pessoas no ambiente acadêmico brasileiro. Poucos são os dados sobre o acesso dos deficientes auditivos ao curso de Medicina no Brasil. Relato de experiência: Este artigo apresenta relatos de experiências de uma estudante com deficiência auditiva que cursou a disciplina de Introdução à Semiologia Médica e de seus professores e da estudante-monitora que acompanhou a disciplina. Para discutir os temas, foram selecionados 12 artigos das bases de dados MEDLINE, SciELO e LILACS, publicados entre julho de 2019 e outubro de 2021. Também se utilizaram informações publicadas pelo IBGE e Portal MEC. Discussão: A estudante relata sua dificuldade em compreender termos semiológicos, bem como suas alternativas para adquirir habilidades referentes ao exame físico. O relato do professor aborda como a inclusão é possível porém desafiadora ao se ensinar semiologia médica a uma pessoa com deficiência auditiva. Conclusão: Estudantes deficientes auditivos se beneficiam de adequação acadêmica visando à integração e inclusão para obter êxito em adquirir e treinar suas habilidades semiotécnicas. Há urgente necessidade de novas pesquisas brasileiras nessa área, principalmente relacionadas à medicina e ao ensino médico.

Abstract: Introduction: Five percent of the Brazilian population lives with some level of hearing impairment. Despite this number, few of these people have access to higher education. National legislation defends the integration and, mainly, the inclusion of these people in the Brazilian academic environment. There are few data on the access of the hearing impaired to the Medicine course in Brazil. Experience report: This article brings reports of experiences of a medicine student with hearing impairment, her monitor and her professors, with the aim of discussing the challenges faced. A contextualization with the current literature was carried out. Discussion: The student reports her difficulty in understanding semiological terms, as well as her alternatives for acquiring skills related to the physical examination. The role of the monitor and the teacher is approached with personal accounts that show how inclusion is possible and challenging. Conclusion: Hearing impaired students benefit from academic adequacy aimed at integration and inclusion to successfully acquire and train their semiotechnical skills. There is an urgent need for new Brazilian research in this area, mainly related to medicine and medical education.

Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity

ABSTRACT Objective: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. Subjects and methods: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. Results: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. Conclusions: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Effects of photobiomodulation and a physical exercise program on the expression of inflammatory and cartilage degradation biomarkers and functional capacity in women with knee osteoarthritis: a randomized blinded study

Abstract Background: The knee osteoarthritis (OA) is a joint disease characterized by degradation of articular cartilage that leads to chronic inflammation. Exercise programs and photobiomodulation (PBM) are capable of modulating the inflammatory process of minimizing functional disability related to knee OA. However, their association on the concentration of biomarkers related to OA development has not been studied yet. The aim of the present study is to investigate the effects of PBM (via cluster) with a physical exercise program in functional capacity, serum inflammatory and cartilage degradation biomarkers in patients with knee OA. Methods: Forty-two patients were randomly allocated in 3 groups: ESP: exercise + sham PBM; EAP: exercise + PBM and CG: control group. Six patients were excluded before finished the experimental period. The analyzed outcomes in baseline and 8-week were: the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the evaluation of serum biomarkers concentration (IL-1β, IL-6, IL-8, IL-10 e TNF-α, and CTX-II). Results: An increase in the functional capacity was observed in the WOMAC total score for both treated groups (p < 0.001) and ESP presents a lower value compared to CG (p < 0.05) the 8-week post-treatment. In addition, there was a significant increase in IL-10 concentration of EAP (p < 0.05) and higher value compared to CG (p < 0.001) the 8-week post-treatment. Moreover, an increase in IL-1β concentration was observed for CG (p < 0.05). No other difference was observed comparing the other groups. Conclusion: Our data suggest that the physical exercise therapy could be a strategy for increasing functional capacity and in association with PBM for increasing IL-10 levels in OA knee individuals. Trial registration: ReBEC (RBR-7t6nzr).

Higher increase degree of FGF21 post long-term interdisciplinary weight loss therapy preserves the free fat mass and rest metabolic rate in adolescents with obesity

ABSTRACT Objective Fibroblast growth factor 21 (FGF21) is among the activators that can stimulate thermogenesis in the white adipose tissue and brown adipose tissue. People with obesity have elevated blood levels of FGF21, but also develop resistance to its action, impairing its beneficial role. Inversely, clinical treatments to weight loss has been pointed out as an important therapy for increasing and recovering sensitivity to FGF21. The aim was to analyse the effect of long-term weight loss interdisciplinary intervention on FGF21 and body composition. Subjects and methods Eighty-six post-pubertal obese adolescents (14-19 years-old), were submitted to 20 weeks of weight loss therapy (clinical, nutritional, psychological and physical exercise support). Anthropometric measures, body composition and rest metabolic rate (RMR) by bioelectrical impedance, and serum FGF21 sample by ELISA were evaluated. The adolescents were grouped according to FGF21 individual delta variations after therapy: Higher Increase (HI); lower increase (LI); lower decrease (LD); higher decrease (HD). Results All groups present weight loss. Only in FGF21 ≥ 76,5 pg/mL variation the free-fat-mass and rest metabolic rate were preserved and to others group these variables were significantly reduced. Conclusion High increase in FGF21 can contribute to preservation of FFM and RMR after weight loss therapy, could have important implications for energy balance regulation. Future studies are necessary to continue determining the role of magnitude effects of FGF21 levels in obesity to improve clinical practice, especially in paediatrics population.

Relationship between adiponectin and leptin on osteocalcin in obese adolescents during weight loss therapy

ABSTRACT Objectives: Obesity is a multifactorial disease characterized by the presence of the pro-inflammatory state associated with the development of many comorbidities, including bone turnover marker alterations. This study aimed to investigate the role of the inflammatory state on bone turnover markers in obese adolescents undergoing interdisciplinary weight loss treatment for one year. Subjects and methods: Thirty four post-pubescent obese adolescents with primary obesity, a body mass index (BMI) greater than > 95th percentile of the CDC reference growth charts, participated in the present investigation. Measurements of body composition, bone turnover markers, inflammatory biomarkers and visceral and subcutaneous fat were taken. Adolescents were submitted to one year of interdisciplinary treatment (clinical approach, physical exercise, physiotherapy intervention, nutritional and psychological counseling). Results: Reduction in body mass, body fat mass, visceral and subcutaneous fat, as well as, an increase in the body lean mass and bone mineral content was observed. An improvement in inflammatory markers was seen with an increase in adiponectin, adiponectin/leptin ratio and inteleukin-15. Moreover, a positive correlation between the adiponectin/leptin ratio and osteocalcin was demonstrated. Further, both lean and body fat mass were predictors of osteocalcin. Negative associations between leptin with osteocalcin, adiponectin with Beta CTX-collagen, and visceral fat with adiponectin were observed. Conclusions: It is possible to conclude that the inflammatory state can negatively influence the bone turnover markers in obese adolescents. In addition, the interdisciplinary weight loss treatment improved the inflammatory state and body composition in obese adolescents. Therefore, the present findings should be considered in clinical practice.

Associação entre sintomas, veias varicosas e refluxo na veia safena magna ao eco-Doppler / Associations between symptoms and varicose veins and great saphenous vein reflux seen on Doppler ultrasonography

Resumo Contexto A doença venosa crônica requer avaliação clínica, quantificação dos efeitos hemodinâmicos e definição da distribuição anatômica para decisão diagnóstica e tratamento. Métodos Estudo prospectivo realizado em 2015 com amostra de 1.384 pacientes (2.669 membros) com idade entre 17 e 85 anos, sendo 1.227 do sexo feminino. Nas respostas do questionário aplicado, os sintomas pesquisados eram dor, cansaço, sensação de peso, queimação, câimbras e formigamento. Para a formação dos grupos, foi considerado o número de membros, distribuídos em relação ao gênero, ao índice de massa corporal e à idade. Após a definição grupos e a realização do eco-Doppler para estudo da veia safena magna (VSM), os pacientes foram distribuídos em três grupos (I: sintomas presentes e varizes ausentes, II: sintomas ausentes e varizes presentes e III: sintomas presentes e varizes presentes). A análise estatística utilizou o teste qui-quadrado ou exato de Fisher para verificar a homogeneidade entre os grupos. Em caso de associação com significância de 5%, foi calculada a razão de chances. Resultados Para ambos os gêneros, foi observada chance de insuficiência da VSM 11,2 vezes maior no grupo III. Por sua vez, os casos de obesidade mórbida ocorreram 9,1 vezes mais no mesmo grupo. Além disso, pacientes na faixa etária entre 30 e 50 anos desse grupo apresentaram chance de insuficiência da VSM 43,1 vezes maior. Conclusões A insuficiência da VSM foi significantemente mais frequente no grupo III, tanto globalmente como considerando apenas os casos de obesidade mórbida e a faixa etária mais elevada.

Abstract Background Chronic venous disease demands clinical assessment, quantification of hemodynamic effects, and definition of anatomic distribution before diagnostic and treatment decisions can be made. Methods This is a prospective study conducted in 2015 with a sample of 1,384 patients (2,669 limbs) aged from 17 to 85 years, 1,227 of whom were female. The most common symptoms reported in response to the questionnaire were pain, tiredness, feelings of heaviness, burning, cramps, and tingling. Subsets were formed on the basis of number of limbs distributed by sex, body mass index, and age. After definition of subsets, Doppler ultrasonography was used to conduct examinations of the great saphenous vein (GSV) and patients were distributed into three clinical groups (I: symptoms present and varicose veins absent, II: symptoms absent and varicose veins present and III: symptoms present and varicose veins present). Statistical analysis employed the chi-square test or Fisher’s exact test to test for homogeneity between groups. When associations significant to 5% were detected, odds ratios were calculated. Results For both sexes, the chance of GSV insufficiency was 11.2 times greater in group III. Among cases with morbid obesity, the chance was 9.1 times greater in the same group. Additionally, patients in this group with ages ranging from 30 to 50 years exhibited a 43.1 times greater chance of GSV insufficiency. Conclusions Insufficiency of the GSV was significantly more frequent in group III, both overall and when considering only cases with morbid obesity, or cases in older age groups.

Os álbuns ilustrados do sertão paulista: a modernidade encarnada (1900-1930) / The illustrated albums from countryside of são paulo: incarnated modernity (1900-1930) 1

RESUMO: O artigo analisa os álbuns ilustrados publicados no Estado de São Paulo, em cidades pelas quais passava a Estrada de Ferro Araraquarense, entre os anos de 1900 e 1930, com ênfase no escrutínio do Album de Araraquara 1915. Discute a confecção de tais álbuns como uma estratégia das elites do interior, visando tornar conhecidos os vastos "sertões" em relação ao restante do país e do mundo. À luz da historiografia cultural francesa, bem como da Análise do Discurso, constata que tais suportes nasceram para ser a síntese gloriosa de um determinado tempo/espaço, tendo se transformado em verdadeiros "documentos monumentos". Considera que em meio à utopia de representação total da realidade levada a cabo pelos artífices daqueles álbuns, a temática educacional ganhou contornos peculiares, consoantes ao processo civilizador em curso nos confins paulistas, particularmente no que concerne a um modo épico de retratar os sujeitos e as instituições escolares daquele rincão.

ABSTRACT: The present paper analyses the illustrated albums published in the Estado de Sao Paulo newspaper in cities served by Araraquara's railroad, from 1900 to 1930, focusing on the scrutiny from the Album of Araraquara 1915. It also discusses the making of such albums as strategies developed by the elites of the countryside. Such group aimed to make their region acclaimed in relation to the rest of the country and the world. Through Cultural French Historiography, as well as Discourse Analysis, we were able to find that those publications were born to be a glorious synthesis of a specific time and space, having turned in truly documents-monuments through the years. It considers that, in the midst of the utopia of total representation of reality carried out by the producers of those albums, the educational theme has acquired peculiar contours, consonant to the civilizing process in progress in the São Paulo countryside, particularly in what concerns an epic way of portraying individuals and school institutions in that corner.

Waist circumference as a marker for screening nonalcoholic fatty liver disease in obese adolescents / Circunferência da cintura como marcador para triagem de doença hepática gordurosa não alcoólica em adolescentes obesos

To assess the relationship between the degree of waist circumference (WC) and nonalcoholic fatty liver disease (NAFLD) in obese adolescents of both genders, analyzed according to quartiles of WC. Methods: Cross-sectional study that involved 247 obese adolescents aged 12–19 years. Mean values of the nutritional parameters and serum analyses were compared with the groups using the independent t-test. Pearson correlation coefficient was used to determine the relationship of the parameters studied. Chi-square test for trend was used to determine the relationship between the prevalence of the NAFLD and WC quartile by gender. Results: NAFLD were presented in 60% of the study participants. Obese adolescents in the 3rd and 4th quartiles of WC presented higher prevalence of NAFLD when compared with that in the 1st quartile in both genders. The NAFLD patients had significantly higher values for body weight, BMI (body mass index), BAZ-score (BMI-for-age z-scores), total fat (% and kg), WC, visceral fat, insulin, insulin resistance index (HOMA-IR), aspartate aminotransferase and alanine aminotransferase, when compared with non-NAFLD obese adolescents. Conclusions: In conclusion, the results presented here suggest that an increase in WC can reliably predict the risk of NAFLD in obese adolescents. This is a low cost and easy-to-use tool that can help in screening in adolescents.

Avaliar a associação entre o grau de circunferência da cintura (CC) e doença hepática gordurosa não alcoólica (DHGNA) em adolescentes obesos de ambos os sexos, avaliados de acordo com quartis de CC. Métodos: Estudo transversal que envolveu 247 adolescentes obesos entre 12 a 19 anos. Os valores médios dos parâmetros nutricionais e as analises séricas foram comparados com o teste t independente. O coeficiente de correlação de Pearson foi usado para determinar a relação entre os parâmetros estudados. O teste do qui-quadrado de tendência foi usado para determinar a relação entre a prevalência da DHGNA e quartil da CC por sexo. Resultados: DHGNA estava presente em 60% dos participantes do estudo. Adolescentes obesos nos quartis 3 e 4 de CC apresentaram maior prevalência de DHGNA quando comparados com aqueles no primeiro quartil em ambos os sexos. Os pacientes com DHGNA tinham valores significativamente mais elevados de peso corporal, IMC (índice de massa corporal), IMC/I (IMC para idade) z-escore, gordura total (% e kg), CC, gordura visceral, insulina, índice de resistência à insulina (HOMA-IR), aspartato aminotransferase e alanina aminotransferase quando comparados com adolescentes obesos sem DHGNA. Conclusões: Os resultados aqui apresentados sugerem que um aumento da CC pode predizer com segurança o risco de DHGNA em adolescentes obesos. Essa é uma ferramenta de baixo custo e fácil de usar que pode ajudar na triagem de adolescentes.

Nutritional and antioxidant potential of canjiqueira fruits affected by maturity stage and thermal processing / Potencial nutritivo e antioxidante de frutos de canjiqueira afetados pelo estádio de maturação e pelo processamento térmico

The effect of jelly processing on the chemical properties, nutrients, antinutritional factors, bioactive compounds, and antioxidant activity of unripe and ripe canjiqueira fruits was evaluated. The fruits were collected from Pantanal regions at two different ripening stages and were used to produce jellies. The processing affected the chemical characteristics and the content of all nutrients, except for the lipids. Moisture and protein content reduced, whereas the energy value increased. The phytic acid found in fresh fruits was eliminated after processing, and the trypsin inhibitors were reduced, especially in ripe fruits. Lectin activity was not verified in unripe and ripe fruits and jellies. The levels of bioactive compounds were reduced after jelly processing, but their retention was higher in unripe fruits. The final levels of bioactive compounds in the jelly made from unripe fruits were higher than that in the jelly made from ripe fruits, whereas the IC50 value was lower, indicating higher potential to prevent free radicals damages to human body. Jelly processing proved to be a good alternative to the use of canjiqueira fruits due to the reduction in antinutritional factors and the retention of bioactive compounds.

Avaliou-se o efeito do processamento de geleia nas características químicas, nos nutrientes, fatores antinutricionais, compostos bioativos e atividade antioxidante de frutos de canjiqueira verdes e maduros. Os frutos foram coletados em regiões de Pantanal em dois estádios de maturação e utilizados para produzir geleias. O processamento afetou as características químicas e os níveis dos nutrientes estudados, exceto de lipídeos. A umidade e o conteúdo proteico reduziram, enquanto o valor energético aumentou. O ácido fítico detectado nos frutos frescos foi eliminado após o processamento e os níveis de inibidores trípticos reduziram, especialmente nos frutos maduros. Não foi verificada atividade de lectinas nos frutos e geleias. Os níveis dos compostos bioativos estudados reduziram após o processamento das geleias, sendo sua retenção maior nos frutos verdes. Os níveis de compostos bioativos na geleia de frutos verdes foram maiores que nos frutos frescos maduros, enquanto o valor de IC50 foi menor, indicando maior potencial em prevenir danos à saúde causados pelos radicais livres. A geleia se mostrou uma boa alternativa para utilização dos frutos de canjiqueira, devido à redução dos fatores antinutricionais e à retenção dos compostos bioativos.

Floriano de Lemos no Correio da Manhã, 1906-1965 / Floriano de Lemos in the Correio da Manhã newspaper, 1906-1965

O artigo discorre sobre a vida e a obra do médico e jornalista carioca Floriano de Lemos, trazendo a lume sua vasta produção como cronista do Correio da Manhã, jornal de significativa importância na história brasileira da primeira metade do século XX. Apresenta temas recorrentemente discutidos por esse intelectual – personagem que pode ser caracterizado como polígrafo e moderno – tal como se dá a ver na coluna “Crônica científica”, publicada aos domingos no suplemento literário do Correio. Analisa, além disso, a trajetória do autor, situando-a como historicamente relevante pelo que ela tem de singular, mas, sobretudo, pelo que revela acerca da cultura intelectual do período.

This article covers the life and work of Rio de Janeiro-born doctor and journalist, Floriano de Lemos, bringing to light his extensive output as a columnist in the Correio da Manhã newspaper, which had a significant impact on Brazilian history in the first half of the twentieth century. It presents recurring themes discussed by this intellectual – a figure who could be described as multifaceted and modern – as expressed in his column, “Scientific Chronicle”, published every Sunday in the newspaper’s literary supplement. It also analyzes Lemos’s career, highlighting its historical significance not just because of its singularities, but primarily for what it reveals about the intellectual culture at the time.

Passive body heating improves sleep patterns in female patients with fibromyalgia

OBJECTIVE: To assess the effect of passive body heating on the sleep patterns of patients with fibromyalgia. METHODS: Six menopausal women diagnosed with fibromyalgia according to the criteria determined by the American College of Rheumatology were included. All women underwent passive immersion in a warm bath at a temperature of 36 ±1 °C for 15 sessions of 30 minutes each over a period of three weeks. Their sleep patterns were assessed by polysomnography at the following time-points: pre-intervention (baseline), the first day of the intervention (acute), the last day of the intervention (chronic), and three weeks after the end of the intervention (follow-up). Core body temperature was evaluated by a thermistor pill during the baseline, acute, chronic, and follow-up periods. The impact of this treatment on fibromyalgia was assessed via a specific questionnaire termed the Fibromyalgia Impact Questionnaire. RESULTS: Sleep latency, rapid eye movement sleep latency and slow wave sleep were significantly reduced in the chronic and acute conditions compared with baseline. Sleep efficiency was significantly increased during the chronic condition, and the awakening index was reduced at the chronic and follow-up time points relative to the baseline values. No significant differences were observed in total sleep time, time in sleep stages 1 or 2 or rapid eye movement sleep percentage. The core body temperature and Fibromyalgia Impact Questionnaire responses did not significantly change over the course of the study. CONCLUSION: Passive body heating had a positive effect on the sleep patterns of women with fibromyalgia.

Influence of visceral and subcutaneous fat in bone mineral density of obese adolescents / A influência da gordura visceral e subcutânea na densidade mineral óssea de adolescentes obesos

OBJECTIVE: To verify the influence of visceral and subcutaneous fat, as well adipokines in bone mineral density (BMD) in obese adolescents. SUBJECTS AND METHODS: The study involved 125 postpubertal obese adolescents (45 boys and 80 girls). Anthropometric measurements, body composition, visceral and subcutaneous fat, and BMD were determined. Leptin, adiponectin, and insulin levels also analyzed. RESULTS: Data demonstrated a negative relationship between BMD with insulin resistance, visceral fat and leptin concentration; and bone mineral content with visceral/subcutaneous ratio. Positive association between BMD and subcutaneous fat was observed. CONCLUSIONS: Visceral fat and insulin resistance, as well as visceral/subcutaneous ratio and leptin concentration, were negative predictors of BMD in boys and girls, respectively. However, subcutaneous fat had a protective influence in BMD only in boys.

OBJETIVO: Verificar a influência da gordura visceral e subcutânea, assim como das adipocinas na densidade mineral óssea (DMO) em adolescentes obesos. SUJEITOS E MÉTODOS: O estudo envolveu 125 adolescentes obesos pós-púberes. Medidas antropométricas, composição corporal, gordura visceral e subcutânea e DMO foram determinadas. Níveis de leptina, adiponectina e insulina foram analisados. RESULTADOS:Os dados demonstraram associação negativa entre DMO com resistência insulínica, gordura visceral e concentração de leptina; e conteúdo mineral ósseo com a razão visceral/subcutânea. Associação positiva entre DMO e gordura subcutânea foi observada. CONCLUSÕES: Gordura visceral, resistência insulínica, razão visceral/subcutânea e concentração de leptina foram preditores negativos da DMO em meninos e meninas, respectivamente. Entretanto, a gordura subcutânea demonstrou exercer influência positivamente na DMO somente nos meninos.

Fibromialgia: nível de atividade física e qualidade do sono / Fibromyalgia: level of physical activity and quality of sleep

O objetivo foi identificar o nível de atividade física e sua relação com sonolência excessiva diurna e qualidade de sono em 15 mulheres com fibromialgia, com idade média de 58±7 anos. Foi utilizado o Questionário Internacional de Atividade Física, o Índice de Qualidade de Sono de Pittsburgh e a Escala de Sonolência de Epworth. O programa SPSS Statistics versão 17 foi utilizado para as analises estatísticas e o valor para significância foi de α ≤ 0,05. Os resultados evidenciaram que 33,3% das pacientes classificaram-se inativas e 66,7% minimamente ativas. Observou-se sonolência excessiva diurna em 60% das pacientes. A qualidade ruim de sono foi observada em 55,6% das pacientes minimamente ativas e em 60% das inativas. O tempo médio para adormecer foi 34,3 minutos, a eficiência do sono foi 81% e o tempo total de sono foi 5,9 horas. O baixo nível de atividade física parece ser um dos fatores capazes de piorar a qualidade do sono de mulheres com fibromialgia.

The objective was to identify the level of physical activity and its relation to excessive daytime sleepiness and sleep quality in 15 women with fibromyalgia and mean age 58 ± 7 years. We used the International Physical Activity Questionnaire, the Sleep Quality Index in Pittsburgh and Epworth Sleepiness Scale. We used SPSS Statistics Version 17 and the value for significance was α ≤ 0.05. The results showed that 33,3% of patients rated themselves inactive and 66,7% minimally active. We observed excessive daytime sleepiness in 60% of patients. The poor quality of sleep was observed in 55,6% of patients in minimally active and 60% of inactive. The average time was 34,3 minutes to fall asleep, sleep efficiency was 81% and total sleep time was 5,9 hours. The low level of physical activity seems to be one of the factors that can worsen sleep quality in women with fibromyalgia.

Food variety, dietary diversity, and food characteristics among convenience samples of Guatemalan women / La variedad, diversidad y características de la dieta en muestras de conveniencia de mujeres guatemaltecas

OBJECTIVE: To compare variety and diversity patterns and dietary characteristics in Guatemalan women. MATERIAL AND METHODS: Two non-consecutive 24-h recalls were conducted in convenience samples of 20 rural Mayan women and 20 urban students. Diversity scores were computed using three food-group systems.Variety and diversity scores and dietary origin and characteristics were compared between settings using independent t-test or Mann-Whitney-U-test. RESULTS: Dietary variety and diversity were generally greater in the urban sample when compared to the rural sample, depending on the number of days and food-group system used for evaluation.The diet was predominantly plant-based and composed of non-fortified food items in both areas.The rural diet was predominantly composed of traditional,non-processed foods. The urban diet was mostly based on non-traditional and processed items. CONCLUSION: Considerations of intervention strategies for dietary improvement and health protection for the Guatemalan countryside should still rely on promotion and preservation of traditional food selection.

OBJETIVO: Comparar patrones y características de diversidad y variedad de la dieta de mujeres guatemaltecas. MATERIEL Y MÉTODOS: Se realizaron dos recordatorios de 24-horas en una muestra de conveniencia de 20 mujeres rurales y 20 estudiantes urbanas. Se calcularon puntajes de diversidad usando tres sistemas de grupos alimentarios. La variedad y diversidad, así como el origen y características de la dieta, se compararon entre ambos sitios. RESULTADOS: La variedad y diversidad en general fueron mayores en la muestra urbana en comparación con la muestra rural, dependiendo del número de días y del sistema de grupos de alimentos utilizados para la evaluación. La dieta rural fue predominantemente vegetal y compuesta de alimentos tradicionales no procesados. La dieta urbana estaba basada primordialmente en alimentos procesados. CONCLUSIÓN: Las consideraciones para crear estrategias de intervención para el mejoramiento de la dieta en el área rural dependen de la conservación de la selección de alimentos tradicionales.

Caracterização química do palmito guariroba in natura e congelado / Chemical characterization of fresh and frozen guariroba palm

No Brasil, diversos tipos de palmeiras nativas podem fornecer palmito de boa qualidade, dentre elas destaca-se a guarirobeira (Syagrus oleracea (Mart.) J. Becc.), pelo palmito de sabor diferenciado e grande aceitação na região do Cerrado. O objetivo do presente trabalho foi determinar as características do palmito de guariroba, quanto à umidade, resíduo mineral fixo, lipídios totais, proteínas, glicídios redutores e não-redutores, fibras totais, valor calórico, ácido ascórbico, compostos fenólicos, pH e minerais (potássio, fósforo, cálcio, sódio e ferro), verificando o efeito do processamento (branqueamento, acidificação e congelamento) no produto a ser comercializado congelado. Os valores médios diferiram significativamente (P<0,05) entre as amostras in natura e congeladas, respectivamente, para umidade 87,68 e 90,56g 100g-1, cinzas 0,96 e 0,73g 100g-1 e lipídios 0,44 e 0,24g 100g-1, além de ocorrer diminuição do valor energético de 11,64 para 9,97kcal 100g-1 de amostra integral. O uso do ácido cítrico no processamento do palmito guariroba reduziu o pH de 5,8 para 4,5 e foi eficiente para evitar seu escurecimento. O palmito guariroba congelado manteve-se como fonte de fibras e de compostos fenólicos, além de oferecer alto teor de vitamina C e de ferro.

In Brazil many kinds of native palms can provide hearth palm of good quality and among them stands out the guarirobeira (Syagrus oleracea (Mart.) J. Becc.), which has different flavor and great acceptance in the Cerrado region. The objective of this research was to determine the characteristics of guariroba palm heart, with relationship to the moisture, ash, total lipids, proteins, reducer and no-reducer sugars, acidity, ascorbic acid, total phenol, pH, total fiber and iron, phosphorus, calcium, sodium and potassium minerals. It was also verified the effect of processing (blanching, acidification and freezing) in the frozen product. Significant differences (P<0.05) was noted among average values found in frozen and raw samples, with contents (g 100g-1) respectively, for moisture, of 87.68 and 90.56; ash, 0.96 and 0.73; and lipids, 0.44 and 0.24; besides the occurrence of decreasing energy value from 11.64 to 9.97kcal 100g-1 in the integral sample. The citric acid use in the processing of guariroba palm heart decreased the pH of 5.8 to 4.5, and was efficient for avoid browning. The guariroba palm heart still be a good source of e fiber and total phenol after freezing, in addition to offer high contents of vitamin C and iron mineral.

Atividade antioxidante em vinhos de jabuticaba e de uva / Antioxidant activity in wines made from jabuticaba and grape

Samples of red and white dry wines made from jaboticaba and grape were analyzed with the purpose of verifying the antioxidant activity of compounds present in the wines. Different volumes of duplicate samples were spectrophotometrically analysed in a ?-carotene/linoleic acid system, every 15 minutes, for two hours. It was observed that the red wine made from jabuticaba presented a better antioxidant activity and inhibition values close to the ones obtained with BHT (a synthetic antioxidant usedin the food industry), with inhibition around 65%. The kinetic study revealed that wines made from jabuticaba are good free-radical scavengers with F <1 in phase 1 of the oxidative chain reaction, with better results than the wines made from grapes. The jabuticaba wine is a good source of antioxidants. However, further studies are necessary, especially concerning the profile of bioactive compounds, since it is a much appreciated beverage in several regions in Brazil

Actividad antioxidante en vinos de jabuticaba:comparación con vinos de uva. Muestras de vinostintos y blancos secos de jabuticaba y uva fueronanalizadas con la finalidad de verificar la actividad antioxidante de los compuestos presentes. Fue utilizado el sistema ?-caroteno/ácido linoleico, en el cual fueron hechas medidasespectrofotométricas de volúmenes de 20?L,50?L, 100?L y 200?L de muestras en duplicadocon lecturas a cada 15 minutos durante doshoras. Fue verificado que el vino tinto de jabuticaba presentó mejor actividad antioxidante con una inhibición de la oxidación próxima a los valores del BHT (antioxidante sintéticoutilizado en la industria alimenticia), inhibiciónen torno de 65%. El estudio cinético reveló quevinos de jabuticaba son eficientes comosecuestradores de radicales libres con F<1 en lafase 1 de la cadena oxidativa, y con resultadossuperiores a los vinos de uvas. El vino dejabuticaba es una buena fuente de antioxidantes,pero son necesarios más estudios en relación aeste, especialmente debido a ser de producciónnacional y a la ausencia de datos sobre el perfilde los compuestos activos de esta bebida muy apreciada en varias regiones del Brasil.

Amostras de vinhos tintos e brancos secos dejabuticaba e uva foram analisadas com afinalidade de verificar a atividade antioxidantedos compostos presentes. Foi utilizado o sistema?-caroteno/ácido linoleico, no qual foram feitasmedidas espectrofotométricas dos volumes de 20?L, 50?L, 100?L e 200?L das amostras em duplicata com leituras a cada 15 minutos porduas horas. Foi verificado que o vinho tinto dajabuticaba apresentou melhor atividade antioxidante e que o mesmo obteve valores deinibição da oxidação próximos ao do BHT (antioxidante sintético utilizado na indústriaalimentícia), com inibição em torno de 65%. No estudo cinético, foi revelado que vinhos de jabuticaba são bons sequestradores de radicais livres com F<1 na fase 1 da cadeia oxidativa ecom resultados superiores aos vinhos de uvas.O vinho de jabuticaba é uma boa fonte de antioxidantes, no entanto, faz-se necessáriomais estudos e em especial sobre perfil de compostos bioativos por se tratar de uma bebida muito apreciada em várias regiões do Brasil.

Atención de enfermería: cuidados intensivos de nefrología / Nursing attention: intensive care in nephrology

Con este trabajo se destaca la labor que desarrolla la enfermera en los diferentes procederes inherentes a la especialidad de Nefrología. En él se exponen cuidados muy especiales y específicos y los tratamientos más complejos del quehacer diario. Todo esto pone de manifiesto que la enfermera es un pilar fundamental en la atención al paciente que necesite tratamiento médico especializado