Genetic polymorphisms in the angiotensin converting enzyme, actinin 3 and paraoxonase 1 genes in women with diabetes and hypertension

ABSTRACT Objective: To study associations between polymorphisms in the angiotensin converting enzyme (ACE I/D), actinin 3 (ACTN3 R577X) and paraoxonase 1 (PON1 T(-107)C) genes and chronic diseases (diabetes and hypertension) in women. Materials and methods: Genomic DNA was extracted from saliva samples of 78 women between 18 and 59 years old used for genetic polymorphism screening. Biochemical data were collected from the medical records in Basic Health Units from Southern Brazil. Questionnaires about food consumption, physical activity level and socioeconomic status were applied. Results: The XX genotype of ACTN3 was associated with low HDL levels and high triglycerides, total cholesterol and glucose levels. Additionally, high triglycerides and LDL levels were observed in carriers of the TT genotype of PON1, and lower total cholesterol levels were associated to the CC genotype. As expected, women with diabetes/hypertense had increased body weight, BMI (p = 0.02), waist circumference (p = 0.01), body fat percentage, blood pressure (p = 0.02), cholesterol, triglycerides (p = 0.02), and blood glucose (p = 0.01), when compared to the control group. Conclusion: Both ACTN3 R577X and PON1 T(-107)C polymorphisms are associated with nutritional status and blood glucose and lipid levels in women with diabetes/hypertense. These results contribute to genetic knowledge about predisposition to obesity-related diseases.

Critical Factors Associated with Morbimortality in COVID-19 Patients Attended at a Brazilian Public Hospital: a Cross-Sectional Study / Fatores Críticos Associados à Morbimortalidade em Pacientes com COVID-19 Atendidos em um Hospital Público Brasileiro: um Estudo Transversal

The association between death from Covid-19 and case management, especially in small and medium-sized municipalities, is still uncertain. To analyze sociodemographic, clinical, and pharmacological factors associated with death in patients with Coronavirus Disease 2019 (COVID-19), from a Brazilian referral public hospital. This is a cross-sectional study, with data from the hospital records of patients (≥ 18 years old) diagnosed with COVID-19, from March 2020 to March 2021. The sample was classified according to the clinical outcome into two groups (death and discharge), among which statistical associations were performed with the variables of interest, with a 5% significance level. Factors such as need for intensive care, use of mechanical ventilation, and total length of hospital stay was related to higher hospital mortality, as well as the permanence of changes in clinical laboratory testing, including lactic acid, D-dimer, markers of hepatic and renal function, C-Reactive protein, anemia, leukocytosis, lymphopenia, thrombocytopenia, pH, and blood oxygen saturation (SpO2) (P < 0.05). Medications used most frequently in the studied hospital for the treatment of COVID-19, such as enoxaparin, dexamethasone, ivermectin, acetylcysteine, chloroquine, and clarithromycin were correlated with morbimortality (P < 0.05). Clinical outcome was influenced by patient-related factors, such as age and comorbidities, however, therapeutic interventions and the choice of medication also impacted morbimortality. These results reinforce the need for preventive actions and adequate clinical protocols in the treatment of hospitalized COVID-19 patients.(AU)

A associação entre o óbito pela Covid-19 e o manejo dos casos, principalmente em municípios de pequeno e médio porte, ainda é incerta. Analisar os fatores sociodemográficos, clínicos e farmacológicos associados à morte em pacientes com a doença do Coronavírus 2019 (COVID-19) em um hospital público brasileiro de referência. Trata-se de um estudo transversal realizado com dados dos prontuários de pacientes (≥ 18 anos) diagnosticados com COVID-19 no período de março de 2020 a março de 2021. A amostra foi classificada de acordo com o desfecho clínico em dois grupos (óbito e alta) e foram realizados testes de associação estatística com as variáveis de interesse com nível de significância de 5%. Fatores como necessidade de terapia intensiva, uso de ventilação mecânica e tempo total de internação estiveram relacionados com maior mortalidade hospitalar, assim como a permanência de alterações nos exames laboratoriais clínicos, incluindo ácido lático, D-dímero, marcadores de função hepática e renal, proteína C reativa, anemia, leucocitose, linfopenia, trombocitopenia, pH e saturação de oxigênio no sangue (SpO2) (P < 0,05). Os medicamentos utilizados com maior frequência no hospital para o tratamento de COVID-19, como enoxaparina, dexametasona, ivermectina, acetilcisteína, cloroquina e claritromicina, foram correlacionados com morbimortalidade (P < 0,05). O desfecho clínico foi influenciado por fatores relacionados ao paciente, como idade e comorbidades, porém as intervenções terapêuticas e a escolha dos medicamentos também impactaram na morbimortalidade. Esses resultados reforçam a necessidade de ações preventivas e protocolos clínicos adequados no tratamento de pacientes hospitalizados com COVID-19.(AU)

Influence of Lycium barbarum Extract Intake on Oxidative Stress in Wistar Rats

Abstract: This study aimed to analyze the effects of Goji Berry extract (GB, Lycium barbarum) gavage administration on liver tissue oxidative stress in Wistar rats as well as to identify and quantify the content of the major bioactive compounds of the fruit. Four diets were applied: SW - standard diet + water; SG - standard diet + Goji Berry extract (125 mg/kg of animal); PW - palatable diet + water; PG - palatable diet + Goji Berry extract (125 mg/kg of animal). Results showed a significant increase in catalase enzyme activity in the liver of rats treated with GB and also in those intaking the palatable diet without GB when compared to the SW group. An increased mRNA expression of this enzyme in the same tissue and groups was also verified. Regarding lipid peroxidation, the GB extract produced a significant decrease in the oxidation state in the SG and PG groups. The results also showed a significant amount of bioactive compounds in GB extract.

The effect of paraoxonase 1 (PON1) gene polymorphisms T(-107)C and L55M and diet composition on serum PON1 activity in women

ABSTRACT Objective: The aim of this study was to evaluate the serum activity of PON1 in women according to SNPs L55M and T-107C and diet composition. Materials and methods: Blood and serum samples from 26 women were used. DNA extraction, PCR and digestion with restriction enzymes of the PCR fragment were performed for genotyping the PON1 SNPs T-107C and L55M. Serum PON1 activity was measured in a single time point. Patients completed the semi-quantitative food frequency questionnaire and diet composition was estimated. Results: Genotypic distribution for L55M SNP was 56% for the LL genotype, 32% for LM and 12% for MM; for the PON1 C(-107)T SNP it was 28% for the TT genotype, 41% for CT and 31% for CC. Individuals with C and L alleles had higher serum PON1 activity. Combining the two SNPs, we observed that individuals carrying the LL and CC genotypes had twice the activity of carriers of the TT and MM genotypes. Considering food intake, no significant difference was observed between genotypes and intake levels. Conclusion: PON1 T(-107)C and L55M SNPs exert a strong effect on serum PON1 activity in an additive manner and are more important than diet to predict serum PON1 activity.

Frequency of alleles associated with celiac disease in patients with autoimmune thyroid disease / Frequência dos alelos associados com a doença celíaca em portadores de doenças autoimunes da tireoide

ABSTRACT Objective To determine the frequency of Human leukocyte antigen alleles and to verify the association of the presence of these alleles with symptoms and other diseases related to celiac disease in patients with autoimmune thyroid diseases. Methods A questionnaire on the symptoms and diseases associated with celiac disease was applied. Genomic deoxyribonucleic acid was extracted by collecting cells from the oral mucosa. The alleles (DQA1*0501; DQB1*0201; DRB1*04) were identified by means of the polymerase chain reaction. Results A total of 110 patients with autoimmune thyroid diseases participated in this study. It was observed that 66.4% of the individuals carried at least one of the alleles assessed and that 58.2% of the individuals were positive for at least one of the DQ2 alleles (DQA1*0501; DQB1*0201) and out of these 18.2% were positive for both DQ2 alleles (DQA1*0501; DQB1*0201). With regard to DQ8 (DRB1*04), 21.8% of the studied population was positive for this allele and 3.6% was positive for both DQ2 (DQA1*0501; DQB1*0201) and DQ8 (DRB1*04). A significant association was found between the presence of the DRB1*04 allele and gastrointestinal symptoms (p=0.02). A significant association of the DRB1*04 allele with type 1 diabetes mellitus (p=0.02) was observed. Conclusion The genetic profiles most commonly associated with celiac disease, such as DQ2 (DQA1*0501; DQB1*0201) and DQ8 (DRB1*04) were around 20.0% prevalent in the studied population. These are risk haplotypes for celiac disease especially when symptoms and diseases related to celiac disease are present. Therefore, it is important to screen patients to investigate a potential diagnosis for celiac disease.

RESUMO Objetivo Determinar a frequência dos alelos do Human leukocyte antigen e verificar a associação da presença desses alelos com sintomas e outras doenças relacionados à doença celíaca em portadores de doenças autoimunes da tireoide. Métodos Aplicou-se um questionário relacionado aos sintomas e doenças associados à doença celíaca. O ácido desoxirribonucleico genômico foi extraído por meio da coleta das células da mucosa bucal. Os alelos (DQA1*0501; DQB1*0201; DRB1*04) foram identificados por meio da reação em cadeia da polimerase. Resultados Participaram deste estudo 110 portadores de doenças autoimunes da tireoide. Observou-se que 66,4% dos indivíduos carregavam pelo menos um dos alelos estudados e que 58,2% dos indivíduos eram positivos para pelo menos um dos alelos DQ2 (DQA1*0501; DQB1*0201) e destes 18,2% foram positivos para ambos alelos do DQ2(DQA1*0501; DQB1*0201). Com relação ao DQ8 (DRB1*04), 21,8% da população estudada eram positivos para esse alelo e 3,6% eram positivos tanto para o DQ2 (DQA1*0501; DQB1*0201) quanto para o DQ8 (DRB1*04). Foi encontrada associação significativa da presença do alelo DRB1*04 com os sintomas gastrointestinais (p=0,02). Houve associação significativa do alelo DRB1*04 com diabetes mellitus tipo 1 (p=0,02). Conclusão O perfil genético mais fortemente associado à doença celíaca, tais como DQ2 (DQA1*0501; DQB1*0201) e DQ8 (DRB1*04) estavam presentes em torno de 20,0% da população estudada, estes são haplótipos de risco para doença celíaca e principalmente na presença de sintomas e doenças relacionadas à doença celíaca. Sendo assim, é importante realizar o rastreamento para investigar um possível diagnóstico para doença celíaca.

Influence of nutritional factors and the PON1 C(-107)T polymorphism on paraoxonase-1 activity in childhood / Influência de fatores nutricionais e do polimorfismo PON1 C(-107)T sobre a atividade da Paraoxonase 1 na infância

Abstract Objective: The cardioprotective enzyme paraoxonase-1 (PON1) suffers an important influence from genetic polymorphisms and nutritional factors. The aim of this study was to investigate the influence of diet, nutritional status, and the C(-107)T polymorphism on PON1 arylesterase activity in children. Methods: This was a cross-sectional study with 97 children, aged between 5 and 8 years, of both genders, from a pediatric outpatient clinic in southern Brazil. A sociodemographic, behavioral, and food consumption questionnaire was applied, and anthropometric measurements and laboratory blood samples were taken. PON1 arylesterase activity was measured by phenol extinction (U/mL), and DNA extraction and analysis of the PON1 C(-107)T polymorphism were performed. The Hardy-Weinberg equilibrium was tested with the chi-squared test and linear regression was used to estimate PON1 activity according to four adjustment models, with an acceptable error of 5%. Results: In the sample, the male gender accounted for 50.5%, 39.2% were 6 years of age, 54.5% had normal weight, and 51.5% had PON1 activity below the median (90.0, 15-30 U/mL). Genotype frequency was 54.6% (53/97), 31.0% (30/97), and 14.4% (14/97), respectively, for CT, CC, and TT, consistent with the Hardy-Weinberg equilibrium (p = 0.22). In the regression analysis, the model that included sociodemographic variables as well as frequency of consumption of fruits, vegetables, legumes, dairy products, and beans estimated a variability of 14.8% in PON1 activity combined with the PON1 C(-107)T polymorphism. Conclusions: During childhood, a good-quality diet with greater inclusion of healthy foods was important to predict the activity of the cardioprotective enzyme PON1 combined with the C(-107)T polymorphism of the PON1 gene.

Resumo Objetivo: A enzima cardioprotetora Paraoxonase 1 (PON1) sofre importante influência de polimorfismos genéticos e fatores nutricionais. O objetivo deste estudo foi investigar a influência da alimentação, do estado nutricional e do polimorfismo C(-107)T sobre a atividade arilesterase da PON1 em crianças. Métodos: Estudo transversal com 97 crianças entre 5 e 8 anos, de ambos os sexos, de um ambulatório de pediatria no sul do Brasil. Realizou-se questionário sociodemográfico, de comportamento e de consumo alimentar, medidas antropométricas e coleta de sangue em laboratório. A atividade arilesterase da PON1 foi mensurada pela extinção de fenol (U/mL), realizada extração do DNA e análise do polimorfismo PON1 C(-107)T. O equilíbrio de Hardy-Weinberg foi testado com qui-quadrado e usada regressão linear para estimar a atividade da PON1 segundo quatro modelos de ajuste, erro aceitável de 5%. Resultados: Na amostra o sexo masculino representou 50,5%, 39,2% tinham 6 anos, 54,5% eram eutróficos e 51,5% tinha atividade da PON1 inferior à mediana (90,0;15-30 U/ml). A frequência dos genótipos foi 54,6% (53/97), 31,0% (30/97) e 14,4% (14/97), respectivamente, para CT, CC e TT, estiveram em equilíbrio de Hardy-Weinberg (p = 0,22). Na análise de regressão o modelo que incluiu variáveis sociodemográficas, de frequência do consumo de frutas, verduras, legumes, laticínios e feijões estimou uma variabilidade de 14,8% na atividade da PON1 combinada ao polimorfismo PON1 C(-107)T. Conclusões: Na infância uma alimentação de boa qualidade, com maior participação de alimentos saudáveis foi importante para predizer a atividade da enzima cardioprotetora PON1 combinada ao polimorfismo C(-107)T do gene da PON1.

Extractos de los documentos de posicionamientos y recomendaciones mexicanas en enfermedades cardiovasculares y COVID-19 / Excerpts from the documents of Mexican positions and recommendations in cardiovascular diseases and COVID-19

Resumen Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.

Abstract The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

Anti-inflammatory Effect of a Goji Berry Extract (Lycium barbarum) in Rats Subjected to Inflammation by Lipopolysaccharides (LPS)

Abstract The present study aimed to evaluate the anti-inflammatory potential of a Lycium barbarum (L. barbarum) fruit extract in Wistar rats submitted to a palatable diet presenting systemic inflammation induced by lipopolysaccharides (LPS). Forty-two Wistar female rats (Rattus Novergicus) were used with 60 days old. The animals were feed for 60 days and divided in six groups (n=7): standard diet+water; standard diet+L. barbarum; palatable diet+water; palatable diet+L. barbarum; standard diet+water+LPS; standard diet+L. barbarum+LPS. A significant difference was shown between the analyzed groups concerning C-reactive protein, with the standard diet+water+LPS group presenting the highest inflammatory response in comparison to the other groups. Decreased inflammatory response was observed in the group administered a palatable diet along with the fruit extract when compared to the group that received only a palatable diet. Significant decrease in glutamic-oxaloacetic transaminase activity was observed in the standard diet+L. barbarum+LPS group compared to the standard diet+water group, as well as in the palatable diet+L. barbarum group compared to the palatable diet+water group. A significant increase in creatinine in the standard diet+water+LPS group was observed in according to the L. barbarum administration groups. The gene expression of the inflammatory markers genes in the liver showed a significant increase in TNF-α and IL-6 genes in the group treated with standard diet+L. barbarum+LPS when compared to the standard diet+LPS group. Thus, the administered L. barbarum extract displays the potential to reduce inflammatory responses induced by LPS and a palatable diet.

Knowledge of physiotherapists working in adult ICU on contraindications to mobilization / Conhecimento dos fisioterapeutas atuantes em UTI adulto sobre as contraindicações à mobilização

Abstract Introduction: Mobilization is an effective therapy to combat the deleterious effects of immobility, but not all patients are in a condition to be moved; thus, knowledge about contraindication criteria is fundamental. Objective: To evaluate the knowledge of physiotherapists working in adult ICUs on contraindications to the mobilization of critical patients. Method: This was a cross-sectional study in which a survey was applied to physiotherapists working in an adult ICU in the city of Recife. Results: Out of the 36 criteria presented, only five were considered contraindication criteria. Clinical parameters were those that obtained higher frequency for not being considered criteria for contraindication, nor were there observed differences in the relation between the time of working in the ICU. Conclusion: Most physiotherapists did not consider the criteria presented as contraindications to mobilization, so that professional training in mobilization practices and the creation of protocols are necessary.

Resumo Introdução: A mobilização é uma terapia eficaz para combater os efeitos deletérios do imobilismo, contudo, é sabido que nem todos os pacientes apresentam condições de saúde para recebê-la, sendo assim, é fundamental o conhecimento sobre os critérios de contraindicação. Objetivo: Avaliar o conhecimento dos fisioterapeutas atuantes em UTI adulto sobre as contraindicações à mobilização de pacientes críticos na cidade do Recife. Método: Este é um estudo transversal, no qual foi aplicado um inquérito aos fisioterapeutas atuantes em UTI adulto na cidade do Recife. Resultados: Dos 36 critérios expostos, apenas cinco foram considerados critérios de contraindicação. Os parâmetros clínicos foram os que obtiveram maior frequência como não sendo considerados critérios de contraindicação, também não foram observadas diferenças na relação entre grau acadêmico e o conhecimento dos critérios, assim como no tempo de atuação em UTI. Conclusão: Uma proporção significativa dos fisioterapeutas atuantes em UTI não considera os critérios expostos como contraindicações à prática da mobilização, sendo assim necessário o aperfeiçoamento profissional sobre as práticas da mobilização e a criação de protocolos.

Paraoxonase 1 serum activity in women: the effects of menopause, the C(-107)T polymorphism and food intake

ABSTRACT Objective The aims of this study were to investigate changes in serum paraoxonase 1 (PON1) activity in women at the pre and postmenopausal stages and its association with the PON1 C(-107)T polymorphism and food intake profile. Subjects and methods A cross-sectional study with female patients aged between 35 and 59 years old was conducted. Women were divided into two groups: premenopausal (n = 40) and postmenopausal (n = 36). Women enrolled in the study had serum PON1, total cholesterol, HDL, LDL, glucose and HbA1c, as well as the BMI measured. Additionally, women were genotyped for the PON1 T(-107)C polymorphism and the food intake profile was obtained through interview. Results Glucose (p = 0.03), HbA1c (p = 0.002) and total cholesterol (p = 0.002)concentrations were higher in post than premenopausal women, however PON1 activity was not different (p > 0.05). Carriers of the C allele had higher PON1 activity (CC: 88.9 ± 6.5 U/mL and CT: 79.9 ± 4.7 U/mL) than women of the TT genotype (66.6 ± 5.9 U/mL) (p < 0.05). However, the model predicting PON1 activity was slightly better when genotype, total fat and cholesterol content in the diet were all included. Conclusion In sum, we observed that the PON1 C(-107)T genotype was the major regulator of PON1 activity, and menopause had no effect on PON1 activity. The lipid and glycemic profile were altered in postmenopausal women.

Putative periodontal bacteria in clinically healthy and diseased sites of periodontitis patients

Aim: The aim of this study was to compare the microbial profile of subgingival sites in Periodontitis (Pd) patients and healthy ones. Methods: Eighteen patients with Pd and 18 gender-matched healthy controls were selected. Subgingival samples were collected from three types of sites: 1) healthy site of healthy subjects (probing pocket depth (PPD) ≤ 3mm, CG), 2) healthy site of Pd patients (PPD ≤ 3mm, PG-C) and 3) diseased site (PPD > 3mm) of the same Pd patients (PG-T). All sites were subjected to microbial analysis for the detection of 40 bacterial species by the "Checkerboard DNA-DNA hybridization" technique. Results: It was observed a great diversity of bacteria in all patients evaluated. The sites from the Pd groups (PG-T and PG-C) showed a higher overall count of the studied bacteria than those of the CG group, especially from Green, Orange, and Red complexes. Also, PG-T showed a higher prevalence of Red complex bacteria than CG. Individual pathogens, such as Porphyromonas gingivalis, Treponema denticola and Treponema socranskii were detected in higher levels and/or prevalence in Pd than in control patients. However, it was not observed any difference between PG-T and PG-C. Conclusion: Pd patients showed higher prevalence and counts of some putative periodontal bacteria, especially from the red complex, than control ones, regardless of the severity of their sites

The attempt to demolish the science and practice of preventive cardiovascular medicine. Part I. Addendum to the positioning around the diagnosis and treatment of dyslipidemias of ANCAM and the joint group of associated medical societies / El intento de demoler la ciencia y la práctica de la medicina cardiovascular preventiva. Parte I. Addendum al posicionamiento en torno al diagnóstico y tratamiento de las dislipidemias de la ANCAM y del grupo conjunto de sociedades médicas asociadas

Abstract: This manuscript is an addendum to the positioning around the diagnosis and treatment of dyslipidemias of ANCAM and the joint group of associated medical societies, already published. It is the first part of a wider reflection aimed on refute several of the theses and arguments of a group of clinicians and researchers who question the validity of the "cholesterol hypothesis", the usefulness and safety of statins and the most modern inhibitors of proprotein convertase of subtilisin/kexin type 9 (iPCSK9,) and the role of saturated fatty acids consumed in the usual diet in the atherosclerotic risk. This iconoclastic point of view is dangerous insofar as it undermines the scaffolding that supports the primary and secondary prevention of atherosclerosis. In this section of the manuscript, only the cholesterol hypothesis is discussed. The data of comparative zoology are reviewed, and several experimental animal models are analyzed, both supporting the link between cholesterol and the appearance and evolution of atherosclerotic lesions. The methodology and the results of the Study of the 7 Countries are defended and are exposed the numerous epidemiological, pathological, clinical and interventional evidences, which in our opinion give a solid sustenance to the cholesterol hypothesis. Based on this knowledge it is criticized the LDL cholesterol values currently considered adequate. Furthermore, the so-called residual risk is considered, as well as the conflicting evidence about the usefulness of statins in elderly patients.

Resumen: Este manuscrito es un apéndice del posicionamiento en torno al diagnóstico y tratamiento de las dislipidemias de la ANCAM y el grupo de las sociedades médicas asociadas, previamente publicado. Es la primera parte de un trabajo más amplio enfocado a refutar varias de las tesis y argumentos de un grupo de clínicos e investigadores que ponen en duda la validez de la "hipótesis del colesterol", la utilidad y seguridad de las estatinas y los más modernos inhibidores de la proproteína convertasa de la subtilisina/kexina tipo 9 (iPCSK9) y el papel de los ácidos grasos saturados consumidos en la dieta habitual en el riesgo ateroscleroso. Este punto de vista iconoclástico es peligroso porque socava el andamiaje que soporta la prevención primaria y secundaria de la aterosclerosis. En esta primera sección del manuscrito, se discute sólo la hipótesis del colesterol. Se revisan los datos de zoología comparada y se analizan varios modelos animales de experimentación, que apoyan la liga entre el colesterol y la aparición y evolución de las lesiones aterosclerosa. Se defienden la metodología y los resultados del estudio de los 7 países y se exponen las numerosas evidencias epidemiológicas, patológicas, clínicas e intervencionistas, que a nuestro juicio dan un sustento sólido a la hipótesis del colesterol. Se critican también, en base a ese conocimiento, los valores de colesterol LDL actualmente considerados adecuados, a la vez que se discute el llamado riesgo residual y las evidencias conflictivas acerca de la utilidad de las estatinas en pacientes ancianos.

Perfil das vítimas não fatais atendidas nos hospitais de Porto Velho entre 2015 e 2016, Rondônia, Brasil / Non-fatal victims profile attended in Porto Velho hospitals between 2015 and 2016, Rondônia, Brasil

Introdução: Os acidentes de trânsito representam uma séria questão para a saúde pública brasileira, já que são responsáveis por alta morbimortalidade de adultos jovens, principalmente entre os usuários de motocicletas. Objetivo: Analisar o perfil dos acidentes de trânsito com vítimas não fatais que geraram internações nos hospitais de Porto Velho - RO, Amazônia Ocidental. Metodologia: Trata-se de um estudo transversal realizado entre agosto de 2015 a março de 2016, por meio da utilização de um formulário on-line com 34 questões que versaram sobre dados sociais, dados do acidente, dados de lesões e traumatismos, dados sobre condutores de veículos e dados de crianças enquanto passageiras. Foram entrevistadas 310 vítimas. Resultados: Houve predominância do sexo masculino 79% (n = 236). A idade média dos indivíduos foi 35 anos. Quanto ao grau de instrução, 43% (n = 128) cursaram até o ensino fundamental incompleto, sendo 3,7% (n=11) analfabetos. As motocicletas corresponderam a 90% (n = 253) dos veículos utilizados pelos entrevistados, sendo a colisão entre carro e moto a mais observada (n = 117). Vítimas condutoras somaram 76,2% (n = 227) e 38,8% (n = 88) destes não possuíam CNH. Apenas 46,9% (n = 140) das vítimas tinham residência na capital. Entre as lesões graves, houve 10 casos com necessidade de amputação. Conclusão: Acidentes de trânsito são um dos principais problemas de saúde pública em Porto Velho. Baixo grau de instrução e um número elevado de condutores sem portar habilitação sugere falha na supervisão da compra e venda informal de veículos.

Introduction: Traffic accidents represents a serious question to brazilian public health, since are responsible for high mortality and morbidity of young adults, mainly among motorcycle users. Objective: To analyse the non-fatal victims and vehicle drivers profile of traffic accidents assisted in the hospitals of Porto Velho - Rondonia, Western Amazonia. Methodology: A cross-sectional study was carried out from august 2015 to march 2016. An on-line form was built with 34 questions about social data, accident data, injury and trauma data, vehicle drivers data and children as passengers data. 310 victims were interviewed. Results: There was a predominance of males (79,1%). The mean age of the individuals was 35 years. In regard to educacional level, 43% (n = 128) presented incomplete primary school and 3,7% (n = 11) were illiterate. Motorcycles corresponded to 90% (n = 253) of the vehicles used, and car and motorcycle collisions were the most observed (n = 117). Victim drivers totaled 76,1% (n = 227) and 38,8% (n = 88) of them did not have National Driver's Licenses. Only 47% (n = 140) of the victims lived at Porto Velho. Among the serious injuries, there were 10 cases of amputation. Conclusion: Traffic accidents are one of the most important issues of Porto Velho public health. Low level of education and a high number of victims among drivers which did not have driving licenses evidences a failure in the supervision of the documentation during the informal purchase and sale of vehicles.

Evaluation of the Redox State of Wistar Rats Submitted to High-Fat Diet Supplemented With Infusion of Ilex paraguariensis

ABSTRACT This study aimed to evaluate the effect of Ilex paraguariensis infusion on redox state of Wistar rats submitted to high-fat and standard diet. Glutathione determination and lipid peroxidation in the hippocampus tissues and liver was performed, as well as the analysis of gene expression of superoxide dismutase, catalase and glutathione peroxidase by real-time polymerase chain reaction. The results from hippocampus showed that the groups fed with standard diet exhibited significant reduction of lipid peroxidation when supplemented with Ilex paraguariensis. The analysis from glutathione determination in the hippocampus showed a significant increase in glutathione activity in the group treated with high-fat diet and Ilex paraguariensis. In the liver, results showed no significant difference in both glutatione and lipid peroxidation analisys. Gene expression of superoxide dismutase, catalase and glutathione peroxidase showed that there was significant difference in the groups treated with high-fat diet and Ilex paraguariensis. In summary, the Ilex paraguariensis showed substantial potential for antioxidant activities.

O protocolo de pesquisa após a aprovação pelo Sistema CEP/CONEP: explorando o caminho das competências e responsabilidades do CEP/Unicamp / The research protocol after the CEP/Unicamp System aproval: exploring the competences and responsabilities' way of CEP/Unicamp

Resumo: Os comitês de ética em pesquisas envolvendo seres humanos têm como principal competência a proteção aos participantes de pesquisa. As regulamentações do Sistema CEP/CONEP em vigência é a Resolução CNS/MS nº 466/12, complementada pela Norma Operacional CNS/MS nº 01 e, para os estudos das CHS, a Resolução 510/2016. Os protocolos de pesquisa são submetidos aos CEPs e a CONEP, quando necessário, através da Plataforma Brasil. O estudo será apresentado como um modelo lógico da pesquisa a ser alicerçado (referencial teórico), construído (métodos e técnicas de pesquisa) e percorrido (análise e resultados). O objetivo foi relacionar as semelhanças e diferenças dos projetos de pesquisa aceitos e aprovados pelo CEP/Unicamp através da Plataforma Brasil, no período de 01/03/2012 até 28/02/2013, com as publicações oriundas de bancos de dados bibliográficos no intuito de explorar os caminhos das competências e responsabilidades do CEP/Unicamp após aprovar seus protocolos de pesquisa. Frente aos métodos e técnicas de pesquisa, obteve-se 876 protocolos de pesquisa extraídos da Plataforma Brasil que, ao aplicar os critérios de inclusão e exclusão e, posteriormente, pesquisar nas seis bases bibliográficas (Google, Google Acadêmico, Repositório da Produção Científica e Intelectual da Unicamp, Web of Science, Biblioteca Virtual em Saúde, SciELO), estratificou-se para 181 protocolos aceitos e aprovados pela Plataforma Brasil que, obteve destes, 246 publicações. Através do formulário Tabela Comparativa de Aspectos Éticos após Aprovação, 19 (10,5%) protocolos foram comparados com as publicações, nas quais 10 foram utilizados por evidenciarem adversidades significativas em seus comparativos entre o que o pesquisador propôs ao CEP e o que foi veiculado pela pesquisa. Este estudo comprovou que o CEP/Unicamp não têm mecanismos de acompanhamento após a aprovação pela Plataforma Brasil e que o pesquisador é o responsável por garantir os aspectos éticos das pesquisas envolvendo seres humanos durante o desenvolvimento da pesquisa. Por fim, o estudo aponta a educação em ética para que os pesquisadores estabeleçam práticas éticas de pesquisa(AU)

Abstract: The Ethics Research Committee involving human being has the protection for research participants as main core competence. The CEP/CONEP System regulamentations in current are the Resolution CNS/MS n. 466/12, it is complemented by Operational Instruction n. 01 and, there are the Resolution 510/16 for the studies of Human and Social Sciences. The research protocols are submitted for CEP and CONEP, where required, by Plataforma Brasil. This study will be present as a research logical model which it will be support (theoretical framework), it will be build (research methods and techniques) and, it will be cross (research analysis and results). The objective of research was related the similarities and differences of protocols who it was accepted and it was approved between 01/03/2012 to 28/02/2013 by the Ethics Research Committee involving human being - UNICAMP (ERC/UNICAMP) though the Plataforma Brasil. Thereafter, we will relate to publications from bibliographic databases in order to explore the competences and responsibilities¿ way of ERC/UNICAMP after the approval their research protocols. With the research methods and techniques, it has obtained 876 research protocols extracted from the Plataforma Brasil that it was applied the criteria of inclusion and exclusion and, afterwards, to research in six bibliographic databases (Google, Google Scholar, Repository of Scientific and Intellectual Production of Unicamp, Web of Science, BVS, SciELO), it was stratified for 181 accepted and approved protocols by Plataforma Brasil who it has gotten 246 publications. Through form Comparative Table of Ethical Aspects after Approval, 19 (10,5%) protocols was been compared with the publications, whose 10 were used in order to confirm the adversities between comparison in what it was proposed by CEP and the publications. These researches has proved that the ERC/UNICAMP does not have evaluation mechanisms ERC/UNICAMP after the approval by Plataforma Brasil and, the researcher is the responsible in order to guarantee the ethical aspects of research. In conclusion, the research points out the education in ethic to the researchers establish ethical practices in research(AU)

Prevalência dos acidentes de trânsito no estado de Rondônia, entre 2001 e 2013 / Prevalence of traffic accidents in Rondônia state, 2001 - 2013

Objetivo: Analisar a prevalência de acidentes de trânsito (AT) no estado de Rondônia e na capital Porto Velho com a influência do Complexo Hidroelétrico Madeira aliado ao impacto do decreto da "Lei Seca". Metodologia: O estudo é retrospectivo, descritivo, sobre AT que ocorreram entre 2001 e 2013 em Rondônia e em Porto Velho. Os dados foram obtidos nos Anuários Estatísticos do DETRAN-RO. Os dados de mortalidade foram obtidos no Sistema de Informações sobre Mortalidade - DATASUS. Foi realizada revisão bibliográfica nos bancos de dados CAPES e Scielo com os descritores 'acidentes de trânsito', 'mortalidade' e 'direção e álcool'. Resultados: No período entre 2001 e 2013, houve aumento de 201% na taxa de mortalidade em Rondônia. A frota de veículos aumentou 297%. Foram 4.849 vítimas fatais. Em Porto Velho, a taxa de mortalidade aumentou 155% entre 2001 e 2008. Encerrou-se o período estudado com crescimento de 1,25%. Entre 2001 e 2013, a frota aumentou 342,7%. Foram 1.161 vítimas fatais. As faixas etárias entre 18 e 29 anos e entre 30 e 59 anos compuseram o número de vítimas fatais mais frequentes. Conclusão: A educação é o passo inicial para a mudança dos hábitos da população, condição necessária para que o número de AT seja reduzido. (AU)

Objective: Analyze the prevalence of traffic accidents at Rondonia state and the capital Porto Velho taking into account the influency of Madeira Hydroeletric Complex allied to the impact of the "Lei Seca" decree. Metodology: This is a retrospective and descriptive study about the traffic injuries that occurred between 2001-2013 in Rondônia and in Porto Velho. The data sources about traffic accidents were obtained from the Mortality Information System ­ DATASUS. A bibliographic review at CAPES and Scielo data base with the descriptors 'traffic accidents', 'mortality', 'driving and alcohol' were carried out. Results: In the period from 2001 to 2013, there was an increase of 201% in the mortality rate in Rondônia. The fleet of vehicles raised 297%. There happened 4. 849 fatal victims. At Porto Velho, the mortality rate increased 155% from 2001 to 2008. The period studied ended with an increase of 1,25%. Between 2001 to 2013, the number of vehicles had an increase of 342,7%. Fatal victims were 1.161. Most victims belonged to the age group from 18 to 29 years old and from 30 to 59 years old. Conclusion: Education is the first step to be taken in order to achieve change of habits, which is an absolute must in order to decrease traffic injuries. (AU)

Association between paraoxonase 1 (PON1) enzyme activity, PON1 C(−107)T polymorphism, nutritional status, and lipid profile in children

BACKGROUND: Paraoxonase 1 (PON1) is an enzyme that possesses anti-atherogenic and anti-inflammatory properties with serum levels determined by genetic and exogenous factors. Lower serum PON1 arylesterase activity is associated to metabolic alterations related to childhood overweight and onset and/or development of diabetes and CVD later in life. However, data on the relationship between genetic PON1 polymorphisms and nutritional status as well as lipid profile in children are limited. To investigate the distribution of the C(−107)T PON1 gene polymorphism and its relation with serum PON1 enzyme activity, nutritional status and lipid profile in children. METHODS: A cross-sectional study was performed including 73 children aged 5 to 7 years who attended public pediatric clinics. PON1 C(−107)T, arylesterase activity, body mass index for the age, and serum lipid profile were evaluated. RESULTS: PON1 activity was higher in overweight children compared to the normal weight ones (p= 0.02). The genotypic frequency did not differ between the two groups (p> 0.05). Carriers of CC genotype had higher enzyme activity than T allele carriers, and this difference was greater among normal weight children. HDL levels were higher among normal weight children carrying CC genotype, compared to those carrying the T allele (p< 0.01).CONCLUSION: The PON1 C(−107)T polymorphism is associated with higher serum enzyme activity in children, as observed previously in adults. In addition, this polymorphism also shows association to higher high density lipoprotein (HDL) levels and serum PON1 arylesterase activity in the normal weight children studied.

Perfil epidemiológico dos membros de uma associação de epilepsia em Santa Catarina / Epidemiological profile of the members of an association of epilepsy in Santa Catarina

Este estudo tem como proposta conhecer o perfil epidemiológico dos membros da Associação Sul Catarinense de Epilepsia (ASSCAE) e comparar com os dados obtidos na literatura. Trata-se de um estudo observacional transversal, com coleta de dados primários e abordagem quantitativa. Foram incluídos 43 dos 52 membros ativos entre agosto de 2014 e março de 2015. Os formulários aplicados, sob a supervisão de um neurologista, eram constituídos por 12 itens, abordando questões sociodemográficas e clínicas. Entre os membros entrevistados, 53,5% eram do sexo masculino e idade média de 43,09±14,63 anos. Houve predomínio de uma população de baixa renda e escolaridade. Das características clínicas analisadas, o tipo de crise mais comum foi a generalizada (65,1%). Apenas 6 entrevistados (14%) alcançaram controle de suas crises (epilepsia inativa), dos quais 70,3% utilizam duas ou mais drogas anticonvulsivantes, apresentado uma associação estatisticamente significativa entre as duas variáveis (p=0,017). A população em estudo apresentou um perfil clínico de epilepsia semelhante aos encontrados em países subdesenvolvidos e em desenvolvimentos, que corrobora com a baixa renda e escolaridade evidenciada nos dados sociodemográficos. Porém, essas informações epidemiológicas não podem ser extrapoladas com precisão para toda região sul catarinense, visto a ASSCAE, por apresentar um caráter assistencial, ter uma população predominantemente de baixa renda.

This study has the purpose to understand the epidemiological profile of the members of the Associação Sul Catarinense de Epilepsia (ASSCAE) and compare the data obtained in the literature. It is a cross-sectional observational study, with primary data collection and quantitative approach. They included 43 of the 52 active members between August 2014 and March 2015. The applied forms, under the supervision of a neurologist, consisted of 12 items, covering sociodemographic and clinical issues. Among the members interviewed, 53.5% are male and the average age of 43.09 ± 14.63 years. There was a predominance of low income and education. Analyzed the clinical features, the most common type of crisis was generalized (65.1%). Only 6 respondents (14%) achieved control of their seizures (epilepsy inactive), associating with it a greater number of members in use of 2 or more medications (p = 0.017). The study population presented a clinical profile of epilepsy similar to those found in developing and under development countries, which corroborates with low income and education evidenced in sociodemographic data. However, these epidemiological information can not be accurately extrapolated to the entire southern region of Santa Catarina, as the ASSCAE, to present an assistance character has a predominantly low-income population.

Efectividad de un programa de prevención en salud mental mediante el diálogo socrático y el pensamiento crítico / Effectiveness of a prevention program in mental health by socratic dialogue and critical thinking

Objetivo: El propósito de este estudio fue analizar el impacto del programa de prevención mediante el diálogo socrático y el pensamiento crítico, en la depresión y la ansiedad. Materiales y métodos: Participaron 110 universitarios que accedían al primer año de la carrera; se utilizó un diseño experimental aleatorizado con grupo experimental y control. La variable independiente fue el diálogo socrático y el pensamiento crítico, y las variables dependientes fueron la sintomatología depresiva y/o ansiosa y los pensamientos negativos, positivos y ansiosos. Como instrumentos se utilizaron la Escala de depresión del Centro de Estudios epidemiológicos (CES-D), el Cuestionario revisado de 90 síntomas (SCL-90R), el Cuestionario de Pensamientos Automáticos Revisado (ATQ-TP), y el Cuestionario de Automanifestaciones Ansiosas (ASSQ). Resultados: Al comparar los resultados entre los dos grupos, se observó que el programa resultó efectivo en la reducción de los pensamientos negativos para el grupo experimental, aunque no se identificaron otros efectos. Conclusiones: El dialogo socrático y el pensamiento crítico - en el marco de un programa de prevención, reducen los pensamientos negativos en los universitarios de primer año.

Objective: The purpose of this study was to analyze the impact of the prevention program by Socratic dialogue and critical thinking, on depression and anxiety. Method: Participants were 110 students who entered their freshman year; an experimental design with experimental and control group was used. Independent variable was Socratic dialogue and critical thinking, and dependent variables were depression and/or anxiety symptoms, and negative, positives and anxious thoughts. Applied instruments consisted on Center for Epidemiologic Studies Depression Scale (CES-D), Symptom Check List - 90 Revised (SCL-90R), Automatic Thoughts Questionnaire - Revised (ATQ-RP), and Anxious Self-Statements Scale (ASSQ). Results: By comparisons between the two groups, it was observed the effectiveness of the program in negative thought reduction, although no other effects were identified. Conclusions: Socratic dialogue and critical thinking - like a prevention program - can change negative thoughts in students at freshman year.