Consumption of sugar-sweetened and artificially sweetened beverages and prevalence of hypertension in adults: a population- based study

Systemic Arterial Hypertension is a multifactorial clinical condition associated with severe outcomes such as stroke and death. One of the main modifiable risk factor for hypertension is an unhealthy diet, often characterized by the consumption of ultraprocessed foods such as sweetened beverages. We aimed to investigate the relationship between the consumption of sweetened beverages, both sugar-sweetened and artificially sweetened, and the prevalence of hypertension in adults. A cross-sectional, household, population-based study with 1,162 adults from two Brazilian cities were carried out. The consumption of food groups and sweetened beverages was obtained by food frequency questionnaire and other data were self-reported. Weight, height, and waist circumference were measured. The association between sweetened beverages consumption and hypertension was analyzed using Poisson regression models, expressed as Prevalence Ratio. The prevalence of hypertension was 16.7%, with no significant difference between genders. The prevalence of consumption of sweetened beverages was 70.3% in men and 54.6% in women, being significantly higher in men. Women who consumed sugar-sweetened and artificially sweetened beverages 6 to 7 days per week had 92% higher prevalence of hypertension compared to those who did not consume or consumed at a lower frequency. Furthermore, women who consumed artificially sweetened beverages at least 1 time per week had 3.36 times higher prevalence of hypertension. The habitual consumption of sweetened beverages may be an important risk factor for hypertension, especially the consumption of diet beverages, which are often marketed as healthier than sugar-sweetened beverages.

La Hipertensión Arterial Sistémica es una condición clínica multifactorial asociada a resultados graves como el ictus y la muerte. Uno de los principales factores de riesgo modificables de la hipertensión es una dieta poco saludable, a menudo caracterizada por el consumo de alimentos ultraprocesados como las bebidas endulzadas. Nuestro objetivo fue investigar la relación entre el consumo de bebidas endulzadas, tanto azucaradas como edulcoradas artificialmente, y la prevalencia de hipertensión en adultos. Se realizó un estudio transversal, domiciliario y poblacional con 1,162 adultos de dos ciudades brasileñas. El consumo de grupos de alimentos y bebidas endulzadas se obtuvo mediante cuestionario de frecuencia de alimentos y los demás datos fueron autoinformados. Se midieron el peso, la talla y el perímetro de la cintura. La asociación entre el consumo de bebidas endulzadas y la hipertensión se analizó mediante modelos de regresión de Poisson, expresados como Ratio de Prevalencia. La prevalencia de hipertensión fue del 16,7%, sin diferencias significativas entre géneros. La prevalencia de consumo de bebidas endulzadas fue del 70,3% en los hombres y del 54,6% en las mujeres, siendo significativamente mayor en los hombres. Las mujeres que consumían bebidas azucaradas y edulcoradas artificialmente entre 6 y 7 días a la semana tenían 92% mayor prevalencia de hipertensión que las que no consumían o consumían con una frecuencia menor. Además, las mujeres que consumían bebidas edulcoradas al menos 1 vez por semana tenían una prevalencia de hipertensión 3,36 veces mayor. Así pues, el consumo habitual de bebidas endulzadas puede ser un importante factor de riesgo de hipertensión, especialmente el consumo de bebidas dietéticas, que a menudo se comercializan como más saludables que las bebidas azucaradas.

Legislation in Hospital Dentistry: Gaps, Perspectives and Desires

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

Prevalence of overweight and association with lifestyle habits in adults: A population-based study

The objective of this study was to verify the association between lifestyle habits and obesity in a sample of adults from the "Inquérito de Saúde Domiciliar no Piauí - ISAD-PI" (Home Health Survey in Piauí - ISAD-PI). A cross-sectional population-based household study was performed with a representative sample of 1,163 adults from the cities of Teresina and Picos, Piauí, Brazil who were participants of ISAD-PI. Sociodemographic and lifestyle data were collected utilizing a structured questionnaire adapted from other Brazilian population studies and analyzed using Stata. Most of the population had healthy lifestyle habits, with adequate consumption of fruits/vegetables and beans, as well as a low consumption of soft drinks, sweets, and red meats. Alcohol consumption was more prevalent among overweight individuals. Individuals who had the habit of consuming alcohol and those who consumed beans less than five days a week had a significantly higher prevalence of overweight. A higher prevalence of overweight was significantly associated with weekly frequency of beans consumption and alcohol intake.

El objetivo de este estudio fue verificar la asociación entre los hábitos de vida y la obesidad en adultos en una muestra del Inquérito de Saúde Domiciliar - ISAD (Encuesta de Salud en el Hogar). Estudio transversal de base poblacional y domiciliar, muestra representativa de 1.163 adultos, de los municipios de Teresina y Picos, Piauí, Brasil, de la ISAD-PI. La recopilación de datos sociodemográficos y de estilo de vida se realizó utilizando un cuestionario estructurado adaptado de otros estudios de población brasileños y analizado con Stata. La mayor parte de la población tenía hábitos de vida más saludables, con un consumo adecuado de frutas/verduras y frijoles, así como un bajo consumo de refrescos, dulces y carnes rojas. El consumo de alcohol fue más frecuente entre las personas con sobrepeso. Los individuos que tenían el hábito de consumir alcohol y los que consumían frijoles menos de cinco días a la semana presentaron prevalencias significativamente mayores de sobrepeso. Se observó dada la alta prevalencia de sobrepeso, que mostró asociaciones significativas entre frecuencia semanal de consumo de frijol y consumo de alcohol.

Perfil clínico e hemodinâmico de pacientes consecutivos com estenose aórtica valvar estudados na era pré-implante transcateter valvar aórtico em instituição acadêmica. Análise comparativa da avaliação invasiva com a ecocardiográfica / Clinical and hemodynamic profile of consecutive patients with aortic valve stenosis studied in the pre-transcatheter aortic valve implantation era at an academic institution. Comparative analysis of invasive evaluation with echocardiography

Introdução: Face à melhor compreensão da fisiopatologia da estenose valvar aórtica, cresceu paralelamente a complexidade da avaliação de sua gravidade, persistindo relevante incerteza quanto à aplicabilidade dos métodos invasivos pelo cateterismo cardíaco e os não invasivos, com base em ecocardiografia. O objetivo deste estudo foi analisar os padrões hemodinâmicos da avaliação com ecocardiografia comparativamente à estimativa da gravidade da estenose aórtica com o cateterismo em pacientes consecutivos referidos para avaliação diagnóstica por laboratório de hospital acadêmico terciário no triênio 2016-2018. Métodos: Estudo observacional, descritivo e retrospectivo das características clínicas e dos resultados das avaliações da gravidade da estenose valvar aórtica obtidas em 96 pacientes consecutivos, por meio de cateterismo e ecocardiografia. Resultados: Amostra populacional de 49 homens e 47 mulheres, com mediana de idade de 66,5 (56,5 a 72,8) anos, estenose valvar aórtica degenerativa em 49% e reumática em 40%, além de diversas comorbidades, inclusive doença coronária (37%). Pelo cateterismo, com base no gradiente pico de 48 (20 a 68), a estenose valvar aórtica foi avaliada como grave em 56%, sendo a pressão telediastólica ventricular de 20mmHg (16 a 30mmHg). Pela ecocardiografia, a área valvar foi 0,9cm2 (0,7 a 1,2cm2), sendo indexado 0,5cm2/m2 (0,43 a 0,5cm2/m2), com gradiente pico de 62±26 mmHg. A estenose valvar aórtica foi considerada severa em 69,2%. Houve discordância entre os métodos sobre a severidade da estenose valvar aórtica em 30% dos exames, com coeficiente de Spearman entre área valvar pelo ecocardiograma e gradiente pico pelo cateterismo de -0,7 (p<0,001). Conclusão: Em amostra representativa dos vários padrões hemodinâmicos, a avaliação da gravidade da estenose valvar aórtica, como praticada rotineiramente em laboratório acadêmico, limitou-se à medida de pico de gradiente transvalvar. A estimativa da área valvar pelo método ecocardiográfico, sendo indireta e também passível de crítica, contribui para as discrepâncias encontradas, tornando-se justificável buscar o aperfeiçoamento de ambos os métodos, em vista da complexidade clínica e hemodinâmica detectada.

Background: In view of the better understanding of the pathophysiology of aortic valve stenosis, the complexity of assessing its severity has simultaneously grown, with relevant uncertainty persisting as to the applicability of invasive methods by cardiac catheterization and non-invasive methods based on echocardiography. The objective of this study was to analyze the hemodynamic patterns of evaluation with echocardiography compared to the estimation of severity of aortic stenosis with catheterization in consecutive patients referred for diagnostic evaluation by the laboratory of a tertiary academic hospital in the 2016 to 2018 triennium. Methods: An observational, descriptive and retrospective study of clinical characteristics and results of assessments of severity of aortic valve stenosis obtained in 96 consecutive patients, through catheterization and echocardiography. Results: A population sample of 49 men and 47 women, with a median age of 66.5 (56.5 to 72.8) years, degenerative aortic valve stenosis in 49%, and rheumatic aortic stenosis in 40%, in addition to several comorbidities, including coronary disease (37%). Using catheterization, based on the peak gradient of 48 (20 to 68), aortic valve stenosis was assessed as severe in 56%, with ventricular end-diastolic pressure of 20mmHg (16 to 30mmHg). Using echocardiography, the valve area was 0.9cm2 (0.7 to 1.2cm2), indexed valve area was 0.5cm2/m2 (0.43 to 0.5cm2/m2), with peak gradient of 62±26mmHg. Aortic valve stenosis was considered severe in 69.2%. There was disagreement between the methods regarding severity of aortic valve stenosis in 30% of exams, with a Spearman coefficient between the valve area on the echocardiogram and the peak gradient on catheterization of -0.7 (p<0.001). Conclusion: In a representative sample of various hemodynamic patterns, the assessment of severity of aortic valve stenosis, as routinely practiced in an academic laboratory, was limited to measuring the peak transvalvular gradient. The estimation of the valve area using the echocardiographic method was indirect and also subject to criticism, and contributed to the discrepancies found, rendering it justifiable to seek the improvement of both methods, in view of the clinical and hemodynamic complexity detected.

Experiencia del Comité de Ética Asistencial del Hospital Carlos van Buren entre los años 2007-2020

Background: Clinical Ethics Committees are deliberative groups whose main functions are to assess cases with ethical-clinical conflicts, to generate institutional protocols for preventive purposes, and to train health teams. Aim: To analyze the activity of a clinical ethics committee of a general hospital in the period 2007-2020. Material and Methods: A retrospective analysis of all session records, annual reports, case resolution and documents generated by the Clinical Ethics Committee of Carlos van Buren Hospital in Valparaíso, Chile, between 2007 and 2020, was carried out. Results: On average, 12 cases are analyzed per year. Sixty percent correspond to requests from pediatric units and in 78% of these cases there was at least one neurological disease. In 62% of cases, the main ethical dilemma was adequacy of therapeutic effort, followed by dilemmas related to the exercise of autonomy in 18.2%. In education, two courses are identified aimed to doctors, residents, and other members of the health team. Regarding normative functions, several documents were generated at the request of the Hospital management or in different clinical situations. During COVID-19 pandemia, the active role of the committee was linked to the three main functions, namely evaluating cases, participating in morbidity and mortality meetings for preventive purposes, and issuing guidelines and recommendations for action. The active participation of Pediatric Neurology residents in the Committee, for educational and administrative purposes, stands out. Conclusions: The three main functions described for the ethics committees were exerted by this Committee during the evaluated period. The impact of our recommendations remain to be objectively evaluated.

Reproductibilidad de pruebas de competencia motriz y percentiles para niños y adolescentes que viven a altitud moderada del Perú / Reproducibility of motor competence tests and percentiles for children and adolescents living at moderate altitude in Peru

Objetivo. Evaluar la reproductibilidad de las pruebas de competencia motriz (CM) de transposición lateral y salto lateral, y estimar percentiles por edad y sexo para niños que viven a altitud modera del Perú.Método. Se efectuó un estudio descriptivo transversal en la provincia de Arequipa (Perú). Se evaluó el peso, la estatura y la circunferencia de cintura. Se calculó el índice de masa corporal e índice ponderal. Se evaluó la prueba de transposición lateral y salto lateral (ambas de la batería Kopfer test für Kinder).Resultados. La muestra estuvo constituida por 885 niñas y 897 niños de 6,0 a 16,9 años. El error técnico de medida intraevaluador para ambas pruebas de CM oscilaron entre 1,75 y 3,9 repeticiones en ambos sexos, mientras que el coeficiente de correlación intraclase fue de 0,77 a 0,99. Los límites de acuerdo oscilaron entre -7,3 y 6,8 repeticiones en ambas pruebas. Se estimaron percentiles 5º, 15º, 50º, 85º y 95º por el método Least-Mean-Square algorithm. Los puntos de corte adoptados para las pruebas CM fueron bajo: < p15; regular: de p15 a p85; y alto: > p85.Conclusión. Las pruebas de transposición lateral y salto lateral mostraron una elevada capacidad de reproductibilidad. Los percentiles propuestos pueden servir para valorar la CM y podrían ser incluidos y adaptados como indicadores de desempeño en la educación física.

Objective. To assess the reproducibility of two motor competence (MC) tests: moving sideways and jumping sideways, and to estimate age and sex percentiles for children living at moderate altitude in Peru.Method. This was a descriptive, cross-sectional study conducted in the province of Arequipa, Peru. Weight, height, and waist circumference were assessed. Body mass index and ponderal index were estimated. The moving sideways and jumping sideways tests were assessed (both from the Körper test für Kinder test battery).Results. The sample was made up of 885 girls and 897 boys aged 6.0-16.9 years. The intra-evaluator technical error of measurement for both MC tests ranged between 1.75 and 3.9 repetitions in both males and females, whereas the intraclass correlation coefficient was 0.77-0.99. Agreement limits ranged between -7.3 and 6.8 repetitions for both tests. The 5th, 15th, 50th, 85th, and 95th percentiles were estimated using the Least-Mean-Square algorithm. The cut-off points for MC tests were low: < p15; medium: p15-p85; and high: > p85. Conclusion. Moving sideways and jumping sideways showed a high capacity for reproducibility. The proposed percentiles may be useful to assess MC and could be included and adapted as performance indicators in physical education

Safety protocols for dental care during the COVID-19 pandemic: the experience of a Brazilian hospital service

Abstract The coronavirus disease (COVID-19) has been prioritized in relation to other illnesses considered critical, such as cancer, cardiovascular diseases/stroke, diabetes, and autoimmune diseases. The management of patients with these diseases involves dental care to reduce systemic complications caused by odontogenic infections, and/or to treat oral manifestations of systemic comorbidities. In this regard, the dental care of these individuals must be guaranteed during the pandemic. Although a high risk of exposure to and catching of COVID-19 is expected to befall dental professionals, biosafety guidelines reduce the likelihood of infection. Thus, the current scenario poses challenges, and offers decision-making approaches and tools that facilitate the management of individuals with oral manifestations of chronic and/or critical diseases, using hospital-based services. This article presents an overview for hospital service providers who are at the forefront of COVID-19 care, including a secure protocol, and clinical guidelines based on the experience of the Hospital das Clínicas in Belo Horizonte, a public referral service, supported by the Brazilian National Health System.

Estudo Comparativo da Doença Coronariana Microvascular Causada por Doença de Chagas e por Outras Etiologias / Chagas Cardiomyopathy as the Etiology of Suspected Coronary Microvascular Disease. A Comparison Study with Suspected Coronary Microvascular Disease of Other Etiologies

Resumo Fundamento A doença de Chagas (DC) constitui uma causa potencial negligenciada de doença microvascular coronariana (DMC). Objetivos Comparar pacientes com DMC relacionada à DC (DMC-DC) com pacientes com DMC ligada a outras etiologias (DMC-OE). Métodos De 1292 pacientes estáveis, encaminhados para angiografia coronária invasiva para elucidar o padrão hemodinâmico e a causa de angina, 247 apresentaram coronárias subepicárdicas normais, e 101 foram incluídos após aplicação dos critérios de exclusão. Desses, 15 compuseram o grupo de DMC-DC e suas características clínicas, hemodinâmicas, angiográficas, e cintilográficas foram comparadas às do grupo de 86 pacientes com DMC-OE. O nível de significância estatística para todas as comparações adotado foi de 0,05. Resultados Pacientes com suspeita de DMC-DC apresentaram características antropométricas, clínicas e angiográficas, além de alterações hemodinâmicas e de perfusão miocárdica estatisticamente comparáveis às detectadas nos 86 pacientes com DMC-OE. Disfunção ventricular diastólica, expressa por elevada pressão telediastólica do ventrículo esquerdo, foi igualmente encontrada nos dois grupos. Entretanto, em comparação a esse grupo com DMC-OE, o grupo com DMC-DC exibiu fração de ejeção ventricular esquerda mais baixa (61,1 ± 11,9 vs 54,8 ± 15,9; p= 0,049) e mais elevado escore de mobilidade da parede ventricular (1,77 ± 0,35 vs 1,18 ± 0,26; p= 0,02). Conclusão A cardiomiopatia crônica da doença de Chagas esteve associada à etiologia de possível doença microvascular coronariana em 15% de amostra de 101 pacientes estáveis, cujo sintoma principal era angina requerendo elucidação por angiografia invasiva. Embora os grupos DMC-DC e DMC-OE apresentassem características clínicas, hemodinâmicas, e de perfusão miocárdica em comum, a disfunção global e segmentar do ventrículo esquerdo foi mais grave nos pacientes com DMC associada à DC em comparação à DMC por outras etiologias. (Arq Bras Cardiol. 2020; 115(6):1094-1101)

Abstract Background Chagas disease (CD) as neglected secondary form of suspected coronary microvascular dysfunction (CMD). Objectives Comparison of patients with CMD related to CD (CMD-CE) versus patients with CMD caused by other etiologies (CMD-OE). Methods Of 1292 stable patients referred for invasive coronary angiography to elucidate the hemodynamic pattern and the cause of angina as a cardinal symptom in their medical history, 247 presented normal epicardial coronary arteries and 101 were included after strict exclusion criteria. Of those, 15 had suspected CMD-CE, and their clinical, hemodynamic, angiographic and scintigraphic characteristics were compared to those of the other 86 patients with suspected CDM-OE. Level of significance for all comparisons was p < 0.05. Results Patients with suspected CMD-CE showed most anthropometric, clinical, angiographic hemodynamic and myocardial perfusion abnormalities that were statistically similar to those detected in the remaining 86 patients with suspected CMD-OE. LV diastolic dysfunction, expressed by elevated LV end-diastolic pressure was equally found in both groups. However, as compared to the group of CMD-OE the group with CMD-CE exhibited lower left ventricular ejection fraction (54.8 ± 15.9 vs 61.1 ± 11.9, p= 0.049) and a more severely impaired index of regional wall motion abnormalities (1.77 ± 0.35 vs 1.18 ± 0.26, p= 0.02) respectively for the CMD-OE and CMD-CE groups. Conclusion Chronic Chagas cardiomyopathy was a secondary cause of suspected coronary microvascular disease in 15% of 101 stable patients whose cardinal symptom was anginal pain warranting coronary angiography. Although sharing several clinical, hemodynamic, and myocardial perfusion characteristics with patients whose suspected CMD was due to other etiologies, impairment of LV segmental and global systolic function was significantly more severe in the patients with suspected CMD related to Chagas cardiomyopathy. (Arq Bras Cardiol. 2020; 115(6):1094-1101)

Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review / Fatores Associados à Recorrência na Síndrome de Takotsubo: Uma Revisão Sistemática

Abstract Background: Takotsubo syndrome (TTS) is characterized by a temporary systolic dysfunction of the left ventricle (LV) related to a stressful event. However, the factors associated with its recurrence are still not well established. Objective: To analyze the main factors associated with TTS recurrence. Methods: A systematic review was performed using the PRISMA model. Observational studies, published between January 2008 and October 2017, which presented a recurrence rate of at least 3% and/or 5 or more patients with recurrence, and who met at least 80% of the STROBE criteria were included. Results: six articles reached the criteria to compose this systematic review. The recurrence rate ranged from 1 to 3.5% per year (global recurrence rate 3.8%). One study associated higher recurrence rate with the female gender, four reported the time between the first and second episodes, one study associated body mass index (BMI) and hypercontractility of the LV middle anterior wall to a higher recurrence rate. No association between recurrence and electrocardiographic changes were determined. Beta-blockers use was not associated with recurrence rates. Conclusions: Female gender, time from the first episode of the syndrome, low BMI and midventricular obstruction were reported as potential predictors of TTS recurrence.

Resumo Fundamento: A síndrome de Takotsubo (STT) é caracterizada por uma disfunção sistólica temporária do ventrículo esquerdo (VE) relacionada a um evento estressante. No entanto, os fatores associados à sua recorrência ainda não estão bem estabelecidos. Objetivo: Analisar os principais fatores associados à recorrência da STT. Métodos: Uma revisão sistemática foi realizada usando o modelo PRISMA. Foram incluídos estudos observacionais, publicados entre janeiro de 2008 e outubro de 2017, que apresentaram uma taxa de recorrência de pelo menos 3% e/ou 5 ou mais pacientes com recidiva e que preencheram pelo menos 80% dos critérios STROBE. Resultados: Seis artigos atenderam aos critérios para esta revisão sistemática. A taxa de recorrência variou de 1 a 3,5% ao ano (taxa de recorrência global 3,8%). Um estudo associou maior taxa de recorrência ao sexo feminino, quatro relataram o tempo entre o primeiro e o segundo episódio, um estudo associou o índice de massa corporal (IMC) e a hipercontratilidade da parede anterior média do VE a uma maior taxa de recorrência. Não foi determinada associação entre recorrência e alterações eletrocardiográficas. O uso de betabloqueadores não foi associado a taxas de recorrência. Conclusões: Sexo feminino, tempo desde o primeiro episódio da síndrome, baixo IMC e obstrução ventricular foram relatados como possíveis preditores de recorrência da STT.

Aneurysmal Patellar Bone Cyst: Case Reportt / Cisto Ósseo Aneurismático de Patela: Relato de Caso

Abstract Patellar tumors are rare. Commonly benign, giant-cell tumors and chondroblastomas are the most frequent types of this tumor. Aneurysmal bone cysts are a less common type, corresponding to less than 1% of the cases. The authors present a case of a 23-year-old male patient who presented left patellar pain and swelling for two years. The radiographic images suggested tumoral causes, and the biopsy was negative for neoplasm. The treatment approach was a complete patellectomy, without complications. The imaging follow-up showed no recurrence.

Resumo Os tumores patelares são uma condição rara. Comumente benignos, o tumor de células gigantes e o condroblastoma são os tipos mais frequentes. O tipo menos comum entre os tumores patelares é o cisto ósseo aneurismático, que corresponde a menos de 1% dos casos. Os autores relatam o caso de um paciente do sexo masculino, de 23 anos, com dor e aumento do volume da patela esquerda havia 2 anos. A radiologia sugeriu causas tumorais, e a biópsia foi negativa para neoplasia. A abordagem terapêutica escolhida foi uma patelectomia total, feita sem intercorrências. O acompanhamento com imagens não mostrou recorrência.

Levantamiento de necesidades prioritarias para la igualdad de oportunidades de personas en situación de discapacidad que residen en la comuna de Santiago / Survey of priority needs for equal opportunities for people with disabilities who reside in the commune of Santiago

El año 2015 el Servicio Nacional de Discapacidad determinó que en Chile el 20% de la población mayor de 18 años presentaba alguno situación de discapacidad Sin embargo, actualmente no se cuenta con datos comunales sobre este fenómeno, complejizando el desarrollo de acciones locales que permitan el tránsito a una comunidad más inclusiva. Por lo anterior; esta investigación se realizó desde un enfoque cualitativo, con actores locales que respondieron a una convocatorio realizada desde la oficina de discapacidad de la comuna de Santiago a instituciones comunales y personas vinculadas al mundo de lo discapacidad Con ellos se incursionó en las percepciones de las personas en situación de discapacidad sobre los conceptos de discapacidad y discriminación, para posteriormente abordar los elementos que facilitan y obstaculizan la inclusión social y lo que consideran como necesidades prioritarios poro lo igualdad de oportunidades. Los resultados evidencian la percepción de discriminación existente en la comuna y recalcan la importancia de contar con políticas locales de inclusión y lineamientos poro su desarrollo.

In 2015, the National Disability Service determined that in Chile,20% of the population over18 yeors of age shows some type of disability. However; there is no communal data on this phenomenon at present, making more complex to develop local actions that allow the development to o more inclusive community. Therefore, this research was conducted from a qualitative approach, with local actors who responded to a call made from the disability office of the commune of Santiago to community institutions and people linked to the world of disability. With them, the perceptions of people with disabilities were explored penetrating in the understanding of the people in situation of disability on the concepts of disability and discrimination, to later address the elements that facilitate and interfere social inclusion and the priority needs for equal opportunities. The results show the perception of discrimination in the commune and emphasize the importance of having local inclusion policies and guidelines for its development.

Efeito agudo do laser de baixa potência na fadiga do bíceps braquial de atletas de voleibol / Acute effect of low-power laser in fatigue of biceps brachii of volleyball athletes / Efecto agudo del láser de baja potencia en la fatiga del bíceps braquial de atletas de voleibol

RESUMO Introdução: A laserterapia de baixa potência tem entre seus propósitos auxiliar a recuperação de tecidos biológicos, atenuando os efeitos da fadiga muscular e contribuindo com a melhora do desempenho em atletas. Aspectos metodológicos ainda limitam as conclusões do efeito agudo da laserterapia sobre o desempenho muscular. Objetivo: Verificar o efeito agudo do laser terapêutico de baixa potência na fadiga induzida do bíceps braquial de atletas de voleibol. Métodos: Este foi um estudo randomizado e duplo-cego, aprovado pelo Comitê de Ética da UNESP de Marília. Participaram do estudo 19 atletas de voleibol de ambos os sexos. Realizou-se coleta de dados eletromiográficos do músculo bíceps braquial no exercício isométrico de flexão de cotovelo antes e após a aplicação do laser terapêutico. Um haltere com 75% do pico de força, obtido por uma célula de carga, foi utilizado para o protocolo de fadiga. Em seguida, os voluntários foram submetidos à aplicação do laser (ativo ou placebo) em seis pontos do músculo bíceps braquial. Os dados eletromiográficos foram analisados no domínio da frequência, utilizando-se o software Myosystem®. Verificou-se a distribuição de normalidade dos dados pelo teste de Shapiro-Wilk, e utilizou-se Anova (split plot) de medidas repetidas a fim de testar a interação entre tempo e grupo. Resultados: Para nenhuma das variáveis analisadas foi observada interação significativa entre grupo e tempo, indicando que o grupo irradiado não apresentou vantagens com relação ao grupo placebo. Conclusão: Após o protocolo de fadiga proposto, uma única aplicação de laser de baixa potência não foi suficiente para produzir efeitos positivos no desempenho de força e no sinal eletromiográfico do músculo bíceps braquial de atletas de voleibol.

ABSTRACT Introduction: Low-power laser therapy has among its aims to aid the recovery of biological tissues, attenuating the effects of muscle fatigue and contributing to the improvement of performance in athletes. Methodological aspects still limit the conclusions of the acute effect of laser therapy on muscular performance. Objective: To verify the acute effect of low-power therapeutic laser in the induced fatigue in biceps brachii of volleyball athletes. Methods: This was a randomized double-blind study, approved by Institutional Review Board of UNESP, Marília. Nineteen volleyball athletes of both sexes participated in this study. Electromyographic data were collected from the biceps brachii muscle in isometric exercise of the elbow flexion before and after the application of the therapeutic laser. A dumbbell with 75% of the force peak, obtained by a load cell, was used for the fatigue protocol. The volunteers then underwent laser (active or placebo) application on six points of the biceps brachii muscle. The EMG data were analyzed in the frequency domain using the Myosystem ® software. The distribution of normality was verified by the Shapiro-Wilk test, and repeated measures ANOVA (split plot) was used to test the interaction between time and group. Results: No significant interaction between group and time was observed for any analyzes variables, indicating that the irradiated group did not show advantages over the placebo group. Conclusion: After the proposed fatigue protocol, a single low-power laser application was not sufficient to produce positive effects on strength performance and on the electromyographic signal of the biceps brachii muscle of volleyball athletes.

RESUMEN Introducción: La láserterapia de baja potencia tiene entre sus propósitos auxiliar la recuperación de los tejidos biológicos, atenuando los efectos de la fatiga muscular y contribuyendo con la mejora del desempeño en atletas. Los aspectos metodológicos todavía limitan las conclusiones del efecto agudo de la láserterapia sobre el rendimiento muscular. Objetivo: Verificar el efecto agudo del láser terapéutico de baja potencia en la fatiga inducida del bíceps braquial de atletas de voleibol. Métodos: Fue un estudio aleatorizado y doble ciego, aprobado por el Comité de Ética de la UNESP de Marília. Participaron del estudio 19 atletas de voleibol de ambos sexos. Se realizó la recolección de datos electromiográficos del músculo bíceps braquial en ejercicio isométrico de flexión de codo antes y después de la aplicación del láser terapéutico. Se utilizó una mancuerna con un 75% del pico de fuerza, obtenido por una célula de carga para el protocolo de fatiga. A continuación, los voluntarios fueron sometidos a la aplicación del láser (activo o placebo) en seis puntos del músculo bíceps braquial. Los datos electromiográficos se analizaron en el ámbito de la frecuencia, utilizando el software Myosystem ® . Se verificó la distribución de la normalidad de los datos por la prueba de Shapiro-Wilk, y se utilizó Anova (split plot) de medidas repetidas para probar la interacción entre tiempo y grupo. Resultados: Para ninguna de las variables analizadas se observó interacción significativa entre grupo y tiempo, indicando que el grupo irradiado no presentó ventajas con relación al grupo placebo. Conclusión: Después del protocolo de fatiga propuesto, una única aplicación láser de baja potencia no fue suficiente para producir efectos positivos en el desempeño de fuerza y en las señales electromiográficas del músculo bíceps braquial de atletas de voleibol.

Tibial shaft fracture and ankle injury - Case report / Fratura diafisária da tíbia e lesão do tornozelo - Relato de caso

ABSTRACT The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

RESUMO Os autores relatam um caso de fratura diafisária de tíbia associado à lesão do tornozelo. As características clínicas, radiológicas e cirúrgicas são discutidas. A avaliação de lesões associadas são muitas vezes negligenciadas e de difícil diagnóstico. Quando um torque no membro inferior ocorre, o tornozelo fica suscetível a uma lesão simultânea. É essencial uma avaliação cuidadosa baseada no aspecto clínico, radiográfico, intra e pós-operatório para recuperação funcional.

Lavado broncoalveolar y derrame pleural con hipereosinofilia: caso clínico y revisión de la literatura / Chronic eosinophilic pneumonia: report of one case

Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.

Macrofauna bêntica do Parque Estadual Marinho de Areia Vermelha, Cabedelo, Paraíba, Brasil / Benthic macrofauna from Areia Vermelha Marine State Park, Cabedelo, Paraíba, Brazil

O Parque Estadual Marinho de Areia Vermelha (Cabedelo, Paraíba) foi criado pelo Governo do Estado da Paraíba com a finalidade de conservar a biodiversidade local e de regulamentar as atividades turísticas na área. Mais de uma década depois de sua criação, este estudo configura-se no primeiro inventário da macrofauna bêntica desta, que, até então, é a única unidade de conservação completamente marinha do litoral paraibano. Os espécimes estudados provêm de coletas realizadas entre fevereiro e abril de 2008. Durante os trabalhos de campo, os animais foram amostrados através de buscas intensivas nos diversos microhabitats do recife. Foram identificadas 102 espécies distribuídas entre os táxons Cnidaria (13 spp.), Mollusca (57 spp.), Crustacea (15 spp.), Echinodermata (15 spp.) e Ascidiacea (2 spp.). Do total de espécies registradas, 14 são novas ocorrências para o litoral do Estado da Paraíba, são elas: Pennaria disticha, Encope emarginata, Aplysia dactylomela, Arene brasiliana, Hipponix leptus, Olivella nivea, Mancinella deltoidea, Notocochlis isabelleana, Pilsbryspira albocincta, Pilsbryspira zebroides, Cymatium cynocephalum, Mactrellona alata, Mactrotoma fragilis e Mulinia cleryana. Três espécies ameaçadas de extinção de acordo com a legislação brasileira foram registradas: Millepora alcicornis (hidrocoral), Echinaster (Othilia) echinophorus e E. (O.) brasiliensis (estrelas-do-mar). Além disso, uma espécie de crustáceo que habita o Parque é considerada ameaçada de sobreexplotação, a lagosta Panulirus laevicauda. Entre os moluscos, destacam-se as espécies Voluta ebraea e Turbinella laevigata, endêmicas do nordeste brasileiro, que também ocorrem nos limites do Parque e que são particularmente vulneráveis devido à sua relevância no comércio ornamental marinho. Apesar de se tratar de um estudo piloto, a macrofauna bêntica registrada no Parque de Areia Vermelha revelou a presença de espécies de importância ecológica e econômica, tornando esta área de especial relevância para a conservação. No entanto, é importante que os órgãos gestores cumpram seu papel no sentido de promover a efetividade de manejo da unidade, que inclui a elaboração do zoneamento ecológico-econômico, do plano de manejo e da aplicação de medidas eficazes de fiscalização e monitoramento da área.

The Areia Vermelha Marine State Park (Cabedelo Municipality, Paraiba State, Brazil) was established by the State Government to preserve the local biodiversity and to regulate touristic activities in the area. More than a decade after the creation of this park, we provide the first inventory of the benthic macrofauna of this single exclusively marine conservation unit in our State. Specimens were collected between February and April of 2008. Animals were sampled through intensive searches in the diverse microhabitats available on the reefs. A total of 102 species were identified belonging to Cnidaria (13 spp.), Mollusca (57 spp.), Crustacea (15 spp.), Echinodermata (15 spp.), and Ascidiacea (2 spp.). Fourteen out of these represent new occurrences for the coast of Paraiba State: Pennaria disticha, Encope emarginata, Aplysia dactylomela, Arene brasiliana, Hipponix leptus, Olivella nivea, Mancinella deltoidea, Notocochlis isabelleana, Pilsbryspira albocincta, Pilsbryspira zebroides, Cymatium cynocephalum, Mactrellona alata, Mactrotoma fragilis, and Mulinia cleryana. Three are endangered species according to the Brazilian legislation: Millepora alcicornis (hydrozoan coral), Echinaster (Othilia) echinophorus, and E. (O.) brasiliensis (sea stars). One species, the lobster Panulirus laevicauda, is considered over-exploited. Among the mollusks, Voluta ebraea and Turbinella laevigata are endemic to northeast Brazil; they are particularly vulnerable in the area of the park because of their relevance to the commerce of marine ornamental species. Our pilot study has revealed the presence of species of particular ecological and economic importance, confirming the special relevance of the studied area for conservation. It now becomes imperative that management entities delineate an efficient plan for the conservation and monitoring of this important conservation unit.

Isolados de Cryptococcus neoformans, C. gattii E C. laurentii produtores de protease e fosfolipase / Protease and phospholipase production of Cryptococcus neoformans, C. gattii and C. laurentii isolates

A criptococose é uma micose sistêmica com caráter oportunista, que pode acometer homens e diferentes espécies animais, principalmente em casos de imunodepressão. A levedura penetra pela via respiratória, pode disseminar-se por via hematógena e atingir o sistema nervoso central. Objetivando o isolamento da levedura Cryptococcus neoformans a partir de sistema nervoso central de cães na cidade do Rio de Janeiro, procederam-se coleta de amostras de cérebro no Laboratório de Diagnóstico de Raiva do Instituto Municipal de Medicina Veterinária Jorge Vaitsman, no bairro da Mangueira, Rio de Janeiro. As etapas de isolamento, identificação e avaliação da produção de protease e fosfolipase ocorreram no Laboratório de Leveduras Patogênicas e Ambientais da Universidade Federal Rural do Rio de Janeiro (LLPA-UFRRJ). Para a avaliação de protease, utilizou-se meio de cultura contendo albumina bovina e para avaliação de fosfolipase, o meio utilizado compunha-se de gema de ovo e CaCi2. Foram utilizadas 166 amostras de sistema nervoso central, com quatro isolamentos positivos para o gênero, sendo um de Cryptococcus laurentii, dois de Cryptococcus neoformans e um de Cryptococcus gattii, todos produtores de protease e fosfolipase.

Implicações clínicas da persistência de anti-GAD positivo e peptídeo C detectável em pacientes com diabetes melito tipo 1 de longa duração / GADA persistence and detectable C peptide in patients with long standing diabetes mellitus type 1

OBJETIVO: Avaliar se anti-GAD positivo e PC detectável se correlacionam com a presença de outras doenças autoimunes, com controle glicêmico e com risco de retinopatia no diabetes melito tipo 1 (DMT1) > 3 anos de duração. PACIENTES E MÉTODOS: Cinquenta sujeitos com DMT1 foram entrevistados, realizaram fundoscopia e dosaram PC pré e pós-glucagon, HbA1C e anti-GAD. RESULTADOS: Pacientes anti-GAD+ (n = 17) apresentaram maior frequência de doenças autoimunes em relação aos demais (p = 0,02). PC detectável (n = 11) também foi associado ao aumento dessa prevalência (p = 0,03), porém nenhum dos dois parâmetros influenciou na presença de retinopatia diabética. PC detectável não influenciou no controle glicêmico (HbA1C média) (p = 0,28), porém as doses diárias de insulina foram mais baixas (0,62 vs. 0,91 U/kg/dia; p = 0,004) neste grupo. CONCLUSÃO: Apesar de não ser um marcador para outras doenças autoimunes, o anti-GAD+ parece ser não só um sinalizador de autoimunidade pancreática. PC detectável também parece ter papel promissor na detecção dessas comorbidades. Ambos não interferiram na presença de retinopatia, entretanto, o PC detectável se relacionou a menores necessidades de insulina.

OBJECTIVE: The aim of this study was to evaluate if GADA+ and detectable CP had any influence in other autoimmune diseases, glycemic control, and risks of retinopathy in diabetes mellitus type 1 (T1DM) lasting longer than 3 years of duration. SUBJECTS AND METHODS: Fifty T1DM subjects were interviewed, performed fundoscopic examination, and measured CP before and after glucagon, HbA1C, and GADA. RESULTS: GADA+ (n = 17) had a higher frequency of other autoimmune diseases when compared to GADA (p = 0.02). Detectable CP was also associated with a higher prevalence of these diseases (p = 0.03), although, retinopathy was not influenced by either one. Detectable CP had no influence in the glycemic control (mean HbA1C) (p = 0.28). However, insulin daily doses were lower in this group (0.62 vs. 0.91 U/kg/day; p = 0.004). CONCLUSION: Although not recommend as a marker of other autoimmune diseases, GADA+ seems to be not only a pancreatic autoimmunity signal. Detectable CP may also have some promising influence in detecting these diseases. Neither influenced the presence of retinopathy, but insulin daily requirements were smaller when CP was present.

Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report / Plasmocitoma da órbita envolvendo glândula lacrimal com transformação secundária para mieloma múltiplo: relato de caso

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.

Os autores relatam um raro caso de plasmocitoma da órbita envolvendo glândula lacrimal com transformação secundária para mieloma múltiplo em uma paciente de 42 anos. A lesão foi removida cirurgicamente e o exame anatomopatológico, aliado à imuno-histoquímica, revelou positividade para imunoglobulina G e cadeias leve tipo Kappa. Após extensa avaliação sistêmica, nenhuma anormalidade foi observada, sendo feito o diagnóstico de plasmocitoma solitário ósseo. A paciente foi submetida à radioterapia, permanecendo livre da doença por 5 anos e 6 meses até 2007, quando apresentou uma fratura patológica devido à infiltração plasmocitária na coluna lombar, sendo feito diagnóstico de mieloma múltiplo. Uma vez que o plasmocitoma solitário ósseo pode ser a primeira manifestação do mieloma múltiplo, esses pacientes necessitam de adequado diagnóstico e seguimento a longo prazo, pois o tratamento e prognóstico dessas duas condições é diferente.

Avaliação da função pancreática em pacientes com diabetes melito tipo 1 de acordo com a duração da doença / Pancreatic function assessment in type 1 diabetes mellitus patients according to disease duration

Os pacientes com diabetes melito tipo 1 (DM1) podem apresentar secreção residual de insulina por longos períodos, o que tem sido associado a prognóstico mais favorável. OBJETIVO: Avaliar a secreção de insulina por meio da dosagem de peptídeo C (PC) em pacientes com DM1 de curta (<5 anos; grupo 1) e longa (> 5 anos; grupo 2) duração da doença. PACIENTES E MÉTODOS: Voluntários com DM1 coletaram sangue em jejum e 6 minutos após a infusão de glucagon para dosagem de PC, HbA1c e anti-GAD. RESULTADOS: Foram avaliados 43 pacientes, 22 no grupo 1 e 21 no grupo 2. Secreção de insulina preservada (PC > 1,5 ng/mL) foi identificada em seis (13,9 por cento) e oito (18,6 por cento) casos nas coletas basal (PC1) e após estímulo (PC2), sem diferença entre os grupos (p = 0,18 e 0,24). PC1 foi detectável (> 0,5 ng/mL) em 13 (30,2 por cento) e PC2 em 18 (41,9 por cento) casos, mais frequentes no grupo 1 do que no 2 (p = 0,045 para PC1/p = 0,001 para PC2). Os títulos de PC1 (1,4 ±0,8 versus 1,2 ±1,0; p = 0,69) ou PC2 (1,8 ±1,5 versus 1,7 ±0,8; p = 0,91) não diferiram entre os grupos. No grupo 1 houve correlação inversa entre tempo de doença e PC2 (R = -0,58; p = 0,025). CONCLUSÃO: Uma proporção significativa dos pacientes com DM1 apresenta secreção residual de insulina, especialmente nos primeiros cinco anos da doença. Tais indivíduos representam a população ideal para estudos visando à prevenção secundária da doença.

Patients with type 1 diabetes (T1D) may exhibit some residual insulin secretion for many years after their diagnosis. This has been associated with a more favorable prognosis. OBJECTIVE: To analyze insulin secretion in individuals with T1D using C-peptide (CP) response to glucagon and comparing patients with recent onset (<5 years - Group 1) and long-standing disease (>5 years -Group 2). METHODS: Subjects with T1D had their blood sampled before (fasting) and 6 minutes after glucagon infusion for CP, HbA1c and anti-GAD measurement. RESULTS: Forty-three individuals were evaluated, 22 in Group 1 and 21 in Group 2. Preserved insulin secretion (CP >1.5 ng/mL) was observed in 6 (13.9 percent) and in 8 (18.6 percent) patients before (CP 1) and after (CP 2) glucagon stimulus, respectively, showing no difference between the groups (p=0.18 and 0.24). CP 1 and CP 2 were detectable (>0.5 ng/dL) in 13 (30.2 percent) and 18 (41.9 percent) patients, respectively. Both were more frequent in Group 1 than in Group 2 (p=0.45 for CP1/p=0.001 for CP 2). Similar serum levels where seen between the groups, both before and after stimulus (1.4±0.8 vs. 1.2±1.0; p=0.69 and 1.8±1.5 vs. 1.7±0.8; p=0.91). Group 1 presented an inverse correlation between disease duration and CP 2 (R=-0.58; p=0.025). CONCLUSION: A significant number of patients with T1D have detectable residual insulin secretion, especially in the first 5 years of disease. These subjects are an ideal population for clinical trials that target the prevention of â cell function loss in T1D.