A link between circulating immune complexes and acute kidney injury in human visceral leishmaniasis.

Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania infantum. Clinically, VL evolves with systemic impairment, immunosuppression and hyperactivation with hypergammaglobulinemia. Although renal involvement has been recognized, a dearth of understanding about the underlying mechanisms driving acute kidney injury (AKI) in VL remains. We aimed to evaluate the involvement of immunoglobulins (Igs) and immune complexes (CIC) in the occurrence of AKI in VL patients. Fourteen VL patients were evaluated between early treatment and 12 months post-treatment (mpt). Anti-Leishmania Igs, CIC, cystatin C, C3a and C5a were assessed and correlated with AKI markers. Interestingly, high levels of CIC were observed in VL patients up to 6 mpt. Concomitantly, twelve patients met the criteria for AKI, while high levels of cystatin C were observed up to 6 mpt. Plasmatic cystatin C was positively correlated with CIC and Igs. Moreover, C5a was correlated with cystatin C, CIC and Igs. We did not identify any correlation between amphotericin B use and kidney function markers in VL patients, although this association needs to be further explored in subsequent studies. Our data reinforce the presence of an important renal function impairment during VL, suggesting the involvement of Igs, CIC, and C5a in this clinical condition.

Intermittent fasting associated with coconut oil (Cocos nucifera L.) alters gut-liver axis parameters in diet-induced obese rats.

OBJECTIVE: The aim of this article is to investigate the effect of intermittent fasting, associated or not with coconut oil intake, on the gut-liver axis of obese rats. METHODS: A total of 50 rats were divided into five groups: control, obese, obese with intermittent fasting, obese with intermittent fasting plus coconut oil, and obese with caloric restriction. The rats were induced to obesity with a high-sugar diet for 17 wk. The respective interventions were carried out in the last 4 wk. RESULTS: The groups with intermittent fasting protocols had reduced total cholesterol (on average 54.31%), low-density lipoprotein (on average 53.39%), and triacylglycerols (on average 23.94%) versus the obese group; and the obese with intermittent fasting plus coconut oil group had the highest high-density lipoprotein compared with all groups. The obese with intermittent fasting plus coconut oil and obese with caloric restriction groups had lower metabolic load compared with the other groups. The obese group had high citric and succinic acid concentrations, which affected the hepatic tricarboxylic acid cycle, while all the interventions had reduced concentrations of these acids. No histologic changes were observed in the intestine or liver of the groups. CONCLUSION: Intermittent fasting, especially when associated with coconut oil, had effects comparable with caloric restriction in modulating the parameters of the gut-liver axis.

Clinical factors associated with systemic sporotrichosis in Brazil.

BACKGROUND: Systemic sporotrichosis occurs when organs, other than subcutaneous tissues and lymph nodes, are infected. Interestingly, systemic sporotrichosis in apparently immunocompetent individuals is increasing in Brazil, but data on clinical manifestations and risk factors are scarce. Most of the existing data on such condition relate to people living with HIV. We aimed to study the risk factors associated with systemic sporotrichosis among HIV-negative and HIV-positive patients. METHODS: We performed a retrospective cross-sectional study with 80 patients from Brazil, diagnosed between 2014 and 2021. The association between disease classification, clinical presentation and risk factors were analysed by logistic regression. RESULTS: Of the 80 patients, 29 (36.3%) presented with systemic sporotrichosis. All HIV-positive patients developed the systemic form, with increased mortality (p = .002). Alcohol ingestion (p = .009) and diabetes (p = .010) were associated with systemic disease. Alcohol ingestion seemed to favour pulmonary infection (p = .013) and, diabetes favoured osteoarticular (p = .009) and ocular involvement (p = .033). The occurrence of fever (p = .001) and weight loss (p = .006) were significantly associated with systemic sporotrichosis, while meningeal involvement (p = .001) increased mortality risk. Nine (11.3%) patients died from sporotrichosis. The presence of fungal structures in the mycological examination of the patients' lesions were associated with the systemic form (p = .017) and death (p = .002). CONCLUSION: Our study points to the factors that drive systemic sporotrichosis other than HIV, such as alcohol ingestion and diabetes. Considering the high number of patients presenting severe sporotrichosis, the recognising these factors may contribute to timely diagnosis and proper treatment.

LOW BACK PAIN ESTIMATES IN PROFESSIONAL SOCCER: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Objective: To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players. Methods: Systematic review and meta-analysis. Results: The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days). Conclusion: Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.

Objetivo: Investigar as características epidemiológicas e clínicas da lombalgia em jogadores profissionais de futebol. Métodos: Revisão sistemática e metanálise. Resultados: A revisão incluiu 44 estudos. A prevalência combinada de lombalgia em até uma temporada foi de 1% (IC95% = 0-4%) em homens. A prevalência pontual combinada de lombalgia foi de 25% (IC95% = 16-36%) em homens e 28% (IC95% = 20-37%) em mulheres. A prevalência combinada de lombalgia no último ano foi de 34% (IC95% = 24-44%) em homens. A prevalência combinada de lombalgia ao longo da vida foi de 32%(IC95% = 25-39%) em homens e 50% (IC95% = 32-69%) em mulheres. A frequência combinada de lombalgia/número total de lesões foi de 2% (IC95% = 1-3%) em homens e 4% (IC95% = 2-5%) em mulheres. A taxa de incidência combinada de lombalgia/1.000 jogador-horas de exposição foi de 0,30 (IC95% = 0,17-0,53) em homens e 0,32 (IC95% = 0,06-1,87) em mulheres. A recorrência de lombalgia variou entre 3-63% em homens. A intensidade da lombalgia variou entre 1,68 (2,39)-4,87 (2,14) pontos em uma escala de 0-10 (mínimo = 0; máximo = 8 pontos). A gravidade da lombalgia (ausência das atividades profissionais devido à dor) variou entre 2 (0)-10 (19) dias (mínimo = 1; máximo = 28 dias). Conclusão: Jogadores de futebol profissional apresentam alta prevalência de lombalgia substancial. A frequência e a incidência da lombalgia parecem ser baixas comparadas a outros esportes e condições. As estimativas de recorrência, intensidade e gravidade da lombalgia são incertas. Nível de Evidência II, Revisão Sistemática de Estudos de Nível II.

Pediatric Interventional Neuroradiology.

Pediatric neurovascular disorders can lead to substantial mortality and morbidity if not diagnosed early and adequately managed. Children with neurovascular diseases cannot be treated as small adults as the vascular and central nervous system anatomy, physiology, and pathologies in children differ greatly from those of adults. In addition, some neurovascular pathologies are seen exclusively in children such as aneurysmal malformation of the vein of Galen, pial fistulas, and dural fistulas in the context of dural sinus disease. In this review, we aim to present an overview of the common pediatric neurovascular diseases along with their endovascular management.

Extra virgin coconut oil (Cocos nucifera L.) intake shows neurobehavioural and intestinal health effects in obesity-induced rats.

The present study aimed to evaluate the effect of E-VCO on the neurobehaviour and intestinal health parameters of obesity-induced rats, focusing on food consumption, body composition, bacterial and faecal organic acids and histological analyses in the hippocampus and colon. A total of 32 male Wistar rats were randomized into healthy (HG, n = 16) and obese groups (OG, n = 16), which consumed a control or cafeteria diet for eight weeks, respectively. After this period, they were subdivided into four groups: healthy (HG, n = 8); healthy treated with E-VCO (HGCO, n = 8); obese (OG, n = 8); obese treated with E-VCO (OGCO, n = 8), continuing for another eight weeks with their respective diets. The treated groups received 3000 mg kg-1 of E-VCO and control groups received water via gavage. Food preference, body weight gain, body composition, anxiety- and depression-like behaviour were evaluated. Bacteria and organic acids were evaluated in faeces, and histological analyses of the hippocampus and M1 and M2 macrophages in the colon were performed. E-VCO reduced energy intake (16.68%) and body weight gain (16%), although it did not reduce the fat mass of obese rats. E-VCO showed an antidepressant effect, increased lactic acid bacteria counts and modulated organic acids in obese rats. Furthermore, E-VCO protected the hippocampus from neuronal degeneration caused by the obesogenic diet, decreased the M1 macrophage and increased the M2 macrophage population in the gut. The results suggest neurobehavioural modulation and improved gut health by E-VCO, with promising effects against obesity-related comorbidities.

Intracranial arteriovenous shunts in infants: A decade of experience from a quaternary pediatric center.

BACKGROUND AND PURPOSE: Intracranial arteriovenous shunts (IAVS) are rare vascular diseases in infants. They can be categorized into vein of Galen aneurysmal malformation (VGAM), pial arteriovenous fistula (PAVF), and dural arteriovenous fistula associated with dural sinus malformation (DAVF/DSM). We sought to review the clinical presentation, imaging characteristics, endovascular treatment (EVT), and outcomes of IAVS in infants presenting to a quaternary pediatric referral center over one decade. METHODS: A retrospective review of a prospectively maintained database was performed of all infants diagnosed with IAVS between January 2011 and January 2021 in a quaternary pediatric referral center. For each patient, demographic data, clinical presentation, imaging findings, management strategies, and outcomes were reviewed and discussed. RESULTS: Over the study period, 38 consecutive infants were diagnosed with IAVS. Patients with VGAM (23/38, 60.5%) presented with congenital heart failure (CHF) (14/23), hydrocephalus (4/23), and seizures (2/23), and three patients were asymptomatic. Eighteen patients with VGAM underwent EVT. Among those, 13 patients (72.2%) were successfully treated with an angiographic cure and three patients (3/18, 17%) died. Patients with PAVF (9/38, 23.7%) presented with CHF (5/9), intracranial hemorrhage (2/9), and seizures (2/9), and all of them were successfully treated endovascularly. Patients with Type I DAVF/DSM (4/6, 66.6%) presented with mass effect (2/4), cerebral venous hypertension (1/4), CHF (1/4), and cerebrofacial venous metameric syndrome (1/4). Patients with type II DAVF/DSM (2/6, 33.3%) presented with a thrill behind the ear. Patients with DAVF/DSM were treated endovascularly, five patients were cured, and one with type I DAVF/DSM died. CONCLUSION: Intracranial arteriovenous shunts are rare but potentially life-threatening neurovascular pathologies in infants. Endovascular treatment is challenging but feasible in carefully selected patients.

A Educação Física e seus processos de trabalho nas Residências em Saúde no Estado do Ceará

Essa é uma pesquisa de natureza qualitativa como parte de um estudo de dissertação de mestrado e tem como objetivo enunciar a atuação dos profissionais de educação física nas residências multiprofissionais em saúde no estado do Ceará. Participaram da pesquisa doze profissionais de educação física que concluíram a sua formação na residência no ano de 2019. Os profissionais foram convidados voluntariamente a participar de uma entrevista semiestrutura após a assinatura do Termo de Consentimento Livre e Esclarecido. Convencionou-se após a análise dos dados, a formação de quatro categorias empíricas: intersetorialidade, grupos terapêuticos, atenção básica e saúde mental. Os principais resultados apontam que a residência em saúde oportuniza ao profissional de educação física, vivências na atenção básica e na saúde mental a partir da intersetorialidade, das ferramentas de cuidado, do trabalho colaborativo e dos grupos terapêuticos. Compreende-se, a partir desta pesquisa que a atuação do profissional de educação física nas residências multiprofissionais em saúde no estado do Ceará tem o propósito de fortalecer os caminhos já trilhados, problematizar novas possibilidades de cuidado e de espaços para a categoria na saúde pública.

Maternal high-fat diet alters the neurobehavioral, biochemical and inflammatory parameters of their adult female rat offspring.

BACKGROUND: Lipid metabolism dysregulations have been associated with depressive and anxious behaviors which can affect pregnant and lactating individuals, with indications that such changes extend to the offspring. Therefore, the aim of this study was to evaluate the effect of a maternal high-fat diet on the neurobehavioral, biochemical and inflammatory parameters of their adult female offspring. METHODS: Wistar rats ± 90 days old were mated. The dams were allocated to consume a control (CTL) or high-fat (HFD) diet during pregnancy and lactation. After weaning, the female offspring from the CTL (N = 10) and HFD (N = 10) groups received standard chow. The offspring behavioral tests were started at 120 days old. Then, the somatic measures were evaluated followed by euthanasia, histological and biochemical analyses. RESULTS: The HFD group had less ambulation and longer immobility time in the open field test compared to the CTL. The HFD group had lower HDL (48.4%) and a higher adiposity (71.8%) and LDL (62.2%) than the CTL. The CTL had a higher organic acid concentration in the intestine, mainly acetic and butyric acids, however the HFD had a higher citric and acetic acid concentration in the brain and ischemic lesion in the hippocampus with a higher NF-κB concentration. CONCLUSION: The results demonstrate deleterious effects of a maternal HFD on the neurobehavioral and biochemical parameters of their offspring which may be associated with the role of organic acids and NF-κB in fetal programming.

Serum soluble mediators as prognostic biomarkers for morbidity, disease outcome, and late-relapsing hepatitis in yellow fever patients.

This study described a soluble mediator storm in acute Yellow Fever/YF infection along the kinetics timeline towards convalescent disease. The analyses of the YF Viral RNAnemia, chemokines, cytokines, and growth factors were performed in YF patients at acute/(D1-15) and convalescent/(D16-315) phases. Patients with acute YF infection displayed a trimodal viremia profile spreading along D3, D6, and D8-14. A massive storm of mediators was observed in acute YF. Higher levels of mediators were observed in YF with higher morbidity scores, patients under intensive care, and those progressing to death than in YF patients who progress to late-relapsing hepatitis/L-Hep. A unimodal peak of biomarkers around D4-6 with a progressive decrease towards D181-315 was observed in non-L-Hep patients, while a bimodal pattern with a second peak around D61-90 was associated with L-Hep. This study provided a comprehensive landscape of evidence that distinct immune responses drive pathogenesis, disease progression, and L-Hep in YF patients.

Characterization and Investigation of Risk Factors for Late-Relapsing Hepatitis After Yellow Fever.

BACKGROUND: Late-relapsing hepatitis after yellow fever (LHep-YF) during the convalescent phase of the disease has been described during recent yellow fever (YF) outbreaks in Brazil. LHep-YF is marked by a rebound in liver enzymes and nonspecific clinical manifestations around 46-60 days after YF symptom onset. METHODS: Here we have characterized the clinical course and risk factors for LHep-YF using data from a representative cohort of patients who survived YF in Brazil, 2017-2018. A total of 221 YF-positive patients were discharged from the infectious disease reference hospital in Minas Gerais and were followed up at 30, 45, and 60 days post-symptom onset. RESULTS: From 46 to 60 days post-symptom onset, 16% of YF patients (n = 36/221) exhibited a rebound of aminotransferases (aspartate aminotransferase or alanine aminotransferase >500 IU/L), alkaline phosphatase, and total bilirubin levels. Other etiologies of liver inflammation such as infectious hepatitis, autoimmune hepatitis, and metabolic liver disease were ruled out. Jaundice, fatigue, headache, and low platelet levels were associated with LHep-YF. Demographic factors, clinical manifestations, laboratory tests, ultrasound findings, and viral load during the acute phase of YF were not associated with the occurrence of LHep-YF. CONCLUSIONS: These findings provide new data on the clinical course of Late-relapsing hepatitis during the convalescent phase of YF and highlight the need for extended patient follow-up after acute YF.

Safety Evaluation of a Novel Potentially Probiotic Limosilactobacillus fermentum in Rats.

Limosilactobacillus (L) fermentum (strains 139, 263, 296) is a novel probiotic mixture isolated from fruit processing by-products. The use of this formulation has been associated with improvements in cardiometabolic, inflammatory, and oxidative stress parameters. The present study evaluated the safety of a potential multi-strain probiotic by genotoxicity (micronucleus assay) and subchronic toxicity study (13-week repeated dose). In the genotoxicity evaluation, L. fermentum 139, 263, 296 did not increase the frequency of micronuclei in erythrocytes of rats of both sexes at doses up to 1010 CFU/mL. In the subchronic toxicity study, the administration of L. fermentum did not promote adverse health effects, such as behavioral changes, appearance of tumors, changes in hematological and biochemical parameters. In addition, higher doses of L. fermentum 139, 263, 296 have been shown to reduce the levels of pro-inflammatory cytokines. Administration of potentially probiotic L. fermentum did not promote adverse health effects in rats and could be evaluated as a potential probiotic for humans.

Retinal Ischemia Following Focal Cerebral Arteriopathy in a Young Girl.

PURPOSE: We present a case of an ischemic retinopathy with severe vision loss secondary to a childhood stroke. METHODS: Case report. RESULTS: An otherwise healthy 9-year-old girl presented with a 1-day history of impaired gait and speech. After performing Computed Tomography and Magnetic Resonance Imaging, thrombosis of the left Internal Carotid Artery was observed and a diagnosis of ischemic stroke was established. Serological autoimmune, coagulation, and viral panels were unrewarding. Cardiac, inflammatory and coagulation disorders were ruled out. The cause was attributed to a Focal Cerebral Arteriopathy, a common cause of childhood stroke. The patient was treated with mechanical thrombectomy followed by anticoagulation. The day after, the patient referred vision loss of 20/100 in the left eye. Fundus evaluation of the left eye depicted diffuse intraretinal hemorrhages as well as cotton-wool spots and there was retinal whitening at the posterior pole. Six weeks after, visual acuity dropped to counting fingers. CONCLUSIONS: A macular optical coherence tomography revealed diffuse atrophic changes in the inner retinal layers at the macula, and the Angio-OCT showed an enlarged Foveal Avascular Zone. We propose ischemia-reperfusion as the primary explanation of this unusual event.

Effect of commercial yeasts (Saccharomyces cerevisiae) on fermentation metabolites, phenolic compounds, and bioaccessibility of Brazilian fermented oranges.

Brazil is the largest producer of oranges worldwide, as well as one of the largest producers of orange juice. Alcoholic fermented beverages have been considered a marketable alternative for oranges. In this study, four S. cerevisiae commercial yeasts were evaluated for metabolites generated during orange juice (cv. 'Pêra D9') fermentation. Alcohols, sugars, and organic acids were evaluated by HPLC-DAD-RID during fermentation, and phenolic compounds were analyzed in fermented orange. Orange juice and fermented oranges were also subjected to digestion simulations. The yeasts presented an adequate fermentation activity, based on sugar consumption, and high ethanol (>10.5%) and glycerol (4.8-5.5 g/L) contents. The yeast strains T-58 and US-05 produced high levels of lactic acid. Phenolic compounds and antioxidant activity did not differ amongst yeasts, presenting hesperidin levels between 115 and 127 mg/L, respectively. The fermented orange showed a >70% bioaccessibility, compared to juice, especially for catechin, epigallocatechin-gallate, procyanidin-B2, rutin, and procyanidin-B1.

Desafios na tessitura da Rede Socioinstitucional de acolhimento e cuidado às mulheres vítimas de violência / Challenges in the weave of the Socio-institutional Network for Welcoming and Caring for Women Victims of Violence

Resumo Este artigo analisa como a rede socioinstitucional para atendimento às mulheres vítimas de violência, prevista nos planos dos três níveis de governo, materializa-se em um município do estado de Mato Grosso do Sul. Trata-se de uma pesquisa qualitativa realizada junto aos serviços, atores e atrizes dessa rede utilizando-se do método etnográfico. Para a análise, foi aplicado o referencial teórico de redes sociais. A partir da identificação dos fluxos, das trocas e dos valores que circulam nessa rede, foi possível compreender como esses aspectos impactam a qualidade e o modo como a assistência é prestada às mulheres. Foram identificadas ausências e desarticulações entre os serviços, bem como necessidade de implementação de uma gestão participativa nos vários níveis de cuidado, visando atender as reais expectativas das mulheres. Conclui-se que o referencial de Redes Sociais contribui para estruturação, planejamento e avaliação das Políticas Públicas pela equidade de gênero.

Abstract This article analyzes how the socio-institutional network for assisting women victims of violence, provided for in the plans of the three levels of government, materializes in a municipality in the state of Mato Grosso do Sul. This is qualitative research carried out along with services, actors, and actresses of this network using the ethnographic method. For the analysis, the theoretical framework of social networks was applied. From the identification of flows, exchanges, and values that circulate in this network, understanding how these aspects impact the quality and the way support assistance is provided to women was possible. Absences and disarticulations between services were identified, as well as the need to implement participatory management at various levels to meet the real expectations of women. In conclusion, the Social Networks framework contributes to the structuring, planning, and evaluation of Public Policies for gender equity.

Low back pain estimates in professional soccer: a systematic review and meta-analysis / Estimativas da dor lombar no futebol profissional: revisão sistemática e metanálise

ABSTRACT Objective: To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players. Methods: Systematic review and meta-analysis. Results: The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days). Conclusion: Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.

RESUMO Objetivo: Investigar as características epidemiológicas e clínicas da lombalgia em jogadores profissionais de futebol. Métodos: Revisão sistemática e metanálise. Resultados: A revisão incluiu 44 estudos. A prevalência combinada de lombalgia em até uma temporada foi de 1% (IC95% = 0-4%) em homens. A prevalência pontual combinada de lombalgia foi de 25% (IC95% = 16-36%) em homens e 28% (IC95% = 20-37%) em mulheres. A prevalência combinada de lombalgia no último ano foi de 34% (IC95% = 24-44%) em homens. A prevalência combinada de lombalgia ao longo da vida foi de 32%(IC95% = 25-39%) em homens e 50% (IC95% = 32-69%) em mulheres. A frequência combinada de lombalgia/número total de lesões foi de 2% (IC95% = 1-3%) em homens e 4% (IC95% = 2-5%) em mulheres. A taxa de incidência combinada de lombalgia/1.000 jogador-horas de exposição foi de 0,30 (IC95% = 0,17-0,53) em homens e 0,32 (IC95% = 0,06-1,87) em mulheres. A recorrência de lombalgia variou entre 3-63% em homens. A intensidade da lombalgia variou entre 1,68 (2,39)-4,87 (2,14) pontos em uma escala de 0-10 (mínimo = 0; máximo = 8 pontos). A gravidade da lombalgia (ausência das atividades profissionais devido à dor) variou entre 2 (0)-10 (19) dias (mínimo = 1; máximo = 28 dias). Conclusão: Jogadores de futebol profissional apresentam alta prevalência de lombalgia substancial. A frequência e a incidência da lombalgia parecem ser baixas comparadas a outros esportes e condições. As estimativas de recorrência, intensidade e gravidade da lombalgia são incertas. Nível de Evidência II, Revisão Sistemática de Estudos de Nível II.

Randomized, phase 1/2, double-blind pioglitazone repositioning trial combined with antifungals for the treatment of cryptococcal meningitis - PIO study.

BACKGROUND: Cryptococcosis affects more than 220,000 patients/year, with high mortality even when the standard treatment [amphotericin B (AMB), 5-flucytosin (5-FC) and fluconazole] is used. AMB presents high toxicity and 5-FC is not currently available in Brazil. In a pre-clinical study, pioglitazone (PIO - an antidiabetic drug) decreased AMB toxicity and lead to an increased mice survival, reduced morbidity and fungal burden in brain and lungs. The aim of this trial is to evaluate the efficacy and safety of PIO combined with standard antifungal treatment for human cryptococcosis. METHODS: A phase 1/2, randomized, double blind, placebo-controlled trial will be performed with patients from Belo Horizonte, Brazil. They will be divided into three groups (placebo, PIO 15 mg/day or PIO 45 mg/day) and will receive an additional pill during the induction phase of cryptococcosis' treatment. Our hypothesis is that treated patients will have increased survival, so the primary outcome will be the mortality rate. Patients will be monitored for survival, side effects, fungal burden and inflammatory mediators in blood and cerebrospinal fluid. The follow up will occur for up 60 days. CONCLUSIONS: We expect that PIO will be an adequate adjuvant to the standard cryptococcosis' treatment. TRIAL REGISTRATION: ICTRP/WHO (and International Clinical Trial Registry Plataform (ICTRP/WHO) (http://apps.who.int/trialsearch/Trial2.aspx?TrialID=RBR-9fv3f4), RBR-9fv3f4 (http://www.ensaiosclinicos.gov.br/rg/RBR-9fv3f4). UTN Number: U1111-1226-1535. Ethical approvement number: CAAE 17377019.0.0000.5149.

High levels of anti-Leishmania IgG3 and low CD4+ T cells count were associated with relapses in visceral leishmaniasis.

BACKGROUND: Visceral leishmaniasis (VL) is severe and potentially fatal. Brazil is one of the countries with the greatest endemicity for the disease in the world. The reduction of CD4+ T lymphocytes, B cells activation and high levels of inflammatory cytokines (IL-6/IL-8/TNF/IL-1ß), plasma LPS, soluble CD14, anti-Leishmania IgG3 and low leptin levels are involved in the immunopathogenesis of VL, most associated with severe VL. Despite relapses occurring in about 4-5% of patients with VL not associated with HIV infection, the factors underlying relapses are little known. Our aim was to identify clinical, laboratory and immunological parameters that may be associated with recurrences in VL. METHODS: Fifteen VL patients recruited from Hospital Eduardo de Menezes (BH-MG) were grouped into relapsing (R-VL, n = 5) and non-relapsing (NR-VL, n = 10) and evaluated during active disease, immediately after treatment (post-treatment) and 6 months post-treatment (6mpt). Clinical and laboratory data obtained from medical records were correlated with CD4+ and CD8+ T cell counts and anti-Leishmania Igs and IL-6 plasma levels and compared to those parameters of ten healthy controls. RESULTS: During the active phase of VL, despite similarity in the clinical symptoms, the rates of thrombocytopenia, elevated transaminases (AST and ALT) and hyperbilirubinemia were higher in the NR-VL group compared to R-VL (p < 0.05), a profile reversed during the post-treatment phase. All patients had low CD4+ T counts in active phase, however, NR-VL patients had a higher gain of this cell type than R-VL in the post-treatment (p < 0.05). There was a significant reduction in IgG3 levels during the follow-up in the NR-VL group compared to the R-VL, especially at 6mpt (p < 0.05). In addition, IgG3 levels were negatively correlated with CD4+ T counts in the R-VL group (r = - 0.52). Elevated levels of IL-6 were observed in active VL and correlated with clinical markers of severity. CONCLUSIONS: During active phase of VL, the NR-VL patients presented more severe laboratorial abnormalities compared to R-VL, probably because the latter had already received previous treatment. On the other hand, R-VL exhibited greater impairment of immune reconstitution and a high degree of B lymphocyte activation, which must be a factor that favored relapses.

Whole, concentrated and reconstituted grape juice: Impact of processes on phenolic composition, "foxy" aromas, organic acids, sugars and antioxidant capacity.

The concentration and reconstitution processes of grape juices can result in losing compounds associated with beverage quality. In this context, three tanks containing 50,000 L of grape juice were individually concentrated up to 68 °Brix using a triple vacuum concentrator. The concentrated juice was reconstituted up to the original °Brix of the whole juice (18.4). Phenolic compounds, sugars and organic acids were quantified by high-performance-liquid-chromatography. "Foxy" aromatic compounds were also quantified by gas-chromatography/mass-spectrometry. The concentration and reconstitution process resulted in significant losses (Tukey test, p < 0.01) of trans-caftaric acid, decreasing from 397.08 to 159.14 mg/L, chlorogenic-acid from 34.97 to 8.44 mg/L, aromatic furaneol compound from 9.06 to 1.93 mg/L, as well as total losses for gallic-acid, caffeic-acid, p-coumaric-acid, syringic-acid, hesperidin, pelargonidin-3-glucoside and epicatechin compounds. The concentration and reconstitution of grape juice preserved the antioxidant capacity and most of the quantified compounds, with the reconstituted juice having good nutritional quality.

Análise dos Projetos Pedagógicos de Cursos de Graduação em Educação Física na Ótica da Formação para o Campo da Saúde Coletiva / Analyze from Projects Pedagogical of Courses in Graduation in Physical Education at Optics the Formation for the Field of Collective Health

A saúde coletiva é um dos campos de intervenção do profissional de Educação Física que vem se expandindo ao longo dos anos. Apesar disso, surgem preocupações quanto à formação inicial e as demandas exigidas no cenário de atuação. Com isso, o objetivo desta pesquisa foi analisar os projetos pedagógicos de cursos de graduação em Educação Física da Região Metropolitana do Cariri e as perspectivas de formação em saúde coletiva. Trata-se de uma pesquisa qualitativa do tipo documental, através de investigação e análise de projetos pedagógicos curriculares. A análise dos dados foi realizada a partir da técnica de análise de conteúdo e construção de categorias empíricas. Os resultados encontrados indicam que os currículos estudados pouco consideram a formação para a saúde coletiva e quando a consideram, relacionam com o campo escolar. Não existem práticas operativas no cenário pesquisado que favoreçam a aprendizagem e a construção de competências relacionadas à saúde coletiva. Deste modo, sugere-se que os documentos sejam atualizados para atender a demanda de formação para o campo da saúde coletiva de acordo com as Diretrizes Curriculares Nacionais dos Cursos de Graduação da Área da Saúde. Além disso, considera-se que novas investigações possam ser realizadas nas instituições visto que mudanças possam ter ocorrido ainda que não constem nos Projetos Pedagógicos de Curso.