Programa estadual de saúde pública: relato de experiência / State public health program: an experience report

Objetivo: relatar a experiência da implantação e processo de trabalho no programa Força Estadual de Saúde do Maranhão. Método: relato de experiência dos profissionais integrantes da equipe da Força Estadual de Saúde do Maranhão em um dos municípios de menor índice de desenvolvimento humano do estado. Resultados: o programa é formado por equipes de caráter interdisciplinar, pautando o processo de trabalho na assistência à saúde e no apoio institucional à gestão municipal para reverter indicadores de saúde como morbimortalidade infantil e materna, taxas de internação por complicações de doenças crônicas e controle de endemias negligenciadas. O apoio institucional foi fundamentado na metodologia Paideia, método reverso da procura de casos e com implementação da Planificação da Atenção à Saúde. Conclusão: o programa possui papel inovador no fortalecimento da atenção primária em saúde, com modelo de cuidado integral ao indivíduo e promovendo articulação com diversos atores envolvidos na organização e processo de trabalho em saúde.

Objective: to report the experience of the "State of Maranhão Health Force Program", its implementation and work process. Method: it is an experience report of health professionals from the State of Maranhão Health Force allocated in a city with the lowest Human Development Index in the State. Results: the program is forged by teams of interdisciplinary nature, lead by the work process in health care and institutional support to the municipal management to the reversal of health indicators such as infant and maternal morbidity and mortality, hospitalization rates due to complications of chronic disorders and control of endemic neglected diseases. Institutional support was based on the Paideia methodology, the reverse case search method and the implementation of Health Care Planning. Conclusion: the program has an innovative role in the strengthening of primary health care, proposing a model of comprehensive care for the individuals and promoting articulation among several actors involved in the work process and organization.

Syzygium cumini Leaf Extract Reverts Hypertriglyceridemia via Downregulation of the Hepatic XBP-1s/PDI/MTP Axis in Monosodium L-Glutamate-Induced Obese Rats.

Syzygium cumini is used worldwide for the treatment of metabolic syndrome-associated outcomes. Previously, we described the antihypertriglyceridemic effect of the hydroethanolic extract of S. cumini leaf (HESc) in monosodium L-glutamate- (MSG-) induced obese rats. This study sought to investigate the molecular mechanisms underlying the antihypertriglyceridemic effect of HESc in MSG-obese rats. Newborn male Wistar rats were injected subcutaneously with MSG (4.0 g/kg/day, obese group) or saline 1.25% (1.0 mL/kg/day, lean group), from 2nd through 10th postnatal day. At 8 weeks old, obese rats started to be orally treated with HESc (0.5 or 1.0 g/kg/day, n = 7) or saline 0.9% (1 mL/kg/day, n = 7). Lean rats received saline solution (1 mL/kg/day, n = 7). Upon 8-week treatment, animals were euthanized for blood and tissue collection. Another set of adult nonobese Wistar rats was used for the assessment of HESc acute effects on Triton WR1339-induced hypertriglyceridemia. HESc reduced weight gain, as well as adipose tissue fat pads, without altering food intake of obese rats. HESc restored fasting serum glucose, triglycerides, total cholesterol, and free fatty acids, as well as insulin sensitivity, to levels similar to lean rats. Additionally, HESc halved the triglyceride content into very low-density lipoprotein particles, as well as healed liver steatosis, in obese rats. Hepatic protein expression of the endoplasmic reticulum chaperone GRP94 was decreased by HESc, which also downregulated the hepatic triglyceride secretion pathway by reducing the splicing of X-box binding protein 1 (XBP-1s), as well as protein disulfide isomerase (PDI) and microsomal triglyceride transfer protein (MTP) translational levels. This action was further corroborated by the acute inhibitory effect of HESc on triglyceride accumulation on Triton WR1339-treated rats. Our data support the downregulation of the XBP-1s/PDI/MTP axis in the liver of MSG-obese rats as a novel feasible mechanism for the antihypertriglyceridemic effect promoted by the polyphenolic phytocomplex present in S. cumini leaf.

Mechanisms underlying hypertriglyceridemia in rats with monosodium L-glutamate-induced obesity: evidence of XBP-1/PDI/MTP axis activation.

Non-alcoholic fatty liver disease (NAFLD) is intimately associated with insulin resistance and hypertriglyceridemia, whereas many of the mechanisms underlying this association are still poorly understood. In the present study, we investigated the relationship between microsomal triglyceride transfer protein (MTP) and markers of endoplasmic reticulum (ER) stress in the liver of rats subjected to neonatal monosodium L-glutamate (MSG)-induced obesity. At age 120 days old, the MSG-obese animals exhibited hyperglycemia, hypertriglyceridemia, insulin resistance, and liver steatosis, while the control (CTR) group did not. Analysis using fast protein liquid chromatography of the serum lipoproteins revealed that the triacylglycerol content of the very low-density lipoprotein (VLDL) particles was twice as high in the MSG animals compared with the CTR animals. The expression of ER stress markers, GRP76 and GRP94, was increased in the MSG rats, promoting a higher expression of X-box binding protein 1 (XBP-1), protein disulfide isomerase (PDI), and MTP. As the XBP-1/PDI/MTP axis has been suggested to represent a significant lipogenic mechanism in the liver response to ER stress, our data indicate that hypertriglyceridemia and liver steatosis occurring in the MSG rats are associated with increased MTP expression.