Examining the mediating role of muscle quantity in adolescents: associations with adiposity, cardiorespiratory fitness, muscular fitness, and cardiometabolic risk factors.

The aim of this study was to evaluate the mediation role of muscle quantity in the relationship between physical fitness and cardiometabolic risk factors (CMRF) in adolescents. This cross-sectional study conducted with 120 adolescents of both sexes, aged between 10 and 17 years. Body mass, height, fat mass (FM), lean mass, blood pressure, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, cardiorespiratory fitness (CRF) and 1 repetition maximum strength (1-RM) with evaluation of the leg press 45° (RM-leg), bench press (RM-bench) and arm curl (RM-arm). Body mass index z-score, appendicular skeletal muscle mass, appendicular skeletal muscle mass index, lean mass index (LMI), muscle-to-fat ratio (MFR), age at peak height velocity, and CMRF z-score were calculated. The direct relation between FM and CMRF was mediated by the LMI (26%) and inverse relation between CRF and CMRF was mediated by the LMI (26%). For girls, the direct relation between FM and CMRF was mediated by the LMI (32%); the inverse relation between CRF, RM-leg, RM-arm and CMRF was mediated by the LMI (32%, 33%, and 32%, respective). For boys, the indirect effect was not significant, indicating that LMI is not a mediator in the relation between FM, CRF, 1-RM with CMRF. The direct relation between RM-leg and CMRF was mediated by the MRF (16%). This finding evidenced the importance of promoting a healthy lifestyle to improve physical fitness levels and the quantity of muscle mass in adolescents.

Moderating role of 1-minute abdominal test in the relationship between cardiometabolic risk factors and adiponectin concentration in adolescents.

BACKGROUND: Adiponectin is an anti-inflammatory cytokine secreted by adipose tissue, has been associated with adiposity and cardiometabolic risk, and has controversial results with muscular fitness. The aim of this study was to analyze the interaction of 1-minute abdominal test in the relationship between adiposity, body composition, cardiometabolic risk and adiponectin concentration in adolescents. METHODS: This is a cross-sectional study conducted with 62 adolescents of both sexes, aged 11 to 16 years, approved by the Ethics Committee of Research in Humans (CAEE: 62963916.0.0000.5223). Body mass, height, abdominal circumference (AC), waist circumference (WC), fat mass (FM), fat-free mass (FFM), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c), triglycerides (TG), adiponectin, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), 1-minute abdominal test (ABD) were measured. Body mass index (BMI), z-score BMI (BMI-z), triponderal mass index (TMI), and waist-to-height ratio (WHtR) were calculated. The macro PROCESS for SPSS v.24.0 was used for moderation analyses, with linear regression models. RESULTS: Inverse interactions were found for adiposity (BMI, BMI-z, TMI, AC, WC, WHtR), body composition (FM, FFM) and CMRF (SBP, DBP, MBP, TG) versus 1-minute abdominal test with adiponectin concentration, demonstrating that abdominal test is a moderator in these relationships. CONCLUSION: We conclude that 1-minute abdominal test may play an important role in the relationship between obesity and cardiometabolic risk. We found that muscular fitness can confer a protective effect on adolescents with high levels of abdominal test.

Moderation of Physical Activity between Cardiometabolic Risk and Adiponectin in Adolescents.

The aims of the study were to examine the moderating role of physical activity in the relationship between cardiometabolic risk factors and adiponectin concentration in adolescents. This is a cross-sectional study conducted with 96 adolescents of both sexes, between 11 and 17 years old. Body mass, height, fat mass (FM), fat-free mass, systolic blood pressure, diastolic blood pressure, high density lipoprotein, low density lipoprotein (LDL-c), triglycerides, insulin, adiponectin, C-reactive protein, and level of physical activity (energy expenditure questionnaire) were measured. Body mass index (BMI), triponderal mass index (TMI), homeostasis model to assessment insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) were calculated. Macro-PROCESS for SPSS was used for moderation analyses. Direct interactions were found for BMI, TMI, FM, insulin, and HOMA-IR and inverse for LDL-c, and QUICKI. Protection against cardiometabolic risk was found when the PA-coeff was completed above 1.57 coeff (BMI), 1.62 coeff (TMI), 1.55 coeff (FM), 1.41 coeff (LDL-c)1.60 coeff (insulin), 1.59 coeff (HOMA-IR) and 1.35 coeff (QUICKI). We conclude that physical activity was a moderator in the relationship with adiposity, insulin resistance and sensitivity, LDL-c, and adiponectin. In this context, we evidenced a relevant clinical impact on the health of adolescents, demonstrating the interaction between anthropometrics variables and physical activity.

Effects and individual response of continuous and interval training on adiponectin concentration, cardiometabolic risk factors, and physical fitness in overweight adolescents.

This study aimed to evaluate the effect and individual responsiveness after 12 weeks of high-intensity interval training (HIIT) and moderate-intensity of continuous training (MICT) on adiponectin, cardiometabolic risk factors and physical fitness in overweight adolescents. This study was participated by 52 adolescents, both sexes, 11 and 16 years old, separated into HIIT (n = 13), MICT (n = 15), and control group (CG, n = 24). Body mass, height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), blood pressure, high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglycerides, glucose, insulin, adiponectin, and C-reactive protein (CRP) were evaluated. Body mass index z-score (BMI-z), waist-to-height ratio (WHtR), insulin resistance, and insulin sensitivity were calculated. Resting heart rate (HRrest), peak oxygen consumption (VO2peak), right handgrip strength (HGS-right), left handgrip strength (HGS-left), and abdominal resistance (ABD) was evaluated. HIIT session lasted around 35 min and MICT of 60 min of exercises on stationary bicycle, three times a weekday for 12 weeks. ANOVA, effect size, and prevalence of responders were used for statistical analysis. HIIT reduced BMI-z, WHtR, LDL-c, and CRP, while increased of physical fitness. MICT reduced HDL-c, while increased of physical fitness. CG reduced FM, HDL-c, and CRP, while increased FFM and HRrest. Frequencies of respondents in HIIT were observed for CRP, VO2peak, HGS-right, and HGS-left. Frequencies of respondents in MICT were observed for CRP and HGS-right. Frequencies of no-respondents in CG were observed for WC, WHtR, CRP, HRrest, and ABD.  Conclusion: Interventions with exercises were effective to adiposity, metabolic health, and physical fitness improvements. Individual responses were observed in inflammatory process and physical fitness, important changes in overweight adolescent's therapy.  Trial registration number and date of registration: This study was registered with the Brazilian Registry of Clinical Trials (REBEC), the number RBR-6343y7, date of registration May 3, 2017. What is Known: • Effect of regular physical exercise positively affects overweight, comorbidities, and metabolic diseases, recommended mainly for children and adolescents. What is New: • Due to the great inter-individual variability, the same stimulus can provide different responses; adolescents who benefit from the stimulus are considered responsive. • Intervention of HIIT and MICT did not alter the concentrations of adiponectin; however, the adolescents presented responsiveness to the inflammatory process and physical fitness.

Prediction equations for maximal heart rate in obese and nonobese children and adolescents: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to analyze which equation best estimates maximal heart rate (HRmax) for the pediatric population according to body mass. DATA SOURCE: We performed a meta-analysis (PROSPERO No. CRD42020190196) of cross-sectional studies that aimed to validate or develop HRmax equations and that had children and adolescents as samples. The search was conducted in Scopus, Science Direct, Web of Science, PubMed, and Biblioteca Virtual em Saúde with the descriptors "prediction or equation," "maximal heart rate," "maximum heart rate," "determination of heart rate," children, and adolescent. The TRIPOD Statement tool was used to assess the methodological quality and the relevant data were extracted for analysis. The meta-analysis was conducted in the Comprehensive Meta-Analysis, adopting p<0.05 and a 95% confidence interval (CI). DATA SYNTHESIS: In total, 11 studies were selected, of which 3 developed predictive equations, 10 performed external validity of the preexisting models, and 1 incremented values related to equations already developed. The results of the methodological quality analysis showed a moderate rating in most studies. The 164 + (0.270 × HRres) - (0.155 × body mass) + (1.1 × METs) + (0.258 × body fat percent) (r=0.500, 95%CI 0.426-0.567, p<0.001) and 166.7+ (0.46 × HRres) + (1.16 × maturation) (r=0.540, 95%CI 0.313-0.708, p<0.001) equations presented stronger correlations with measured HRmax in nonobese adolescents. The predictive model developed by 208 - (0.7 × age) showed a greater accuracy among the possible models for analysis (SDM=-0.183, 95%CI -0.787 to -0.422, p=0.554). No specific predictive equation was found for obese adolescents. CONCLUSIONS: Future research should explore new possibilities for developing predictive equations for this population as a tool to control exercise intensity in the therapeutic management of childhood and adolescent obesity.

Symptomatic uterine leiomyomatosis with intracaval and intracardiac invasion: Video case report.

Background: Fibroid is the most prevalent benign tumor of the female genital tract. Intravenous and intracardiac leiomyomatosis (IVL and ICLM, respectively) are rare complications that present with symptoms of pulmonary thromboembolism and heart failure and whose etiology, despite controversial, is a direct vascular invasion by a primary uterine leiomyoma. Case presentation: We present the case of a 31-year-old female patient with a previous history of pelvic pain and dysmenorrhea, whose ultrasound showed an enlarged and heterogeneous uterus. Complete hysterectomy was performed, and the anatomopathological examination showed leiomyomas without evidence of malignancy. One month later, the patient manifested dyspnea and chest pain. A neoplastic thrombus was identified, extending from the inferior vena cava to the right atrium, for which we proceeded with cavo-atrial thrombectomy under Normothermic Cardiopulmonary Bypass (CPB) with Warm Blood Cardioplegia (WBC). A metastatic lung injury of non-malignant histology was also detected. Discussion: Uterine leiomyoma is a very common benign tumor of the female genital tract. IVL with ICLM are rare and difficult-to-treat complications, whose etiology is a direct vascular invasion by a primary uterine leiomyoma, although it is still controversial. The incidence of ICLM is 10 to 30% of IVL cases. The main symptoms of ICLM are dyspnea, syncope, edema of the lower extremities and palpitations. Treatment is based on complete surgical removal of the tumor thrombus. Studies demonstrated that the one-stage procedure is safer from the patient's perspective and that CPB with WBC reduced intraoperative blood loss and total operative time, ensuring a less traumatic postoperative. Conclusions: Most patients with uterine leiomyoma are asymptomatic and acute complications are rare. In ICLM clinical manifestations are related to heart failure and flow obstruction. Because of the severity of the condition and the curative potential of treatment, surgery is morbid but highly recommended. The use of CPB with WBC improved the postoperative period and increased the patient's quality of life.

Prediction equations for maximal heart rate in obese and nonobese children and adolescents: a systematic review and meta-analysis / Equações preditivas da frequência cardíaca máxima em crianças e adolescentes obesos e não obesos: uma revisão sistemática e metanálise

Abstract Objective: The aim of this study was to analyze which equation best estimates maximal heart rate (HRmax) for the pediatric population according to body mass. Data source: We performed a meta-analysis (PROSPERO No. CRD42020190196) of cross-sectional studies that aimed to validate or develop HRmax equations and that had children and adolescents as samples. The search was conducted in Scopus, Science Direct, Web of Science, PubMed, and Biblioteca Virtual em Saúde with the descriptors "prediction or equation," "maximal heart rate," "maximum heart rate," "determination of heart rate," children, and adolescent. The TRIPOD Statement tool was used to assess the methodological quality and the relevant data were extracted for analysis. The meta-analysis was conducted in the Comprehensive Meta-Analysis, adopting p<0.05 and a 95% confidence interval (CI). Data synthesis: In total, 11 studies were selected, of which 3 developed predictive equations, 10 performed external validity of the preexisting models, and 1 incremented values related to equations already developed. The results of the methodological quality analysis showed a moderate rating in most studies. The 164 + (0.270 × HRres) - (0.155 × body mass) + (1.1 × METs) + (0.258 × body fat percent) (r=0.500, 95%CI 0.426-0.567, p<0.001) and 166.7+ (0.46 × HRres) + (1.16 × maturation) (r=0.540, 95%CI 0.313-0.708, p<0.001) equations presented stronger correlations with measured HRmax in nonobese adolescents. The predictive model developed by 208 - (0.7 × age) showed a greater accuracy among the possible models for analysis (SDM=-0.183, 95%CI -0.787 to -0.422, p=0.554). No specific predictive equation was found for obese adolescents. Conclusions: Future research should explore new possibilities for developing predictive equations for this population as a tool to control exercise intensity in the therapeutic management of childhood and adolescent obesity.

Resumo Objetivo: Analisar qual equação melhor estima a frequência cardíaca máxima (FCmáx) na população pediátrica conforme a massa corporal. Fontes de dados: Foi realizada uma metanálise (PROSPERO no CRD42020190196) de estudos transversais que visavam validar ou desenvolver equações da FCmáx para crianças e adolescentes. As bases de dados foram Scopus, Science Direct, Web of Science, PubMed e Biblioteca Virtual em Saúde. Utilizaram-se os descritores "prediction or equation", "maximal heart rate", "maximum heart rate", "determination of heart rate", "children" e "adolescents". A ferramenta TRIPOD Statement foi utilizada para avaliar a qualidade metodológica e os dados relevantes foram extraídos para análise. A metanálise foi conduzida no Comprehensive Meta-Analysis, adotando-se valor de p<0,05 e intervalo de confiança de 95%. Síntese dos dados: Foram selecionados 11 estudos, dos quais três desenvolveram equações preditivas, dez realizaram a validade externa de modelos preexistentes e um a incrementação de valores relacionados com equações já desenvolvidas. Em sua maioria, os estudos foram classificados com qualidade moderada. As equações 164 + (0.270 × FCrep) - (0.155 × massa corporal) + (1.1 × METs) + (0.258 × percentual de gordura) (2017) (r=0,500; p<0,001) e 166.7+ (0.46 × FCrep + (1.16 × maturação) (r=0,540; p<0,001) apresentaram correlações mais fortes com a FCmáx medida em adolescentes não obesos. O modelo de 208 - (0.7 × idade) mostrou a maior precisão entre os modelos possíveis para análise (SDM=-0,183; p=0,554). Não foi encontrada nenhuma equação preditiva específica para adolescentes obesos. Conclusões: Pesquisas futuras devem explorar novas possibilidades de desenvolvimento de equações preditivas para essa população, uma vez que elas são uma ferramenta para controlar a intensidade do exercício na gestão terapêutica da obesidade infantil e do adolescente.

Excess adiposity and low physical fitness hamper Supine-to-Stand test performance among sedentary adolescents

Abstract Objective: The aim of this study was to analyze the relationship between body adiposity and physical fitness with performance in the Supine-to-Stand test (STS-test) in sedentary adolescents. Methods: Sixty-two adolescents, of both sexes, between 10 and 16 years old, participated in the study. Body mass (BM), height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), right and left handgrip strength (HGS-right, HGS-left), abdominal resistance (ABDO), flexibility (FLEX), and cardiorespiratory fitness (VO2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), tri-ponderal mass index (TMI) and waist-to-height ratio (WHtR) were calculated. The STS-test was applied to evaluate the STS-MC by the movement patterns in the execution of the test. The STS-time in seconds (s) was categorized into terciles: fast (FG < 2.0 s), intermediate (IG = 2.0-2.6 s) and slow (SG > 2.6 s). One-way ANOVA, Chi-square, Spearman's correlation coefficient as well as non-parametric tests were used, with significance p 0.05. Results: The SG presented higher BMI, BMI-z, TMI, WHtR, FM, %FM, as well as lower averages for %FFM, HGS-right, HGS-left, FLEX, ABDO, VO2peak, VO2peak relative to BM (VO2peakBM) in relation to GF. The BMI, BMI-z, TMI, WC, WHtR and FM showed moderate and direct correlations with STS-time and inverse with STS-MC (p < 0.01). HGS-right, HGS-left, ABDO, and VO2peakBM showed moderate and an inverse correlation with STS-time (p < 0.05). The VO2peakBM was moderate and with direct correlations to STS-MC (p < 0.01). Conclusion: It is concluded that excess fat and low physical fitness hamper STS-test performance. Therefore, the STS-test can be used for screening students to assess MC.

Excess adiposity and low physical fitness hamper Supine-to-Stand test performance among sedentary adolescents.

OBJECTIVE: The aim of this study was to analyze the relationship between body adiposity and physical fitness with performance in the Supine-to-Stand test (STS-test) in sedentary adolescents. METHODS: Sixty-two adolescents, of both sexes, between 10 and 16 years old, participated in the study. Body mass (BM), height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), right and left handgrip strength (HGS-right, HGS-left), abdominal resistance (ABDO), flexibility (FLEX), and cardiorespiratory fitness (VO2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), tri-ponderal mass index (TMI) and waist-to-height ratio (WHtR) were calculated. The STS-test was applied to evaluate the STS-MC by the movement patterns in the execution of the test. The STS-time in seconds (s) was categorized into terciles: fast (FG < 2.0 s), intermediate (IG = 2.0-2.6 s) and slow (SG > 2.6 s). One-way ANOVA, Chi-square, Spearman's correlation coefficient as well as non-parametric tests were used, with significance p ≤ 0.05. RESULTS: The SG presented higher BMI, BMI-z, TMI, WHtR, FM, %FM, as well as lower averages for %FFM, HGS-right, HGS-left, FLEX, ABDO, VO2peak, VO2peak relative to BM (VO2peakBM) in relation to GF. The BMI, BMI-z, TMI, WC, WHtR and FM showed moderate and direct correlations with STS-time and inverse with STS-MC (p < 0.01). HGS-right, HGS-left, ABDO, and VO2peakBM showed moderate and an inverse correlation with STS-time (p < 0.05). The VO2peakBM was moderate and with direct correlations to STS-MC (p < 0.01). CONCLUSION: It is concluded that excess fat and low physical fitness hamper STS-test performance. Therefore, the STS-test can be used for screening students to assess MC.

Posição prona em pacientes em ventilação espontânea com insuficiência respiratória por COVID-19: relato de caso / Prone position in patients in spontaneous ventilation with respiratory failure by COVID-19: case report

A Posição Prona (PP) geralmente é utilizada em casos de Insuficiência Respiratória Aguda (IRpA) grave, em pacientes com Síndrome da Angústia Respiratória Aguda (SARA) e em ventilação mecânica invasiva, com o objetivo de melhorar a oxigenação. Entretanto, pode ser útil em casos de IRpA leve secundária ao COVID -19 reduzindo a necessidade de ventilação mecânica invasiva e as complicações associadas ao ventilador. OBJETIVO: Descrever o relato de caso do uso da posição prona (PP) em pacientes em ventilação espontânea com Insuficiência Respiratória Leve secundária ao COVID-19. MÉTODO: Trata-se de um relato de caso de um paciente com diagnóstico de COVID-19, com IRpA leve, com dispneia, tosse, hipoxemia e dessaturação, que dentre as técnicas de tratamento utilizou um protocolo de posição prona por períodos de duas horas, duas vezes ao dia, durante todo o período de internação. RESULTADOS: O paciente apresentou hipoxemia (SPO2 -94% e PO2- 62,9), associada a dispneia (Borg 6) na admissão, tendo apresentado melhora na dispneia (Borg 4) e saturação na oximetria de pulso de 96% após 24 horas de início do protocolo. Após 48 horas apresentou melhora gasométrica com valores e SPO2 e PO2 de 96,5% e 80,6 mmHg respectivamente. CONCLUSÃO: A posição prona em pacientes em ventilação espontânea, com insuficiência respiratória leve secundária ao COVID-19 é segura e pode ser utilizada como terapia adjuvante ao tratamento desse perfil de pacientes.

The Prone Position (PP) is generally used in cases of Acute Respiratory Insufficiency (IRPA), in patients with Acute Respiratory Distress Syndrome (ARDS) and in invasive mechanical ventilation, in order to improve oxygenation, but it can be used useful in cases of mild IRPA, using the need for invasive mechanical ventilation and complications associated with the ventilator. OBJECTIVES: To describe or report the case of using the prone position (PP) in patients with spontaneous ventilation with mild respiratory failure secondary to COVID-19. METHODS: this is a case of a patient diagnosed with COVID-19, with an IRPA level, with dyspnea, cough, hypoxemia and desaturation, which includes treatment techniques that use a prone position protocol for two hours, twice a day for the entire hospital stay. RESULTS: The patient presented hypoxemia (SpO2 -94% and PO2- 62.9), associated with a food (Borg 6) on admission, having received improvements in food (Borg 4) and 96% saturation in pulse oximetry after 24 hours from the beginning of the protocol and after 48 hours it improves the gasometric and SpO2 and PaO2 values of 96.5% and 80.6 mmHg, respectively. CONCLUSION: The prone position in patients on spontaneous ventilation, with respiratory failure secondary to COVID-19 is safe and can be used as adjunctive therapy to treatment in this patient profile.

Algumas pistas sobre o marketing ambiental pelo olhar da psicossociologia / Some clues about environmental marketing through the view of psychsociology

Este ensaio teórico busca uma reflexão crítica sobre o marketing ambiental, pelo olhar da psicossociologia, para discutir sobre o conceito de ecosofia, enfocando como ocorrem os processos de agenciamento de enunciação de um "rizoma verde" na captura de modos de ser "ecológico" ou "ecopsicossocial". Desta forma, o presente trabalho visa trazer uma proposta contra-hegemônica, consubstanciada pelo olhar da esquizoanálise, de modo a romper antigas formas de pensar e produzir conhecimento na pesquisa em ciências humanas e sociais. O objetivo central é pensar sob a égide do conceito das três ecologias - conforme postulado por Félix Guattari - por meio dos paradigmas da sociedade de controle e do Capitalismo Mundial Integrado (CMI) como são produzidas as "subjetividades verdes" que exploram recursos naturais e produtilizam a natureza. A pesquisa é bibliográfica, fundamentada nas pistas teóricas trilhadas por Félix Guattari, Gilles Deleuze e por outros autores que dialogam com seus pensamentos. As pistas sugerem uma discussão psicossocial que desvela novos rumos para a ressignificação do marketing ambiental, apontando para a necessidade de se pensar um novo "marketing ecosófico" baseado nas três ecologias, bem como pensado sob um novo paradigma ético-político e estético, no qual as relações socioambientais sejam priorizadas.(AU)

This theoretical essay seeks a critical reflection on environmental marketing, through the view of psychosociology, to discuss under the concept of ecosophy as occur the processes of agency of enunciation of a "green rhizome" in the capture of modes of being "ecological" or "ecopsicossocial". Thus, the study aims to bring a counter-hegemonic proposal, consubstantiated by the schizoanalytic view, in order to break with old ways of thinking and produce knowledge in research in human and social sciences. The central objective is to think under the aegis of the concept of the three ecologies - as postulated by Félix Guattari- through the paradigms of the control society and Integrated World Capitalism (IWC) howare produced the "green subjectivities" thatexploit natural resources and produce nature. The research is bibliographical, based on the theoretical tracks traced by Félix Guattari, Gilles Deleuze and other authors who dialogue with their thoughts. The clues suggest a psychosocial discussion that reveals new directions for the re-signification of environmental marketing, pointing to the need to think about a new "ecosophy-marketing" based on the three ecologies, as well as thinking under a new ethical paradigm - political and aesthetic, in which socio-environmental relations are prioritized.(AU)

Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study.

OBJECTIVE: Colorectal cancer is one of the most frequent types of malignant neoplasms. Age is a risk factor for this disease, with 75% of cases diagnosed in patients older than 65 years. Complications such as obstruction, hemorrhage, and perforation are present in more than one-third of cases and require emergency treatment. We aim to analyze the profile of elderly patients undergoing surgery for complicated colorectal cancer, and to evaluate factors related to worse short-term prognosis. METHODS: A retrospective analysis of patients who underwent emergency surgical treatment for complicated colorectal cancer was performed. Demographics, clinical, radiological and histological data were collected. RESULTS: Sixty-seven patients were analyzed. The median age was 72 years, and almost half (46%) of the patients were female. Obstruction was the most prevalent complication at initial presentation (72%). The most common sites of neoplasia were the left and sigmoid colon in 22 patients (32.8%), and the right colon in 17 patients (25.4%). Resection was performed in 88% of cases, followed by primary anastomosis in almost half. The most frequent clinical stages were II (48%) and III (22%). Forty-three patients (65.7%) had some form of postoperative complication. Clavien-Dindo grades 1, 2, and 4, were the most frequent. Complete oncologic resection was observed in 80% of the cases. The thirty-day mortality rate was 10.4%. Advanced age was associated with worse morbidity and mortality. CONCLUSION: Elderly patients with complicated colorectal cancer undergoing emergency surgery have high morbidity and mortality rates. Advanced age is significantly associated with worse outcomes.

Adrb2 gln27glu polymorphism associated with adiposity indicators and il-10 in adolescents / Polimorfismo adrb2 gln27glu associado a indicadores de adiposidade e il-10 em adolescentes / Polimorfismo adrb2 gln27glu asociado a indicadores de adiposidad e il-10 en adolescentes

ABSTRACT Introduction: Studies of association between obesity and genetic factors have demonstrated a significant contribution of polymorphisms related to body fat distribution and subclinical inflammatory process. Objective: To investigate the association between genotypes of the Gln27Glu polymorphism of the ADRB2 gene and indicators of adiposity, inflammatory markers, metabolic parameters and parameters of physical fitness in overweight adolescents. Methods: A total of 44 male and female adolescents, aged between 13 and 17 years, with positive clinical diagnosis of overweight, were divided into two groups according to the Gln27Glu polymorphism genotypes of the ADRB2 gene: a) Group of carriers of the 27Glu allele (Gln27Glu/Glu27Glu) (n = 22); b) Group of non-carriers of the 27Glu allele (Gln27Gln) (n = 22). Both groups were evaluated for body composition, sexual maturation, cardiorespiratory fitness variables and indicators of muscle strength. Basal glycemia and insulin, lipid profile and inflammatory profile were measured. Abdominal subcutaneous and visceral adiposities were evaluated by ultrasonography. Genotyping of the Gln27Glu polymorphism of the ADRB2 gene was performed by the Taqman allelic discrimination assay. Results: The genotype frequency found was: Gln/Gln (n = 22) (50.0%), Gln/Glu (n = 18) (41.0%) and Glu/Glu (n = 4) %). The frequency of the 27Glu allele was 29.5%. The group of adolescent carriers of the 27Glu allele of the ADRB2 gene presented higher mean adiposity indicators (abdominal circumference, trunk fat mass and visceral fat), as well as lower IL-10 concentrations when compared to non-carriers. Conclusions: The 27Glu allele was associated with adiposity indicators in overweight adolescents, while subcutaneous abdominal fat exhibited an inverse relationship with inflammatory variables and maximum oxygen uptake, which may result in more damage to health. Level of evidence III; Case-control study.

RESUMO Introdução: Estudos de associação entre a obesidade e fatores genéticos têm demonstrado a significativa contribuição de polimorfismos relacionados à distribuição de gordura corporal e processo inflamatório subclínico. Objetivo: Investigar a associação entre os genótipos do polimorfismo Gln27Glu do gene ADRB2 e indicadores de adiposidade, marcadores inflamatórios, parâmetros metabólicos e de aptidão física em adolescentes com excesso de peso. Métodos: Participaram 44 adolescentes, de ambos os sexos, com idade entre 13 e 17 anos, com diagnóstico clínico positivo de excesso de peso, divididos em dois grupos conforme os genótipos do polimorfismo Gln27Glu do gene ADRB2: a) Grupo de portadores do alelo 27Glu (Gln27Glu/Glu27Glu) (n=22); b) Grupo de não portadores do alelo 27Glu (Gln27Gln) (n=22). Ambos os grupos foram avaliados quanto à composição corporal, maturação sexual, variáveis de aptidão cardiorrespiratória e indicadores de força muscular. Foram dosados glicemia e insulina basais, perfil lipídico e perfil inflamatório. As adiposidades abdominais subcutânea e visceral foram avaliadas através de ultrassonografia. A genotipagem do polimorfismo Gln27Glu do gene ADRB2 foi realizada através do ensaio de discriminação alélica Taqman. Resultados: A frequência genotípica encontrada foi: Gln/Gln (n=22) (50,0%), Gln/Glu (n=18) (41,0%) e Glu/Glu (n=4) (9,0%). A frequência do alelo do 27Glu foi de 29,5%. O grupo de adolescentes portadores do alelo 27Glu do gene ADRB2 apresentou maiores médias de indicadores de adiposidade (circunferência abdominal, massa gorda troncular e gordura visceral), assim como menores concentrações de IL-10 quando comparados aos não portadores. Conclusões: O alelo 27Glu apresentou associação com os indicadores de adiposidade em adolescentes com excesso de peso, assim como a gordura abdominal subcutânea demonstrou relação inversa com as variáveis inflamatórias e o consumo máximo de oxigênio, podendo resultar em maiores prejuízos à saúde. Nível de evidência III; Estudo de caso-controle.

RESUMEN Introducción: Estudios de asociación entre la obesidad y factores genéticos han demostrado la significativa contribución de polimorfismos relacionados a la distribución de grasa corporal y proceso inflamatorio subclínico. Objetivo: Investigar la asociación entre los genotipos del polimorfismo Gln27Glu del gen ADRB2 e indicadores de adiposidad, marcadores inflamatorios, parámetros metabólicos y de aptitud física en adolescentes con exceso de peso. Métodos: Participaron 44 adolescentes, de ambos sexos, con edad entre 13 y 17 años, con diagnóstico clínico positivo de exceso de peso, divididos en dos grupos según los genotipos del polimorfismo Gln27Glu del gen ADRB2: a) Grupo de portadores del alelo 27Glu (Gln27Glu/Glu27Glu) (n = 22); b) Grupo de no portadores del alelo 27Glu (Gln27Gln) (n = 22). Ambos grupos fueron evaluados cuanto a la composición corporal, madurez sexual, variables de aptitud cardiorrespiratoria e indicadores de fuerza muscular. Fueron dosificadas glucemia e insulina basales, perfil lipídico y perfil inflamatorio. Las adiposidades abdominales subcutánea y visceral fueron evaluadas a través de ultrasonografía. El genotipado del polimorfismo Gln27Glu del gen ADRB2 fue realizado a través del ensayo de discriminación alélica Taqman. Resultados: La frecuencia genotípica encontrada fue: Gln/Gln (n = 22) (50,0%), Gln/Glu (n = 18) (41,0%) y Glu/Glu (n = 4) (9,0%). La frecuencia del alelo del 27Glu fue del 29,5%. El grupo de adolescentes portadores del alelo 27Glu del gen ADRB2 presentó mayores promedios de indicadores de adiposidad (circunferencia abdominal, masa grasa troncular y grasa visceral), así como menores concentraciones de IL-10, en comparación con los no portadores. Conclusiones: El alelo 27Glu presentó asociación con los indicadores de adiposidad en adolescentes con exceso de peso, así como la grasa abdominal subcutánea demostró relación inversa con las variables inflamatorias y el consumo máximo de oxígeno, lo que puede resultar en mayores perjuicios a la salud. Nivel de Evidencia III; Estudio de caso-control.

Outcomes of elderly patients undergoing emergency surgery for complicated colorectal cancer: a retrospective cohort study

OBJECTIVE: Colorectal cancer is one of the most frequent types of malignant neoplasms. Age is a risk factor for this disease, with 75% of cases diagnosed in patients older than 65 years. Complications such as obstruction, hemorrhage, and perforation are present in more than one-third of cases and require emergency treatment. We aim to analyze the profile of elderly patients undergoing surgery for complicated colorectal cancer, and to evaluate factors related to worse short-term prognosis. METHODS: A retrospective analysis of patients who underwent emergency surgical treatment for complicated colorectal cancer was performed. Demographics, clinical, radiological and histological data were collected. RESULTS: Sixty-seven patients were analyzed. The median age was 72 years, and almost half (46%) of the patients were female. Obstruction was the most prevalent complication at initial presentation (72%). The most common sites of neoplasia were the left and sigmoid colon in 22 patients (32.8%), and the right colon in 17 patients (25.4%). Resection was performed in 88% of cases, followed by primary anastomosis in almost half. The most frequent clinical stages were II (48%) and III (22%). Forty-three patients (65.7%) had some form of postoperative complication. Clavien-Dindo grades 1, 2, and 4, were the most frequent. Complete oncologic resection was observed in 80% of the cases. The thirty-day mortality rate was 10.4%. Advanced age was associated with worse morbidity and mortality. CONCLUSION: Elderly patients with complicated colorectal cancer undergoing emergency surgery have high morbidity and mortality rates. Advanced age is significantly associated with worse outcomes.

Localized fat-free mass does not influence muscle strength in obese and non-obese boys / Massa livre de gordura localizada não influencia força muscular em rapazes obesos e não obesos / Masa libre de grasa localizada no influencia la fuerza muscular en jóvenes obesosy no obesos

INTRODUCTION: Obesity in adolescents has increased worldwide, and is generally associated with poor eating habits and physical inactivity. OBJECTIVE: To compare absolute and relative muscle strength with body mass (BM), fat-free mass (FFM) and localized FFM of upper and lower limbs among obese and non-obese adolescents. METHODS: BM, height and body mass index (BMI) were verified in 39 male adolescents (aged 13-17 years). Body composition was measured by dual-energy X-ray absorptiometry (DXA) and maximal strength of upper and lower limbs was estimated by a one-repetition maximum (1RM) test. Participants were divided into three groups: eutrophic (normal weight) (n=11), overweight (n=14), and obese (n=14). One-way ANOVA was used to compare the variables, followed by a Bonferroni post-hoc test for multiple comparisons. Pearson's correlation coefficient was used for relevant correlations and multiple linear regression to verify the influence of anthropometric variables, body composition and muscle strength of upper and lower limbs. RESULTS: Obese and overweight adolescents had absolute muscle strength values similar to those of the eutrophic adolescents, which were lower when corrected by BM (p<0.001). However, muscle strength related to FFM and localized FFM were similar between groups in both upper and lower limbs. Linear regression showed that BMI explained 59% of the variation in absolute muscle strength of the lower limbs (ß=0.59, p<0.05), FFM explained 84% of the variation in absolute muscle strength of the upper limbs (ß=0.84, p<0.01) and 68% of the lower limbs (ß=0.68; p<0.01), while localized FM was inversely associated in the lower limbs (ß=−0.53, p<0.05). CONCLUSION: Muscle strength of lower and upper limbs, when corrected by localized FFM, does not distinguish between overweight and normal weight adolescents, indicating that obesity does not have a negative effect on generation of muscle strength in obese boys. Level of Evidence III; Case-control study.

INTRODUÇÃO: A obesidade em adolescentes tem aumentado em todo o mundo, geralmente associada a hábitos alimentares inadequados e inatividade física. OBJETIVO: Comparar a força muscular absoluta e relativa com a massa corporal (MC), massa livre de gordura (MLG) e MLG localizada dos membros superiores e inferiores entre adolescentes obesos e não obesos. MÉTODOS: Em 39 adolescentes do sexo masculino (entre 13 e 17 anos) foram verificados MC, estatura e índice de massa corporal (IMC). A composição corporal foi medida por absorciometria de raios-x de dupla energia (DXA) e a força máxima de membros superiores e inferiores foi estimada por um teste de repetição máxima (1RM). Os participantes foram divididos em três grupos: eutrófico (n = 11), sobrepeso (n = 14) e obeso (n = 14). Utilizou-se o teste One-way ANOVA para comparar as variáveis, seguido de teste post hoc de Bonferroni para comparações múltiplas, para as correlações relevantes, usou-se o coeficiente de correlação de Pearson e a regressão linear múltipla foi usada para verificar a influência das variáveis antropométricas, composição corporal e a força muscular dos membros superiores e inferiores. RESULTADOS: Os adolescentes obesos e com sobrepeso tinham força muscular absoluta similar aos dos eutróficos, sendo menores quando corrigidas pela MC (p < 0,001). Porém, a força muscular relacionada com a MLG e a MLG localizada foi semelhante entre os grupos, tanto em membros superiores como inferiores. A regressão linear mostrou que o IMC explicou 59% da variação da força muscular absoluta dos membros inferiores (ß = 0,59, p < 0,05), a MLG explicou 84% da variação da força muscular absoluta dos membros superiores (ß = 0,84, p < 0,01) e 68% dos membros inferiores (ß = 0,68; p < 0,01), enquanto a massa gorda localizada foi inversamente associada nos membros inferiores (ß = −0,53; p < 0,05). CONCLUSÃO: A força muscular dos membros superiores e inferiores, quando corrigida pela MLG localizada, não diferencia adolescentes com sobrepeso e eutróficos, indicando que a obesidade não afeta negativamente a geração de força muscular em rapazes obesos. Nível de Evidência III; Estudo de caso-controle.

INTRODUCCIÓN: La obesidad en adolescentes ha aumentado en todo el mundo, generalmente asociada a malos hábitos alimenticios y falta de actividad física. OBJETIVO: Comparar fuerza muscular absoluta y relativa de la masa corporal (MC), MLG y MLG localizada en miembros inferiores y superiores entre adolescentes obesos y no obesos. MÉTODOS: Se verificó en 39 adolescentes hombres (entre 13 y 17 años) sus MC, estaturas e índices de masa corporal (IMC). La composición corporal fue mensurada por absorciometría de rayos-x de doble energía (DXA) y el test de repetición máxima para estimar la fuerza máxima de miembros superiores e inferiores, divididos en tres grupos: 11 eutróficos, 14 con sobrepeso y 14 obesos. Se usó ANOVA (one way) para comparación de variables, seguido de Post Hoc de Bonferroni para comparaciones múltiples, correlaciones por el coeficiente de correlación Pearson y Regresión Lineal Múltiple para la influencia de variables antropométricas, composición corporal y fuerza muscular de miembros inferiores y superiores. RESULTADOS: Obesos y con sobrepeso presentaron valores de fuerza muscular absoluta similares a los eutróficos, pero menor si se corrigen por MC (p<0,001). Sin embargo, la fuerza muscular relativa a MLG y MLG localizada fue semejante. En regresión lineal, el IMC explicó el 59% de variación de fuerza muscular absoluta en miembros inferiores (ß=0,59, p<0,05), MLG 84% de variación de fuerza muscular absoluta en miembros superiores (ß=0,84, p<0,01) y 68% en miembros inferiores (ß=0,68; p<0,01), mientras que la MG localizada fue inversamente asociada a los superiores (ß=−0,53; p<0,05). CONCLUSIÓN: La fuerza muscular de miembros superiores e inferiores, cuando es corregida por la MLG localizada, no se diferencia en adolescentes con sobrepeso y eutróficos, indicando que la obesidad no afecta negativamente la generación de fuerza muscular en jóvenes obesos. Nivel de Evidencia III; Estudio caso-control.

Níveis de atividade física e estágios de mudança de comportamento de universitários da área de saúde / Level of physical activity and behavior change stages among undergraduate students of health sciences

O presente estudo teve como objetivo verificar o nível de atividade física e estágios de mudança de comportamento em universitários da área de saúde. A amostra foi composta por 416 indivíduos, com idade de 20,6 ± 2,8 anos, proveniente dos cursos de Educação Física (n=67), Enfermagem (n=87), Farmácia (n=79), Fisioterapia (n=99) e Nutrição (n=84). A massa corporal e a estatura foram reportadas e o índice de massa corporal (IMC) foi calculado pela equação de Quételet. Utilizou-se o Questionário Internacional de Atividade Física (IPAQ) - versão curta, para avaliar o nível de atividade física. Quanto ao estágio de mudança de comportamento, os indivíduos foram avaliados através do modelo transteorético de mudança de comportamento. Os resultados encontrados neste estudo indicaram que quase 30% dos acadêmicos da área de saúde foram considerados fisicamente inativos ou insuficientemente ativos, sendo 6% no curso de Educação Física, 34,5% em Enfermagem, 35,5% em Farmácia, 28,3 em Fisioterapia e 40,5 em Nutrição. Em relação ao estágio de mudança de comportamento, mais de 35% estavam se preparando para iniciar a prática de atividade física num futuro próximo. Conclui-se que, com exceção dos estudantes de Educação Física, há um número elevado de fisicamente inativos e insuficientemente ativos entre os acadêmicos dos cursos avaliados, mesmo se tratando de jovens e estudantes de cursos da área da saúde. Além disso, uma grande quantidade dos estudantes está propensa a mudar seu estilo de vida e terem uma vida mais ativa, o que deveria estimular o surgimento de mais oportunidades para a prática de atividade física.

This study aimed to verify the level of physical activity and behavior change stages among undergraduate students of health sciences. The sample was composed of 416 students majoring in Physical Education (n=67), Nursing (n=87), Pharmacy (n=79), Physiotherapy (n=99) and Nutrition (n=84). Weight and height were assessed in order to calculate the body mass index (BMI). The International Physical Activity Questionnaire (IPAQ) was used to evaluate the level of physical activity. In relation to the behavior change stage, the individuals were evaluated through a transtheoretical model of health behavior change (TTM). The results found in this study indicate that almost 30% of the undergraduate students of health sciences are considered physically inactive or insufficiently active (6% in Physical Education, 34,5% in Nursing, 35,5% in Pharmacy, 28,3% in Physiotherapy, and 40,5% in Nutrition). In the stage of behavior change, more than 35% intend to engage in physical activity in the near future. We conclude that, with the exception of Physical Education students, there are high numbers of physically inactive and insufficiently active undergraduate students, especially when taking into consideration that the individuals are young and students at a university health sector. Moreover, there are also a lot of subjects likely to change and have a more active lifestyle, which should stimulate the emergence of more opportunities for physical activity.

Influência da obesidade na força muscular de membros inferiores e superiores em adolescentes / Influence of obesity on the upper and lower body muscular strength in adolescents

Comparar a força muscular de membros inferiores e superiores entre adolescentes obesas e não-obesas e verificar a associação da força muscular com as variáveis antropométricas e da composição corporal. Participaram 36 adolescentes, do sexo feminino, com idade entre 13-17 anos, divididas em três grupos: obeso (n=13), sobrepeso (n=13) e eutrófico (n=10). Foram medidos massa corporal, estatura, índice de massa corporal (IMC) e a circunferência da cintura. A composição corporal foi mensurada pelo método de impedância bioelétrica e a força muscular estimada pelo teste de uma repetição máxima. As adolescentes obesas apresentaram maiores valores de força muscular absoluta nos membros inferiores (F=10,43; p=0,0003) e nos superiores (F=4,72; p=0,01) que as não-obesas. O IMC, a massa gorda (MG) e a massa livre de gordura (MLG) foram direta e significativamente correlacionados com a força muscular de membros inferiores (r= 0,66, p<0,01; r= 0,58, p<0,01; r= 0,54, p<0,01) e superiores (r= 0,54, p<0,01; r= 0,43, p<0,01; r= 0,57, p<0,01), respectivamente. A regressão linear mostrou que o IMC explicou 44% da variação da força muscular absoluta dos membros inferiores (?=4,81, p<0,01) e a MLG explicou 32% da variação da força muscular absoluta dos membros superiores (?=0,52, p<0,05). A obesidade afetou a força muscular absoluta de membros inferiores e superiores em adolescentes e a magnitude deste efeito foi maior nos membros inferiores. O IMC foi a variável que melhor explicou a variação da força muscular absoluta dos membros inferiores em adolescentes obesas e não-obesas na amostra estudada...

To compare the muscle strength of upper and lower limbs among adolescent obese and non-obese and the association of muscle strength with anthropometric and body composition. Thirty-six adolescent girls, with 13-17 years-old, participated in the study and were divided into three groups: obese (n = 13), overweight (n = 13) and healthy (n = 10). Body mass, height, body mass index (BMI) and waist circumference were evaluated. Body composition was measured by the bioelectric impedance method. Muscular strength was estimated by 1RM. Obese girls showed higher absolute muscle strength in the lower (F = 10.43, p = 0.0003) and higher (F = 4.72, p = 0.01) than non-obese. The BMI, fat mass (FM) and fat free mass (FFM) were directly and significantly correlated with lower limb muscle strength (r = 0.66, p<0.01; r = 0.58, p<0.01; r = 0.54, p<0.01) and higher (r = 0.54, p<0.01; r = 0, 43, p<0.01; r = 0.57, p<0.01), respectively. Linear regression showed that BMI explained 44% of the variation in absolute muscle strength of the lower limbs (? = 4.81, p <0.01) and FFM explained 32% of the variation in strength absolute muscle of the upper (? = 0.52, p <.05). Obesity affected absolute muscle strength of the lower limbs and in the upper teens and the magnitude of the effect was greater in the lower limbs than in the upper. BMI was the variable that best explained the variation in absolute muscle strength of the lower limbs in adolescent obese and non-obese in the assessed sample...

Acamprosato para dependência de álcool / Acamprosate for alcohol dependence

Introdução: A dependência do álcool está entre os principais fatores de risco à saúde na maioria dos países desenvolvidos e em desenvolvimento. O sucesso terapêutico dos programas psicossociais para a prevenção de recaída é moderado, mas poderia ser melhorado com o acréscimo do acamprosato (antagonista do glutamato) como tratamento adjuvante...

Efeito da guia dental anterior na etiologia das DTM's / Effect of the anterior guidance at the TMD's etiology

Este trabalho baseou-se em uma revisão da literatura, com o intuito de analisar o papel descrito pela guia dentária anterior como fator etiológico das DTMs. Também foram analisados estudos associando-a a atividades eletromiográficas dos músculos elevadores da mandíbula. Como resultados, não foram encontradas relações entre a guia dentária anterior e sinais e sintomas de DTM que forneçam dados suficientes para colocá-la como único fator etiológico, mas averiguou-se grande relação entre a falta de guia dentária anterior e problemas como osteoartrose associada ao deslocamento do disco sem redução. Em relação à atividade eletromiográfica, encontrou-se grande variação nos níveis de atividade dos músculos. Assim, novos trabalhos são necessários para uma melhor avaliação desta importante condição oclusal, que é a guia dentária anterior

Estudo de flebotomíneos (Diptera: Psychodidae) em foco de leishmaniose visceral no Estado de Mato Grosso do Sul, Brasil / Study of phlebotomines (Diptera: Psychodidae) in focus of visceral leishmaniasis in Brazil

Nas Américas, Lutzomyia longipalpis tem sido incriminada como vetora da leishmaniose visceral em, praticamente, todas as áreas de ocorrência dessa parasitose. A notificaçäo de casos humanos a partir de 1980 e a presença de cäes com aspecto sugestivo de leishmaniose visceral no Município de Corumbá, Estado de Mato Grosso do Sul, Brasil, levaram a investigaçöes entomológicas na área, com o objetivo de identificar a populaçäo de flebotomíneo vetora. A pesquisa foi realizada no peri e intradomicílio de três residências urbanas e em ecótopo natural, representado por uma gruta, situado fora doperímetro urbano. As capturas, semanais em sua maioria, foram realizadas com armadilhas automáticas luminosas, no período de 1984 a 1986. Os dados metereológicos desse período foram obtidos junto à Estaçäo Metereológica da cidade e os de 1925 a 1982, de bibliografia. A fauna flebotomínea urbana, composta de oito espécies, mostrou-se semelhante à da gruta, porém nesta, a abundância das espécies foi maior. Na área urbana, Lu. cruzi predominou tanto no intra como no peridomicílio: no bairro central, representou 90,3 por cento dos espécimes e nos dois bairros periféricos, os seus percentuais foram menores. Lu. forattinii, também, teve freqüência expressiva em um dos bairros periféricos (39,0 por cento). Na gruta, Lu. corumbaensis foi a espécie predominante. Comenta-se o impacto das condiçöes climáticas e do inseticida aplicado na área urbana na freqüência das espécies, e da utilizaçäo da gruta como criadouro pelos flebotomíneos, com base na evoluçäo da razäo entre os sexos ao longo do período. Foram adicionadas informaçöes sobre antropofilia e de coleta com isca canina de Lu. forattinii. O predomínio de Lu. cruzi na área urbana; a expressiva freqüência de Lu. forattinii na periferia da cidade, bem como a sua antropofilia e o estreito grau de parentesco destas espécies com Lu. longipalpis, a principal vetora da leishmaniose visceral em outras áreas da América, säo aspectos que sugerem a participaçÝo de ambas na transmissäo da doença, em Corumbá.