Is Shift Work Sleep Disorder a Risk Factor for Metabolic Syndrome and Its Components? A Systematic Review of Cross-Sectional Studies.

Shift work sleep disorder is prevalent in night shift workers due to prolonged misalignment of the circadian rhythm. Night shift workers comprise a significant portion of the workforce and it is important to study the potential implications on their health. Studies have shown the association of metabolic syndrome (MetS) and the components, that is, obesity, dyslipidemia, hypertension, and insulin resistance, with shift workers. Nocturnal exposure to bright light can affect various physiological processes including melatonin secretion, which is a regulator in insulin synthesis. A systematic review was conducted to identify studies showing the association between shift work and MetS and/or its components, as well as to review the pathophysiology for further investigations. This review follows the guidelines as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist 2009. One thousand nine hundred ten records were identified from the PubMed database using both keywords and medical subject headings terms. After applying the inclusion/exclusion and eligibility criteria, 18 observational studies were included in the qualitative synthesis. Quality appraisal was conducted by two investigators independently using the Newcastle/Ottawa Scale, and 11 articles were finalized for the review after scoring 60% and above. Each study measured the different components of MetS and/or the presence of MetS. Statistically significant results were reported for the association between shift work and MetS, shift work and obesity, shift work and dyslipidemia, shift work and hypertension, and shift work and insulin resistance. This review identifies a need to emphasize treatment plans for shift workers to manage not only sleep disorders but other chronic diseases such as MetS, obesity, hypertension, dyslipidemia, and insulin resistance.

Decoding the Pathophysiology of Non-alcoholic Fatty Liver Disease Progressing to Non-alcoholic Steatohepatitis: A Systematic Review.

Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic manifestation of metabolic syndromes, and its roots are strongly associated with obesity and insulin resistance. The excess fat induces inflammatory pathways by tissue irritation and progresses to non-alcoholic steatohepatitis (NASH), fibrosis, and has emerged as the most frequent cause of hepatocellular cancer (HCC). This systematic review was structured per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The evidence was obtained from 13 research articles published in PubMed, Google Scholar, and Science Direct databases, including cross-sectional, case-control, prospective cohort studies, meta-analysis, and systematic reviews. The inclusion/exclusion criteria of free articles, published in English involving humans of mid-age in the last five years were applied. This review highlights findings in 7781 individuals, including non-NAFLD, NAFLD, and NASH positive individuals based on anthropometric measurement, blood samples, FibroScan, flow cytometry, and liver biopsy. The results underscored that the onset of inflammation set on the background of NAFLD starts NASH; the understanding and control of inflammation will help us design definitive biomarkers and treatment modalities. The complex pathogenesis and comparatively slow advancement but high morbidity have led investigators to understand the nuts and bolts for early management and prevention. Lipotoxicity and dysbiosis stimulate the immune system to generate cytokines and chemokines and decline in adipokines. The role of proteinase3 (PR3) and antitrypsin (ATT) ratio and biliverdin reductase (BVR) compel the exploration for non-invasive tests for definitive therapy.

Effectiveness of Manual Therapy and Acupuncture in Tension-Type Headache: A Systematic Review.

Tension-type headache is one of the most prevalent types of headache. The common presentation is a mild-to-moderate dull aching pain around the temporal region, like a tight band around the forehead, neck, shoulder, and sometimes behind eyes. It can occur at any age but most commonly in the adult female population. The exact underlying mechanism is not clear but muscle tension is one of the main causes, which can be due to stress and anxiety. There are several non-pharmacologic treatment options suggested for tension-type headaches, such as cognitive behavioral therapy, relaxation, biofeedback, acupuncture, exercise, manual therapy, and even some home remedies. This systematic review was performed to evaluate the effectiveness of acupuncture and manual therapy in tension-type headaches. The literature search was primarily done on PubMed. Eight articles involving 3846 participants showed evidence that acupuncture and manual therapy can be valuable non-pharmacological treatment options for tension-type headaches. Acupuncture was compared to routine care or sham intervention. Acupuncture was not found to be superior to physiotherapy, exercise, and massage therapy. Randomized controlled trials done in various countries showed manual therapy also significantly decreased headache intensity. Manual therapy has an efficacy that equals prophylactic medication and tricyclic antidepressants in treating tension-type headaches. The available data suggests that both acupuncture and manual therapy have beneficial effects on treating symptoms of tension-type headache. However, further clinical trials looking at long-term benefits and risks are needed.

Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis.

Cesarean section endometriosis (CSE) can be caused by the iatrogenic deposition of endometrial cells, glands, and stroma during any time of the surgical procedure. It can be asymptomatic or, more frequently, resulting in chronic pain. Our article intends to provide more clinical information on CSE symptomatology, diagnosis, and preventive methods available in the literature, and discuss the malignancy transformation risk. We performed a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We included all types of study designs and selected only English articles from 2016 and forward. A total of 268 patients with abdominal wall endometriosis (AWE) were included in the final review; 260 women had CSE and eight women had endometriosis related to another gynecologic procedure. Attention for suggestive symptoms during anamnesis and the presence of abdominal nodules close to the cesarean scar should raise suspicions of scar endometriosis. In addition, abdominal ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and fine-needle aspiration (FNA) biopsy can be helpful to differentiate from other conditions such as incisional hernias, suture granulomas, or malignant tumors. However, the final diagnosis and treatment is still the complete excision of the tumor. Therefore, additional studies on pathophysiology would help with new preventive methods and less invasive therapeutic options.

Indicações de cesárea nas gestantes classificadas como Robson 1 / Indication of cesarean section on pregnant women classified as Robson 1

Objetivos: os objetivos foram identificar as indicações mais prevalentes de cesárea em parturientes Robson 1, comparando variáveis maternas, antecedentes obstétricos e resultados perinatais. Métodos: estudo analítico observacional transversal, onde avaliou-se o Livro de Partos e prontuários eletrônicos das gestantes em trabalho de parto, classificadas como Robson 1. As variáveis quantitativas foram comparadas utilizando-se Teste T de Student ou Mann Whitney, às qualitativas foi empregado teste Qui-quadrado ou Exato de Fisher. Resultados: elegíveis 2267 gestantes, sendo 570 (25,1%) cesáreas. As indicações mais prevalentes de cesariana foram: sofrimento fetal, em 213 (37,4%) dos casos, e desproporção cefalopélvica, em 212 (37,2%). As variáveis relevantes para o desfecho do parto foram: idade materna (razão de chance 1,0), idade gestacional (1,4), índice de massa corpórea pré-gestacional (1,6 em sobrepeso e 1,8 em obesidade) e presença de síndrome hipertensiva (aumentou 3,6). Conclusão: conclui-se que algumas características maternas e obstétricas afetam diretamente a indicação de cesariana.

Aims: the goal was to identify the most prevalent indications of cesarean section in pregnant women classified as Robson 1, comparing motherly variables, obstetric background and perinatal outcomes. Methods: cross-sectional analytical study, evaluating the electronic medical records of birthing women classified as Robson 1. The quantitative variables were compared using Student's T Test or Mann Whitney, the qualitative ones were applied to the Chi-square Test or Fisher's Exact. Results: of the 2267 eligible women in the study 570 (25,1%) had C-section. The most prevalent indications of C-section were fetal distress numbering 213 (37,4%) of the reports and cephalopelvic disproportion reaching as high as 212 (37,2%) cases. The relevant variables to the outcome were: age (odds ratio 1,0), gestational age (1,4), Pregestational Body Mass Index (1,6 in overweight and 1,8 seen in obesity) and hypertensive syndrome (3,6). Conclusion: some pregnant and obstetric characteristics directly affect the indication of C-sections.

O projeto produtor de água no Pipiripau (DF) e o pagamento por serviços ambientais / The Producer Water Project in Pipiripau (DF) and payment for environmental services

A questão da carência hídrica, tanto na quantidade quanto na qualidade, é um problema que afeta várias comunidades no Brasil e no mundo. A carência hídrica associada à falta de um planejamento ocupacional e ao mau uso dos recursos naturais causam diversos conflitos pelo uso da água. Estas questões são motivo de preocupação daqueles que são afetados e também de instituições que direta ou indiretamente interagem com os problemas relativos à água. O Projeto Produtor de Água no Pipiripau faz parte do esforço coletivo de diferentes instituições que, atuando na Bacia do Ribeirão Pipiripau (DF) junto a produtores rurais, se propõem a minimizar as carências hídricas visando à redução do conflito principalmente entre os usuários de irrigação e o abastecimento urbano. O Projeto leva consigo o conceito inovador de Pagamento por Serviços Ambientais – PSA, instrumento econômico que se assenta no princípio do provedor-recebedor. O presente trabalho procura explicar a gênese, a importância e as perspectivas do Projeto Produtor de Água no Pipiripau, fazendo uma exposição de como se dará o Pagamento por Serviços Ambientais – PSA, enquanto política preservacionista dos recursos hídricos. O presente trabalho estudará as principais etapas pelas quais se estabeleceu o arranjo institucional que tornou possível a assinatura do Acordo de Cooperação Técnica – ACT entre os parceiros; as funções assumidas pelos diferentes parceiros e como que se viabilizou o início das ações preservacionistas na bacia; o atual estágio e as dificuldades envolvidas na condução do Projeto; o que prevê e quando se deram os primeiros contratos para Pagamento por Serviços Ambientais; a importância do PSA, na sua forma direta e indireta, para a preservação dos recursos hídricos; os valores a serem pagos aos produtores rurais e a caracterização das ações que serão incentivadas por PSA e as perspectivas do Projeto na Bacia.