Comparative Analysis of Epidemiological Outcome of Incidence, Mortality and Lethality by COVID-19 between the States of Espírito Santo and Minas Gerais, Brazil.

At the beginning of December 2019, a new type of coronavirus emerged, SARS-CoV-2. This virus causes COVID-19, a highly contagious disease that can initially present asymptomatically and can also lead to death. Our ecological study goal was to evaluate the incidence, mortality, and lethality rates for COVID-19 between the states of Espírito Santo and Minas Gerais, with time series analysis using secondary and public databases on COVID-19 from January 2020 to December 2022. Prais-Winsten linear regression was used for trend analyses. In 2020, the rate in Espírito Santo was 2.19 times greater than in Minas Gerais. This trend continued in 2021, with Espírito Santo's rate being 1.29 times greater. In 2022, Espírito Santo's rate remained 2.65 times higher than Minas Gerais. Furthermore, Espírito Santo had the highest mortality, with the exception of 2021. In turn, Minas Gerais had the highest fatality rate throughout the analyzed pandemic period. The state of Espírito Santo had a higher incidence of COVID-19, as well as higher mortality when compared to the state of Minas Gerais. Furthermore, both states showed similar trends for mortality, lethality, and incidence in the years 2020 and 2021.

Construction and Validation of an Educational Technology to Promote the Health of Postmenopausal Women with Dry Eye Syndrome.

The climacteric heralds a transition from reproductive to non-reproductive life in women, often accompanied by various clinical manifestations such as dry eye, impacting their quality of life. This study focuses on systematically developing and suitability an educational digital booklet to promote eye health practices and prevent problems among postmenopausal women. The methodological approach encompassed semi-structured interviews with women diagnosed with Dry Eye Syndrome (DES), then constructing the material integrating content, script, illustrations, and layout informed by the interview findings. Subsequent validation involved assessment by 24 health experts for content, appearance, and evaluation by a target audience of 22 women. The booklet attained high suitability scores, with a Global Content Validity Index (CVI) of 0.96, indicating superior suitability as judged by experts. Additionally, it achieved a Global CVI of 0.98 for validation by the target audience. In conclusion, the educational booklet emerges as a suitable and reliable resource for promoting eye heath among DES and non-syndrome women, offering significant potential for broader application in relevant populations.

Chronic Pain Self-Management Strategies for Older Adults: An Integrative Review.

INTRODUCTION: Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others. OBJECTIVE: To analyze the self-management strategies currently used by older adults with chronic pain. METHOD: An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years. RESULTS AND CONCLUSION: Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.

Congenital short QT syndrome: A review focused on electrocardiographic features

Congenital short QT syndrome is a very low prevalence inherited primary arrhythmia syndrome first reported in 2000 by Gussak et al., who described two families with a short QT interval, syncope, and sudden cardiac death. In 2004, Ramon Brugada et al. identified the first genetic type of this entity. To date, a total of nine genotypes have been described. The diagnosis is easy from the electrocardiogram (ECG), not only due to the short QT duration, but also based on other aspects covered in this review. During 24-h Holter monitoring, paroxysmal atrial fibrillation spontaneously converting to sinus rhythm may be found. Even though the T wave may appear symmetric on the ECG, the T loop of the vectorcardiogram confirms that the T wave is constantly asymmetric due to the presence of dashes closer to each other in the efferent branch. In this review, we also describe the minus-plus T wave sign that we have described in a previously published article. In addition to congenital causes, we briefly highlight the existence of numerous acquired causes of short QT interval.

Analyzing the COVID-19 Transmission Dynamics in Acre, Brazil: An Ecological Study.

The north region of Brazil is characterized by significant vulnerabilities, notably surpassing national poverty indicators. These disparities exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas with limited healthcare resources, inadequate infrastructure, and barriers to healthcare access. The crisis was further influenced by multiple lineages that emerged as significant virus variants associated with increased transmissibility. Within this context, our ecological study focused on analyzing the epidemiological evolution of COVID-19 in the state of Acre. We constructed time-series trends in incidence, lethality, and mortality from March 2020 to December 2022 using the Prais-Winsten regression model. Our findings revealed that in 2020, there was an increasing trend in incidence, while mortality and lethality continued to decrease (p < 0.05). In the following year, both incidence and mortality decreased, while lethality increased at a rate of 1.02% per day. By the end of 2022, trends remained stationary across all rates. These results underscore the importance of ongoing surveillance and adaptive public health measures to bolster the resilience of healthcare systems in remote and vulnerable regions. Indeed, continuous monitoring of the most predominant SARS-CoV-2 lineages and their dynamics is imperative. Such proactive actions are essential for addressing emerging challenges and ensuring effective responses to adverse situations.

Response Surface Model of the Reduced Flexibility Matrix for Bayesian Damage Identification.

The present work is concerned with the use of a Response Surface Model of the reduced flexibility matrix for structural damage identification. A Response Surface Model (RSM) is fitted with the aim at providing a polynomial relationship between nodal cohesion parameters, used to describe the damage field within the structure, and elements of the reduced flexibility matrix. A design of experiment built on combinations of a relatively small number of nodal cohesion parameters is used to fit the RSM. The damage identification problem is formulated within the Bayesian framework and the Delayed Rejection Adaptive Metropolis method is used to sample the posterior probability density function of the uncertain cohesion parameters. Numerical simulations addressing damage identification in plates were carried out in order to assess the proposed approach, which succeeded in the identification of the different damage profiles considered. Besides, the use of a RSM, instead of a FEM of the structure, resulted in reductions of up almost 78% in the required computational cost.

Aprendizagem sobre teleconsulta: representações de um grupo de alunos de um curso de Medicina / Learning about teleconsultation: representations of a group of Medical students / Aprendizaje sobre teleconsulta: representaciones de un grupo de alumnos de un curso de Medicina

Com o avançar da tecnologia, passou a fazer parte da graduação médica atual o aprendizado em teleconsultas. Esta pesquisa apresenta as representações de um grupo de alunos de um curso de Medicina localizado na capital do estado de São Paulo sobre suas experiências com a realização de teleconsultas síncronas supervisionadas durante estágio realizado em um ambulatório-escola, durante o segundo semestre de 2021. Trata-se de pesquisa qualitativa que utilizou o software IRaMuTeQ® e "Análise do Conteúdo". Esses educandos pontuam entraves para a utilização das teleconsultas, destacando preocupações com a humanização, segurança da pessoa atendida e qualidade da consulta, mas visualizam potencialidades tais como a facilidade de acesso e a comodidade. Reconhecem a importância da prática durante sua Graduação em um mundo cada vez mais tecnológico, mas trazem inquietações relacionadas à perda do exame físico e à mercantilização da Medicina.

With the progress of technology, teleconsultation has become part of medical degree courses. This article presents the representations of a group of medical students from a university in the capital of the state of São Paulo regarding their experiences with supervised synchronous teleconsultations during an internship in a teaching clinic in the second semester of 2021. We conducted a qualitative study using the software IRaMuTeQ® and content analysis. The students highlighted barriers to the use of teleconsultation, emphasizing concerns with humanization, patient safety and consultation quality, but also perceived strengths such as ease of access and convenience. They recognize the importance of practice on the degree course in an ever more technological world, but raise concerns about the lack of physical examination and the commodification of medicine.

Con el avance de la tecnología, el aprendizaje en teleconsultas pasó a formar parte de la graduación médica actual. Esta investigación presenta las representaciones de un grupo de alumnos de un curso de medicina localizado en la capital del estado de São Paulo sobre sus experiencias con la realización de teleconsultas sincronizadas supervisadas durante una pasantía realizada en un ambulatorio escuela, durante el segundo trimestre de 2021. Se traba de una investigación cualitativa que utilizó el software IRaMuTeQ® y Análisis de Contenido. Estos alumnos puntúan obstáculos para la utilización de las teleconsultas, destacando preocupaciones con la humanización, seguridad de la persona atendida y calidad de la consulta, pero visualizan potencialidades tales como la facilidad de acceso y la comodidad. Reconocen la importancia de la práctica durante su graduación en un mundo cada vez más tecnológico, pero presentan inquietudes relacionadas a la pérdida del examen físico y a la mercantilización de la medicina.

Temporal Analysis of COVID-19 Epidemiological Indicators in a Low-Income Brazilian Context: A Retrospective Analysis in Paraiba State.

Northeast Brazil is a region with great international tourist potential. Among the states that make up this region, Paraíba stands out due to the presence of vulnerable groups and factors that contribute to adverse outcomes of COVID-19. Therefore, the aim of this study was to analyze the epidemiological data on the incidence, mortality, and case fatality of COVID-19 in Paraíba. An ecological, population-based study was performed, with data extracted from the Brazilian Ministry of Health database. All cases and deaths from COVID-19 from March 2020 to December 2022 were included. The time series was built by applying the Prais-Winsten regression model, and the daily percent change was calculated to analyze the trends. The highest case fatality of the entire period was in April 2020 (7.8%), but in March 2021, the state broke the dismal record of 1248 deaths and the highest mortality rate (30.5 deaths per 100,000 inhabitants). Stationary mortality and case fatality were better in 2022; however, in February 2022, the mortality rate was at levels similar to the same month of the previous year. These results illustrate that COVID-19 is evolving and needs to be constantly monitored.

Effect of clonidine on heart rate variability during spinal anaesthesia: randomized clinical trial.

INTRODUCTION: Spinal anaesthesia consists of administering a local anaesthetic in the subarachnoid space, thus causing sensory, motor, and autonomic nerve conduction block. Currently, recovery from spinal anaesthesia is evaluated by the return of motor function, without considering the autonomic blockade, which is responsible for most complications of the technique. Heart rate variability (HRV) is an indirect method to measure the autonomic nervous system and may be useful in assessing autonomic recovery after spinal anaesthesia. The study objective was to evaluate the autonomic function, through HRV, at the moment of return of motor function in patients who received spinal anaesthesia when clonidine is used as an adjuvant. MATERIAL AND METHODS: This was a randomised, double-blind clinical trial. The sample consisted of 64 ASA I-II patients who underwent spinal anaesthesia and were divided into 2 groups. Group C received 20 mg of bupivacaine with 75 mcg of clonidine, and group B received 20 mg of bupivacaine. HRV was evaluated at rest (T1) and at the time of motor function recovery (T2). Data were collected using a Polar V800® heart rate monitor and then analysed and filtered using Kubios 3.0® software. RESULTS: There was no difference in the values of the low-frequency/high-frequency (LF/HF) ratio, Poincaré plot standard deviation (SD2/SD1), detrended fluctuation analysis (DFAα1, DFAα2), or correlation dimension (D2) indices in any of the groups between the 2 moments. In the clonidine group, there was a difference only in approximate entropy (ApEn), where a P of 0.0124 was obtained considering a 95% confidence interval ranging from 17.83 to 141.47. CONCLUSIONS: There was no significant difference between the duration of sympathetic blockade and motor blockade in spinal anaesthesia.

Describing Trends in Maternal Mortality in the State of São Paulo, Brazil, from 2009 to 2019.

BACKGROUND: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. MATERIALS AND METHODS: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. RESULTS: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. CONCLUSIONS: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period.

Left septal fascicular block: Evidence, causes, and diagnostic criteria.

The existence of a tetrafascicular intraventricular conduction system is widely accepted by researchers. In this review, we have updated the criteria for left septal fascicular block (LSFB) and the differential diagnosis of prominent anterior QRS forces. More and more evidence points to the fact that the main cause of LSFB is critical proximal stenosis of the left anterior descending coronary artery before its first septal perforator branch. The most important characteristic of LSFB that has been incorporated in the corresponding diagnostic electrocardiographic criteria is its transient/intermittent nature mostly observed in clinical scenarios of acute (ie, acute coronary syndrome including vasospastic angina) or chronic (ie, exercise-induced ischemia) ischemic coronary artery disease. In addition, the phenomenon proved to be phase 4 bradycardia rate dependent and induced by early atrial extrastimulus. Finally, we believe that intermittent LSFB has the same clinical significance as "Wellens syndrome" and the "de Winter pattern" in the acute coronary syndrome scenario.

Indicators of Eating Disorders in Sexually Abused Brazilian Adolescents: Family and School Contexts.

Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study's objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants' health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students' daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one's body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one's body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse.

Description of the scientific method for the preparation and validation of educational technologies in digital format: a methodological study

Introduction: the use of digital technologies constitutes a process that allows the dynamization of the care process, based on aspects related to criticality and creativity. It is emphasized that the development of technologies must, therefore, be inserted in a context for changes and innovation in response to the population's health demand, and must follow a precise methodological path that goes from the construction to the validation of the appearance, content and effect . Objective: to describe the scientific method of elaboration and validation of educational technologies in digital format. Methods: methodological study, conducted according to the following steps: development of the research project and submission to the Research Ethics Committee; data collection; elaboration of the content, script, illustrations and layout of the booklet; and validation of educational technology. Results: the process of developing a technology requires methodological rigor, enabling coherence between theory and the purpose of the desired product, guaranteeing the internal quality of the developed technology. The use of educational technologies in health reinforces information, serving as a guide for guidelines regarding care and assisting in decision-making. Technological innovations in health, consists of a socio-technical process , permeated by professional and user reflections and experiences. Final considerations: educational technologies represent a potential resource for the development of health education practices, encouraging greater interaction between professionals and users, and an active attitude regarding self-care actions related to their health condition.

Introdução: o uso de tecnologias digitais constitui como um processo que permite a dinamização no processo de cuidar, pautada nos aspectos relacionados a criticidade e criatividade. Enfatiza-se, que o desenvolvimento de tecnologias deve, portanto, insere-se em um contexto por mudanças e inovação em resposta a demanda de saúde da população devendo seguir um percurso metodológico preciso que vai desde a construção à validação da aparência, conteúdo e efeito. Objetivo: descrever o método científico de elaboração e validação de tecnologias educativas no formato digital. Método: estudo metodológico, conduzido de acordo com as seguintes etapas: elaboração do projeto de pesquisa e submissão ao Comitê de Ética em Pesquisa; levantamento dos dados; elaboração do conteúdo, roteiro, ilustrações e diagramação da cartilha; e validação da tecnologia educacional. Resultados: o processo de elaboração de uma tecnologia requer rigor metodológico, possibilitando coerência entre teoria e finalidade do produto desejado, garantindo qualidade interna da tecnologia elaborada. O uso de tecnologias educativas em saúde reforça informações, servindo como guia para orientações quanto ao cuidado e auxiliando nas tomadas de decisões. Inovações tecnológicas em saúde, consiste em um processo sócio-técnico, permeado por reflexões e experiências profissionais e usuários. Considerações finais: tecnologias educacionais representam um recurso potencializador para o desenvolvimento de práticas de educação em saúde, estimulando maior interação entre profissionais e usuários, e uma postura ativa quanto a ações de autocuidado relacionado a sua condição de saúde.

Association Between Hormone Therapy and Weight Gain in the Menopause Transition and After Menopause: A Systematic Review and Meta-Analysis

Objectives: to conduct a systematic review and meta-analysis in order to assess whether hormone therapy (HT) increases weight in women in the menopausal transition and after menopause. Method: this article proposes an update to the systematic review published in 2005 by the Cochrane Library (Kongnyuy EJ et al 2005) with reference to studies assessing weight changes in women receiving HT from 1986 to 2005. Following PRISMA recommendations, we included randomized controlled trials (RCTs) ) from May 2005 onwards from Medline, Embase, and the Cochrane CENTRAL databases. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Two authors independently assessed the risk of biases in the selected studies. Results: ten RCTs were included, totaling 2,588 HT users and 764 non-users. Different regimens, dosages, and routes of administration in HT users were analyzed and compared to non-users. The results did not show statistically significant differences for most of the HT regimens evaluated. There was significant weight gain only in patients using EEC alone at dosages of 0.45 mg/day and 0.3 mg/day when compared to placebo (p 0.01); as well as in patients receiving esto-progestative combinations of 0.5 mg/day 17-beta-estradiol (E2) + 100 mg/day progesterone, with a 0.7 kg weight increase (p 0.032). On the other hand, the combinations of 1 mg/day estradiol valerate + 3 mg/day drospirenone showed a -1.0 kg reduction (p = 0.04), whereas a -0.2 kg reduction (p = 0.001) was identified in patients using 1 mg /day estradiol (E) + 0.5 mg norethisterone acetate (NETA). Tibolone therapy showed no statistically significant changes in weight. After performing a meta-analysis, the comparative results between users and non-users showed that there was a slight weight increase (+0.279 kg ; CI -1.71 to 2.27) in patients using 0.625 mg/day conjugated equine estrogen (CEE) + 2.5 mg/day medroxyprogesterone acetate (MPA). As for the patients receiving 2.5 mg/day Tibolone, weight gain (+0.670 kg; CI from -1.14 to 2.48) was also observed in them. However, these increases were not significant when compared to non-HT users. Conclusions: most regimens studied showed that patients using HT in the menopausal transition and after menopause did not show significant weight gain. The only combination that showed weight gain was 0.5 mg/day 17-beta-estradiol (E2) + 100 mg/day progesterone observed, while there was weight reduction in patients using 1 mg/day estradiol valerate + 3 mg/day drospirenone and 1 mg/day estradiol (E) + norethisterone acetate.

Objetivo: realizar uma revisão sistemática e meta-análise para avaliar se a terapia hormonal (TH) aumenta o peso em mulheres na transição menopausal e após a menopausa. Métodos: este artigo propõe uma atualização da revisão sistemática publicada em 2005 pela Cochrane Library (Kongnyuy EJ et al., 2005) com referência a estudos avaliando mudanças de peso em mulheres recebendo TH de 1986 a 2005. Seguindo as recomendações do PRISMA, incluímos ensaios clínicos randomizados (RCTs) de maio de 2005 em diante do Medline, Embase e dos bancos de dados Cochrane CENTRAL. Diferenças médias padronizadas (SMD) e intervalos de confiança de 95% (IC) foram calculados. Dois autores avaliaram independentemente o risco de vieses nos estudos selecionados. Resultados: foram incluídos dez ECRs, totalizando 2.588 usuários de HT e 764 não usuários. Diferentes esquemas, dosagens e vias de administração em usuários de HT foram analisados e comparados a não usuários. Os resultados não mostraram diferenças estatisticamente significativas para a maioria dos esquemas de TH avaliados. Houve ganho de peso significativo apenas nos pacientes que usaram apenas EEC nas doses de 0,45 mg/dia e 0,3 mg/dia quando comparados ao placebo (p 0,01); assim como em pacientes recebendo combinações estoprogestativas de 0,5 mg/dia de 17-beta-estradiol (E2) + 100 mg/dia de progesterona, com aumento de peso de 0,7 kg (p 0,032). Por outro lado, as combinações de 1 mg/dia de valerato de estradiol + 3 mg/dia de drospirenona apresentaram redução de -1,0 kg (p = 0,04), enquanto foi identificada redução de -0,2 kg (p = 0,001) nas pacientes que usaram 1 mg /dia estradiol (E) + 0,5 mg de acetato de noretisterona (NETA). A terapia com tibolona não mostrou alterações estatisticamente significativas no peso. Após realizar uma meta-análise, os resultados comparativos entre usuárias e não usuárias mostraram que houve um leve aumento de peso (+0,279 kg ; IC -1,71 a 2,27) em pacientes em uso de 0,625 mg/dia de estrogênio equino conjugado (CEE) + 2,5 mg/dia de acetato de medroxiprogesterona (MPA). Quanto aos pacientes que receberam Tibolona 2,5 mg/dia, também foi observado ganho de peso (+0,670 kg; IC de -1,14 a 2,48). No entanto, esses aumentos não foram significativos quando comparados aos não usuários de HT. Conclusões: a maioria dos esquemas estudados mostrou que as pacientes em uso de TH na transição menopausal e após a menopausa não apresentaram ganho de peso significativo. A única combinação que apresentou ganho de peso foi 0,5 mg/dia de 17-beta-estradiol (E2) + 100 mg/dia de progesterona, enquanto houve redução de peso nas pacientes que usaram 1 mg/dia de valerato de estradiol + 3 mg/dia de drospirenona e 1 mg/dia estradiol (E) + acetato de noretisterona.

Maternal obesity and its repercussions on melatonin and cortisol in breast milk and human colostrum

Introduction: scientific evidence has highlighted the role of chronobiological disruptions in promoting obesity through mechanisms involving important circadian rhythm hormones: melatonin and cortisol. These hormones are present in human colostrum and serve as crucial maternal and child protection mechanisms against obesity and childhood infections, owing to the intense interaction between mother and child during pregnancy and breastfeeding. Consequently, the melatonin and cortisol hormones present in human colostrum hold promise as potential candidates for yielding clinically applicable results and supporting future intervention strategies aimed at reducing obesity and neonatal infections. However, there is a scarcity of literature on this subject. Objective: the objective of this study is to to analyze the impact of maternal obesity on the levels and functions of melatonin and cortisol in colostrum and breast milk. Methods: a systematic review of the scientific literature was conducted following the recommendations outlined in the PRISMA protocol. Original articles published in English were searched in the PubMed, Medline, Lilacs, and Scopus databases. There were no restrictions on the publication year. Results: a total of 37 articles were identified from the searched databases. After removing duplicates and applying the inclusion and exclusion criteria, only five studies were relevant to the topic: two studies addressing melatonin and three studies analyzing cortisol. This review revealed that melatonin levels are elevated in the colostrum of obese women, and for this particular group, it has the potential to restore phagocyte activity and increase lymphocyte proliferation. Studies on cortisol have demonstrated that maternal obesity does not alter the levels of this hormone in breast milk. Conclusion: breastfeeding should be encouraged for all populations, and further original research should be conducted to elucidate the protective mechanisms of colostrum and breast milk.

Introdução: evidências científicas enfatizam que disrupções cronobiológicas podem promover a obesidade por mecanismos envolvendo ação de importantes hormônios marcadores do ritmo circadiano: a melatonina e cortisol. Estes hormônios estão presentes no colostro humano e representam importante mecanismo de proteção materno infantil frente à obesidade e infecções infantis, devido à intensa interação entre mãe e filho durante a gravidez e amamentação. Assim, os hormônios melatonina e cortisol presentes no colostro humano representam promissores candidatos para fornecer resultados com capacidade de aplicação clínica e de embasamento de futuras estratégias de intervenção com enfoque na redução da obesidade e de infecções neonatais. Entretanto, são escassos os estudos na literatura sobre o tema. Objetivo: analisar as repercussões da obesidade materna sobre os níveis e as ações da melatonina e do cortisol no colostro e leite materno. Método: foi realizada uma revisão sistematizada da literatura científica seguindo as recomendações do protocolo Prisma. Foram pesquisados artigos originais, publicados em inglês, nas bases de dados PubMed, Medline, Lilacs e Scopus. Não houve restrição quanto ao ano de publicação. Resultados: foram identificados 37 artigos nas bases de dados pesquisados, 15 artigos foram excluídos por estarem duplicados, após aplicação do critério de inclusão e exclusão apenas 5 estudos tiveram relação ao tema, sendo 2 estudos abordando sobre melatonina e 3 pesquisas que analisaram o cortisol. Esta revisão mostrou que a melatonina está elevada em colostro de obesas e para este grupo ela possui potencial de restaurar atividade de fagócitos e de elevar a proliferação de linfócitos. Os estudos sobre o cortisol ilustraram que os níveis deste hormônio no leite materno não foram alterados pela obesidade materna. Conclusão: o aleitamento materno deve ser encorajado para todos os públicos, assim como mais pesquisas originais devem ser desenvolvidas para descrever os mecanismos protetores do colostro e leite materno