Revisão Integrativa: amenorreia lactacional como método contraceptivo para puérperas

Este estudo tem como objetivo analisar as evidências científicas na literatura sobre o método da amenorreia lactacional como contraceptivo para puérperas. Trata-se de um estudo bibliográfico, tipo revisão integrativa, realizado através de busca sistemática no mês de março na BVS, nas bases de dados LILACS, MEDLINE, BDENF e no SCIELO com os descritores em saúde. A amostra foi composta por artigos originais na íntegra, publicados entre o ano de 2002 e 2018, em idioma português, inglês e espanhol, apresentada em figura e analisada de forma descritiva. Foi obtido um total de 508 artigos, após inserir os critérios de inclusão e realizar a análise de elegibilidade, obtiveram-se seis artigos para revisão. Diante da análise do estudo foi possível observar que este método contraceptivo pode ser empregado de forma segura durante o puerpério, levando a contracepção e extensão do período da amamentação, mas existe uma grande dificuldade em estabelecê-lo, pois, o desconhecimento da ação contraceptiva é a principal barreira para sua utilização, observa-se a necessidade do aprimoramento científico dos profissionais de saúde para realizar sua indicação.

O manejo da sífilis gestacional no pré-natal / The management of gestational syphilis in the prenatal

Objetivo: analisar o manejo da sífilis gestacional durante a assistência pré-natal. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, desenvolvido por meio de uma pesquisa sistemática na BVS com os descritores em saúde, nas bases de dados LILACS, MEDLINE e BDENF durante o mês de junho. Selecionaram-se artigos originais na íntegra; em português, inglês e espanhol; publicados entre 2017 a 2019. Utilizou-se o CASP para análise de elegibilidade dos estudos, apresentando-os em forma de figuras e analisando-os-de maneira descritiva. Resultados: encontraram-se 303 artigos e, após filtrá-los com os critérios de elegibilidade, sete artigos foram selecionados para esta revisão. Conclusão: certifica-se de que o manejo da sífilis gestacional foi realizado inadequadamente na maioria dos estudos analisados devido ao diagnóstico e ao tratamento tardios, não adesão ao tratamento, pela gestante e pelo parceiro, número reduzido de consultas pré-natais, insegurança profissional de realizar os esquemas terapêuticos e problemas organizacionais dos serviços de saúde. Percebe-se a necessidade de implementar medidas mais eficazes no contexto profissional e melhoria dos serviços de saúde para a realização do manejo adequado.(AU)

Objective: to analyze the management of gestational syphilis during prenatal care. Method: this is a bibliographic study, type integrative review, developed through a systematic search in the VHL with the health descriptors, in the databases LILACS, MEDLINE and BDENF during the month of June. Original articles in full were selected; in Portuguese, English and Spanish; published between 2017 and 2019. CASP was used to analyze the eligibility of studies, presenting them in the form of figures and analyzing them in a descriptive manner. Results: 303 articles were found and, after filtering them with the eligibility criteria, seven articles were selected for this review. Conclusion: it makes sure that the management of gestational syphilis was performed inappropriately in most studies analyzed due to late diagnosis and treatment, non-adherence to treatment, by the pregnant woman and her partner, reduced number of prenatal consultations, professional insecurity of carry out the therapeutic schemes and organizational problems of health services. It is perceived the need to implement more effective measures in the professional context and improvement of health services to carry out the appropriate management.(AU)

Objetivo: analizar el manejo de la sífilis gestacional durante la atención prenatal. Método: es un estudio bibliográfico, tipo revisión integradora, desarrollado a través de una búsqueda sistemática en la BVS con los descriptores de salud, en las bases de datos LILACS, MEDLINE y BDENF durante el mes de junio. Se seleccionaron artículos originales completos; en portugués, inglés y español; publicado entre 2017 y 2019. Se utilizó el CASP para analizar la elegibilidad de los estudios, presentándolos en forma de cifras y analizándolos de manera descriptiva. Resultados: se encontraron 303 artículos y, después de filtrarlos con los criterios de elegibilidad, se seleccionaron siete artículos para esta revisión. Conclusión: se asegura de que el manejo de la sífilis gestacional se realizó de manera inapropiada en la mayoría de los estudios analizados debido a un diagnóstico y tratamiento tardíos, la no adherencia al tratamiento, por parte de la mujer embarazada y su pareja, un número reducido de consultas prenatales, inseguridad profesional de llevar a cabo los esquemas terapéuticos y los problemas organizacionales de los servicios de salud. Se percibe la necesidad de implementar medidas más efectivas en el contexto profesional y la mejora de los servicios de salud para llevar a cabo la gestión adecuada.(AU)

Resistance training and L-arginine supplementation are determinant in genomic stability, cardiac contractility and muscle mass development in rats.

L-arginine supplementation has been related to increased maximum strength and improvement of hemodynamic parameters in several diseases. The aim of our study was to evaluate the effect of L-arginine supplementation and resistance training on muscle mass, hemodynamic function and DNA damage in healthy rats subjected to a low-arginine concentration diet. Twenty three Wistar rats (290-320g) were divided into 4 groups: Sedentary (SED-Arg, n = 6), Sedentary+Arg (SED+Arg, n = 6), Resistance Training (RT-Arg, n = 5), Resistance Training+Arg (RT+Arg, n = 6). Trained animals performed resistance training protocol in a squat apparatus adapted for rats (4 sets of 10-12 repetitions, 90s of interval, 4x/week, 65-75% of One Maximum Repetition, for 8 weeks). Comet assay was performed to measure DNA damage in leukocytes. The resistance training induced higher muscle mass in trained groups. The L-arginine supplementation increased both gastrocnemius and left ventricle to body mass ratio and increased left ventricle contractility without changing hemodynamic variables. The SED+Arg group showed higher concentration of extracellular heat shock protein 72 (eHSP72) and total testosterone, as well as lower uric acid concentration in blood versus SED-Arg group. The administration of isolated L-arginine supplementation and its association with resistance training promoted less damage in leukocytes DNA. In conclusion, the L-arginine supplementation showed synergistic effect with resistance training regarding leukocyte genomic stability in a low-L-arginine diet scenario.

Functional capacity in a rat model of heart failure: impact of myocardial infarct size.

NEW FINDINGS: What is the central question of this study? To the best of our knowledge, no studies have evaluated oxygen uptake, carbon dioxide production and exercise tolerance in rats that have undergone myocardial infarction classified by myocardial infarct (MI) size. What is the main finding and its importance? Oxygen uptake and exercise intolerance are MI size dependent, and classification based on MI size can distinguish rats with functional capacity impairment. Rats with a large MI (>40% of the left ventricle) might provide a good model for the testing of new therapies that have the potential to modify the variables of functional capacity. Oxygen uptake (V̇O2) and exercise tolerance in rats classified by myocardial infarct (MI) size are underexplored. The aim of this study was to evaluate V̇O2, carbon dioxide production (V̇CO2) and exercise tolerance in rats that had undergone myocardial infarction. Fourteen weeks after myocardial infarction or sham surgery, rats underwent an integrated approach to evaluation of left ventricular function and V̇O2/V̇O2V̇CO2V̇CO2, exercise tolerance and skeletal muscle weight. Based on determination of MI size, rats were assigned to sham-operated controls (Sham, n = 12), small myocardial infarction (SMI, n = 8) and large myocardial infarction (LMI, n = 5) groups. The LMI rats showed lower systolic (ejection fraction and fractional shortening) and diastolic (E/A ratio) left ventricular function compared with SMI. Maximal V̇O2 (∼24%, P < 0.05), V̇O2 reserve (∼30%, P < 0.05), time to exhaustion (∼36%, P < 0.05) and maximal velocity (∼30%, P < 0.05) were lower in LMI compared with sham-operated control animals, with no difference between SMI rats and sham-operated controls. Maximal V̇CO2 and respiratory exchange ratio showed no significant difference between MI rats and sham-operated control rats. The LMI rats demonstrated lower gastrocnemius weight (∼12%, P < 0.05) and soleus weight (∼19%, P = 0.07) compared with sham-operated control rats. Significant correlations between MI size, left ventricular end-diastolic pressure, right ventricle hypertrophy, pulmonary congestion, ejection fraction and fractional shortening with maximal V̇O2 and distance run were observed. Oxygen uptake and exercise intolerance are MI size dependent.

High-intensity resistance training alone or combined with aerobic training improves strength, heart function and collagen in rats with heart failure.

BACKGROUND: Resistance training (RT) has been associated with positive responses in patients with cardiovascular disease, and when it is combined with continuous aerobic training (CAT), favorable adaptations appear to be even more pronounced. However, the effects of high-intensity RT alone or in combined with CAT in the case of heart failure (HF) is not completely elucidated. METHODS: 28 male Wistar rats with HF (90 days old) were allocated to 4 groups: high-intensity RT (RT, n=7), CAT (CAT, n=7), RT and CAT (RT+CAT, n=7) and sedentary (Sed, n=7). Trained animals were subjected to a RT protocol in an adapted squat apparatus for rats (4 bouts, 6-8 reps, 90 s interval, 3×/week, 75% to 85% of one maximum repetition (1RM) for 8 weeks). The animals subjected to CAT performed it 3×/week during 50 min/session at 16 m/min. The animals of the combined exercise regimen performed both the RT and CAT exercise protocols. RESULTS: The left ventricular end-diastolic pressure (LVEDP), collagen volume fraction and right ventricular hypertrophy were lower in RT, CAT and RT+CAT groups when compared to Sed group (P<0.05) for all outcomes. Regarding the inflammatory profile, only the CAT group showed greater IL-10 concentrations. CONCLUSION: We concluded that RT combined with CAT was able to improve the strength in animals with HF, which was associated to improvement in ventricular structure and function.

Maximal oxygen uptake and exercise tolerance are improved in rats with heart failure subjected to low-level laser therapy associated with resistance training.

Exercise tolerance and maximal oxygen uptake (VO2max) are reduced in heart failure (HF). The influence of combined resistance training (RT) and low-level laser therapy (LLLT) on exercise tolerance and VO2max in HF has not yet been explored. The aim of this study was to evaluate the influence of combined RT and LLLT on VO2max and exercise tolerance in rats with HF induced by myocardial infarction (MI). Rats were allocated to sedentary sham (Sed-Sham, n = 12), sedentary heart failure (Sed-HF, n = 9), RT heart failure (RT-HF, n = 7) and RT associated with LLLT heart failure (RT + LLLT-HF, n = 7) groups. After MI or sham surgery, rats underwent a RT and LLLT protocol (applied immediately after RT) for 8 weeks. VO2max and exercise tolerance were evaluated at the end of protocol. HF rats subjected to LLLT combined with RT showed higher VO2basal (41 %), VO2max (40 %), VO2reserve (39 %), run distance (46 %), time to exhaustion (30 %) and maximal velocity (22 %) compared with HF rats that underwent RT alone. LLLT associated with RT improved oxygen uptake and exercise tolerance compared with RT alone in HF rats.

Interval and continuous exercise enhances aerobic capacity and hemodynamic function in CHF rats.

OBJECTIVE: The aim of the present study was to compare the effects of continuous versus interval aerobic exercise training on hemodynamic parameters, cardiac remodeling, and maximal exercise capacity (MEC) in chronic heart failure (CHF) rats. METHOD: Twenty-four male Wistar rats were subjected to myocardial infarction (MI) surgery. Five weeks post MI, the animals were assigned to one of three groups: sedentary group (CHF-Sed, n=8), aerobic continuous training group (CHF-ACT, n=8), and aerobic interval training group (CHF-AIT, n=8). Treadmill training was performed five times a week for 8 weeks (ACT: 50 min/day at 15 m/min and AIT: 40 min/day with 8 min of warm-up at 10 m/min and exercise at 15 m/min 4×4 min interspersed with 4×4 min at 23 m/min). MEC was evaluated pre and post exercise program. RESULTS: Left ventricular end-diastolic pressure (LVEDP), left ventricular mass/body mass ratio (LVM:BM), and total collagen volume fraction were lower in the trained groups compared with the sedentary group, but no difference was found between the trained groups. Systolic ventricular pressure (SVP) and maximum positive derivative of LV pressure (+dP/dtmax) were higher in the trained groups, but CHF-ACT showed higher +dP/dt(max) compared to CHF-AIT. Both training regimens were able to increase MEC. However, the aerobic interval training was superior for improving MEC. CONCLUSION: Aerobic training is an important intervention to improve cardiac function and remodeling and physical capacity in CHF rats. Interval training is a potential strategy to maximize the results, but exercise type and intensity are still topics to be explored.

Interval and continuous exercise enhances aerobic capacity and hemodynamic function in CHF rats

OBJECTIVE: The aim of the present study was to compare the effects of continuous versus interval aerobic exercise training on hemodynamic parameters, cardiac remodeling, and maximal exercise capacity (MEC) in chronic heart failure (CHF) rats.METHOD: Twenty-four male Wistar rats were subjected to myocardial infarction (MI) surgery. Five weeks post MI, the animals were assigned to one of three groups: sedentary group (CHF-Sed, n=8), aerobic continuous training group (CHF-ACT, n=8), and aerobic interval training group (CHF-AIT, n=8). Treadmill training was performed five times a week for 8 weeks (ACT: 50 min/day at 15 m/min and AIT: 40 min/day with 8 min of warm-up at 10 m/min and exercise at 15 m/min 4×4 min interspersed with 4×4 min at 23 m/min). MEC was evaluated pre and post exercise program.RESULTS: Left ventricular end-diastolic pressure (LVEDP), left ventricular mass/body mass ratio (LVM:BM), and total collagen volume fraction were lower in the trained groups compared with the sedentary group, but no difference was found between the trained groups. Systolic ventricular pressure (SVP) and maximum positive derivative of LV pressure (+dP/dtmax) were higher in the trained groups, but CHF-ACT showed higher +dP/dtmax compared to CHF-AIT. Both training regimens were able to increase MEC. However, the aerobic interval training was superior for improving MEC.CONCLUSION: Aerobic training is an important intervention to improve cardiac function and remodeling and physical capacity in CHF rats. Interval training is a potential strategy to maximize the results, but exercise type and intensity are still topics to be explored.

Resistance training improves hemodynamic function, collagen deposition and inflammatory profiles: experimental model of heart failure.

The role of resistance training on collagen deposition, the inflammatory profile and muscle weakness in heart failure remains unclear. Therefore, this study evaluated the influence of a resistance training program on hemodynamic function, maximum strength gain, collagen deposition and inflammatory profile in chronic heart failure rats. Thirty-two male Wistar rats submitted to myocardial infarction by coronary artery ligation or sham surgery were assigned into four groups: sedentary sham (S-Sham, n = 8); trained sham (T-Sham, n = 8); sedentary chronic heart failure (S-CHF, n = 8) and trained chronic heart failure (T-CHF, n = 8). The maximum strength capacity was evaluated by the one maximum repetition test. Trained groups were submitted to an 8-week resistance training program (4 days/week, 4 sets of 10-12 repetitions/session, at 65% to 75% of one maximum repetition). After 8 weeks of the resistance training program, the T-CHF group showed lower left ventricular end diastolic pressure (P<0.001), higher left ventricular systolic pressure (P<0.05), higher systolic blood pressure (P<0.05), an improvement in the maximal positive derivative of ventricular pressure (P<0.05) and maximal negative derivative of ventricular pressure (P<0.05) when compared to the S-CHF group; no differences were observed when compared to Sham groups. In addition, resistance training was able to reduce myocardial hypertrophy (P<0.05), left ventricular total collagen volume fraction (P<0.01), IL-6 (P<0.05), and TNF-α/IL-10 ratio (P<0.05), as well as increasing IL-10 (P<0.05) in chronic heart failure rats when compared to the S-CHF group. Eight weeks of resistance training promotes an improvement of cardiac function, strength gain, collagen deposition and inflammatory profile in chronic heart failure rats.

Effect of prior exercise training and myocardial infarction-induced heart failure on the neuronal and glial densities and the GFAP-immunoreactivity in the posterodorsal medial amygdala of rats.

Exercise training has neuroprotective effects whereas myocardial infarction (MI) and heart failure (HF) can cause neuronal death and reactive gliosis in the whole amygdala. The posterodorsal medial amygdala (MePD) is involved with cardiovascular reflexes and the central control of sympathetic/parasympathetic responses. Our aim was to study the effects of prior exercise training and of MI-induced HF on the neuronal and glial densities and the glial fibrillary acidic protein-immunoreactivity (GFAP-ir) in the MePD of adult male rats. Animals (n= 5/group) were: control, sedentary submitted to a sham MI (Sed Sham), sedentary submitted to MI/HF (Sed HF), trained on a treadmill and submitted to a sham MI (T Sham) or trained on a treadmill and submitted to MI/HF (T HF). The number of neurons and glial cells in the MePD was estimated using the optical fractionator and the GFAP-ir was quantified by optical densitometry. In the respective groups, treadmill training improved physical performance and MI damaged near 40% of the left ventricle. There was a hemispheric lateralization effect on the density of neurons (higher in the right MePD), but no significant difference in either the neuronal or the glial densities due to experimental condition. Regional GFAP-ir results revealed that the Sed HF group had a higher expression in the left MePD compared to the control and the Sed Sham rats (p⟨0.01). The present data did not evidence the effects of training or MI/HF in the MePD cellular density, but indicate a possible local restructuring of astrocytic cytoskeleton after MI/HF in rats.

Effects of creatine supplementation associated with resistance training on oxidative stress in different tissues of rats.

BACKGROUND: Creatine supplementation is known to exert an effect by increasing strength in high intensity and short duration exercises. There is a hypothesis which suggests that creatine supplementation may provide antioxidant activity by scavenging Reactive Oxygen Species. However, the antioxidant effect of creatine supplementation associated with resistance training has not yet been described in the literature. Therefore, we investigated the effect of creatine monohydrate supplementation associated with resistance training over maximum strength gain and oxidative stress in rats. METHODS: Forty male Wistar rats (250-300 g, 90 days old) were randomly allocated into 4 groups: Sedentary (SED, n = 10), Sedentary + Creatine (SED-Cr, n = 10), Resistance Training (RT, n = 10) and Resistance Training + Creatine (RT-Cr, n = 10). Trained animals were submitted to the RT protocol (4 series of 10-12 repetitions, 90 second interval, 4 times per week, 65% to 75% of 1MR, for 8 weeks). RESULTS: In this study, greater strength gain was observed in the SED-Cr, RT and RT-Cr groups compared to the SED group (P < 0.001). The RT-Cr group showed a higher maximum strength gain when compared to other groups (P < 0.001). Creatine supplementation associated with resistance training was able to reduce lipoperoxidation in the plasma (P < 0.05), the heart (P < 0.05), the liver (P < 0.05) and the gastrocnemius (P < 0.05) when compared to control groups. However, the supplementation had no influence on catalase activity (CAT) in the analyzed organs. Only in the heart was the CAT activity higher in the RT-Cr group (P < 0.05). The activity of superoxide dismutase (SOD) was lower in all of the analyzed organs in the SED-Cr group (P < 0.05), while SOD activity was lower in the trained group and sedentary supplemented group (P < 0.05). CONCLUSIONS: Creatine was shown to be an effective non-enzymatic antioxidant with supplementation alone and also when it was associated with resistance training in rats.

Effects of resistance training associated with whey protein supplementation on liver and kidney biomarkers in rats.

The aim of this study was to investigate the impact of whey protein (WP) supplementation and resistance training (RT) on liver and kidney biomarkers. The sedentary + WP group showed higher levels of plasma liver and kidney dysfunction markers compared with the other groups. In addition, WP supplementation associated with RT resulted in physiologic cardiac hypertrophy. WP supplementation without RT affected liver and kidney function.

Aerobic exercise improves the inflammatory profile correlated with cardiac remodeling and function in chronic heart failure rats.

OBJECTIVE: The aim of the present study was to evaluate the effect of 8 weeks of aerobic exercise training on cardiac functioning and remodeling and on the plasma levels of inflammatory cytokines in chronic heart failure rats. METHODS: Wistar rats were subjected to myocardial infarction or sham surgery and assigned to 4 groups: chronic heart failure trained (n=7), chronic heart failure sedentary (n=6), sham trained (n=8) and sham sedentary (n=8). Four weeks after the surgical procedures, the rats were subjected to aerobic training in the form of treadmill running (50 min/day, 5 times per week, 16 m/min). At the end of 8 weeks, the rats were placed under anesthesia, the hemodynamic variables were recorded and blood samples were collected. Cardiac hypertrophy was evaluated using the left ventricular weight/body weight ratio, and the collagen volume fraction was assessed using histology. RESULTS: The chronic heart failure trained group showed a reduction in left ventricular end-diastolic pressure, a lower left ventricular weight/body weight ratio and a lower collagen volume fraction compared with the chronic heart failure sedentary group. In addition, exercise training reduced the plasma levels of TNF-α and IL-6 and increased the plasma level of IL-10. CONCLUSION: An 8-week aerobic exercise training program improved the inflammatory profile and cardiac function and attenuated cardiac remodeling in chronic heart failure rats.

Aerobic exercise improves the inflammatory profile correlated with cardiac remodeling and function in chronic heart failure rats

OBJECTIVE: The aim of the present study was to evaluate the effect of 8 weeks of aerobic exercise training on cardiac functioning and remodeling and on the plasma levels of inflammatory cytokines in chronic heart failure rats. METHODS: Wistar rats were subjected to myocardial infarction or sham surgery and assigned to 4 groups: chronic heart failure trained (n = 7), chronic heart failure sedentary (n = 6), sham trained (n = 8) and sham sedentary (n = 8). Four weeks after the surgical procedures, the rats were subjected to aerobic training in the form of treadmill running (50 min/day, 5 times per week, 16 m/min). At the end of 8 weeks, the rats were placed under anesthesia, the hemodynamic variables were recorded and blood samples were collected. Cardiac hypertrophy was evaluated using the left ventricular weight/body weight ratio, and the collagen volume fraction was assessed using histology. RESULTS: The chronic heart failure trained group showed a reduction in left ventricular end-diastolic pressure, a lower left ventricular weight/body weight ratio and a lower collagen volume fraction compared with the chronic heart failure sedentary group. In addition, exercise training reduced the plasma levels of TNF-α and IL-6 and increased the plasma level of IL-10. CONCLUSION: An 8-week aerobic exercise training program improved the inflammatory profile and cardiac function and attenuated cardiac remodeling in chronic heart failure rats. .