Does the Quality of Postpartum Hemorrhage Local Protocols Improve the Identification and Management of Blood Loss after Vaginal Deliveries? A Multicenter Cohort Study.

Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February−July 2011), and an audit of the written protocols (177 French maternity units; September 2010−June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0−8), category 2 (9−12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60−0.86 and 0.77, 95% CI 0.68−0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures.

Risk Factors and Comorbidities Associated with Diabetic Kidney Disease.

INTRODUCTION/OBJECTIVES: Diabetic Kidney Disease (DKD) is the leading cause of end-stage kidney disease. Despite optimal glycemic control and blood pressure management, progression to DKD cannot be halted in some patients. We aimed to find the association of modifiable and non-modifiable risk factors and comorbid conditions in patients with DKD. METHODS: Retrospective medical record review of adult patients with diabetes mellitus (DM) was performed who visited our internal medicine office between January 1, 2020 and December 31, 2020. RESULTS: Among 728 patients with DM, 471 (64.7%) patients had DKD, and 257 (35.3%) patients were without DKD. Among the group of patients with DKD, the majority were in CKD stage G1A2 (34.6%), followed equally by G2A2 and G3aA1 (16.8% each). Mean age of the patients with DKD was significantly greater than the patients without DKD (69.4 years vs 62.2 years; P < .001). For each unit increase in age, there was a 7.8% increase in the odds of DKD (95% CI 5.3-10.4; P < .001). Women had 2.32 times greater odds of DKD (95% CI, 1.41-3.81; P = .001). We found decreased odds of DKD for those who consumed alcohol moderately (OR 0.612, 95% CI 0.377-0.994; P < .05). Significantly higher frequencies of associations of several comorbid medical conditions were seen in patients with DKD compared to the patients without DKD, such as hypertension (91.9% vs 75.6%), hyperlipidemia (86.6% vs 78.2%), coronary artery disease (39.3% vs 16.8%), cerebrovascular accidents (13.4% vs 7.4%), congestive heart failure (12.9% vs 4.1%), carotid artery stenosis (11.3% vs 2.6%), aortic aneurysm (5.4% vs 2.0%), peripheral artery disease (10.8% vs 3.5%), gout (12.4% vs 5.5%), and osteoarthritis (41.4% vs 31.2%). CONCLUSIONS: In patients with diabetes, increasing age, female sex, and lack of moderate alcohol consumption were associated with increased odds of DKD. Higher frequencies of association of hypertension, hyperlipidemia, coronary artery disease, cerebrovascular accidents, congestive heart failure, carotid artery stenosis, aortic aneurysm, peripheral artery disease, gout, and osteoarthritis were also seen in patients with DKD.

Estudo das prevalências de distúrbios metabólicos em pacientes obesos e em portadores de hepatite C / Study of prevalence of metabolic disorders in obese patients and in patients with hepatitis C

Introdução: a infecção crônica pelo vírus da hepatite C (HCV) e a obesidade podem induzir esteatose hepática e diabetes mellitus (DM). Objetivo: avaliar a prevalência de obesidade e de distúrbios metabólicos em pacientes com HCV; estudar a prevalência de HCV e os distúrbios metabólicos em pacientes obesos. Comparar o perfil glicêmico entre os grupos. Metodologia: estudo analítico, com pacientes acompanhados nos ambulatórios de Hepatite C e Obesidade. Variáveis analisadas: glicemia, hemoglobina glicada (A1C), esteatose hepática, HCV, estágio de fibrose hepática e dados sociodemográficos. Resultados: no ambulatório de obesidade 45 pacientes foram avaliados, dos quais 6,7% tinham hepatite C, 40% DM e 61-73% esteatose hepática. As médias das enzimas hepáticas (U/L) foram: AST 22,9; ALT 25,2; FAL 146,5 e GGT 63. Nos obesos com DM, 72,2% apresentavam A1C < 7%. A segunda amostra continha 159 portadores de HCV do ambulatório de hepatologia: 17,9% tinham obesidade, 18,9% DM e 27% esteatose hepática. As médias das enzimas hepáticas (U/L) consistiram em: AST 70,5; ALT 90,6; FAL 108,5 e GGT 131,7. Entre os diabéticos com HCV, 52% não apresentavam A1C < 7%. Conclusão: foi encontrada alta prevalência de hepatite C em pacientes com obesidade (6,7%) quando comparados com a população de Salvador (1,5-1,8%). Os distúrbios metabólicos foram mais frequentes entre obesos, porém os diabéticos com obesidade revelaram A1C menores do que os diabéticos com HCV, sugerindo, neste estudo, que pode existir interferência viral no controle glicídico. A esteatose hepática foi mais prevalente entre obesos.

Introduction: Hepatitis C virus infection (HCV) and Obesity can to induce hepatic steatosis and diabetes mellitus (DM). Objectives: to evaluate the prevalence of obesity and metabolic disorders in HCV viremic patients. To study the prevalence of hepatitis C and metabolic disorders in patients with obesity. To compare glycemic profile between the groups. Methods: analytical study, with patients followed up at hepatitis C and Obesity outpatient clinics patients. Variables studied: blood glucose, glycated hemoglobin (A1C), hepatic steatosis, HCV, hepatic fibrosis stage and sociodemographic data. Results: in Obesity clinic sample 45 patients were evaluated, 6,7% was hepatitis C, 40% DM and 61% -73% hepatic steatosis. Mean of liver enzymes levels (U/L) were: AST 22.9; ALT 25.2; FAL 146.5 and GGT 63. In obese with DM, 72.2% of them were able to maintain A1C < 7%. The second sample contained 159 HCV carriers at the hepatology clinic, 17,9% was Obesity, 18,9% DM and 27% hepatic steatosis. Averages of serum liver enzymes level (U/ L) were: AST 70.5; ALT 90.6; FAL 108.5 and GGT 131.7. Among diabetics with HCV, 52% are unable to maintain A1C < 7%. Conclusions: found high prevalence of hepatitis C in patients with obesity (6.7%) when compared to the population of Salvador (1.5%-1.8%). Metabolic disorders were more frequent in the obese group, but diabetics with obesity have lower A1C values than diabetics with HCV, suggesting, in this study, that there may be a viral interference with glycid control. Liver steatosis is more prevalent among obese people

Alterations in nicotinic receptor alpha5 subunit gene differentially impact early and later stages of cocaine addiction: a translational study in transgenic rats and patients.

Cocaine addiction is a chronic and relapsing disorder with an important genetic component. Human candidate gene association studies showed that the single nucleotide polymorphism (SNP) rs16969968 in the α5 subunit (α5SNP) of nicotinic acetylcholine receptors (nAChRs), previously associated with increased tobacco dependence, was linked to a lower prevalence of cocaine use disorder (CUD). Three additional SNPs in the α5 subunit, previously shown to modify α5 mRNA levels, were also associated with CUD, suggesting an important role of the subunit in this pathology. To investigate the link between this subunit and CUD, we submitted rats knockout for the α5 subunit gene (α5KO), or carrying the α5SNP, to cocaine self-administration (SA) and showed that the acquisition of cocaine-SA was impaired in α5SNP rats while α5KO rats exhibited enhanced cocaine-induced relapse associated with altered neuronal activity in the nucleus accumbens. In addition, we observed in a human cohort of patients with CUD that the α5SNP was associated with a slower transition from first cocaine use to CUD. We also identified a novel SNP in the ß4 nAChR subunit, part of the same gene cluster in the human genome and potentially altering CHRNA5 expression, associated with shorter time to relapse to cocaine use in patients. In conclusion, the α5SNP is protective against CUD by influencing early stages of cocaine exposure while CHRNA5 expression levels may represent a biomarker for the risk to relapse to cocaine use. Drugs modulating α5 containing nAChR activity may thus represent a novel therapeutic strategy against CUD.

Impact of Correcting Nutritional Deficiency Anemias in the Elderly on Hospitalizations, Falls, and Mortalities.

BACKGROUND: The incidence and prevalence of anemia increase with age, particularly in adults older than 65 years, and it is associated with a number of adverse health outcomes (AHO), particularly hospitalizations, falls and mortalities. Given that approximately one-third of these anemias are due to reversible causes, we studied whether the treatment of nutritional deficiency anemia (NDA), namely iron deficiency anemia (IDA), cobalamin deficiency anemia (CDA), and folate deficiency anemia (FDA), improves AHO; and explored whether each NDA had different AHO. METHODS: We reviewed electronic medical records of our internal medicine office patients aged 65 years or older, who had a diagnosis of anemia in a non-acute setting. RESULTS: Total 600 patients were included. Mean age was 75.2 years. Thirty-one point three percent had NDA (CDA 15.3%, IDA 12.3%, FDA 3.7%); and 68.7% had other anemias whom we categorized as non-nutritional deficiency anemias (NNDA), which included anemia of chronic disease (11.2%), myelodysplastic syndrome (6.2%), renal insufficiency anemia (5.7%) and unexplained anemia (45.6%). Even after adequate treatment, IDA group had significantly more hospitalizations (median, 25th - 75th: 2 (0 - 4) vs. 0 (0 - 1), P < 0.001), falls (median, 25th - 75th: 1 (0 - 3) vs. 0 (0 - 1), P < 0.001) and mortalities (10.8% vs. 3.4%, P = 0.011); CDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.007), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.171) and mortalities (7.6% vs. 3.4%, P = 0.083); and FDA group had significantly more hospitalizations (median, 25th - 75th: 1 (0 - 2) vs. 0 (0 - 1), P = 0.001), but no difference in falls (median, 25th - 75th: 0 (0 - 1) vs. 0 (0 - 1), P = 0.615) and mortalities (4.5% vs. 3.4%, P = 0.550), compared to the NNDA group. Age, Black race, higher number of comorbidities, presence of malignancy and use of direct oral anticoagulants were associated with increased odds of AHO in patients with NDA. CONCLUSIONS: Compared to the patients with NNDA, patients with IDA had more hospitalizations, falls and mortalities even after adequate treatment; while patients with CDA and FDA had only more hospitalizations. Adequate treatment mitigated falls and mortalities in elderly patients with CDA and FDA.

A French audit of maternity unit protocols for immediate postpartum hemorrhage: A cross-sectional study (HERA).

OBJECTIVES: The principal objective of this work was to assess how well the written protocols of maternity units used for the prevention and management of postpartum hemorrhage (PPH) corresponded to the 2004 French guidelines on this topic. The second objective was to assess whether or not this correspondence with the national guidelines varied according to hospital level (basic, specialized, and subspecialized) and status (teaching, public, and private). METHODS: This observational multicenter cross-sectional study took place in September 2010 and included French perinatal networks that volunteered to participate. We asked 300 French maternity units belonging to these networks to participate by emailing a copy of their department's protocol for PPH to the study team. This team designed and performed a clinical audit of these protocols, defining 16 criteria that incorporated the 2004 French guidelines for prevention and management of PPH. The main outcome measure was the percentage of units reporting protocols meeting these criteria. RESULTS: Of the 244 maternity units responding, 97.1 % had a written protocol but only 67.0 % had a local protocol. Protocol correspondence with the 2004 French guidelines was good for the criteria involving quantitative assessment of the quantity of blood loss (83.5 %) and secondary management of PPH (>80 %). Correspondence with the guidelines was poor in terms of defining PPH in the protocol (25.3 %) and of requiring the recording of the time of PPH diagnosis (53.2 %) and of the volume of blood loss (55.7 %). These results differed only slightly according to maternity unit status or level. CONCLUSION: In all, 67.0 % (159/237) of maternity units had a local protocol for PPH. The contents of these protocols should be improved to be closer to the national guidelines.

Individual and household correlates of Helicobacter pylori infection among Young Ethiopian children in Ziway, Central Ethiopia.

BACKGROUND: Investigating distinct individual- and household-level risk factors for acquiring Helicobacter pylori (H. pylori) infection can inform disease prevention efforts and implicate possible routes of transmission. This study determined the magnitude of H. pylori infection among schoolchildren in Ziway, central Ethiopia and identified personal and household correlates of H. pylori infection in young Ethiopian children. METHODS: A total of 434 schoolchildren participated in this cross-sectional study. Infection status was assessed using antigen and antibody rapid tests. Demographic and lifestyle information was obtained from parents via an interviewer-led questionnaire. Univariate and multivariate logistic regressions were performed to assess the relationships between potential individual- and household-level risk factors and H. pylori infection. RESULTS: The prevalence of H. pylori infection was 65.7% (285/434). Of the personal variables assessed, the age group 10-14 years was found to be significantly associated with higher odds of H. pylori infection in univariate analysis (COR = 2.22, 95% CI: 1.06-4.66, p = 0.03) and remained positively correlated after adjusting for confounding factors. Of the household-level factors explored, having a traditional pit or no toilet was found to be significantly associated with 3.93-fold higher odds of H. pylori infection (AOR = 3.93, 95% CI: 1.51-10.3, p = 0.01), while the presence of smokers in the household was associated with 68% lower odds of infection (AOR = 0.32, 95% CI: 0.11-0.89, p = 0.03). CONCLUSION: This study from a developing country provides additional evidence for older age as a personal risk factor for H. pylori infection and identifies correlations between socioeconomic and sanitation household factors and positive childhood infection status. The associations reported here support the hypothesized fecal-oralroute of transmission for H. pylori.

Can cocaine-induced neuroinflammation explain maladaptive cocaine-associated memories?

Persistent and intrusive memories define a number of psychiatric disorders, including posttraumatic stress disorder and substance use disorder. In the latter, memory for drug-paired cues plays a critical role in sustaining compulsive drug use as these are potent triggers of relapse. As with many drugs, cocaine-cue associated memory is strengthened across presentations as cues become reliable predictors of drug availability. Recently, the targeting of cocaine-associated memory through disruption of the reconsolidation process has emerged as a potential therapeutic strategy; reconsolidation reflects the active process by which memory is re-stabilized after retrieval. In addition, a separate line of work reveals that neuroinflammatory markers, regulated by cocaine intake, play a role in memory processes. Our review brings these two literatures together by summarizing recent findings on cocaine-associated reconsolidation and cocaine-induced neuroinflammation. We discuss the interactions between reconsolidation processes and neuroinflammation following cocaine use, concluding with a new perspective on treatment to decrease risk of relapse to cocaine use.

Profound alteration in reward processing due to a human polymorphism in CHRNA5: a role in alcohol dependence and feeding behavior.

Human genetic variation in the nicotinic receptor gene cluster CHRNA5/A3/B4, in particular the non-synonymous and frequent CHRNA5 variant rs16969968 (α5SNP), has an important consequence on smoking behavior in humans. A number of genetic association studies have additionally implicated the CHRNA5 gene in addictions to other drugs, and also body mass index (BMI). Here, we model the α5SNP, in a transgenic rat line, and establish its role in alcohol dependence, and feeding behavior. Rats expressing the α5SNP consume more alcohol, and exhibit increased relapse to alcohol seeking after abstinence. This high-relapsing phenotype is reflected in altered activity in the insula, linked to interoception, as established using c-Fos immunostaining. Similarly, relapse to food seeking is increased in the transgenic group, while a nicotine treatment reduces relapse in both transgenic and control rats. These findings point to a general role of this human polymorphism in reward processing, and multiple addictions other than smoking. This could pave the way for the use of medication targeting the nicotinic receptor in the treatment of alcohol use and eating disorders, and comorbid conditions in smokers.

Notificações da Hepatite B no Estado da Bahia, Brasil / Notification Hepatitis B in the state of Bahia, Brazil

Introdução: a Hepatite B é um problema de saúde pública no Brasil por ser prevenível. Objetivou-se analisar as associações entre as características individuais, sócio demográficas e os comportamentos de risco com os casos de Hepatite B no estado da Bahia. Metodologia: estudo epidemiológico de corte transversal exploratório. Todos os casos de VHB, notificados em 2014 no Sistema de Informação de Agravos de Notificação (SINAN), foram analisados com testes estatísticos para verificar as associações entre as variáveis. Resultados: a prevalência do VHB, em relação às outras hepatites, foi de 32,6%, atingindo pessoas, principalmente, com média de 37+13,92 anos de idade. Apresentou associação estatisticamente significante com a Hepatite B: o sexo masculino, a escolaridade com ensino médio completo, todas as faixas etárias, vacinação incompleta e não vacinados, fonte de infecção sexual e vertical, exposição a múltiplos parceiros e drogas injetáveis. Conclusão: a Hepatite B esteve associada a fatores individuais, sociodemográficos e comportamentos de risco entre a população estudada. Diante dos resultados percebe-se a necessidade de medidas de prevenção para o VHB, orientações acerca da doença e dos principais meios de infecção, diagnóstico precoce oportuno e a vacinação contra hepatite B em vários ambientes comunitários. É preciso capacitação dos profissionais de saúde para notificação adequada e completa, assim como a vigilância desta infecção para facilitar o planejamento de medidas adequadas de controle e prevenção.

Introduction: Hepatitis B is a major public health problem in Brazil because it is preventable. This study aimed to examine the associations between individual characteristics, socio-demographic and the risk behavior with the cases of Hepatitis B in the state of Bahia. Methodology: epidemiological study of exploratory cross-section. All cases of HBV reported in 2014 in the Notifiable Diseases Information System (SINAN) were analyzed with statistical tests to verify the associations between variables. Results: the prevalence of HBV in relation to other hepatitis, was 32.6%, reaching people, mainly with mean 37 + 13.92 years old. Showed a statistically significant association with hepatitis B: male, education with high school education, all age groups, incompletely vaccinated and unvaccinated, sexual and vertical infection source, exposure to multiple partners and injecting drugs. Conclusion: Hepatitis B has been associated with individual factors, sociodemographic and risk behavior among the study population. Based on the results we see the need for prevention measures for HBV, guidelines about the disease and the main means of infection, appropriate early diagnosis and vaccination against hepatitis B in various community settings. It takes training of health professionals for proper and complete notification and the monitoring of this infection to facilitate the planning of appropriate measures for control and prevention

Cariograma e sua utilização clínica / Cariogram and its clinical utilization

A cárie dentária é uma doença multifatorial, e a combinação “diagnóstico + atendimento precoce” desta doença permite um melhor controle da evolução da mesma. A busca por estratégias preventivas aceitáveis, precisas e de baixo custo, para identificação de indivíduos de alto risco ao acometimento de lesões cariosas, tem sido alvo de inúmeras pesquisas. O cariograma é um método quantitativo que utiliza um programa computadorizado para calcular objetivamente, a partir dos dados inseridos no programa, as chances de se evitar a ocorrência de lesões cariosas. Esses dados podem ser impressos, salvos e utilizados como meio motivacional para discutir, a nivel individual e/ou familiar, o plano de tratamento, ofertado pelo próprio programa. O cariograma oferta uma série de recomendações para a ação preventiva, de acordo com o risco de desenvolvimento de lesões cariosas, de forma individual. A apresentação gráfica, em cores distintas, facilita o entendimento para os pacientes do seu processo saúde/doença cárie, e pode ser usada para motivar o paciente, tornando-o participativo e corresponsável pela sua saúde bucal. Os autores concluíram que o cariograma é uma ferramenta de grande valor, podendo ser utilizada para traçar um perfil de risco individual e/ou global de chances de se evitar a ocorrência de lesões cariosas, propondo a partir dos dados obtidos uma série de medidas preventivas que, se utilizadas corretamente, tentam evitar a ocorrência de cavitações cariosas; entretanto, necessita da capacitação de cirurgiões-dentistas em prol da promoção de saúde.

Avaliação do consumo de fluoreto na merenda escolar: estudo comparativo entre creches de diferentes áreas geodemográficas do estado do Rio de Janeiro, Brasil

Objetivo: avaliar a quantidade diária de fluoreto presente nas refeições de duas creches localizadas em diferentes regiões do Estado do Rio de Janeiro e o impacto das concentrações de fluoreto encontradas nestas refeições. Método: as refeições foram coletadas durante quatro semanas consecutivas (20 dias úteis) em uma creche privada e outra pública do estado do Rio de Janeiro. Todas as refeições oriundas do cardápio de cada creche foram coletadas em caixas plásticas separadamente e todos os alimentos e as bebidas foram homogeneizados em 50 ml de água deionizada. A concentração de fluoreto nas refeições foi determinada pelo método de difusão facilitada por HMDS, usando-se um eletrodo íon-específico (Orion 9609). Os dados foram analisados por Anova e teste de Tukey para comparações individuais (p < 0,05). Resultados: as concentrações de fluoreto analisadas nas refeições (média ± DP) foram de 0,14 ± 0,03 µg/ml na primeira semana, se-guido por 0,17 ± 0,03 µg/ml na segunda semana, 0,11 ± 0,02 µg/ml e 0,13 ± 0,04 µg/ml na terceira e quarta semana, respectivamente. Embora fraca correlação, houve significância estatística (p = 0,0042) entre as refeições das duas creches analisadas. Conclusão: as concentrações de fluoreto presentes nas refeições fornecidas às crianças das duas creches tiveram papel importante na avaliação da ingestão diária deste íon. Torna-se relevante este tipo de análise para que possamos ter como base a ingestão crônica de fluoretos contidos em diferentes tipos de refeições fornecidas às crianças pertencentes ao jardim de infância.

Convênios odontológicos: visão dos cirurgiões-dentistas do Município de Duque de Caxias/RJ / Dental private insurance: vision of The dentists of the city of Duque de Caxias/RJ

O objetivo do presente estudo foi a partir de uma abordagem indutiva, utilizando um questionário fechado nos consultórios dentários que atendem a convênios odontológicos no município de Duque de Caxias (RJ), fazer o levantamento do perfil de relacionamento técnico-profissional entre esses profissionais e as empresas de Planos de Saúde Odontológicos. Dos 74 questionários respondidos, observou-se uma distribuição homogênea de 20% quanto ao tempo de formado, em cada faixa de tempo. O atendimento a mais de um plano de saúde se mostrou mais comum (88% da amostra). O aumento de volume de pacientes se destacou entre os pontos positivos (81%) e falta de clareza, quanto a valores diferenciados entre colegas (89%) e falta de reajuste financeiro e ou pagamento não compatível com o mercado (52%) como principais pontos negativos.

The aim of this study was an inductive approach through a close questionnaire applied in private dental offices that offer dental pre-payment assistance, in order to analyse the working relationship between dentists and private dental insurances in the City of Duque de Caxias (RJ). A sample of 74 questionnaires, were equally distributed (20% each), by graduation time. The attendance to more than one pre-payment oral health company insurance was the most common (88% of the sample). From the positive aspects, the patients increase were most mentioned (81%) and the lack of clarity about the different values paid between colleagues (89%) and lack of financial adjustment or payment not compatible with the market (52%) as the main negative points.

Autopercepção sobre o impacto de saúde bucal na qualidade de vida em pacientes com doença falciforme / Self perception of the impact of oral health in life quality patients with silk cell disease

As estruturas bucais parecem ter um papel fundamental na vida dos indivíduos por estarem associados, funcionalmente, à capacidade de mastigação e alimentação, tornado os indivíduos socialmente aceitáveis do ponto de vista estético e de bem-estar. Dessa forma, a saúde bucal pode influenciar a percepção de qualidade de vida das pessoas. Na população que demanda os serviços de saúde, a relação da saúde bucal com a qualidade de vida precisa ser melhor esclarecida para se identificar as necessidades das pessoas em estabelecer prioridades que levem em consideração a autopercepção de saúde bucal, da qualidade de vida e as subjetividades inerentes ao tema. O objetivo do estudo foi avaliar a percepção da qualidade de vida dos pacientes com doença falciforme que são atendidas na Clínica do Departamento de Odontologia Social e Preventiva da Faculdade de Odontologia da UFRJ. Foi utilizado o instrumento OHIP-14, que avalia limitação funcional, dor física, desconforto psicológico, incapacidade psicológica, física e social e deficiência. Dos 23 entrevistados, a dimensão que apresentou maior impacto na qualidade de vida foi dor física e desconforto psicológico com 30,4% das respostas. A população estudada necessita de atendimento de saúde multiprofissional para melhorar sua qualidade de vida, de saúde bucal e geral, voltando a se sentir socialmente inserido.

Hypertrophy with unilateral resistance exercise occurs without increases in endogenous anabolic hormone concentration.

We aimed to gain insight into the role that the transitory increases in anabolic hormones play in muscle hypertrophy with unilateral resistance training. Ten healthy young male subjects (21.8 +/- 0.4 years, 1.78 +/- 0.04 m, 75.6 +/- 2.9 kg; mean +/- SE) engaged in unilateral resistance training for 8 week (3 days/week). Exercises were knee extension and leg press performed at 80-90% of the subject's single repetition maximum (1RM). Blood samples were collected in the acute period before and after the first training bout and following the last training bout and analyzed for total testosterone, free-testosterone, luteinizing hormone, sex hormone binding globulin, growth hormone, cortisol, and insulin-like growth factor-1. Thigh muscle cross sectional area (CSA) and muscle fibre CSA by biopsy (vastus lateralis) were measured pre- and post-training. Acutely, no changes in systemic hormone concentrations were observed in the 90 min period following exercise and there was no influence of training on these results. Training-induced increases were observed in type IIx and IIa muscle fibre CSA of 22 +/- 3 and 13 +/- 2% (both P < 0.001). No changes were observed in fibre CSA in the untrained leg (all P > 0.5). Whole muscle CSA increased by 5.4 +/- 0.9% in the trained leg (P < 0.001) and remained unchanged in the untrained leg (P = 0.76). Isotonic 1RM increased in the trained leg for leg press and for knee extension (P < 0.001). No changes were seen in the untrained leg. In conclusion, unilateral training induced local muscle hypertrophy only in the exercised limb, which occurred in the absence of changes in systemic hormones that ostensibly play a role in muscle hypertrophy.