Importância dos estudos interdisciplinares na construção de ementas dos cursos da área da saúde / Importância dos estudos interdisciplinares na construção de ementas dos cursos da área da saúde / Importância dos estudos interdisciplinares na construção de ementas dos cursos da área da saúde

A estrutura curricular interdisciplinar na construção de ementas para formação em saúde vem se tornando um diferencial singular na especialização de profissionais (Okamura, 2019). A introdução da interdisciplinaridade no meio acadêmico e currículos profissionais fornece uma estrutura para a preparação dos alunos para fazer conexões entre diferentes elos do conhecimento, aparentemente fragmentados (Ashby; Exter, 2019) e aplicá-los a problemas do mundo real.

Serum levels and gestational curve of adiponectin and leptin during adolescent pregnancy.

OBJECTIVE: This study aimed to develop a curve of weekly serum levels of adiponectin and leptin among pregnant adolescents. In addition, pregestational body mass index and weight gain were assessed and correlated with the serum concentration of these molecules. METHODS: This was a prospective cohort study, including only pregnant adolescents with eutrophic pre-gestational body mass index who were weekly followed during the evolution of gestation. The serum concentrations of adipokines were determined using commercial ELISA kits and were correlated to pre-gestational body mass index and pregnancy weight gain. A total of 157 pregnant women participated in this study. RESULTS: Adiponectin levels showed a significant decrease among the trimesters (p=0.0004). However, we did not observe significant differences among its levels when compared weekly, neither of which was between adiponectin concentration and pre-gestational body mass index or weight gain (p=0.36 and p=0.10, respectively). In contrast, we detected a significant increase in weekly serum leptin levels (p<0.0001), positively correlated to both pre-gestational body mass index and weight gain (p=0.003 and p=0.0007, respectively). CONCLUSION: These adipokines present a different profile throughout adolescent pregnancy.

Serum levels and gestational curve of adiponectin and leptin during adolescent pregnancy

SUMMARY OBJECTIVE: This study aimed to develop a curve of weekly serum levels of adiponectin and leptin among pregnant adolescents. In addition, pregestational body mass index and weight gain were assessed and correlated with the serum concentration of these molecules. METHODS: This was a prospective cohort study, including only pregnant adolescents with eutrophic pre-gestational body mass index who were weekly followed during the evolution of gestation. The serum concentrations of adipokines were determined using commercial ELISA kits and were correlated to pre-gestational body mass index and pregnancy weight gain. A total of 157 pregnant women participated in this study. RESULTS: Adiponectin levels showed a significant decrease among the trimesters (p=0.0004). However, we did not observe significant differences among its levels when compared weekly, neither of which was between adiponectin concentration and pre-gestational body mass index or weight gain (p=0.36 and p=0.10, respectively). In contrast, we detected a significant increase in weekly serum leptin levels (p<0.0001), positively correlated to both pre-gestational body mass index and weight gain (p=0.003 and p=0.0007, respectively). CONCLUSION: These adipokines present a different profile throughout adolescent pregnancy.

Adiponectin and leptin serum levels in normal adolescent pregnancies.

INTRODUCTION: Adiponectin and leptin play a critical role in pregnancy development, the blood levels of these adipokines have been extensively investigated in healthy adult women, however there are no similar studies in adolescents. The aim of this study was to evaluate adiponectin and leptin serum levels in adolescents during pregnancy. METHODS: This prospective cohort study recruited 105 healthy, normal-weight adolescents, within the ages from 13 to 19 years old. Leptin and adiponectin serum levels of the 43 pregnant participants were assessed at 10-14, 24-28 and 30-34 weeks and their concentrations were compared with those of the 62 nonpregnant adolescents. Commercial ELISA kits were used for all assessments. RESULTS: There were no clinical and sociodemographic differences between the pregnant and nonpregnant adolescents. Adiponectin serum levels were significantly lower in the pregnant compared to the nonpregnant adolescents 3600 ± 1730 ng/ml versus 4144 ± 1583 ng/ml, respectively. (p < .0001). Moreover, adiponectin concentration decreased significantly with pregnancy progress: being 4295 (± 2003) ng/ml at the first trimester; 3419 (±1803) ng/ml at the 2nd; and 3112 (±1442) ng/ml at the 3rd trimesters, respectively (p = .004). Overall leptin serum concentrations were significantly higher in pregnant than in nonpregnant adolescents (p < .0001). During pregnancy, leptin concentration increased significantly between the first and third trimesters: 35,688 (±33,637) pg/ml versus 49,388 (±33,186) pg/ml, respectively, (p < .0001). CONCLUSIONS: The profile of adiponectin and leptin serum levels in adolescent are similar to that observed in adult women. In both cases, there are significant changes with gestational age during healthy pregnancy.Key MessageAdiponectin and leptin serum levels in healthy teenager changes with pregnancy.

Blood level of adipokines and nutritional status variables in adolescent pregnancy.

OBJECTIVE: To evaluate the serum levels of adiponectin and leptin and their relationship with nutritional variables during pregnancy in adolescents. METHODS: This prospective cohort study evaluated eutrophic pregnant adolescents (body mass index [BMI], 18.5-24.9 kg/m2) during the 3 gestational trimesters (first, 10-14 weeks; second, 24-28 weeks; and third, 30-34 weeks). Serum adiponectin and leptin concentrations were measured using the enzyme-linked immunosorbent assay method. The relationship of these adipokines with the pre-gestational BMI, gestational weight gain, weight at the time of sample collection, and newborn weight were evaluated. Analysis of variance and the Kruskal-Wallis test were used for statistical analysis. RESULTS: The study group comprised 62 pregnant adolescents. The serum concentration of adiponectin showed a significant difference between the first and third trimesters (P=0.003), which decreased during pregnancy, but unrelated to nutritional variables. Serum leptin levels increased throughout the pregnancy (P<0.0001) and showed a positive correlation with pre-gestational BMI, total weight gain, pregnancy weight at the time of sample collection, and newborns' weight. CONCLUSION: Serum levels of adiponectin and leptin vary inversely throughout pregnancy. This pattern in adolescents is similar to that observed in adults. Moreover, leptin concentrations increased throughout pregnancy, and they were positively correlated with all variables evaluated.

Impaired Treg and NK cells profile in overweight women with gestational diabetes mellitus.

PROBLEM: Maternal obesity is frequently associated with gestational diabetes mellitus (GDM), and immunological mechanisms seem to be involved in the physiopathology of these conditions. The aim of this study was to characterize the profile of immune cells in peripheral blood of overweight women with GDM. METHOD OF STUDY: This case-control study included 27 glucose-tolerant (controls) and 31 GDM overweight pregnant women. Flow cytometry was used to assess the number of regulatory T cells (Treg) and natural killer (NK) cells in the peripheral blood. In addition, the expression of IL-10, TGF-B, and TNF-A in Treg and expression of IFN-G, TNF-A, granzyme, and perforin in NK cells were analyzed. RESULTS: GDM patients had significantly lower frequency of TCD4+ CD25bright and TCD4+ CD25+ FOXP3high cells, higher production of TNF-A by Treg cells and higher percentage of NKCD16+ 56dim cells than the controls. CONCLUSION: The association between obesity and GDM is a condition where it is observed impaired Treg and NK cells profile, findings that seem to be related with the development of IR and inflammation.

Monocyte profile in peripheral blood of gestational diabetes mellitus patients.

OBJECTIVE: Gestational diabetes Mellitus has been considered an inflammatory disease involving different cells and mediators in its development. The role of innate immune cells in GDM physiopathology remains unclear, therefore this study was conducted to assess monocyte profile in GDM patients. DESIGN: This was a case-control study including 20 glucose-tolerant pregnant women (controls) and 18 GDM patients. METHODS: Flow cytometry was used to assess peripheral blood monocytes subsets (classical, intermediate, non-classical), the expression of TLR4 and CCR2 chemokine receptor (CD192) and cytokines (TNFA, IL6, IL10) secretion by monocytes subsets. In addition, sCD14 serum levels were evaluated by ELISA. RESULTS: We observed increased percentage of CD14+ cells, decreased frequency of intermediate monocytes (CD14+CD16+), and lower percentage of circulating monocytes (classical, intermediate and non-classical) that express TLR4 in the diabetic group compared to controls. Soluble CD14+ serum levels were higher in GDM patients compared to controls. There were no differences in the expression of the CCR2 chemokine receptor and cytokines (TNFA, IL6 and IL10) secretion between the studied groups. CONCLUSIONS: Our results demonstrated that GDM patients present impaired monocyte profile in the peripheral blood, suggesting that these cells are involved in GDM physiopathology.

Fetal growth restriction: current knowledge.

BACKGROUND: Fetal growth restriction (FGR) is a condition that affects 5-10% of pregnancies and is the second most common cause of perinatal mortality. This review presents the most recent knowledge on FGR and focuses on the etiology, classification, prediction, diagnosis, and management of the condition, as well as on its neurological complications. METHODS: The Pubmed, SCOPUS, and Embase databases were searched using the term "fetal growth restriction". RESULTS: Fetal growth restriction (FGR) may be classified as early or late depending on the time of diagnosis. Early FGR (<32 weeks) is associated with substantial alterations in placental implantation with elevated hypoxia, which requires cardiovascular adaptation. Perinatal morbidity and mortality rates are high. Late FGR (≥32 weeks) presents with slight deficiencies in placentation, which leads to mild hypoxia and requires little cardiovascular adaptation. Perinatal morbidity and mortality rates are lower. The diagnosis of FGR may be clinical; however, an arterial and venous Doppler ultrasound examination is essential for diagnosis and follow-up. There are currently no treatments to control FGR; the time at which pregnancy is interrupted is of vital importance for protecting both the mother and fetus. CONCLUSION: Early diagnosis of FGR is very important, because it enables the identification of the etiology of the condition and adequate monitoring of the fetal status, thereby minimizing risks of premature birth and intrauterine hypoxia.

Lipid Fingerprinting in Mild versus Severe Forms of Gestational Diabetes Mellitus.

The blood serum lipid profile of women with Gestational Diabetes Mellitus (GDM) is still under study. There are no data on the serum lipid profile of GDM patients with more severe (insulin treated) compared to milder forms (diet treated) GDM. The aim of our study was to analyze the blood serum lipid profile of patients with milder versus more severe forms of GDM and to compare these findings with those of healthy pregnant women. This cross-sectional analytical study included 30 insulin-treated GDM, 30 diet-only GDM and 30 healthy pregnant women. Serum lipid was extracted from the 90 participants and their lipid profiles were analyzed by lipid fingerprinting using liquid-chromatography-mass spectrometry. A total of 143 parent ions were differentially represented in each of the three groups, belonging to the following classes: Glycerophospholipids, Sterol Lipids, Sphingolipids, Prenol Lipids, Fatty Acyls and Glycerolipids. There were significant differences in the lipid profiles of healthy pregnant women compared to GDM patients and also between milder versus more severe forms of GDM. There are marked differences in lipid fingerprinting between healthy pregnant women compared to those with GDM in the third trimester. Moreover, the lipid profile of women with more severe forms of GDM differs considerably from that of women with milder forms of GDM. These findings may be useful to help clarify the pathogenesis of milder and more severe forms of GDM.

Resistin concentration and gestational diabetes: a systematic review of the literature.

Gestational diabetes (GD) exposes mothers and infants to the risk of immediate and later adverse outcomes. Increased insulin resistance is a common feature of GD and obesity. Because of its critical role in regulating insulin sensitivity, resistin has been implicated in the physiopathology of GD. The aim of this study was to review the existing literature on the relationship between circulating maternal resistin levels and GD. Three electronic databases (MEDLINE, EMBASE, and LILACS) were searched for pertinent studies published from 2001 to 2012, without language restrictions. Eleven studies, with a total of 639 participants between 23 and 41 weeks of gestation, were included. The number of GD patients per study ranged from 11 to 81, with varying degrees of disease severity and several different GD diagnostic criteria. Mean concentrations of resistin varied widely both in control women (0.05-22.21 ng/ml) and in GD patients (0.05-62.38 ng/ml). We performed a meta-analysis including a total of 10 studies, and also subgroup analyses according to gestational age at sample collection (up to 32 and >33 weeks). The pooled absolute mean difference (WMD) in resistin levels was slightly lower in GD patients than in controls, but this did not reach statistical significance (WMD=-0.02, 95% CI -0.07 to 0.04). According to the data from the 11 studies analyzed, there was no association between circulating resistin levels and GD. However, this result should be interpreted with caution owing to the large heterogeneity amongst the existing published studies.