Effects of ezetimibe on markers of synthesis and absorption of cholesterol in high-risk patients with elevated C-reactive protein

AbstractAimsHigh-risk subjects with elevated C-reactive protein (CRP) are at high risk for cardiovascular events and frequently require potent statins or combined lipid-lowering therapy to achieve lipid targets and decrease inflammation. Our study aimed at evaluating the effects of three lipid-modifying therapies on LDL-cholesterol, CRP levels and markers of cholesterol absorption and synthesis.Main methodsA prospective intervention study was performed in high cardiovascular risk individuals receiving atorvastatin 10mg daily for four weeks. Those with CRP≥2.0mg/L were randomized to another four-week treatment period with atorvastatin 40mg, ezetimibe 10mg or the combination of atorvastatin 40mg / ezetimibe 10mg. Lipids, markers of cholesterol absorption (campesterol and β-sitosterol), and synthesis (desmosterol), as well as CRP were quantified at baseline and end of study.Key findingsOne hundred and twenty two individuals were included. Atorvastatin alone or combined with ezetimibe reduced both LDL-cholesterol and CRP (P<0.002 vs. baseline; Wilcoxon); ezetimibe did not modify CRP. Ezetimibe-based therapies reduced absorption markers and their ratios to cholesterol (P<0.0001 vs. baseline, for all; Wilcoxon), whereas atorvastatin alone increased campesterol/cholesterol and β-sitosterol/cholesterol ratios (P<0.05 vs. baseline; Wilcoxon). In addition, ezetimibe also increased desmosterol and desmosterol/cholesterol ratio (P<0.0001 vs. baseline; Wilcoxon).SignificanceThese results contribute to understanding the link between cellular cholesterol homeostasis, inflammation and lipid-modifying therapies. Our findings highlight the broader benefit of combined therapy with a potent statin and ezetimibe decreasing inflammation, and preventing increase in cholesterol biosynthesis, an effect not observed with ezetimibe alone

Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS)

<p>Abstract</p> <p>Background</p> <p>Oral disorders can have a negative impact on the functional, social and psychological wellbeing of young children and their families and cause pain/discomfort for the child. Oral health-related quality of life (OHRQoL) has emerged as an important health outcome in clinical trials and healthcare research. The Early Childhood Oral Health Impact Scale (ECOHIS) is a proxy measure of children's OHRQoL designed to assess the negative impact of oral disorders on the quality of life of preschool children. The objective of this study was to evaluate the psychometric properties of the Brazilian version of the ECOHIS (B-ECOHIS).</p> <p>Methods</p> <p>This investigation was carried out in preliminary and field studies. The preliminary study comprised a cross-sectional study carried out in the city of Petropolis, Brazil. A sample of 150 children from two to five years of age was recruited at a public hospital. In the field study, an epidemiological survey was carried out in public and private preschools of Belo Horizonte, Brazil. The B-ECOHIS was answered by 1643 parents/caregivers of five-year-old male and female preschool children. In both phases, oral examinations were performed by a single previously calibrated dentist. Reliability was determined through test-retest reliability and internal consistency. Validity was determined through convergent and discriminant validities. The correlation between the scores obtained on the child and family impact sections was assessed.</p> <p>Results</p> <p>In the preliminary (P) and field (F) study, test-retest reliability correlation values were 0.98 and 0.99 for the child impact section and 0.97 and 0.99 for the family impact section, respectively. The B-ECOHIS demonstrated internal consistency: child impact section (P: α = 0.74; F: α = 0.80) and family impact section (P: α = 0.59; F: α = 0.76). The correlation between the scores obtained on the child and family impact sections was statistically significant (P: r_s= 0.54; F: r_s= 0.62; p ≤ 0.001). In both phases of the study, B-ECOHIS scores were significantly associated with the decayed, missing and filled teeth index, decayed teeth and discolored upper anterior teeth (p < 0.05).</p> <p>Conclusion</p> <p>The B-ECOHIS proved reliable and valid for assessing the negative impact of oral disorders on the quality of life of preschool children.</p

Chronic inflammatory diseases, subclinical atherosclerosis, and cardiovascular diseases: Design, objectives, and baseline characteristics of a prospective case-cohort study ‒ ELSA-Brasil

Objectives: This analysis describes the protocol of a study with a case-cohort to design to prospectively evaluate the incidence of subclinical atherosclerosis and Cardiovascular Disease (CVD) in Chronic Inflammatory Disease (CID) participants compared to non-diseased ones. Methods: A high-risk group for CID was defined based on data collected in all visits on self-reported medical diagnosis, use of medicines, and levels of high-sensitivity C-Reactive Protein&nbsp;&gt;10&nbsp;mg/L. The comparison group is the Aleatory Cohort Sample (ACS): a group with&nbsp;10% of participants selected at baseline who represent the entire cohort. In both groups, specific biomarkers for DIC, markers of subclinical atherosclerosis, and CVD morbimortality will be tested using weighted Cox. Results: The high-risk group (n&nbsp;=&nbsp;2,949; aged 53.6 ± 9.2; 65.5%&nbsp;women) and the ACS (n=1543; 52.2±8.8; 54.1%&nbsp;women) were identified. Beyond being older and mostly women, participants in the high-risk group present low average income (29.1%&nbsp;vs.&nbsp;24.8%, p &lt; 0.0001), higher BMI (Kg/m2) (28.1&nbsp;vs.&nbsp;26.9, p &lt; 0.0001), higher waist circumference (cm) (93.3&nbsp;vs.&nbsp;91, p &lt; 0.0001), higher frequencies of hypertension (40.2%&nbsp;vs.&nbsp;34.5%, p &lt; 0.0001), diabetes (20.7%&nbsp;vs.&nbsp;17%, p&nbsp;=&nbsp;0.003) depression (5.8%&nbsp;vs.&nbsp;3.9%, p&nbsp;=&nbsp;0.007) and higher levels of GlycA a new inflammatory marker (p &lt; 0.0001) compared to the ACS. Conclusions: The high-risk group selected mostly women, older, lower-income/education, higher BMI, waist circumference, and of hypertension, diabetes, depression, and higher levels of GlycA when compared to the ACS. The strategy chosen to define the high-risk group seems adequate given that multiple sociodemographic and clinical characteristics are compatible with CID

CONSENSO SOBRE EL USO DE PROTEÍNA EN EL PACIENTE CRÍTICO – ACNC

El paciente crítico tiene una pérdida de masa muscular significativa, observando frecuentemente sarcopenia en estos pacientes. Su presencia aumenta los desenlaces adversos, estancias hospitalarias, mayor riesgo de infecciones, aumento del tiempo de asistencia ventilatoria mecánica, mayor discapacidad al alta hospitalaria, menor posibilidad del retorno normal a la vida habitual de los pacientes, incremento en gastos en salud y mayor mortalidad. Objetivo: Indicar el uso oportuno y adecuado de la proteína en el paciente crítico. Métodos: la Asociación Colombiana De Nutrición Clínica (ACNC) y la Asociación Colombiana de Medicina Critica y Cuidados Intensivos (AMCI) mediante metodología de consenso realizaron unas recomendaciones con un grupo de expertos. Resultados: 46 recomendaciones fueron aprobadas con consenso superior al 80%. Conclusiones: La intervención óptima proteica temprana y progresiva en el paciente crítico, es importante para obtener los mejores desenlaces clínicos, disminuir complicaciones e impactar en costos de atención hospitalaria.

CONSENSO SOBRE O USO DE PROTEÍNA EM PACIENTES CRÍTICOS – ACNC

The critical patient has a significant loss of muscle mass, frequently observing sarcopenia in these patients. Its presence increases adverse outcomes, hospital stays, increased risk of infections, increased time on mechanical ventilatory assistance, greater disability at hospital discharge, less possibility of return to normal life for patients, increased health costs, and higher mortality. Objective: Indicate the opportune and adequate use of the protein in the critically ill patient. Methods: the Colombian Association of Clinical Nutrition (ACNC) and the Colombian Association of Critical Medicine and Intensive Care (AMCI), using a consensus methodology, made recommendations with a group of experts. Results: 46 recommendations were approved with a consensus greater than 80%. Conclusions: Optimal early and progressive protein intervention in critically ill patients is important to obtain the best clinical outcomes, reduce complications, and have an impact on hospital care costs.El paciente crítico tiene una pérdida de masa muscular significativa, observando frecuentemente sarcopenia en estos pacientes. Su presencia aumenta los desenlaces adversos, estancias hospitalarias, mayor riesgo de infecciones, aumento del tiempo de asistencia ventilatoria mecánica, mayor discapacidad al alta hospitalaria, menor posibilidad del retorno normal a la vida habitual de los pacientes, incremento en gastos en salud y mayor mortalidad. Objetivo: Indicar el uso oportuno y adecuado de la proteína en el paciente crítico. Métodos: la Asociación Colombiana De Nutrición Clínica (ACNC) y la Asociación Colombiana de Medicina Critica y Cuidados Intensivos (AMCI) mediante metodología de consenso realizaron unas recomendaciones con un grupo de expertos. Resultados: 46 recomendaciones fueron aprobadas con consenso superior al 80%. Conclusiones: La intervención óptima proteica temprana y progresiva en el paciente crítico, es importante para obtener los mejores desenlaces clínicos, disminuir complicaciones e impactar en costos de atención hospitalaria.&nbsp;O paciente crítico apresenta perda importante de massa muscular, observando-se frequentemente sarcopenia nesses pacientes. Sua presença aumenta os desfechos adversos, internações hospitalares, aumento do risco de infecções, aumento do tempo de assistência ventilatória mecânica, maior incapacidade na alta hospitalar, menor possibilidade de retorno à vida normal dos pacientes, aumento dos custos de saúde e maior mortalidade. Objetivo: Indicar o uso oportuno e adequado da proteína no paciente crítico. Métodos: a Associação Colombiana de Nutrição Clínica (ACNC) e a Associação Colombiana de Medicina Crítica e Terapia Intensiva (AMCI), utilizando uma metodologia de consenso, fizeram recomendações com um grupo de especialistas. Resultados: 46 recomendações foram aprovadas com consenso superior a 80%. Conclusões: A intervenção proteica precoce e progressiva ideal em pacientes críticos é importante para obter os melhores resultados clínicos, reduzir complicações e impactar nos custos hospitalares

Global assessment of marine plastic exposure risk for oceanic birds

Plastic pollution is distributed patchily around the world’s oceans. Likewise, marine organisms that are vulnerable to plastic ingestion or entanglement have uneven distributions. Understanding where wildlife encounters plastic is crucial for targeting research and mitigation. Oceanic seabirds, particularly petrels, frequently ingest plastic, are highly threatened, and cover vast distances during foraging and migration. However, the spatial overlap between petrels and plastics is poorly understood. Here we combine marine plastic density estimates with individual movement data for 7137 birds of 77 petrel species to estimate relative exposure risk. We identify high exposure risk areas in the Mediterranean and Black seas, and the northeast Pacific, northwest Pacific, South Atlantic and southwest Indian oceans. Plastic exposure risk varies greatly among species and populations, and between breeding and nonbreeding seasons. Exposure risk is disproportionately high for Threatened species. Outside the Mediterranean and Black seas, exposure risk is highest in the high seas and Exclusive Economic Zones (EEZs) of the USA, Japan, and the UK. Birds generally had higher plastic exposure risk outside the EEZ of the country where they breed. We identify conservation and research priorities, and highlight that international collaboration is key to addressing the impacts of marine plastic on wide-ranging speciespublishedVersio

Profile of paediatric rheumatology specialists and services in the state of São Paulo

INTRODUCTION: Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country. OBJECTIVE: To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo. PATIENTS AND METHODS: In 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care. RESULTS: Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as restricted use by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection. CONCLUSION: The field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.INTRODUÇÃO: A reumatologia pediátrica (RP) é uma especialidade emergente, com número restrito de especialistas, e ainda não conta com uma casuística brasileira sobre o perfil dos pacientes atendidos e as informações sobre a formação de profissionais capacitados. OBJETIVO: Estudar o perfil dos especialistas e dos serviços em RP e as características dos pacientes com doenças reumáticas nessa faixa etária a fim de estimar a situação atual no estado de São Paulo (ESP). PACIENTES E MÉTODOS: No ano de 2010 o departamento científico de RP da Sociedade de Pediatria de São Paulo encaminhou um questionário respondido por 24/31 especialistas com título de especialização em RP que atuam no ESP e por 8/12 instituições com atendimento nesta especialidade. RESULTADOS: A maioria (91%) dos profissionais exerce suas atividades em instituições públicas. Clínicas privadas (28,6%) e instituições (37,5%) relataram não ter acesso ao exame de capilaroscopia e 50% das clínicas privadas não tem acesso à acupuntura. A média de tempo de prática profissional na especialidade foi de 9,4 anos, sendo 67% deles pós-graduados. Sete (87,5%) instituições públicas atuam na área de ensino, formando novos reumatologistas pediátricos. Cinco (62,5%) delas têm pós-graduação. Dois terços dos especialistas utilizam imunossupressores e agentes biológicos de uso restrito pela Secretaria da Saúde. A doença mais atendida foi artrite idiopática juvenil (29,1%-34,5%), seguida de lúpus eritematoso sistêmico juvenil (LESJ) (11,6%-12,3%) e febre reumática (9,1%-15,9%). Vasculites (púrpura de Henoch Schönlein, Wegener, Takayasu) e síndromes autoinflamatórias foram mais incidentes nas instituições públicas (P = 0,03; P = 0,04; P = 0,002 e P < 0,0001, respectivamente). O LESJ foi a doença com maior mortalidade (68% dos óbitos), principalmente por infecção. CONCLUSÃO: A RP no ESP conta com um número expressivo de especialistas pós-graduados, que atuam especialmente em instituições de ensino, com infraestrutura adequada ao atendimento de pacientes de alta complexidade.34635