Cirurgia Bariátrica Em Indivíduos Com Déficits Cognitivos Graves: Relato De Dois Casos

Bariatric surgery has become the gold-standard treatment for refractory morbid obesity. Obesity is frequently associated with certain syndromes that include coexisting cognitive deficits. However, the outcomes from bariatric surgery in this group of individuals remain incompletely determined. CASE REPORT: A 25-year-old male with Prader-Willi syndrome, whose intelligence quotient (IQ) was 54, was admitted with a body mass index (BMI) of 55 kg/m2, associated with glucose intolerance. He underwent the Scopinaro procedure for biliopancreatic diversion, with uneventful postoperative evolution, and presented a 55% loss of excess weight one year after the surgery, with resolution of glucose intolerance, and without any manifestation of protein-calorie malnutrition. A 28-year-old male with Down syndrome, whose IQ was 68, was admitted with BMI of 41.5 kg/m2, associated with hypertension. He underwent Roux-en-Y gastric bypass, with uneventful postoperative evolution. He presented a 90% loss of excess weight one year after the surgery, with resolution of the hypertension. CONCLUSION: Bariatric surgery among individuals with intellectual impairment is a controversial topic. There is a tendency among these individuals to present significant weight loss and comorbidity control, but less than what is observed in the general obese population. The severity of the intellectual impairment may be taken into consideration in the decision-making process regarding the most appropriate surgical technique. Bariatric surgery is feasible and safe among these individuals, but further research is necessary to deepen these observations

Effects of aerobic training during hemodialysis on heart rate variability and left ventricular function in end-stage renal disease patients

INTRODUCTION: Decreased heart rate variability (HRV) in patients with end stage renal disease (ESRD) undergoing hemodialysis is predictive of cardiac death, especially due to sudden death. OBJECTIVE: To evaluate the effects of aerobic training during hemodialysis on HRV and left ventricular function in ESRD patients. METHODS: Twenty two patients were randomized into two groups: exercise (n = 11; 49.6 ± 10.6 years; 4 men) and control (n = 11; 43.5 ± 12.8; 4 men). Patients assigned to the exercise group were submitted to aerobic training, performed during the first two hours of hemodialysis, three times weekly, for 12 weeks. HRV and left ventricular function were assessed by 24 hours Holter monitoring and echocardiography, respectively. RESULTS: After 12 weeks of protocol, no significant differences were observed in time and frequency domains measures of HRV in both groups. The ejection fraction improved non-significantly in exercise group (67.5 ± 12.6% vs. 70.4 ± 12%) and decreased non-significantly in control group (73.6 ± 8.4% vs. 71.4 ± 7.6%). CONCLUSION: A 12-week aerobic training program performed during hemodialysis did not modify HRV and did not significantly improve the left ventricular function.INTRODUÇÃO: Pacientes com doenca renal crônica (DRC) sob tratamento hemodialítico apresentam diminuicao da variabilidade da frequência cardíaca (VFC) que representa um fator de risco independente para a mortalidade cardíaca, especialmente a morte súbita. OBJETIVO: Avaliar o efeito do exercício aeróbico, realizado durante as sessões de hemodiálise, na VFC e na funcao ventricular esquerda de pacientes portadores de DRC. MÉTODOS: Foram avaliados 22 pacientes randomizados em dois grupos: exercício (n = 11; 49,6 ± 10,6 anos; 4 homens) e controle (n = 11; 43,5 ± 12,8; 4 homens). Os pacientes do grupoexercício foram submetidos a três sessões semanais de exercício aeróbico, realizado nas duas horas iniciais da hemodiálise, durante 12 semanas. Para a análise da VFC e da funcao ventricular esquerda, todos os pacientes foram submetidos aos exames de Holter de 24 horas e ecocardiograma, respectivamente. RESULTADOS: Após 12 semanas de protocolo, nao foi observada diferenca significante em nenhum dos parámetros da VFC nos domínios do tempo e da frequência em ambos os grupos. A fração de ejeção aumentou de modo nao significante nos pacientes do grupo-exercício (67,5 ± 12,6% vs. 70,4 ± 12%) e diminuiu nao significantemente nos pacientes do grupo-controle (73,6 ± 8,4% vs. 71,4 ± 7,6%). CONCLUSÃO: A realizacao de 12 semanas de exercício aeróbico, durante as sessões de hemodiálise, nao modificou a VFC e nao promoveu melhora significante na funcao ventricular esquerda.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Instituto Federal de Educação, Ciência e Tecnologia do Sudeste de Minas GeraisUniversidade Federal de Juiz de Fora Departamento de Clínica MédicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUFJFUNIFESP, EPMSciEL

Residência em Ciência, Tecnologia e Sociedade (CTS) : habitat, agroecologia, economia solidária e saúde ecossistêmica : integrando pós-graduação e extensão

Este livro tem como objetivo apresentar os fundamentos e a base do curso multiprofissional em CTS-Ciência, Tecnologia e Sociedade na modalidade Residência (Pós-Graduação Lato Sensu + Extensão), caracterizado poruma prática pedagógica e de planejamento educacional do tipo PEX–pesquisa associada com ensino e integrada com extensão. A proposta articula social e territorialmente três temáticas interdisciplinares: Habitat (Habitação, Arquitetura, Urbanismo, Ambiente no Campo e na Cidade); Agroecologia (Soberania Alimentar, Agricultura Familiar, Integração Campo e Cidade); Saúde (Vigilância Epidemiológica, Saúde Coletiva, Saúde da Família, Saneamento, Ecossaneamento e Infraestrutura Ecológica) e uma quarta temática transdisciplinar: Trabalho Associado (Economia Solidária, Formação e Educação, Ocupação, Renda e Tecnociência Solidária). Os conteúdos dos capítulos foram desenvolvidos na disciplina de Estudos Especiais em Tecnologia, Ambiente e Sustentabilidade do Programa de Pós-Graduação da Faculdade de Arquitetura e Urbanismo da Universidade de Brasília (PPG-FAU/UnB), ofertada em 2021, integrada ao Curso de Extensão Fundamentos em Ciência Tecnologia e Sociedade (CTS) – Habitat, Agroecologia, Economia Solidária e Saúde Ecossistêmica, uma parceria do Núcleo de Política de Ciência, Tecnologia e Sociedade(NPCTS/CEAM/UnB) e professores da Faculdade de Arquitetura e Urbanismo (PPG-FAU), da Faculdade de Planaltina (FUP), da Faculdade de Agricultura e Medicina Veterinária (FAV) e CDS/UnB, do curso de Saúde Coletiva da Faculdade de Ceilândia (FCE), da Faculdade de Educação (FE) e do Instituto de Humanas (IH)

The Promigratory Activity of the Matricellular Protein Galectin-3 Depends on the Activation of PI-3 Kinase

Expression of galectin-3 is associated with sarcoma progression, invasion and metastasis. Here we determined the role of extracellular galectin-3 on migration of sarcoma cells on laminin-111. Cell lines from methylcholanthrene-induced sarcomas from both wild type and galectin-3−/− mice were established. Despite the presence of similar levels of laminin-binding integrins on the cell surface, galectin-3−/− sarcoma cells were more adherent and less migratory than galectin-3+/+ sarcoma cells on laminin-111. When galectin-3 was transiently expressed in galectin-3−/− sarcoma cells, it inhibited cell adhesion and stimulated the migratory response to laminin in a carbohydrate-dependent manner. Extracellular galectin-3 led to the recruitment of SHP-2 phosphatase to focal adhesion plaques, followed by a decrease in the amount of phosphorylated FAK and phospho-paxillin in the lamellipodia of migrating cells. The promigratory activity of extracellular galectin-3 was inhibitable by wortmannin, implicating the activation of a PI-3 kinase dependent pathway in the galectin-3 triggered disruption of adhesion plaques, leading to sarcoma cell migration on laminin-111

Why do tuberculosis patients look for urgency and emergency unities for diagnosis: a study on social representation

Objective: To understand the social representations of patients and professionals working in the field of tuberculosis, on the reasons for seeking diagnosis and treatment in the emergency room and not in the primary health care units called Unidades Básicas de Saúde (UBS) or in the health program Programa de Saúde da Família near their residence. Methods: The survey was conducted in the health services in the municipalities of São Paulo and Guarulhos, Brazil, in hospitals and UBS. We interviewed 20 patients and 20 employees of these units, using the Collective Subject Discourse methodology to analyze their statements. The question presented to the users was: "Why did you seek the urgent emergency hospital and not the UBS to see if you had tuberculosis?" For professionals it was asked: "Why do you think the patient seeks diagnosis in the hospital and not in the UBS?" Results: As a result, two categories were found: (A) the cultural patterns; and (B) faults of the basic network. Conclusion: Analysis of the two explanatory dimensions show that the actions triggered by the health services should take into account the cultural patterns present in the social imaginary of the population; the health staff should receive training on specific knowledge of tuberculosis; there is a necessity of hiring human resources for the UBS and more inputs for programming

Urban adaptation index: assessing cities readiness to deal with climate change

Worldwide cities are at the forefront of tackling climate change; however, it is not clear to what extent they are prepared for the challenge, particularly in the context of lower income countries, where the need for action is urgent. In this context, many of cities struggle to develop evidence-based approaches to assess their current and future capacity to deal with climate impacts and inform the design of policies to respond in the short/long term. Based both on extensive field research carried out in Brazilian cities and on urban adaptation literature, we develop and test the Urban Adaptation Index (UAI) that cities can use to assess their current adaptive capacity in a realistic/achievable way. The index includes 26 indicators and focuses on a set of public policies to support interventions connected to adaptation: housing, urban mobility, sustainable agriculture, environmental management, and climate impact response. To make the UAI more usable/accessible, we use empirical data that is publicly available, and develop an approach that can be implemented with resources already available in many Brazilian cities. We illustrate the UAI usability by applying the index to the 645 municipalities of the state of São Paulo. Results show that more than half of the municipalities present low UAI ratings; however, municipalities located in metropolitan regions, where the majority of the population live, tend to have higher ratings. Practitioners agreed on the value of the UAI as a tool to monitor the current situation and changes regarding local potential capacity to adapt to climate change