Influência do tempo de uso de Antirretrovirais na resistência insulínica entre pessoas vivendo com HIV com síndrome lipodistrófica

Objetivo: O presente estudo avaliou a influência do tempo de uso de antirretrovirais na resistência insulínica (HOMA-IR) entre pacientes vivendo com HIV, com síndrome lipodistrófica. Métodos: Foram avaliados 36 indivíduos de ambos os sexos, com idade entre 22 e 60 anos, divididos em três grupos: 1) Soropositivo para HIV em uso de TARV com síndrome de lipodistrofia (VIH + LIPO +); 2) Soropositivo para HIV em uso de TARV sem síndrome de lipodistrofia (VIH + LIPO-); 3) Soronegativo para HIV (Controle). Os dados foram coletados na Unidade Especial de Tratamento para Doenças Infecciosas (UETDI), no Ambulatório de Dislipidemia (ADIS) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HC-FMRP). Para a análise bioquímica foram utilizados kits de laboratório, quando os mesmos não estavam disponíveis nos prontuário eletrônico. Resultados: Foram observados maiores valores de HOMA-IR para o grupo GRUPO 1: HIV+LIPO+ (1,61 ± 1,17), comparado aos grupos GRUPO 2: HIV+LIPO- (0,79 ± 0,87) e GRUPO 3: Controle (0,46 ± 0,72), sendo que o HOMA-IR apresentou correlação positiva com o tempo de uso dos antirretrovirais (r=0,41). Conclusão: O tempo de infecção por HIV e o uso de antirretrovirais influenciam o metabolismo glicídico, com modificações nos níveis séricos de insulina e consequentemente resistência à insulina e maior risco para desenvolver diabetes e enfermidades relacionadas ao metabolismo de carboidratos.Objective: The present study evaluated the influence of the duration of antiretroviral therapy on insulin resistance among people living with HIV with lipodystrophic syndrome. Methods: The study assessed 36 subjects of both sexes between 22 and 60 years old split into three groups: 1) HIV-positive using antiretroviral with lipodystrophy syndrome (HIV+LIPO+); 2) HIV-positive using antiretroviral therapy with no lipodystrophy syndrome (HIV+LIPO-); and 3) HIV-negative and healthy (Control). The data were collected at the Special Unit for the Treatment of Infectious Diseases (Unidade Especial de Tratamento para Doenças Infecciosas - UETDI) of the Dyslipidemia Outpatient Clinic (Ambulatório de Dislipidemia - ADIS) of the General Hospital of the Medical School of Ribeirão Preto (HC-FMRP). The biochemical assessment used laboratory kits when the results were not available in the volunteer's records. Results: Higher HOMA-IR values were observed for the group 1: HIV+LIPO+ (1,61 ± 1,17 ) compared to group 2: HIV+LIPO- (0,79 ± 0,87) and group 3: Control (0,46 ± 0,72 ) and such values were positively correlated with the time of antiretroviral medication use (r=0,41). Conclusions: The time of infection by HIV and the use of antiretrovirals impact the glucose metabolism with changes in serum insulin levels and consequent insulin resistance and increased risk for the development of diabetes and diseases related to carbohydrate metabolism

Ultrasonographic evaluation of the thyroid, determination of ioduria and iodine concentration in kitchen salt used by schoolchildren in Ribeirão Preto, São Paulo, Brazil

OBJETIVO E MÉTODOS: Estudos prévios apontaram Ribeirão Preto, São Paulo, como área de carência limítrofe de iodo e, posteriormente, de iodação excessiva. Reavaliando seu estado iódico em 2007-2008, foram analisados 300 escolares entre 8 e 10 anos de idade, procedentes de três escolas de diferentes níveis socioeconômicos e realizadas dosagens de iodo urinário e da concentração de iodo no sal doméstico e ultrassonografia tireoidiana. RESULTADOS E CONCLUSÃO: A iodúria foi superior na escola com maior nível socioeconômico, comparada às outras, e a diferença foi significante aos 8 e 10 anos para os meninos (p < 0,0001 e p = 0,0106, respectivamente) e aos 8 e 9 anos para as meninas (p = 0,0024 e p = 0,0154, respectivamente). As concentrações medianas de iodo em amostras de sal doméstico variaram entre 26,6 e 27,8 mg iodo/kg e não foram diferentes nas escolas estudadas. À ultrassonografia, 15,6% das tireoides examinadas apresentaram-se hipoecoicas, sugerindo que elas possam apresentar mudanças em sua arquitetura sem ainda alterar seus volumes.OBJECTIVE AND METHODS: Previous studies have pointed out that Ribeirão Preto, São Paulo, is an area of borderline iodine deficiency, later becoming a region of excessive iodination. In a reevaluation of the iodine status of the city in 2007-2008, 300 schoolchildren aged 8 to 10 years were evaluated, from 3 schools of 3 different socioeconomic levels who were submitted to the determination of iodine concentration in urine samples and in kitchen salt and thyroid ultrasound. RESULTS AND CONCLUSION: Among boys and girls ioduria was higher in the school of highest socioeconomic level compared to the others, with a significant difference in the ages 8 and 10 years for boys with ranges : p < 0,0001 and p = 0,0106, respectively; and in the ages 8 and 9 years for girls with ranges: p = 0,0024 and p = 0,0154, respectively. Median iodine concentrations in samples of kitchen salt ranged from 26.6 to 27.8 mg iodine/kg and did not differ between the schools studied. Ultrasound evaluation revealed that 15,6% of thyroids examined were hypoechoic, suggesting that these glands may present changes in the architecture not reflected yet in their volume

¿Puede la antropometría medir la grasa corporal de las personas que viven con el VIH/SIDA?: revisión sistemática

Introduction: Assessment of the quantity and distribution of body fat in people living with HIV/AIDS is of great importance in clinical practice, due to the association of body fat changes with clinical conditions. The aim of this systematic review was to answer the central question: Can anthropometry accurately measure the body fat in people living with HIV/AIDS?Material and Methods: Systematic review carried out using four databases: Medline, LILACS, Scopus and BDTD.Results: Of the 581 studies found, 11 met the eligibility criteria. To assess the validate of anthropometry, only two studies employed regress analysis to development of predictive body fat equations in people living with HIV/AIDS and nine studies employed correlation analysis. This coefficient only measures the strength of the relation between two variables, and there is not concordance between them and therefore, these studies did not accurately evaluate whether or not the anthropometric information showed good concordance with the gold standard. The other two studies developed five equations to evaluate the total fat and limbs (arm, leg and trunk) in people living with HIV/AIDS using antiretrovirals and showed R2 between 0.50 and 0.83.Conclusions: Further research needs to be conducted to answer the central question of this review, as the small number of articles that applied the correct statistical test and the absence of research on people living with HIV/AIDS without the use of antiretrovirals.Introducción: La evaluación de la cantidad y distribución de la grasa corporal en personas que viven con el VIH/SIDA es de gran importancia en la práctica clínica, debido a la asociación de los cambios de grasa corporal con condiciones clínicas. El objetivo de esta revisión es responder a la pregunta central: ¿Puede la antropometría medir con precisión la grasa corporal en las personas que viven con el VIH/SIDA?Material y Métodos: Revisión sistemática llevada a cabo por medio de cuatro bases de datos: Medline, LILACS, Scopus y BDTD.Resultados: De los 581 estudios encontrados, 11 cumplieron con los criterios de elegibilidad. Para evaluar la validación de la antropometría, sólo dos estudios emplearon análisis de regresión para el desarrollo de las ecuaciones de predicción de grasa corporal en las personas que viven con el VIH/SIDA y nueve estudios emplearon análisis de correlación. Este coeficiente sólo mide la fuerza de la relación entre dos variables, y no hay concordancia entre ellos y, por lo tanto, estos estudios no evaluaron con precisión si la información antropométrica mostró buena concordancia con el estándar de oro. Los otros dos estudios desarrollaron cinco ecuaciones para evaluar la grasa total y en las extremidades (brazos, piernas y tronco) en personas que viven con el VIH/SIDA y usan antirretrovirales y mostraron R2 entre 0,50 y 0,83.Conclusiones: Más investigación debe llevarse a cabo para responder a la pregunta central de esta revisión, dado el pequeño número de artículos en que se aplicó la prueba estadística correcta y la ausencia de investigaciones sobre personas que viven con el VIH/SIDA que no usan antirretrovirales

Can anthropometry measure the body fat of people living with HIV/AIDS?: A systematic review

Introduction: Assessment of the quantity and distribution of body fat in people living with HIV/AIDS is of great importance in clinical practice, due to the association of body fat changes with clinical conditions. The aim of this systematic review was to answer the central question: Can anthropometry accurately measure the body fat in people living with HIV/AIDS? Material and Methods: Systematic review carried out using four databases: Medline, LILACS, Scopus and BDTD. Results: Of the 581 studies found, 11 met the eligibility criteria. To assess the validate of anthropometry, only two studies employed regress analysis to development of predictive body fat equations in people living with HIV/AIDS and nine studies employed correlation analysis. This coefficient only measures the strength of the relation between two variables, and there is not concordance between them and therefore, these studies did not accurately evaluate whether or not the anthropometric information showed good concordance with the gold standard. The other two studies developed five equations to evaluate the total fat and limbs (arm, leg and trunk) in people living with HIV/AIDS using antiretrovirals and showed R2 between 0.50 and 0.83. Conclusions: Further research needs to be conducted to answer the central question of this review, as the small number of articles that applied the correct statistical test and the absence of research on people living with HIV/AIDS without the use of antiretrovirals

Sobrepeso e obesidade em crianças pré-escolares matriculadas em cinco centros de educação infantil de Botucatu, SP

The objetive of present study was to determine overweight and obesity prevalence of preschool students in five kindergarten schools in Botucatu. Cross-sectional study of 1232 preschool children enrolled in five public kindergarten schools in Botucatu, in 2005 was developed. Overweight was defined as weight-for-height between +1 and +2 z escores, and obesity as weight-for-height above +2 scores. Prevalence rates were 25,3% for overweight and 12,2% for obesity. Among female children, overweight prevalence was 29% and obesity prevalence was 15%. Among males, overweight prevalence was 20% and obesity prevalence was 17,6%. Overweight and obesity prevalence were high among preschool children from low income families. Nutritionists must be aware of the increasing prevalence of childhood obesity to be able to prevent, diagnose and treat this condition.Este estudio tuvo como objetivo investigar el predominio del sobrepeso y la obesidad entre los preescolares de cinco Centros de Educación Infantil de la Red Municipal en Botucatu. Así, fue realizado un estudio de corte transversal con 1232 preescolares matriculados en cinco Centros de Educación Infantil, durante el año de 2005. Fueron clasificados como portadores de sobrepeso los niños con índice peso/estatura entre+1 a +2 escores z, y como obesas, aquellos con peso/estatura encima de +2 escores z. El predominio del sobrepeso y la obesidad fue de 25,3% y 12,2% respectivamente. Entre las niñas el predominio del sobrepeso fue de 29% y de la obesidad de 15%. Entre los niños el predominio del sobrepeso fue de 20% y dela obesidad 17,6%. El predominio del sobrepeso y de la obesidad fue elevada en este grupo de preescolares, procedentes, en su mayoría, de las clases socioeconómicas media y baja. Los especialistas en nutrición deben estar atentos para el aumento del predominio de la obesidad infantil para actuar preventivamente, para diagnosticar y para tratar esa condiciónO objetivo do presente estudo foi investigar a prevalência de sobrepeso e obesidade entre pré-escolares de cinco Centros de Educação Infantil da rede municipal de ensino em Botucatu. Para isso, foi realizado um estudo de corte transversal com 1232 pré-escolares matriculados em cinco Centros de Educação Infantil, no ano de 2005. Foram classificadas como portadoras de sobrepeso as crianças com índice peso/estatura entre +1 a +2 escores z e, como obesas, aquelas com peso/estatura acima de +2 escores z. As prevalências de sobrepeso e obesidade foram de 25,3% e 12,2%, respectivamente. Entre as crianças do gênero feminino, a prevalência de foi de 29% e a de obesidade foi de 15%. No sexo masculino, a prevalência de sobrepeso foi de 20% e a de obesidade 17,6%. As prevalências de sobrepeso e obesidade foram elevadas nesse grupo de pré-escolares, provenientes em sua maioria de famílias de classe socioeconômica média e baixa. O nutricionista deve estar atento para a crescente prevalência da obesidade infantil, a fim de atuar na prevenção, diagnóstico e tratamento dessa condição

Chance aumentada de síndrome metabólica em mulheres vivendo com HIV/AIDS e Síndrome da Lipodistrofia

Modelo do estudo: Estudo de prevalência de corte transversal. Objetivo: comparar a sintomatologia critério para Síndrome Metabólica em homens e mulheres que vivem com HIV/aids, pacientes com Síndrome Lipoditrófica em terapia antirretroviral. Método: participaram do estudo 41 pacientes HIV positivos de ambos os sexos (18 a 69 anos), de um programa de orientação de exercício físico como terapia alternativa. Foi determinada a composição corporal total e regional por DXA, estatura, peso, circunferência de abdome, e determinação de parâmetros metabólicos (perfil lipídico e glicêmico) e imunológicos (detecção de carga viral e contagem de células T CD4+). Foram utilizados os critérios da IDF para o diagnóstico de SM. Resultados: As mulheres apresentaram maior gordura relativa (p = 0,001), obesidade central (p = 0,005), colesterol total (p = 0,043), LDL colesterol (p = 0,034) e contagem de CD4+ (p = 0,034) quando comparadas aos homens. Os valores médios para ambos os sexos apresentaram níveis elevados de triglicerídeos (&gt; 211,4 mg.dL-1) e baixos de HDL (&lt; 39,5 mg.dL- 1). A prevalência de Síndrome Metabólica nas mulheres foi duas vezes maior do que nos homens (p = 0,021), com significantes diferenças também na obesidade abdominal central (p = 0,005). Conclusões: A razão de prevalência (RP = 0,465) do sexo associado à Síndrome Metabólica indicou que as mulheres têm maior risco relativo e, portanto requerem ações alternativas na redução das chances de desenvolvimento desta síndromeStudy design: cross-sectional and prevalence study. Objective: compare symptoms criteria for Metabolic Syndrome (MS) in men and women living with HIV/aids, patients with lipodystrophy syndrome on antiretroviral therapy. Method: Forty-one patients of both sexes (18-69 years), from an exercise guidance program as alternative therapy. They had their body composition (DXA), height, weight, abdomen circumference, and lipid profile, blood glucose, blood pressure, and CD4+ count, determined. The IDF criteria for diagnosis of MS were used. Results: Women showed greater relative fat (p = 0.001), central obesity (p = 0.005), total cholesterol (p = 0.043) and LDL cholesterol (p = 0.034), and CD4+ count (p = 0.034) when compared to men. The mean values for both sexes showed high levels of triglycerides (&gt; 211.4 mg.dL-1) and low HDL (&lt; 39.5 mg.dL-1). The prevalence ratio of MS was twice in women than men (p = 0.005). Conclusion: The prevalence ratio (PR = 0.465) of sex metabolic syndrome-associated, shown that woman patients have higher relative risk and therefore require alternative actions to reduce the chances of developing this syndrom

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially