A Placebo-Controlled Trial of Pioglitazone in Subjects with Nonalcoholic Steatohepatitis

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A atuação do enfermeiro na saúde indigena: uma análise integrativa da literatura / Nurses 'performance in indigenous health: an integrative analysis of the literature.

O presente estudo aborda quanto à Atuação do Enfermeiro na Saúde Indígena, procurando descrever a assistência de enfermagem nos serviços de saúde indígena. Tendo por objetivo geral: investigar a atuação do enfermeiro na saúde indígena, segundo a percepção da literatura. E objetivos específicos: caracterizar a literatura consultada acerca da atuação do enfermeiro na saúde indígena; identificar as ações realizadas pelos enfermeiros no campo de saúde indígena, a partir da literatura consultada; e identificar as dificuldades encontradas pelos enfermeiros frente à assistência oferecida à população indígena, a partir da literatura consultada. Quanto a metodologia do presente estudo, optou-se pela pesquisa do tipo revisão bibliográfica de cunho exploratório, com abordagem quantitativa – qualitativa. Utilizou-se como método de coleta para o estudo, as bases de dados LILACS (literatura latino Americano de Ciências da Saúde), Scielo (Scientific Eletronic Libray Online) e BVS (Biblioteca Virtual de Saúde). Considerando como critérios de seleção das obras, ano de publicação entre 2000 a 2016, pesquisas realizadas no Brasil em qualquer região do país, e como descritores em saúde: enfermagem em saúde indígena, saúde indígena, e assistência ao índio. Buscou-se através desta pesquisa conhecer as práticas e cuidados fornecidos pelo enfermeiro dentro do subsistema de saúde indígena, além de conhecer as características e divisões do DSEI (Distrito Sanitário Especial Indígena). Através das obras selecionadas foi possível analisar a atuação da enfermagem junto a equipe de saúde, além das dificuldades de atuação encontradas pelos profissionais da equipe multidisciplinar de saúde indígena. Durante o período de seleção das obras a maior dificuldade para o desenvolvimento do estudo, foi a precária oferta de obras publicadas contendo como tema central a assistência desenvolvida pelos enfermeiros na atenção à saúde indígena. Por isso, percebe-se a importância deste estudo e a necessidade de mais pesquisas envolvendo a saúde indígena na atuação da enfermagem, pois sabe-se que a presença do enfermeiro junto as aldeias indígenas torna-se crucial para o desenvolvido de um cuidado voltados para os cumprimentos dos princípios do SUS (Sistema Único de Saúde) universalidade, integralidade e equidade. 

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Pigmentos maculares Macular pigments

A luteína e a zeaxantina são pigmentos amarelos que se localizam na mácula. Devido à sua localização, diminuem e filtram a quantidade de luz principalmente azul que chega aos fotorreceptores, atuam como antioxidantes e podem melhorar a qualidade visual. Esta é uma revisão do seu mecanismo de incorporação, ação, possíveis aplicações e conhecimento científico a respeito.<br>Lutein and Zeaxanthin are yellow pigments located at the macula. Because of your location macular pigments decrease and filter the amount of blue light that reach photoreceptors, protect the outer retina from oxidative stress and may improve the vision quality. This is a review regarding incorporation mechanism, function and knowledge update

Physicochemical characterization and label comparison among diet yogurts sold in the city of Limoeiro do Norte – CE

Abstract This work aimed at analyzing labels (based on the current legislation) and confirm the nutritional information given on the label of five brands of diet yogurt. The physicochemical analyses carried out were: moisture, minerals, proteins, lipids, reducing carbohydrates in lactose, non-reducing carbohydrates in sucrose, total carbohydrates, acidity and pH. All brands of diet yogurt had mandatory nutritional information on their label. As for content, only brands B and C are compliant with the current legal demands. The numbers found in the analyses for protein and carbohydrates were higher than the percentages shown on the labels in all brands. There were no numbers for lipids. Despite the differences found on the labels, all brands of diet yogurt are in accordance with the Identity and Quality Standards for Fermented Milk as for protein, acidity and fat content. There was a significant difference in the complementary analyses for moisture, minerals and acidity. Nevertheless, the numbers assigned to carbohydrates and protein were lower than the actual values determined in lab and, in some brands, carbohydrates were three times higher. Thus, despite presenting all the necessary information on the label, the companies are not concerned about showing the correct nutritional data to consumers

Fructose levels are markedly elevated in cerebrospinal fluid compared to plasma in pregnant women.

Fructose, unlike glucose, promotes feeding behavior in rodents and its ingestion exerts differential effects in the human brain. However, plasma fructose is typically 1/1000 th of glucose levels and it is unclear to what extent fructose crosses the blood-brain barrier. We investigated whether local endogenous central nervous system (CNS) fructose production from glucose via the polyol pathway (glucose → sorbitol → fructose) contributes to brain exposure to fructose.In this observational study, fasting glucose, sorbitol and fructose concentrations were measured using gas-chromatography-liquid mass spectroscopy in cerebrospinal fluid (CSF), maternal plasma, and venous cord blood collected from 25 pregnant women (6 lean, 10 overweight/obese, and 9 T2DM/gestational DM) undergoing spinal anesthesia and elective cesarean section.As expected, CSF glucose was ~ 60% of plasma glucose levels. In contrast, fructose was nearly 20-fold higher in CSF than in plasma (p < 0.001), and CSF sorbitol was ~ 9-times higher than plasma levels (p < 0.001). Moreover, CSF fructose correlated positively with CSF glucose (ρ 0.45, p = 0.02) and sorbitol levels (ρ 0.75, p < 0.001). Cord blood sorbitol was also ~ 7-fold higher than maternal plasma sorbitol levels (p = 0.001). There were no differences in plasma, CSF, and cord blood glucose, fructose, or sorbitol levels between groups.These data raise the possibility that fructose may be produced endogenously in the human brain and that the effects of fructose in the human brain and placenta may extend beyond its dietary consumption