A influência do polimorfismo rs9939609 do gene FTO na predisposição à obesidade e na responsividade a diferentes intervenções nutricionais / The influence of the rs9939609 polymorphism of the FTO gene on the predisposition to obesity and responsiveness to different nutritional interventions

Com a crescente incidência da obesidade e o grande avanço que se tem atribuído à nutrigenética, a relação entre polimorfismos de nucleotídeo simples (SNP) do gene FTO tem sido bastante investigada junto a essa manifestação fenotípica. Dessa maneira, objetivou-se avaliar a relação entre o SNP rs9939609 do gene FTO e a predisposição à obesidade para a formulação de estratégias dietéticas mais eficazes. O presente estudo compreende uma revisão sistemática da literatura científica, na qual foram selecionados artigos publicados entre os anos de 2009 a 2018, utilizando de bancos de dados como o Science Direct, Scielo e PubMed, incluindo estudos publicados na língua inglesa e portuguesa. Estratégias dietéticas baseadas na modulação de componentes como os ácidos graxos saturados e proteínas demonstrou exercer efeitos significativos no processo de emagrecimento aos portadores do SNP rs9939609. Analisando o contexto de possíveis alterações que predispõem a obesidade, o desenvolvimento de estratégias nutricionais otimizadoras da homeostase metabólica, que levem em conta a variabilidade genética individual para a formulação de intervenções mais efetivas, é de extrema relevância na prevenção e no combate à obesidade por portadores do alelo de risco do SNP rs9939609 do gene FTO

Evaluation of respiratory muscle strength and endurance, peripheral muscle strength, and functional capacity in patients with COPD / Avaliação da força e resistência muscular respiratória, força muscular periférica e capacidade funcional em pacientes com DPOC

This is an analytical, observational and cross-sectional study conducted from August 2017 to February 2020 in patients with Chronic Obstructive Pulmonary Disease (COPD) that aimed to assess respiratory muscle strength and endurance, peripheral muscle strength and functional capacity in patients with COPD. Respiratory muscle function was assessed using strength and endurance, peripheral muscle strength using the handgrip test, and functional capacity using the six-minute walk test (6MWT). The sensation of dyspnea was assessed by modified Medical Research Council and risk of exacerbation/hospitalization according to the classification of the Global Initiative for Chronic Obstructive Lung (GOLD). For statistical analysis, the Kolmogorov Smirnov, Chi-square, Pearson's correlation, Student t, ANOVA, and Bonferroni tests were performed with a significance level of 0.05. Forty patients were analyzed. There was a reduction in inspiratory and peripheral muscle strength in 97.5% (p <0.001) and 80% of patients (p = 0.001), respectively, in addition to a decrease in functional capacity in 97.4% (p <0.001) of individuals evaluated. There was a correlation between the GOLD classification with 6MWT (p=0.005) and inspiratory muscle strength (p=0.041), in addition to a relation between distance traveled and spirometric severity of obstruction (p=0.049). We conclude that there was a significant reduction in respiratory and peripheral muscle strength and functional capacity. The higher the degree of obstruction, the worse the performance on the 6MWT. In addition, patients who walked less have a higher risk of exacerbation and hospitalization, as well as those who have less respiratory muscle strength

Impacto da pré-eclâmpsia grave na saúde materna e fetal

Introduction: Pre-eclampsia, a serious gestational complication, involves hypertension and organ dysfunction after the 20th week, with complex etiology. Classified as mild and severe, the latter presents intense symptoms such as severe hypertension, proteinuria and organic dysfunction. As for diagnosis, clinical criteria and exams such as blood pressure measurement, urine analysis and ultrasound are used. Severe pre-eclampsia increases risks such as placental abruption, fetal growth restriction and premature birth, requiring hospital treatment and, in critical cases, immediate delivery. Investments in research are crucial to optimize the prevention and management of this complex condition. Objective: Therefore, the present study aims to analyze the impacts of severe preeclampsia on maternal and fetal health. Methodology: The study employs a methodological approach to literature review to comprehensively and updatedly analyze preeclampsia, maternal health, fetal health, and complications. The search was conducted across various platforms using specific descriptors, resulting in 295 items. After eliminating duplicates, inclusion criteria were applied, yielding 32 relevant articles from 2019 to 2024, in English, Portuguese, and Spanish. This rigorous selection ensured the relevance of the information to achieve the research objectives.Results and Discussion: Severe pre-eclampsia has significant impacts on mothers and fetuses, both in the short and long term. In the short term, maternal health is compromised, with risks of eclampsia, kidney failure, HELLP syndrome and placental abruption, often leading to premature birth. In the long term, women face a greater risk of cardiovascular disease, type 2 diabetes and kidney damage, with possible emotional repercussions. For fetuses, there are immediate risks such as growth restriction and neonatal complications, while studies point to an increased risk of cardiovascular diseases, metabolic disorders and neurological problems in adult life. The uniqueness of each case demands regular medical monitoring and preventive measures.Introdução: A pré-eclâmpsia, complicação gestacional grave, envolve hipertensão e disfunção de órgãos após a 20ª semana, com etiologia complexa. Classificada em leve e grave, esta última apresenta sintomas intensos como hipertensão severa, proteinúria e disfunção orgânica. Quanto ao diagnóstico, utilizam-se critérios clínicos e exames como medição da pressão, análise de urina e ultrassonografia. A pré-eclâmpsia grave aumenta riscos como descolamento prematuro da placenta, restrição do crescimento fetal e parto prematuro, exigindo tratamento hospitalar e, em casos críticos, parto imediato. Investimentos em pesquisa são cruciais para otimizar a prevenção e manejo dessa condição complexa. Objetivo: Sendo, assim, o presente estudo tem como objetivo analisar os impactos da pré-eclâmpsia grave para saúde materna e fetal.  Metodologia: O estudo emprega uma abordagem metodológica de revisão de literatura para analisar de forma abrangente e atualizada a pré-eclâmpsia, saúde materna, saúde fetal e complicações. A busca foi realizada em diversas plataformas, utilizando descritores específicos, resultando em 295 itens. Após a eliminação de duplicatas, critérios de inclusão foram aplicados, resultando em 32 artigos relevantes de 2019 a 2024, em inglês, português e espanhol. Essa seleção rigorosa assegurou a pertinência das informações para alcançar os objetivos da pesquisa. Resultados e Discussão: A pré-eclâmpsia grave tem impactos significativos para mães e fetos, tanto a curto quanto a longo prazo. No curto prazo, a saúde materna é comprometida, com riscos de eclâmpsia, insuficiência renal, síndrome HELLP e descolamento prematuro da placenta, frequentemente levando a parto prematuro. A longo prazo, mulheres enfrentam maior risco de doenças cardiovasculares, diabetes tipo 2 e danos renais, com possíveis repercussões emocionais. Para os fetos, há riscos imediatos como restrição de crescimento e complicações neonatais, enquanto estudos apontam para aumento do risco de doenças cardiovasculares, distúrbios metabólicos e problemas neurológicos na vida adulta. A singularidade de cada caso demanda acompanhamento médico regular e medidas preventivas

A IMPORTÂNCIA DA EQUIPE MULTIDISCIPLINAR NA REABILITAÇÃO DE PACIENTES CRÍTICOS: AVALIANDO A COLABORAÇÃO ENTRE PROFISSIONAIS DE SAÚDE NA REABILITAÇÃO DE PACIENTES DE UTI

The rehabilitation of critically ill patients in the Intensive Care Unit (ICU) requires a multidisciplinary approach, bringing together intensivist physicians, physiotherapists, nurses, psychologists, occupational therapists, and speech therapists. This collaboration is essential to provide holistic care, going beyond medical treatment. Coordination led by intensivist physicians, along with physiotherapists, nurses, and mental health professionals, plays a crucial role in early mobilization, preserving muscle and respiratory function, psychosocial assessment, and patient reintegration. Effective communication among these professionals is vital to optimize outcomes, reduce complications, and improve the patient's quality of life. This integrated approach not only enhances the patient experience but also reduces ICU stay duration, lowers mortality rates, and promotes quicker recovery post-discharge. The combined efforts of the multidisciplinary team highlight the importance of a holistic approach, integrating psychological, spiritual, and familial aspects. Efficient communication humanizes care and prevents hospital errors. Collaboration among healthcare professionals, focusing on a multidisciplinary approach, is crucial to providing a comprehensive and high-quality care plan for critically ill patients in the ICU, representing a significant advancement in healthcare services for this group.A reabilitação de pacientes críticos na Unidade de Terapia Intensiva (UTI) exige uma abordagem multidisciplinar, unindo médicos intensivistas, fisioterapeutas, enfermeiros, psicólogos, terapeutas ocupacionais e fonoaudiólogos. Essa colaboração é essencial para oferecer cuidados holísticos, indo além do tratamento médico. A coordenação liderada pelos médicos intensivistas, junto aos fisioterapeutas, enfermeiros e profissionais de saúde mental, desempenha papel crucial na mobilização precoce, preservação da função muscular e respiratória, avaliação psicossocial e reintegração do paciente. A comunicação eficaz entre esses profissionais é vital para otimizar os resultados, reduzir complicações e melhorar a qualidade de vida do paciente. Essa abordagem integrada não só melhora a experiência do paciente, mas também reduz o tempo de internação na UTI, diminui a taxa de mortalidade e promove uma recuperação mais rápida após a alta. A atuação conjunta da equipe multidisciplinar destaca a importância da abordagem holística, integrando aspectos psicológicos, espirituais e familiares. A comunicação eficiente humaniza o cuidado e evita erros hospitalares. A colaboração entre os profissionais de saúde, com foco na abordagem multidisciplinar, é crucial para proporcionar um plano de cuidados completo e de alta qualidade aos pacientes críticos na UTI, representando um avanço significativo nos serviços de saúde para esse grupo

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Extraprensa. Cultura e comunicação na América Latina (Edição Especial sep 2019)

A revista Extraprensa é um periódico destinado à publicação da produção científica nas áreas da cultura e da comunicação no Brasil e América Latina, abrangendo temas como a diversidade cultural, cidadania, expressões das culturas populares, artes, mídias alternativas, epistemologia e metodologia em cultura e comunicação

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt