Hanseníase: apresentação rara de comprometimento das 20 unhas - relato de caso / Hansen's disease: a rare presentation with the involvement of 20 nails – case report

Alterações ungueais são comuns na hanseníase e atribuídas a uma combinação de fatores como neuropatia, trauma, desordens vasculares e infecções.  Estima-se que 56% dos pacientes paucibacilares e 87% dos pacientes multibacilares apresentem alterações nas unhas, das quais as mais comuns são: hiperceratose ungueal, onicogrifose, onicorréxis, microníquia, anoníquia, sulcos de Beau, escleroníquia, melanoníquia longitudinal e pterígio ungueal inverso. Relatamos caso clínico de paciente que apresentava alterações ungueais da Hanseníase na sua manifestação mais rara de acometimento das 20 unhas e o diagnóstico diferencial com o líquen plano ungueal, a candidíase mucocutânea, a paquidermoperiostose, e outras neuropatias periféricas como no Diabetes Mellitus.

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effect of eating different fatty acids with or without a fructose based beverage intake on postprandial inflammatory response in normal weight or overweight women

A inflamação tem sido proposta como elo entre a obesidade e diversas condições clínicas como a síndrome metabólica, diabetes e aterosclerose. Por sua vez, a dieta é um reconhecido fator modulador da resposta inflamatória. Neste sentido, os ácidos graxos podem influenciar muitos eventos e mecanismos celulares, e desempenhar importante papel na regulação de respostas imunes e inflamatórias. O consumo de frutas, por outro lado, resultam em importante redução de marcadores pró-inflamatórios. Diante do exposto, o presente estudo teve como objetivo avaliar o efeito do consumo de refeições com alto conteúdo de ácidos graxos saturados (AGS) e monoinsaturados (AGMI), acompanhadas de suco de laranja ou não, na resposta inflamatória pós-prandial em mulheres eutróficas ou com excesso de peso. Tratou-se de um estudo pós-prandial, aleatório, cruzado e controlado. Participaram do estudo 55 mulheres adultas (com idade entre 20 a 40 anos), pré-menopáusicas e não gestantes. Na primeira etapa do estudo, um grupo de voluntárias (n=33, 27±01 anos) recebeu uma refeição (≈1.000 kcal) com alto conteúdo de AGS (37% do valor calórico total), acompanhadas de 500 mL de suco de laranja (teste), ou de água (controle negativo). Na segunda etapa, outro grupo (n=22, 27±1 anos) recebeu uma refeição (≈1.000 kcal) com alto conteúdo de AGMI (53% do valor calórico total), acompanhadas de 500 mL de suco de laranja (teste), de uma bebida à base de frutose (controle), ou de água (controle negativo). As concentrações plasmáticas de marcadores inflamatórios (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN- , TNF e PCR) foram determinadas antes (jejum) e depois de 2, 3 e 5 horas da ingestão das refeições testes. Como resultados, o consumo agudo de uma refeição com alto conteúdo de AGS, em comparação a refeição com alto conteúdo de AGMI, apresentou maiores valores para AUC ajustada das citocinas TNF e IL-6, independente da bebida que acompanhou as refeições. Ainda, o consumo de AGS acompanhado de água, mas não de suco de laranja, também apresentou maiores valores para AUC ajustada para citocinas IL-17A, IL-4 e IL- 2, em relação à refeição com alto conteúdo de AGMI acompanhada ou não da ingestão de suco de laranja. Também foi observado o aumento da AUC ajustada para IL-10, após o consumo de AGS, em relação ao AGMI, possivelmente relacionado a uma compensação do organismo visando limitar a inflamação subclínica induzida pelo consumo desse ácido graxo. O consumo do suco de laranja, por sua vez, reduziu a inflamação pós-prandial, induzida pelo consumo de uma refeição com alto conteúdo de AGS, mediante a redução das concentrações de ΔIL-17A. Ainda, o consumo de refeições com alto conteúdo de AGS ou AGMI aumentou a concentração pós-prandial da IL-6 plasmática, independente da refeição ser acompanhada ou não de suco de laranja. Nós não identificamos diferenças na resposta inflamatória pós-prandial de acordo com estado nutricional das voluntárias (eutrofia vs. excesso de peso) que consumiram uma refeição com alto conteúdo de AGS ou AGMI, acompanhadas ou não da ingestão de suco de laranja. Em conclusão, os resultados do presente estudo indicam um efeito anti- inflamatório dos AGMI em relação aos AGS. O consumo de suco de laranja, por sua vez, se mostrou capaz de atenuar o aumento subclínico da inflamação pós-prandial induzida pela dieta com alto conteúdo de AGS para um marcador específico (IL-17A). Estudos em longo prazo são necessários para avaliar os benefícios do seu consumo regular de AGMI e suco de laranja, bem como os mecanismos envolvidos.Inflammation has being proposed as a link between obesity and various clinical conditions such as metabolic syndrome, diabetes and atherosclerosis. Besides diet is a recognized modulator of the inflammatory response. In this regard, the fatty acids can influence many events and cellular mechanisms, and play an important role in regulating immune and inflammatory responses. The consumption of fruit on the other hand, results in significant reduction of pro-inflammatory markers. Considering the above, this study aimed to evaluate the effect of food consumption with high content of saturated fatty acids (SFA) and monounsaturated (MUFA), accompanied by orange juice or not, on postprandial inflammatory response in normal or overweight/obesity women. This was a post-prandial, randomized, crossover and controlled study design. The study included 55 adult women (aged 20 to 40 years), premenopausal and not pregnant. In the first stage of the study, a group of volunteers (n=33, 27±1 years) received a meal (≈1.000 kcal) rich in AGS (37% of energy intake) together with 500 ml of orange juice (test) or water (negative control). At the second stage, another group (n=22, 27±1 years) received a meal (≈1.000 kcal) rich in MUFA (53% of energy intake) together with 500 ml of orange juice (test), fructose beverage (control), or water (negative control). Plasma concentrations of inflammatory markers (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN- , TNF and hs-CRP) were determined before (fasting) and after 2, 3 and 5 hours of ingestion of the test meals. As a result, the acute consumption of a high-SFA meal compared with a high-MUFA meal, showed higher values for AUC of TNF and IL-6 cytokines, independent of the drink that accompanied the meals. Also, consumption of a high-SFA meal accompanied by water intake, but not orange juice, also had higher values for AUC of IL-17A, IL-4 and IL-2 for in relation to a high-MUFA meal with or without orange juice intake. It was also observed an increase in AUC of IL-10, after consumption of high-SFA meal, compared to a high- MUFA meal, possibly related to a compensation to limit the subclinical inflammation induced by the consumption of this fatty acid. On the other hand, the consumption of orange juice reduced postprandial inflammation induced by the consumption of a meal rich in AGS, by reducing the concentrations of ΔIL-17A. Moreover, the consumption of meals with high MUFA or SFA content, followed by orange juice or not, increased postprandial plasma concentration of IL-6. We have not identified differences in postprandial inflammatory response according to nutritional status of volunteers (normal weight vs. overweight) that consumed a meal rich in MUFA or SFA, with or without orange juice intake. In summary, the results of this study indicate an anti-inflammatory effect of MUFA compared to AGS. The consumption of orange juice, in turn, was able to mitigate the subclinical increase of postprandial inflammation induced by diet with high content of AGS for a particular biomarker (IL-17A). Long-term studies are needed to assess the benefits of MUFA and orange juice regular consumption, as well as the mechanisms involved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Influence of Brazilian nuts consumption on body weight, appetite, glycemic response and inflammatory markers in overweight women

O consumo de castanhas tem efeitos benéficos à saúde, quando incorporadas em uma alimentação saudável e balanceada. Contudo, o papel das castanhas no controle do peso, a saciedade, homeostase glicêmica e inflamação, especialmente das castanhas brasileiras (CB: Anacardium accidentale e Bertholetia excelsa) não está ainda estabelecido. Assim, o presente estudo avaliou os efeitos do consumo de 45 g de CB (15g de castanha-do-brasil + 30g de castanha de caju) sobre a perda de peso, apetite, resposta glicêmica e inflamação, em mulheres adultas com excesso de peso em risco cardiometabólico. Vinte e nove mulheres participaram de um ensaio clínico randomizado controlado aberto de oito semanas, para receber uma dieta com restrição calórica (-500 kcal/d) contendo CB ou uma dieta isenta de castanhas com mesma restrição (grupo controle). No início e no final do estudo, as participantes compareceram ao Laboratório de Metabolismo Energético e Composição Corporal da Universidade Federal de Viçosa (LAMECC/ UFV) pela manhã após jejum noturno (10- 12h) para avaliação do peso corporal e da composição corporal. Nesse momento, também foram avaliados os escores subjetivos de apetite pós-prandial pela escala visual analógica (EVA) antes e após o consumo (0, 10, 60, 120, 180 e 240 min.) de uma bebida contendo castanhas (grupo CB) ou isenta de castanhas (controle). Também foram avaliados o consumo de almoço ad libitum, EVA aos 280 min e registro alimentar nas 24 h subsequentes em ambiente livre. As concentrações plasmáticas de glicemia, insulina, grelina, GIP, GLP-1 e leptina foram dosadas em jejum e 60, 120 e 240 minutos após bebida teste. Os marcadores inflamatórios adiponectina, resistina, PAI-1, IL-1β, IL-6, IL-8, IL-10, IL-17A e TNF foram determinados em jejum e 240 min pós-prandial. Os valores de HOMA-IR, do índice de triglicerídeo-glicose (TyG), do cortisol, e da PCR em jejum também foram avaliados. Após oitos semanas de intervenção nutricional, as mulheres no grupo CB tiveram perda significante de peso,mas similar àquela do grupo controle. Contudo, nas participantes aderentes ao protocolo de restrição calórica (82%), foi observada uma maior perda de peso e de gordura corporal, em comparação ao grupo controle. Além disso, a grelina (ΔAUC) diminuiu no grupo CB em comparação ao grupo controle, após 8 semanas. Em relação a resposta inflamatória, o grupo controle apresentou aumento pós-prandial da citocina pró-inflamatória IL-6 e, possivelmente, como mecanismo de compensação, estimulou o aumento do hormônio anti-inflamatório cortisol. O consumo de CB, por sua vez, evitou o aumento pós-prandial da IL-6, sem alterar outros marcadores inflamatórios avaliados. Ainda, o consumo de CB não alterou as respostas de jejum ou pós-prandial relacionadas ao controle glicêmico. Como conclusão, o consumo de 45 g das CB (Anacardium accidentale e Bertholetia excelsa), associado a uma dieta com restrição calórica, apresentou efeitos benéficos no peso e na perda de gordura corporal, além de potencial para aumentar a saciedade e um efeito modesto sobre a inflamação. Ainda, o consumo agudo e crônico das castanhas brasileiras não foi capaz de alterar as respostas pós-prandiais glicêmicas e insulinêmicas, em mulheres com excesso de peso normoglicêmicas, em risco cardiometabólico. Palavras-chave: Apetite. Castanhas. Glicemia. Inflamação. Mulheres. Nutrição.The consumption of nuts has beneficial effects on health, when incorporated into a healthy and balanced diet. However, the role of nuts in weight control, satiety, glycemic homeostasis and inflammation, especially of Brazilian nuts (BN: Anacardium accidentale and Bertholetia excelsa), is not well established. Thus, the present study evaluated the effects of 45 g of BN (15g of Brazil nuts + 30g of cashew nuts) on weight loss, appetite, glycemic response, and inflammation in overweight adult women at cardiometabolic risk. Twenty-nine women participated in an 8-week open-label randomized controlled trial to receive an energy-restricted diet (-500 kcal/d) containing BN or a nut-free diet with the same energy restriction (control group). At the beginning and at the end of the study, the participants attended the Laboratório de Metabolismo Energético e Composição Corporal of Universidade Federal de Viçosa (LAMECC/UFV) in the morning after an overnight fast (10-12h) to assess body weight and body composition. At that time, subjective scores of postprandial appetite were evaluated by visual analogue scale (VAS) before and after consumption (0, 10, 60, 120, 180, and 240 min.) of a drink containing nuts (group BN) or free of nuts (control). Ad libitum lunch consumption, VAS at 280 min and food record in the subsequent 24 h in an open environment were also evaluated. Plasma concentrations of blood glucose, insulin, ghrelin, GIP, GLP-1 and leptin were measured in fasting and 60, 120 and 240 minutes after the test drink. Inflammatory markers, adiponectin, resistin, PAI- 1, IL-1β, IL-6, IL-8, IL-10, IL -17A, and TNF were determined at fasting and 240 min postprandial. HOMA-IR, triglyceride-glucose index (TyG), cortisol, and fasting CRP concentrations were also evaluated. After eight weeks of nutritional intervention, women in the BN group had significant weight loss, but similar to that of the control group. However, in those energy-restriction protocol compliance participants (82%), a greater loss of weight and body fat was observed, compared to the control group.Furthermore, ghrelin (ΔAUC) decreased in the BN group compared to the control group after 8 weeks. Regarding the inflammatory response, the control group showed a postprandial increase in the proinflammatory cytokine IL-6 and, possibly, as a compensation mechanism, it stimulated the increase in the anti-inflammatory hormone cortisol. The consumption of BN, in turn, prevented the postprandial increase in IL-6, without altering the other inflammatory markers evaluated. Furthermore, BN consumption did not change fasting or postprandial responses related to glycemic control. In conclusion, the consumption of 45 g of BN (Anacardium accidentale and Bertholetia excelsa), combined with a calorie-restricted diet, had beneficial effects on weight and body fat loss, as well as a potential to increase satiety and a modest effect on inflammation. Furthermore, the acute and chronic consumption of Brazilian nuts was not able to alter postprandial glycemic and insulinemic responses in normoglycemic overweight women at cardiometabolic risk. Keywords: Appetite. Blood glucose. Inflammation. Nuts. Nutrition. Women.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superio