Acute cardiometabolic effects of brief active breaks in sitting for patients with rheumatoid arthritis

Exercise is a treatment in rheumatoid arthritis, but participation in moderate-to-vigorous exercise is challenging for some patients. Light-intensity breaks in sitting could be a promising alternative. We compared the acute effects of active breaks in sitting with those of moderate-to-vigorous exercise on cardiometabolic risk markers in patients with rheumatoid arthritis. In a crossover fashion, 15 women with rheumatoid arthritis underwent three 8-h experimental conditions: prolonged sitting (SIT), 30-min bout of moderate-to-vigorous exercise followed by prolonged sitting (EX), and 3-min bouts of light-intensity walking every 30 min of sitting (BR). Postprandial glucose, insulin, c-peptide, triglycerides, cytokines, lipid classes/subclasses (lipidomics), and blood pressure responses were assessed. Muscle biopsies were collected following each session to assess targeted proteins/genes. Glucose [−28% in area under the curve (AUC), P = 0.036], insulin (−28% in AUC, P = 0.016), and c-peptide (−27% in AUC, P = 0.006) postprandial responses were attenuated in BR versus SIT, whereas only c-peptide was lower in EX versus SIT (−20% in AUC, P = 0.002). IL-1β decreased during BR, but increased during EX and SIT (P = 0.027 and P = 0.085, respectively). IL-1ra was increased during EX versus BR (P = 0.002). TNF-α concentrations decreased during BR versus EX (P = 0.022). EX, but not BR, reduced systolic blood pressure (P = 0.013). Lipidomic analysis showed that 7 of 36 lipid classes/subclasses were significantly different between conditions, with greater changes being observed in EX. No differences were observed for protein/gene expression. Brief active breaks in sitting can offset markers of cardiometabolic disturbance, which may be particularly useful for patients who may find it difficult to adhere to exercise. NEW & NOTEWORTHY Exercise is a treatment in rheumatoid arthritis but is challenging for some patients. Light-intensity breaks in sitting could be a promising alternative. Our findings show beneficial, but differential, cardiometabolic effects of active breaks in sitting and exercise in patients with rheumatoid arthritis. Breaks in sitting mainly improved glycemic and inflammatory markers, whereas exercise improved lipidomic and hypotensive responses. Breaks in sitting show promise in offsetting aspects of cardiometabolic disturbance associated with prolonged sitting in rheumatoid arthritis

Evaluation of structure and process in care in Diabetes mellitus

Objetivo: Avaliar a atenção à saúde aos pacientes com Diabetes mellitus tipo 2 a partir dos recursos humanos, registros de profissionais e de atividades técnicas em um Centro de Saúde Escola. Metodologia: Estudo avaliativo quantitativo, descritivo por meio de observação e análise de 150 pacientes com DM em um Centro de Saúde Escola no interior paulista. Resultados: A estrutura física segue a maioria das exigências da Agência Nacional de Vigilância Sanitária, os recursos materiais atendem as necessidades em relação às quantidades e qualidade. Em 145 (96.6%) prontuários haviam registros médicos o que aponta a organização do trabalho centrada no modelo biomédico. O registro das medidas antropométricas foi considerado baixo, sendo que em apenas 4 (2.6%) havia a medida da circunferência abdominal. Apenas 5 (3.3%) dos pacientes tiveram consulta com o enfermeiro. Essas consultas foram pontuais enfatizando orientações sobre uso dos medicamentos e aparentemente não se constitui em rotina no serviço. Conclusão: Considerou-se a estrutura do serviço como apropriada, no entanto o processo é um fator a ser revisto pela equipe de saúdeObjective: Evaluate health care to patients with Diabetes mellitus type 2 by means of human resources, records of professional and technical activities in a School Health Center. Methodology: A quantitative, descriptive evaluative study through observation and analysis of 150 patients with DM at a School Health Center in São Paulo. Results: The physical structure follows most of the requirements of the National Health Surveillance Agency; the material resources cater the needs in the quantities and quality. The medical records 145 (96.6%) indicates that work organization was focused on the biomedical model. The registration of anthropometric measures was considered low, and in only 4 (2.6%) had the measure of waist circumference. Only 5 (3.3%) patients had consultation with the nurse. These consultations were punctual and highlighting specific guidelines on use of medications and there seems to be not in the service routine. Conclusion: We considered the structure of the service as appropriate but the process is a factor to be reviewed by the health tea

Determinants of the organization of diabetes mellitus care in user satisfaction

The objective of the study was analyze user satisfaction determinants of patients with Diabetes Mellitus (DM) regarding the outpatient clinic specialties at the Health Centre of the School. Qualitative cross-sectional study was carried out in outpatient specialty with 20 users with diagnosis of DM. We adopted the method of semi-structured interview using a scripting guide. We used Atlas it software 7.0 to aid in the decoding of speech, and analyzed it by content analysis. The empirical material encoded enabled to observe that the most evident themes are related to organizational accessibility and the relationship between user and service staff in perspective of longitudinality. It was observed the outpatient identifying clinic specialties as a regular source of care and dissatisfaction with regard to service accessibility.O objetivo do estudo foi analisar os determinantes da satisfação do usuário com Diabetes Mellitus (DM) sobre o atendimento no ambulatório de especialidades de um Centro de Saúde Escola. O estudo transversal com abordagem qualitativa foi desenvolvido no ambulatório de especialidades com 20 usuários com diagnóstico de DM. Foram aplicadas entrevistas semiestruturadas por meio de um roteiro norteador. Utilizou-se software Atlas ti 7.0 para auxílio na codificação das falas e técnica de Análise de Conteúdo para análise dos dados. Como resultado, observou-se que os temas mais evidenciados estão relacionados à acessibilidade organizacional e à relação entre usuário, equipe e serviço na perspectiva da longitudinalidade. Observou-se a identificação do ambulatório de especialidade como fonte regular de cuidado e a insatisfação no que se refere à acessibilidade ao serviço.

Physical activity: a strategy to improve antibody response to a SARS-CoV-2 vaccine booster dose in patients with autoimmune rheumatic diseases.

Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac's inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. This was a phase-4 trial conducted in Sao Paulo, Brazil. Patients with ARD underwent a 3-dose schedule of CoronaVac. One month after the booster, we assessed seroconversion rates of anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity. Physical activity was assessed through questionnaire. Physically active (n = 362) and inactive (n = 278) patients were comparable for most characteristics; however, physically active patients were younger (P<.01) and had a lower frequency of chronic inflammatory arthritis (P<.01). Adjusted models showed that physically active patients had -2 times odds of seroconversion rates (OR: 2.09; 95% confidence interval, 1.22 to 3.61), -22% greater geometric mean titers of anti-S1/S2 IgG (22.09%; 95% confidence interval, 3.91 to 65.60), and -7% greater neutralizing activity (6.76%; 95% confidence interval, 2.80 to 10.72) than inactive patients. Patients with ARD who are physically active have greater odds of experiencing better immunogenicity to a booster dose of CoronaVac. These results support the recommendation of physical activity to improve vaccination responses, particularly for immunocompromised individuals

No associations between physical activity and immunogenicity in SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and after vaccination.

To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (30 kg/m2), and use of prednisone, immunosuppressants, and biologics. A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity

Intercontinental distributions, phylogenetic position and life cycles of species of Apharyngostrigea (Digenea, Diplostomoidea) illuminated with morphological, experimental, molecular and genomic data

When subjected to molecular study, species of digeneans believed to be cosmopolitan are usually found to consist of complexes of species with narrower distributions. We present molecular and morphological evidence of transcontinental distributions in two species of Apharyngostrigea Ciurea, 1924, based on samples from Africa and the Americas. Sequences of cytochrome c oxidase I and, in some samples, internal transcribed spacer, revealed Apharyngostrigea pipientis (Faust, 1918) in Tanzania (first known African record), Argentina, Brazil, USA and Canada. Sequences from A. pipientis also match previously published sequences identified as Apharyngostrigea cornu (Zeder, 1800) originating in Mexico. Hosts of A. pipientis surveyed include definitive hosts from the Afrotropic, Neotropic and Nearctic, as well as first and second intermediate hosts from the Americas, including the type host and type region. In addition, metacercariae of A. pipientis were obtained from experimentally infected Poecilia reticulata, the first known record of this parasite in a non-amphibian second intermediate host. Variation in cytochrome c oxidase I haplotypes in A. pipientis is consistent with a long established, wide-ranging species with moderate genetic structure among Nearctic, Neotropic and Afrotropic regions. We attribute this to natural dispersal by birds and find no evidence of anthropogenic introductions of exotic host species. Sequences of CO1 and ITS from adult Apharyngostrigea simplex (Johnston, 1904) from Egretta thula in Argentina matched published data from cercariae from Biomphalaria straminea from Brazil and metacercariae from Cnesterodon decemmaculatus in Argentina, consistent with previous morphological and life-cycle studies reporting this parasite—originally described in Australia—in South America. Analyses of the mitochondrial genome and rDNA operon from A. pipientis support prior phylogenies based on shorter markers showing the Strigeidae Railliet, 1919 to be polyphyletic.Facultad de Ciencias Naturales y MuseoCentro de Estudios Parasitológicos y de Vectore

Beta-alanine (Carnosyn™) supplementation in elderly subjects (60–80 years): effects on muscle carnosine content and physical capacity

The aim of this study was to investigate the effects of beta-alanine supplementation on exercise capacity and the muscle carnosine content in elderly subjects. Eighteen healthy elderly subjects (60–80 years, 10 female and 4 male) were randomly assigned to receive either beta-alanine (BA, n = 12) or placebo (PL, n = 6) for 12 weeks. The BA group received 3.2 g of beta-alanine per day (2 × 800 mg sustained-release Carnosyn™ tablets, given 2 times per day). The PL group received 2 × (2 × 800 mg) of a matched placebo. At baseline (PRE) and after 12 weeks (POST-12) of supplementation, assessments were made of the muscle carnosine content, anaerobic exercise capacity, muscle function, quality of life, physical activity and food intake. A significant increase in the muscle carnosine content of the gastrocnemius muscle was shown in the BA group (+85.4%) when compared with the PL group (+7.2%) (p = 0.004; ES: 1.21). The time-to-exhaustion in the constant-load submaximal test (i.e., TLIM) was significantly improved (p = 0.05; ES: 1.71) in the BA group (+36.5%) versus the PL group (+8.6%). Similarly, time-to-exhaustion in the incremental test was also significantly increased (p = 0.04; ES 1.03) following beta-alanine supplementation (+12.2%) when compared with placebo (+0.1%). Significant positive correlations were also shown between the relative change in the muscle carnosine content and the relative change in the time-to-exhaustion in the TLIM test (r = 0.62; p = 0.01) and in the incremental test (r = 0.48; p = 0.02). In summary, the current data indicate for the first time, that beta-alanine supplementation is effective in increasing the muscle carnosine content in healthy elderly subjects, with subsequent improvement in their exercise capacity