Celiac disease: effects on bone mineralization

Universidade Federal de PernambucoUNIFESP-EPMUNIFESP, EPMSciEL

Effects of oral breathing in the nutritional state: why does it happen?

INTRODUCTION: Some children who breathe through the mouth and present nocturnal obstructive apnea can present retardation of the structural pondero growing. OBJECTIVE: The objective of this article is to analyse the orofacial miofuctional alterations presentin the oral breathing individual and the effects over the nutritional state. Focus the importance of the interdisciplinary team following the global alterations present in the oral breathing. METHOD: The used method was a literature's revision, from published articles in indexed scientific magazines, books and works from pos-graduation. The major of the articles was identified from the bases of LILACS, MEDLINE, and SCIELO informations. RESULTS: Can be noticed the relationship of the oral breathing with a change in the general process of alimentation linked to the taste, oral miofunction and smell difficulties, reflecting in this way in the nutritional state. Final Commentaries: The cause diversities envolved in oral breathing require a trained interdisciplinary team to identify these alterations, making possible the preventive measure implementation which can avoid alterations in general health, in the face normal development and the nutritional state in important stage of theseindividuals growing.INTRODUÇÃO: Algumas crianças que respiram pela boca e apresentam apneias obstrutivas noturnas podem apresentar retardo do crescimento pôndero-estatural. OBJETIVO: O objetivo deste artigo é analisar as alterações miofuncionais orofaciais presentes no indivíduo respirador oral e as repercussões sobre o estado nutricional. Enfoca a importância da equipe interdisciplinar no acompanhamento das alterações globais presentes na respiração oral. MÉTODO: O método utilizado foi uma revisão da literatura, a partir de artigos publicados em revistas cientificas indexadas, livros e trabalhos de pós-graduação. A maioria dos artigos foi identificada a partir das bases de dados, LILACS, MEDLINE e SCIELO. RESULTADOS: Percebe-se relação da respiração oral com a modificação no processo geral de alimentação, associada às dificuldades no olfato, paladar e distúrbios miofuncionais orofaciais, repercutindo assim no estado nutricional. Comentários Finais: A diversidade de causas envolvidas na respiração oral requer uma equipe interdisciplinar treinada para identificar estas alterações, possibilitando a implementação de medidas preventivas, que evitem alterações na saúde geral, no desenvolvimento normal da face e no estado nutricional em importantes fases do crescimento desses indivíduos.Faculdade Integrada do RecifeUNIFESP-EPMUniversidade Federal de PernambucoUniversidade Federal de Pernambuco Departamento de FonoaudiologiaUNIFESP, EPMSciEL

Esteatose hepática em crianças e adolescentes obesos

Objective: To assess the frequency of hepatic steatosis and metabolic syndrome among obese children and adolescents.Method: A descriptive case series was conducted with 77 patients, aged 2 to 13 years and 11 months, who were followed up from February to July 2007. Obesity was defined as body mass index >= P-95 adjusted for age and sex. Liver ultrasound was performed to diagnose hepatic steatosis. Metabolic syndrome was defined according to the modified criteria suggested by Cook et al.Results: Hepatic steatosis was diagnosed in 33/77 patients (42.9%), 25/33 (75.8%) with mild steatosis and 8/33 (24.2%) with moderate steatosis. Those aged less than 10 years showed only mild steatosis, and the moderate degree of the disease was restricted to adolescents. Aminotransferase alterations were found in 9.1% (3/33) of patients with hepatic steatosis and in 4.9% (2/41) of those without the disorder. Mean waist circumference was 84.74 +/- 2.84 cm for patients with hepatic steatosis and 78.24 +/- 1.60 cm for those without the disease (p = 0.04). Metabolic syndrome was diagnosed in 27.3% (21/77) of obese patients, 47.6% (10/21) of them having steatosis, 60% had mild steatosis and 40% had a moderate degree of the disorder.Conclusions: the frequency of hepatic steatosis and metabolic syndrome was high. the association of larger waist circumference with hepatic steatosis highlights the importance of taking this parameter into consideration when investigating obese patients.Fundacao de Amparo a Ciencia e Tecnologia do estado de Pernambuco (FACEPE)Univ Fed Pernambuco, Dept Materno Infantil, Ctr Ciencias Saude, Recife, PE, BrazilHosp Barao Lucena, Serv Endocrinol Pediat, Recife, PE, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilWeb of Scienc

Ensino baseado em simulação e promoção de autoconfiança em estudantes de medicina

Through the last decades, Realistic Simulation for medical undergraduates has been consolidated as an important active learning method, known as Simulation Based Learning, a strategy able to foster self-confidence and courage to act in real situations as the medical students develop skills, attitudes and values related to the medical practice. This study aimed to evaluate the impact of realistic simulation in the teaching of pediatric emergencies in terms of promoting self-confidence in undergraduate among medical students. A prospective interventional study was conducted in a medical course at a public University in Brazil. The study sample included 40 medical students from the fourth to the eighth semesters of the course. The group attended to a workshop on pediatric emergencies entitled “Cardiopulmonary resuscitation in pediatrics” and at the end of this activity they engaged in a realistic simulation exercise. Then, a Scale for satisfaction and self-confidence, translated and validated for Portuguese in 2015, was applied to the medical students.The average age of the students ranged between 21.8 and 22.2 yo. As for gender, 60% were male and 40% female. Most students (67.5%) were in the fourth semester of the course and for 80 of them, this simulation activity represented their first experience with this learning method. In terms of self-confidence, 97% of the participants felt confident about the content of the simulation activity. Moreover, all the students involved in simulation activity felt more confident to act in a similar scenario in the real- life medical practice. Self-confidence resulting from realistic simulation can foster positive attitudinal changes among medical undergraduates. Higher self-confidence levels among medical students and physicians are related to more successful medical interventions as they can practice, test, and improve their medical skills before being exposed to similar real-life medical situations. Accordingly, there is a greater need to implement realistic simulations as an active learning methodology in the undergraduate medical curriculum.A simulação realística tem se difundido nas escolas médicas nas últimas décadas, conferindo a esta o status de metodologia ativa denominada de Ensino Baseado em Simulação. Este tem se mostrado eficaz na promoção da autoconfiança de estudantes de medicina e relevante por estimular a segurança de agir, baseado nas habilidades, valores, metas e experiências vivenciadas na formação. Este estudo teve como objetivo avaliar o impacto do uso da simulação realística no ensino de emergências pediátricas para a promoção de autoconfiança de graduandos em medicina. Realizou-se um estudo prospectivo de intervenção educacional, em um curso de Graduação em Medicina no Brasil. A amostra por conveniência foi composta por 40 graduandos entre o segundo e o quarto ano do curso. Os estudantes participaram de um workshop sobre emergência pediátrica com tema “reanimação cardiopulmonar em pediatria”, sendo ao final submetidos à simulação realística. Foi aplicada a Escala de Satisfação dos Estudantes e Autoconfiança com a Aprendizagem, traduzida e validada para o português em 2015. A idade dos estudantes variou entre 21,8 e 22,2 anos. Quanto ao sexo, 60% eram do masculino e 40% do feminino. Estavam matriculados no segundo ano do curso, 67,5% dos estudantes e 32,5% no terceiro e quarto. Para 80% dos estudantes, esta foi a primeira experiência com simulação e 90% deles não estavam participando de outra atividade extracurricular. Acerca da autoconfiança, 95% dos estudantes afirmaram que a simulação abordou o conteúdo necessário para a formação, 97,5% referiram estar confiantes sobre o domínio do conteúdo da atividade apresentada e 100% dos estudantes afirmou autoconfiança para realizar um atendimento em ambiente real, reportando os conhecimentos adquiridos na simulação. A autoconfiança promovida pela simulação é um pré-requisito necessário para mudanças positivas no comportamento e nas ações dos estudantes. Profissionais e estudantes de medicina, com maiores níveis de autoconfiança, têm melhores perspectivas de serem bem-sucedidos nas suas intervenções, pois conseguem prontamente testar e aplicar as suas competências. Assim, sinaliza-se para uma maior necessidade de incluir a simulação nos currículos dos cursos médicos como metodologia ativa

Fequency distribution of HLA DQ2 and DQ8 in celiac patients and first-degree relatives in Recife, northeastern Brazil

AIMS: The aim of this study was to evaluate the frequencies of the HLA genotypes DQ2 and DQ8 and the alleles A1*05, A1*0201, B1*0201 and B1*0302 in individuals with celiac disease in Recife, northeastern Brazil. METHODS: HLA DQ2 and DQ8 genotyping was performed for 73 individuals with celiac disease and 126 first-degree relatives with negative transglutaminase serology. The alleles DQA1*05, DQA1*0201, DQB1*02 and DQB1*0302 were identified by sequencing using specific primers and the EU-DQ kit from the Eurospital Laboratory, Trieste, Italy and double-checked by the All Set SPP kit (Dynal). RESULTS: Among the 73 cases, 50 (68.5%) had the genotype DQ2, 13 (17.8%) had DQ8, 5 (6.8%) had DQ2 and DQ8, and 5 did not have any of these genotypes. Among the 5 negative individuals, four had the B1*02 allele and one did not have any of the alleles studied. B1*02 was the most frequent allele in both groups (94% in the patients and 89% in the control relatives). CONCLUSIONS: In this study, celiac disease was associated with the genotypes DQ2 and DQ8. DQ2 predominated, but the distribution of the frequencies was different from what has been found in European populations and was closer to what has been found in the Americas. The high frequencies of the HLA genotypes DQ2 and DQ8 that were found in first-degree relatives would make it difficult to use these HLA genotypes for routine diagnosis of celiac disease in this group

Maternal obesity programs mitochondrial and lipid metabolism gene expression in infant umbilical vein endothelial cells

Background/Objectives Maternal obesity increases risk for childhood obesity, but molecular mechanisms are not well understood. We hypothesized that primary umbilical vein endothelial cells (HUVEC) from infants of overweight and obese mothers would harbor transcriptional patterns reflecting offspring obesity risk. Subjects/Methods In this observational cohort study, we recruited 13 lean (pre-pregnancy BMI <25.0 kg/m2) and 24 overweight-obese (‘ov-ob’, BMI ≥25.0 kg/m2) women. We isolated primary HUVEC, and analyzed both gene expression (Primeview, Affymetrix) and cord blood levels of hormones and adipokines. Results: 142 transcripts were differentially expressed in HUVEC from infants of overweight-obese mothers (false discovery rate, FDR <0.05). Pathway analysis revealed that genes involved in mitochondrial and lipid metabolism were negatively correlated with maternal BMI (FDR <0.05). To test whether these transcriptomic patterns were associated with distinct nutrient exposures in the setting of maternal obesity, we analyzed the cord blood lipidome and noted significant increases in levels of total free fatty acids (lean: 95.5 ± 37.1 ug/ml, ov-ob: 124.1 ± 46.0 ug/ml, P=0.049), palmitate (lean: 34.5 ± 12.7 ug/ml, ov-ob: 46.3 ± 18.4 ug/ml, P=0.03) and stearate (lean: 20.8 ± 8.2 ug/ml, ov-ob: 29.7 ± 17.2 ug/ml, P=0.04), in infants of overweight-obese mothers. Conclusion: Prenatal exposure to maternal obesity alters HUVEC expression of genes involved in mitochondrial and lipid metabolism, potentially reflecting developmentally-programmed differences in oxidative and lipid metabolism