Physical activity, strength training and nutritional support in patients with metabolic syndrome from a Northeaster Portuguese primary health care: a pilot community intervention program

The prevalence of Metabolic Syndrome (MetS) has been increasing exponentially in the Portuguese population. Primary prevention using physical activity (PA), exercise and healthy lifestyles seems to be limited. Thus, current study aims to present the design and preliminary findings of a pilot community intervention for patients with MetS. Methods: A randomized controlled trial was conducted between April and July 2022 with patients with MetS, from a Northeaster Portuguese primary health care. Eight participants completed the three-month intervention program, 6 women (51.0±6.4 years) and 2 men (46.5±4.9 years). The program included: (1) evaluation and prescription of PA (steps/day and floors/day); (2) nutritional and dietary support; (3) strength training sessions; (3) blood testing; (4) anthropometric and body composition assessment. A pre- and post-intervention follow up was conducted. Garmin®F 745 were used for PA prescription and assessment. PA targets per day were: number of steps ≥10 000; uphill walking ≥10 floors; and minutes of intensity ≥150 per week. Nutritional and dietary evaluation was recorded by completing the food frequency questionnaire with subsequent recommendation of changes to healthy diet. The designed strength training program was: (i) frequency of 2x/week; (ii) 8 to 10 exercises, in order to work the main muscle groups; (iii) 2 sets of 10 to 12 repetitions; (iv) 60 to 70% of one maximum repetition. Blood samples evaluated glycated hemoglobin (HbA1c), fating glucose (FG), triglycerides (TG), high-density lipoprotein (HDL) cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Body weight (kg), lean body mass (kg) and fat mass percentage (%) was evaluated by bio-impedance scale (Tanita MC 780-P MA®). MetS parameters was defined by joint interim statement (JIS) criteria (Alberti et al, 2009). Results: Regarding PA parameters at the end of the three-month program, the average number of daily steps was 11 818, the number of daily floors was 15.35 and moderate to vigorous PA was 253 minutes/week. An improvement in pre- and post-intervention blood concentrations and pressure was observed, namely in HbA1c (-7.4%±15.2), FG (-4.9%±14.4), HDL (-4.8%±9.7), TC (-1.9%±19.9), SBP (-15.6%±10.7) and DBP (-12.7%±9.3). All participants registered a weight loss (-3.4%±2.0), with an increase in lean mass (-4.5%±2.0) and a decrease in fat mass (-8.7%±6.3). Except for one participant, all improved in heart rate recovery after exercise (19.3%±28.2), suggesting an improvement in cardiovascular capacity. Conclusions: The effect of the implemented pilot community intervention program was greater in the participants who followed the program more rigorously. Additionally, the strength training may have been important in increasing lean body mass. The inclusion of PA, strength training and nutritional support in primary health care, through a supervised program, seems to be a key strategy to reduce the risk associated with MetS and delay the complications associated with cardiometabolic diseases.info:eu-repo/semantics/publishedVersio

Avaliação morfológica e morfométrica das ilhotas pancreáticas na fase crônica da doença de Chagas

PURPOSE: Hyperglycemia and abnormal glucose tolerance tests observed in some patients with chronic Chagas' disease suggest the possibility of morphological changes in pancreatic islets and/or denervation. The purpose of this study was to describe the morphology and morphometry of pancreatic islets in chronic Chagas' disease. METHODS: Morphologic and computerized morphometric studies were performed in fragments of the head, body, and tail regions of the pancreas obtained at necropsies of 8 normal controls and 17 patients with chronic Chagas' disease: 8 with the digestive form (Megas) and 9 with the congestive heart failure form. RESULTS: The Megas group had a larger (p < 0.05) pancreatic islet area in the tail of the pancreas (10649.3 ± 4408.8 µm²) than the normal control (9481.8 ± 3242.4 µm²) and congestive heart failure (9475.1 ± 2104.9 µm²) groups; likewise, the density of the pancreatic islets (PI) was greater (1.2 ± 0.7 vs. 0.9 ± 0.6 vs. 1.9 ± 1.0 PI/mm², respectively). In the tail region of the pancreas of patients with the Megas form, there was a significant and positive correlation (r = +0.73) between the area and density of pancreatic islets. Discrete fibrosis and leukocytic infiltrates were found in pancreatic ganglia and pancreatic islets of the patients with Chagas' disease. Trypanosoma cruzi nests were not observed in the examined sections. Individuals with the Megas form of Chagas' disease showed increased area and density of pancreatic islets in the tail of the pancreas. CONCLUSION: The observed morphometric and morphologic alterations are consistent with functional changes in the pancreas, including glycemia and insulin disturbances.OBJETIVO: Hiperglicemia e anormalidades em testes de tolerância à glicose, observadas em alguns pacientes chagásicos crônicos, sugerem um possível papel de alterações morfológicas e desnervação de ilhotas pancreáticas (IP). Nosso objetivo foi descrever a morfologia e a morfometria de ilhotas pancreáticas na doença de Chagas crônica. MÉTODOS: Estudo morfológico e morfometria computadorizada foram realizados em fragmentos da cabeça, corpo e cauda de pâncreas obtidos em necropsias de oito controles normais e dezessete pacientes chagásicos crônicos; oito com a forma digestiva (Megas) e nove com o quadro clínico de insuficiência cardíaca congestiva. RESULTADOS: O grupo Megas mostrou ilhotas pancreáticas de maior (p < 0,05) área na cauda do pâncreas (10.649,3 ± 4.408,8 µm²) do que os controles normais (9.481,8 ± 3.242,4 µm²) e que o grupo com insuficiência cardíaca congestiva (9.475,1 ± 2.104,9 µm²); o mesmo ocorrendo com a densidade das ilhotas na cauda do pâncreas (respectivamente, 1,2 ± 0,7 vs. 0,9 ± 0,6 vs. 1,9 ± 1,0 IP/mm²). Na cauda do pâncreas dos casos com Megas, houve correlação positiva e significante (r = + 0,73) entre a área e a densidade das ilhotas pancreáticas. Discreta fibrose e infiltrados leucocitários foram vistos nas ilhotas e em gânglios pancreáticos dos pacientes chagásicos. Ninhos de Trypanosoma cruzi não foram observados nos cortes examinados. Indivíduos com a forma Megas da doença de Chagas mostraram aumento da área e da densidade das ilhotas na cauda do pâncreas. CONCLUSÃO: As alterações morfológicas e morfométricas observadas são consistentes com alterações funcionais do pâncreas, incluindo distúrbios da glicemia e da insulinemia

MBL2 gene polymorphisms and its relation to infection in Brazilian systemic lupus erythematosus patients : a 10-years followup study

Introduction: Systemic lupus erythematosus (SLE) is a multifactorial disease and MBL2 genetic variants, which are associated to differential peripheral MBL levels, potentially affect its etiology and increase infection risk in this population. Objective: To evaluate the potential association of MBL2 polymorphisms of the coding and promoter gene region and haplotypes on hospitalization, number of admission and days of admission for major infection causes in Brazilian SLE patients. Methods: 325 SLE patients from a southern Brazilian outpatient SLE clinic were genotyped in 2006 for MBL2 gene polymorphisms from coding and promoter region (rs1800450, rs1800451, rs5030737, rs11003125, and rs7096206) and followed until 2016. Clinical and laboratory data from each patient were obtained and information regarding the need for hospitalization, the number of admissions and number of days admitted for infection treatment were compiled and compared with MBL2 gene polymorphisms and haplotypes. A linear regression analysis was constructed considering the variables of bivariate which demonstrated an association (p<0.05) and variables which had a theoretical basement. Results: No difference was found in polymorphism prevalence when comparing the group that was admitted for infection treatment and the group who did not. Allele C, and haplotypes LY and HY correlated with more infection hospitalizations [wild-type homozygosis for C: 2 (IQR 1–3), heterozygosis for C: 3 (IQR 2–6) p=0.038; LY 2 (IQR 1–3) p=0.049; HY 2 (IQR 1–3) p=0.005] and haplotype HY carriers stayed fewer days in hospital for infection treatment: 18 (IQR 10–38) p=0.041. When linear regression was applied HY associated with shorter admission time for infections ( 18.11 days, p=0.021) and HY ( 1.52 admission, p 0.001) carriers with older age at diagnosis had less admissions for infection (HY regression model: 0.42, p=0.006; LY regression model 0.04, p=0.010; 0.04, p=0.013). Conclusion: The presence of the HY promoter haplotype associated to fewer in hospital care for infection treatment probably due to higher MBL plasma levels. Also, HY haplotype and older age at SLE diagnosis is related to less admissions for infection. This factor should be taken into consideration, since infection is a very import cause of mortality in SLE patients being also related to aggressive immunosuppressive treatment

Sensibility and specificity analysis for waist to height ratio, body mass index and waist circumference as a screening criterion for metabolic syndrome in an adult North East Portuguese population

Obesity is a central component of Metabolic Syndrome (MetS) and a major public health concern. A harmonizing MetS definition was developed to aggregate the different criteria used by the umbrella organizations, however there is still controversy over the most sensitive and specific parameter to characterize each MetS componentinfo:eu-repo/semantics/publishedVersio

Widespread hematogenous metastases and Trousseau's syndrome in gastric adenocarcinoma

A case of widespread hematogenous metastases and Trousseau's syndrome is reported in a 40 year-old white housewife with gastric cancer, presenting subdural hematoma, ecchymoses, epistaxis, stomach and uterine bleeding. After undergoing hematoma drainage, she was unsuccessfully treated with platelets, red blood cells, plasma cryoprecipitate transfusions, and antibiotics. Necropsy disclosed gastric ring-signet adenocarcinoma invading the serous layer, with massive disseminated intravascular coagulation and systemic neoplastic embolism. Multiple old and recent hyaline (rich in fibrin and platelets) microthrombi, and tumor emboli were observed in the bone marrow, meninges, liver, lungs, kidneys, lymph nodes, adrenals, thyroid, heart, pancreas, and ovaries (Krukenberg tumor).Relata-se caso de metástases hematogênicas disseminadas e síndrome de Trousseau em mulher branca de 40 anos, portadora de câncer gástrico, apresentando hematoma subdural, equimoses, epistaxes, hemorragia gástrica e metrorragia. Inicialmente submetida à drenagem do hematoma, foi tratada sem sucesso com transfusões de plaquetas, hemácias e plasma crioprecipitado, além de antibióticos. O estudo de necropsia revelou adenocarcinoma gástrico com células em anel de sinete invadindo a serosa, com maciça coagulação intravascular disseminada e embolismo neoplásico sistêmico. Microtrombos hialinos (constituídos de fibrina e plaquetas) antigos e recentes, além de êmbolos tumorais, foram observados na medula óssea, meninges, fígado, pulmões, rins, linfonodos, adrenais, tireóide, coração, pâncreas e ovários (tumor de Krukenberg)

A base nacional comum curricular – bncc: uma discussão sobre educação ambiental e sustentabilidade / The common national curriculum base - bncc: a discussion on environmental education and sustainability

Este trabalho, de cunho bibliográfico e de análise documental, adota como objetivo geral analisar como a Base Nacional Comum Curricular – BNCC, para o Ensino Fundamental, materializa a discussão sobre Educação Ambiental e Sustentabilidade. Para tanto, destacam-se no referencial teórico as contribuições de Guimarães (2000/2007), Loureiro (2004), Bonfim (2008), Layrargues e Lima (2011), Andrade e Piccinini (2017), Galiazzi, Behrend e Cousin (2018), Silva e Loureiro (2019), dentre outros. Os resultados apontam para o esvaziamento da discussão sobre Educação Ambiental e Sustentabilidade na BNCC. Sob essa perspectiva, a BNCC materializa concepções de meio ambiente fundamentadas numa abordagem naturalista que restringe as dimensões sociais, políticas e culturais em torno da discussão sobre Meio Ambiente e Sustentabilidade

Reflexões sobre a pedagogia de projetos / Reflections on project pedagogy

Este trabalho, de cunho bibliográfico, adota como objetivo geral analisar as bases conceituais da Pedagogia de Projetos. Para tanto, partimos do pressuposto de que o trabalho pedagógico centrado em projetos pode contribuir para o processo de aprendizagem significativa. Como aporte teórico, destacam-se as contribuições de Moreto (2018), Unesco (1996), Jolibert (1994), Ventura (2002), Barbosa e Horn (2008), Leite, Malpique e Santos (1989), dentre outros. Os resultados apontam para a Pedagogia de Projetos como alternativa teórica e prática de ensino-aprendizagem que rompem com o modelo tradicional de ensino centrado no professor, colocando o aluno como sujeito partícipe da aprendizagem, por sua vez, fundamentada, em atividades práticas e significativas

Anti-inflammatory, antinociceptive and antioxidant activities of the hydromethanolic fraction from Annona nutans leaves

Annona nutans (Annonaceae) is a plant species found in Bolivia, Paraguay, Argentina, and the Brazilian Cerrado, specifically in the states of Mato Grosso and Mato Grosso do Sul (Brazil). Its common names are Araticû-Mi and Araticû-Ñu. The research contributions regarding the chemical composition and biological activities of extracts from A. nutans are rare, with only four articles being found in the literature. Therefore, the present study evaluated the anti-inflammatory and antinociceptive activities of the hydromethanolic fraction (FHMeOH) using carrageenan-induced paw edema and hot-plate tests. In addition, the antioxidant activity was evaluated by DPPH radical scavenging, total phenolic, flavonoid and tannin content assays and quantification of the major metabolites by LC-MS were performed. Oral treatment with the FHMeOH (at a dose of 300 mg.kg-1) significantly reduced paw edema 2 h and 4 h after the inflammatory stimulus. The intraperitoneal (i.p.) treatment with the FHMeOH (50 and 100 mg.kg-1) proved to be most effective, and the inhibition of acute inflammation was still visible 6 h after carrageenan injection. At doses of 50 and 100 mg.kg-1 (i.p.), FHMeOH exhibits central antinociceptive effects by increasing the latency of the reaction in the hot-plate model. The FHMeOH showed antioxidant potential, and the metabolites quercetin-3-O-galactoside, quercetin-3-O-glucoside, isorhamnetin-3-O-galactoside, quercetin-3-O-β-D-apiofuranosyl-(1→2)-galactopyranoside, and chlorogenic acid were identified and quantified by LC-MS. Our results indicate, for the first time, that FHMeOH has anti-inflammatory, antinociceptive and antioxidant potential, and it is a promising source of studies for new herbal medicine

Prevalence, Awareness, and Treatment of Hypertension in Patients with Type 1 Diabetes: A Nationwide Multicenter Study in Brazil

Objective. This study evaluated the prevalence, awareness, and type of treatment for hypertension in Brazil in patients with type 1 diabetes (T1D). Methods. This was a cross-sectional, multicenter study that was conducted from December 2008 to December 2010 in 28 public clinics located in 20 Brazilian cities. Results. A total of 3,591 patients were studied, 56% female, average age 21.2±11.7 years, with a median duration of diabetes 9.6±8.1 years. Blood pressure levels were available for a total of 3,323 patients and 689 (19.2%) patients were hypertensive. Hypertensive patients were older, exhibited longer duration of diabetes, and had higher body mass index (BMI), total cholesterol, triglycerides, and LDL-C values (P<0.001, for all comparisons), but only 370 (53.7%) received treatment. Patient awareness of hypertension was documented in 453 (65.5%) patients. However, only 76 (22.9%) of the treated patients attained the target systolic (sBP) and diastolic blood pressures (dBP). Conclusions. Our results demonstrate that a large number of T1D patients with hypertension do not receive appropriate treatment; few of the treated T1D patients achieved the target sBP and dBP values. Greater attention should be paid to blood pressure evaluation, hypertension diagnosis, and treatment of T1D patients in Brazil