Qualidade de vida na síndrome do intestino curto: em um único centro

Model of the study: This is an exploratory and descriptive study which was executed in sector of Nutrologynursing at University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRPUSP). Objective: The aim of this research was to evaluate the perception of quality of life of individualswith short bowel syndrome (SBS) with the help of the Quality of Life Core - 30 Questionnaire (QLQ - C30).Methods: The instrument used was the EORTC- QLQ-C30 (European Organization for Research andTreatment of Cancer Quality of Life Questionnaire/ Quality of Life Core - 30 Questionnaire) version 3.0 inPortuguese. The study was conducted on six patients with SBS. Results: The applicability of the questionnaire was adequate and the mean score obtained for this sample (70.7) was considered to besatisfactory. Conclusions: The most affected domains were: Emotional Function and Symptoms: pain,insomnia, fatigue, and diarrhea. The application of the QLQ - C30 permitted us to evaluate the perceptionof the patieModelo do estudo: Estudo de corte transversal do tipo descritivo e exploratório realizado na enfermariada Unidade Metabólica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP). Objetivos do estudo: Avaliar a aplicabilidade do Quality of Life Core- 30 Questionnaire (QLQ - C30), não específico para Síndrome do intestino curto (SIC) em portadores dasíndrome. Metodologia: Para a coleta de dados foi utilizado como instrumento o questionário EORTCQLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire/Quality of Life Core - 30 Questionnaire) versão 3.0 em português. O estudo foi realizado com 6 pacientescom SIC. Resultados: A aplicabilidade deste questionário foi adequada; o escore médio obtido nestaamostra foi considerado satisfatório (escore médio = 70,7). Conclusões: Os domínios mais afetadosforam: Função Emocional e sintomas: dor, insônia, fadiga e diarréia. A aplicação do questionário QLQ -C30 possibilitou avaliar a percepção dos pacientes quanto a sua condição de saúde e qualidade devida, revelando pontos importantes que devem ser considerados pela equipe

Low medication adherence in patients with Short Bowel Syndrome dependent on parenteral nutrition

Study design: Cross-sectional. Aim: We aimed to investigate adherence to oral medications in patients with severe Short Bowel Syndrome (SBS). Casuistic and Methods: Ten patients with severe intestinal failure attending a specialized unit in a university hospital were enrolled in this study. All patients received intermittent parenteral nutrition for at least 4 months. The participants (six men and four women) had 56 ± 13 years and body mass index of 18 ± 3 kg/m2. Information related to the use of medications at home was recorded, and adherence behavior was assessed by using the Morisky Medication Adherence Scale. Results: Four patients (40%) had high medication adherence. Among patients with low medication adherence, unintentional behavior was observed in two patients, intentional behavior was observed in one patient, and an association of unintentional with intentional behavior was identified in three patients. Conclusion: Outside the hospital setting, most patients with SBS have low adherence to oral medications. These results suggest the development and implementation of targeted strategies aimed to promote awareness and adherence to medication treatmentModelo do estudo: Transversal. Objetivo do estudo: Avaliar a adesão de pacientes com Síndrome do Intestino Curto ao tratamento medicamentoso por via oral. Casuística e Métodos: O estudo inclui 10 pacientes com Síndrome do Intestino Curto (SIC) acompanhados em unidade especializada de um hospital universitário. Todos os pacientes recebiam nutrição parenteral por no mínimo quatro meses. A casuística consistia em seis homens e quatro mulheres, com idade de 56 ± 13 anos e Índice de Massa Corporal de 18 ± 3kg/m2. Foram registradas informações sobre o uso de medicamentos no domicílio. A adesão ao tratamento medicamentoso foi avaliada pelo teste de Morisky e foi identificada a natureza do comportamento em relação à não adesão. Resultados Apenas 40% dos pacientes foram classificados como “mais aderentes”. Dentre os “menos aderentes”, a baixa adesão por associação do comportamento intencional e não intencional foi observada em três casos; dois pacientes apresentavam apenas o comportamento intencional e o comportamento não intencional foi documentado em um paciente. Conclusões: A maioria dos pacientes tem baixa adesão ao tratamento medicamentoso por via oral durante o período em que eles permanecem em seus domicílios. Tais resultados sugerem o desenvolvimento e a implementação de estratégias que visem à percepção da relevância do uso correto dos medicamentos e a promoção da adesão ao tratamento medicamentos

Impact of the AHI1 Gene on the Vulnerability to Schizophrenia: A Case-Control Association Study

BackgroundThe Abelson helper integration-1 (AHI1) gene is required for both cerebellar and cortical development in humans. While the accelerated evolution of AHI1 in the human lineage indicates a role in cognitive (dys)function, a linkage scan in large pedigrees identified AHI1 as a positional candidate for schizophrenia. To further investigate the contribution of AHI1 to the susceptibility of schizophrenia, we evaluated the effect of AHI1 variation on the vulnerability to psychosis in two samples from Spain and Germany.Methodology/Principal Findings29 single-nucleotide polymorphisms (SNPs) located in a genomic region including the AHI1 gene were genotyped in two samples from Spain (280 patients with psychotic disorders; 348 controls) and Germany (247 patients with schizophrenic disorders; 360 controls). Allelic, genotypic and haplotype frequencies were compared between cases and controls in both samples separately, as well as in the combined sample. The effect of genotype on several psychopathological measures (BPRS, KGV, PANSS) assessed in a Spanish subsample was also evaluated. We found several significant associations in the Spanish sample. Particularly, rs7750586 and rs911507, both located upstream of the AHI1 coding region, were found to be associated with schizophrenia in the analysis of genotypic (p = 0.0033, and 0.031, respectively) and allelic frequencies (p = 0.001 in both cases). Moreover, several other risk and protective haplotypes were detected (0.006<p<0.036). Joint analysis also supported the association of rs7750586 and rs911507 with the risk for schizophrenia. The analysis of clinical measures also revealed an effect on symptom severity (minimum P value = 0.0037).Conclusions/SignificanceOur data support, in agreement with previous reports, an effect of AHI1 variation on the susceptibility to schizophrenia in central and southern European populations

Endothelial, platelet, and macrophage microparticle levels do not change acutely following transcatheter aortic valve replacement

Background: Patients with severe aortic stenosis have increased levels of prothrombotic and proinflammatory microparticles (MP), and MPs actively regulate pathological processes that lead to atherothrombotic cardiovascular events. Shear stress is a validated stimulus of MP production, and abnormal shear stress in aortic stenosis increases MP release in ex-vivo studies. We hypothesized that in patients with severe aortic stenosis, percutaneous replacement of the aortic valve (TAVR) would reduce abnormal shear stress and would decrease levels of circulating MPs. Findings: The experimental protocol utilized flow cytometry (FC) and nanoparticle tracking analysis (NTA) to quantify circulating plasma MP levels in aortic stenosis patients at baseline and 5 days after TAVR. The baseline and 5 day MP counts measured by FC were 6.10⋅105 ± 1.21⋅105 MP/μL and 5.74⋅105 ± 9.54⋅104 MP/μL, respectively (p = 0.91). The baseline and 5 day MP counts measured by NTA were 9.29⋅1013 ± 1.66⋅1013 MP/μL and 3.95⋅1014 ± 3.11⋅1014 MP/μL, respectively (p = 0.91). When MPs were stratified by cell source, there was no difference in pre/post TAVR endothelial, platelet, or leukocyte MP levels. Conclusion: Levels of circulating MPs do not change acutely following TAVR therapy for aortic stenosis. Trial registered at clinicaltrials.gov NCT02193035 on July 11, 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12952-016-0051-2) contains supplementary material, which is available to authorized users

Glutamine supplementation does not improve protein synthesis rate by the jejunal mucosa of the malnourished rat

It has been demonstrated that glutamine, a conditionally essential amino acid, improves nitrogen balance, acts as a stimulant of protein synthesis, and decreases proteolysis in myopathic children. In contrast, other studies have shown no beneficial effect of glutamine supplementation on burn victims or critically ill patients. Nonetheless, we hypothesized that glutamine supplementation would increase the fractional protein synthesis rate (FSR) in the jejunal mucosa of malnourished male Wistar rats. Thus, the objective of the present study was to test the effect of daily oral glutamine supplementation (0.42 g kg(-1) d(-1) for 14 days) on the FSR of the jejunal mucosa of healthy and malnourished rats. A 4-hour kinetic study with L-[1-(13)C]leucine was subsequently performed, and jejunal biopsies were obtained 1.5 cm from the Treitz angle and analyzed. Malnourished rats showed a 25% weight loss and increased urinary nitrogen excretion. Plasma amino acid concentration did not differ between groups. (13)C enrichment in plasma and jejunal cells was higher in the malnourished groups than in the healthy group. The FSR (percent per hour) was similar for the control and experimental groups (P > .05), with a mean range of 220%/h to 27%/h. Oral glutamine supplementation alone did not induce higher protein incorporation by the jejunal mucosa in malnourished rats, regardless of total food intake or the presence or absence of glutamine supplementation. (C) 2009 Elsevier Inc. All rights reserved.FAPESP[01/12736-4]CNPq[306824

Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study

The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries. Copyright (C) 2010 John Wiley & Sons, Ltd

Prevalência de alta reatividade plaquetária em pacientes tratados com aspirina encaminhados para angiografia coronária Prevalence of high platelet reactivity in aspirin-treated patients referred for coronary angiography

FUNDAMENTO: A aspirina (Ácido Acetilsalicílico - AAS) é capaz de reduzir eventos adversos cardiovasculares em pacientes portadores de Doença Arterial Coronariana (DAC) através da inibição da atividade plaquetária. Alguns pacientes com DAC, apesar da terapia com AAS, apresentam Alta Reatividade Plaquetária (ARP), o que determina um maior risco para o desenvolvimento de eventos cardiovasculares. OBJETIVO: O objetivo deste estudo foi determinar a prevalência de ARP em pacientes tratados com AAS e encaminhados para cinecoronariografia, além de avaliar se existe uma possível correlação entre a gravidade da DAC e o desenvolvimento de ARP. MÉTODOS: Estudo de centro único onde foram incluídos 115 pacientes consecutivos, tratados com AAS e portadores de DAC estável. A reatividade plaquetária induzida pelo ADP e colágeno foram avaliadas através da Agregometria de Transmitância Luminosa (ATL). Pacientes com agregação plaquetária maior que 70%, induzida por ambos os reagentes, foram classificados como tendo ARP e, neste grupo, a adesão ao tratamento com AAS foi avaliada através da dosagem dos níveis séricos de salicilato. RESULTADOS: A média de idade foi de 60,9 anos e a dose média de AAS foi de 164,2 mg. Tabagismo e diabetes melito estavam presentes em 28,7% e 31,5% dos pacientes, respectivamente. Foi encontrada ARP em 14 pacientes (13%), entretanto, em sete indivíduos (50%) com ARP observaram-se baixos níveis séricos de salicilato (< 2,0 µg/mL), sugerindo não adesão à terapia medicamentosa. Em 6,5% dos pacientes com ARP identificou-se níveis detectáveis de salicilato sérico, sugerindo uma eficácia reduzida do AAS. A ARP se correlacionou com o número e a gravidade das estenoses coronárias (p = 0,04). CONCLUSÃO: Em uma população de pacientes tratados com AAS e encaminhados para angiografia coronária, a reatividade plaquetária elevada é prevalente (13%), sendo 50% destes pacientes não aderentes à terapia farmacológica e 50% apresentam redução da efetividade da droga.<br>BACKGROUND: Aspirin (ASA) reduces adverse events in coronary artery disease (CAD) patients by inhibiting platelets. Some CAD patients have high platelet reactivity (HPR) despite ASA therapy and these individuals have increased risk of adverse events. OBJECTIVE: The purpose of this study was to determine the prevalence of HPR in ASA-treated patients referred for coronary angiography and to assess whether the HPR correlates with the severity of CAD. METHODS: This single center investigation enrolled 115 consecutive ASA-treated patients with stable CAD. ADP- and collagen-induced platelet reactivity were evaluated by light transmittance aggregometry (LTA). Patients with greater than 70% ADP- and collagen-induced aggregation were determined to have HPR and, in this group, ASA compliance was assessed by examining blood salicylate levels. Mean age was 60.9 years and average ASA dose was 164.2 mg. RESULTS: Smoking and DM were present in 28.7% and 31.5% respectively. HPR was found in 14 patients (13%) however 7 of the 14 patients (50%) with HPR had low serum salicylate levels (< 2.0 µg/mL) suggesting medication noncompliance. Of the entire cohort, 6.5% of patients had HPR and detectable serum salicylate levels suggesting reduced ASA efficacy. HPR correlated with number and severity of coronary stenosis (p = 0.04). CONCLUSION: In a general population of ASA-treated patients referred for coronary angiography, elevated platelet reactivity is prevalent (13%) with 50% related to noncompliance and 50% related to reduced aspirin efficacy

Prevalência de alta reatividade plaquetária em pacientes tratados com aspirina encaminhados para angiografia coronária

FUNDAMENTO: A aspirina (Ácido Acetilsalicílico - AAS) é capaz de reduzir eventos adversos cardiovasculares em pacientes portadores de Doença Arterial Coronariana (DAC) através da inibição da atividade plaquetária. Alguns pacientes com DAC, apesar da terapia com AAS, apresentam Alta Reatividade Plaquetária (ARP), o que determina um maior risco para o desenvolvimento de eventos cardiovasculares. OBJETIVO: O objetivo deste estudo foi determinar a prevalência de ARP em pacientes tratados com AAS e encaminhados para cinecoronariografia, além de avaliar se existe uma possível correlação entre a gravidade da DAC e o desenvolvimento de ARP. MÉTODOS: Estudo de centro único onde foram incluídos 115 pacientes consecutivos, tratados com AAS e portadores de DAC estável. A reatividade plaquetária induzida pelo ADP e colágeno foram avaliadas através da Agregometria de Transmitância Luminosa (ATL). Pacientes com agregação plaquetária maior que 70%, induzida por ambos os reagentes, foram classificados como tendo ARP e, neste grupo, a adesão ao tratamento com AAS foi avaliada através da dosagem dos níveis séricos de salicilato. RESULTADOS: A média de idade foi de 60,9 anos e a dose média de AAS foi de 164,2 mg. Tabagismo e diabetes melito estavam presentes em 28,7% e 31,5% dos pacientes, respectivamente. Foi encontrada ARP em 14 pacientes (13%), entretanto, em sete indivíduos (50%) com ARP observaram-se baixos níveis séricos de salicilato (< 2,0 µg/mL), sugerindo não adesão à terapia medicamentosa. Em 6,5% dos pacientes com ARP identificou-se níveis detectáveis de salicilato sérico, sugerindo uma eficácia reduzida do AAS. A ARP se correlacionou com o número e a gravidade das estenoses coronárias (p = 0,04). CONCLUSÃO: Em uma população de pacientes tratados com AAS e encaminhados para angiografia coronária, a reatividade plaquetária elevada é prevalente (13%), sendo 50% destes pacientes não aderentes à terapia farmacológica e 50% apresentam redução da efetividade da droga

PHYSICAL TRAINING PROMOTES TELOMERE ELONGATION IN OBESE WOMEN

Introduction: While sedentary and obese individuals have shorter telomere lengths (TL) due to their inflammatory status, physical activity may be associated with longer TL. In line of this, physical activity may protect against the deleterious effects of obesity on shortening TL. This study aimed to evaluate the changes of TL of obese women submitted to a concurrent physical training intervention.Materials and Methods: This is a cross-sectional interventional study conducted with 7 obese (BMI>30 kg/m²) women (35.1±7 years). The concurrent exercise intervention (strength and aerobic) was performed for 8 weeks (3 times a week with high intensity). Anthropometric (weight, height and body mass index - BMI), body composition assessment (fat mass, by Deuterium oxide), blood collection for TL (by quantitative PCR) and inflammatory cytokines analysis (by Multiplex assays using Luminex) were performed before and after intervention. Shapiro-Wilk test, Wilcoxon test, and Spearman correlation were performed as statistical analyses (p<0.05).Results: There was a significant increase on TL after the intervention (0.007±0.008 to 0.084±0.1 T/S ratio; p=0.043) and a decrease of fat mass (40±4.9 to 38.2±5.8 kg, p=0.018). However, there were no significant weight loss (83.2±7.7 to 84.2±7.7 kg, p=0.204) or changes of cytokines (IL-6: 1.51±0.42 to 1.33±0.41; p=0.091; IL-10: 1.37±0.25 to 1.33±0.19; p=0.336; IL-4: 26.2±28.1 to 23.6±24.4; p=0.176; IL-1beta: 7.6±9.7 to 6.5±7.2; p=0.172; IL-17a: 1.15±0.15 to 1.1±0.1; p=0.317). Indeed, we observed a tendency for positive correlation between baseline TL and weight changes (r= 0.750; p=0.052). We did not find a correlation between TL and inflammatory biomarkers.Conclusion: Concurrent physical training intervention promotes telomere elongation in obese women, fat mass decrease, but the obesity inflammatory status is not associated with TL.Acknowledgements: National Council of Scientific and Technological Development (CNPq