Comparison of Virtual Nutri Plus® and Dietpro 5i® software systems for the assessment of nutrient intake before and after Roux-en-Y gastric bypass

OBJECTIVES: The assessment of nutritional intake before and after bariatric surgery assists in identifying eating disorders, nutritional deficiencies and weight loss/maintenance. The 7-day record is the gold standard for such an assessment and is interpreted using specialized software. This study sought to compare the Virtual Nutri Plus® and Dietpro 5i® software systems in assessing nutrient intake in obese patients with type 2 diabetes mellitus who underwent a Roux-en-Y gastric bypass. METHODS: Nutritional intake was assessed in 10 obese women with type 2 diabetes mellitus before and 3 months after Roux-en-Y gastric bypass. The 7-day record was used to assess food intake and then, the Virtual Nutri Plus® and Dietpro 5i® software systems were used to calculate calorie, macronutrient and micronutrient intake based on validated food chemical composition databases. Clinicaltrials.gov: NCT01251016. RESULTS: During the preoperative period, deficits in the ingestion of total fiber and 15 out of 22 estimated micronutrients were observed when using the Virtual Nutri Plus®, compared to deficiencies in total fiber and 4 micronutrients when using the Dietpro 5i®. During the postoperative period, both the Virtual Nutri Plus® and Dietpro 5i® systems detected deficits in the ingestion of total fiber, carbohydrates and 19 micronutrients, but only the Virtual Nutri Plus® detected deficits in complex B vitamins (except B12) and minerals. CONCLUSION: Virtual Nutri Plus® was more sensitive than Dietpro 5i® for the identification of deficits in nutrient intake in obese, type 2 diabetes mellitus patients undergoing Roux-en-Y gastric bypass

Eleven-year descriptive analysis of closed court verdicts on medical errors in Spain and Massachusetts

To evaluate and compare the characteristics of court verdicts on medical errors allegedly harming patients in Spain and Massachusetts from 2002 to 2012. We reviewed 1041 closed court verdicts obtained from data on litigation in the Thomson Reuters Aranzadi Westlaw databases in Spain (Europe), and 370 closed court verdicts obtained from the Controlled Risk and Risk Management Foundation of Harvard Medical Institutions (CRICO/RMF) in Massachusetts (USA). We included closed court verdicts on medical errors. The definition of medical errors was based on that of the Institute of Medicine (USA). We excluded any agreements between parties before a judgement. Medical errors were involved in 25.9% of court verdicts in Spain and in 74% of those in Massachusetts. The most frequent cause of medical errors was a diagnosis-related problem (25.1%; 95% CI 20.7% to 31.1% in Spain; 35%; 95% CI 29.4% to 40.7% in Massachusetts). The proportion of medical errors classified as high severity was 34% higher in Spain than in Massachusetts (p=0.001). The most frequent factors contributing to medical errors in Spain were surgical and medical treatment (p=0.001). In Spain, 98.5% of medical errors resulted in compensation awards compared with only 6.9% in Massachusetts. This study reveals wide differences in litigation rates and the award of indemnity payments in Spain and Massachusetts; however, common features of both locations are the high rates of diagnosis-related problems and the long time interval until resolution

Licopeno e prevenção do câncer de próstata: Uma revisão integrativa

Currently, prostate cancer is an important public health problem, constituting one of the main types of cancer diagnosed in male patients, which is becoming the primary cause of morbidity and mortality. Studies have shown that habits and lifestyle, along with the installation of a framework of oxidative stress, are presented as important factors involved in the process of carcinogenesis. On the other hand, food habits has been considered an ally in cancer prevention through food groups with antioxidant and anti-inflammatory properties capable of acting as anticarcinogenic compounds, with lycopene being considered as a chemopreventive antioxidant. The present review summarizes some of the results relevant to the role of lycopene in the prevention of prostate cancer in the last 7 years. We have selected articles from the following databases: Scielo, Lilacs, BVS, PubMed, and MEDLINE. According to the inclusion and exclusion criteria, 20 international articles were selected. In clinical reviews, clinical trials (in vivo and in vitro) have shown the influence of the supplementation and of the consumption of lycopene from different sources of tomato-based products and other food sources in the decrease in the cell viability of prostatic cells after treatment, in addition to an increase in apoptosis and in the regulation of transcriptional levels, indicating lycopene as an important phytochemical. However, future clinical trials with the use of lycopene should be carried out to enable accurate recommendations and to provide information on the adequate consumption and amount of this compound, so that it can be used for the prevention of prostate cancer

Prebiotic and Synbiotic Modifications of Beta Oxidation and Lipogenic Gene Expression after Experimental Hypercholesterolemia in Rat Liver

Background and aims: Non-alcoholic fatty liver disease (NAFLD) is characterized by the presence of fat in hepatocytes because of decreased β-oxidation and increased lipogenesis. Prebiotics, probiotics, and synbiotic have modulatory effects on intestinal microbiota and may influence the gut-liver axis. Our aim was to evaluate the effects of prebiotic, probiotics, and synbiotic on liver histopathology and gene expression related to β-oxidation and lipogenesis after hypercholesterolemia. Methods: Wistar male adult rats (n = 40) were submitted to hypercholesterolemic conditions (HPC) (60 days). On Day 30 of HPC, rats were subdivided in 5 groups: negative control (NC): without HPC + Gv (distilled water); positive control (PC): with HPC + Gv (distilled water); prebiotic (PRE): HPC + Gv with prebiotic (Fiber FOS®); probiotic (PRO): HPC + Gv with probiotic strains Gv (Probiatop®); and synbiotic (SYN): HPC + Gv with synbiotic (Simbioflora®). All rats were sacrificed on Day 30 post-treatment. Blood was collected to verify total serum cholesterol, and liver tissue was sampled to verify histopathological changes and gene expression. Gene expression related to ß-oxidation (PPAR-α and CPT-1) and lipogenesis (SREBP-1c, FAS and ME) was evaluated in liver tissue using RT-qPCR. Results: PC had higher cholesterol levels when compared to NC. PRE and SYN rats had lower cholesterol levels than PC. PC rats showed more histopathological changes than NC rats; PRE and SYN rats showed fewer alterations than PC rats. PPAR-α was expressed at higher levels in SYN and PC rats compared with PRE and PRO rats. CPT-1 expression was similar in all groups. SREBP-1c was expressed at higher levels in PC rats compared with NC rats; levels were lower in SYN rats compared with PRO rats; levels were lower in PRE rats compared with PC and PRO rats. FAS was expressed at lower levels in PRE rats compared with SYN rats. ME expression was lower in PC rats compared with NC rats. Conclusion: Prebiotic and synbiotic supplementation improve hepatic alterations related to hypercholesterolemia. These changes appear to be mediated by altered expression of genes related to β-oxidation and lipogenesis.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed Sao Paulo, Dept Biosci, Santos, BrazilUniv Sao Paulo, Dept Gastroenterol, Sch Med, Sao Paulo, BrazilUniv Fed Sao Paulo, Nutr Grad, Santos, BrazilUniv Fed Sao Paulo, Dept Biosci, Santos, BrazilUniv Fed Sao Paulo, Nutr Grad, Santos, BrazilFAPESP: 2011/50289-1Web of Scienc

INSTRUMENTOS URBANÍSTICOS PARA INCREMENTO DE VEGETAÇÃO EM ÁREAS URBANAS: Análise comparada a partir da quota ambiental do município de São Paulo

Os instrumentos urbanísticos têm evoluído ao considerarem quantitativamente a inclusão de vegetação nas cidades, visando o manejo de águas pluviais, aumento da biodiversidade além dos benefícios microclimáticos. Neste contexto, e tomando como referência a Quota Ambiental (QA) do município de São Paulo, este trabalho analisou comparativamente parâmetros de projeto exigidos em diferentes instrumentos, de diferentes cidades, objetivando melhorar a compreensão sobre a QA. O método incluiu levantamento de dados disponibilizados pelos órgãos oficiais responsáveis por cada instrumento, estes dados foram compilados e cruzados para utilização em simulações computacionais. Posteriormente, para aplicação dos instrumentos, foi selecionada uma área em Zona Eixo de Estruturação da Transformação Urbana (ZEU), destinada a promover usos residenciais e não residenciais com densidades demográfica e construtiva altas, visando à qualificação paisagística e de espaços públicos, articulados com o sistema de transporte público coletivo. Foram definidos e estudados cinco cenários comparativos com a utilização dos seguintes instrumentos urbanísticos: Quota Ambiental de São Paulo, Biotope Area Factor de Berlim (BAF), Malmö Green Space Factor (GSF) e Seattle Green Factor (SGF). Essa comparação permitiu identificar que somente os instrumentos QA e SGF consideram quantidade e porte da vegetação arbórea, apesar do baixo peso que assumem nos cálculos. Ainda assim, nenhum deles utiliza diretamente, indicadores que permitem a quantificação de serviços ecossistêmicos como interceptação de água, absorção de carbono e promoção de sombreamento, tais quais o “índice de área foliar” ou a “densidade de área foliar”, como acontece no Green Plot Ratio, de Singapura

IL-38 Ameliorates Skin Inflammation and Limits IL-17 Production from γδ T Cells

Summary: Interleukin-38 (IL-38) is a cytokine of the IL-1 family with a role in chronic inflammation. However, its main cellular targets and receptors remain obscure. IL-38 is highly expressed in the skin and downregulated in psoriasis patients. We report an investigation in cellular targets of IL-38 during the progression of imiquimod-induced psoriasis. In this model, IL-38 knockout (IL-38 KO) mice show delayed disease resolution with exacerbated IL-17-mediated inflammation, which is reversed by the administration of mature IL-38 or γδ T cell-receptor-blocking antibodies. Mechanistically, X-linked IL-1 receptor accessory protein-like 1 (IL1RAPL1) is upregulated upon γδ T cell activation to feedforward-amplify IL-17 production and is required for IL-38 to suppress γδ T cell IL-17 production. Accordingly, psoriatic IL1RAPL1 KO mice show reduced inflammation and IL-17 production by γδ T cells. Our findings indicate a role for IL-38 in the regulation of γδ T cell activation through IL1RAPL1, with consequences for auto-inflammatory disease. : Han et al. report that genetic depletion of IL-38 in mice delays the resolution of imiquimod-induced psoriasis by increasing the production of the inflammatory cytokine IL-17A by skin-infiltrating T cells. Depleting these T cells or the receptor that is targeted by IL-38 reduces psoriatic skin inflammation. Keywords: IL-38, IL1RAPL1, IL-17, γδ T cells, psoriasis, inflammatio

Orientações de metodologia de pesquisa digital para o estudante de medicina obter adequado estudo de diretrizes nacionais de medicina / Digital research methodology guidance for medical students in obtaining adequate study within the national medicine guidelines

É fato que a sociedade sofre modificações ao longo dos anos, logo, no âmbito da medicina não seria diferente, e para acompanhar esse processo é fundamental a utilização de uma metodologia eficaz que transmita o conhecimento desejado. Neste contexto, estão inseridos diferentes mecanismos de busca e pesquisa que tem por finalidade gerar esse conhecimento de forma completa e confiável, minimizando possíveis erros. Desta maneira, este estudo visou desenvolver um raciocínio crítico a partir dos resultados encontrados nos mecanismos de busca como Google, Google Acadêmico, Scielo e Diretrizes Médicas, estabelecendo uma análise de como pesquisas simples sem os adequados processos de busca acabam por se tornar inviáveis para o estudante e profissional da área médica. Além disso, com os novos modelos pedagógicos na medicina, a busca pelo desenvolvimento da autonomia na educação deve ser pautada na estratégia da ação-reflexão-ação, logo, este estudo procurou também ressaltar os impactos que um corpo docente preparado acarreta na vida acadêmica do estudante de medicina, levando à uma formação médica eficaz e baseada em evidência. Como resultado, verificou-se que a pesquisa por artigos acadêmicos no banco de dados Scielo e a busca por Diretrizes Médicas são fontes de alta confiabilidade e transparência, necessárias para o adequado raciocínio clínico e prática médic