Low dynamic muscle strength and its associations with fatigue, functional performance, and quality of life in premenopausal patients with systemic lupus erythematosus and low disease activity : a case–control study

Background: The purpose of the present study was to compare dynamic muscle strength, functional performance, fatigue, and quality of life in premenopausal systemic lupus erythematosus (SLE) patients with low disease activity versus matched-healthy controls and to determine the association of dynamic muscle strength with fatigue, functional performance, and quality of life in SLE patients. Methods: We evaluated premenopausal (18–45 years) SLE patients with low disease activity (Systemic lupus erythematosus disease activity index [SLEDAI]: mean 1.5 ± 1.2). The control (n = 25) and patient (n = 25) groups were matched by age, physical characteristics, and the level of physical activities in daily life (International Physical Activity Questionnaire IPAQ). Both groups had not participated in regular exercise programs for at least six months prior to the study. Dynamic muscle strength was assessed by one-repetition maximum (1-RM) tests. Functional performance was assessed by the Timed Up and Go (TUG), in 30-s test a chair stand and arm curl using a 2-kg dumbbell and balance test, handgrip strength and a sit-and-reach flexibility test. Quality of life (SF-36) and fatigue were also measured. Results: The SLE patients showed significantly lower dynamic muscle strength in all exercises (leg press 25.63%, leg extension 11.19%, leg curl 15.71%, chest press 18.33%, lat pulldown 13.56%, 1-RM total load 18.12%, P < 0.001-0.02) compared to the controls. The SLE patients also had lower functional performance, greater fatigue and poorer quality of life. In addition, fatigue, SF-36 and functional performance accounted for 52% of the variance in dynamic muscle strength in the SLE patients. Conclusions: Premenopausal SLE patients with low disease activity showed lower dynamic muscle strength, along with increased fatigue, reduced functional performance, and poorer quality of life when compared to matched controls

Paternal resistance training modulates calcaneal tendon proteome in the offspring exposed to high-fat diet

The increase in high-energy dietary intakes is a well-known risk factor for many diseases, and can also negatively impact the tendon. Ancestral lifestyle can mitigate the metabolic harmful effects of offspring exposed to high-fat diet (HF). However, the influence of paternal exercise on molecular pathways associated to offspring tendon remodeling remains to be determined. We investigated the effects of 8 weeks of paternal resistance training (RT) on offspring tendon proteome exposed to standard diet or HF diet. Wistar rats were randomly divided into two groups: sedentary fathers and trained fathers (8 weeks, three times per week, with 8–12 dynamic movements per climb in a stair climbing apparatus). The offspring were obtained by mating with sedentary females. Upon weaning, male offspring were divided into four groups (five animals per group): offspring from sedentary fathers were exposed either to control diet (SFO-C), or to high-fat diet (SFO-HF); offspring from trained fathers were exposed to control diet (TFO-C) or to a high-fat diet (TFO-HF). The Nano-LC-MS/MS analysis revealed 383 regulated proteins among offspring groups. HF diet induced a decrease of abundance in tendon proteins related to extracellular matrix organization, transport, immune response and translation. On the other hand, the changes in the offspring tendon proteome in response to paternal RT were more pronounced when the offspring were exposed to HF diet, resulting in positive regulation of proteins essential for the maintenance of tendon integrity. Most of the modulated proteins are associated to biological pathways related to tendon protection and damage recovery, such as extracellular matrix organization and transport. The present study demonstrated that the father’s lifestyle could be crucial for tendon homeostasis in the first generation. Our results provide important insights into the molecular mechanisms involved in paternal intergenerational effects and potential protective outcomes of paternal RT

Paternal resistance training induced modifications in the left ventricle proteome independent of offspring diet

Ancestral obesogenic exposure is able to trigger harmful effects in the offspring left ventricle (LV) which could lead to cardiovascular diseases. However, the impact of the father’s lifestyle on the offspring LV is largely unexplored. The aim of this study was to investigate the effects of 8 weeks of paternal resistance training (RT) on the offspring left ventricle (LV) proteome exposed to control or high-fat (HF) diet. Wistar rats were randomly divided into two groups: sedentary fathers and trained fathers (8 weeks, 3 times per week with weights secured to the animals’ tails). The offspring were obtained by mating with sedentary females. Upon weaning, male offspring were divided into 4 groups (5 animals per group): offspring from sedentary fathers, exposed to control diet (SFO-C); offspring from trained fathers, exposed to control diet (TFO-C); offspring from sedentary fathers, exposed to high-fat diet (SFO-HF); and offspring from trained fathers, exposed to highfat diet (TFO-HF). The LC-MS/MS analysis revealed 537 regulated proteins among groups. Offspring exposure to HF diet caused reduction in the abundance levels of proteins related to cell component organization, metabolic processes, and transport. Proteins related to antioxidant activity, transport, and transcription regulation were increased in TFO-C and TFO-HF as compared with the SFO-C and SFO-HF groups. Paternal RT demonstrated to be an important intervention capable of inducing significant effects on the LV proteome regardless of offspring diet due to the increase of proteins involved into LV homeostasis maintenance. This study contributes to a better understanding of the molecular aspects involved in transgenerational inheritance

Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness &gt; 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (&gt; 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor &gt; 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (&gt; 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura &gt; 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (&gt; 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.&nbsp;&nbsp; Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI)

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.&nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. &nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.&nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.&nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.&nbsp; &nbsp;&nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.&nbsp;&nbsp;&nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Gender habitus and school experience: high-school gay youths in São Paulo

Este trabalho investiga a produção de masculinidades de jovens estudantes homossexuais durante o Ensino Médio. Inicia com uma reflexão que visa a articular os conceitos de gênero de Joan Scott, de sexualidade de Jeffrey Weeks, de habitus de Pierre Bourdieu, de experiência social e escolar de François Dubet e de preconceito de Agnes Heller. Na análise, realizada com base em entrevistas com alunos secundaristas de escolas públicas e privadas da cidade de São Paulo, ressaltaram-se diversos elementos das trajetórias escolares dos sujeitos pesquisados. Constatam-se diversas contradições que revelam a instituição de ensino, de um lado, como um lugar ainda permeado pela homofobia, marcado pela violência física e verbal, pelas pressões que reiteram o padrão heterrosexual e pela constante referência à homossexualidade como um não-lugar; de outro, como espaço onde também se observam o revide às agressões, situações de acolhimento e aceitação pelos colegas bem como o empoderamento resultante da transgressão das normas de gênero, possibilitados pelos movimentos feminista e GLBT (gays, lésbicas, bissexuais e transgêneros).This work investigates the production of masculinities of young gay students in Senior High-School. It starts with an attempt to intertwine the concepts of gender by Joan Scott, sexuality by Jeffrey Weeks, habitus by Pierre Bourdieu, school and social experience by François Dubet, and prejudice by Agnes Heller. The analysis, based on interviews with students from public and private schools in the city of São Paulo, Brazil, highlighted several elements in the school itinerary of the young men being researched. Contradictions were found that reveal, on one hand, school yet as a place permeated by homophobia with the presence of physical and verbal violence, with pressures that reiterate the heterosexual standard, and the constant reference of homosexuality as nonplace; on the other hand, school is also seen as a place where there are retaliation to assaults, situations of welcome and acceptance by classmates and empowerment resulting from transgression of gender rules, made possible by the feminist and GLBT (gay, lesbian, bissexual and transgender) movements

Cultural capital, habitus and the educational field: school trajectories of pedagogy students in distance education (DE)

Sob o prisma da discussão dos limites e possibilidades da formação superior a distância, a presente pesquisa teve por objetivo analisar as trajetórias de escolarização de estudantes de Pedagogia em Educação a Distância de Pedagogia em um curso da Universidade Federal de São Carlos (UFSCAR) , mapeando as potenciais diferenças que impactam diretamente (1) o caminho entre o ensino básico e o ensino superior; (2) a percepção do campo educacional como discentes e como futuros profissionais do mesmo; e (3) a relação dos sujeitos deste estudo com a experiência universitária e a vida profissional que já têm ou almejam. Para tanto, se discute o papel do contexto familiar das e dos jovens entrevistados e a operacionalização de capitais específicos, tanto os herdados da família quanto os adquiridos na universidade, no caminho entre a infância e o mundo do trabalho. Como referencial conceitual, recorreu-se à teoria praxiológica de Pierre Bourdieu, com destaque para a noção de capital cultural, em diálogo com outros autores nacionais (Setton, Catani, Nogueira, Brandão, Almeida) e estrangeiros (Lahire, Wacquant, Dubet. Com este intuito, discutir-se-á o papel da trajetória familiar dos jovens entrevistados e a operacionalização de capitais específicos (tanto os prévios quanto os adquiridos durante o ensino superior) no caminho entre a infância e o mundo do trabalho. O ponto de partida foi traçar um breve panorama da educação superior, da licenciatura em Pedagogia e do estado atual da educação a distância. A coleta de material empírico envolveu o levantamento de dados junto ao INEP (Censo da Educação Superior 2017), contatos iniciais com gestores da universidade em questão, observação de inspiração etnográfica do Ambiente Virtual de Aprendizagem de uma das disciplinas do 3o ano do curso, um questionário enviado por e-mail aos alunos e alunas matriculados nesta disciplina naquele momento e entrevistas abertas e semiestruturadas com cinco destes estudantes de Pedagogia, sendo três do sexo feminino e dois do sexo masculino, com idades entre 28 e 43 anos, de diversas localidades do Estado de São Paulo. A análise constatou que a EAD pode ser, de fato, uma política pública capaz de ampliar a democratização da educação no Brasil e, que, ademais, sob determinadas condições, é capaz de transmitir capital cultural a ser apropriado de maneira eficiente e eficaz por estudantes desta modalidade a distância, conduzindo a posições profissionais às quais não chegariam por outras vias. Questões referentes à contemporaneidade como o uso intensivo da tecnologia e seus efeitos individuais e sociais também foram levantadas.In order to discuss the limits and possibilities of higher distance education, this study had the objective of analyzing the school trajectories of Pedagogy students in Distance Education in the course given by the Federal University of São Carlos (UFSCAR), by mapping the potential differences that directly impact (1) the path from basic education to higher education; (2) the perception of the educational field as students and as future professionals of that field; and (3) the relation of the interviewees with their experience at the university and professional life that they either have or intend to have. For such, the role of the family context of the students is discussed as well as the operationalization of specific capitals, both the inherited from the family and those acquired at the university in their path between childhood and the world of labor. As conceptual reference, Pierre Bourdieu s praxiological theory was utilized, highlighting the notion of cultural capital, in dialogue with other national authors (Setton, Catani, Nogueira, Brandão, Almeida) and foreign thinkers (Lahire, Wacquant, Dubet). The starting point was to draw a brief overview of higher education in Brazil, of degree in Pedagogy, and of the current situation of distance education. Collecting empirical materials involved a search among data provided by INEP (2017 Higher Education Census), initial contact with the mentioned university managers, ethnographic observation in the Virtual Learning Environment for a discipline from the 3rd year of the course, a questionnaire emailed to the students enrolled in that discipline at the time and open semi-structured interviews with five of those students of Pedagogy, three females and two males, aged between 28 and 43 years old, from different cities in the state of Sao Paulo. Analysis has found that DE may in fact be a public policy capable of expanding the democratization of education in Brazil and, additionally, that under certain conditions, it is capable of transmitting cultural capital cultural to be efficiently and effectively appropriated by students in this type of learning, leading them to professional positions they would not reach otherwise. Issues regarding the present-day intensive use of technology and its individual and social effects have also been raised

Gender habitus and school experience: high-school gay youths in São Paulo

Este trabalho investiga a produção de masculinidades de jovens estudantes homossexuais durante o Ensino Médio. Inicia com uma reflexão que visa a articular os conceitos de gênero de Joan Scott, de sexualidade de Jeffrey Weeks, de habitus de Pierre Bourdieu, de experiência social e escolar de François Dubet e de preconceito de Agnes Heller. Na análise, realizada com base em entrevistas com alunos secundaristas de escolas públicas e privadas da cidade de São Paulo, ressaltaram-se diversos elementos das trajetórias escolares dos sujeitos pesquisados. Constatam-se diversas contradições que revelam a instituição de ensino, de um lado, como um lugar ainda permeado pela homofobia, marcado pela violência física e verbal, pelas pressões que reiteram o padrão heterrosexual e pela constante referência à homossexualidade como um não-lugar; de outro, como espaço onde também se observam o revide às agressões, situações de acolhimento e aceitação pelos colegas bem como o empoderamento resultante da transgressão das normas de gênero, possibilitados pelos movimentos feminista e GLBT (gays, lésbicas, bissexuais e transgêneros).This work investigates the production of masculinities of young gay students in Senior High-School. It starts with an attempt to intertwine the concepts of gender by Joan Scott, sexuality by Jeffrey Weeks, habitus by Pierre Bourdieu, school and social experience by François Dubet, and prejudice by Agnes Heller. The analysis, based on interviews with students from public and private schools in the city of São Paulo, Brazil, highlighted several elements in the school itinerary of the young men being researched. Contradictions were found that reveal, on one hand, school yet as a place permeated by homophobia with the presence of physical and verbal violence, with pressures that reiterate the heterosexual standard, and the constant reference of homosexuality as nonplace; on the other hand, school is also seen as a place where there are retaliation to assaults, situations of welcome and acceptance by classmates and empowerment resulting from transgression of gender rules, made possible by the feminist and GLBT (gay, lesbian, bissexual and transgender) movements

Pink brains and education: a postfeminist analysis of neuroscience and neurosexism

This article examines the representations of girls and gender that operate within the popular ideas of ‘pink brains’ and ‘blue brains’. As brain research moves into education and teacher training, what are the implications for curriculum, pedagogy, and school organization? We noticed that findings from neuroscience confirm familiar images of girls: as early maturing, emotional, needing to feel accepted by teachers, and as needing abstract ideas connected to real life. Writers utilizing the evidence of brain research are quick to call brains ‘hard-wired’ and equally quick to call for sex- segregated classrooms. In interpreting neuroscience in critical ways, the social contexts and political implications of imaging young women as hard-wired brains are highlighted