Avaliação da adição de diferentes concentrações de sementes de chia e linhaça nas características físico-químicas do queijo tipo minas frescal

O desenvolvimento de formulações alimentícias é uma necessidade constante para o mercado visando otimizar processamentos e agregar diferentes ingredientes. Neste contexto, o queijo tipo minas frescal um dos mais consumidos no país, torna-se um produto alvo a ser investigado. Assim, o presente trabalho tem como objetivo avaliar as características físico-químicas, bem como a oxidação lipídica e a concentração de minerais em queijo tipo minas frescal elaborado com a adição de diferentes concentrações de chia e linhaça. Os dados foram avaliados de acordo com o planejamento experimental onde se observou valores próximos de proteína, umidade, cinzas e pH para as amostras acrescidas de sementes e a formulação padrão. Para o teor de potássio e ferro, as formulações contendo sementes indicaram maior teor desses minerais devido à quantidade destes nas sementes, em relação à amostra padrão, o que ressalta a importância do produto proposto. Os teores de lipídios e oxidação lipídica apresentaram variações entre as formulações acrescidas de sementes e em relação a formulação padrão, esta foi maior, o que indica que as formulações propostas tornam-se interessantes em relação a preservação das características primordiais para produtos alimentícios em especial devido as características de acidez do queijo e traços de oxidação lipídica

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Background: Surfactant therapy is the cornerstone of respiratory distress syndrome management. “Less-invasive surfactant administration (LISA)” is now recommended for spontaneously breathing preterm infants. Analgosedation remains controversial as 52% of European neonatologists do not use any. This systematic review aims to describe the efficacy and safety of different drugs for analgosedation during LISA. Methods: MEDLINE via Ovid, Embase, Scopus, and Cochrane Library of Trials were searched independently by 2 reviewers for studies on sedation or analgesia for LISA, without filters or limits. Results: Eight studies (1 randomized controlled trial) recruiting 945 infants were included. Infant pain was significantly reduced, with more infants evaluated as comfortable. Failure, defined as need for intubation or for a second dose of surfactant, was not different between sedated and unsedated groups. Analgosedation was associated with a higher occurrence of desaturation and need for positive pressure ventilation during procedure, but the need for mechanical ventilation within 24 or 72 h of life was not significantly different. There does not seem to be any difference in clinical tolerance and complications (e.g., hypotension, mortality, air leaks, etc.). Procedural conditions were evaluated as good or excellent in 83% after sedation. Discussion and Conclusion: Analgesia or sedative drugs increase infant comfort and allow good procedural conditions, with a limited impact on the clinical evolution. Questions remain about the best choice of drugs and dosages, with the constraint to maintain spontaneous breathing and have a rapid offset. Further good quality studies are needed to provide additional evidence to supplement those limited existing data

Elaboração e caracterização de biscoito tipo sequilho com farinha de amaranto, milho e arroz/Preparation and characterization of biscuit type sequilho with amaranth flour, maize and rice

A utilização das farinhas mistas para a fabricação de biscoitos é crescente, já que este produto é aceito e consumido por pessoas de qualquer idade e tem um grande poder atrativo. O objetivo do presente estudo foi desenvolver e avaliar os efeitos da adição de farinhas mistas (amaranto, milho e arroz) nas características de qualidade do biscoito “Tipo Sequilhos” isento de glúten. Na elaboração das formulações empregou-se metodologia de planejamento de experimentos variando-se a concentração de farinha de amaranto (0 a 140 g/300g farinha mista), milho (0 a 200 g/300g farinha mista) e arroz (11 a 250 g/300g farinha mista). As características de qualidade avaliadas nas formulações foram os teores de proteína, lipídios, carboidratos, fibra alimentar, sabor e aceitabilidade. A formulação de biscoito tipo Sequilho isento de glúten, com 140 g de farinha de amaranto, 100 g de farinha de milho e 60 g de farinha arroz, apresentou um incremento no valor nutricional e gerou produtos de aceitabilidade sensorial, contribuindo para a difusão do amaranto no país

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Sédation intranasale en soins intensifs néonatals: une revue systématique

[en] AIM: Pain management is important for newborns' immediate and long-term well-being. While intranasal analgesia and sedation have been well studied in children, their use could be extended to term and preterm infants. This systematic review aims to assess the use of intranasal medications for procedural analgesia or sedation in the neonatal intensive care unit. METHODS: MEDLINE via Ovid, Scopus, Embase, and Cochrane Library were searched independently by two reviewers for clinical studies on sedation or analgesia given intranasally. RESULTS: Seven studies, with 401 patients, were included. The studies described various molecules (midazolam, fentanyl, ketamine, or dexmedetomidine) for different procedures such as intubation in the delivery room, screening for retinopathy, or magnetic resonance imaging. All studies reported significant reduction in pain and sedation markers (based on clinical scales, skin conductance, and clinical variables such as heart rate and crying time). Adverse effects were uncommon and mostly consisted in desaturation, apnoea, hypotension, or paradoxical reactions. DISCUSSION AND CONCLUSION: The intranasal route seems a potential alternative for procedural pain management and sedation in neonates, especially when intravenous access is not available. However, data about safety remain limited. Reported sides effects could be attributed to molecules used rather than the intranasal route. Optimal drugs and doses still need to be characterized. Further studies are needed to ensure safety before promoting a widespread use of intranasal medications in neonatology.OBJECTIF : La gestion de la douleur est importante pour le bien-être immédiat et à long terme des nouveau-nés. Si l'analgésie et la sédation intranasales ont été bien étudiées chez les enfants, leur utilisation pourrait être étendue aux nouveau-nés à terme et prématurés. Cette revue systématique vise à évaluer l'utilisation de médicaments intranasaux pour l'analgésie ou la sédation procédurale en soins intensifs néonatals. MÉTHODES : MEDLINE via Ovid, Scopus, Embase et la Cochrane Library ont été recherchés indépendamment par deux examinateurs pour les études cliniques sur la sédation ou l'analgésie administrée par voie intranasale. RÉSULTATS : Sept études, portant sur 401 patients, ont été incluses. Les études décrivaient diverses molécules (midazolam, fentanyl, kétamine ou dexmedetomidine) pour différentes procédures telles que l'intubation en salle d'accouchement, le dépistage de la rétinopathie ou l'imagerie par résonance magnétique. Toutes les études ont rapporté une réduction significative des marqueurs de la douleur et une amélioration de la sédation (sur la base d'échelles cliniques, de la conductance cutanée et de variables cliniques telles que la fréquence cardiaque et le temps de pleurs). Les effets indésirables étaient peu fréquents et consistaient principalement en une désaturation, une apnée, une hypotension ou des réactions paradoxales. DISCUSSION ET CONCLUSION : La voie intranasale semble être une alternative potentielle pour le traitement de la douleur et la sédation chez les nouveau-nés, en particulier lorsque l'accès intraveineux n'est pas disponible. Cependant, les données sur la sécurité restent limitées. Les effets secondaires rapportés pourraient être attribués aux molécules utilisées plutôt qu'à la voie intranasale. Les médicaments et les doses optimales doivent encore être caractérisés. D'autres études sont nécessaires pour garantir la sécurité avant de promouvoir une utilisation généralisée des médicaments intranasaux en néonatologie

Prémédication avant administration moins invasive de surfactant: revue systématique

Background: Surfactant therapy is the cornerstone of the management of respiratory distress syndrome. Alternatives to endotracheal intubation for surfactant administration currently include “less invasive surfactant administration”. Its effectiveness was demonstrated by meta-analyses and guidelines now recommend it as the optimal method of surfactant administration in spontaneously breathing babies. While it still requires a direct laryngoscopy, the issue of sedation and analgesia during the procedure remains controversial as 52% of European neonatologists do not use any. Methods: Medline via Ovid, Embase, Scopus and Cochrane Library of Trials were searched for studies of LISA after sedation without any filters or limits independently by two reviewers. Risk of bias (RoB) and quality assessment were evaluated using the RoB2 for RCT or the Newcastle Ottawa Scales (NOS) for cohort studies. Results: We included eight studies: one RCT, two prospective, three retrospective and two RCT comparing INSURE and LISA after sedation (LISA arms assessed as prospective cohorts), for a total of 908 newborns. Failure, defined as need for intubation or for a second dose of surfactant was no different between sedated and unsedated groups. Infant pain was significantly reduced, with more infants evaluated as comfortable. LISA with sedations led to higher occurrences of intraprocedural desaturation and need for positive pressure ventilation, but need for mechanical ventilation within 24 or 72 h of life was not significantly different. Clinical tolerance and complications (hypotension, mortality, air leaks, BPD…) were similar. Procedural conditions were evaluated as good or excellent in 83% after sedation. Discussion and conclusion: This systematic review highlighted that analgesia or sedative drugs increase infant comfort and allow good procedural conditions, with a limited impact on the clinical evolution. Many questions remain about the optimal drug and dosage, given the need to maintain spontaneous breathing and to act only for the shortest duration. Despite limited data, we found no reason to avoid sedative drugs for LISA, given how deleterious awake laryngoscopy can be. Large RCT’s should be initiated in units currently not sedating infants prior to LISA. Other Prospero registration: CRD42020205365.Contexte : Le traitement par surfactant est la pierre angulaire de la prise en charge du syndrome de détresse respiratoire. Parmi les alternatives à l'intubation endotrachéale pour l'administration de surfactant, on trouve actuellement "l'administration moins invasive de surfactant". Son efficacité a été démontrée par des méta-analyses et les directives la recommandent désormais comme la méthode optimale d'administration de surfactant chez les bébés à respiration spontanée. Bien qu'elle nécessite toujours une laryngoscopie directe, la question de la sédation et de l'analgésie pendant la procédure reste controversée puisque 52% des néonatologistes européens n'en utilisent aucune. Méthodes : Medline via Ovid, Embase, Scopus et Cochrane Library of Trials ont été recherchés pour les études de LISA après sédation sans aucun filtre ou limite, indépendamment par deux examinateurs. Le risque de biais (RoB) et l'évaluation de la qualité ont été évalués à l'aide du RoB2 pour les ECR ou des Newcastle Ottawa Scales (NOS) pour les études de cohorte. Résultats : Nous avons inclus huit études : un ECR, deux études prospectives, trois rétrospectives et deux ECR comparant INSURE et LISA après sédation (bras LISA évalués comme cohortes prospectives), pour un total de 908 nouveau-nés. L'échec, défini comme la nécessité d'une intubation ou d'une deuxième dose de surfactant, n'était pas différent entre les groupes sous sédation et sans sédation. La douleur du nourrisson a été réduite de manière significative, et un plus grand nombre de nourrissons ont été jugés confortables. La LISA avec sédation a entraîné une fréquence plus élevée de désaturation intraprocédurale et de besoin de ventilation à pression positive, mais le besoin de ventilation mécanique dans les 24 ou 72 heures de vie n'était pas significativement différent. La tolérance clinique et les complications (hypotension, mortalité, fuites d'air, DBP...) étaient similaires. Les conditions procédurales ont été évaluées comme bonnes ou excellentes dans 83% après sédation. Discussion et conclusion : Cette revue systématique a mis en évidence que les médicaments analgésiques ou sédatifs augmentent le confort du nourrisson et permettent de bonnes conditions procédurales, avec un impact limité sur l'évolution clinique. De nombreuses questions subsistent quant au médicament et au dosage optimal, étant donné la nécessité de maintenir la respiration spontanée et de n'agir que pendant la plus courte durée possible. Malgré des données limitées, nous n'avons trouvé aucune raison d'éviter les médicaments sédatifs pour la LISA, étant donné le caractère délétère de la laryngoscopie éveillée. Des ECR de grande envergure devraient être lancés dans les unités qui ne sédatent pas actuellement les nourrissons avant la LISA

Late preterm : high risk newborns despite appearances.

peer reviewedLes enfants nés entre 34 semaines d’aménorrhée et 36 semaines 6 jours sont dans la période de prématurité tardive. Ils sont également appelés late-preterm. Ces enfants représentent près de 75% des naissances prématurées dans les pays industrialisés. Cette prématurité tardive est en augmentation croissante sur les dernières décennies. Alors qu’initialement les études se concentraient essentiellement sur la mortalité et les morbidités liées à la grande prématurité, la population des prématurés tardifs a fait l’objet d’une attention accrue ces 15 dernières années. Il est ainsi démontré que les late-preterm présentent un risque accru de complications respiratoires, d’infections, de problèmes d’alimentation, d’hypothermie et d’hypoglycémie. La mortalité néonatale, infantile et jusqu’à l’âge adulte des late- preterm est significativement plus élevée que chez les nouveau-nés à terme. De plus, les morbidités à long terme, tels que le retard neurodéveloppemental, l’infirmité motrice cérébrale, les pathologies respiratoires chroniques ou métaboliques sont significativement plus élevées. A travers cette revue de la littérature, nous revoyons ces risques, qui contribuent à faire des late preterm une population fragile et nécessitant un suivi adapté.Late preterm infants are born between 34 weeks of amenorrhea and 36 weeks 6 days. Late preterm represents the largest proportion of premature infants (about 75%). Late prematurity is increasing in recent decades. While studies initially focused on mortality and morbidity related to very preterm birth, the late-preterms have been the subject of increased attention over the past 15 years. Late-preterm infants have an increased risk of respiratory complications, infections, feeding problems, hypothermia and hypoglycemia. Neonatal, infant and during adulthood mortalities are significantly higher in late preterm than in term infants. In addition, they carry an increased risk of long-term morbidities, such as neurodevelopmental delay, cerebral palsy, chronic respiratory or metabolic diseases. This review highlights the evidence that late preterm infants are high risk newborns and require adapted follow-up