The Effectiveness of Extra Virgin Olive Oil and the Traditional Brazilian Diet in Reducing the Inflammatory Profile of Individuals with Severe Obesity: A Randomized Clinical Trial

We analyzed the effectiveness of two nutritional interventions alone and together, EVOO and the DieTBra, on the inflammatory profile of severely obese individuals. This study was an RCT with 149 individuals aged from 18 to 65 years, with a body mass index ≥ 35 kg/m2, randomized into three intervention groups: (1) 52 mL/day of EVOO (n = 50); (2) DieTBra (n = 49); and (3) DieTBra plus 52 mL/day of EVOO (DieTBra + EVOO, n = 50). The primary outcomes we measured were the-neutrophil-to-lymphocyte ratio (NLR) and the secondary outcomes we measured were the lymphocyte-to-monocyte ratio (LMR); leukocytes; and C reactive protein (CRP). After 12 weeks of intervention, DieTBra + EVOO significantly reduced the total leucocytes (p = 0.037) and LMR (p = 0.008). No statistically significant differences were found for the NLR in neither the intra-group and inter-group analyses, although a slight reduction was found in the DieTBra group (-0.22 ± 1.87). We observed reductions in the total leukocytes and LMR in the three groups, though without statistical difference between groups. In conclusion, nutritional intervention with DietBra + EVOO promotes a significant reduction in inflammatory biomarkers, namely leukocytes and LMR. CRP was reduced in EVOO and DieTBra groups and NLR reduced in the DieTBra group. This study was registered at ClinicalTrials.gov under NCT02463435. Keywords: diet; inflammation; leukocytes; lymphocyte; monocytes; nutritional intervention; olive oil; severe obesity

Multimorbidity and complex multimorbidity in Brazilians with severe obesity

To investigate the prevalence of multimorbidity and complex multimorbidity and their association with sociodemographic and health variables in individuals with severe obesity. This is a baseline data analysis of 150 individuals with severe obesity (body mass index ≥ 35.0 kg/m2) aged 18-65 years. The outcomes were multimorbidity and complex multimorbidity. Sociodemographic, lifestyle, anthropometric and self-perceived health data were collected. Poisson multiple regression was conducted to identify multimorbidity risk factors. The frequency of two or more morbidities was 90.7%, three or more morbidities was 76.7%, and complex multimorbidity was 72.0%. Living with four or more household residents was associated with ≥ 3 morbidities and complex multimorbidity. Fair and very poor self-perceived health was associated with ≥ 2 morbidities, ≥ 3 morbidities and complex multimorbidity. A higher BMI range (45.0-65.0 kg/m2) was associated with ≥ 2 morbidities and ≥ 3 morbidities. Anxiety (82.7%), varicose veins of lower limbs (58.7%), hypertension (56.0%) were the most frequent morbidities, as well as the pairs and triads including them. The prevalence of multimorbidity and complex multimorbidity in individuals with severe obesity was higher and the risk for multimorbidity and complex multimorbidity increased in individuals living in households of four or more residents, with fair or poor/very poor self-perceived health and with a higher BMI

Cuidados odontológicos em pacientes renais crônicos

 A insuficiência renal crônica (IRC) é caracterizada pela incapacidade de o rim manter níveis normais dos metabólitos e da pressão arterial no organismo, bem como o equilíbrio hidroeletrolítico, limitando a metabolização de alguns fármacos. Os objetivos com este trabalho são comparar o funcionamento do rim sadio e do mórbido e apresentar os cuidados que o cirurgião-dentista (CD) deve ter ao tratar o paciente renal crônico. Trata-se de uma revisão de literatura, cujo levantamento bibliográfico dos dados foi obtido por meio de livros de farmacologia e fisiologia e cinco artigos científicos da base SciELO. Os pacientes com IRC apresentam alterações orgânicas que devem ser consideradas durante o atendimento odontológico, como as alterações plaquetárias, que levam ao aumento do tempo de sangramento. Além disso, apresentam sintomas orais, como palidez da mucosa oral, úlceras, hálito amoniacal, alterações do paladar, gengivite e parotidites. Os pacientes com IRC que já se encontram em programa de diálise interativa devem ser submetidos a cirurgias orais no dia seguinte ao tratamento de hemodiálise, visto que a heparina permite que o sangue passe pelo hemodializador sem coagular. Desse modo, o paciente renal encontra-se em melhor estado fisiológico, descartando o risco de hemorragia. Enfatiza-se a importância da manutenção da saúde bucal nos portadores de IRC, eliminando qualquer foco de infecção oral, já que são potenciais candidatos a transplante renal, o qual será realizado somente se o paciente estiver saudável, pois infecções podem ser fatais ou provocar a falência do órgão doado. Cabe ao CD conhecer as diferentes alterações dessa patologia e saber que esses pacientes exigem cuidados peculiares, como ajuste na dosagem ou contraindicação de fármacos empregados na odontologia, como anestésicos locais, tetraciclinas e aminoglicosídeos, além de motivá-los a manter uma boa saúde bucal ao longo de sua vida.Palavras-chave: Insuficiência renal crônica. Odontologia. Saúde bucal.

Traditional Brazilian Diet and Olive Oil Reduce Cardiometabolic Risk Factors in Severely Obese Individuals: A Randomized Trial

Cardioprotective effects associated with extra virgin olive oil (EVOO) have been studied within the Mediterranean diet. However, little is known about its consumption in the traditional Brazilian diet (DieTBra) or without any dietary prescription, particularly in severely obese individuals. This study aimed to assess the effectiveness of DieTBra and EVOO in cardiometabolic risk factor (CMRF) reduction in severely obese individuals. We conducted a parallel randomized clinical trial with 149 severely obese individuals (body mass index ≥ 35.0 kg/m2) aged 18–65 years, assigned to three groups: 52 mL/day of EVOO (n = 50), DieTBra (n = 49), and DieTBra + 52 mL/day of EVOO (n = 50). Participants were followed up for 12 weeks. Low-density lipoprotein cholesterol (LDL-c) was the primary endpoint and several cardiometabolic parameters were secondary endpoints. Endpoints were compared at baseline and at the end of the study using analysis of variance, the Kruskal–Wallis test, and Student’s t-test. The TC/High-density lipoprotein (HDL) ratio (−0.33 ± 0.68, p = 0.002) and LDL/HDL ratio (−0.26 ± 0.59, p = 0.005) decreased in the EVOO group. Delta values for all variables showed no significant statistical difference between groups. However, we highlight the clinical significance of LDL-c reduction in the EVOO group by 5.11 ± 21.79 mg/dL and in the DieTBra group by 4.27 ± 23.84 mg/dL. We also found a mean reduction of around 10% for Castelli II (LDL/HDL) and homocysteine in the EVOO group and TG and the TG/HDL ratio in the DieTBra group. EVOO or DieTBra when administered alone lead to reduction in some cardiometabolic risk parameters in severely obese individuals

Profissionais de saúde no processo de vacinação contra hepatite B em duas unidades básicas de Belo Horizonte: uma avaliação qualitativa

Em Belo Horizonte, a cobertura vacinal contra a hepatite B para menores de um ano foi aquém do preconizado pelo Programa Nacional de Imunização-PNI, de acordo com o Inquérito de Cobertura Vacinal realizado em 2007. A referida vacina foi então utilizada como fio condutor para esta pesquisa, que procurou avaliar o envolvimento dos profissionais de saúde no processo de vacinação, em duas unidades básicas de saúde (UBS) do município. O presente estudo é qualitativo e utiliza as noções da Teoria das Representações Sociais (TRS) e o método de Análise Estrutural de Narração para realizar a interpretação das entrevistas. Os resultados indicam que há falhas no que se refere ao controle e à utilização do cartão espelho, à orientação dos pais/responsáveis, e também no monitoramento da cobertura vacinal (CV) e utilização dos dados de CV como subsídio para o planejamento das ações em saúde. Verificou-se que o processo de trabalho nas UBS está concentrado na rotina do serviço, com baixa criatividade dos profissionais, o que inclui representações que mantêm forte tendência à valorização de atividades voltadas à saúde individual em detrimento de atividades abrangentes de saúde coletiva. Conclui-se que a defasagem apresentada no processo de vacinação pode ser superada com uma maior valorização das ações cotidianas, com o uso mais adequado das informações geradas sobre a vacinação, e com o planejamento e incremento das atividades de saúde coletiva em nível local da atenção básica

Gastrointestinal Symptoms in HIV-Infected Patients: Female Sex and Smoking as Risk Factors in an Outpatient Cohort in Brazil.

This study aimed to estimate the incidence of gastrointestinal symptoms (GIS) and associated factors in an outpatient cohort of people living with HIV/AIDS (PLWHA) followed between October 2009 and July 2011. We evaluated nausea and/or vomiting, dyspepsia, heartburn, diarrhea, constipation, and flatulence. The outcome variable was the presence of three or more GIS. Sociodemographic (sex, skin color, age, income, years of schooling), lifestyle (smoking status, alcohol consumption, physical activity level), clinical (antiretroviral therapy, time of HIV infection, CD4 lymphocyte count, viral load), and anthropometric (nutritional status and waist circumference) variables were investigated. Data on sociodemographic and lifestyle variables were collected through a pre-tested and standardized questionnaire. CD4 count was determined by flow cytometry and viral load by branched DNA (bDNA) assays for HIV-1. All variables were analyzed at a p<0.05 significance level. Among 290 patients, the incidence of three or more GIS was 28.8% (95% CI 23.17 to 33.84) and 74.48% presented at least one symptom. Female gender (IR 2.29, 95% CI 1.63 to 3.22) and smoking status (IR 1.93, 95% CI 1.30 to 2.88) were risk factors for the presence of three or more GIS after multivariate Poisson regression. A high incidence of gastrointestinal symptoms was found among PLWHA, and it was significantly associated with female sex and tobacco use. Those results reinforce the relevance of investigating the presence of GIS in PLWHA as it may affect treatment adherence

The Effectiveness of Extra Virgin Olive Oil and the Traditional Brazilian Diet in Reducing the Inflammatory Profile of Individuals with Severe Obesity: A Randomized Clinical Trial

We analyzed the effectiveness of two nutritional interventions alone and together, EVOO and the DieTBra, on the inflammatory profile of severely obese individuals. This study was an RCT with 149 individuals aged from 18 to 65 years, with a body mass index ≥ 35 kg/m2, randomized into three intervention groups: (1) 52 mL/day of EVOO (n = 50); (2) DieTBra (n = 49); and (3) DieTBra plus 52 mL/day of EVOO (DieTBra + EVOO, n = 50). The primary outcomes we measured were the-neutrophil-to-lymphocyte ratio (NLR) and the secondary outcomes we measured were the lymphocyte-to-monocyte ratio (LMR); leukocytes; and C reactive protein (CRP). After 12 weeks of intervention, DieTBra + EVOO significantly reduced the total leucocytes (p = 0.037) and LMR (p = 0.008). No statistically significant differences were found for the NLR in neither the intra-group and inter-group analyses, although a slight reduction was found in the DieTBra group (−0.22 ± 1.87). We observed reductions in the total leukocytes and LMR in the three groups, though without statistical difference between groups. In conclusion, nutritional intervention with DietBra + EVOO promotes a significant reduction in inflammatory biomarkers, namely leukocytes and LMR. CRP was reduced in EVOO and DieTBra groups and NLR reduced in the DieTBra group. This study was registered at ClinicalTrials.gov under NCT02463435