ERICA: prevalências de hipertensão arterial e obesidade em adolescentes brasileiros

OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.OBJETIVO Estimar as prevalências de hipertensão arterial e obesidade e a fração atribuível populacional de hipertensão arterial devida à obesidade em adolescentes brasileiros. MÉTODOS Foram avaliados dados dos participantes do Estudo de Riscos Cardiovasculares em Adolescentes, estudo seccional l nacional de base escolar. A amostra foi dividida em 32 estratos geográficos e conglomerados de escolas e turmas, com representatividade nacional, macrorregional e de capitais. Obesidade foi classificada pelo índice de massa corporal segundo idade e sexo. Considerou-se hipertensão arterial a média da pressão arterial sistólica ou diastólica maior ou igual ao percentil 95 da curva de referência. Foram estimadas prevalências e intervalos de confiança de 95% (IC95%) de hipertensão arterial e de obesidade, nacionais e nas macrorregiões do País, por sexo e grupo etário, assim como as frações de hipertensão atribuíveis à obesidade na população. RESULTADOS Foram avaliados 73.399 estudantes, 55,4% do sexo feminino, com média de idade 14,7 anos (DP = 1,6). A prevalência de hipertensão arterial foi 9,6% (IC95% 9,0-10,3); sendo as mais baixas observadas nas regiões Norte, 8,4% (IC95% 7,7-9,2) e Nordeste, 8,4% (IC95% 7,6-9,2) e a mais alta na região Sul, 12,5% (IC95% 11,0-14,2). A prevalência de obesidade foi 8,4% (IC95% 7,9-8,9), mais baixa na região Norte e mais alta na Sul. As prevalências de hipertensão arterial e obesidade foram maiores no sexo masculino. Adolescentes com obesidade tiveram prevalência de hipertensão arterial mais elevada, 28,4% (IC95% 25,5-31,2), do que aqueles com sobrepeso, 15,4% (IC95% 13,8-17,0), ou eutróficos, 6,3% (IC95% 5,6-7,0). A fração de hipertensão arterial atribuível à obesidade foi de 17,8%. CONCLUSÕES O ERICA foi o primeiro estudo brasileiro com representatividade nacional a estimar a prevalência de hipertensão arterial aferida em adolescentes. A fração da prevalência de hipertensão arterial atribuível à obesidade mostrou que cerca de 1/5 dos hipertensos poderiam não ser hipertensos se não fossem obesos

Using the Robson classification to assess caesarean section rates in Brazil: an observational study of more than 24 million births from 2011 to 2017.

BACKGROUND: Applying the Robson classification to all births in Brazil, the objectives of our study were to estimate the rates of caesarean section delivery, assess the extent to which caesarean sections were clinically indicated, and identify variation across socioeconomic groups. METHODS: We conducted a population-based study using routine records of the Live Births Information System in Brazil from January 1, 2011, to December 31, 2017. We calculated the relative size of each Robson group; the caesarean section rate; and the contribution to the overall caesarean section rate. We categorised Brazilian municipalities using the Human Development Index to explore caesarean section rates further. We estimated the time trend in caesarean section rates. RESULTS: The rate of caesarean sections was higher in older and more educated women. Prelabour caesarean sections accounted for more than 54 % of all caesarean deliveries. Women with a previous caesarean section (Group 5) made up the largest group (21.7 %). Groups 6-9, for whom caesarean sections would be indicated in most cases, all had caesarean section rates above 82 %, as did Group 5. The caesarean section rates were higher in municipalities with a higher HDI. The general Brazilian caesarean section rate remained stable during the study period. CONCLUSIONS: Brazil is a country with one of the world's highest caesarean section rates. This nationwide population-based study provides the evidence needed to inform efforts to improve the provision of clinically indicated caesarean sections. Our results showed that caesarean section rates were lower among lower socioeconomic groups even when clinically indicated, suggesting sub-optimal access to surgical care

Trends and factors associated with dengue mortality and fatality in Brazil.

INTRODUCTION: Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011. METHODS: Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression. RESULTS: The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036), in patients aged 0-14 years (β=0.48; p=0.030) and in those aged ≥15 years (β=1.1; p<0.01). Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038) and the number of basic health units per population (MRR=0.89; p<0.001). Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002).Factors associated with mortality were inequality (RR=1.02; p=0.001) high income per capita (MRR=0.99; p=0.005), and higher proportions of populations living in urban areas (MRR=1.01; p<0.001). CONCLUSIONS: The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes

Impact of COVID-19 pandemic on time series of maternal mortality ratio in Bahia, Brazil: analysis of period 2011-2020.

BACKGROUND: Most studies on the effects of SARS-CoV-2 infection have been conducted with adults and non-pregnant women. Thus, its impacts on maternal health are not yet fully established. This study aimed to verify the relationship between the maternal mortality ratio and the incidence of COVID-19 in the State of Bahia, Brazil, 2020. METHODS: This time-series study used publicly available information in Brazil, to obtain data on maternal deaths and live births in Bahia, State, from January 1, 2011, to December 31, 2020. The time trend of Maternal Mortality Ratio (MMR) was analysed through polynomial regression, of order 6. Expected MMR, monthly (Jan-Dec) and annual values for 2020, were predicted by the additive Holt-Winters exponential smoothing algorithm, with 95% confidence interval, based on the time series of the MMR from 2011 to 2019, and the accuracy of the forecasts for 2020 was assessed by checking the smoothing coefficients and the mean errors. According to the statistical forecast, the MMR values ​​recorded in the year 2020 were compared to those expected. RESULTS: In 2020, the annual MMR in Bahia, Brazil, was 78.23/100,000 live births, 59.46% higher than the expected ratio (49.06 [95% CI 38.70-59.90]). The increase in maternal mortality ratio relative to expected values was observed throughout the 2020 months; however, only after May, when the COVID-19 epidemic rose sharply, it exceeded the upper limit of the 95% CI of the monthly prediction. Of the 144 registered maternal deaths in 2020, 19 (13.19%) had COVID-19 mentioned as the cause of death. CONCLUSIONS: Our study revealed the increase in maternal mortality, and its temporal relationship with the incidence of COVID-19, in Bahia, Brazil, in 2020. The COVID-19 pandemic may be directly and indirectly related to this increase, which needs to be investigated. An urgent public health action is needed to prevent and reduce maternal deaths during this pandemic, in Brazil

Spread pattern of the first dengue epidemic in the city of Salvador, Brazil

<p>Abstract</p> <p>Background</p> <p>The explosive epidemics of dengue that have been occurring in various countries have stimulated investigation into new approaches to improve understanding of the problem and to develop new strategies for controlling the disease. The objective of this study was to evaluate the characteristics of diffusion of the first dengue epidemic that occurred in the city of Salvador in 1995.</p> <p>Methods</p> <p>The epidemiological charts and records of notified cases of dengue in Salvador in 1995 constituted the source of data. The cases of the disease were georeferenced according to census areas (spatial units) and epidemiological weeks (temporal unit). Kernel density estimation was used to identify the pattern of spatial diffusion using the R-Project computer software program.</p> <p>Results</p> <p>Of the 2,006 census areas in the city, 1,400 (70%) registered cases of dengue in 1995 and the spatial distribution of these records revealed that by the end of 1995 practically the entire city had been affected by the virus, with the largest concentration of cases occurring in the western region, composed of census areas with a high population density and predominantly horizontal residences compared to the eastern region of the city, where there is a predominance of vertical residential buildings.</p> <p>Conclusion</p> <p>The pattern found in this study shows the characteristics of the classic process of spreading by contagion that is common to most infectious diseases. It was possible to identify the epicenter of the epidemic from which centrifugal waves of the disease emanated. Our results suggest that, if a more agile control instrument existed that would be capable of rapidly reducing the vector population within a few days or of raising the group immunity of the population by means of a vaccine, it would theoretically be possible to adopt control actions around the epicenter of the epidemic and consequently reduce the incidence of the disease in the city. This finding emphasizes the need for further research to improve the technology available for the prevention of this disease.</p

Influence of the expression of inflammatory markers on kidney after fetal programming in an experimental model of renal failure

Objective. To evaluate the expression of inflammatory markers in experimental renal failure after fetal programming. Methods. The offspring aged two and fivemonths were divided into four groups: CC (control dams, control offspring)DC (diabetic dams, control offspring)CFA (control dams, folic acid offspring, 250 mg/Kg)and DFA (diabetic dams, folic acid offspring). Gene expression of inflammatory markersMCP-1, IL-1, NOS3, TGF-beta, TNF-alpha, and VEGF was evaluated by RT-PCR. Results. MCP-1 was increased in the CFA and DFA groups at two and fivemonths of age, as well as in DC5 when compared to CC5. There was a higher expression of IL-1 in the CFA2, DFA2, and DC2 groups. There was a decrease in NOS3 and an increase in TNF-alpha in DFA5 in relation to CFA5. The gene expression of TGF-beta increased in cases that had received folic acid at two and five months, and VEGF decreased in the CFA5 and DFA5 groups. DC5 showed increased VEGF expression in comparison with CC5. Conclusions. Gestational diabetes mellitus and folic acid both change the expression of inflammatory markers, thus demonstrating that the exposure to harmful agents in adulthood has a more severe impact in cases which underwent fetal reprogramming.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Fundacao de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG)Fundacao de Ensino e Pesquisa de Uberaba (FUNEPU)Discipline of General Pathology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, BrazilDepartment of Health Sciences, Lavras Federal University, Lavras, MG, BrazilDiscipline of Physiology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, BrazilNephrology Division, Federal University of São Paulo (UNIFESP), São Paulo, SP, BrazilDepartment of Immunology, Institute of Biomedical Sciences IV, University of São Paulo (USP), São Paulo, SP, BrazilDepartment of General Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO, BrazilNephrology Division, Federal University of São Paulo (UNIFESP), São Paulo, SP, BrazilWeb of Scienc

Neuroprotective effects on microglia and insights into the structure–activity relationship of an antioxidant peptide isolated from Pelophylax perezi

© 2022 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly citedTryptophyllins constitute a heterogeneous group of peptides that are one of the first classes of peptides identified from amphibian's skin secretions. Here, we report the structural characterization and antioxidant properties of a novel tryptophyllin-like peptide, named PpT-2, isolated from the Iberian green frog Pelophylax perezi. The skin secretion of P. perezi was obtained by electrical stimulation and fractionated using RP-HPLC. De novo peptide sequencing was conducted using MALDI MS/MS. The primary structure of PpT-2 (FPWLLS-NH2 ) was confirmed by Edman degradation and subsequently investigated using in silico tools. PpT-2 shared physicochemical properties with other well-known antioxidants. To test PpT-2 for antioxidant activity in vitro, the peptide was synthesized by solid phase and assessed in the chemical-based ABTS and DPPH scavenging assays. Then, a flow cytometry experiment was conducted to assess PpT-2 antioxidant activity in oxidatively challenged murine microglial cells. As predicted by the in silico analyses, PpT-2 scavenged free radicals in vitro and suppressed the generation of reactive species in PMA-stimulated BV-2 microglia cells. We further explored possible bioactivities of PpT-2 against prostate cancer cells and bacteria, against which the peptide exerted a moderate antiproliferative effect and negligible antimicrobial activity. The biocompatibility of PpT-2 was evaluated in cytotoxicity assays and in vivo toxicity with Galleria mellonella. No toxicity was detected in cells treated with up to 512 µg/ml and in G. mellonella treated with up to 40 mg/kg PpT-2. This novel peptide, PpT-2, stands as a promising peptide with potential therapeutic and biotechnological applications, mainly for the treatment/prevention of neurodegenerative disorders.This work was financed by FEDER - Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020 - Operacional Programme for Competitiveness and Internationalization (POCI), and by Portuguese funds through FCT - Fundação para a Ciência e a Tecnologia in the framework of the project POCI-01-0145-FEDER-031158 – PTDC/BII-BIO/31158/2017. The authors would like to thank the participation and scientific support of the Unit projects UIDB/50006/2020 | UIDP/50006/2020, and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Universal Faixa ‘B’ (grant number 32103/2018-0). A.P. is a recipient of a post-doctoral grant from the project PTDC/BII-BIO/31158/2017. The authors would like to thank the researcher Roberto Resendes (CiBio, University of the Azores, Ponta Delgada, São Miguel, Azores, Portugal) for the logistical support in the collection of samples. C.P.A acknowledges FCT-MCTES fellowship PD/BD/136860/2018. A.B.-N. and F.C.D.A.L. acknowledge CNPq (grants 420449/2018-3 and 428211/2018-6) for financial support.info:eu-repo/semantics/publishedVersio

Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil.

BACKGROUND: There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. METHODS AND FINDINGS: We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. CONCLUSIONS: In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality