Relationship between vitamin D deficiency and psychophysiological variables: a systematic review of the literature

Vitamin D is a fat-soluble vitamin that plays a role not only in calcium homeostasis, but also in several other functions, including cell growth and immune functions, and is considered a neurosteroid. Vitamin D deficiency is highly prevalent worldwide and has been suggested to be associated with an increased risk of emotional disorders. Therefore, the association between vitamin D levels and psychophysiological disorders, such as depression, anxiety, and mood, has been investigated. To list these variables, a bibliographical literature research was conducted in the MEDLINE/PubMed, Web of Science, Scopus, Science Direct and PsycINFO databases, between November and December 2020, with no year limits of publication. The studies involved humans aged between 18 and 59 years without associated diseases. This review presents evidence of the main variables involved in this association, main tools used to verify these variables, and methods used to verify circulating vitamin D levels in populations. Most studies have indicated that the main psychophysiological variables involved with vitamin D levels are depression and anxiety followed by mood, and an association has been observed between increased serum vitamin D levels and reduction in symptoms of depression, anxiety, and mood, and there is a heterogeneity of methods for assessing vitamin D. More studies are clearly needed to improve our understanding of their role in modulating the psychophysiological aspects of vitamin D levels

Perception of the level of physical activity of university professors during the isolation of COVID-19 / Percepção do nível de atividade física dos professores universitários durante o isolamento da COVID-19

COVID-19 is characterized by a severe acute respiratory syndrome (SARS), caused by the SARS-CoV-2 coronavirus, which started in China, in Wuhan, spreading throughout the world in an advanced way and has become a global health emergency, affecting 216 countries. The most recent number of confirmed cases of COVID- 19 is> 23.3 million worldwide, including> 806.4 confirmed deaths, as well as having forced> 4 billion people to be confined to their homes. In Brazil, more than 3.5 million people have been infected, with a total of more than 114,250 confirmed deaths today. On January 30, 2020, WHO notified COVID-19 as the sixth international public health emergency. The uncertainty of not knowing when the pandemic will end can affect people's physical health and can lead to other associated symptoms. The objective of the study was to investigate the consequences that social isolation can cause in aspects of physical activity in teachers of all undergraduate courses at the Centro Universitário Escritor Osman da Costa Lins - UNIFACOL, in Vitória de Santo Antão-PE. A cross-sectional study was carried out. Data collection took place through online questionnaires containing sociodemographic information and levels of physical activity. There were 115 participants, of which 57.4% were male and 42.6% female. Regarding the level of physical activity, there was a statistically significant difference between the sexes in moderate-intensity and walking. And during the pandemic, there were more active women and more sedentary men

Effect of Metabolic Syndrome on Parkinson’s Disease: A Systematic Review

Evidence shows that metabolic syndrome (MS) is associated with a greater risk of developing Parkinson’s disease (PD) because of the increase in oxidative stress levels along with other factors such as neuroinflammation and mitochondrial dysfunction. However, because some studies have reported that MS is associated with a lower risk of PD, the relationship between MS and PD should be investigated. This study aimed to investigate the effect of MS on PD. Two authors searched five electronic databases, namely, MEDLINE, PubMed, Scopus, PsycINFO, Web of Science, and Science Direct, for relevant articles between September and October 2020. After screening the title and abstract of all articles, 34 articles were selected for full-text review. Finally, 11 articles meeting the eligibility criteria were included in the study. The quality of articles was critically evaluated using the Joanna Briggs Institute. Overall, we evaluated data from 23,586,349 individuals (including healthy individuals, with MS and PD) aged 30 years or more. In cohort studies, the follow-up period varied between 2 and 30 years. MS contributed considerably to the increase in the incidence of PD. In addition, obesity, a component of MS, alone can increase the probability of developing neurodegenerative diseases. However, despite few studies on MS and PD, changes in cognitive function and more rapid progression of PD disease has been documented in patients with MS using methods commonly used in research

DIAGNÓSTICO LABORATORIAL DA TROMBOFILIA GESTACIONAL: UMA ATUALIZAÇÃO.

Introdução: A trombofilia é uma desordem multigênica que pode ser definida como uma predisposição ao processo tromboembólico, que são decorrentes de alterações hereditárias ou adquiridas da coagulação ou da fibrinólise, que levam a estado pró-trombótico. A trombofilia hereditária está associada com aproximadamente 50% dos eventos tromboembólicos é listada como fator de risco para ocorrência de complicações gestacionais, elevando significativamente os riscos materno e fetais, incluindo aborto precoce e tardio, descolamento prematuro da placenta, restrição de crescimento fetal e pré-eclâmpsia. A adquirida pode ser por decorrência outra condição clínica, como neoplasia, síndrome antifosfolípide, imobilização, ou do uso de medicamentos, como terapia de reposição hormonal, anticoncepcionais orais e heparina. Objetivo: Este trabalho objetivou abordar sobre o diagnóstico laboratorial da trombofilia gestacional, discutindo seus aspectos clínicos, prognóstico e tratamento. Métodos: O presente estudo trata-se de uma pesquisa bibliográfica, abrangendo artigos científicos e periódicos existentes, compreendidos entre os anos de 2003 a 2017. Foi feita uma busca de artigos científicos nas bases de dados Medline e SciELO, utilizando como descritores: diagnóstico laboratorial, trombofilia, resultado da gravidez. Resultados: A investigação da trombofilia não é útil nos eventos agudos, pois o manejo imediato da trombose não depende da definição de sua etiologia e os eventos tromboembólicos agudos podem influenciar ou dificultar a interpretação dos resultados. Quando houver indicação para estudo de trombofilia, este deve ser iniciado pela análise dos seguintes testes: hemograma, leucograma e contagem de plaquetas. Seguida pela investigação das vias plasmáticas anticoagulantes (deficiências de antitrombina, proteína C, proteína S), na pesquisa de disfibrogenemia e na presença de anticoagulante lúpico e anticorpos anti-fosfolípides. Mais recentemente, foram introduzidos novos testes, tais como a resistência à proteína C ativada, atribuída ou não à presença da mutação do fator V de Leiden; a hiperprotombinemia atribuída à presença de mutação do gene da protrombina G20210A; e a hiperhomocisteinemia atribuída a deficiências enzimáticas e ou vitamínicas. Conclusão: Portanto conclui-se que gestantes com marcadores séricos para trombofilia hereditária e histórico anterior de complicações obstétricas podem ser tratadas com enoxaparina, destaca-se ainda que a identificação de pacientes portadores de trombofilia é de importância para a prevenção de acidentes tromboembólicos, porém o rastreamento antes da gravidez é controverso, devido aos custos nos testes necessários para o seu diagnostico acaba se tornando inviável

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research