Hiperferritinemia em pacientes com doença hepática gordurosa não alcoólica / Hyperferritinemia in patients with non alcoholic fatty liver disease

Introdução: A Doença Hepática Gordurosa não Alcoólica (DHGNA) é caracterizada pela deposição de gordura no fígado superior a 5% do peso do órgão, na ausência de outras etiologias de dano hepático como hepatites virais, consumo de álcool e doenças metabólicas. A maioria dos pacientes com a DHGNA é assintomática e seu diagnóstico ocorre de forma acidental através de um exame de imagem de rotina. O aumento da concentração hepática de ferro, parece estar relacionado à resistência insulínica, ao aumento do risco de esteato-hepatite e ao maior desenvolvimento de carcinoma hepatocelular. Objetivo: Avaliar os níveis séricos de ferritina nos pacientes portadores de esteatose hepática não alcoólica diagnosticada pela ultrassonografia. Metodologia: Estudo clínico, prospectivo e tipo survey, com abordagem analítica quantitativa. Incluiu-se pacientes de ambos os sexos, de 18 a 70 anos de idade, avaliados pela ultrassonografia abdominal. A dosagem da ferritina foi realizada pelo método da quimioluminescência. Foram critérios de exclusão pacientes com consumo de álcool de ? 140g/semana nos homens e ? 70g/semana nas mulheres, portadores de neoplasias malignas do fígado, hepatopatias prévias e deficiência cognitiva e uso regular de drogas indutoras de esteatose hepática. A variável numérica ferritina foi observada quanto à distribuição de normalidade pelo teste de Shapiro-Wilk e apresentada em forma de mediana com os respectivos intervalos de interquartis. Em seguida, esta variável foi submetida à transformação Box-Cox e seu logaritmo usado no teste de ANOVA, considerando significância estatística p < 0,05. Resultados: Analisou-se 49 pacientes, sendo 35 mulheres e 14 homens, em que 33 (67,34%) apresentaram esteatose hepática não alcoólica. Verificou-se um aumento na mediana do nível de ferritina nos portadores de esteatose hepática não alcoólica 148,62 versus 113,1 em relação aos indivíduos controle. Entretanto, ao realizar o teste estatístico entre os graus de esteatose hepática não alcoólica e os níveis séricos de ferritina, não houve significância (p=0,537). Conclusão: A ferritina é um marcador inflamatório importante, porém inespecífico para avaliar a gravidade das DHGNA

AVALIAÇÃO DAS VÍSCERAS DE NOVILHOS NELORE E F1 NELORE X SINDI AOS 36 E 48 MESES DE IDADE

Objetivou-se com esta pesquisa avaliar o peso das vísceras de novilhos de dois grupos genéticos. Utilizaramse dezesseis machos castrados, sendo oito bovinos Nelore e oito F1 Nelore x Sindi com 36 e 48 meses de idade, confinados em baias separadas. Os animais receberam a mesma dieta e foram abatidos com peso médio de 460,0 (±10,1) kg. O delineamento experimental foi o inteiramente casualizado em esquema fatorial 2 (dois grupos genéticos) x 2 (duas idades). Não houve interação entre grupo genético e idade. O fator idade também não apresentou diferença para as características estudadas. Não houve influência do grupo genético para os pesos do trato digestivo, rins, fígado e pulmões. Animais Nelore apresentaram maior peso do coração (1,6 vs 1,2 Kg) e do baço (1,1 vs 0,9 Kg) do que bovinos F1 Nelore x Sindi. Conclui-se que o produto do cruzamento Nelore x Sindi promoveu redução no peso do coração e baço, mas as idades estudadas não exercem influência no peso das vísceras. PALAVRAS-CHAVE: Baço, coração, fígado, pulmão, ri

Bayesian Multilevel Modeling in Dental Research

Clinical designs in dentistry collect measurements of the teeth of each subject, forming complex data structures; however, standard statistical methods (Student’s t-test, ANOVA, and regression models) do not treat the data as a grouped data type; that is, the measurements are treated as independent despite not being the case. A disadvantage of not considering the dependence on multilevel data is that if there is a significant correlation between the observations, it is ignored by the researcher and consequently finds statistically significant results when in fact they are not. Bayesian methods have the advantage of not assuming normality, unlike maximum likelihood estimation, and Bayesian methods are appropriate when you have small samples. We showed the minimum statistical theory for the use of multilevel models in dental research when the response variable is numerical. In this regard, it was proposed to carry out a Bayesian multilevel analysis to determine the clinical factors associated with the depth of periodontal probing. We adapted the bottom-up strategy to specify a multilevel model in the frequentist approach to the Bayesian approach. We checked the adequacy of the fit of the postulated model using posterior predictive density

Metabolically Obese Normal-Weight Phenotype as a Risk Factor for High Blood Pressure: A Five-Year Cohort

"Background: The metabolically obese normal-weight (MONW) phenotype has been considered a risk factor for different chronic diseases, but its role in high blood pressure (HBP) is still unclear. The aim of the study is to determine if the MONW phenotype constitutes a risk factor for hypertension in Peruvian adults belonging to a 5-year cohort. Methods: This is a retrospective cohort study. A secondary analysis from the database of the PERU MIGRANT study was carried out from the MONW and non-MONW cohorts; after a 5-year follow-up, the appearance of HBP was evaluated in the subjects of both cohorts. To assess the strength and magnitude of the association, a Poisson regression model (crude and adjusted) with robust variance was used. The measure of association was the relative risk (RR). Results: The incidence of HBP was 11.30%. In the multivariable analysis, subjects with the MONW phenotype had a 2.879-fold risk of presenting HBP in 5 years compared with those who were not MONW at the beginning of the study; this was adjusted for categorized age, sex, group, and state of smoker and alcohol drinker (RR: 2.055; 95% confidence interval (CI): 1.118 - 3.777; P = 0.020). Conclusions: The presence of the MONW phenotype doubled the incidence of HBP, even after adjusting for other covariates. However, studies in this field should continue. If these findings are confirmed, it should be considered that presenting an adequate weight for height should not be interpreted as a condition free of metabolic alterations, so screening for hypertension should be carried out regardless of w

Prevalência da automedicação com anti-inflamatórios não esteroides entre pacientes com lesões musculoesqueléticas

Lesões musculoesqueléticas são disfunções que acometem diferentes estruturas do sistema musculoesquelético. Elas causam perda de funcionalidade e gastos médicos elevados. Neste contexto, surgem os anti-inflamatórios não esteroides (AINEs), medicamentos que compõe o tratamento clínico desses pacientes. Eles são usados por conta própria de forma corriqueira, o que pode causar prejuízos à saúde. O estudo objetivou descrever a prevalência da automedicação com anti-inflamatórios não esteroides entre pacientes com lesões musculoesqueléticas em uma cidade do sudoeste da Bahia. Trata-se de um estudo quantitativo, descritivo e transversal. A lesão mais prevalente é a lombalgia. O sexo mais acometido por lesões musculoesqueléticas é o feminino. 92% dos indivíduos relataram que fizeram uso de medicamentos por conta própria. Os principais motivos alegados para automedicação foi a falta de acessibilidade à um médico (54%), seguida pela indicação de familiares e/ou amigos (23%) e indicação de farmacêutico balconista (21%). Evidenciou-se que a prevalência da automedicação com anti-inflamatórios não esteroides entre pacientes com lesões musculoesqueléticas foi de 92%

Factors associated with adherence to the Mediterranean diet among medical students at a private university in Lima, Peru

Introduction: The Mediterranean diet (MedD)is a characteristic eating pattern of the countries of the Mediterranean region. Nonetheless, is unknown its adherence in medical students. We aimed to determine the prevalence of adherence to the Mediterranean diet (AMedD) and associated factors in medical students from Peru. Material and methods: Analytical cross-sectional study carried out by means of a virtual survey. PREDIMED scale was used to evaluate AMedD. The factors assessed were age, sex, academic year, body mass index (BMI), place of lunch consumption, cigarette smoking, and physical activity. Poisson regression with robust variance was used to present it in crude and adjusted prevalence ratios (PRa). Results: High AMedD was present in 38.50%. Statistically significant association was found for sex (PRa: 0.623; 95%CI 0.488-0.796); for overweight (PRa: 0.417; 95%CI 0.270-0.644), obesity (PRa: 0.591; 95%CI 0.400-0.874) versus normopese; cigarette smoking (PRa: 0.450; 95%CI 0.263-0.773); and high physical activity (PRa: 1.652; 95%CI 1.233- 2.215). Conclusions: AMedD was low. The related factors were sex, BMI, consumption of lunch outside the home, cigarette smoking, anda high level of physical activity. Ifthis is confirmed in future studies, it would be necessary to consider these elements to encourage greater consumption of MedD components by students, which would help to improve their long-term health

Assessment of platelet REACtivity after transcatheter aortic valve replacement

OBJECTIVES: The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI. BACKGROUND: Current recommendations support short-term use of aspirin + clopidogrel for patients with severe AS undergoing TAVR despite the lack of compelling evidence. METHODS: This was a prospective, randomized, multicenter investigation. Platelet reactivity was measured at 6 different time points with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR was defined as (P2Y12 reaction units (PRU) ≥208. Patients with HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin + clopidogrel for 3 months. Patients without HPR continued with aspirin + clopidogrel (registry cohort). The primary endpoint was non-HPR status (PRU <208) in ≥70% of patients treated with ticagrelor at 90 days post-TAVR. RESULTS: A total of 68 patients were included. Of these, 48 (71%) had HPR (PRU 273 ± 09) and were randomized to aspirin + ticagrelor (n = 24, PRU 277 ± 08) or continued with aspirin + clopidogrel (n = 24, PRU 269 ± 49). The remaining 20 patients (29%) without HPR (PRU 133 ± 12) were included in the registry. Overall, platelet reactivity across all the study time points after TAVR was lower in patients randomized to ticagrelor compared with those treated with clopidogrel, including those enrolled in the registry (p < 0.001). The primary endpoint was achieved in 100% of patients with ticagrelor compared with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel responder patients at baseline developed HPR status during the first month after TAVR. CONCLUSIONS: HPR to clopidogrel is present in a considerable number of patients with AS undergoing TAVR. Ticagrelor achieves a better and faster effect, providing sustained suppression of HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter Pilot Study [REAC-TAVI]; NCT02224066)

The Fruit Intake–Adiposity Paradox: Findings from a Peruvian Cross-Sectional Study

Due to the increase in obesity worldwide, international organizations have promoted the adoption of a healthy lifestyle, as part of which fruit consumption stands out. However, there are controversies regarding the role of fruit consumption in mitigating this disease. The objective of the present study was to analyze the association between fruit intake and body mass index (BMI) and waist circumference (WC) in a representative sample of Peruvians. This is an analytical cross-sectional study. Secondary data analysis was conducted using information from the Demographic and Health Survey of Peru (2019–2021). The outcome variables were BMI and WC. The exploratory variable was fruit intake, which was expressed in three different presentations: portion, salad, and juice. A generalized linear model of the Gaussian family and identity link function were performed to obtain the crude and adjusted beta coefficients. A total of 98,741 subjects were included in the study. Females comprised 54.4% of the sample. In the multivariate analysis, for each serving of fruit intake, the BMI decreased by 0.15 kg/m2 (β = −0.15; 95% CI −0.24 to −0.07), while the WC was reduced by 0.40 cm (β = −0.40; 95% CI −0.52 to −0.27). A negative association between fruit salad intake and WC was found (β = −0.28; 95% CI −0.56 to −0.01). No statistically significant association between fruit salad intake and BMI was found. In the case of fruit juice, for each glass of juice consumed, the BMI increased by 0.27 kg/m2 (β = 0.27; 95% CI 0.14 to 0.40), while the WC increased by 0.40 cm (β = 0.40; 95% CI 0.20 to 0.60). Fruit intake per serving is negatively related to general body adiposity and central fat distribution, while fruit salad intake is negatively related to central distribution adiposity. However, the consumption of fruit in the form of juices is positively associated with a significant increase in BMI and WC

Assessment of Platelet REACtivity After Transcatheter Aortic Valve Replacement: The REAC-TAVI Trial

OBJECTIVES: The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI. BACKGROUND: Current recommendations support short-term use of aspirin + clopidogrel for patients with severe AS undergoing TAVR despite the lack of compelling evidence. METHODS: This was a prospective, randomized, multicenter investigation. Platelet reactivity was measured at 6 different time points with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR was defined as (P2Y12 reaction units (PRU) ≥208. Patients with HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin + clopidogrel for 3 months. Patients without HPR continued with aspirin + clopidogrel (registry cohort). The primary endpoint was non-HPR status (PRU <208) in ≥70% of patients treated with ticagrelor at 90 days post-TAVR. RESULTS: A total of 68 patients were included. Of these, 48 (71%) had HPR (PRU 273 ± 09) and were randomized to aspirin + ticagrelor (n = 24, PRU 277 ± 08) or continued with aspirin + clopidogrel (n = 24, PRU 269 ± 49). The remaining 20 patients (29%) without HPR (PRU 133 ± 12) were included in the registry. Overall, platelet reactivity across all the study time points after TAVR was lower in patients randomized to ticagrelor compared with those treated with clopidogrel, including those enrolled in the registry (p < 0.001). The primary endpoint was achieved in 100% of patients with ticagrelor compared with 21% with clopidogrel (p < 0.001). Interestingly, 33% of clopidogrel responder patients at baseline developed HPR status during the first month after TAVR. CONCLUSIONS: HPR to clopidogrel is present in a considerable number of patients with AS undergoing TAVR. Ticagrelor achieves a better and faster effect, providing sustained suppression of HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter Pilot Study [REAC-TAVI]; NCT02224066)

Whole-Genome Sequences of Five Acinetobacter baumannii Strains From a Child With Leukemia M2

Acinetobacter baumannii is an opportunistic pathogen and is one of the primary etiological agents of healthcare-associated infections (HAIs). A. baumannii infections are difficult to treat due to the intrinsic and acquired antibiotic resistance of strains of this bacterium, which frequently limits therapeutic options. In this study, five A. baumannii strains (810CP, 433H, 434H, 483H, and A-2), all of which were isolated from a child with leukemia M2, were characterized through antibiotic susceptibility profiling, the detection of genes encoding carbapenem hydrolyzing oxacillinases, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), adherence and invasion assays toward the A549 cell line, and the whole-genome sequence (WGS). The five strains showed Multidrug resistant (MDR) profiles and amplification of the blaOXA-23 gene, belonging to ST758 and grouped into two PFGE clusters. WGS of 810CP revealed the presence of a circular chromosome and two small plasmids, pAba810CPa and pAba810CPb. Both plasmids carried genes encoding the Sp1TA system, although resistance genes were not identified. A gene-by-gene comparison analysis was performed among the A. baumannii strains isolated in this study and others A. baumannii ST758 strains (HIMFG and INCan), showing that 86% of genes were present in all analyzed strains. Interestingly, the 433H, 434H, and 483H strains varied by 8–10 single-nucleotide variants (SNVs), while the A2 and 810CP strains varied by 46 SNVs. Subsequently, an analysis using BacWGSTdb showed that all of our strains had the same resistance genes and were ST758. However, some variations were observed in relation to virulence genes, mainly in the 810CP strain. The genes involved in the synthesis of hepta-acylated lipooligosaccharides, the pgaABCD locus encoding poly-β-1-6-N-acetylglucosamine, the ompA gene, Csu pili, bap, the two-component system bfms/bfmR, a member of the phospholipase D family, and two iron-uptake systems were identified in our A. baumannii strains genome. The five A. baumannii strains isolated from the child were genetically different and showed important characteristics that promote survival in a hospital environment. The elucidation of their genomic sequences provides important information for understanding their epidemiology, antibiotic resistance, and putative virulence factors