Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines.

AIM: The study aimed to analyse the currently available national and international guidelines for areas of consensus and contrasting recommendations in the treatment of diverticulitis and thereby to design questions for future research. METHOD: MEDLINE, EMBASE and PubMed were systematically searched for guidelines on diverticular disease and diverticulitis. Inclusion was confined to papers in English and those < 10 years old. The included topics were classified as consensus or controversy between guidelines, and the highest level of evidence was scored as sufficient (Oxford Centre of Evidence-Based Medicine Level of Evidence of 3a or higher) or insufficient. RESULTS: Six guidelines were included and all topics with recommendations were compared. Overall, in 13 topics consensus was reached and 10 topics were regarded as controversial. In five topics, consensus was reached without sufficient evidence and in three topics there was no evidence and no consensus. Clinical staging, the need for intraluminal imaging, dietary restriction, duration of antibiotic treatment, the protocol for abscess treatment, the need for elective surgery in subgroups of patients, the need for surgery after abscess treatment and the level of the proximal resection margin all lack consensus or evidence. CONCLUSION: Evidence on the diagnosis and treatment of diverticular disease and diverticulitis ranged from nonexistent to strong, regardless of consensus. The most relevant research questions were identified and proposed as topics for future research.

The biological basis of the aging process

El procés biològic bàsic subjacent de l’envelliment va ésser avançat per la teoria de l’envelliment basada en els radicals lliures l’any 1954: la reacció dels radicals lliures actius, produïts fisiològicament en l’organisme, amb els constituents cel·lulars inicia els canvis associats a l’envelliment. La implicació dels radicals lliures en l’envelliment està relacionada amb el seu paper clau en l’origen i l’evolució de la vida. La informació disponible avui en dia ens mostra que la composició específica de les macromolècules cel·lulars (proteïnes, àcids nucleics, lípids i carbohidrats) en les espècies animals longeves tenen intrínsicament una resistència elevada a la modificació oxidativa, la qual cosa probablement contribueix a la longevitat superior d’aquestes espècies. Les espècies longeves també mostren unes taxes reduïdes de producció de radicals lliures i de lesió oxidativa. D’altra banda, la restricció dietària disminueix la producció de radicals lliures i la lesió molecular oxidativa. Aquests canvis estan directament associats a la reducció de la ingesta de proteïnes dels animals sotmesos a restricció, que alhora sembla que són deguts específicament a la reducció de la ingesta de metionina. En aquesta revisió s’emfatitza que una taxa baixa de generació de lesió endògena i una resistència intrínsecament elevada a la modificació de les macromolècules cel·lulars són trets clau de la longevitat de les espècies animals.

Is altitude training an efficient treatment for obesity?

Worldwide, about half the adult population is considered overweight as defined by a body mass index (BMI - calculated by body weight divided by height squared) ratio in excess of 25 kg.m-2. Of these individuals, half are clinically obese (with a BMI in excess of 30) and these numbers are still increasing, notably in developing countries such as those of the Middle East region. Obesity is a disorder characterised by increased mass of adipose tissue (excessive fat accumulation) that is the result of a systemic imbalance between food intake and energy expenditure. Although factors such as family history, sedentary lifestyle, urbanisation, income and family diet patterns determine obesity prevalence, the main underlying causes are poor knowledge about food choice and lack of physical activity3. Current obesity treatments include dietary restriction, pharmacological interventions and ultimately, bariatric surgery. The beneficial effects of physical activity on weight loss through increased energy expenditure and appetite modulation are also firmly established. Another viable option to induce a negative energy balance, is to incorporate hypoxia per se or combine it with exercise in an individual's daily schedule. This article will present recent evidence suggesting that combining hypoxic exposure and exercise training might provide a cost-effective strategy for reducing body weight and improving cardio-metabolic health in obese individuals. The efficacy of this approach is further reinforced by epidemiological studies using large-scale databases, which evidence a negative relationship between altitude of habitation and obesity. In the United States, for instance, obesity prevalence is inversely associated with altitude of residence and urbanisation, after adjusting for temperature, diet, physical activity, smoking and demographic factors.

Spreading depression is facilitated in adult rats previously submitted to short episodes of malnutrition during the lactation period

Lactating rat dams were submitted to short episodes (1, 2 or 3 weeks) of nutritional restriction by receiving the "regional basic diet" (RBD, with 8% protein) of low-income human populations of Northeast Brazil. Their pups were then studied regarding the developmental effects on body and brain weights. When the rats reached adulthood, cortical susceptibility to the phenomenon of spreading depression (SD) was evaluated by performing electrophysiological recordings on the surface of the cerebral cortex. SD was elicited at 20-min intervals by applying 2% KCl for 1 min to a site on the frontal cortex and its occurrence was monitored at 2 sites in the parietal region by recording the electrocorticogram and the slow potential change of SD. When compared to control rats fed a commercial diet with 23% protein, early malnourished rats showed deficits in body and brain weights (10% to 60% and 3% to 15%, respectively), as well as increases in velocity of SD propagation (10% to 20%). These effects were directly related to the duration of maternal dietary restriction, with pups malnourished for 2 or 3 weeks presenting more intense weight and SD changes than those malnourished for 1 week. The effects of 1-week restrictions on SD were less evident in the pups malnourished during the second week of lactation and were more evident in pups receiving the RBD during the third week. The results indicate that short episodes of early malnutrition during the suckling period can affect body and brain development, as well as the cortical susceptibility to SD during adulthood. The data also suggest that the third week of lactation is the period during which the brain is most sensitive to malnutrition, concerning the effects on SD

Influence of the test situation on pup retrieval behavior of normal and undernourished lactating rats

Undernutrition of dams and pups disrupts the retrieval efficiency of mothers. However, if the mothers are assessed in their home cages, they spend more time with their litters. In the present study the effect of test conditions on pup retrieval behavior of mothers receiving a 25% (well-nourished group) and 8% casein diet (undernourished group) was examined. In agreement with previous studies, undernourished mothers spent more time with their litters than well-nourished dams as lactation proceeded. Pup retrieval behavior varied with test conditions. In the first experiment, the maternal behavior of dams was assessed by the standard procedure (pups were separated from their mother and scattered over the floor of the home cage). The mother was then returned and the number of retrieved pups was recorded. From day 3 to 8, the retrieval efficiency of undernourished dams decreased, while the retrieval efficiency of well-nourished mothers did not vary. In the second experiment, mothers were subjected to a single retrieval test (on day 9 of lactation) using the procedure described for experiment 1. No difference between well-nourished and undernourished mothers was observed. In the third experiment, seven-day-old pups were separated from the mothers and returned individually to a clean home cage. Dietary treatment did not affect the retrieval efficiency. However, undernourished dams reconstructed the nest more slowly than did well-nourished dams. Taken together, these results suggest that pup retrieval behavior of the undernourished mother is not impaired by dietary restriction when the maternal environment is disturbed minimally.

Effect of postnatal malnutrition on hyperoxia-induced newborn lung development

Several factors are associated with bronchopulmonary dysplasia. Among them, hyperoxia and lung immaturity are considered to be fundamental; however, the effect of malnutrition is unknown. Our objective was to evaluate the effects of 7 days of postnatal malnutrition and hyperoxia on lung weight, volume, water content, and pulmonary morphometry of premature rabbits. After c-section, 28-day-old New Zealand white rabbits were randomized into four groups: control diet and room air (CA, N = 17), control diet and ≥95% O2 (CH, N = 17), malnutrition and room air (MA, N = 18), and malnutrition and ≥95% O2 (MH, N = 18). Malnutrition was defined as a 30% reduction of all the nutrients provided in the control diet. Treatments were maintained for 7 days, after which histological and morphometric analyses were conducted. Lung slices were stained with hematoxylin-eosin, modified orcein-resorcin or picrosirius. The results of morphometric analysis indicated that postnatal malnutrition decreased lung weight (CA: 0.83 ± 0.19; CH: 0.96 ± 0.28; MA: 0.65 ± 0.17; MH: 0.79 ± 0.22 g) and water content, as well as the number of alveoli (CA: 12.43 ± 3.07; CH: 8.85 ± 1.46; MA: 7.33 ± 0.88; MH: 6.36 ± 1.53 x 10-3/mm) and elastic and collagen fibers. Hyperoxia reduced the number of alveoli and increased septal thickening and the mean linear intercept. The reduction of alveolar number, collagen and elastic fibers was intensified when malnutrition and hyperoxia were associated. These data suggest that dietary restriction enhances the magnitude of hyperoxia-induced alveolar growth arrest and lung parenchymal remodeling. It is interesting to consider the important influence of postnatal nutrition upon lung development and bronchopulmonary dysplasia.

Relations entre les facteurs de risque maternels et l’indice de masse corporelle d’enfants québécois avec surcharge pondérale dans un hôpital de soins tertiaires

L’étiologie de l’obésité infantile est multifactorielle et complexe. Le patrimoine génétique tout comme l’environnement d’un enfant peuvent favoriser l’apparition d’un surplus de poids. C’est pourquoi plusieurs études se sont penchées sur le lien entre l’environnement familial et en particulier le rôle de la mère et le risque d’obésité chez l’enfant. L’objectif est de mieux comprendre quels sont les facteurs de risque maternels spécifiques à chaque population afin de mieux prévenir ce fléau. Ce projet a donc cherché à identifier quelles sont les relations entre les facteurs de risque maternels et l’indice de masse corporelle d’enfants québécois avec surcharge pondérale. Parmi les facteurs de risque étudiés, on note des liens entre le niveau de scolarité de la mère, son statut familial et son niveau d’insécurité alimentaire. Sur le plan cognitif et comportemental, le lien entre l’indice de masse corporelle (IMC) de l’enfant et la perception maternelle du poids de son enfant ainsi que le niveau de restriction alimentaire maternel ont également été analysés. Au total, 47 entrevues ont été complétées par téléphone auprès des mères d’enfants obèses ou en embonpoint grâce à un large questionnaire destiné à décrire le profil des familles consultant les cliniques externes du CHU Ste Justine. Les tests de Fisher pour les variables catégorielles, le test de T de comparaison des moyennes du Z-score de l’IMC des enfants ont permis d’effectuer les analyses statistiques. Les résultats obtenus démontrent qu’un lien existe entre le niveau de scolarité maternel et la présence d’insécurité alimentaire. De même, il a été possible de constater que les enfants avec une mère restrictive des apports alimentaires de leur enfant avaient un Z-score de l’IMC significativement plus élevé. Ces résultats suggèrent qu’il existe des liens entre le profil socio-économique et comportemental de la mère et le surplus de poids de l’enfant. Des tests auprès d’un plus large échantillon seront nécessaires afin de confirmer ces résultats, l’objectif étant, entre autres, de mieux cibler les enfants à risque d’embonpoint ou d’obésité et de mieux outiller les professionnels de la santé en contact avec ces familles.

Changing attitudes, beliefs and feelings towards food in bulimic patients

Eating attitudes are defined as beliefs. thoughts, feelings and behaviors towards food. Bulimia nervosa (BN) is ail eating disorder, in which the eating, attitudes are Seriously disturbed. Studies that evaluated nutritional aspects of BN focus mainly oil food intake, dietary restriction and binge eating. while the follow-up Studies evaluate mainly clinical symptoms. The objective of this study was to evaluate eating attitudes of patients with BN. during and after cognitive-behavioral intervention. Thirty nine (39) BN female patients received cognitive behavioral treatment with a Multidisciplinary team and had eating attitudes assessed by a questionnaire developed for this research. Frequencies of the attitudes assessed were compared at baseline. after 12 weeks and 24 weeks of treatment. After treatment, patients had less distorted beliefs about food, less guilty after eating ""forbidden"" foods and they felt more tranquil while caring outside home. Other negative behaviors, as dietary restriction, the desire of not cat, being angry when feeling hungry and using the food to relive stress. persisted. Eating attitudes of patients with BN are hard to be changed in a short-term. More attention to this disease`s component and new approaches to treatment are needed in order to have a better recovery.

Osteocondrite dissecante da cabeça do úmero em cães: Estudo retrospectivo de 36 casos (1991-1996)

A osteocondrite dissecante da cabeça do úmero (OCD) é uma condição patológica da cartilagem articular, decorrente de distúrbio da ossificação endocondral. Foram analisados 36 casos de OCD em cães com idades compreendidas entre 5 e 24 meses, observando-se maior representação entre machos comparados com fêmeas (3,5:1). A maioria destes animais (80,6%) tinha recebido suplementação alimentar. Oito cães foram tratados conservativamente através de repouso e restrição alimentar, enquanto os demais foram submetidos a intervenção cirúrgica por meio de artrotomia e remoção do retalho de superfície articular da cabeça do úmero. Concluiu-se que a predisposição de algumas raças, associada ao desequilíbrio nutricional durante os primeiros meses de vida, são as causas determinantes da OCD, e que a cirurgia é a melhor terapia a ser empregada.

Administration of physiologic levels of triiodothyronine increases leptin expression in calorie-restricted obese rats, but does not influence weight loss

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Compreendendo o significado de qualidade de vida segundo idosos portadores de diabetes mellitus tipo II

Trata-se de uma pesquisa qualitativa com abordagem fenomenológica, objetivando descrever o significado de qualidade de vida, segundo relatos de idosos portadores de diabetes mellitus tipo II, e avaliar as repercussões da doença sobre sua vida. Entrevistamos 12 idosos diabéticos, no período de setembro a outubro de 2008, entre um e quarenta anos de evolução da doença. Foi feita a seguinte questão norteadora: Para o Sr. (a), o que significa qualidade de vida? A análise dos discursos mostrou facetas relevantes ligadas ao cotidiano do idoso com diabetes mellitus. Para eles, a qualidade de vida está intimamente relacionada à saúde física, independência na vida diária e econômica, integração social, suporte familiar e saúde mental-espiritual. A restrição alimentar foi o ponto de maior repercussão do diabetes sobre seu modo de viver. Verificou-se que cabe aos profissionais de saúde ampliar o diálogo profissional-paciente, promovendo autonomia e independência no cuidado e corresponsabilização.

Study of the evolution of the placenta and fetal pancreas in the pathophysiology of growth retardation intrauterine due to restricted maternal diet

CONTEXTO: O retardo do crescimento intra-uterino (RCIU) continua sendo importante problema em perinatologia neste final de século. A natureza do agente etiológico, o período da gestação em que ocorreu o insulto e a sua duração influenciam o tipo de RCIU. OBJETIVO: Estudar a fisiopatologia do retardo de crescimento intrauterino (RCIU) em ratas, decorrente da restrição protéico-calórica materna, em relação à evolução do pâncreas fetal e placenta entre o 18o e 21o dias de prenhez. TIPO DE ESTUDO: Ensaio clínico randomizado em animal de laboratório. PARTICIPANTES: 41 ratas prenhes, normoglicêmicas, da raça Wistar. INTERVENÇÃO: Constituíram-se seis grupos experimentais: controle, com dieta ad libitum e cesárea, respectivamente, no 18º e 21º dias; grupos dieta restritiva a 25% introduzida no 1o dia da prenhez e cesárea no 18o e 21o dias; grupos com a mesma restrição, porém iniciada no 3o dia, com cesárea no 18o e 21o dias. VARIÁVEIS ESTUDADAS: Os recém-nascidos foram classificados, em relação à média mais ou menos um desvio padrão do grupo controle, em peso pequeno (PIP), adequado (AIP) e grande (GIP) para a idade de prenhez; as placentas foram pesadas e processadas para estudo histopatológico, incluindo morfologia e histoquímica, e os pâncreas fetais, para estudo morfológico. RESULTADOS: A desnutrição protéico-calórica materna causou RCIU após o 18o dia da prenhez. Antes desse período não ocorreu RCIU, porque a desnutrição materna diminuiu o número da prole e a placenta tornou-se vicariante. A restrição alimentar não interferiu com a morfologia do pâncreas fetal, e o estudo imunohistoquímico da placenta mostrou que, quando a restrição é introduzida no 1o dia de prenhez, os estoques de glicogênio também não sofrem alterações, diminuindo entre o 18o e 21o dias, como na prenhez normal. A restrição no 3o dia cursou com baixas concentrações de glicogênio placentário no 18o dia e desaparecimento no 21o dia. CONCLUSÃO: A fisiopatologia do RCIU, decorrente da restrição protéico-calórica materna em ratas, está relacionada com menor peso placentário e baixos estoques de glicogênio placentário.

Immunization protected well nourished mice but not undernourished ones from lung injury in Methicillin-resistant Staphylococcus aureus (MRSA) infection

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Is the BCG Vaccine Safe for Undernourished Individuals?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudos de expressão gênica utilizando-se microarrays: delineamento, análise, e aplicações na pesquisa zootécnica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)