Imbalances in the gut microbiota, the bacteria that inhabit the intestines, are central to the pathogenesis of obesity. This systematic review assesses the association between the gut microbiota and weight loss in overweight/obese adults and its potential manipulation as a target for treating obesity. This review identified 43 studies using the keywords 'overweight' or 'obesity' and 'microbiota' and related terms; among these studies, 17 used dietary interventions, 11 used bariatric surgery and 15 used microbiota manipulation. The studies differed in their methodologies as well as their intervention lengths. Restrictive diets decreased the microbiota abundance, correlated with nutrient deficiency rather than weight loss and generally reduced the butyrate producers Firmicutes, Lactobacillus sp. and Bifidobacterium sp. The impact of surgical intervention depended on the given technique and showed a similar effect on butyrate producers, in addition to increasing the presence of the Proteobacteria phylum, which is related to changes in the intestinal absorptive surface, pH and digestion time. Probiotics differed in strain and duration with diverse effects on the microbiota, and they tended to reduce body fat. Prebiotics had a bifidogenic effect and increased butyrate producers, likely due to cross-feeding interactions, contributing to the gut barrier and improving metabolic outcomes. All of the interventions under consideration had impacts on the gut microbiota, although they did not always correlate with weight loss. These results show that restrictive diets and bariatric surgery reduce microbial abundance and promote changes in microbial composition that could have long-term detrimental effects on the colon. In contrast, prebiotics might restore a healthy microbiome and reduce body fat.

BACKGROUND: The vitamin B12 absorption can be affected in patients with nonalcoholic fatty liver disease (NAFLD), and low serum vitamin B12 levels has been related to the high homocysteine (HCY) levels and to the degree of NAFLD. OBJECTIVE: To carry out a systematic review and metanalysis of serum vitamin B12 and HCY levels in patients with NAFLD. METHODS: Original studies including serum vitamin B12 and HCY levels in humans with NAFLD were included. The searches were performed in four databases. RESULTS: 159 studies were identified, and after excluding the duplicates and non-eligible titles, eight original articles were included. Six out of eight showed higher B12 levels in NAFLD patients (404.9±136.2 pg/mL in relation to controls 353.91±117.3 pg/mL). Seven of the eight studies also showed higher HCY levels in NAFLD patients (14.2±3.44 umol/L in relation to controls 11.05±3.6 umol/L). The results for serum vitamin B12 and HCY levels were submitted to metanalysis, showing no difference in the vitamin B12 levels between patients with NAFLD and controls. However, the levels of Hcy were higher in NAFLD patients than in controls. CONCLUSION: There was no relashionship between the vitamin B12 levels and NAFLD. The levels of HCY were significantly higher in patients with NAFLD, suggesting this could be a potential marker for liver damage.

Patients with lymphoproliferative diseases are at an increased risk of an incomplete immune response following vaccination or SARS‐CoV‐2 infection and might develop persistent viral infection and severe COVID‐19 disease. We present a case of successful treatment of persistent and mechanical‐ventilation‐requiring SARS‐CoV‐2 infection in a del17 + CLL patient using exogenous antibodies.

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A patient living with HIV developed disseminated erythematous plaques and the biopsy was consistent with hematological neoplasm infiltration. Further evaluation revealed hepatosplenomegaly, anemia, thrombocytopenia, and leukocytosis, with 33% myeloblasts. Bone marrow assessment confirmed acute myelomonocytic leukemia, with NPM1 mutation. The patient was treated with a conventional induction regimen obtaining complete remission.

Este artigo deriva de um conjunto de ideias experimentadas por discentes do Programa de Pós-graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em uma disciplina que procurou conhecer melhor o docente típico e suas atipias. O texto pretende auxiliar no entendimento de quem é o professor na área da saúde. Discute o sujeito e sua obra, para além do já conhecido modelo centrado na profissão da saúde que exerce e que procura ensinar. Antes de docente, o professor é uma pessoa. Como pessoa, precisa sentir-se estimada e estimar ao outro (aluno). Ao prosperar em seu trabalho, o docente tem compromissos para com o desenvolvimento intelectual e moral de seus alunos e o planejamento de ações para que exerça a percepção crítica da realidade. A relação ensino-aprendizagem com o educando deve favorecer a análise de valores necessários ao convívio social. Na área da saúde, é requisitado ao aluno aprender a fazer, sendo pouca importância referida ao aprender a conhecer, ao aprender a ser ou a viver em comunhão com os pares. É essencial ter a percepção de que o professor necessita, inicialmente, acolher a si próprio: entender quem é ele, como é e porque chegou ali. A construção da identidade profissional docente é um processo contínuo estabelecido pelo domínio de sua área de ensino, pelos conhecimentos pedagógicos voltados à aprendizagem dos alunos e experiência docente, além das relações sociais do cotidiano.

Introduction: Hereditary hemochromatosis (HH) is a genetic disease that causes systemic iron overload. The excess of iron accumulates in several organs, leading to organ dysfunction. Therefore, the excess of iron deposition might create an endocrine impairment, and can further lead to hypogonadism and, rarely, to amenorrhea. In this study, we aim to report a rare cause of HH and primary amenorrhea, with the help of clinical investigations. case Description: This study is based on a single patient who was diagnosed with amenorrhea. The patient had a previous history of HH, type I diabetes mellitus, and chronic liver disease. The physical and hormonal investigations were normal, and her karyotype was 46 XX. A magnetic resonance imaging (MRI) demonstrated a diffuse reduction of the pituitary tissue signal, which might resemble HH. Discussion: The diagnosis of HH is based on a biochemical and genetic evaluation. The treatment includes regular phlebotomies and the control of comorbidities. In most of the cases, the hypogonadotropic hypogonadism leads to amenorrhea due to a pituitary impairment. However, a rare appearance of amenorrhea without hypogonadism may also be possible. Hence, the investigation of HH should be suggested incases of primary amenorrhea. The early diagnosis of HH is crucial to prevent the morbidity and mortality in patients with these clinical features.