It is speculated that exercise training decreases resting levels of tumor necrosis factor alpha (TNF-alpha) and C-reactive protein (CRP); reduces body mass and leptin (LP); and increases adiponectin (AD) and insulin sensitivity. This systematic review analyzed the effectiveness of resistance training (RT) longitudinal clinical studies on AD, LP, CRP and TNF-alpha. Seventeen studies were included and the majority of randomized controlled trials support that RT produces increases in AD, and decreases in both LP and CRP. Greater responses in AD and LP were evident in overweight and obese individuals; while RT appeared to be effective in reducing CRP in obese individuals, and older adults. Additionally, women may be more responsive to RT effects on AD, LP and CRP. Training duration and intensity may affect the response of AD and CRP with greater responses shown with 16 weeks or more of training and/or with intensities greater than 80% of one repetition maximum. No response to RT of TNF-alpha levels was apparent. Although based on a limited number of studies, some of which are uncontrolled non-randomized in design, our review suggests some positive effects of RT programs on cytokine levels, but specifics of the responses in different populations need further elucidation.

Brazil. CNPq Researcher, level 1D. Scientific and intellectual content of the study; conception and design of the study; analysis and interpretation of data; statistical analysis; manuscript preparation and writing; critical revision; final approval. ABSTRACT PURPOSE:To investigate gender differences in the evolution of the inflammatory process in rats subjected to brain death (BD). METHODS:Adult Wistar rats were divided into three groups: female; ovariectomized female; and male rats. BD was induced using intracranial balloon inflation and confirmed by maximal pupil dilatation, apnea, absence of reflex, and drop of mean arterial pressure. Six hours after BD, histological evaluation was performed in lungs, heart, liver and kidneys, and levels of inflammatory proteins, estrogen, progesterone, and corticosterone were determined in plasma. RESULTS:In the lungs, females presented more leukocyte infiltration compared to males (p<0.01). Ovariectomized female rat lungs were more hemorrhagic compared to other groups (p<0.001). In the heart, females had higher leukocyte infiltration and tissue edema compared to males (p<0.05). In the liver and kidneys, there were no differences among groups. In female group estradiol and progesterone were sharply reduced 6 hours after BD (p<0.001) to values observed in ovariectomized females and males. Corticosterone levels were similar. CONCLUSIONS:Sex hormones influence the development of inflammation and the status of organs. The increased inflammation in lungs and heart of female rats might be associated with the acute reduction in female hormones triggered by BD.

The prophylactic treatment with 17β-estradiol showed better overall repercussions and was able to prevent any fatal occurrence, increase eNOS expression, thus preserving mesenteric perfusion and intestinal integrity, and reduce inflammation.

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Carta referente ao trabalho "Controle da pressão arterial após denervação simpática renal percutânea em paciente com hipertensão arterial resistente" premiado no O tratamento da HAS requer, como bem se sabe, uma abordagem de cunho multiprofissional e contempla a associação de mudanças de hábitos de vida e terapêutica medicamentosa. Entretanto, alguns pacientes são refratários a esta abordagem e evoluem sem controle adequado da pressão arterial (PA), podendo, então, ser parte de um grupo que possui hipertensão arterial resistente (HAR).A HAR é definida por (1) persistência da PA acima de 140/90mmHg, apesar do uso de três medicamentos anti-hipertensivos, que atuem sinergicamente e sejam utilizados em dose máxima, sendo um deles diurético; ou por (2) PA controlada, porém em uso de quatro ou mais anti-hipertensivos. Estima-se que 15% dos indivíduos hipertensos preencham critérios para HAR; nessa condição, apresentam morbimortalidade cardiovascular ainda maior 3 . Nesse contexto, a Denervação Simpática Renal (DSR) emerge como uma nova opção de tratamento clínico para os casos de HAR. A DSR tem como intuito primordial reduzir a ação dos nervos simpáticos renais, ao realizar a ablação de tais nervos por radiofrequência (RF). Esse procedimento tem como base fisiológica a influência da aferência e eferência simpáticas na fisiopatologia da HAS 4 . Os nervos eferentes modulam a resistência vascular renal e, quando ativados, aumentam tanto a retenção de sódio e água quanto a liberação de renina, levando, desse modo, à elevação dos níveis pressóricos. Os nervos aferentes, por sua vez, aumentam a atividade simpática adrenal.Na literatura, existe uma controvérsia a respeito do tema, não havendo um consenso claramente definido no que tange à eficácia da DSR para o tratamento da HAR 5,6 . Assim, escrevemos um relato objetivando mostrar o resultado de uma DSR realizada no Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP) em uma paciente jovem com HAR e buscamos, dessa forma, avaliar a eficácia do procedimento neste caso.A paciente é do sexo feminino e tinha, na época da admissão no InCor, 43 anos. Apresentava quadro de HAS diagnosticado desde 2007, com crises hipertensivas recorrentes, tendo palpitações, sudorese e cefaleia de alta intensidade. Descartada a hipótese de HAS secundária e estando a paciente sem controle dos níveis pressóricos mesmo em uso de oito drogas anti-hipertensivas, foi sugerida a realização de DSR percutânea por RF.Por meio de um acesso na artéria femoral, foi realizada uma série de ablações em cada artéria renal, com o intuito de abolir a inervação simpática. Não houve quaisquer intercorrências durante o procedimento.Dezoito meses após a DSR, a paciente encontrava-se em bom estado geral, com níveis pressóricos adequados, em uso de somente dois anti-hipertensivos.Portanto, neste caso, a DSR mostrou ser eficaz para o controle da PA, melhorando em demasia a qualidade de

INTRODUÇÃO: Considerando-se que os cuidados e a atenção à saúde transpassam as barreiras físicas do consultório médico e podem se efetivar em diversos âmbitos e por diferentes profissionais, buscou-se, por meio de dois projetos de intervenção, contribuir para a articulação entre os equipamentos sociais, a população e os funcionários de duas Unidades Básicas de Saúde (UBS). Tal atividade faz parte da formação de estudantes do curso de Medicina da Universidade de São Paulo e teve como foco enfatizar o aspecto da intersetorialidade na prática médica e sua relação com a promoção da saúde. OBJETIVOS: Primariamente, descreve-se a construção de materiais informativos de fácil acesso (folder e cartilha) sobre os equipamentos sociais existentes na região e sua divulgação para funcionários e usuários da UBS. Secundariamente, espera-se refletir sobre os efeitos da condução desses projetos na educação médica. METODOLOGIA: São descritos os percursos de dois projetos de intervenção, bem como sua avaliação por parte dos profissionais de saúde, usuários dos serviços envolvidos e também como parte do processo de educação médica. Um quadro síntese aponta as semelhanças e as diferenças dos projetos. RESULTADOS: Notou-se que grande parte dos funcionários conhecia e, de certa forma, utilizava parte dos equipamentos existentes no território. O desconhecimento de outros equipamentos foi diretamente relacionado à maior distância desses em relação a UBS. A construção de material informativo na forma de cartilha e folder foi avaliado de forma positiva pelos serviços e pela comunidade envolvidos. CONCLUSÃO: Foi possível concluir que a confecção desses materiais atendeu a uma das demandas de saúde dessas comunidades e, apesar de simples, eles contribuirão para a estruturação de redes de cuidado. Ademais, a aproximação com o SUS e o desenvolvimento de conhecimentos, habilidades e atitudes ao longo da prática possibilitaram um aprendizado significativo.

Introduction: Failure to accurately estimate energy requirements may result in an impaired recovery. Overfeeding has been associated with increased carbon dioxide production, respiratory failure, hyperglycemia and fat deposits in the liver, while underfeeding can lead to malnutrition, muscle weakness and impaired immunity. Objective: This study aimed to determine the metabolic profile of infant and preschool children submitted to mechanical ventilation in the ICU. Methods: A prospective study was carried out in a pediatric ICU in Rio de Janeiro that included children aged from 1 month to 6 years submitted to mechanical ventilation from June 2013 to May 2015. Indirect calorimetry was used to obtain resting energy expenditure (REE) and oxygen consumption (VO 2) in the first 48 hours of admission. The predicted basal metabolic rate (PBMR) was calculated using the Schofield equation. The metabolic state of each patient was assigned as hypermetabolic (REE/PBMR >110%), hypometabolic (REE/PBMR <90%) or normal (REE/PBMR 90-110%). The ratio of caloric intake to REE was also calculated and ratios of >1.5 and <0.5 were classified as overfeeding and underfeeding respectively. Results: A total of 35 infants and 17 preschool children were included. The male/female ratio was 34/18. In respect of severity of sepsis, 19 patients had septic shock, 24 had sepsis, five had severe sepsis and four had systemic inflammatory response syndrome. We observed a high incidence of hypometabolism (88.5%) and a low incidence of normal metabolism (7.7%) and hypermetabolism (3.8%). A low value of VO 2 was observed in 46.1% of the patients (VO 2 ≤120 ml/minute/m 2), a normal value in 40.4% (VO 2 >120 to ≤160 ml/minute/m 2) and a high value in only 13.5% of the patients (VO 2 > 160 ml/minute/m 2). Among the 52 included patients, 18 were fasting at the moment of the examination. The ratio of caloric intake to REE for the remaining 34 patients showed 38.2% overfeeding, 11.8% underfeeding and 50.0% normal feeding. Conclusion: Predictive equations do not accurately predict REE in critically ill infants and preschool children, resulting in inadequate feeding. Although hypermetabolism and enhanced energy expenditure are the main clinical features of critical illness in adults, the majority of our patients were found to be hypometabolic which reinforces the need for a different approach between adult and pediatric critically ill patients.

Background The relationship between protein dietary intake and Bone Mass Index (BMI) is controversial. Hyperproteic diet increases urinary calcium excretion but without obvious impact in Osteoporosis (OP). Sarcopenia in the elderly may be associated with low protein diet. High BMI and with high fat content was considered a protective factor for OP but it may be related to vitamin D deficiency and subclinical hyperparathyroidism. Objectives This study aims to evaluate the relationship between protein diet intake, BMI and and parathyroid hormone (PTH) levels. Methods A questionnaire on dietary protein intake was applied to patients at a Rheumatology clinic during 4 non-consecutive weeks from July to September 2013. Nutritional evaluation included body composition (InBody 720). Clinical data collected included: fall occurrence; history of clinical and/or radiologic vertebral fractures; total serum protein, albumin, inorganic phosphate, calcium, PTH, vitamin D and calcium urinary excretion levels and neck/lumbar densitometry. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, Qui-Square and Spearman correlation were applied for a significance of p<0,05. Results 189 subjects were enrolled, 88% female, mean age 58 years, mean BMI 27kg/m2 (low weight in 1,7%, normal in 33,1%, overweight in 37,7% and obesity in 27,6%). Regarding protein intake, 66,7% drunk milk >5 times/week and 22,2% >2 glasses/day; 61,3% of the patients consumed yogurt 1-3 times/day and 20,6% <1/week; 44% consumed cheese once a day. Lean and fatty fish were consumed weekly in 75% of the subjects and canned fish in up to 86%. Codfish and eggs consumption varied between 1 to 4 times/week in 68% and 77%, respectively. Red meat ingestion was: 2-4 times/week in 51%, <3 times/month in 27%. We found an association between weight (r=-0,131;p=0,043), body fat content (r=-0,174;p=0,007) and higher ingestion of lean fish. Patients with lower body fat content had a higher milk intake (r=-0,274;p=0,001). Higher consumption of red meat was associated with higher muscle mass and protein content (r>0,142;p<0,033). We also found a relation between higher PTH and higher BMI (r=0,310;p=0,034). Conclusions Patients that had a lower BMI and reduced body fat content consumed more lean fish, also those with lower body fat content showed a higher intake of milk. Red meat was associated with higher muscle mass and protein content. High PTH levels were correlated with higher BMI, which is in concordance with new evidence suggesting that overweight and obesity do not protect against OP. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5279