| To promote quality of life to intensive care unit (ICU) patients, treatments need and must be humanized, in that we are committed to preventing, caring, protecting, and recovering; that is, to promote health. Physical therapists play a fundamental role in the rehabilitation of ICU patients. Not only must they strive for technical quality but also for quality in the relationships involving the care they provide, in order to be viewed as reliable by patients and to be aware of their needs.The aim of this study was to verify whether the physical therapy care in an intensive care unit is conducted in a humanized way. This is a cross-sectional cohort study that used patient interviews via evaluation questionnaires and included 60 subjects over 18 years of age which had been discharged from the adult ICU. The interviewed patients approved the procedures carried out by the physical therapists and stressed their concern while conducting these procedures in way to keep their patients from experiencing discomfort. They were also satisfied with the treatment dimensions, with dignity, communication, reliability, interpersonal aspects, and receptivity reaching 100% of positive answers; assurance reaching 98.3%; empathy, 96.7%; and autonomy and effectiveness aspects, 95% of answers favoring humanization. The patients were shown to be satisfied, in the various aspects analyzed, with the care provided by the physical therapists, who must strive to carry out humanized professional practices.WE concluded that the physical therapy treatments the ICU patients received were characterized as humanized by RESUMEN | Para promocionar la calidad de vida a pacientes hospitalizados en unidades de cuidados intensivos (UCI), debe ser necesario humanizar la atención, en la que estamos comprometidos a prevenir, cuidar, proteger y recuperar, es decir, promocionar la salud. El fisioterapeuta es clave fundamental en la rehabilitación de pacientes hospitalizados en UCI, y además de calidad técnica debe apreciar la calidad relacional del cuidado, para tener confiabilidad y estar atento a lo que necesita el paciente. El propósito de este estudio es verificar si el cuidado fisioterapéutico en una unidad de cuidados intensivos es llevado a cabo de forma humanizada. Se trata de un estudio transversal, a través de entrevistas con cuestionario evaluativo en los cuartos de los pacientes, en lo cual fueron entrevistados 60 sujetos, con más de 18 años de edad y que tuvieron alta de la UCI adulta. Los entrevistados aprobaron la forma de trabajo de los fisioterapeutas, destacaron el cuidado que les tenían al realizar los procedimientos para que evitasen causarles más molestias. También estaban satisfechos en las dimensiones de atención, siendo que dignidad, comunicación, confiabilidad, aspectos interpersonales y receptividad llegaron a 100% de respuestas positivas, garantía 98,3%, empatía 96,7%, los aspectos autonomía y eficacia llegaron a 95% de las respuestas en pro de la humanización. Los pacientes mostraron alto grado de satisfacción en varios ...

Background Obesity in children and adolescents is associated with increased morbidity and mortality due to multisystemic impairment, including deleterious changes in lung function, which are poorly understood. Objectives To perform a systematic review to assess lung function in children and adolescents affected by obesity and to verify the presence of pulmonary changes due to obesity in individuals without previous or current respiratory diseases. Methods A systematic search was performed in the MEDLINE-PubMed (Medical Literature Analysis and Retrieval System Online), Embase (Excerpta Medica Database) and VHL (Virtual Health Library/Brazil) databases using the terms “Lung Function” and “Pediatric Obesity” and their corresponding synonyms in each database. A period of 10 years was considered, starting in February/2008. After the application of the filters, 33 articles were selected. Using the PICOS strategy, the following information was achieved: (Patient) children and adolescents; (Intervention/exposure) obesity; (Control) healthy children and adolescents; (Outcome) pulmonary function alterations; (Studies) randomized controlled trial, longitudinal studies (prospective and retrospective studies), cross-over studies and cross-sectional studies. Results Articles from 18 countries were included. Spirometry was the most widely used tool to assess lung function. There was high variability in lung function values, with a trend towards reduced lung function markers (FEV1/FVC, FRC, ERV and RV) in obese children and adolescents. Conclusion Lung function, measured by several tools, shows numerous markers with contradictory alterations. Differences concerning the reported results of lung function do not allow us to reach a consensus on lung function changes in children and adolescents with obesity, highlighting the need for more publications on this topic with a standardized methodology.

We compared the effect of dapagliflozin versus glibenclamide on the ratio of lean-to total mass in patients with type 2 diabetes mellitus, carotid subclinical atherosclerosis, HbA1c 7.0–9.0% and 40–70 years-old. Ninety-eight patients (61% male; mean age 57 ± 7 years) were randomized into dapagliflozin 10 mg/day or glibenclamide 5 mg/day on top of metformin. Body composition was measured by Dual Energy X-Ray at randomization and after 12 weeks of treatment. Glycemic control was equivalent in both groups. Dapagliflozin decreased total body mass (−2741 g [95% CI: −3360 to 1945]; p < 0.001) and lean mass (−347 g [95% CI: −761 to −106]; p < 0.001), while glibenclamide increased total body mass (1060 g [95% CI: 140 to 1836]; p < 0.001) and lean mass (929 g [95% CI: 575 to 1283]; p < 0.001) for the differences between arms. The lean-to-total mass ratio increased by 1.2% in the dapagliflozin group and 0,018% in the glibenclamide group (p < 0.001). Dapagliflozin reduced the risk of a negative balance in the lean-to total mass ratio [OR: 0.16 (95% CI: 0.05 to 0.45); p < 0.001] even after adjustment for baseline lean-to total mass ratio, waist circumference, HOMAIR, HbA1c, mean of the two hands handgrip strength and gait speed [OR: 0.13 (95% CI: 0.03–0.57); p < 0.007]. In conclusion, under equivalent glycemic control, dapagliflozin reduced total body mass but increased the ratio of lean-to-total mass when compared with glibenclamide.

Background: Endothelial dysfunction (ED) is a hallmark in type 2 diabetes mellitus (T2DM) that favor both atherogenesis and ischemia and reperfusion injury (IRI). Sodium-glucose-2 co-transporter inhibitors (SGLT2i) may hypothetically improve microvascular and macrovascular functions via a broad spectrum of mechanisms, being superior to traditional antidiabetic therapy such as sulfonylurea, even in subjects under equivalent glycemic control. Hence, the present clinical trial was designed to compare the effect of these two treatments on markers of arterial wall function and inflammation in T2DM patients as well as on the potential mediating parameters. Method and results: ADDENDA-BHS2 is a prospective, single-center, active-controlled, open, randomized trial. Ninety-eight participants (40-70 years old) with HbA1c 7-9% were randomized (1:1, stratified by gender, BMI and HbA1c levels) to either dapagliflozin 10 mg/day or glibenclamide 5 mg/day on top of metformin. The primary endpoint was the change of flow-mediated dilation (FMD) after a 12-week period of treatment evaluated at rest and after IRI between dapagliflozin and glibenclamide arms. Secondary outcomes were defined as the difference between treatments regarding: plasma nitric oxide (NO) change after FMD, plasma isoprostane, plasma levels of vascular inflammatory markers and systemic inflammatory markers, plasma levels of adipokines, anthropometric measures, glucose control parameters, office and ambulatory BP control. Safety endpoints were defined as systolic and diastolic function assessed by echocardiography and retinopathy change. Serious adverse events were recorded. The study protocol was approved by the Independent Scientific Advisory Committee. Conclusion: The ADDENDA-BHS2 trial is an investigator-initiated clinical trial comparing the effect of dapagliflozin versus glibenclamide on several aspects of vascular function in high cardiovascular risk T2DM patients. Besides, a large clinical and biochemical phenotype assessment will be obtained for exploring potential mediations and associations.

ABSTRACT Objective: To analyze the studies that identified the frequency of meals ingested by Brazilian adolescents and associated habits. Data sources: A systematic search was made in the databases and electronic databases: MEDLINE/PubMed, The Latin American and Caribbean Center of Information in Health Sciences (BIREME), Scopus, Web of Science and Embase, with articles published between January/2007 until December/2017, which addressed the evaluation of the frequency of meals performed by adolescents, considering or not associations with eating patterns and meal replacement. Data synthesis: 6,608 studies were obtained through the search and nine were included in this review, all of them with a cross-sectional design. Eight studies used school surveys and only one was a population survey. Seven studies evaluated the frequency of the main daily meals that ranged from 47.0 to 79.0% at breakfast, from 65.0 to 98.4% at lunch, and from 51.0 to 94.0% at dinner. Five studies identified the frequencies of consumption of snacks between meals, finding higher values for afternoon snack (variation from 42.0 to 78.0%). Regarding the substitution of meals for snacks, in three of the four selected studies; it was observed that this practice occurred mainly in substitution of dinner (24.6 to 42.0%). Conclusions: Breakfast was the most omitted meal for adolescents, and dinner was replaced with snacks. Among the between meal snacks, the afternoon snack was the most consumed.