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Congenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disease characterized by near complete absence of functional adipose tissue from birth. CGL diagnosis can be based on clinical data including acromegaloid features, acanthosis nigricans, reduction of total body fat, muscular hypertrophy, and protrusion of the umbilical scar. The identification and knowledge of CGL by the health care professionals is crucial once it is associated with severe and precocious cardiometabolic complications and poor outcome. Image processing by deep learning algorithms have been implemented in medicine and the application into routine clinical practice is feasible. Therefore, the aim of this study was to identify congenital generalized lipodystrophy phenotype using deep learning. A deep learning approach model using convolutional neural network was presented as a detailed experiment with evaluation steps undertaken to test the effectiveness. These experiments were based on CGL patient's photography database. The dataset consists of two main categories (training and testing) and three subcategories containing photos of patients with CGL, individuals with malnutrition and eutrophic individuals with athletic build. A total of 337 images of individuals of different ages, children and adults were carefully chosen from internet open access database and photographic records of stored images of medical records of a reference center for inherited lipodystrophies. For validation, the dataset was partitioned into four parts, keeping the same proportion of the three subcategories in each part. The fourfold cross-validation technique was applied, using 75% (3 parts) of the data as training and 25% (1 part) as a test. Following the technique, four tests were performed, changing the parts that were used as training and testing until each part was used exactly once as validation data. As a result, a mean accuracy, sensitivity, and specificity were obtained with values of [90.85 ± 2.20%], [90.63 ± 3.53%] and [91.41 ± 1.10%], respectively. In conclusion, this study presented for the first time a deep learning model able to identify congenital generalized lipodystrophy phenotype with excellent accuracy, sensitivity and specificity, possibly being a strategic tool for detecting this disease.

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Type 1 diabetes mellitus (T1DM) results from the immune cell-mediated destruction of functional pancreatic ß-cells. In the presymptomatic period, T1DM is characterized by the presence of two or more autoantibodies against the islet cells in patients without glycemic decompensation. Therapeutic strategies that can modify the autoimmune process could slow the progression of T1DM. Dipeptidyl peptidase-4 (DPP-4) or CD26, a multifunctional serine protease with a dual function (regulatory protease and binding protein), can modulate inflammation and immune cell-mediated ß-cell destruction. CD26 is involved in T-cell co-stimulation, migration, memory development, thymic maturation, and emigration patterns. DPP-4 degrades the peptide hormones GLP-1 and GIP. In addition to regulating glucose metabolism, DPP-4 exerts anti-apoptotic, regenerative, and proliferative effects to promote ß-cell mass expansion. GLP-1 receptor signaling may regulate murine lymphocyte proliferation and maintenance of peripheral regulatory T-cells. In patients with T1DM, the serum DPP-4 activity is upregulated. Several studies have suggested that the upregulated DPP-4 activity is correlated with T1DM pathophysiology. DPP-4, which is preferentially expressed on the Th1 surface, can promote the polarization of Th1 immunity, a prerequisite for T1DM development. CD26 inhibition can suppress T-cell proliferation and Th1 cytokine production and stimulate tumor growth factor beta-1 (TGF-ß1) secretion, which plays an important role in the regulation of autoimmunity in T1DM. Studies on humans or animal models of T1DM have suggested that DPP-4 inhibitors can improve ß-cell function and attenuate autoimmunity in addition to decreasing insulin dependence. This review summarizes the emerging roles of DPP-4 inhibitors in potentially delaying the progression of T1DM.

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PURPOSE: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by the absence of functional adipocytes resulting in ectopic lipid storage, metabolic disorders and early cardiovascular disease. Two-dimensional speckle-tracking (2D-STE) allows the detection of early abnormalities in myocardial function. We aimed to evaluate myocardial deformation in a large sample of CGL patients using 2D-STE. PATIENTS AND METHODS: A cross-sectional study of 22 patients with CGL and 22 healthy subjects, matched for sex and age, was conducted from 2013 to 2018. All participants had undergone standard conventional echocardiography (ECHO) and 2D-STE. Determination of blood glucose, lipids, insulin, and leptin were performed in all CGL patients. RESULTS: In the CGL group the mean age was 14.6±10.7 years where 68.2% (n=15) were younger than 18 years old. All the patients had hypoleptinemia, 95.4% (21/22) low HDL-c, 86.4% (19/22) hypertriglyceridemia, 68.2% (15/22) diabetes, 50% (11/22) hepatic steatosis, 41% (9/22) insulin resistance, 41% (9/22) hypercholesterolemia, and 18.2% (4/22) hypertension. ECHO showed that 36.6% (8/22) of CGL patients presented diastolic dysfunction, 31.8% (7/22) left ventricular hypertrophy (LVH), 27.3% (6/22) increased left atrial volume index (LAVI), and 18.2% (4/22) increased left ventricular systolic diameter (LVDS) but normal ejection fraction (EF), whether using 2D-STE, 68.2% (15/22) of CGL patients showed abnormal global longitudinal strain (GLS) (p<0.01), and in almost LV segments. Positive association between abnormal GLS and A1c (r=0.57, p=0.005), glucose (r=0.5, p=0.018) and basal insulin (r= 0.69, p= 0.024), and negative association with leptin (r = -0.51, p = 0.005) were found in these patients. CONCLUSION: The 2D-STE revealed precocious left ventricular systolic dysfunction in a young CGL population with normal systolic function by ECHO. Early exposure to common metabolic abnormalities as insulin resistance, hyperglycemia, and hypoleptinemia must be involved in myocardial damage in these patients.

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The purpose of this paper is to describe the glycosylation of ambrisentan (AMB) by cultures of Cunninghamella elegans ATCC 9245. AMB is an endothelin receptor antagonist, which is used to treat pulmonary arterial hypertension. Filamentous fungi are morphologically complex and may exhibit different forms depending on the species and the nature of the culture medium. A biotransformation study was conducted to investigate the ability of C. elegans to metabolize AMB. Parameters were optimized by testing on different culture media and concentrations, pH, drug concentration, static and shaking conditions. Ambrisentan's metabolite, obtained after 240 h of incubation as a result of glycosylation pathway, was separated by HPLC and determined by high-resolution mass spectrometry. The method showed linearity over 300-1000 µg mL-1 (r = 0.998). Accuracy, precision, robustness and stability studies agree with international guidelines. Results are consistent in accordance with the principles of green chemistry as the experimental conditions had a low environmental impact, and used little solvent.

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Abstract Introduction: Temporomandibular disorders (TMD) comprise a group of diseases that affect not only the temporomandibular joint, but also different areas extrinsic to the joints. Quality of life has been the subject of numerous studies in the Health area, especially aimed at people with chronic diseases, such as TMD. Objective: To evaluate effects of a physical therapy protocol on the quality of life of patients with temporomandibular disorder. Methods: Blinded, prospective, clinical trial, with 60 patients of both genders, aged between 18 and 70 years with TMD diagnosis attended in the clinic of Ribeirão Preto School of Dentistry. The patients were divided into two groups, with one group, in addition to dental treatment, receiving a physical therapy protocol and the other group dental treatment only, for 5 weeks. The measurement of quality of life was obtained through the generic SF-36 questionnaire, at the beginning and end of the proposed protocol. Results: The patients to whom the physical therapy protocol was applied associated with dental care presented increased scores in all the domains of the questionnaire. In the group that received only dental treatment, improvements were only found in the domain related to pain. Conclusion: The application of a physical therapy protocol was able to improve the quality of life of patients with temporomandibular disorder.

Resumo Introdução: A disfunção temporomandibular (DTM) compõem um conjunto de doenças que afetam não somente a articulação Temporomandibular, mas também diferentes áreas extrínsecas às articulações. A qualidade de vida tem sido motivo de inúmeros estudos na área da saúde, especialmente voltados para pessoas com doenças crônicas, como a DTM. Objetivo: Avaliar efeitos de um protocolo fisioterapêutico na qualidade de vida de pacientes com disfunção temporomandibular. Métodos: Estudo do tipo ensaio clínico, cego e prospectivo, com 60 pacientes de ambos os sexos, com idade variando entre 18 a 70 anos com diagnóstico de DTM atendidos na clínica da Faculdade de Odontologia de Ribeirão Preto. Os pacientes foram divididos em dois grupos, em um grupo, além do acompanhamento odontológico, foi aplicado um protocolo fisioterapêutico e no outro grupo foi realizado apenas o acompanhamento odontológico, durante 5 semanas. A mensuração da qualidade de vida foi obtida pelo questionário genérico SF-36, no início e final do protocolo proposto. Resultados: Nos pacientes em que foi aplicado o protocolo fisioterapêutico associado ao acompanhamento odontológico apresentaram escores mais elevados em todos os domínios do questionário. No grupo que recebeu apenas acompanhamento odontológico, verificou-se melhora apenas no domínio relacionado a dor. Conclusão: A aplicação de um protocolo fisioterapêutico foi capaz de melhorar a qualidade de vida de pacientes com disfunção temporomandibular.

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Introdução: As disfunções temporomandibulares (DTM) podem acarretar alterações gerais nos movimentos mandibulares devido à modificação nas condições musculares e articulares. Objetivo: Avaliar os sinais e sintomas da disfunção temporomandibular e sua relação com a postura cervical. Material e método: Estudo transversal e descritivo, com abordagem quantitativa, realizado na Universidade de Fortaleza, de agosto de 2011 a abril de 2012, em que 23 participantes com disfunção temporomandibular responderam o questionário ProDTMmulti sobre os sinais e sintomas da patologia, e foram fotografados para avaliação da postura da cabeça e mensuração da lordose cervical. Resultado: A idade média das participantes foi de 34,7 anos. A média do ângulo cervical foi de 29,7 graus e da lordose cervical, 3,6 cm. A cefaleia (82,6%), a dor muscular (78,3%) e o ruído na articulação temporomandibular (73,9%) foram os sinais e sintomas mais referidos pela amostra. A otalgia (26,1%) também figurou entre os sintomas, sendo o menos relatado. A maioria dos participantes relatou os sinais e sintomas bilateralmente. Não se observou correlação entre a medida do ângulo cervical e os sinais, sintomas e dificuldades pesquisados. Foi constatada uma correlação moderada entre a medida da lordose cervical e a dificuldade em abrir a boca (r= -0,4; p= 0,03). Conclusão Evidenciou-se que, na população do estudo, dentre os sinais e sintomas de DTM, a cefaleia é a mais referida, e que a maior dificuldade apresentada pelos participantes com disfunção foi a de mastigar. Evidenciou-se ainda correlação entre a dificuldade de abrir a boca e a lordose cervical. .

Introduction: The temporomandibular disorders (TMD) can cause general changes in mandibular movements due to changes in muscle and joint conditions. Objective: To evaluate the signs and symptoms of temporomandibular disorders and its relationship to cervical posture. Material and method: Cross-sectional and descriptive study with a quantitative approach conducted at the University of Fortaleza from August 2011 to April 2012, where 23 participants with temporomandibular disorders answered the questionnaire (PorDTMmulti) about the signs and symptoms of the condition and were photographed for measurement of head posture evaluation and cervical lordosis. Result: The average age of participants was 34.7 years. The average cervical angle was 29.7 degrees and 3.6 cm of cervical lordosis. Headache (82.6%), muscle pain (78.3%) and noise in the temporomandibular joint (73.9%) were the most commonly reported signs and symptoms by the sample. The ear pain (26.1%) was the least reported symptom. Most participants reported signs and symptoms from both sides. No correlation between the measurement of cervical angle and the sings, symptoms and difficulties surveyed was noted. A moderate correlation between the extent of cervical lordosis and the difficulty in opening the mouth (p=0.03; r= -0.4) was found. Conclusion: It was demonstrated that in the study population, among the signs and symptoms of TMD, headache was the most cited, and the greatest difficulty presented by participants about the dysfunction was chewing. It was revealed further correlation between the difficulty opening the mouth and cervical lordosis. .

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Apresentar o Instrumento de Avaliação da Promoção da Saúde na Universidade(IAPSU) e seu processo de avaliação de reprodutibilidade. Métodos: Estudo transversalrealizado entre maio e julho de 2014 com 50 acadêmicos de uma universidade de FortalezaCE,o qual desenvolveu o IAPSU a partir da análise de documentos governamentais e deuma revisão sistemática da literatura acerca de uma universidade potencialmente saudável. Oinstrumento possui 41 questões, divididas em cinco domínios: atividade física, alimentação,fatores ambientais, fatores psicossociais e consumo de álcool e drogas, e práticasintegrativas e complementares. Para avaliação da reprodutibilidade interobservador, osacadêmicos responderam duas vezes ao questionário, aplicado por examinadores distintos;para a avaliação intraobservador, outra aplicação do instrumento ocorreu sete dias depois.Resultados: Participaram do estudo 40 alunos do curso de Enfermagem e 10 do curso deFisioterapia, com idade média de 25 ± 5,4 anos, sendo 88% do sexo feminino e predomínioda raça branca. Na análise da reprodutibilidade, foram observados fortes coeficientesde correlação intraclasse, intraexaminador e interexaminador, acima de 0,8 em todos osdomínios estudados. Conclusão: Conclui-se que o IAPSU é um instrumento reprodutível econfiável para avaliação da promoção da saúde no âmbito universitário...

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Introduction The six minute walk test (6MWT) is considered an important tool in the evaluation of physical capacity, monitoration and the effectiveness of treatment in cardiac patients.Objective To compare the 6MWT on the treadmill and corridor in cardiac patients.Methods Participated 24 cardiac patients, being 12 male and 12 female with 56.7 ± 12.7 years age average, submitted to the six-minute walk test on the treadmill (6MWTT) and on the corridor (6MWTC) in an interval of seven days. The analyzed variables were: walked distance, respiratory rate (RR), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and oxygen saturation (SatO2).Results It was statistically significant difference in the comparison between the tests for the variables: walked distance, SBP, DBP and SatO2 (p > 0.05). The only statistically significant variable was the HR after the test application (p = 0.03).Conclusion After the two tests application, there was similarity in the variables: walked distance, SBP, DBP and SatO2 with no significant statistical differences. Only the HR presented statistical significance between groups at the end of the tests.

Introdução O teste da caminhada de seis minutos (TC6) é considerado uma ferramenta importante na avaliação da capacidade física, monitorização e efetividade do tratamento de indivíduos cardiopatas.Objetivo Comparar o TC6 realizado na esteira e no corredor aplicado em pacientes cardiopatas.Método Participaram do estudo 24 pacientes cardiopatas, sendo 12 do sexo masculino e 12 do feminino, com idade média de 56,7 ± 12,7 anos, submetidos à aplicação do TC6 na esteira ergométrica (TC6E) e no corredor (TC6C), em um intervalo de 7 dias. As variáveis analisadas foram: distância percorrida no teste, frequência respiratória (FR), frequência cardíaca (FC), pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e saturação de oxigênio (SatO2).Resultados Não houve diferença estatisticamente significante na comparação entre os testes nas variáveis: distância percorrida, FR, PAS, PAD e SatO2 (p > 0,05). Somente a variável FC após a realização do TC6E obteve aumento significante (p = 0,03).Conclusão Após a aplicação dos dois testes, houve semelhança nas variáveis: distância percorrida, FR, PAS, PAD e SatO2, não havendo diferenças estatísticas significantes. Apenas a variável FC apresentou significância estatística entre os grupos ao final dos testes.

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OBJECTIVE: To assess the measurement properties of the COPD assessment test (CAT) in a randomized trial comparing a face-to-face interview (FFI) with a telephone interview (TI). METHODS: A randomized study was conducted at two teaching hospitals in Fortaleza, Brazil. Patients were randomly assigned to answer the CAT questionnaire either in a FFI or by TI. The two groups were assessed for internal consistency reliability, cross-sectional validity and test-retest reliability. All patients performed spirometry and answered the modified medical research council dyspnea scale and the St. George's respiratory questionnaire (SGRQ). RESULTS: The total scores of the CAT questionnaire were similar for face-to-face and TI groups, 20.71 (95 % CI 18-23.4) versus 20.81 (95 % CI 19.31-21.7), respectively. For both mode of administration, we found good internal consistency reliability, the Cronbach's alpha ranged from 0.74 (95 % CI 0.61-0.84) to 0.89 (95 % CI 0.84-0.93) for the TI and FFI, respectively. In general, moderate-to-high correlations of CAT with SGRQ were observed, independent of the administration format. For the test-retest reliability, the intraclass correlation coefficients were very similar for both FFI and TI group 0.96 (95 % CI 0.93-0.97) versus 0.98 (95 % CI 0.96-0.98), respectively. CONCLUSION: This study demonstrated that the CAT questionnaire administration either in a FFI or by TI presents moderate-to-high measurement properties. This provides support for the use of both modes of questionnaire administration.

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A automedicação é definida como o uso de medicamentos sem prescrição médica pelo próprio paciente com o objetivo de tratar ou aliviar sintomas, ou mesmo de promover a saúde, independentemente da prescrição profissional. Esta pesquisa teve como objetivo analisar as concepções e práticas dos docentes de uma escola pública de ensino médio profissionalizante do estado do Ceará, Brasil sobre automedicação, suas implicações para a saúde e atuação da escola na promoção da saúde dos alunos. Estudo descritivo com abordagem qualitativa com 20 docentes da escola, realizado entre julho e agosto de 2010. A coleta de dados foi realizada usando-se a técnica de entrevista semiestruturada aplicada pelos pesquisadores aos docentes de todos os cursos profissionalizantes. Uma das concepções sobre medicamentos para os professores participantes da pesquisa é que está relacionada com o termo ?droga? e sua finalidade de curar males e moléstias. A constatação de que o professor assume que promover saúde na escola não faz parte de suas atribuições, leva-o a corresponsabilizar a família e o sistema público pelo cuidado com a saúde dos estudantes. Concluiu-se que os docentes possuem conhecimentos sobre medicamentos e suas consequências à saúde, entretanto não têm uma noção mais aprofundada sobre o uso racional de medicamento, sendo necessário implementar estratégias para promover este uso, além de fortalecer ações em prol da compreensão do conceito de promoção da saúde nos contextos educacionais.

Self-prescription is defined as the use of unprescribed drugs by the patient himself with the aim of treating or relieving symptoms or even to promote health independently from professional prescribing. This research has as aim to analyze the conceptions and practices of teachers of a professionalizing public high school in the State of Ceará, Brazil on self-medication and its implications for the health as well as analyzing the way the school promotes the health of the students. This is a descriptive study using the qualitative approach conducted with 20 schoolteachers between July and August of 2010. For data collection the researchers used a semi-structured interview technique conducted with the teachers of all professional courses. One of the conceptions about medications of the teachers participating in the research is the one related to the term ?drug? and its purpose to cure ailments and diseases. The finding shows that the teachers assume that promoting health in schools is not part of their duties what leads them to blame both the family and the public system about the health care of the students. It can be concluded that teachers have knowledge about drugs and their consequences to health, however, they don?t have a deeper understanding about the rational use of medication, thus, being necessary to implement strategies to promote the rational use of medications, and the strengthening of actions for the implementation of health promotion in educational contexts.

La automedicación es definida como el uso de medicamentos sin prescripción médica por el propio paciente, con el objetivo de tratar o aliviar síntomas, o mismo, promover la salud, independiente de la orientación profesional. Esta investigación analiza los conceptos y las prácticas de los docentes en una escuela pública de enseñanza secundaria con formación profesional, en el estado de Ceará, Brasil, sobre la automedicación y sus consecuencias para la salud, así como la actuación de la escuela en la promoción de la salud de los alumnos. Estudio con enfoque cualitativo, con 20 docentes de dicha escuela, realizado entre julio y agosto de 2010. Para la recolecta se utilizó la entrevista semiestructurada aplicada por los investigadores a los docentes de todos los cursos de formación profesional. Para los profesores que participan en la investigación, una de las concepciones acerca de los medicamentos es la que está relacionada con el término ?droga? y su propósito para curar males y dolencias. La constatación de que el profesor asume que el hecho de promover la salud en las escuelas no es parte de sus funciones, lo lleva a corresponsabilizar a la familia y el sistema público por el cuidado con la salud de los estudiantes. Se concluye que los docentes poseen conocimientos sobre las medicinas drogas y sus consecuencias para la salud, sin embargo, no tienen una idea más profunda sobre el uso racional de las mismas, siendo necesario implementar estrategias para promover dicho uso, además del fortalecer las acciones en pro de la implementación del concepto de promoción de la salud en contextos educativos.

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