Arise Garcia de Siqueira Galil

O tabagismo é responsável por mais de 8 milhões de mortes anuais em todo o mundo. No Brasil, após décadas de redução consistente, a prevalência de fumantes adultos foi de 9,3% em 2023, com indícios recentes de estabilização e discreto aumento em alguns grupos populacionais. O objetivo deste estudo foi avaliar os fatores que influenciam as escolhas alimentares de tabagistas e analisar a adesão ao tratamento para cessação tabágica realizado por telemedicina. Foi realizada uma pesquisa com 90 fumantes portadores de múltiplas doenças crônicas, recrutados em ambulatórios e Unidades de Atenção Primária à Saúde. Foram incluídos indivíduos com idade superior a 18 anos, portadores de pelo menos duas doenças crônicas e em acompanhamento médico. Coletaram-se informações sociodemográficas, antropométricas, nível de atividade física, histórico tabágico, dependência nicotínica, craving e escolhas alimentares. A maioria dos participantes era do sexo feminino (67,8%), idosa (55,6%), branca (56,5%), casada (40,5%) e apresentava escolaridade inferior a oito anos de estudo (49,9%). Embora tenha predominado a eutrofia pelo índice de massa corporal, 69% apresentaram circunferência abdominal aumentada. As escolhas alimentares foram influenciadas principalmente pelo apelo sensorial e pelo controle de peso. Observou-se associação entre alta dependência nicotínica e maior consumo de cigarros, bem como boa adesão inicial ao modelo de telemedicina, com redução da participação ao longo do acompanhamento. Os resultados sugerem que aspectos relacionados ao comportamento alimentar devem ser considerados nas estratégias de cessação tabágica, especialmente em programas realizados por telemedicina.

Hereditary transthyretin amyloidosis (ATTRv) is a rare, autosomal dominant, inherited disease caused by variants in the gene encoding the transthyretin (TTR) protein. These variants lead to TTR tetramer destabilization, resulting in the formation and progressive deposition of insoluble amyloid fibrils in various tissues, including those of the central nervous system (CNS). Although previously neglected, the recognition of CNS involvement in ATTRv has become progressively relevant due to prolonged patient survival and the ineffectiveness of the current therapies in addressing CNS synthesis of TTR. The first descriptions of the pathological involvement of the CNS in ATTRv date from the 1960s; however, this topic has not been fully explored. In the present article, the main CNS clinical manifestations of ATTRv, such as transient focal neurological episodes, bleeding complications, leptomeningeal amyloidosis, and cognitive impairment, are reviewed, and the phenotypic variability of this condition is highlighted. A literature review of the PubMed/Medline database was conducted using the following keywords: hereditary amyloidosis, transthyretin amyloidosis, familial amyloidosis, central nervous system, neurological manifestations, leptomeningeal amyloidosis, cognition, and cognitive impairment. Studies published in the last 15 years, including review articles, prospective observational studies, experimental studies and clinical trials, were evaluated. Improving our understanding of CNS involvement in ATTRv will enable the early identification of neurological symptoms in this condition, which will enhance the understanding of the pathophysiological mechanisms and boost the advancement of research, expanding potential treatments and improving the quality of life of these individuals.

Background: In the Americas, the number of people living with diabetes is expected to rise from 92 million in 2024 to 120 million by 2050. Indigenous populations may experience distinct biological, environmental, and sociocultural risk factors; however, they are often treated as a homogeneous group in epidemiological research, and consolidated evidence on diabetes prevalence across diverse Indigenous populations remains limited. This scoping review examines the prevalence of diabetes among Indigenous populations in the Americas. Methods: Following PRISMA-ScR guidelines, we conducted a systematic scoping review of population-based studies reporting the prevalence of diabetes among Indigenous adult populations in the Americas. Searches were performed in PubMed and Scopus. Collected data included study location, Indigenous group, population characteristics, diagnostic criteria, and test used and reported prevalence estimates. Results: Sixty documents encompassing 73 studies met the inclusion criteria, representing 45,503 individuals from 16 countries between 1975 and 2025. The total number of ethnic groups represented was 111, and 12 studies did not identify a specific ethnic group. Fasting blood glucose (FBG) was the most frequently used diagnostic method, followed by the oral glucose tolerance test (OGTT). Estimates of the prevalence of diabetes varied widely across populations, regions, and time periods. Five studies—from Brazil, Chile, Colombia, Mexico, and Paraguay—did not identify any cases of diabetes. Among studies reporting cases, prevalence ranged from 1 to 70% in North America, 5 to 14% in Central America, and 1 to 29% in South America. Conclusions: The prevalence of diabetes among Indigenous populations varied widely across the region, with substantially higher estimates reported in North America than in Central and South America. The decline in published studies in recent years suggests reduced research attention to this topic. The marked heterogeneity identified in this review underscores the need for standardized measurement approaches to support population-specific strategies aligned with personalized care and precision public health.

Background: Diabetes is a growing public health concern worldwide, with an estimated 537 million people affected in 2021. This number is projected to increase by 46% over the next 25 years. In the Americas, the prevalence of diabetes is expected to rise from 84 million in 2021 to 112 million by 2045. Indigenous populations may face unique risk factors, yet there is limited consolidated data on diabetes prevalence within these communities. This systematic review examines the prevalence of diabetes among Indigenous populations in the Americas. Methods: Following PRISMA-ScR guidelines, a systematic search was conducted in Scopus and PubMed. Studies were included if they reported population-based surveys on diabetes prevalence among Indigenous and mestizo adults in the Americas. Data extraction focused on study location, population characteristics, diagnostic criteria, and reported prevalence. Results: A total of 60 documents, representing 73 studies, met the inclusion criteria and covered 45,503 individuals from 16 countries between 1975 and 2025. Mexico contributed the largest number of studies (17), followed by the United States (15), Brazil (10), Canada (7), Chile (6), and Guatemala (5). Most participants were from North America (29,093), followed by Central America (8,144) and South America (6,911). No eligible reports were identified from Caribbean nations, Peru, or Guyana. In total, 111 Indigenous groups were represented. The most frequently used diagnostic method was fasting blood glucose (FBG), applied in 50 studies (75%), followed by the oral glucose tolerance test (OGTT) in 41 studies (61%). The combined prevalence of diabetes among Indigenous and mestizo populations was 12% overall (17% among women and 14% among men). Mean diabetes prevalence was highest in North America (17%), followed by Central America (8.9%) and South America (4.9%). Notably, five studies—from Brazil, Chile, Colombia, Mexico, and Paraguay—reported no cases of diabetes. Conclusions: The prevalence of diabetes among Indigenous populations in the Americas is highly heterogeneous, with considerably higher rates reported in North America compared with Central and South America. Although genetic predisposition may play an important role, environmental and lifestyle factors likely contribute substantially to these differences. The decline in published studies in recent years suggests a reduction in research focus on this topic. Further investigation into modifiable risk factors—such as diet, physical activity, and socioeconomic conditions—is essential to better understand the epidemiology of diabetes, clarify how these determinants interact, and support the development of targeted interventions to reduce risk and address health disparities among Indigenous populations across the region. Keywords: Diabetes, Indigenous populations, Americas, epidemiology, public health, prevalence, systematic review.

Objective: Analyze craving in smokers with cardiovascular comorbidities submitted to a nutritional approach. Methods: Two groups were randomized and submitted to clinical intervention (n = 32): Group 1 (G1, n = 15): ingested 40 g of chocolate containing 70% cocoa/day and behavioral intervention for smoking cessation for one month; Group 2 (G2, n = 17): control group, only behavioral intervention. Questionnaire of Smoking Urges-Brief (QSU-Brief) - Brazil version measured total craving and its factors. Anthropometric measurements verified the nutritional interference of the procedure and the serum assessment verified the interference of inflammatory processes related to smoking. The study was registered on the Brazilian Registry of Clinical Trials (ReBEC): RBR-83jr3. Results: After one month, compared to the initial evaluation, the G1 reduced the craving evaluated by the QSU-Brief and its Factors 1 and 2. Total QSU-Brief: 44.27 ± 15.82 x 27.00 ± 18.03 (p = 0.008); Factor 1: 21.90 ± 7.70 x 12.90 ± 8.87 (p = 0.006); Factor 2: 11.90 ± 6.30 x 7.00 ± 6.63 (0.007). G2 showed a reduction in total QSU-Brief and Factor 1, but not in Factor 2. QSU-Brief total 28.17 ± 17.24 x 19.52 ± 9.50 (p = 0.049); Factor 1: 14.47 ± 8.74 x 9.23 ± 6.11 (p = 0.046). Serum levels of cortisol, leptin, serotonin, C-Reactive Protein (CRP) and insulin did not show differences (p > 0.05). No anthropometric differences were found. Conclusion: The results demonstrate that daily consumption of chocolate for one month (70%) reduced craving in smokers at the beginning of treatment. Chocolate potentiated the well-known effect of behavioral counseling on Factor 1 (pleasurable drug effects) and also interfered with factor 2 (unpleasant withdrawal effects).

Background: Diabetes accounted for approximately 10% of all-cause mortality among those 20–79 years of age worldwide in 2019. In 1986–1989, Hispanics in the United States of America (USA) represented 6.9% of the national population with diabetes, and this proportion increased to 15.1% in 2010–2014. Recently published findings demonstrated the impact of attained education on amenable mortality attributable to diabetes among Non-Hispanic Whites (NHWs) and Non-Hispanic Blacks (HNBs). Previous cohort studies have shown that low education is also a detrimental factor for diabetes mortality among the Hispanic population in the USA. However, the long-term impact of low education on diabetes mortality among Hispanics in the USA is yet to be determined. Aims and methods: The aim of this study was to measure the impact of achieving a 12th-grade education on amenable mortality due to diabetes among Hispanics in the USA from 1989 to 2018. We used a time-series designed to analyze death certificate data of Hispanic-classified men and women, aged 25 to 74 years, whose underlying cause of death was diabetes, between 1989 and 2018. Death certificate data from the USA National Center for Health Statistics was downloaded, as well as USA population estimates by age, sex, and ethnicity from the USA Census Bureau. The analyses were undertaken using JointPoint software and the Age–Period–Cohort Web Tool, both developed by the USA National Cancer Institute. Results: The analyses showed that between 1989 to 2018, age- and sex-standardized diabetes mortality rates among the least educated individuals were higher than those among the most educated individuals (both sexes together, p = 0.036; males, p = 0.053; females, p = 0.036). The difference between the least and most educated individuals became more pronounced in recent years, as shown by independent confidence intervals across the study period. Sex-based analyses revealed that the age-adjUSAted diabetes mortality rate had increased to a greater extent among the least educated males and females, respectively, than among the most educated. Conclusions: The results of the analyses demonstrated a powerful effect of low education on amenable mortality attributable to diabetes among the Hispanic population in the USA. As an increasing prevalence of diabetes among the least educated Hispanics has been reported, there is a great need to identify and implement effective preventive services, self-management, and quality care practices, that may assist in reducing the growing disparity among those most vulnerable, such as minority populations.

Objective: The objective of this study was to assess dried fruit mix and nuts and their effect on craving associated with the serum leptin of tobacco smokers. Materials and Methods: This is a clinical intervention study with a nonprobabilistic sample (n=23). The intervention group (IG) received 30 g of dried fruit and mix, and the control group (CG) received standard interventions. Test craving was analyzed using the Questionnaire of Smoking Urges (QSU-Brief). Serum leptin was assessed at the beginning and after 3 weeks. The data was tested using the SPSS program through the Shapiro-Wilk, unpaired Student t, or Mann-Whitney tests and multivariate linear regression. Results: The study showed significant difference between initial and final weights and body mass indices. The IG showed a high degree of smoking dependence. The IG showed reduced craving. In the CG, median serum leptin levels showed increased craving in the second and third weeks. Conclusions: Our results establish that craving decreased among smokers only in the IG. In the CG, above-median serum leptin levels reported a greater sense of pleasure in the second week. And in the third week, they experienced difficulties maintaining abstinence.

SUMMARY Cardiovascular diseases are important causes of morbidity and mortality in the course of chronic kidney disease (CKD). Diastolic dysfunction (DD) may progress with the clinical manifestation of heart failure, known as heart failure with preserved ejection fraction, a condition that precedes systolic dysfunction. The early identification of DD by echocardiography at the point-of-care before the appearance of symptoms and signs of pulmonary congestion and the implementation of appropriate treatment can improve the prognosis of CKD. This review article briefly addresses DD in kidney disease and presents a practical approach to the echocardiographic diagnosis of DD at the point of care.