Ana Marice Teixeira Ladeia

INTRODUCTION: Sickle cell disease (SCD) is the most common hemoglobinopathy worldwide, and pain is the main clinical manifestation, affecting the physical, emotional, and social well-being of children and adolescents. However, currently available pediatric pain assessment tools have limitations in capturing the multidimensional nature of pain in this population. OBJECTIVE: To describe the development and validation of a multidimensional pain assessment instrument for children and adolescents with SCD. METHOD: A psychometric evaluation study was conducted according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN), made in four stages involving healthcare professionals, children, and adolescents from referral centers for SCD treatment in Salvador, Bahia, Brazil (ethical approved 10195319.9.0000.5544/67895822.0.0000.5544). RESULTS: Expert evaluation demonstrated a high rate of agreement regarding the domains and items (Kappa=0.82–0.95). Semantic validation indicated the need to reduce the number of items and modify illustrations, resulting in satisfactory content validity (CVI=0.80–1.00). Construct validation with 70 participants showed factor loadings ranging from 0.428 to 0.792 and Cronbach's alpha values between 0.421 and 0.817. Three items were removed after psychometric analysis. Convergent validity, assessed against the Pediatric Quality of Life Inventory (PedsQL), Wong-Baker Faces Scale (WBS), and Adolescent Pediatric Pain Tool (APPT), demonstrated satisfactory correlations and discriminative ability (p<0.05). CONCLUSION: The final QUEST-DOR-DF, comprising 60 items across four domains, demonstrated preliminary evidence of validity and reliability, suggesting its use as a multidimensional pain assessment instrument for children and adolescents with SCD in clinical practice and future research.

Background: A functional balance between angiotensin II receptors (AT1R/AT2R) is associated with the regulation of cardiovascular, inflammatory, and tissue remodeling processes. Interventions that promote this balance have a significant impact on quality of life. Physical exercise stands out among these interventions, as the literature extensively identifies it as a therapeutic tool for managing conditions linked to the main axis of the renin–angiotensin system (RAS). Despite its beneficial role regarding the RAS, its effects on AT1R and AT2R receptor expression have not yet been systematically synthesized. Objective: To review the literature and systematically compile existing knowledge regarding the effect of physical exercise on the expression of angiotensin II receptors (AT1R and AT2R) within the RAS. Methods: This is a systematic review registered in PROSPERO (CRD420251267388). Searches were conducted in the PubMed/MEDLINE, PEDro, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature (LILACS), Web of Science, and Scopus databases. Risk of bias was assessed using the RoB 2 and SYRCLE tools. A total of 724 studies were identified, of which 11 met the eligibility criteria: 10 conducted using experimental animal models and 1 involving humans. Results: Eleven studies were included, predominantly animal experimental models. The findings indicate that chronic cyclic physical exercise is associated with reduced AT1R expression and increased AT2R expression in different tissues. In contrast, the only study that evaluated resistance exercise showed a distinct physiological response, with increased AT1R expression. Conclusions: The results suggest that chronic cyclical physical exercise promotes an increase in AT2R receptor expression and a reduction in AT1R expression in various body tissues, although the evidence is derived primarily from animal studies.

INTRODUCTION: Sickle cell disease (SCD) presents pain as one of its primary symptoms, manifesting from early childhood, and requiring effective strategies for its control and management. OBJECTIVE: To evaluate the feasibility, safety and preliminary effects of photobiomodulation (LASER acupuncture) for pain control in children with sickle cell disease. Secondly, we decided to analyze the changes in brain waves before and after a single session. METHOD: A pilot study was conducted in children aged 6 to 12 years, followed at the Pediatric Hematology Outpatient Clinic of Professor Edgard Santos University Hospital, Federal University of Bahia, Brazil. A body diagram, the Wong-Baker Faces Pain Rating Scale, the PedsQL Quality of Life Questionnaire, and electroencephalographic (EEG) recordings were applied before and after a single session of acupuncture through LASER therapy photobiomodulation based on Traditional Chinese Medicine procedures. The brain activities were evaluated comparing children with SCD with health children pared by age and sex. RESULTS: Ten girls and five boys participated in the study, with a mean age of 9.93 ± 1.71 years. Most (80.00%) had HbSS phenotype, with pain primarily located in the lumbosacral region, knees, and head. The mean pain intensity was 6.00 ± 1.633, described as severe (93.3%), involving sensory, affective, and mixed components. A positive immediate effect was observed with photobiomodulation, reducing pain intensity to 1.75 ± 2.363 (p=0.036). Quantitative EEG tracings also revealed in an exploratory analysis a modulation potential for alpha, theta, beta, gamma, and sensorimotor waves. CONCLUSION: Acupuncture using LASER therapy photobiomodulation demonstrates promising potential for brain-mediated pain modulation in children with Sickle Cell Disease.

Objective: To test the hypothesis that the quarterly injectable contraceptive increases the activity of the renin-angiotensin-aldosterone system. Methods: This was a cross-sectional observational study that included eutrophic, irregularly active women, aged between 18 and 30 years, who had been taking quarterly injectable contraceptive (150mg of medroxyprogesterone acetate) for at least 6 months or who had not used any type of hormonal contraceptive for at least 6 months. At first the volunteers underwent a physical examination and answered a standard questionnaire. They were then sent for blood collection of laboratory variables: plasma renin activity and concentration, angiotensin-converting enzyme 1 (ACE 1), and aldosterone. The data was analyzed using the two-tailed Student's t-test, with significance <0.05. Results: Sixty-two women were included in this study, divided into the Injectable Contraceptive Group (ICG) with n=23 and the No Contraceptive Group (NCG) with n=39. ICG had lower mean plasma renin activity values than NCG, respectively 0.4 ± 0.17 vs 1 ± 0.6 (p <0.01). The mean values for plasma renin concentration, ACE 1, and aldosterone did not differ between the groups (respectively, p= 0.21; 0.66; 0.09). Conclusion: Women using quarterly injectable contraceptives do not show greater activity of the renin-angiotensin-aldosterone system than their counterparts who do not use this drug.

Background: Cardiovascular diseases (CVDs) are the leading cause of death in the world, and companies can implement prevention and control actions aimed at reducing risk factors among their workers. Objectives: To verify whether the result of model A of a CVD prevention and control program was superior to model B in reducing the cardiovascular risk (CVR) of individuals from an oil company. Methods: Retrospective evaluation of secondary data from a restricted and fixed cohort of 670 workers, from 01/01/2016 [...] Abstract Background: Cardiovascular diseases (CVDs) are the leading cause of death in the world, and companies can implement prevention and control actions aimed at reducing risk factors among their workers. Objectives: To verify whether the result of model A of a CVD prevention and control program was superior to model B in reducing the cardiovascular risk (CVR) of individuals from an oil company. Methods: Retrospective evaluation of secondary data from a restricted and fixed cohort of 670 workers, from 01/01/2016

Background: Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia’s backlands — a region known for its low-income population — is essential. Objective: To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia. Methods: This study is part of a project evaluating the impact of a [...] Abstract Background: Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia’s backlands — a region known for its low-income population — is essential. Objective: To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia. Methods: This study is part of a project evaluating the impact of a

Background: The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence. Objective: To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence. Methods: Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three [...] Abstract Background: The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence. Objective: To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence. Methods: Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three

Plant-based diets have been linked to various health benefits, including an improved gut microbiota composition, potentially influencing non-communicable diseases. This study investigates the impact of a school meal intervention on the gut microbiota, specifically the abundance of Bifidobacterium spp. (BIF), in Brazilian schoolchildren. A quasi-experimental intervention was conducted in 2019 across four municipalities in the semi-arid region of Bahia, Brazil. The Sustainable School Program aimed to replace animal-based and ultra-processed foods with plant-based options. Clinical, dietary, anthropometric, and laboratory data were collected at the beginning and end of the school year. Fecal samples were analyzed for BIF abundance using RT-PCR. The intervention improved anthropometric and laboratory outcomes, including increased serum hemoglobin levels and reduced LDL-cholesterol. Despite these benefits, no significant change in BIF abundance was observed. However, a negative correlation between BIF abundance and waist-to-height ratio was found. While the intervention positively affected several health parameters, it did not significantly alter BIF abundance. Nevertheless, the abundance of BIF may explain some of these positive outcomes. The findings highlight the potential of plant-based diets to improve overall health, but suggest that further research is needed to understand the role of the gut microbiota in these outcomes. Future studies should explore the influence of factors such as physical activity on the gut microbiota and health.

Objective: To evaluate the relationship between laboratory biomarkers of severity and functional limitations analyzed by the PCFS (Post COVID Functional Scale) in COVID-19 survivors. Methods: ambispective, quantitative and longitudinal cohort study. Data collection took place in two moments: initially during hospitalization, recording the percentage of lung impairment, D-dimer, CRP (C Reative Protein), BMI (Body Mass Index), age, smoking time, mechanical ventilation (MV), MV time, lenght of hospitalization, thrombosis, use of vasoactive drugs, anticoagulants and corticosteroids. The second by applying the PCFS scale. Results: 80 individuals were included. 46 (57.5%) were female with a mean age of 52.3 years (SD 14.5) and a BMI of 27.5 kg/m2 (SD 4.4). Of these, 64 (80%) had limitations. Comparing the groups by dependent factor, functional profile, smoking time (12 vs. 28 years, p=0.041), BMI (25 vs. 28 kg/m2, p=0.036), age (43 vs. 54 years, p=0.008), D-dimer (421 vs 788 mg/L p=0.012) and CRP (2 vs 12mg/L, p=0.047) were higher in the group with limitations. In logistic regression, D-dimer and BMI remain as independent predictors of worse functional profile. Conclusion: D-dimer and BMI changes during hospital stay can modify the post-COVID-19 functional profile. Therefore, the early inclusion of individuals with changes in these markers in rehabilitation programs is an assertive strategy for COVID-19 survivors.