The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients.

BACKGROUND & AIMS: Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality. METHODS: This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72 h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values < 50th percentile for sex and age were considered low. CC values of ≤33 cm for women and ≤34 cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected. RESULTS: A total of 249 patients were included (53.4% men, 62.2 ± 13.9 years of age, SOFA severity score 9.6 ± 3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p < 0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR = 2.63; 95% CI 1.65-4.18) or reduced MAC (HR = 2.11; 95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age. CONCLUSION: Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality.

Relação entre função cognitiva e capacidade funcional em idosos institucionalizados de Caxias do Sul/RS / Relationship between cognitive function and functional capacity in institutionalized elderly of Caxias do Sul/RS

O envelhecimento normal engloba um declínio gradual nas funções cognitivas, dependentes de processos neurológicos quese alteram com a idade. O declínio que acompanha o idoso tem início e progressão extremamente variáveis, e a perda de memória aparece como uma das funções mais acometidas. O objetivo deste estudo foi caracterizar uma população de idosos institucionalizados de Caxias do Sul/RS quanto ao seu estado cognitivo, às atividades comuns de vida diária, à mobilidade e à autonomia funcional a fim de identificar possível associação existente entre déficit cognitivo e prejuízo motor decorrentes da institucionalização destes sujeitos e vice-versa. Participaram deste estudo 67 sujeitos (77,59 ± 8 anos),os quais foram submetidos ao teste cognitivo Mini-Exame do Estado Mental (MEEM). Mobilidade para membros superiores e inferiores,e as atividades de vida diária foram avaliadas através do Índice de Katz. Não foi encontrada correlação estatisticamente significativa entre MEEM e idade, gênero, escolaridade e mobilidade de membros inferiores (r = 0,02, p > 0,05, Pearson). Uma associação foi detectada entre o desempenho dos idosos no teste para mobilidade dos membros superiores e o teste cognitivo MEEM (p = 0,01 e r= 0,251 Pearson). Os idosos demonstraram um déficit significativo na realização das tarefas banho, vestuário e transferência através do Índice de Katz. Portanto, podemos concluir através deste estudo que as alterações cognitivas detectadas através do MEEM não tiveram associação com o desempenho dos idosos nos testes de mobilidade para membros inferiores. Entretanto, verificou-se uma associação significativa entre o desempenho dos idosos no teste de capacidade funcional para membros superiores e o teste cognitivo avaliado através do MEEM.

Normal aging involves a gradual decline in cognitive abilitieswhich are dependent on neurological processes that change withage. The decline accompanying the elderly is extremely variable inrelation to initiation and progression, and memory loss is one of themost affected functions. The aim of this study was to characterize a population of institutionalized elderly people of the city of Caxias do Sul/RS concerning their cognitive state, common activitiesof daily living, mobility and functional autonomy, in order toidentify possible association between cognitive deficit and motor impairment as a result of institutionalization of these subjects and vice-versa. Sixty-seven subjects (77.59 ± 8 years old) participated onthis study, and underwent cognitive testing using the Mini-MentalState Examination (MMSE). Mobility of upper and lower limbsand activities of daily life were evaluated using the Katz Index. Nostatistically significant correlation was found between MMSE withage, gender, education and mobility of lower limbs (r = 0.02, p >0.05, Pearson). Association was detected between the performance of the elderly in the mobility test of the upper limbs and cognitivetest MMSE (p = 0.01 e r = 0.251 Pearson). The Katz Index showed that the elderly had a significant deficit in performing the following tasks: bathing, clothing and transfer. Therefore, we conclude thatthe cognitive impairments of these elderly people, detected via theMMSE, did not have any association with their performance in thetest of lower limbs mobility. How ever, it was found a significant association between the performance of the elderly in the upperlimbs functional capacity test and the assessment of cognitive function using the MMSE

A importância de incluir neurossífilis no diagnóstico diferencial de pacientes com déficit cognitivo e alteração do comportamento / The importance of including neurosyphilis in the differential diagnosis of patients with cognitive decline and behavior disturbances

É resultado da infecção do cérebro, das meninges ou medula espinhal pelo Treponema pallidum e desenvolve-se em cerca de 25-40% das pessoas que não são tratadas para a sífilis. A demência por neurossífilis é uma manifestação tardia da sífilis e era causa frequente de deterioração cognitiva antes do aparecimento e da disseminação do uso da penicilina no tratamento das fases iniciais da doença. Embora incomum nos dias de hoje, a demência por neurossífilis ainda constitui diagnóstico diferencial a considerar-se, diante de síndromes demenciais atípicas ou com manifestações frontais, particularmente em populações menos favorecidas socialmente. Esse caso destaca a importância do diagnóstico precoce da neurossífilis, e que os médicos devem se alertar para a possibilidade desta doença em pacientes que apresentam demência, principalmente por pertencer ao grupo das demências potencialmente reversíveis,pois o tratamento adequado pode reverter o declínio cognitivo. E ainda, pelo aumento no número de casos de sífilis na última década, particularmente pela coinfecção com HIV, que pode acelerar o curso e alterar a resposta ao tratamento da sífilis. Este aumento da incidência de sífilis, observado também na Europa e nos Estados Unidos, poderá traduzir-se num acréscimo do número de casos de neurossífilis observados na prática clínica.

Neurosyphilis results from infection of the brain, meninges or spinal cord by Treponema pallidum and develops in about 25-40% of persons who are not treated for syphilis. Dementia by neurosyphilis is a late manifestation of syphilis and was a frequent cause of dementia before the advent and widespread use of penicillin in the treatment of early stages of the disease. Although uncommon today, dementia of neurosyphilis still a differential diagnosis to consider in the face of atypical dementia or with manifestations front, particularly in socially disadvantaged populations socially. This case underscores the importance of early diagnosis of neurosyphilis, which clinicians should alert the possibility of neurosyphilis in patients who present with dementia, mainly belonging to the group of potentially reversible dementias, because proper treatment can reverse cognitive decline. And also, by increasing the number of syphilis cases in the last decade, particularly in combination with HIV, which can acelerate the course and alter the response to treatment of syphilis. This increasedincidence of syphilis, also observed in Europe and the United States, could result in an increase in the number of cases of neurosyphilis observed in clinical practice.