Body mass index-adjusted calf circumference is associated with mortality in hospitalized older patients with excess weight.

OBJECTIVES: Given the innovative nature of the method, our study aimed to assess the prognostic significance of body mass index (BMI)-adjusted calf circumference (CC) in older patients who are hospitalized. METHODS: This was a unique analysis as part of other cohorts comprising general hospitalized patients aged 60 years or older of both sexes. Only patients with excess weight (BMI ≥ 25 kg/m2) were included. CC was adjusted by reducing 3, 7, or 12 cm for BMI (in kg/m2) within 25-29.9, 30-39.9, and ≥40 kg/m2, respectively. CC was considered low if ≤ 34 cm for males and ≤ 33 cm for females. Clinical outcomes included prolonged length of hospital stay (LOS) and mortality. RESULTS: A total of 222 patients were included. After BMI adjustments, 72.1% of the patients were reclassified from a normal CC category to a low CC category. The frequency of low CC increased from 33.8% to 81.9% following BMI adjustments. Among those reclassified to the low CC, 11 died, compared to only 2 patients in the group that maintained a normal CC classification. BMI-adjusted CC was inversely associated with mortality (HR adjusted 0.84, 95% CI 0.73 to 0.95), but not with prolonged LOS. CONCLUSIONS: Our novel study highlights the prognostic value of BMI-adjusted CC. As an anthropometric marker of muscle mass, it proved to be a predictor of mortality in older patients with high BMI. This adjustment is further important because it may help to better detect low muscle mass in these patients where such conditions might be masked.

Dynapenic abdominal obesity is related to cardiovascular risk in older adults with Parkinson's disease: A cross sectional study.

BACKGROUND AND AIMS: Currently, the impact of nutritional status in Parkinson's disease over the cardiovascular risk is poorly understood. Thus, this study aimed to evaluate dynapenic abdominal obesity and its influence in anthropometric parameters of cardiovascular risk in older patients with Parkinson's disease. METHODS: This is a cross-sectional study involving outpatients diagnosed with Parkinson's disease in two treatment centers in northeast of Brazil. We included patients who aged 60 years and older. The data was collected from January to July of 2019. For abdominal obesity, waist circumference was used. For dynapenia, Handgrip Strength was measured. Dynapenic abdominal obesity was established as the coexistence of dynapenia and abdominal obesity. RESULTS: The dynapenic abdominal obesity occurred in 25% of the patients and was higher in women (p = 0.073). The dynapenic abdominal obesity group had a decreased muscle strength, higher values of Body Mass Index, a worse Waist Height Ratio; increased values of Fat Mass and percentual of Fat Mass and an increased value of Conicity Index (p < 0,05). CONCLUSION: The occurrence of dynapenic abdominal obesity in our population was related to the worsening of anthropometric values of cardiovascular risk. From our results we can suggest that the early identification of the coexistence of nutritional disorders, such as dynapenia and abdominal obesity can help in the appropriate intervention to mitigate the risks related to adverse events.

Aspectos clínicos e epidemiológicos e aceitabilidade da terapia larval em pacientes com feridas crônicas / Clinical and epidemiological aspects and acceptability of larval therapy in patients with chronic wounds / Aspectos clínicos y epidemiológicos y aceptabilidad de la terapia larval en pacientes con heridas crónicas

Objetivo: avaliar o perfil epidemiológico e clínico de pacientes com feridas e a aceitabilidade à Terapia Larval (TL). Método: acompanhados 15 pacientes com feridas crônicas e registrados em fichas clínicas. Resultados: pacientes não conheciam a TL. Idades variaram (45 a 73), pretos (46,66%), brancos (26,66%) e pardos (20,00%), predominantemente mulheres (73,33%). Tinham ensino fundamental (53,33%), médio (20,00%) e superior (26,6%) completos. 60% residiam no RJ; Lesões, (idade média de 6 anos e área média de 9,4 cm²) no terço distal das pernas (53,00%) e nos pés (47,00%), com origem vascular (40,88%), úlceras por pressão (31,69%), diabéticas (16,66%) e infecciosa (10,77%). Pacientes apresentavam três (20,00%), duas (20,00%) ou uma lesão (60,00%), com necrose (80,00%), infecção (37,60%), granulação (50,30%), epitelização (15,00%), dor (54,0%) e dificuldade de locomoção (47,00%). Insuficiência venosa como antecedente patológico mais observado. A aceitabilidade para TL foi 93,33%. Conclusão: TL é alternativa para melhor qualidade de vida

Objectives: to evaluate the epidemiological and clinical profile of patients with wounds and acceptability to Larval Therapy (LT). Method: followed 15 patients with chronic wounds and recorded in clinical records. Results: patients didn't know LT. Ages varied (45 to 73 y.o.), were black (46.66%), white (26.66%) and yellow (20.00%), predominantly women (73.33%). They had Elementary (53.33%), High (20.00%) and Higher education (26.60%). 60% lived in Rio de Janeiro; Wounds (mean age of 6 years; mean area of 9.4 cm²) in the distal third of the legs (53.00%) and feet (47.00%), with vascular origin (40.88%), pressure (31.69%), diabetic (16.66%) and infectious ulcers (10.77%). Patients had three (20.00%), two (20.00%) or one wound (60.00%), with necrosis (80.00%), infection (37.60%), granulation (50.30%), epithelialization (15.00%), pain (54.00%) and locomotion difficulty (47.00%). Venous insufficiency as the most observed pathological antecedent. Acceptability for LT was 93.33%. Conclusion: LT is an alternative to better quality of life

Objetivos: evaluar el perfil epidemiológico y clínico de pacientes con heridas y aceptabilidad a Terapia Larvaria (TL). Método: seguimiento de 15 pacientes con heridas crónicas y registrados en historias clínicas. Resultados: pacientes no conocían TL. Edades variaron (45 a 73%), negros (46,66%), blancos (26,66%) y morenos (20,00%), predominantemente mujeres (73,33%). Habían completado la educación primaria (53,33%), media (20,00%) y superior (26,6%). 60% vivían en RJ; Lesiones (edad media de 6 años y superficie media de 9,4 cm²) en el tercio distal de las piernas (53,00%) y pies (47,00%), con origen vascular (40,88%), úlceras por presión (31,69%), diabéticas (16,66%) e infecciosas (10,77%). Pacientes presentaban tres (20,00%), dos (20,00%) o una lesión (60,00%), con necrosis (80,00%), infección (37,60%), granulación (50,30%), epitelización (15,00%), dolor (54,0%) y dificultad locomotiva (47,00%). Insuficiencia venosa como antecedente patológico más observado. Aceptabilidad para TL fue del 93,33%. Conclusión: TL es una alternativa a una mejor calidad de vida

Case Report: Galvanic Vestibular Stimulation in the Chronic Spinal Cord Injury Patient.

The traumatic spinal cord injury can generate sequels with high clinical severity and dysfunction and limitations of irreversible character. Current studies seek to reverse the sequelae and gain functionality in these individuals. Galvanic vestibular stimulation (GVS) has shown to be beneficial in spinal cord function as an evaluation correlated to functionality and for stimulation with physiological and functional characteristics in disease and healthy people. The present study observed the effects of Noise Galvanic Vestibular Stimulation in a patient with chronic spinal cord injury with tetraplegia on postural and trunk control. The evaluations were the Functional Independence Measure (FIM), the American Spinal Injury Association (ASIA) evaluation, and the Clinical Posturography, using force platform to assess postural balance, in the sitting position, through Sensory Organization and Functional Reach Tests. Ten sessions of Noise Galvanic Vestibular Stimulation associated with customized vestibular and neurofunctional rehabilitation were performed. The effects observed were increments in all assessments and tests that include modifications in functional independence, motor and sensory levels, change in disability grade from A (complete) to C (incomplete), and improvements in postural balance and trunk control. The phenomenon of stochastic resonance has shown benefits in postural control in people without vestibular lesions and we could observe some of these phenomena in our patients. We emphasize the need for evaluation with larger populations to observe the phenomena and effects in this group of patients and potential benefits and limitations.

Arcuate AgRP, but not POMC neurons, modulate paraventricular CRF synthesis and release in response to fasting.

BACKGROUND: The activation of the hypothalamic-pituitary-adrenal (HPA) axis is essential for metabolic adaptation in response to fasting. However, the neurocircuitry connecting changes in the peripheral energy stores to the activity of hypothalamic paraventricular corticotrophin-releasing factor (CRFPVN) neurons, the master controller of the HPA axis activity, is not completely understood. Our main goal was to determine if hypothalamic arcuate nucleus (ARC) POMC and AgRP neurons can communicate fasting-induced changes in peripheral energy stores, associated to a fall in plasma leptin levels, to CRFPVN neurons to modulate the HPA axis activity in mice. RESULTS: We observed increased plasma corticosterone levels associate with increased CRFPVN mRNA expression and increased CRFPVN neuronal activity in 36 h fasted mice. These responses were associated with a fall in plasma leptin levels and changes in the mRNA expression of Agrp and Pomc in the ARC. Fasting-induced decrease in plasma leptin partially modulated these responses through a change in the activity of ARC neurons. The chemogenetic activation of POMCARC by DREADDs did not affect fasting-induced activation of the HPA axis. DREADDs inhibition of AgRPARC neurons reduced the content of CRFPVN and increased its accumulation in the median eminence but had no effect on corticosterone secretion induced by fasting. CONCLUSION: Our data indicate that AgRPARC neurons are part of the neurocircuitry involved in the coupling of PVNCRF activity to changes in peripheral energy stores induced by prolonged fasting.

Phase angle, muscle mass, and functionality in patients with Parkinson's disease.

OBJECTIVE: To evaluate the association of phase angle (PA) with clinical and nutritional aspects in patients with Parkinson's disease (PD) treated in an outpatient clinic in northeastern Brazil. METHODS: This is a case series study involving adults and the elderly with PD of both genders. We collected data such as stage, severity, and time of diagnosis of the disease, muscle strength, gait speed, and level of physical activity. We evaluated the nutritional status using body mass index, calf circumference, skeletal appendicular muscle mass index, and the presence of sarcopenia. We obtained the PA through the analysis by electrical bioimpedance. After obtaining the result of the division between reactance and resistance, with later transformation into degrees, we multiplied the result by 180/π. RESULTS: We evaluated 77 individuals with a mean age of 65.4 ± 8.9 years. 63.6% of them had reduced PA values and 19.7% of them had sarcopenia. Age (rho = - 0.423; p = < 0.001) was inversely correlated with PA. Skeletal appendicular muscle mass index (rho = 0.251; p = 0.028), pressure force (rho = 0.240; p = 0.035), and gait speed (rho = 0.323; p = 0.005) showed a direct correlation with age. When adjusted for confounding factors, only age remained associated with PA (p = 0.012). CONCLUSION: Most individuals had reduced PA, and only age was associated with this result. Aging is a risk factor for reducing muscle mass and physical disability in PD. Although this study indicates a relationship between PA, age, muscle mass, and functionality, further prospective studies are needed to confirm these findings.

Ultrasound Protocols to Assess Skeletal and Diaphragmatic Muscle in People Who Are Critically Ill: A Systematic Review.

This study aims to review published studies that use protocols and ultrasound measurements to evaluate skeletal and diaphragmatic muscles in patients who are critically ill. We searched for references on databases through September 2020 and included in our systematic review studies that used muscular ultrasound to assess skeletal or diaphragm muscles in patients who are critically ill. Seventy-six studies were included, 32 (1720 patients) using skeletal-muscle ultrasound and 44 (2946 patients) using diaphragmatic-muscle ultrasound, with a total of 4666 patients. The population is predominantly adult men. As for designs, most studies (n = 62) were cohort studies. B-mode B was dominant in the evaluations. Medium-to-high frequency bands were used in the analysis of peripheral muscles and medium-to-low frequency bands for diaphragmatic muscles. Evaluation of the echogenicity, muscle thickness and pennation angle of the muscle was also reported. These variables are important in the composition of the diagnosis of muscle loss. Studies demonstrate great variability in their protocols, and sparse description of the important variables that can directly interfere with the quality and validity of these measures. Therefore, a document is needed that standardizes these parameters for ultrasound assessment in patients who are critically ill.

Estado nutricional, hábitos alimentares e saúde bucal em um grupo de escolares / Nutritional condition, food habits and oral health in a group of school children

Objetivo: Investigar o estado nutricional, hábitos alimentares, experiência de cárie e práticas de higiene bucal em um grupo de escolares. Metodologia: Realizou-se um estudo transversal com 171 crianças de 4 a 8 anos de idade, matriculadasem uma escola municipal do Recife/PE. Na avaliação antropométrica foi utilizado o registro do sexo, idade, peso e estatura, tendo como critério para o diagnóstico o Z-escore na classificação do índice de massa corporal/idade. Por meio de um questionário, foi veri-ficado a frequência de alguns alimentos e as práticas de higiene bucal. Os exames bucais foram realizados no ambiente escolar utilizando-se o índice ceo-d (OMS), como critério diagnóstico para a experiência de cárie. Os dados foram avaliados por meio de análise descritiva. Resultados:Das crianças avaliadas, 25% apresentaram excesso de peso e 3,5% baixo peso. Quanto ao consumo de alimentos, observou-se alta a frequência (3 a 6 vezes/dia) de: biscoito recheado (28,8%), refrigerantes (19,9%), balas/pirulito (27,8%) e de açúcar adicionado aos alimentos/bebidas (42,5%). A prevalência de cárie foi de 46,4%, com média de 1,47 dentes decíduos cariados e ceo-d médio de 1,8. A maioria das crianças realizava a escovação sem supervisão (60,3%), e 56,2% usavam escova e creme dental fluoretado. Do total de crianças, 39,2% nunca visitaram o dentista e 60,2% das crianças necessitavam de tratamento odontológico. Conclusão:O estado nutricional bem como a saúde bucal das crianças não apresentou resultados satisfatórios, estando em desacordo com as diretrizes e recomendações atuais da Organização Mundial de Saúde. (AU)

Objective: Investigate nutritional status, dietary habits, caries experience and oral hygiene practices in a group of school-children. Methods: A cross-sectional study was conducted with 171 children aged four to eight years at a public school in the city of Recife, Brazil. The anthropometric evaluation involved recording sex, age, weight and height, using the z-score of body mass index/age as the criterion for the diagnosis. A questionnaire was used to collect information on the intake frequency of foods and beverages and oral hygiene practices. Oral examinations were performed in the school setting using the dmft index (World Health Organization) as the diagnostic criterion for caries experience. The data were evaluated using descriptive analysis. Results: Among the children evaluated, 25% were classified as overweight and 3.5% were classified as underweight. Regarding diet, high intake frequencies (three to six times a day) were found for cookies (28.8%), soft drinks (19.9%), candy/suckers (27.8%) and sugar added to foods/beverages (42.5%). The prevalence of caries was 46.4%, with a mean of 1.47 carious primary teeth and mean dmft index of 1.8. The majority of children performed tooth brushing with no supervision (60.3%) with a toothbrush and fluoride toothpaste (56.2%); 39.2% had never been to a dentist and 60.2% were in need of dental treatment. Conclusion: Considering the current guidelines of the World Health Organization, the nutritional sta-tus and oral health of the children analyzed were not satisfactory. (AU)

Phytochemical and biological evaluation of metabolites produced by alginate-immobilized Bionts isolated from the lichen Cladonia substellata vain.

In this work, new biotechnological procedures have been optimized on the basis of immobilization in alginate of bionts isolated from the lichen C. substellata. From these immobilizates, soluble and biologically active phenolics can be obtained. During bionts-immobilization, stictic, norstictic and usnic acids were secreted to the medium. The amount produced of each of them differed depending on the immobilization time, the precursor supplied and the type of biont used. Greater amounts of stictic acid were detected and maintained over time in all bioreactors. The opposite occurs in non-immobilized thallus. Virtually, all lichen phenols exhibit antioxidant activity to a greater or lesser degree, so that the antioxidant capacity of stictic acid (82.13% oxidation inhibition) was tested. The soluble extract of immobilized algae co-incubated in sodium acetate with fungal hyphae contained carbohydrates and exhibited a potent antioxidant capacity after 13 days of immobilization (94.87%). Therefore, attempts have been made to relate both parameters. On the other hand, the growth of Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae was inhibited by phenolic compounds produced by immobilizates, although the organic extract of the whole lichen showed the highest activity due to a possible synergy with other indeterminate compounds. Thus, C. substellata immobilized bionts are a potential source of different natural antioxidant and antimicrobial compounds.

Supplementation-Dependent Effects of Vegetable Oils with Varying Fatty Acid Compositions on Anthropometric and Biochemical Parameters in Obese Women.

Fatty acid (FA) composition is a determinant of the physiological effects of dietary oils. This study investigated the effects of vegetable oil supplementation with different FA compositions on anthropometric and biochemical parameters in obese women on a hypocaloric diet with lifestyle modifications. Seventy-five women (body mass index, BMI, 30⁻39.9kg/m²) were randomized based on 8-week oil supplementation into four experimental groups: the coconut oil group (CoG, n = 18), the safflower oil group (SafG, n = 19), the chia oil group (ChG, n = 19), and the soybean oil placebo group (PG, n = 19). Pre- and post-supplementation weight, anthropometric parameters, and body fat (%BF), and lean mass percentages (%LM) were evaluated, along with biochemical parameters related to lipid and glycidemic profiles. In the anthropometric evaluation, the CoG showed greater weight loss (Δ% = -8.54 ± 2.38), and reduced BMI (absolute variation, Δabs = -2.86 ± 0.79), waist circumference (Δabs = -6.61 ± 0.85), waist-to-height ratio (Δabs = -0.041 ± 0.006), conicity index (Δabs = -0.03 ± 0.016), and %BF (Δabs = -2.78 ± 0.46), but increased %LM (Δabs = 2.61 ± 1.40) (p < 0.001). Moreover, the CoG showed a higher reduction in biochemical parameters of glycemia (Δabs = -24.71 ± 8.13) and glycated hemoglobin (Δabs = -0.86 ± 0.28) (p < 0.001). The ChG showed a higher reduction in cholesterol (Δabs = -45.36 ± 0.94), low-density lipoprotein cholesterol (LDLc; Δabs = -42.53 ± 22.65), and triglycerides (Δabs = -49.74 ± 26.3), but an increase in high-density lipoprotein cholesterol (HDLc; abs = 3.73 ± 1.24, p = 0.007). Coconut oil had a more pronounced effect on abdominal adiposity and glycidic profile, whereas chia oil had a higher effect on improving the lipid profile. Indeed, supplementation with different fatty acid compositions resulted in specific responses.