Trends and Missing Links in (De)Hydration Research: A Narrative Review.

Despite decades of literature on (de)hydration in healthy individuals, many unanswered questions remain. To outline research and policy priorities, it is fundamental to recognize the literature trends on (de)hydration and identify current research gaps, which herein we aimed to pinpoint. From a representative sample of 180 (de)hydration studies with 4350 individuals, we found that research is mainly limited to small-scale laboratory-based sample sizes, with high variability in demographics (sex, age, and level of competition); to non-ecological (highly simulated and controlled) conditions; and with a focus on recreationally active male adults (e.g., Tier 1, non-athletes). The laboratory-simulated environments are limiting factors underpinning the need to better translate scientific research into field studies. Although, consistently, dehydration is defined as the loss of 2% of body weight, the hydration status is estimated using a very heterogeneous range of parameters. Water is the most researched hydration fluid, followed by alcoholic beverages with added carbohydrates (CHO). The current research still overlooks beverages supplemented with proteins, amino acids (AA), and glycerol. Future research should invest more effort in "real-world" studies with larger and more heterogeneous cohorts, exploring the entire available spectrum of fluids while addressing hydration outcomes more harmoniously.

Therapeutics That Can Potentially Replicate or Augment the Anti-Aging Effects of Physical Exercise.

Globally, better health care access and social conditions ensured a significant increase in the life expectancy of the population. There is, however, a clear increase in the incidence of age-related diseases which, besides affecting the social and economic sustainability of countries and regions around the globe, leads to a decrease in the individual's quality of life. There is an urgent need for interventions that can reverse, or at least prevent and delay, the age-associated pathological deterioration. Within this line, this narrative review aims to assess updated evidence that explores the potential therapeutic targets that can mimic or complement the recognized anti-aging effects of physical exercise. We considered pertinent to review the anti-aging effects of the following drugs and supplements: Rapamycin and Rapamycin analogues (Rapalogs); Metformin; 2-deoxy-D-glucose; Somatostatin analogues; Pegvisomant; Trametinib; Spermidine; Fisetin; Quercetin; Navitoclax; TA-65; Resveratrol; Melatonin; Curcumin; Rhodiola rosea and Caffeine. The current scientific evidence on the anti-aging effect of these drugs and supplements is still scarce and no recommendation of their generalized use can be made at this stage. Further studies are warranted to determine which therapies display a geroprotective effect and are capable of emulating the benefits of physical exercise.

European Portuguese Language and Cultural Validation of the Chronic Obstructive Pulmonary Disease Assessment Test.

INTRODUCTION: The chronic obstructive pulmonary disease assessment test (CAT) is a self-administered questionnaire that measures health-related quality of life. GOLD proposes using this questionnaire, since it provides thorough coverage of the impact of chronic obstructive pulmonary disease (COPD) on well-being. This questionnaire has been widely used in daily clinical practice in Portugal, but it lacks validation for European Portuguese. The aim of this study was to carry out the cultural adaptation and validation of the CAT questionnaire so that the most appropriate version can be made available to Portuguese researchers and clinicians. MATERIAL AND METHODS: A cross-sectional descriptive study was performed involving 65 patients with COPD aged 40 years or older. CAT and the previously validated Portuguese-language version of the Clinical Questionnaire for COPD were applied between January 2019 and June 2019. The agreement between the two questionnaires was determined with Kappa agreement with a 95% confidence interval. Spearman correlation was used to find the correlation between two scores. RESULTS: The 65 patients included in the study were observed in a hospital-based pulmonology clinic [aged 68 ± 7 years; forced expiratory volume in 1 sec (FEV1) 49.86% ± 16.5% predicted]. CAT correlated significantly with all the domains and the overall score of the CCQ (0.47 < r < 0.75; p < 0.001). The bilingual patient interclass correlation coefficient was 0.922; Pearson's r = 0.928; p < 0.001. The Cronbach's alpha coefficient was 0.96 (p < 0.001). CONCLUSION: The European Portuguese version of the COPD Assessment Test is a valid instrument for measurement of health-related quality of life in COPD patients. The use of validated questionnaires is of great importance since it generates reliable and reproducible evidence for use either in research or clinical practice.

Introdução: O teste de avaliação da doença pulmonar obstrutiva crónica (CAT) é um questionário autoaplicável que mede a qualidade de vida relacionada com a saúde. As normas internacionais GOLD propõem o uso deste questionário, uma vez que traduz o impacto da doença pulmonar obstrutiva crónica (DPOC) no bem-estar. Este questionário tem sido amplamente utilizado na prática clínica diária em Portugal, mas carece de validação para o português europeu. Assim, o objetivo deste estudo foi realizar a adaptação cultural e validação do questionário CAT para que a sua versão mais adequada possa ser disponibilizada a investigadores e clínicos portugueses. Material e Métodos: Foi realizado um estudo transversal descritivo com 65 doentes com DPOC com 40 anos ou mais. O CAT e a versão em português previamente validada do questionário clínico para DPOC foram aplicados entre janeiro de 2019 e junho de 2019. A concordância entre os dois questionários foi determinada com o teste de concordância de Kappa com intervalo de confiança de 95%. A correlação de Spearman foi usada para avaliar a presença de uma correlação entre os dois scores. Resultados: Os 65 doentes incluídos no estudo foram observados em consulta de pneumologia hospitalar [idade 68 ± 7 anos; volume expiratório máximo no 1º segundo (FEV1) 49,86% ± 16,5% do previsto]. O CAT correlacionou-se significativamente com todos os domínios e com a pontuação geral do CCQ (0,47 < r < 0,75; p < 0,001). O coeficiente de correlação interclasse de doentes bilíngues foi de 0,922; R de Pearson = 0,928; p < 0,001. O coeficiente alfa de Cronbach foi de 0,96 (p < 0,001). Conclusão: A versão em português europeu do CAT é um instrumento válido para medir a qualidade de vida relacionada com a saúde em doentes com DPOC. A aplicação de questionários validados é fundamental, visto que gera evidência confiável e reprodutível para uso em ensaios clínicos ou na prática clínica.

Confirmatory Evaluation of the Modified Medical Research Council Questionnaire for Assessment of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease in Portugal.

INTRODUCTION: The Modified British Medical Research Council Questionnaire is considered an adequate and simple measure of breathlessness in chronic obstructive pulmonary disease. It is widely used in clinical practice in Portugal, but it still lacks confirmatory evaluation for the Portuguese setting. The aim of this study was to perform a cultural adaptation and validation of the Modified British Medical Research Council Questionnaire so that its most suitable version can be made available to researchers and clinicians in Portugal. MATERIAL AND METHODS: We performed a cross-sectional descriptive study involving patients with chronic obstructive pulmonary disease aged 40 years or older. We applied the Modified British Medical Research Council Questionnaire and the previously validated Portuguese-language version of the clinical questionnaire for chronic obstructive pulmonary disease between January and June 2019. We determined the agreement between the two questionnaires with kappa agreement, with a 95% confidence interval, and we used Spearman correlation to find a correlation between two scores. RESULTS: The study included 65 patients managed in a hospital pulmonology clinic (aged 68 ± 7 years; with predicted FEV1 of 49.86% ± 16.5%). The Modified British Medical Research Council scale correlated significantly with all the domains and the overall score of the clinical questionnaire for chronic obstructive pulmonary disease (0.46 < r < 0.68; p < 0.001). In bilingual patients, interclass correlation coefficient was 0.912 (p < 0.001). DISCUSSION: Our study showed that the Portuguese-language version of the Modified British Medical Research Council Questionnaire is feasible and externally valid when compared with a traditional and previously validated instrument. CONCLUSION: The Portuguese version of the Modified British Medical Research Council Questionnaire is a valid instrument for measurement of breathlessness in chronic obstructive pulmonary disease.

Introdução: O Questionário British Medical Research Council (mMRC) Modificado é considerado um instrumento adequado e simples para a medição da dispneia na doença pulmonar obstrutiva crónica (DPOC). Tem sido amplamente usado na prática clínica em Portugal, mas carece de avaliação confirmatória para o cenário português. O objetivo deste estudo é realizar a adaptação cultural e validação do Questionário British Medical Research Council Modificado para que a versão mais adequada possa estar disponível a investigadores e clínicos em Portugal. Material e Métodos: Realizamos um estudo descritivo e transversal com doentes com doença pulmonar obstrutiva crónica e idade ≥ 40 anos. Aplicamos o Questionário British Medical Research Council Modificado e o questionário clínico para a doença pulmonar obstrutiva crónica previamente validado para a língua portuguesa, entre janeiro e junho de 2019. Determinámos a concordância entre os dois questionários com kappa agreement, com 95% de intervalo de confiança, e usámos o coeficiente de correlação de Spearman para determinar a correlação entre os dois scores. Resultados: O estudo incluiu 65 doentes seguidos em consulta hospitalar de Pneumologia (idades de 68 ± 7 anos; com FEV1 49,86% ± 16,5% do predito). A Escala Modificada do British Medical Research Council correlacionou-se significativamente com todos os domínios e pontuação total do questionário clínico (0,46 < r < 0,68; p < 0,001). Nos doentes bilingues, o coeficiente de correlação interclasse foi 0,912 (p < 0,001). Discussão: O nosso estudo mostrou que a versão portuguesa do Questionário Modificado do British Medical Research Council apresenta exequibilidade e validade externa quando comparado com um instrumento tradicional e previamente validado. Conclusão: A versão portuguesa do Questionário Modificado do British Medical Research Council é um instrumento válido para a medição da dispneia na doença pulmonar obstrutiva crónica.

Effect of physical activity and exercise on telomere length: Systematic review with meta-analysis.

PURPOSE: To compare a physically active lifestyle or structured exercise program to physically inactive lifestyle or control groups on telomere length (TL). METHOD: We searched PubMed, EMBASE, Cochrane Library, and Open Gray databases up to March 31, 2020. We calculated standardized mean differences (SMD) with 95% confidence intervals (CI) of TL comparing physically active to physically inactive individuals and exercise intervention to control groups. Risk of bias was judged using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS) for physical activity (PA) studies and the Cochrane risk-of-bias (RoB2) for exercise intervention studies. Certainty of evidence was judged using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: We included 30 studies (24 assessing the effects of PA and 6 assessing the effects of exercise interventions) comprising 7418 individuals. Physically active individuals had longer telomeres (SMD = 0.70, 95% CI 0.12-1.28, very-low certainty), especially in middle-aged individuals (SMD = 0.90, 95% CI 0.08-1.72, very-low certainty) and when considering only athletes (SMD = 0.54, 95% CI 0.18-0.90, very-low certainty). Trim-and-fill analyses revealed that most of the pooled effects were overestimated. Exercise interventions did not yield any significant effect on TL. CONCLUSION: There is very-low certainty that physically active individuals have longer telomeres with a moderate effect, but this effect is probably overestimated.

Menstrual pattern and contraceptive choices of Portuguese athletes.

OBJECTIVES: Menstrual symptoms are commonly cited barriers to physical activity in women. Delay or avoidance of menstruation through hormonal contraceptives may mitigate those barriers. Our purpose is to identify the uterine bleeding patterns of Portuguese athletes, their contraceptive choices and the impact of contraceptive methods in sports performance. We aim also to compare the outcomes between users and non-users of contraception. METHODS: Observational, descriptive and comparative study based on a customised self-assessment online survey aimed at Portuguese athletes. Athletes had to be at least 16 years old and competing at a national, international or professional level. RESULTS: A total of 256 athletes from 18 modalities were eligible. The mean age was 29 years and the mean age of menarche was 12.8 years. Monthly bleeding pattern was prevailing and 50% presented dysmenorrhoea. More than 85% experience fluctuations in sports performance throughout the month. The majority (71.5%) used contraceptive methods. Only 16% believed that contraception decreased sports performance. Contraceptive users exhibit a lower mean body mass index, blood loss and percentage of dysmenorrhoea than the non-users. CONCLUSION: Most athletes had the perception that performance varies throughout the month. The majority of participants do not report amenorrhoea and have monthly menses. The use of contraceptive methods is reportedly high, benefit cycle control and apparently without any physical inconvenience.

STOP-Bang and NoSAS questionnaires as a screening tool for OSA: which one is the best choice?

INTRODUCTION: Currently there has been significant growth in the number of patients with suspected obstructive sleep apnea (OSA) referred to sleep clinics. In this sense, screening and stratification methods of the severity of this pathology have become increasingly relevant. OBJECTIVE: To evaluate the performance of the NoSAS and STOP-Bang scores in the screening of OSA in a sleep clinic. METHODS: Prospectively, for 12 months, all patients referred by primary care physicians to our sleep unit for clinical evaluation and who underwent in-lab polysomnography (PSG), also completed the NoSAS score (Neck circumference, Obesity, Snoring, Age, Sex) and STOP-Bang (Snoring, Tiredness, Observed apnea, Pressure (high blood), BMI, Age, Neck circumference, Gender). A ROC (receiver operating characteristic) analysis was used to find the scores that simultaneously maximize sensitivity and specificity for each diagnosis. RESULTS: Of the 294 individuals included, 84% had OSA, of which 28.8% were mild, 34.8% moderate, and 36.4% were severe. USING THE NOSAS SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.770 (95% CI: 0.703-0.837), p<0.001, sensitivity of 57.5%, and specificity of 83.0% for a score of 12; 0.746 (95% CI: 0.691-0.802), p<0.001, sensitivity of 68.2% and specificity of 75.4% for a score of 13; 0.686 (95% CI: 0.622-0.749), p<0.001, sensitivity of 71.1% and specificity of 58.3% for a score of 13, respectively. USING THE STOP-BANG SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.862 (95% CI: 0.808-0.916), p<0.001, sensitivity of 68.4% and specificity of 85.1% for a score of 5; 0.813 (95% CI: 0.756-0.861), p<0.001, sensitivity of 77.3% and specificity of 66.1% for a score of 5; 0.787 (95% CI: 0.732-0.841), p<0.001, sensitivity of 70.0% and specificity of 79.9% for a score of 6, respectively. CONCLUSIONS: The ROC area was consistently high for both scores confirming the diagnostic ability of the NoSAS and STOP-Bang questionnaires for all OSA severities. Thus, our results suggest that these questionnaires may be a powerful tool for the screening and stratification of patients in the diagnosis of OSA. Overall, the diagnostic ability of the STOP-Bang was higher than the NoSAS.

STOP-Bang and NoSAS questionnaires as a screening tool for OSA: which one is the best choice?

SUMMARY INTRODUCTION: Currently there has been significant growth in the number of patients with suspected obstructive sleep apnea (OSA) referred to sleep clinics. In this sense, screening and stratification methods of the severity of this pathology have become increasingly relevant. OBJECTIVE: To evaluate the performance of the NoSAS and STOP-Bang scores in the screening of OSA in a sleep clinic. METHODS: Prospectively, for 12 months, all patients referred by primary care physicians to our sleep unit for clinical evaluation and who underwent in-lab polysomnography (PSG), also completed the NoSAS score (Neck circumference, Obesity, Snoring, Age, Sex) and STOP-Bang (Snoring, Tiredness, Observed apnea, Pressure (high blood), BMI, Age, Neck circumference, Gender). A ROC (receiver operating characteristic) analysis was used to find the scores that simultaneously maximize sensitivity and specificity for each diagnosis. RESULTS: Of the 294 individuals included, 84% had OSA, of which 28.8% were mild, 34.8% moderate, and 36.4% were severe. USING THE NOSAS SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.770 (95% CI: 0.703-0.837), p<0.001, sensitivity of 57.5%, and specificity of 83.0% for a score of 12; 0.746 (95% CI: 0.691-0.802), p<0.001, sensitivity of 68.2% and specificity of 75.4% for a score of 13; 0.686 (95% CI: 0.622-0.749), p<0.001, sensitivity of 71.1% and specificity of 58.3% for a score of 13, respectively. USING THE STOP-BANG SCORE FOR PREDICTING OSA, MODERATE TO SEVERE OSA, AND SEVERE OSA, THE ROC AREA WAS: 0.862 (95% CI: 0.808-0.916), p<0.001, sensitivity of 68.4% and specificity of 85.1% for a score of 5; 0.813 (95% CI: 0.756-0.861), p<0.001, sensitivity of 77.3% and specificity of 66.1% for a score of 5; 0.787 (95% CI: 0.732-0.841), p<0.001, sensitivity of 70.0% and specificity of 79.9% for a score of 6, respectively. CONCLUSIONS: The ROC area was consistently high for both scores confirming the diagnostic ability of the NoSAS and STOP-Bang questionnaires for all OSA severities. Thus, our results suggest that these questionnaires may be a powerful tool for the screening and stratification of patients in the diagnosis of OSA. Overall, the diagnostic ability of the STOP-Bang was higher than the NoSAS.

RESUMO INTRODUÇÃO: Na atualidade tem se verificado um crescimento significativo no número de doentes com suspeita de apneia obstrutiva do sono (AOS) referenciados para consulta do sono. Nesse sentido, instrumentos de rastreio e estratificação da gravidade dessa patologia têm se tornado cada vez mais relevantes. OBJETIVO: Avaliar e comparar o desempenho da escala NoSAS e Stop-Bang para o rastreio de AOS. MÉTODOS: Estudo prospectivo durante 12 meses. Avaliados todos os doentes encaminhados aos cuidados de saúde primários do centro de medicina do sono que completaram o questionário NoSAS (Neck circumference, Obesity, Snoring, Age, Sex), Stop-Bang (Snoring, Tiredness, Observed apnea, Pressure [high blood], BMI, Age, Neck circumference, Gender) e foram submetidos a polissonografia. Utilizou-se uma análise ROC (receiver operating characteristic) para encontrar as pontuações que maximizam simultaneamente a sensibilidade e especificidade para cada diagnóstico. RESULTADOS: Incluídos 294 indivíduos, 84% apresentavam AOS, sendo que em 28,8% a OAS era ligeira, 34,8% moderada e 36,4% grave. USANDO A ESCALA NOSAS PARA PREVISÃO DE AOS, AOS MODERADA A GRAVE E AOS GRAVE, A ÁREA ROC FOI: 0,770 (IC95%: 0,703-0,837), p<0,001, sensibilidade de 57,5% e especificidade de 83,0% para a pontuação 12); 0,746 (IC95%: 0,691- 0,802), p<0,001, sensibilidade de 68,2% e especificidade de 75,4% para a pontuação 13); 0,686 (IC95%: 0,622-0,749), p<0,001, sensibilidade de 71,1% e especificidade de 58,3% para a pontuação 13), respectivamente. USANDO A ESCALA STOP-BANG PARA A PREVISÃO DE AOS, AOS MODERADA A GRAVE E AOS GRAVE, A ÁREA ROC FOI: 0,862 (IC95%: 0,808-0,916), p<0,001, sensibilidade de 68,4% e especificidade de 85,1% para pontuação 5); 0,813 (IC95%: 0,756-0,861), p<0,001, sensibilidade de 77,3% e especificidade de 66,1% para a pontuação 5); 0,787 (IC95%: 0,732-0,841), p<0,001, sensibilidade de 70,0% e especificidade de 79,9% para a pontuação 6), respectivamente. CONCLUSÕES: A área ROC foi consistentemente alta para as duas escalas, confirmando a capacidade diagnóstica dos questionários NoSAS e Stop-Bang para todos os graus de gravidade de AOS. Assim, os nossos resultados sugerem que esses questionários podem ser um importante instrumento para rastreio e estratificação de doentes no diagnóstico de AOS. Globalmente, a capacidade de diagnóstico do Stop-Bang foi superior à do NoSAS.

Is the Acute: Chronic Workload Ratio (ACWR) Associated with Risk of Time-Loss Injury in Professional Team Sports? A Systematic Review of Methodology, Variables and Injury Risk in Practical Situations.

BACKGROUND: The acute: chronic workload ratio (ACWR) is an index of the acute workload relative to the cumulative chronic workloads. The monitoring of physical workloads using the ACWR has emerged and been hypothesized as a useful tool for coaches and athletes to optimize performance while aiming to reduce the risk of potentially preventable load-driven injuries. OBJECTIVES: Our goal was to describe characteristics of the ACWR and investigate the association of the ACWR with the risk of time-loss injuries in adult elite team sport athletes. DATA SOURCES: PubMed, EMBASE and grey literature databases; inception to May 2019. ELIGIBILITY CRITERIA: Longitudinal studies that assess the relationship of the ACWR and time-loss injury risk in adult professional or elite team sports. METHODS: We summarized the population characteristics, workload metrics and ACWR calculation methods. For each workload metric, we plotted the risk estimates for the ACWR in isolation, or when combined with chronic workloads. Methodological quality was assessed using a modified version of the Downs and Black scale. RESULTS: Twenty studies comprising 2375 injuries from 1234 athletes (all males and mean age of 24 years) from different sports were included. Internal (65%) and external loads (70%) were collected in more than half of the studies and the session-rating of perceived exertion and total distance were the most commonly collected metrics. The ACWR was commonly calculated using the coupled method (95%), 1:4 weekly blocks (95%) and subsequent week injury lag (80%). There were 14 different binning methods with almost none of the studies using the same binning categories. CONCLUSION: The majority of studies suggest that athletes are at greater risk of sustaining a time-loss injury when the ACWR is higher relative to a lower or moderate ACWR. The heterogenous methodological approaches not only reflect the wide range of sports studied and the differing demands of these activities, but also limit the strength of recommendations. PROSPERO REGISTRATION NUMBER: CRD42017067585.

Physical Activity Promotion Tools in the Portuguese Primary Health Care: An Implementation Research.

BACKGROUND: This paper aims to discuss how physical activity (PA) brief assessment, brief counseling, and self-monitoring tools were designed and implemented in the Portuguese National Health Service (NHS), and to report on their current use by health professionals and citizens. METHODS: Three digital tools to facilitate PA promotion in primary health care (PHC) were developed: 1) a PA brief assessment tool was incorporated in the electronic health record platform "SClínico Cuidados de Saúde Primários"; 2) a brief counseling tool was developed in the software "PEM-Prescrição Eletrónica Médica" (electronic medical prescription); and 3) a "Physical Activity Card" was incorporated in an official NHS smartphone app called "MySNS Carteira". RESULTS: From September 2017 to June 2019, 119,386 Portuguese patients had their PA assessed in PHC. Between December 2017 and June 2019, a total of 7957 patients received brief intervention for PA by a medical doctor. Regarding the app "MySNS Carteira", 93,320 users activated the "Physical Activity Card", between February 2018 and December 2018. CONCLUSIONS: These tools represent key actions to promote PA among Portuguese citizens using PHC as a priority setting. Further initiatives will follow, including proper assessment of their clinical impact and training programs for health care professionals on PA promotion.

Late-Night Salivary Cortisol: Cut-Off Definition and Diagnostic Accuracy for Cushing's Syndrome in a Portuguese Population.

INTRODUCTION: Diagnosis of Cushing's syndrome remains a challenge in clinical endocrinology. Even though late-night salivary cortisol is used as screening tool, individualized cut-off levels for each population must be defined. MATERIAL AND METHODS: Three groups of subjects were studied: normal subjects, suspected and proven Cushing's syndrome. Salivary cortisol was measured using an automated electrochemiluminescence assay. The functional sensitivity of the assay is 0.018 µg/dL. The diagnostic cut-off level was defined by Receiver Operating Characteristic curve and Youden's J index. RESULTS: We studied 127 subjects: 57 healthy volunteers, 39 patients with suspected and 31 with proven Cushing's syndrome. 2.5th - 97.5th percentile of the late-night salivary cortisol concentrations in normal subjects was 0.054 to 0.1827 µg/dL. Receiver Operating Characteristic curve analysis showed an area under the curve of 0.9881 (p < 0.0001). A cut-off point of 0.1 µg/dL provided a sensitivity of 96.77% (95% CI 83.3 - 99.92%) and specificity of 91.23% (95% CI 80.7 - 97.09%). There was a significant correlation between latenight salivary cortisol and late-night serum cortisol (R = 0.6977; p < 0.0001) and urinary free cortisol (R = 0.5404; p = 0.0025) in proven Cushing's syndrome group. DISCUSSION: The mean ± SD late-night salivary cortisol concentration in patients with proven Cushing's syndrome (0.6798 ± 0.52 µg/ dL) was significantly higher (p < 0.0001). In our population, the late-night salivary cortisol cut-off was 0.1 µg/dL with high sensitivity and specificity. CONCLUSION: Late-night salivary cortisol has excellent diagnostic accuracy, making it a highly reliable, noninvasive, screening tool for outpatient assessment. Given its convenience and diagnostic accuracy, late-night salivary cortisol may be added to other traditional screening tests on hypercortisolism.

Introdução: O diagnóstico de síndrome de Cushing continua a ser um desafio complexo. Apesar do cortisol salivar noturno ser utilizado como teste de rastreio, a definição de um valor diagnóstico deverá ser individualizada. Material e Métodos: Foram estudados 3 grupos: voluntários saudáveis, com suspeita clínica e com diagnóstico estabelecido de Síndrome de Cushing. O doseamento de cortisol salivar foi realizado por eletroquimioluminescência automatizado. A definição do ponto-de-corte foi obtida pela curva Receiver Operating Characteristic e índice J de Youden. Resultados: Entre os 127 indivíduos, 57 pertenciam ao grupo de voluntários saudáveis, 39 com suspeita clínica e 31 com diagnóstico estabelecido. O percentil 2,5 ­ 97,5 de cortisol salivar noturno no grupo de voluntários saudáveis foi 0,054 ­ 0,1827 µg/dL. A análise da curva Receiver Operating Characteristic revelou uma área abaixo da curva de 0,9881 (p < 0,0001) e o ponto-de-corte de 0,1 µg/dL com sensibilidade de 96,77% e especificidade de 91,23%. Verificou-se uma correlação significativa entre cortisol salivar noturno e o cortisol sérico noturno (R = 0,6977; p < 0,0001), bem como, com cortisol livre urinário (R = 0,5404; p = 0,0025) no grupo com diagnóstico estabelecido. Discussão: A concentração média ± DP cortisol salivar noturno no grupo com diagnóstico estabelecido (0,6798 ± 0,52 µg/dL) foi significativamente superior aos restantes grupos. Na nossa população, o valor de ponto-de-corte foi de 0,1 µg/dL com elevada sensibilidade e especificidade. Conclusão: Os resultados demonstram uma excelente acurácia do cortisol salivar noturno. Dada a sua conveniência e elevada exatidão, o doseamento de cortisol salivar noturno poderá ser adicionado aos testes de rastreio tradicionais para estudo de hipercortisolismo.

Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies.

PURPOSE: To identify the normal and injured magnetic resonance imaging appearance of the anterolateral ligament (ALL). METHODS: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed and Cochrane Library electronic databases were used to search for studies that reported the imaging outcomes of the appearance of the ALL. Two authors performed the searches in duplicate up to April 30, 2018, and interobserver agreement was calculated. The methodologic quality of included articles was assessed using an adaptation of the Arrivé methodologic quality scale for clinical studies of radiologic examinations. RESULTS: From the original 270 records, a total of 24 studies (κ = 0.94) comprising 2,427 knees in 2,388 patients (mean age, 33.3 years; 66% male patients; 63% with anterior cruciate ligament [ACL] injury) were included. The ALL appeared in 51% to 100% of all assessed knees (71%-100% in ACL-injured knees and 64%-97% in uninjured knees) and was injured in 11% to 79% of ACL-injured knees. Reliability rates varied considerably (0.04-1.0 for intraobserver and 0.143-1.0 for interobserver agreement), and the entire portion of the ligament was often not seen. The tibial insertion was seen in 21% to 96% of cases, followed by the meniscal (range, 0%-100%) and femoral (range, 0%-90%) insertions. The mean methodologic quality score was 5.1 ± 1.8 out of a possible score of 9. CONCLUSIONS: High variability was found in the identification of normal and injured ALL definition methods and the respective magnetic resonance imaging findings. Reliability rates varied considerably, and the entire portion of the ligament was often not seen. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.

Aging Hallmarks: The Benefits of Physical Exercise.

World population has been continuously increasing and progressively aging. Aging is characterized by a complex and intraindividual process associated with nine major cellular and molecular hallmarks, namely, genomic instability, telomere attrition, epigenetic alterations, a loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. This review exposes the positive antiaging impact of physical exercise at the cellular level, highlighting its specific role in attenuating the aging effects of each hallmark. Exercise should be seen as a polypill, which improves the health-related quality of life and functional capabilities while mitigating physiological changes and comorbidities associated with aging. To achieve a framework of effective physical exercise interventions on aging, further research on its benefits and the most effective strategies is encouraged.

STOP-Bang questionnaire: the validation of a Portuguese version as a screening tool for obstructive sleep apnea (OSA) in primary care.

INTRODUCTION: The growing number of suspected patients diagnosed with obstructive sleep apnea (OSA) that are observed in sleep units has increased in the last decade. Therefore, screening methods have become important, especially in primary care (PC). AIM: This work aimed to test the performance of the STOP-Bang questionnaire for the suspicion/diagnosis of obstructive sleep apnea. METHODS: Eight-month prospective study; all patients referred from PC to the respective sleep clinic accompanied by a completed and translated version of the STOP-Bang questionnaire for a clinical evaluation. RESULTS: Two hundred fifty-nine observed patients were the study object. The age was 55.14 ± 12.07 years, 71.03% were male patients with a neck circumference of 40.97 ± 3.07 cm and BMI of 31.1 ± 5.14 kg/m2. The diagnosis was confirmed in 82.6% of the patients: 34.6% having moderate and 36.8% severe disease. A STOP-Bang score of 3 or more resulted in positive predictive value (PPV) of 88.4% and a sensitivity for OSA of 98.6%. Has the questionnaire score raises, OSA's probability also raises in a proportional basis. For a STOP-Bang score of 6, the OSA probability reaches 98% and for a score of 8, it reaches 80% for severe OSA. Lower scores, 3 or 2, had a negative predictive value (NPV) for moderate-to-severe OSA of 86.96 and 87.5%, respectively. CONCLUSION: As much as we know, our study is the first that applied the STOP-Bang questionnaire in Portuguese PC. We demonstrate that these is a useful tool for the stratification of patients with suspicion and diagnosis of OSA, showing a high sensitivity and PPV. Besides that, the probability of severe OSA steadily increases along with its score and we show an excellent NPV with lower scores.