Estimation of fat mass in Southern Brazilian female adolescents: development and validation of mathematical models / Estimativa da massa gorda em adolescentes do sexo feminino do sul do Brasil: desenvolvimento e validação de modelos matemáticos

abstract This study aimed to develop and validate the first mathematical models, based on anthropometric properties, to estimate fat mass (FM) in a heterogeneous sample of female adolescents. A cross-sectional and quantitative study conducted with 196 individuals aged 12 to 17 years from the metropolitan region of Curitiba, Paraná, Brazil. The participants were randomly divided into two groups: regression sample (n = 169) and validation sample (n = 27). Dual-energy X-ray absorptiometry (DXA) was used as the reference method to determine body fat in relative and absolute values. Stature, body mass, waist girth and triceps, subscapular, biceps, iliac crest, abdominal, front thigh and medial calf skinfold thickness were defined as independent variables and measured according to an international technical protocol. Statistical analyzes used the Ordinary Least Square (OLS) regression model, paired t test and Pearson correlation. Four multivariate mathematical models with high determination coefficients (R2 ≥90%) and low estimated standard errors (SEE = ≤2.02 kg) were developed. Model 4 stands out for its low number of independent variables and significant statistical performance (R2 = 90%; SEE = 1.92 kg). It is concluded that the four mathematical models developed are valid for estimating FM in female adolescents in southern Brazil.

resumo Este estudo teve como objetivo desenvolver e validar os primeiros modelos matemáticos, baseados em propriedades antropométricas, para estimar a massa gorda (MG) em uma amostra heterogênea de adolescentes do sexo feminino. Estudo transversal e quantitativo conduzido com 196 indivíduos de 12 a 17 anos da região metropolitana de Curitiba, Paraná, Brasil. Os participantes foram divididos aleatoriamente em dois grupos: amostra de regressão (n = 169) e amostra de validação (n = 27). A absorciometria de raios X de dupla energia (DXA) foi usada como método de referência para determinar a gordura corporal em valores relativos e absolutos. A estatura, a massa corporal, o perímetro da cintura e a espessura das dobras cutâneas do tríceps, subescapular, bíceps, crista ilíaca, abdominal, coxa anterior e panturrilha medial foram definidas como variáveis independentes e mensuradas de acordo com um protocolo técnico internacional. As análises estatísticas utilizaram modelo de regressão Ordinary Least Square (OLS), teste t pareado e correlação de Pearson. Foram desenvolvidos quatro modelos matemáticos multivariados com altos coeficientes de determinação (R2 ≥90%) e baixos erros padrão estimados (SEE = ≤2,02 kg). O modelo 4 destaca-se pelo baixo número de variáveis independentes e desempenho estatístico significativo (R2 = 90%; SEE = 1,92 kg). Conclui-se que os quatro modelos matemáticos desenvolvidos são válidos para estimar a MG em adolescentes do sexo feminino do sul do Brasil

Pinch size can affect the skinfold thickness measurement and interfere in the estimation and classification of body adiposity / O tamanho da pinça pode afetar a medida de espessura das dobras cutâneas e interferir na estimativa e classificação da adiposidade corporal

Abstract The aim of this study was to verify the effect of pinch size on skinfold thickness measurement and the consequent interference in the estimation and classification of body adiposity components. Cross-sectional and quantitative study carried out with a sample of 29 subjects recruited from a university in the city of Fortaleza, Ceará, Brazil. Four measurement steps were performed at each site of the eight chosen skinfolds. The first step was performed with a subjective-landmark and the three subsequent steps with fixed-landmarks defined with an expanding secondary line at 2 cm intervals. Body adiposity components were determined from the skinfold thickness measured at each landmark. Repeated measures ANOVA and Bland-Altman agreement analysis were applied. The subjective-landmark was chosen as the dependent variable. The 6 cm-landmark showed similarity and statistical agreement with the subjective-landmark for all skinfolds except the thigh, and with the sums of five and eight skinfolds. All fixed-landmarks showed agreement below the cut-off point for the percentile classification of subcutaneous adiposity and normative relative body fat. Variation in pinch size is an important source of TEM that can affect the reproducibility of skinfold thickness measurements and interfere in the estimation and classification of the molecular and tissue component of body adiposity.

Resumo O objetivo deste estudo foi verificar o efeito do tamanho da pinça na medida de espessura das dobras cutâneas e a consequente interferência na estimativa e classificação dos componentes da adiposidade corporal. Estudo transversal e quantitativo realizado com amostra de 29 sujeitos recrutados em uma universidade da cidade de Fortaleza, Ceará, Brasil. Quatro etapas de medição foram realizadas em cada sítio das oito dobras cutâneas escolhidas. A primeira etapa foi realizada com um marco subjetivo e as três etapas subsequentes com marcos fixos definidos com uma linha secundária expansiva em intervalos de 2 cm. Os componentes da adiposidade corporal foram determinados a partir da espessura de dobras cutâneas mensuradas em cada marco. ANOVA de medidas repetidas e análise de concordância de Bland-Altman foram aplicadas. O marco subjetivo foi escolhido como variável dependente. O marco de 6 cm apresentou semelhança e concordância estatística com o marco subjetivo para todas as dobras cutâneas, exceto a coxa, e com as somas de cinco e oito espessuras de dobras cutâneas. Todos os marcos fixos mostraram concordância abaixo do ponto de corte para a classificação percentílica de adiposidade subcutânea e gordura corporal relativa normativa. A variação no tamanho da pinça é uma importante fonte de ETM que pode afetar a reprodutibilidade de medida de espessura das dobras cutâneas e interferir na confiabilidade da estimativa e classificação do componente molecular e tecidual da adiposidade corporal.

A century of skinfolds for body composition estimation: what we learned? / Um século das dobras cutâneas para estimativa da composição corporal: o que aprendemos?

abstract In 2021, we reached the centenary of the creation of the first body composition assessment model based on the use of skinfolds. A hundred years after Matiegka's application in 1921 to the analysis of "human efficiency", this point of view study seeks to bring reflections on the continuous applicability of the method, historical points, relevant advances, and possible projections for the future. Indeed, the comparability of skinfolds with multicompartmental reference methods shows several advantages and disadvantages; if on the one hand we have low cost, speed, and reproducibility, on the other hand we have problems associated with the quality of the equipment, the evaluator's skill and mainly the adequate choice of the predictive model. Thus, when it comes to the assessment of body composition, skinfolds are still a good option for application in different contexts by health professionals as long as the evaluator pays attention to the critical aspects that may represent sources of errors (for example, the level of training/experience, correct skinfold location). Even with the numerous advances in the area, there is solidity and continuity for the application of skinfolds for the future.

resumo No ano de 2021 chegamos ao centenário da criação do primeiro modelo de avaliação da composição corporal a partir do uso de dobras cutâneas. Passado cem anos da aplicação por Matiegka em 1921 para análise da "eficiência humana", esse estudo de ponto de vista busca trazer reflexões sobre a contínua aplicabilidade do método, pontos históricos, avanços relevantes e possíveis projeções para o futuro. De fato, a comparabilidade das dobras cutâneas com métodos de referência multicompartimanentais mostra diversas vantagens e desvantagens; se por um lado temos o baixo custo, rapidez, reprodutibilidade, por outro lado temos problemas associados a qualidade do equipamento, habilidade do avaliador e principalmente a escolha adequada do modelo preditivo. Deste modo, em se tratando de avaliação da composição corporal, as dobras cutâneas continuam sendo uma boa opção de aplicação em diferentes contextos por profissionais da saúde desde que o avaliador se atente aos aspectos críticos que podem representar fontes de erros (por exemplo o nível de treinamento/experiência, local correto da prega cutâneas). Mesmo com os inúmeros avanços da área, percebe-se uma solidez e continuidade para a aplicação das dobras cutâneas para o futuro.

Inflammatory myofibroblastic bladder tumor: A very rare presentation.

Inflammatory myofibroblastic tumor (IMT) is a rare benign lesion with similarities to malignant lesions due to possible aggressive behavior. Although highly uncommon, this condition usually occurs in lungs and retroperitoneum. The involvement of the genitourinary tract represents a singular occasion. May present with nonspecific manifestations such as painless hematuria, dysuria, voiding urgency and low abdominal pain. We describe a Case of a 55-year-old patient who presented to the urology service complaining of hematuria. Imaging studies showed a 62mm lesion on the upper right side of the bladder and the diagnosis of IMT was confirmed by immunohistochemical evaluation after laparoscopic partial cystectomy.

ASSOCIATED FACTORS WITH THE ISOLATED AND SIMULTANEOUS PRESENCE OF OVERWEIGHT AND ABDOMINAL OBESITY IN ADOLESCENTS.

OBJECTIVE: To analyze the sociodemographic and lifestyle factors associated with excessive weight (EW), abdominal obesity (AO) and the simultaneous presence of EW and AO in adolescents from Southern Brazil. METHODS: Cross-sectional study with 583 adolescents (11 to 17 years old) of Criciúma, Santa Catarina, Brazil. EW was assessed by body mass index (BMI) and AO by waist circumference (WC). The independent variables analyzed were gender, age, maternal schooling, balanced diet, physical activity, cigarette use, excessive alcohol use and screen time. Binary logistic regression was used to estimate Odds Ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Boys had 58% higher likelihood of having EW (OR 1.58; 95%CI 1.08-2.29; p<0.05). Younger age group (11 to 14 years) was directly associated with higher likelihood of EW (OR 6.07; 95%CI 4.05-9.11; p<0.05). Adolescents whose mothers had higher education had 75% more likelihood of having AO (OR 1.75; 95%CI 1.01-3.00; p<0.05). Higher likelihood for EW and AO (OR 1.84; 95%CI 1.01-3.34; p<0.05) was identified in younger adolescents (11 to 14 years). CONCLUSIONS: Boys and younger age (11 to 14 years) were associated with a higher likelihood of EW. Adolescents whose mothers studied nine years or more were more likely to have AO. The younger age group (11 to 14 years) was associated with greater chances for the simultaneous presence of EW and AO.

Associated factors with the isolated and simultaneous presence of overweight and abdominal obesity in adolescents / Fatores associados à presença isolada e simultânea de excesso de peso e obesidade abdominal em adolescentes

ABSTRACT Objective: To analyze the sociodemographic and lifestyle factors associated with excessive weight (EW), abdominal obesity (AO) and the simultaneous presence of EW and AO in adolescents from Southern Brazil. Methods: Cross-sectional study with 583 adolescents (11 to 17 years old) of Criciúma, Santa Catarina, Brazil. EW was assessed by body mass index (BMI) and AO by waist circumference (WC). The independent variables analyzed were gender, age, maternal schooling, balanced diet, physical activity, cigarette use, excessive alcohol use and screen time. Binary logistic regression was used to estimate Odds Ratios (OR) and 95% confidence intervals (95%CI). Results: Boys had 58% higher likelihood of having EW (OR 1.58; 95%CI 1.08-2.29; p<0.05). Younger age group (11 to 14 years) was directly associated with higher likelihood of EW (OR 6.07; 95%CI 4.05-9.11; p<0.05). Adolescents whose mothers had higher education had 75% more likelihood of having AO (OR 1.75; 95%CI 1.01-3.00; p<0.05). Higher likelihood for EW and AO (OR 1.84; 95%CI 1.01-3.34; p<0.05) was identified in younger adolescents (11 to 14 years). Conclusions: Boys and younger age (11 to 14 years) were associated with a higher likelihood of EW. Adolescents whose mothers studied nine years or more were more likely to have AO. The younger age group (11 to 14 years) was associated with greater chances for the simultaneous presence of EW and AO.

RESUMO Objetivo: Analisar os fatores sociodemográficos e do estilo de vida associados ao excesso de peso (EP), à obesidade abdominal (OA) e à presença simultânea de EP e OA em adolescentes do Sul do Brasil. Métodos: Estudo transversal de base escolar realizado com 583 adolescentes (11 a 17 anos) da cidade de Criciúma, Santa Catarina. O EP foi avaliado pelo índice de massa corpórea (IMC) e a OA, mediante perímetro da cintura (PC). As variáveis independentes analisadas foram sexo, idade, escolaridade materna, dieta balanceada, atividade física, uso de cigarro, uso de álcool em excesso e tempo de tela. Utilizou-se regressão logística binária para estimar as razões de chances (RC) e intervalos de confiança de 95% (IC95%). Resultados: Os meninos tiveram 58% de chances a mais de terem EP (RC 1,58; IC95% 1,08-2,29; p<0,05). Menor faixa etária (11 a 14 anos) foi diretamente associada a maiores chances de EP (RC 6,07; IC95% 4,05-9,11; p<0,05). Adolescentes cujas mães tinham maior escolaridade apresentaram 75% de chances a mais de terem OA (RC 1,75; IC95% 1,01-3,00; p<0,05). Maiores chances para a simultaneidade EP e OA (RC 1,84; IC95% 1,01-3,34; p<0,05) foram identificadas nos adolescentes de menor faixa etária (11 a 14 anos). Conclusões: Meninos e menor faixa etária (11 a 14 anos) estiveram associados a maiores chances para EP. Os adolescentes cujas mães estudaram nove anos ou mais apresentaram maiores chances de terem OA. Menor faixa etária (11 a 14 anos) esteve associada a maiores chances para a presença simultânea de EP e OA.

The influence of physical activity and eating behaviour on body mass index in children and adolescents: A review the literature / Influencia de la práctica de la actividad física y del comportamiento dietético en el índice de masa corporal de niños y adolescentes: Revisión de literatura

ABSTRACT The object of the present study was to carry out a literature review to analyze the influence of physical activity and dietary behavior on body mass index in school-age children and adolescents. A search was carried out using the PubMed and LILACS databases, in which 1,412 articles were found. After application of inclusion and exclusion criteria, 17 studies were selected for qualitative analysis. Overweight and obesity were related with incorrect dietary habits (skipping breakfast, consumption of foods with high fat contents and high-sugar soft drinks), low levels of physical activity and long hours devoted to sedentary activities (playing video games or watching TV) were also related.

RESUMEN El objetivo de este estudio fue analizar, mediante una revisión de la literatura, la influencia de la práctica de actividad física y del comportamiento dietético sobre el índice de masa corporal de niños y adolescentes en fase escolar. Se realizó una búsqueda en las bases PubMed y LILACS. Se encontraron 1.412 artículos. Tras la aplicación de los criterios de inclusión y exclusión fueron seleccionados 17 estudios para realizar un análisis cualitativo. El sobrepeso y la obesidad están relacionadas a una alimentación in-adecuada (saltar el desayuno, consumo de alimentos con alto contenido de grasa y de bebidas azucaradas), niveles bajos de actividad física y longas horas realizando actividad sedentaria (jugando video-juegos o visualizando la TV).

[Protocol for the Prevention of Infections Related to the Treatment of Hematological Malignancies]. / Protocolo de Prevenção de Infeções Relacionadas com o Tratamento de Neoplasias Hematológicas.

Patients with haematological malignancies have a higher incidence of infection compared with the general population. Several factors contribute to this but specially chemotherapy drugs carry different and specific infectious risks. This protocol discusses the prevention of infections in patients who will undergo chemotherapy for the treatment of haematological malignancies. It is divided into: study prior to the initiation of chemotherapy; vaccination and eradication prior to initiation of chemotherapy; antimicrobial prophylaxis during chemotherapy; special situations. The main aims of this protocol are to serve as support to a more systematic and individualized approach to patients undergoing chemotherapy for the treatment of haematological malignancies and by doing so prevent the infectious complications that may arise.

Os doentes com doença hematológica neoplásica apresentam uma incidência de infeções superior à da população geral. Vários fatores contribuem para este aumento de incidência destacando-se os fármacos quimioterápicos que acarretam riscos infeciosos diferentes e específicos. Este protocolo versa a prevenção de infeções em doentes que vão ser submetidos a quimioterapia para tratamento de neoplasias hematológicas. Divide-se em: estudo prévio ao início de quimioterapia; vacinação e erradicações prévias ao início de quimioterapia; profilaxias antimicrobianas durante a quimioterapia; situações especiais. Pretende-se com este protocolo uma abordagem sistematizada e individualizada da situação clínica de cada doente de forma a prevenir de forma a prevenir de infeções emdoentes sob quimioterapia para tratamento de neoplasias hematológicas.

Reactivation of hepatitis B virus without core antibody.

We present the case of a male patient not vaccinated against hepatitis B virus (HBV) and with reactivity to a surface antibody who, after immunosuppression for a multiple myeloma, had HBV reactivation. Pharmacological HBV suppression was tried, but viremia could not be suppressed. Production-detection core mutations or immunity issues can explain this clinical phenomenon.

[Adulthood Langerhans cell histiocytosis: experience of two Portuguese hospitals]. / Histiocitose de Largerhans no Adulto: Experiência de Dois Hospitais Portugueses.

INTRODUCTION: Langerhans cell histiocytosis is a heterogeneous disease, more frequently diagnosed during childhood. Between 1/2001 and 12/2013, 20 adult patients were admitted at both Hospitals. This work aimed at characterizing this population. MATERIAL AND METHODS: Retrospective study, review of clinical records. RESULTS: 16 patients were eligible to analysis. The median age at diagnosis was 34 years (15-48); 10 males and 6 females. The referral motive was: respiratory complaints - 37.5%; bone changes - 37.5%; dental complaints - 25%; constitutional symptoms - 19%; mucocutaneous lesions - 6% and one patient (6%) was accidentally diagnosed after a thyroidectomy. The tissue of histological diagnosis was: bone - 50%; pulmonary tissue - 37.5%; liver, genital mucosa and thyroid - 6%, respectively. Staging was: single organ involvement (uni/multifocal) - 69% and multisystem disease in 31%. Clinical re-evaluation of these cases is being done at the moment. The median follow up was 5 years (1 month - 11 years) and the overall survival was 92%. Currently 19% are alive without signs of disease; 44% are alive with disease; 25% are under treatment and 12% died. DISCUSSION: These results agree with published literature. Considering the actual guidelines 56% patients were incompletely staged, which probably lead to suboptimal treatment. There is heterogeneity of clinical procedures aiming at staging and treatment of these patients. CONCLUSION: The diagnosis of adulthood Langerhans cell histiocytosis is difficult considering the diversity of clinical behavior. Frequently this also leads to diagnosis delay. Prospective international clinical trials enrolling adult patients are important.

IntroduçÉo: A histiocitose de células de Langerhans é uma doença heterogénea e mais frequente em crianças. Entre 1/2001 e 12/2013 admitimos 20 doentes com HCL nas duas instituições. O objectivo deste trabalho foi caracterizar esta populaçÉo, avaliando as formas de apresentaçÉo, o estadiamento e tratamento.Material e Métodos: Estudo retrospectivo; consulta do processo clínico.Resultados: Dos 16 doentes analisáveis verificamos uma mediana de idade 34 anos (15-48), 10 mulheres e 6 homens. Os motivos que determinaram a referenciaçÉo dos doentes foram: queixas respiratórias em 37,5%; alterações ósseas em 37,5%; queixas dentárias em 25%; sintomas constitucionais em 19%; lesões mucocut'neas em 6% e outro foi um achado histológico inesperado após tiroidectomia. O diagnóstico histológico foi obtido em: osso em 50%; pulmÉo em 37,5%; fígado, mucosa vulvar e peça de tiroidectomia em 6%, respectivamente. O estadiamento assumido na prática clínica foi: envolvimento de órgÉo único (uni/multifocal) em 69% e doença multissistémica em 31%. A mediana de seguimento foi cinco anos (dois meses-11 anos) e a sobrevivência global 92%. Actualmente: 19% estÉo vivos sem doença; 44% estÉo vivos com doença; 25% estÉo em tratamento e 12% morreram.DiscussÉo: Estes resultados estÉo de acordo com a literatura. No entanto, segundo as recomendações actuais consideramos que 56% doentes efectuaram estudo complementar incompleto condicionando subestadiamento e provavelmente subtratamento. Verifica-se heterogeneidade de procedimentos no estadiamento e tratamento.ConclusÉo: Frequentemente há dificuldades e atraso no diagnóstico desta entidade clínica. SÉo importantes estudos prospectivos internacionais na populaçÉo adulta.

Renal failure due to primary amyloidosis: a case report and literature review.

CONTEXT: Primary amyloidosis, also known as AL amyloidosis, is commonly caused by clonal expansion of plasma cells in the bone marrow, thereby segregating light chains of clonal immunoglobulin that settle in tissues in the form of insoluble amyloid fibrils. The aim of this study was to report a case of primary amyloidosis with renal failure, diagnosed in Hospital São João, Porto, Portugal, focusing on the diagnostic difficulties and presenting a literature review. CASE REPORT: A 68-year-old Caucasian man was admitted to the Internal Medicine Department of the hospital with a condition of anasarca and nephrotic syndrome. After performing a renal biopsy that tested positive using Congo red and immunohistochemistry, lambda light chain amyloidosis was diagnosed. This evolved into terminal renal disease, which led to hemodialysis and several episodes of urinary and catheter infections. He was started on chemotherapy, consisting of bortezomib 0.7 mg/m(2) and dexamethasone 40 mg in six cycles. This led to clinical improvement, stabilization of the illness and good tolerance of the treatment. CONCLUSION: Amyloidosis is a rare entity that is difficult to diagnose. This is because of the unspecific early clinical manifestations of the disease. The hypothesis of amyloidosis is only considered when specific organ failure occurs. This case consisted of primary amyloidosis with involvement of the kidneys as an initial presentation of the disease and its difficulties were shown, going from the clinical approach to the final diagnosis.

Renal failure due to primary amyloidosis: a case report and literature review / Falência renal devida a amiloidose primária: um relato de caso e revisão da literatura

CONTEXT: Primary amyloidosis, also known as AL amyloidosis, is commonly caused by clonal expansion of plasma cells in the bone marrow, thereby segregating light chains of clonal immunoglobulin that settle in tissues in the form of insoluble amyloid fibrils. The aim of this study was to report a case of primary amyloidosis with renal failure, diagnosed in Hospital São João, Porto, Portugal, focusing on the diagnostic difficulties and presenting a literature review. CASE REPORT: A 68-year-old Caucasian man was admitted to the Internal Medicine Department of the hospital with a condition of anasarca and nephrotic syndrome. After performing a renal biopsy that tested positive using Congo red and immunohistochemistry, lambda light chain amyloidosis was diagnosed. This evolved into terminal renal disease, which led to hemodialysis and several episodes of urinary and catheter infections. He was started on chemotherapy, consisting of bortezomib 0.7 mg/m² and dexamethasone 40 mg in six cycles. This led to clinical improvement, stabilization of the illness and good tolerance of the treatment. CONCLUSION: Amyloidosis is a rare entity that is difficult to diagnose. This is because of the unspecific early clinical manifestations of the disease. The hypothesis of amyloidosis is only considered when specific organ failure occurs. This case consisted of primary amyloidosis with involvement of the kidneys as an initial presentation of the disease and its difficulties were shown, going from the clinical approach to the final diagnosis.

CONTEXTO: A amiloidose primária, também conhecida como amiloidose AL, é geralmente causada pela expansão clonal de plasmócitos na medula óssea que segregam cadeias leves de imunoglobulina clonal, as quais se depositam nos tecidos na forma de fibrilas amiloides insolúveis. O objetivo deste estudo é relatar um caso de amiloidose primária com acometimento renal diagnosticado no Hospital São João, Porto, Portugal, enfatizando as dificuldades do diagnóstico e apresentando uma revisão da literatura. RELATO DO CASO: Homem de 68 anos, branco, foi admitido no Serviço de Medicina Interna do hospital com quadro de anasarca e síndrome nefrótica. Após realizar biópsia renal, que foi positiva para o vermelho congo e imunoistoquímica, foi diagnosticada amiloidose de cadeia leve lambda. Evoluiu para doença renal terminal, o que levou a hemodiálise e tendo vários episódios de infecções urinárias e do cateter. Iniciou a quimioterapia com bortezimib, 0,7 mg/m², e dexametasona, 40 mg em seis ciclos, levando a uma melhoria clínica, a estabilização da doença e boa tolerância ao tratamento. CONCLUSÃO: Amiloidose consiste em uma entidade rara e de difícil diagnóstico. Isso ocorre devido a manifestações clínicas da doença pouco específicas, e esta hipótese só é considerada quando do acometimento de um órgão em particular. O caso em questão refere-se a uma apresentação da amiloidose primária com envolvimento renal, como apresentação clínica inicial da doença, e as dificuldades desde a abordagem clínica até o diagnóstico final.