Nutrition adequacy in the late period of the acute phase is associated with a lower risk of 30-day mortality in critically ill patients: A prospective cohort study.

BACKGROUND: The provision of nutrition support for critically ill patients in the early phase of intensive care unit (ICU) admission plays a vital role in their recovery. However, there is still debate regarding the impact of nutrition adequacy of critical illness phases. We aimed to investigate whether nutrition adequacy in the acute phase (early and late periods) is associated with 30-day mortality in critically ill patients. METHODS: We prospectively collected nutrition and clinical data from critically ill patients receiving exclusive enteral nutrition (EN) within the first 10 days of ICU admission. EN was classified as adequate when ≥80% of the prescribed EN was administered. Directed acyclic graphs were constructed to identify the minimum set of adjustment variables required to control for confounding factors. The relationships between energy and protein intake and 30-day mortality were assessed using the Cox regression analysis. RESULTS: A total of 119 patients were evaluated (70 years old, 56.3% male, and 68.1% with medical admission). The 30-day mortality rate was 23%. After adjusting for confounders, in the late period (days 5-10), energy adequacy (hazard ratio [HR] = 0.960; 95% CI, 0.937-0.984) and protein adequacy (HR = 0.960; 95% CI, 0.937-0.982) were predictors of 30-day mortality. No associations were observed in the early period (days 1-4) of the acute phase. CONCLUSION: In critically ill patients, nutrition adequacy (≥80% EN) during days 5-10 in the ICU was associated with a lower risk of 30-day mortality.

Vitamin D and depression in older adults: lessons learned from observational and clinical studies.

Depression is a mental disorder triggered by the interaction of social, psychological and biological factors that have an important impact on an individual's life. Despite being a well-studied disease with several established forms of treatment, its prevalence is increasing, especially among older adults. New forms of treatment and prevention are encouraged, and some researchers have been discussing the effects of vitamin D (VitD) on depression; however, the exact mechanism by which VitD exerts its effects is not yet conclusive. In this study, we aimed to discuss the possible mechanisms underlying the association between VitD and depression in older adults. Therefore, we conducted a systematic search of databases for indexed articles published until 30 April 2021. The primary focus was on both observational studies documenting the association between VitD and depression/depressive symptoms, and clinical trials documenting the effects of VitD supplementation on depression/depressive symptoms, especially in older adults. Based on pre-clinical, clinical and observational studies, it is suggested that the maintenance of adequate VitD concentrations is an important issue, especially in older adults, which are a risk population for both VitD deficiency and depression. Nevertheless, it is necessary to carry out more studies using longitudinal approaches in low- and middle-income countries to develop a strong source of evidence to formulate guidelines and interventions.

Vitamin D, Depressive Symptoms, and Covid-19 Pandemic.

Since the COVID-19 outbreak, studies across diverse countries have strongly pointed toward the emergence of a mental health crisis, with a dramatic increase in the prevalence of depressive psychopathology and suicidal tendencies. Vitamin D deficiency has been associated with an increased risk of mental health problems as well as individual responses to stress. Studies have discussed the relationship between low serum vitamin D concentrations and depressive symptoms, suggesting that maintaining adequate concentrations of serum vitamin D seems to have a protective effect against it. Vitamin D was found to contribute to improved serotonergic neurotransmission in the experimental model of depression by regulating serotonin metabolism. The signaling of 1,25-dihydroxyvitamin D3, the active form of vitamin D, through vitamin D receptor (VDR) induces the expression of the gene of tryptophan hydroxylase 2 (TPH2), influences the expression of serotonin reuptake transporter (SERT) as well as the levels of monoamine oxidase-A (MAO-A), the enzyme responsible for serotonin catabolism. Vitamin D also presents a relevant link with chronobiological interplay, which could influence the development of depressive symptoms when unbalance between light-dark cycles occurs. In this Perspective, we discussed the significant role of vitamin D in the elevation of stress-related depressive symptoms during the COVID-19 pandemic. It is suggested that vitamin D monitoring and, when deficiency is detected, supplementation could be considered as an important healthcare measure while lockdown and social isolation procedures last during the COVID-19 pandemic.

Functional Spectroscopy Mapping of Pain Processing Cortical Areas During Non-painful Peripheral Electrical Stimulation of the Accessory Spinal Nerve.

Peripheral electrical stimulation (PES), which encompasses several techniques with heterogeneous physiological responses, has shown in some cases remarkable outcomes for pain treatment and clinical rehabilitation. However, results are still mixed, mainly because there is a lack of understanding regarding its neural mechanisms of action. In this study, we aimed to assess its effects by measuring cortical activation as indexed by functional near infrared spectroscopy (fNIRS). fNIRS is a functional optical imaging method to evaluate hemodynamic changes in oxygenated (HbO) and de-oxygenated (HbR) blood hemoglobin concentrations in cortical capillary networks that can be related to cortical activity. We hypothesized that non-painful PES of accessory spinal nerve (ASN) can promote cortical activation of sensorimotor cortex (SMC) and dorsolateral prefrontal cortex (DLPFC) pain processing cortical areas. Fifteen healthy volunteers received both active and sham ASN electrical stimulation in a crossover study. The hemodynamic cortical response to unilateral right ASN burst electrical stimulation with 10 Hz was measured by a 40-channel fNIRS system. The effect of ASN electrical stimulation over HbO concentration in cortical areas of interest (CAI) was observed through the activation of right-DLPFC (p = 0.025) and left-SMC (p = 0.042) in the active group but not in sham group. Regarding left-DLPFC (p = 0.610) and right-SMC (p = 0.174) there was no statistical difference between groups. As in non-invasive brain stimulation (NIBS) top-down modulation, bottom-up electrical stimulation to the ASN seems to activate the same critical cortical areas on pain pathways related to sensory-discriminative and affective-motivational pain dimensions. These results provide additional mechanistic evidence to develop and optimize the use of peripheral nerve electrical stimulation as a neuromodulatory tool (NCT03295370- www.clinicaltrials.gov).

Distinct aspects of pain catastrophizing according to chronic pain syndromes

Introduction: Catastrophizing is the tendency to magnify the threat value of pain and has been associated with measures of physical and psychological disability among individuals with several pain conditions. The aim of this study was to investigate whether pain catastrophizing is differentially associated with distinct pain syndromes. Methods: This is a cross-sectional study including 158 patients (40 with fibromyalgia, 25 with myofascial pain syndrome, 33 with chronic tensional type headache, 33 with endometriosis, and 27 with knee osteoarthritis) and 93 healthy subjects. The recruitment procedure occurred in concurrence with randomized controlled trials. Participants answered the following instruments: Brazilian Portuguese Pain-Catastrophizing Scale, Beck Depression Inventory II, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, visual analogue scale for pain, as well as a sociodemographic questionnaire. Results: For the total pain catastrophizing score, patients with endometriosis had significantly more catastrophizing thoughts than knee osteoarthritis (p < 0.05). Healthy participants had lower scores than any clinical group. More interestingly were the dimensions of pain catastrophizing, which showed significant differences in more than two groups, especially magnification scores, since these scores were able to discriminate, in a particular way, the majority of clinical samples from each other. We also observed differences between rumination, magnification and helplessness scores in all groups, suggesting that the characteristics of pain catastrophizing are distinct according to the pain disorder. Conclusions: The results suggest that dimensions of pain catastrophizing differ between pain syndromes. Therefore, it is important that researchers and clinicians focus on cognitive and emotional aspects of pain perception to have more successful interventions.

Níveis de zinco sérico em pacientes internados com depressão / Serum zinc levels in hospitalized patients with depression

RESUMO Objetivo Comparar pacientes internados com depressão e com transtorno de humor bipolar em episódio depressivo quanto aos níveis séricos de zinco. Métodos Foram incluídos 46 pacientes com idade igual ou superior a 19 anos, de ambos os sexos, internados em Unidade de Internação Psiquiátrica de um hospital universitário do sul do Brasil. Os participantes foram divididos em dois grupos: Grupo Depressão (Grupo D) e Grupo com Transtorno de Humor Bipolar em episódio depressivo (Grupo THB). A análise do zinco sérico foi realizada por meio de espectrofotometria de absorção atômica. Como valores de referência para normalidade, foram adotados níveis de zinco sérico acima de 59 µg/dL para mulheres e acima de 61 µg/dL para homens. Resultados Os níveis de zinco sérico estavam dentro do padrão de normalidade em 95,7% dos pacientes. A mediana de zinco no Grupo D foi de 88,5 µg/dL e de 81,5 µg/dL no Grupo THB, porém essa diferença não foi estatisticamente significativa. O Grupo THB apresentou valores maiores de índice de massa corporal (IMC), LDL colesterol e mais internações psiquiátricas prévias. Conclusão Os resultados encontrados no presente estudo mostram que os níveis de zinco sérico em pacientes em uso de antidepressivos e outras medicações psiquiátricas, internados por THB em episódio depressivo, quando comparados a pacientes com depressão, não diferiram e estavam dentro da faixa de normalidade. O uso dessas medicações pode ter influência nas concentrações séricas do mineral.

ABSTRACT Objective To evaluate the serum zinc levels of patients with depression, with or without bipolar disorder, hospitalized in a psychiatric inpatient unit of a university hospital in southern Brazil. Methods Participated in the study 46 patients, aged 19 or over, both sexes, admitted to psychiatric inpatient unit of a university hospital in southern Brazil. The participants were divided in two groups: Group Depression (D group) and Group with Bipolar Disorder in depressive episode (THB Group). The analysis of serum zinc has been done through atomic absorption spectrophotometry. Were adopted as reference values for normality serum zinc levels over 59 µg/dL for women and over 61 µg/dL for men. Results The serum zinc levels were normal in 95.7% of the patients. The average of zinc in D Group were 88.5 µg/dL and 81.5 µg/dL in THB Group, however this difference was not statistically significant. The THB Group showed higher values of IMC, LDL cholesterol and previous psychiatric hospitalizations. Conclusion The results of this study show that serum zinc levels in patients using antidepressants and other psychiatric medications, hospitalized for bipolar disorder in depressive episode, compared with patients with depression did not differ and were within the normal range. The use of these medications may affect serum concentrations of this mineral.

Fasting ghrelin but not PYY(3-36) is associated with insulin-resistance independently of body weight in Wistar rats.

OBJECTIVE: The objective of this study was to evaluate the association between insulin-resistance and fasting levels of ghrelin and PYY in Wistar rats. MATERIALS AND METHODS: A total of 25 male Wistar rats, weighing 200-300 g, was included in this study. The animals were maintained in cages with a 12/12h light-dark cycle and fed standard chow and water ad libitum. After 12-h overnight fasting, ghrelin, PYY, insulin and glucose values were determined. Insulin resistance was assessed by means of the HOMA-IR, which was ranked and the median was used as a cut-off value to categorize insulin-resistance. HOMA-IR values equal and above 2.62 were considered insulin-resistant (IR) while values below 2.62 were considered insulin sensitive (IS). Differences between means were determined using the Student t-test. Multiple regression and Pearson's correlation test were used to evaluate the association between variables. RESULTS: HOMA-IR median IQ range values for IS and IR groups were, respectively, 1.56 (0.89 - 2.16) vs. [4.06 (3.50 - 4.61); p < 0.001]. The IR group presented increased levels of fasting ghrelin, PYY and insulin respectively: [50.35 (25.99 - 74.71) pg/mL vs. 12.33 (8.77 - 15.89) pg/mL; p = 0.001]; [54.38 (37.50 - 71.26) pg/mL vs. 33.17 (22.34 - 43.99) pg/mL; p = 0.016]; [18.04 (14.48 - 21.60) uU/mL vs. 7.09 (4.83 - 9.35) uU/mL; p = 0.001]. Ghrelin, but not PYY, correlated linearly and positively with HOMA-IR: ghrelin vs. HOMA-IR (r = 0.52; p = 0.008), and PYY vs. HOMA-IR (r = 0.22; p = 0.200). This correlation was independent of body weight. CONCLUSION: Fasting ghrelin and PYY serum levels are increased in lean, relatively insulin resistant Wistar rats, and this increase is independent of weight.

Fasting ghrelin but not PYY(3-36) is associated with insulin-resistance independently of body weight in Wistar rats / A grelina, mas não PYY(3-36), está associada com a resistência à insulina independente do peso corporal em ratos Wistar

Objective: The objective of this study was to evaluate the association between insulin-resistance and fasting levels of ghrelin and PYY in Wistar rats. Materials and methods: A total of 25 male Wistar rats, weighing 200-300 g, was included in this study. The animals were maintained in cages with a 12/12h light-dark cycle and fed standard chow and water ad libitum. After 12-h overnight fasting, ghrelin, PYY, insulin and glucose values were determined. Insulin resistance was assessed by means of the HOMA-IR, which was ranked and the median was used as a cut-off value to categorize insulin-resistance. HOMA-IR values equal and above 2.62 were considered insulin-resistant (IR) while values below 2.62 were considered insulin sensitive (IS). Differences between means were determined using the Student t-test. Multiple regression and Pearson’s correlation test were used to evaluate the association between variables. Results: HOMA-IR median IQ range values for IS and IR groups were, respectively, 1.56 (0.89 – 2.16) vs. [4.06 (3.50 – 4.61); p < 0.001]. The IR group presented increased levels of fasting ghrelin, PYY and insulin respectively: [50.35 (25.99 – 74.71) pg/mL vs. 12.33 (8.77 – 15.89) pg/mL; p = 0.001]; [54.38 (37.50 – 71.26) pg/mL vs. 33.17 (22.34 – 43.99) pg/mL; p = 0.016]; [18.04 (14.48 – 21.60) uU/mL vs. 7.09 (4.83 – 9.35) uU/mL; p = 0.001]. Ghrelin, but not PYY, correlated linearly and positively with HOMA-IR: ghrelin vs. HOMA-IR (r = 0.52; p = 0.008), and PYY vs. HOMA-IR (r = 0.22; p = 0.200). This correlation was independent of body weight. Conclusion: Fasting ghrelin and PYY serum levels are increased in lean, relatively insulin resistant Wistar rats, and this increase is independent of weight. .

Objetivo: O objetivo deste estudo foi avaliar a associação entre a resistência à insulina e os níveis de grelina e PYY em jejum em ratos Wistar. Materiais e métodos: Um total de 25 ratos Wistar machos, pesando 200-300 g, foi usado neste estudo. Os animais foram mantidos em gaiolas com um ciclo de luz escuro de 12/12h e alimentados com ração padrão e água ad libitum. Depois de um jejum de 12h, os valores de grelina, PYY, insulina e glicose foram determinados. A resistência à insulina foi avaliada pelo HOMA-IR que foi ordenado e a mediana utilizada como valor de corte para categorizar a resistência à insulina. Os valores de HOMA-IR iguais ou acima de 2,62 foram considerados resistentes à insulina (RI), enquanto valores abaixo de 2,62 foram considerados sensíveis (SI). As diferenças entre as médias foram determinadas usando-se o teste t de Student. A análise de regressões múltiplas e o teste de correlação de Pearson foram usados para se avaliar a associação entre as variáveis. Resultados: A mediana e a variação IQ do HOMA-IR para os grupos RI e SI foram, respectivamente, 1,56 (0,89 – 2,16) contra [4,06 (3,50 – 4,61); p < 0,001]. O grupo RI apresentou níveis aumentados de grelina, PYY e insulina em jejum, respectivamente, [50,35 (25,99 – 74,71) pg/mL contra 12,33 (8,77 – 15,89) pg/mL; p = 0,001]; [54,38 (37,50 – 71,26) pg/mL contra 33,17 (22,34 – 43,99) pg/mL; p = 0,016]; [18,04 (14,48 – 21,60) uU/mL contra 7,09 (4,83 – 9,35) uU/mL; p = 0.001]. A grelina, mas não PYY, se correlacionou de forma linear e positiva com o HOMA-IR: a grelina contra HOMA-IR (r = 0,52; p = 0,008), e PYY contra HOMA-IR (r = 0,22; p = 0,200). Essa correlação foi independente do peso corporal. Conclusão: Os níveis séricos de jejum de grelina ...

Correlation of shift work and waist circumference, body mass index, chronotype and depressive symptoms.

OBJECTIVE: Correlate shift work with body mass index (BMI), waist circumference, chronotype and depressive symptoms. SUBJECTS AND METHODS: This study comprising 14 shift workers and 13 day workers. Subjects were workers from the health area aged 25 to 60 years. Minor psychiatric disorders were accessed by Self Report Questionnaire (SRQ-20) and depressive symptoms by Beck Depression Inventory (BDI). Chronotype was accessed using Morningness-Eveningness Questionnaire (MEQ). Anthropometric measures were taken. RESULTS: Shift workers presented higher BMI (P = 0.03) and waist circumference (P = 0.004) than day workers. Years on shift work were significantly correlated to waist circumference (r = 0.43; P = 0.03) and age (r = 0.47; P = 0.02). Shift work was not correlated with depressive symptoms and chronotype. CONCLUSION: These results may suggest a role played by shift work on the development and/or the early clinic manifestations of metabolic disturbances, becoming a risk factor to metabolic syndrome.

Correlation of shift work and waist circumference, body mass index, chronotype and depressive symptoms / Correlação entre trabalho de turno e circunferência abdominal, índice de massa corporal, cronotipo e sintomas depressivos

OBJECTIVE: Correlate shift work with body mass index (BMI), waist circumference, chronotype and depressive symptoms. SUBJECTS AND METHODS: This study comprising 14 shift workers and 13 day workers. Subjects were workers from the health area aged 25 to 60 years. Minor psychiatric disorders were accessed by Self Report Questionnaire (SRQ-20) and depressive symptoms by Beck Depression Inventory (BDI). Chronotype was accessed using Morningness-Eveningness Questionnaire (MEQ). Anthropometric measures were taken. RESULTS: Shift workers presented higher BMI (P = 0.03) and waist circumference (P = 0.004) than day workers. Years on shift work were significantly correlated to waist circumference (r = 0.43; P = 0.03) and age (r = 0.47; P = 0.02). Shift work was not correlated with depressive symptoms and chronotype. CONCLUSION: These results may suggest a role played by shift work on the development and/or the early clinic manifestations of metabolic disturbances, becoming a risk factor to metabolic syndrome.

OBJETIVO: Correlacionar o trabalho de turno com índice de massa corporal (IMC), circunferência abdominal, cronotipo e sintomas depressivos. SUJEITOS E MÉTODOS: Amostra de 14 trabalhadores de turno e 13 diurnos, com idade entre 25 e 60 anos. Transtornos psiquiátricos menores foram aferidos pelo Self Report Questionnaire (SRQ-20), sintomas depressivos pelo inventário de Depressão de Beck (BDI) e o cronotipo pelo Morningness-Eveningness Questionnaire (MEQ). As medidas antropométricas foram mensuradas. RESULTADOS: Trabalhadores de turno apresentaram maior IMC (P = 0,03) e circunferência abdominal (P = 0,004) quando comparados aos diurnos. O tempo de trabalho de turno foi correlacionado à circunferência abdominal (r = 0,43; P = 0,03). Não houve correlação entre trabalho e sintomas depressivos e cronotipo. CONCLUSÃO: Os resultados podem sugerir que o trabalho de turno desempenhe um papel no desenvolvimento e/ou nas precoces manifestações clínicas de distúrbios metabólicos, tornando-se um fator de risco para a síndrome metabólica.