Factors associated with vertical transmission of syphilis in a city in the State of São Paulo / Fatores associados à transmissão vertical de sífilis em um município do Estado de São Paulo / Factores asociados a transmisión vertical de sífilis en una ciudad del Estado de São Paulo

Background and Objectives: Syphilis is a sexually transmitted infection with low-cost and accessible treatment; however, it is considered a public health problem. Further studies are needed to improve knowledge about the factors that may contribute to the mother-to-child transmission of syphilis. Given its high detection rate in pregnant women and the possible adverse events of syphilis in Brazil, the objective was to evaluate the association of individual and clinical characteristics of syphilis with the incidence of congenital syphilis in pregnant women. Methods: This retrospective study was performed in a medium-size municipality in the State of São Paulo. Notification forms from the Notifiable Diseases Information System were used and the occurrence of congenital syphilis was the outcome of the study. Bivariate analyses and logistic regression were performed with variables that obtained p values <0.25. Results: Most pregnant women were 20-34 years old (62.2%) and had white skin (63.2%) and incomplete elementary schooling (35.4%). The occurrence of congenital syphilis was associated with the maternal syphilis diagnosis (p<0,001) and with not performing the treponemal test during the prenatal examination (p =0.014). There was a greater risk for the occurrence of congenital syphilis in cases with late diagnosis during pregnancy (OR=16.48; 95%CI 3.22-84.26) and tertiary/latent clinical classification (OR=7.62; 95%CI 1.40-41.54). Conclusion: Maternal diagnosis in the third trimester of pregnancy and tertiary/latent clinical classification were the main risk factors for the occurrence of congenital syphilis, reinforcing the importance of a quality prenatal examination performed timely.(AU)

Justificativa e Objetivos: A sífilis é uma Infecção Sexualmente Transmissível, com tratamento de baixo custo e acessível; porém, ela é considerada um problema de saúde pública. Para aprimorar o conhecimento sobre os fatores que podem contribuir para transmissão vertical da sífilis, mais estudos são necessários. Diante da elevada taxa de detecção em gestantes e dos possíveis eventos adversos da sífilis no Brasil, o objetivo foi avaliar a associação das características individuais e clínicas de sífilis com a incidência de sífilis congênita em gestantes. Métodos: Este estudo retrospectivo foi realizado em um município de médio porte no Estado de São Paulo. Foram usadas as fichas de notificação do Sistema de Informação de Agravos de Notificação e o desfecho do estudo foi a ocorrência de sífilis congênita. Foram realizadas análises bivariadas e regressão logística com as variáveis que obtiveram valores de p<0,25. Resultados: As maioria das gestantes tinha 20-34 anos (62,2%), era branca (63,2%), com escolaridade fundamental incompleta (35,4%). A ocorrência de sífilis congênita esteve associada ao diagnóstico de sífilis materno no terceiro trimestre de gestação (p<0,001) e com a não realização de teste treponêmico durante o pré-natal (p=0,014). Houve maior risco para a ocorrência de sífilis congênita os casos com diagnóstico tardio na gestação (OR=16,48; IC95% 3,22-84,26) e classificação clínica terciária/latente (OR=7,62; IC95% 1,40-41,54). Conclusão: Os principais fatores de risco para ocorrência de sífilis congênita foram o diagnóstico materno no terceiro trimestre de gestação e classificação clínica terciária/latente, reforçando a importância de um exame pré-natal de qualidade e em tempo oportuno.(AU)

Justificación y objetivos: La sífilis es una Infección de Transmisión Sexual con tratamiento accesible y de bajo coste, sin embargo, es considerada un problema de salud pública. Se necesitan más estudios para mejorar el conocimiento sobre los factores que pueden contribuir a la transmisión maternoinfantil de la sífilis. Dada su alta tasa de detección en gestantes y los posibles eventos adversos de la sífilis en Brasil, el objetivo fue evaluar la asociación de las características individuales y clínicas de la sífilis con la incidencia de sífilis congénita en gestantes. Métodos: Estudio retrospectivo realizado en una ciudad de mediano porte del Estado de São Paulo. Fueran utilizados formularios de notificación obligatoria del Sistema de Información de Enfermedades de Declaración Obligatoria y el desenlance fue la ocurrencia de sífilis congénita. Se realizaron análisis bivariados y regresión logística con las variables que obtuvieron p-value<0,25. Resultados: La mayoría de las mujeres embarazadas tenían entre 20 y 34 años (62,2%), eran blancas (63,2%), con instrucción primaria incompleta (35,4%). La aparición de sífilis congénita se asoció con el diagnóstico de sífilis materna en el tercer trimestre del embarazo (p<0,001) y con la no realización de prueba treponémica durante el prenatal (p=0,014). Hubo un mayor riesgo de sífilis congénita en los casos diagnosticados tardíamente en el embarazo (OR=16,48; IC95% 3,22-84,26) y clasificación clínica terciaria/latente (OR=7,62; IC95% 1,40-41,54). Conclusiones: Los principales factores de riesgo de aparición de sífilis congénita fueron el diagnóstico materno en el tercer trimestre de gestación y la clasificación clínica terciaria/tardía, lo que refuerza la importancia de una atención prenatal de calidad y oportuna.(AU)

Evidence of Lactobacillus reuteri to reduce colic in breastfed babies: Systematic review and meta-analysis.

OBJECTIVE: To investigate evidence for the treatment of childhood colic by supplementing Lactobacillus reuteri in infants breastfed with breast milk. METHODS: The study was conducted according to the PRISMA protocol. The databases used for acquiring data were PubMed and Web of Science, applying MeSH terms and free terms. Meta-analysis was conducted using Stata ™ 12.0. The risk of bias was evaluated by the Review Manager (RevMan) 5.3 tool, and the strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten clinical trials were included in the review. The administration of L. reuteri (DSM 17938 or ATCC55730) was tested in infants (n = 248) versus the control/placebo group (n = 229). Eight articles were included in the meta-analysis. There was a significant response in reducing crying time (minutes/day) and treatment effectiveness (reduction ≥ 50% in average daily crying time) in the first week (p = 0.001 and p = 0.003, respectively). These results were similar in the second, third weeks (p < 0.001 for both outcomes) and fourth weeks (p<0.001 and p = 0.002, respectively). The risk of bias was low for the majority of the studies. Confidence in evidence was considered very low for crying time and low for effectiveness treatment. CONCLUSIONS: The evidence shows that the administration of Lactobacillus reuteri to babies fed with breast milk reduces the crying time in babies diagnosed with colic. But our confidence in the effect estimate is limited.

Dynapenic abdominal obesity in hospitalized elderly patients with acute myocardial infarction.

Obesity and dynapenia are cardiovascular risk factors. When present together, it is called dynapenic abdominal obesity and can potentiate adverse outcomes. This study aims to estimate the prevalence of dynapenic abdominal obesity and its relationship with prognostic markers in patients with acute myocardial infarction (AMI). This is a hybrid study with a longitudinal component plus a cross-sectional component at baseline involving elderly patients admitted to a reference hospital in cardiology due to AMI in the Brazilian Northeast from May to October 2015. We analyzed patients' admission data and evaluated some prognostic markers up to two years after admission. We established abdominal obesity by measuring waist circumference (>102 cm for men and >88 cm for women) and dynapenia by handgrip strength (<27 kg/F for men and <16 kg/F for women). We considered the prognostic markers troponin and creatinine kinase - MB (CKMB), AMI classification according to ST segment elevation, TIMI score, need for coronary angioplasty or coronary artery bypass surgery, complications during hospitalization and within two years after admission, and re-admission to the same service. We evaluated 92 patients with a mean age of 71.4 ± 7.5 years. The prevalence of abdominal obesity and dynapenia was 56.5% and 44.6%, respectively. The coexistence of the two conditions occurred in 25.0% of the patients, being higher among women (p < 0.001). When comparing the dynapenic abdominal obese groups with the group of patients who had one of the two isolated conditions we observed that, for a same mean age and clinical characteristics, patients with only one of the conditions had a higher CKMB (p = 0.046) and troponin median (p = 0.032). The presence of dynapenia in the groups of abdominal obese and non-abdominal obese individuals is not associated with risk marker parameters (p > 0.05). High prevalence of abdominal obesity and dynapenia occurred among patients with AMI and in a quarter of these both conditions coexisted. Dynapenic abdominal obesitydoes not increase the risk of adverse outcomes and isolated dynapenia is not a marker of a poor prognosis.

Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations.

Although increased weight, and particularly obesity, has been associated with a more severe clinical course of COVID-19 and risk of fatality, the course of the illness can lead to prolonged length of stay. Changes in nutritional status and weight loss during hospitalisation are largely reported in some populations, but still not explored in COVID-19 patients. Considering that patients with COVID-19 show an increased inflammatory response, other signs and symptoms, which can lead to weight and muscle loss, should be monitored. The aim of this article was to establish possible connections between COVID-19, prolonged hospitalisation and muscle wasting, as well as to propose nutritional recommendations for the prevention and treatment of cachexia, through a narrative review. Identification of risk and presence of malnutrition should be an early step in general assessment of all patients, with regard to more at-risk categories including older adults and individuals suffering from chronic and acute disease conditions, such as COVID-19. The deterioration of nutritional status, and consequently cachexia, increases the risk of mortality and needs to be treated with attention as other complications. There is, however, little hard evidence of nutritional approaches in assisting COVID-19 treatment or its management including cachexia.

Different Expression of Duodenal Genes Related to Insulin Resistance Between Nonobese Women and Those with Severe Obesity.

OBJECTIVE: The study aim was to identify changes in duodenal gene expression associated with the development of insulin resistance according to the BMI of women. METHODS: Duodenal samples were assessed by microarray in four groups of women, nonobese women and women with severe obesity, with both low and high insulin resistance. RESULTS: There was a group of shared downregulated differentially expressed genes (DEGs) related to tissue homeostasis and antimicrobial humoral response in women with higher insulin resistance both with severe obesity and without obesity. In the exclusive DEGs found in severe obesity, downregulated DEGs related to the regulation of the defense response to bacterium and cell adhesion, involving pathways related to the immune system, inflammation, and xenobiotic metabolism, were observed. In the exclusive DEGs from nonobese women with higher insulin resistance, upregulated DEGs mainly related to the regulation of lipoprotein lipase activity, very low-density lipoprotein particle remodeling, lipid metabolic process, antigen processing, and the presentation of peptide antigen were found. CONCLUSIONS: Independent of BMI, higher insulin resistance was associated with a downregulation of duodenal DEGs mainly related to the immune system, inflammation, and xenobiotic metabolism. Also, intestinal lipoprotein metabolism may have a certain relevance in the regulation of insulin resistance in nonobese women.

The Effect of the Inflammatory Bowel Disease Classroom in Nature on the Quality of Life of Patients With Inflammatory Bowel Disease.

"The IBD Classroom in Nature" is an initiative that combines training and leisure activities in an ideal environment where families and patients can interact with each other. The objective of the present study was to quantify the effect that "The IBD Classroom in Nature" had on the health-related quality-of-life of patients with Inflammatory bowel disease (IBD). We conducted a prospective, analytical study with a pre-post design to demonstrate the impact on health-related quality-of-life (measured with the IMPACT-III questionnaire) of 3 days together in the context of The IBD Classroom in Nature. The study included 13 patients with IBD with a mean age of 12.3 years (interquartile range 11.9-14.5). After "The IBD Classroom in Nature" there was an improvement in the IMPACT-III score with significant improvements in the emotional functioning and body image domains. The present study objectively shows the beneficial effect of group activities focused on the most diverse aspects of their disease.

A lower duodenal immune response is associated with an increase of insulin resistance in patients with morbid obesity.

OBJECTIVE: The intestinal immune response could play an important role in obesity-related comorbidities. We aim to study the profile of duodenal cytokines and chemokines in patients with morbid obesity (MO), its relation with insulin resistance (IR) and the intake of metformin, and with the evolution of MO after sleeve gastrectomy (SG). RESEARCH DESIGN AND METHODS: Duodenal levels of 24 cytokines and 9 chemokines were analyzed in 14 nonobese and in 54 MO who underwent SG: with lower IR (MO-lower-IR), with higher IR (MO-higher-IR), and with type 2 diabetes treated with metformin (MO-metf-T2DM). RESULTS: MO-lower-IR had higher levels of cytokines related to Th1, Th2, Th9, Th17, Th22, M1 macrophages, and chemokines involved in the recruitment of macrophages and T-lymphocytes (p < 0.05), and total (CD68 expression) and M1 macrophages (ITGAX expression) (p < 0.05) when compared with nonobese patients, but with a decrease in M2 macrophages (MRC1 expression) (p < 0.05). In MO-higher-IR, these chemokines and cytokines decreased and were similar to those found in nonobese patients. In MO-metf-T2DM, only IL-4 (Th2) and IL-22 (Th22) increased their levels with regard to MO-higher-IR (p < 0.05). In MO-higher-IR and MO-metf-T2DM, there was a decrease of CD68 expression (p < 0.05) while ITGAX and MRC1 were similar with regard to MO-lower-IR. We found an association between CXCL8, TNFß and IL-2 with the evolution of body mass index (BMI) after SG (p < 0.05). CONCLUSIONS: There is an association between a higher IR and a lower duodenal immune response in MO, with a slight increase in those patients with metformin treatment. Intestinal immune response could be involved in the evolution of BMI after SG.

Sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction.

OBJECTIVE: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. METHODS: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. RESULTS: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). CONCLUSION: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.

Analgesia em pacientes de trauma no serviço de emergência / Analgesia in trauma patients in emergency department / Analgesia en pacientes de trauma en el servicio de emergencia

Objetivo avaliar a eficácia da analgesia e a concordância entre as escalas Numérica e de Faces em pacientes de trauma no serviço de emergência. Método: estudo transversal com 173 pacientes, realizado de fevereiro-2013 a setembro-2014. A dor foi avaliada na admissão e uma hora após analgesia, pelas escalas Numérica e de Faces. Para comparar a dor antes e após analgesia, utilizou-se o Coeficiente de Correlação de Spearman e, para analisar a concordância entre as escalas, o Índice Kappa. Resultados: na admissão, a maioria dos pacientes relatou dor moderada e intensa. Houve melhora da dor, porém 36,0% dos pacientes permaneceram com dor leve e 33,7% moderada, necessitando de complementação analgésica. A concordância entre as escalas foi considerável antes da analgesia (Kappa = 0,31; p-valor <0,0001) e moderada após (Kappa = 0,56; p-valor <0,0001). Conclusão: a maioria dos pacientes obteve melhora da dor após analgesia, sendo que houve concordância entre as escalas.

Objective: to evaluate the effectiveness of analgesia and the agreement between the Numerical and Faces scales in trauma patients in the emergency department. Method: a cross-sectional study with 173 patients, performed from February 2013 to September 2014. Pain was evaluated at admission and one hour after analgesia, using the Numerical and Faces scales. To compare pain before and after analgesia, the Spearman Correlation Coefficient was used and, to analyze the agreement between the scales, the Kappa Index. Results: At admission, the majority of patients reported moderate and severe pain. There was pain relief, but 36.0% of patients remained with mild pain and 33.7% moderate pain, requiring analgesic supplementation. The agreement between the scales was considerable before analgesia (Kappa = 0.31, p-value <0.0001) and moderate after (Kappa = 0.56, p-value <0.0001). Conclusion: the majority of patients obtained pain relief after analgesia, and there was agreement between the scales.

Objetivo: evaluar eficacia de analgesia y concordancia entre las escalas Numérica y de Faces en pacientes de trauma en servicio de emergencia. Método: Estudio transversal con 173 pacientes, realizado de febrero-2013 a septiembre-2014. Dolor fue evaluado en admisión y una hora después de analgesia, por escalas Numérica y de Faces. Para comparar dolor antes y después de analgesia, se utilizó el Coeficiente de Correlación de Spearman, para analizar la concordancia entre las escalas, el Índice Kappa. Resultados: en admisión, la mayoría de pacientes relató dolor moderado e intensa. Se ha mejorado el dolor, pero el 36,0% de pacientes permanecieron con dolor leve y el 33,7% moderado, necesitando de complementación analgésica. La concordancia entre las escalas fue considerable antes de analgesia (Kappa = 0,31; p-valor <0,0001) y moderada después (Kappa = 0,56; p-valor <0,0001). Conclusión: la mayoría de pacientes obtuvo mejora del dolor después de analgesia, y hubo concordancia entre las escalas.

Sarcopenia in elderly hospitalized coronary patients / Sarcopenia en pacientes coronarios hospitalizados

ABSTRACT Sarcopenia is a syndrome characterized by the progressive and widespread loss of skeletal muscle mass and strength, with a risk of adverse outcomes such as disability, reduced quality of life and death. Objective: To investigate the prevalence of sarcopenia and its associated factors in cardiac patients. Methods: We performed a cross-sectional study in a public hospital in northeast Brazil, involving patients aged ≥60 years with coronary artery disease. Sarcopenia was determined by muscle mass (bioelectrical impedance analysis) and skeletal muscle mass index by a predictive equation, muscle strength (measured by grip strength) and physical performance (driving speed test). We tested relationships between sarcopenia and socioeconomic, demographic, clinical, nutritional and lifestyle variables. Results: We evaluated 148 patients, with an average age of 73.9±7.4years. We observed a prevalence of sarcopenia of 62.8%; of which 72% were classified as having severe sarcopenia. The variables associated with sarcopenia were male sex (p= 0.014), age >80 years (p= 0.005), and being malnourished according to BMI (p< 0.001), arm circumference (p= 0.006) and calf circumference (p= 0.045); the other variables were not statistically significant. Conclusion: The prevalence of sarcopenia in our sample was high. We found that sarcopenia related to sex, age, and nutritional status.

RESUMEN La sarcopenia se define como un síndrome caracterizado por una pérdida progresiva y generalizada de la masa muscular y la fuerza del esqueleto, con un riesgo de resultados adversos como la discapacidad, la reducción de la calidad de vida y de muerte. Objetivo: Investigar la prevalencia de sarcopenia y sus factores asociados en pacientes cardíacos Métodos: Se realizó un estudio transversal en el hospital público del noreste de Brasil, en el que participaron pacientes mayores de 60 años con enfermedad coronaria. La sarcopenia fue determinada por la masa muscular (análisis de impedancia bioeléctrica y ecuación predictiva para determinar el índice de masa muscular esquelético), la fuerza muscular (medida por la fuerza de agarre) y el rendimiento físico (prueba de velocidad de conducción). Entre la asociación de variables se consideraron aspectos socioeconómicos, demográficos, clínicos, nutricionales y de estilo de vida. Resultados: Fueron evaluados 148 pacientes, con una edad promedio de 73,9±7,4 años. Se observó una prevalencia de sarcopenia del 62,8%; incluyendo un 72% clasificado como severamente sarcopénico. Las variables asociadas a sarcopenia fueron sexo masculino (p= 0,014), edad > 80 años (p= 0,005) y desnutrida según IMC (p< 0,001), CB (p= 0,006) y CP (p= 0,045); las otras variables no fueron estadísticamente significativas. Conclusión: La prevalencia de sarcopenia fue mayor, se encontró en una asociación con el género, un aumento en la edad, y el estado nutricional desfavorable.

Sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction / Relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos hospitalizados com infarto agudo do miocárdio

ABSTRACT Objective: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. Methods: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. Results: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). Conclusion: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.

RESUMO Objetivo: Verificar a relação entre sarcopenia e obesidade sarcopênica como preditores de prognóstico em pacientes idosos com infarto agudo do miocárdio internados. Métodos: Estudo transversal envolvendo pacientes idosos com infarto agudo do miocárdio, hospitalizados no período de abril a julho de 2015, em serviço público, no Nordeste brasileiro. A sarcopenia foi determinada por meio das medidas de massa muscular, força muscular e desempenho físico. Foram utilizados os marcadores de risco cardiovascular e de prognóstico, como os valores de troponina e da isoenzima MB da creatinina quinase, classificação do infarto agudo do miocárdio de acordo com a elevação do segmento ST e o escore de risco de trombólise em infarto do miocárdio. Resultados: Foram avaliados 99 pacientes, com média de idade de 71,6 (±7,4) anos. Verificou-se prevalência de sarcopenia de 64,6% e 35,4% de obesidade sarcopênica. A sarcopenia foi mais prevalente no sexo masculino (p=0,017), na faixa etária >80 anos (p=0,008). Dentre os marcadores de risco cardiovascular, apenas o escore de risco trombólise em infarto do miocárdio esteve estatisticamente associado à sarcopenia (p=0,002). Conclusão: A prevalência da sarcopenia foi elevada e se associou com o escore de risco de trombólise em infarto do miocárdio. A obesidade sarcopênica acometeu cerca de um terço dos pacientes e não se associou a nenhum parâmetro preditor prognóstico.

Epidemiology and socioeconomic impact of the rheumatic diseases on indigenous people: an invisible syndemic public health problem.

Epidemiological studies in Latin America suggest indigenous people lack proper healthcare for musculoskeletal (MSK) and rheumatic diseases. OBJECTIVES: This study aimed to estimate the prevalence of MSK disorders and rheumatic diseases in eight Latin American indigenous communities, and to identify which factors influence such prevalence using network analysis and syndemic approach. METHODS: This is a cross-sectional, community-based census study according to Community-Oriented Program for the Control of Rheumatic Diseases methodology. Individuals with MSK pain, stiffness or swelling in the past and/or during the last 7 days were evaluated by participating physicians. A descriptive, univariable and multivariable analysis was performed, followed by a network analysis. RESULTS: We surveyed 6155 indigenous individuals with a mean age of 41.2 years (SD 17.6; range 18-105); 3757 (61.0%) were women. Point prevalence in rank order was: low back pain in 821 (13.3%); osteoarthritis in 598 (9.7%); rheumatic regional pain syndromes in 368 (5.9%); rheumatoid arthritis in 85 (1.3%); undifferentiated arthritis in 13 (0.2%); and spondyloarthritis in 12 (0.1%). There were marked variations in the prevalence of each rheumatic disease among the communities. Multivariate models and network analysis revealed a complex relationship between rheumatic diseases, comorbidities and socioeconomic conditions. CONCLUSIONS: The overall prevalence of MSK disorders in Latin American indigenous communities was 34.5%. Although low back pain and osteoarthritis were the most prevalent rheumatic diseases, wide variations according to population groups occurred. The relationship between rheumatic diseases, comorbidities and socioeconomic conditions allows taking a syndemic approach to the study.

Phase Angle as a Sarcopenia Marker in Hospitalized Elderly Patients.

BACKGROUND: Phase angle (PhA) has been proposed as a parameter to predict clinical outcomes and mortality for various diseases. Several studies have considered it an important nutrition assessment tool. However, the usefulness of this parameter as a sarcopenia marker has not yet been evaluated. This study was developed to evaluate the performance of PhA as a sarcopenia marker in hospitalized elderly patients. MATERIALS AND METHODS: This was a cross-sectional study involving elderly patients admitted to a hospital in northeastern Brazil. The PhA was obtained from resistance and reactance measurements by bioelectrical impedance. Sarcopenia was defined as a decrease in muscle mass associated with a reduced muscle strength or physical performance. RESULTS: The sample consisted of 148 patients with a mean age of 71.6 (±7.6) years and a 62.8% prevalence of sarcopenia. The average PhA was 5.9 ± 2.0°, similar for men and women (5.9 ± 2.3 vs 5.9 ± 1.8; P = .946). In men, sarcopenic patients had a lower average PhA (5.6 ± 2.3°) when compared with patients without this condition (6.8 ± 1.9°; P = .024). When comparing the value of PhA regarding the degree of sarcopenia, it was found that patients from both sexes with severe sarcopenia had lower averages. The PhA had a low predictive capacity in relation to the diagnostic components of sarcopenia (physical performance, muscle mass, and strength). CONCLUSION: PhA was an inaccurate marker to identify sarcopenia and presented low predictive capacity to explain muscle mass, muscle strength, and functional capacity, components involved in the diagnosis of sarcopenia.

Main predictors of periphyton species richness depend on adherence strategy and cell size.

Periphytic algae are important components of aquatic ecosystems. However, the factors driving periphyton species richness variation remain largely unexplored. Here, we used data from a subtropical floodplain (Upper Paraná River floodplain, Brazil) to quantify the influence of environmental variables (total suspended matter, temperature, conductivity, nutrient concentrations, hydrology, phytoplankton biomass, phytoplankton species richness, aquatic macrophyte species richness and zooplankton density) on overall periphytic algal species richness and on the richness of different algal groups defined by morphological traits (cell size and adherence strategy). We expected that the coefficients of determination of the models estimated for different trait-based groups would be higher than the model coefficient of determination of the entire algal community. We also expected that the relative importance of explanatory variables in predicting species richness would differ among algal groups. The coefficient of determination for the model used to predict overall periphytic algal species richness was higher than the ones obtained for models used to predict the species richness of the different groups. Thus, our first prediction was not supported. Species richness of aquatic macrophytes was the main predictor of periphyton species richness of the entire community and a significant predictor of the species richness of small mobile, large mobile and small-loosely attached algae. Abiotic variables, phytoplankton species richness, chlorophyll-a concentration, and hydrology were also significant predictors, depending on the group. These results suggest that habitat heterogeneity (as proxied by aquatic macrophytes richness) is important for maintaining periphyton species richness in floodplain environments. However, other factors played a role, suggesting that the analysis of species richness of different trait-based groups unveils relationships that were not detectable when the entire community was analysed together.

Eichhornia azurea decomposition and the bacterial dynamic: an experimental research

Abstract Organic decomposition is a complex interaction between chemical, physical and biological processes, where the variety of aquatic vascular plants is essential for the trophic dynamics of freshwater ecosystems. The goal of this study was to determine the aquatic macrophyte Eichhornia azurea (Sw.) Kunth decomposition rate, the time relation with the limnological parameters, and whether this relationship is a result of decomposition processes. To that end, we collected water and leaves of E. azurea in Surf Leopoldo, PR. The experiment consisted of two treatments: 25 containers with 450 mL of water and 0.8 g of biomass dry weight were used with or without the addition of macrophytes. Samples were collected in triplicate at times 0, 3 h, 6 h, 12 h, 24 h, 72 h, 120 h, 168 h and 240 h. When the container was removed, the plant material was dried in an oven. After 48 h, the material was measured to obtain the final dry weight. Analyses of pH, conductivity, dissolved oxygen, total phosphorus N-ammonia (NH4), soluble reactive phosphorus (PO4) and dissolved organic carbon were performed, and the decomposition rate was calculated. The results showed significant temporal variation of limnological parameters in the study. Additionally, dissolved oxygen, conductivity, dissolved organic carbon and total phosphorus were correlated with the dry weight of the biomass, suggesting that E. azurea decomposition significantly interferes with the dynamics of these variables.

Vitamin K3 induces antiproliferative effect in cervical epithelial cells transformed by HPV 16 (SiHa cells) through the increase in reactive oxygen species production.

PURPOSE: Cervical cancer is characterized as an important public health problem. According to latest estimates, cancer of the cervix is the fourth most common cancer among women. Due to its high prevalence, the search for new and efficient drugs to treat this infection is continuous. The progression of HPV-associated cervical cancer involves the expression of two viral proteins, E6 and E7, which are rapidly degraded by the ubiquitin-proteasome system through the increase in reactive oxygen species generation. Vitamins are essential to human substances, participate in the regulation of metabolism, and facilitate the process of energy transfer. METHODS: Some early studies have indicated that vitamin K3 exerts antitumor activity by inducing cell death by apoptosis through an increase in the generation of reactive oxygen species. Thus, we evaluated the antiproliferative effect and a likely mechanism of action of vitamin K3 against cervical epithelial cells transformed by HPV 16 (SiHa cells) assessing the production of total ROS, the mitochondrial membrane potential, the cell morphology, the cell volume, and the cell membrane integrity. RESULTS: Our results show that vitamin K3 induces an increase in ROS production in SiHa cells, triggering biochemical and morphological events, such as depolarization of mitochondrial membrane potential and decreasing cell volume. CONCLUSION: Our data showed that vitamin K3 generates an oxidative imbalance in SiHa cells, leading to mechanisms that induce cell death by apoptosis.

Prevalence of rheumatic diseases in Raramuri people in Chihuahua, Mexico: a community-based study.

This study aimed to determine the prevalence of musculoskeletal (MSK) pain and rheumatic diseases in the Raramuri population (also known as Tarahumaras) who are an indigenous group in the northern state of Chihuahua in Mexico. We used the Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology. An analytical cross-sectional study was conducted including indigenous Raramuri aged ≥18 years from communities settled in Chihuahua City. Subjects with positive MSK pain were evaluated by primary care physicians and rheumatologists. Demographic and occupational factors such as gender and job type associated with rheumatic disease were investigated. A total of 380 indigenous Raramuri (mean age 33.6 ± 13.1 years; 37.9 % male) were interviewed. Seventy-six individuals (20 %) reported MSK pain in the last 7 days. Pain intensity was reported as "severe" and "the most severe" in 30 % of the cases. Fifty-six individuals (14.7 %) reported pain in the past and 86 (22.6 %) had either past or current pain. The prevalence of rheumatic diseases was 10.5 %. Diagnosed diseases were osteoarthritis (6.6 %), low back pain (1.6 %), spondyloarthritis (0.8 %), rheumatoid arthritis (0.5 %), non-specific arthritis (0.5 %), rheumatic regional pain syndromes (0.3 %), and fibromyalgia (0.3 %). Rheumatic disease was associated with the following variables: age (odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.02-1.08; p = 0.006), family history of rheumatic symptoms (OR 6.9; 95 % CI 2.6-18.7; p < 0.001), and Health Assessment Questionnaire-Disability Index (OR 28.9; 95 % CI 2.8-289.7; p < 0.001). A high prevalence of non-traumatic MSK pain suggests the need for a rheumatic disease prevention program in the Raramuri people in Chihuahua, Mexico.

Eichhornia azurea decomposition and the bacterial dynamic: an experimental research.

Organic decomposition is a complex interaction between chemical, physical and biological processes, where the variety of aquatic vascular plants is essential for the trophic dynamics of freshwater ecosystems. The goal of this study was to determine the aquatic macrophyte Eichhornia azurea (Sw.) Kunth decomposition rate, the time relation with the limnological parameters, and whether this relationship is a result of decomposition processes. To that end, we collected water and leaves of E. azurea in Surf Leopoldo, PR. The experiment consisted of two treatments: 25 containers with 450mL of water and 0.8g of biomass dry weight were used with or without the addition of macrophytes. Samples were collected in triplicate at times 0, 3h, 6h, 12h, 24h, 72h, 120h, 168h and 240h. When the container was removed, the plant material was dried in an oven. After 48h, the material was measured to obtain the final dry weight. Analyses of pH, conductivity, dissolved oxygen, total phosphorus N-ammonia (NH4), soluble reactive phosphorus (PO4) and dissolved organic carbon were performed, and the decomposition rate was calculated. The results showed significant temporal variation of limnological parameters in the study. Additionally, dissolved oxygen, conductivity, dissolved organic carbon and total phosphorus were correlated with the dry weight of the biomass, suggesting that E. azurea decomposition significantly interferes with the dynamics of these variables.

Gender Differences in Risk Factors for Delayed Diagnosis of HIV/AIDS in a Midsized City of Brazil.

Patients treated in the specialized service at a midsized city in Brazil participated in a cross-sectional study that aimed to identify the risk factors for delayed diagnosis of HIV/AIDS. Through interviews and review of medical records, information was collected on sociodemographic and clinical characteristics and diagnoses. The study included 403 patients, of whom 216 (53.6%) were male and 311 (77.1%) had ≤8 years of education. According to the criteria adopted in this study, 162 (40.2%) of the participants had a late diagnosis of AIDS. Only 19 (4.7%) were diagnosed by routine examinations and 45 (11.2%) presented with AIDS-defining disease at the time of diagnosis. After adjustments, the results showed that having more education was protective against a late diagnosis for women. With the advance of the AIDS epidemic to small town and rural Brazil, vulnerable populations now include low-income and less educated women, most of whom have had monogamous relationships throughout their lives.

Anticardiolipin antibodies and recurrent spontaneous abortion in Brazilianwomen / Anticardiolipin antibodies and recurrent spontaneous abortion in Brazilianwomen

Aims: To determine the frequency of anti-cardiolipin antibodies (aCL) in women with previous history of recurrent spontaneous abortion (RSA).Methods: Medical records from pregnant women seen from April 2005 to December 2008 at the High-Risk Pregnancy Unit at the Hospital de Base from FUNFARME (Fundação Faculdade Regional de Medicina), in São José do Rio Preto, São Paulo, Brazil, were revised. Patients olderthan 18 years who had at least two spontaneous abortions and who were tested for aCL wereincluded in the study. Data on maternal age, number of miscarriages and the results of serological tests for aCL were recorded. The exact Fisher's test was used to compare the results. A p value less than 0.05 was considered significant.Results: During the study period a total of 294 pregnant women were seen, from whom 44 consecutive women fulfilled the inclusion criteria. The overall mean age was 33.8±5.4 years (range: 22 to 44; median: 34). Eighteen (40.9%) patients were reagent for aCL and 26 (59.1%) non-reagent,and the difference between their mean age was not statistically significant (reagent: 34.6±5.8 years; non reagent: 33.2±5.2 years, p=0.4001). Fourteen (77.8%) patients presented IgM aCL and six (33.2%), IgG aCL. Two patients (11%) were reagent for both IgM and IgG aCL. In the most of cases the aCL antibody titers were compatible with low risk for pregnancy morbidity. The number of abortions ranged from two to six. The average number of abortions among those reagent for aCL was 3.5±1.1 and in those non-reagent was 2.9±1.1 (p=0.0813). Conclusions: The frequency of aCL was elevated among patients with a history of RSA,especially those having higher number of fetal losses. Among women with at least two spontaneousabortions, the mean number of abortions was not significantly different between those reagent for aCL and those non reagent.

Objetivos: Avaliar a frequência de anticorpos anticardiolipina (aCL) em mulheres comhistória prévia de aborto espontâneo recorrente (AER).Métodos: No período de abril de 2005 a dezembro de 2008 foram avaliados os dados deprontuários de gestantes atendidas no Ambulatório de Gestação de Alto Risco do Hospital de Baseda Fundação Faculdade Regional de Medicina (FUNFARME), em São José do Rio Preto, SãoPaulo, Brasil. Foram incluídas neste estudo pacientes com idade acima de 18 anos que tiveram pelomenos dois abortos espontâneos e foram avaliadas para aCL. O teste exato de Fisher foi usado paracomparar os resultados. Valor de p menor que 0,05 foi considerado significante.Resultados: Um total de 294 mulheres gestantes foram avaliadas durante o período doestudo, das quais 44 atendiam aos critérios de inclusão. A média de idade foi 33,8±5,4 anos(variação: 22 a 44; mediana: 34). Dezoito pacientes (40,9%) foram reagentes para aCL e 26 (59,1%)não reagentes, e a diferença entre a média de idade não foi estatisticamente significante (reagentes:34,6±5,8 anos; não reagentes: 33,2±5,2 anos, p=0,4001). Quatorze (77,8%) pacientes apresentaramaCL IgM e seis (33,2%) aCL IgG. Duas pacientes (11%) foram reagentes para ambas as classes deaCL, IgM e IgG. Na maioria dos casos os títulos de anticorpos aCL foram compatíveis com baixorisco para morbidade na gravidez. O número de abortos variou de dois a seis. O número médio deabortos entre as reagentes para aCL foi de 3,5±1,1 e entre as não reagentes foi de 2,9±1,1(p=0,0813).Conclusões: A frequência de aCL foi alta entre as pacientes com história de AER,especialmente entre aquelas que tiveram um maior número de perdas fetais. Entre as mulheres compelo menos dois abortos espontâneos, a média do número de abortos não foi significativamentediferente entre aquelas reagentes e não reagentes para aCL.