A critical assessment of bioactive compounds databases.

Compound databases (DBs) are essential tools for drug discovery. The number of DBs in public domain is increasing, so it is important to analyze these DBs. In this article, the main characteristics of 64 DBs will be presented. The methodological strategy used was a literature search. To analyze the characteristics obtained in the review, the DBs were categorized into two subsections: Open Access and Commercial DBs. Open access includes generalist DBs (containing compounds of diverse origins), DBs with specific applicability, DBs exclusive to natural products and those containing compounds with specific pharmacological action. The literature review showed that there are challenges to making these repositories available, such as standardizing information curation practices and funding to maintain and sustain them.

[Box: see text].

Zinc, antioxidant enzymes in preeclampsia, and association with newborn outcome.

BACKGROUND: The etiology of preeclampsia (PE) may be associated with the increased of production of reactive species and decreased antioxidant activity of enzymes. Inadequate intake of Zn can affect gestational health due to its biological functions, such as its role in the antioxidant defense system. The study aimed to assess the nutritional status of Zn and antioxidant enzymes in postpartum women and its correlation with neonatal outcomes. METHODS: A cross-sectional analytical study was carried out at a referral gynecology and obstetrics hospital. A total of 119 women (PE = 58, HP = 61) participated in the study. A quantitative food-frequency questionnaire was used to assess food consumption and further analyze the dietary Zn levels. Zinc levels in plasma and erythrocytes samples were analyzed by flame atomic absorption spectrometry, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels were determined by UV-Vis spectrophotometry. RESULTS: Plasma and dietary intake Zn results were considered adequate and without statistical difference between groups. SOD levels were significantly higher in the HP group (p = 0.011), and CAT levels were higher in the PE group (p = 0.050). There was a positive correlation between SOD activity in women with PE and the weight of their newborns (r = 0.336, p=0.021). CONCLUSION: The results showed adequate Zn levels (consumption and serum levels) in the groups studied, although with a reduction of plasma Zn in the PE group compared to the PH group. Zinc in plasma fractions and erythrocytes are important markers for oxidative stress, in particular, plasma Zn seems to be related to the rapid response to preeclampsia. The activity of antioxidant enzymes was elevated in the groups studied. Better SOD activity improves birth weight in children of pregnant women with preeclampsia.

Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study.

BACKGROUND: Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. METHODS: This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. RESULTS: A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). CONCLUSION: Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.

Dietary self-perception by women beneficiaries of the Bolsa Família Program in Fortaleza, Ceará, Brazil / Autopercepção alimentar de mulheres beneficiárias do Programa Bolsa Família em Fortaleza, Ceará, Brasil

ABSTRACT Objective To evaluate the association between dietary self-perception and socioeconomic, health, diet, and lifestyle variables of socially vulnerable women in primary health care. Methods This cross-sectional study was conducted in a Primary Health Care Unit in Fortaleza, Ceará, with 158 women beneficiaries of the Bolsa Família (Family Aid) Program. We applied a questionnaire containing socioeconomic and health variables, food knowledge, and self-perception. Pearson's chi-square test, with a 5% significance level, was adopted to investigate possible associations between women's food self-perception and other variables. Results The women had a mean age of 31.2 years. Most had a household income of less than one minimum wage (75.9%), a high school education level (53.8%), were overweight (67.7%), did not engage in physical activity (72.8%), and received dietary guidance (51.9%). Negative dietary self-perception was reported by 57.0% of the sample. Women who did not engage in physical activity had a higher frequency of negative dietary self-perception (p=0.007). Conclusion Most women showed negative dietary self-perception. The variable "physical activity" was positively associated with dietary self-perception. Knowing how women perceive their diet and which factors are associated with their food choices can help health professionals in their daily conduct in health care units.

RESUMO Objetivo Avaliar a associação entre a autopercepção alimentar negativa e variáveis socioeconômicas, de saúde, alimentação e estilo de vida de mulheres em vulnerabilidade social, na atenção primária à saúde. Métodos Estudo do tipo transversal realizado em uma Unidade de Atenção Primária à Saúde de Fortaleza, Ceará, com 158 mulheres beneficiárias do Programa Bolsa Família. Um questionário foi aplicado contendo as variáveis investigadas. O teste Qui-quadrado de Pearson, com nível de significância 5% foi utilizado para investigar possíveis associações entre a autopercepção alimentar das mulheres e as demais variáveis. Resultados As mulheres apresentaram média de idade de 31,2 anos e a maioria tinha renda familiar inferior a um salário-mínimo (75,9%), ensino médio como o nível de escolaridade (53,8%), apresentou excesso de peso (67,7%), não praticava atividade física (72,8%) e recebeu orientações sobre alimentação (51,9%). A autopercepção alimentar negativa foi relatada por 57,0% da amostra. As mulheres que não praticavam atividade física, tiveram maior frequência de autopercepção alimentar negativa (p=0,007). Conclusão A maioria das mulheres apresentou autopercepção negativa da alimentação e a variável "atividade física" mostrou associação positiva em relação à autopercepção alimentar. Conhecer como as mulheres percebem sua alimentação e quais fatores se associam às suas escolhas pode auxiliar os profissionais de saúde em suas condutas no cotidiano dos atendimentos nas unidades de saúde.

Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study

Abstract Background Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. Methods This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. Results A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). Conclusion Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.

From Prevention to Care: Unveiling a Parasitic Leiomyoma Within a Gigantic Abdominal Mass.

Leiomyomas are non-cancerous tumors emerging from the smooth muscle cells and fibroblasts of the myometrium. They are the most common pelvic tumors in females and are usually asymptomatic. Parasitic leiomyomas have been defined as unusual variants of pedunculated leiomyomas. When symptomatic, leiomyomas can cause abnormal uterine bleeding, pelvic pain/pressure, and reproductive effects, such as infertility or adverse pregnancy outcomes. Treatment varies depending on age, symptoms, and the preference to preserve fertility. In this article, we describe the case of a 58-year-old woman who presented for a scheduled cervical cancer screening in primary healthcare. Upon objective examination, the patient exhibited a distended and tense abdomen, along with edema in the lower limbs. These symptoms were associated with fatigue and weight gain over the last few months. Subsequent investigation led to an exploratory laparotomy which revealed a massive abdominal mass, measuring approximately 45 cm in diameter and weighing 35 kg. The findings were suggestive of a parasitic leiomyoma.

Brazilian society of rheumatology methodological guide for the development of evidence-based clinical guidelines in rheumatology.

Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination of the recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.

Brazilian society of rheumatology methodological guide for the development of evidence-based clinical guidelines in rheumatology

Abstract Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination ofthe recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic / Perfil de uso de sedativos e ocorrência de quedas e fratura de fêmur entre idosos em um ambulatório de geriatria

OBJECTIVE: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. METHODS: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine ("z-drugs") intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. RESULTS: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p < 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). CONCLUSIONS: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults

OBJETIVO: Investigar a utilização de sedativos entre idosos atendidos em ambulatório privado de geriatria em Belo Horizonte (MG), bem como sua associação com quedas e fraturas de fêmur. METODOLOGIA: Trata-se de estudo longitudinal, no qual foi descrita a prevalência de uso de benzodiazepínicos e drogas Z entre idosos (60 anos ou mais) e avaliada sua associação com a incidência de queda e fratura (30 dias após consulta inicial) por meio de regressão logística. RESULTADOS: Foram incluídos no estudo 7821 idosos, com maioria feminina (72,50%), idade média de 77,5 anos e Índice de Vulnerabilidade Clínico Funcional (IVCF-20) médio de 16,5 pontos. A prevalência de uso de sedativos em geral foi de 6,19%, sendo 4,48% de benzodiazepínicos e 1,98% de drogas Z. Os medicamentos sedativos mais utilizados foram clonazepam (29,04%), zolpidem (28,65%) e alprazolam (23,44%). Relatou-se queda para 182 idosos (2,33%), com incidência maior entre usuários de sedativos (4,34; p = 0,002; OR = 1,94 ajustada por sexo, idade e IVCF-20) e de benzodiazepínicos (5,14%; p < 0,001; OR = 2,28) do que entre não usuários (2,19%). Identificou-se fratura de fêmur em 33 idosos (0,42%), sendo mais frequente entre usuários de sedativos (1,03%; p = 0,032; OR = 2,57) e de benzodiazepínicos (1,43%; p = 0,003; OR = 3,45) do que entre não usuários (0,38%). CONCLUSÃO: Concluiu-se que a incidência de quedas e fraturas de fêmur em idosos possui associação com o uso de medicamentos sedativos, em especial os benzodiazepínicos

Telemonitoramento de idosos usuários de anticoagulante durante a pandemia da COVID-19 / Telemonitoring of older anticoagulant users during the COVID-19 pandemic

A pandemia da COVID-19 trouxe desafios para o monitoramento de usuários de anticoagulantes, sobretudo idosos, sendo o telemonitoramento uma alternativa para dar continuidade aos cuidados para esses pacientes. O presente estudo teve como objetivo descrever a experiência do telemonitoramento de idosos usuários de anticoagulantes na pandemia da COVID-19. Trata-se de estudo referente ao serviço farmacêutico de telemonitoramento de idosos (≥60 anos) em uso de anticoagulantes orais em ambulatório de geriatria privado (Belo Horizonte). Idosos tiveram parâmetros de efetividade e segurança dos anticoagulantes monitorados mensalmente por telefone (abr-dez/2021). Problemas identificados geraram intervenções ao paciente ou equipe multiprofissional. Ao total 425 idosos foram incluídos no serviço. A maioria usava apixabana (189;41,9%), rivaroxabana (146;34,4%) e varfarina (47;11,1%). Observou-se média de idade de 82,1 anos, maioria feminina (65,2%), maioria com alto risco de vulnerabilidade (69%), e incidência de 9,9% de COVID-19. Realizou-se 219 intervenções relativas à varfarina (média de 4,6 intervenções/paciente); referiram-se à solicitação de exame de RNI (57,5%), orientações em saúde (19,6%), alteração da dose (redução - 10,5%; aumento - 5,9%; suspensão - 0,6%), ou encaminhamento (5,9%). Usuários de outros anticoagulantes não apresentaram alterações nos parâmetros acompanhados. Onze idosos sofreram quedas e 10 demandaram internação por eventos tromboembólicos ou hemorrágicos. Não houve diferença estatisticamente significativa nas proporções de internação entre usuários de varfarina ou outros anticoagulantes (p=0,314). Acompanhar idosos usuários de anticoagulantes é importante, sobretudo considerando-se o alto nível de fragilidade identificado e os riscos tromboembólicos e não-tromboembólicos que a COVID-19 traz. O telemonitoramento foi importante, permitindo realização de múltiplas intervenções.

The COVID-19 pandemic brought challenges to the monitoring of anticoagulant users, especially older adults, making telemonitoring an alternative to provide continuity of care for these patients. The present study aimed to describe the experience of telemonitoring of older anticoagulant users during the COVID-19 pandemic. This is a descriptive study concerning the telemonitoring pharmaceutical service for older adults (≥60 years old) using oral anticoagulants in a private geriatric outpatient clinic (Belo Horizonte). Older people had parameters of effectiveness and safety of anticoagulants monitored monthly by telephone (Apr-Dec/2021). Identified problems generated interventions for the patient or the multidisciplinary team. A total of 425 older adults were included in the service. Most used apixaban (189;41.9%), rivaroxaban (146;34.4%) and warfarin (47;11.1%). There was a mean age of 82.1 years, mostly female (65.2%), most at high risk of vulnerability (69%), and an incidence of 9.9% of COVID-19. There were 219 interventions related to warfarin (average of 4.6 interventions/patient); including requests for an INR test (57.5%), health guidelines (19.6%), dosage change (reduction - 10.5%; increase - 5.9%; suspension - 0.6%), or referral (5.9%). Users of other anticoagulants did not show alterations in the monitored parameters. Eleven older adults suffered falls and 10 required hospitalizations due to thromboembolic or hemorrhagic events. There was no statistically significant difference in hospitalization rates between users of warfarin or other anticoagulants (p=0.314). Monitoring older anticoagulant users is important, especially considering the high level of frailty identified and the thromboembolic and non-thromboembolic risks that COVID-19 brings. Telemonitoring was important, allowing for multiple interventions to be performed.

The contribution of prenatal care in the dietary patterns of high-risk pregnant women / A contribuição do acompanhamento pré-natal nos padrões alimentares de gestantes de alto risco

Abstract Objectives: investigate whether prenatal characteristics were associated with dietary pattern of pregnant women. Methods: we studied 200 high-risk pregnant women in Fortaleza, Ceará. The identification of dietary patterns was performed through principal component analysis with the orthogonal Varimax rotation. Poisson regression was used to estimate prevalence ratios (PR) and respective confidence intervals (CI95%). Results: three major dietary patterns were identified: 'common Brazilian', 'healthy' and 'energy-dense'. After adjustments conducted with multivariate analysis, pregnant women who had not received dietary guidance in prenatal consultations (34%) were less likely to adhere to the 'healthy' pattern (PR = 0,81; CI95%= 0,67-0,95). Pregnant women who attended an appropriate number of consultations (≥ 6 consultations) (41%) showed greater adherence to the 'healthy' pattern (PR = 1,15; CI95%= 1,01-1,32) and lower adherence to the 'energy-dense' pattern (PR = 0,85; CI95%= 0,74-0,99). Conclusion: it was observed that the high-risk pregnant women who attended an adequate number of consultations during the prenatal care had a higher chance to adhere to the 'healthy' pattern and a lower chance to adhere to the 'energy-dense' pattern. Not receiving guidelines on prenatal nutrition was inversely associated with the healthy pattern. Thus, the importance of high-risk pregnant women undergoing an appropriate prenatal care is reinforced.

Resumo Objetivos: investigar o efeito potencial das características de acompanhamento do pré-natal em padrões alimentares identificados em gestantes de alto risco. Métodos: foram estudadas 200 gestantes de alto-risco de Fortaleza, Ceará. Os padrões alimentares foram identificados pela análise de componentes principais seguida de rotação ortogonal Varimax. Utilizou-se Regressão de Poisson para estimar as razões de prevalência (RP) e os intervalos de confança (IC95%). Resultados: três padrões alimentares foram identificados: 'comum brasileiro', 'saudável' e 'denso em energia'. Após a realização de ajuste com análise multivariada, as gestantes que não receberam orientação sobre alimentação nas consultas do pré-natal (34%) apresentaram menores chances de adesão ao padrão 'saudável' (RP = 0.81, IC95%= 0.67-0.95). Aquelas que realizaram um número de consultas adequado (≥ 6 consultas) (41%) apresentaram maior adesão ao padrão 'saudável' (RP = 1.15, IC95%= 1.01-1.32) e menor adesão ao padrão 'denso em energia' (RP = 0.85, IC95%= 0.74-0.99). Conclusão: observou-se que as gestantes de alto risco que compareceram a um número adequado de consultas no pré-natal tiveram maior chance de aderir ao padrão 'saudável' e menor chance de aderir ao padrão 'denso em energia'. Não receber orientações sobre nutrição durante o pré-natal foi inversamente associado ao padrão 'saudável'. Reforçando a importância das gestantes de alto risco realizarem um pré-natal adequado.

Silymarin inhibits the lipogenic pathway and reduces worsening of non-alcoholic fatty liver disease (NAFLD) in mice.

CONTEXT: The role of silymarin in hepatic lipid dysfunction and its possible mechanisms of action were investigated. OBJECTIVE: To evaluate the effects of silymarin on hepatic and metabolic profiles in mice fed with 30% fructose for 8 weeks. METHODS: We evaluated the antioxidant profile of silymarin; mice consumed 30% fructose and were treated with silymarin (120 mg/kg/day or 240 mg/kg/day). We performed biochemical, redox status, and histopathological assays. RT-qPCR was performed to detect ACC-1, ACC-2, FAS, and CS expression, and western blotting to detect PGC-1α levels. RESULTS: Silymarin contains high levels of phenolic compounds and flavonoids and exhibited significant antioxidant capacity in vitro. In vivo, the fructose-fed groups showed increased levels of AST, ALT, SOD/CAT, TBARS, hepatic TG, and cholesterol, as well as hypertriglyceridaemia, hypercholesterolaemia, and increased ACC-1 and FAS. Silymarin treatment reduced these parameters and increased mRNA levels and activity of hepatic citrate synthase. CONCLUSIONS: These results suggest that silymarin reduces worsening of NAFLD.

How Portuguese Health Entities Used Social Media to Face the Public Health Emergency during COVID-19 Disease.

BACKGROUND: During the COVID-19 pandemic, social media became an important and easily accessible source of information to keep the population informed. In this study, we explored how Portuguese health entities used social media during the public health emergency caused by COVID-19 disease. METHODS: A retrospective study on Portuguese public health entities' communication with the public using social media platforms was performed. Data were retrieved from Facebook, Instagram, and Twitter. All retrieved posts were analyzed, and the engagement of the public was calculated. A thematic analysis of all COVID-19-related posts was conducted. RESULTS: The analysis of each social media platform revealed that during the COVID-19 pandemic, health entities reinforced their presence on social media platforms. The most published posts were related to "epidemiological context" and "encouragement to take actions" to avoid the spread of COVID-19. High engagement frames were not associated with the most frequently published posts. CONCLUSIONS: Although health entities have reinforced their presence on social media platforms, they do not take full advantage of these platforms to improve health literacy.

Risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people: a retrospective cohort study

ABSTRACT BACKGROUND: Advanced age, multiple chronic diseases and frailty have been correlated with worse prognosis among coronavirus disease 2019 (COVID-19) inpatients. OBJECTIVE: To investigate potential risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people. DESIGN AND SETTING: Retrospective cohort study of patients followed up at a geriatric outpatient clinic in Belo Horizonte, Minas Gerais, Brazil. METHODS: The associations of demographic characteristics (age and sex) and clinical characteristics (frailty, multimorbidity, number of medications with long-term use, obesity, smoking, diabetes mellitus, pulmonary diseases, cardiovascular diseases, cerebrovascular disease, and chronic kidney disease) with the risk of hospitalization and death due to COVID-19 were explored using a multivariable logistic regression model. RESULTS: 5,295 patients (mean age 78.6 ± 9.4 years; 72.6% females) were included. After adjustments, the number of medications with long-term use was found to increase the odds of hospitalization due to COVID-19 (odds ratio, OR: 1.13; 95% confidence interval, CI: 1.06-1.22). Frailty, multimorbidity and diabetes mellitus also increased the odds of hospitalization (OR: 1.06, 95% CI: 1.02-1.09; OR: 1.17, 95% CI: 1.09-1.26; and OR: 2.27, 95% CI: 1.45-3.54, respectively) and the odds of death due to COVID-19 (OR: 1.07, 95% CI: 1.00-1.14; OR: 1.16, 95% CI: 1.03-1.32; and OR: 2.69, 95% CI: 1.79-6.14, respectively). CONCLUSIONS: Multimorbidity, frailty and diabetes mellitus increased the odds of hospitalization and death due to COVID-19 and the number of medications with long-term use increased the odds of hospitalization due to COVID-19 among frail community-dwelling elderly people.

Osteopenia of prematurity and associated nutritional factors: case-control study.

BACKGROUND: Preterm newborn nutrition affects postnatal skeletal growth and bone mineralization, but studies have not yet fully concluded the relationship between nutrition and osteopenia. This study was intended to investigate the impact of nutritional factors on osteopenia in preterm newborns. METHODS: This is a case-control study with babies born with gestational age ≤ 32 weeks in a high-risk maternity hospital, between 2018 and 2019. The population consisted of 115 newborns, being 46 cases (40%) and 69 controls (60%). Disease outcome was based on serum alkaline phosphatase levels > 900UL/l and hypophosphatemia < 4 mg/dl. Gestational data at birth and clinical and nutritional follow-up data during 8 weeks postnatally were assessed. Variables were assessed using regressive logistic models. FINDINGS: Preterm infants who were fed pasteurized fresh human milk with acidity ≥ 4 ºDornic are 5.36 times more likely to develop osteopenia (p = 0.035). Higher calcium intake, compared to controls, also increased the probability of disease occurrence [OR 1.05 (CI 1.006-1.1); p = 0.025], while the presence of a partner [OR 0.10 (CI 0.02-0.59); p = 0.038] and the shortest time using sedatives [OR 0.89 (CI 0.83-0.98); p = 0.010] were protective factors associated with osteopenia. Extremely low birth weight [OR 5.49 (CI 1.20-25.1); p = 0.028], sepsis [OR 5.71 (CI 1.35-24.2); p = 0.018] and invasive ventilatory support [OR 1.09 (CI 1.03-1.18); p = 0.007] were risk factors. CONCLUSIONS: Acidity and high calcium intake are the main nutritional factors associated with osteopenia of prematurity. Further studies on the use of human milk with lower acidity, recommendation and nutritional supplementation of calcium should be accomplished to guide prevention strategies in newborns at risk for osteopenia during hospital stay.

Potentially Inappropriate Medication Prescribing in Older Adults According to EU(7)-Potentially Inappropriate Medication List: A Nationwide Study in Portugal.

Background: Portugal has among the highest rates of dependency among older adults in Europe. Older adults with aging-related comorbidities are prone to the use of potentially inappropriate medication (PIM). Objective: The aim of this study was to analyze PIM prescriptions in older Portuguese adults, as well as the change rate of PIM prescriptions over time, and assess the geographical variability between the different regions of mainland Portugal. Methods: Using a national database, PIM prescriptions were analyzed for older adults (aged 65 years and older) between 2019 and 2021 from 2 perspectives: PIM-defined daily dose (DDD) frequency (%) and DDD per 1000 inhabitants per day (DID). Results: Overall, mainland Portugal presented a PIM DDD frequency of 9.20%, which was relatively higher in Alentejo and Centro and lower in the North. Alprazolam, fluoxetine, and rivaroxaban were PIM with higher DDD frequency values. Over the years, the DID change rates for these three PIM were -3.80%, -14.86%, and +18.54%, respectively, depending on the geographic region. Alprazolam and fluoxetine were mostly prescribed to older women, whereas rivaroxaban was mostly prescribed to older men. Conclusions: These results emphasize the need to implement initiatives and interventions to decrease PIM prescriptions in older adults.

Risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people: a retrospective cohort study.

BACKGROUND: Advanced age, multiple chronic diseases and frailty have been correlated with worse prognosis among coronavirus disease 2019 (COVID-19) inpatients. OBJECTIVE: To investigate potential risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people. DESIGN AND SETTING: Retrospective cohort study of patients followed up at a geriatric outpatient clinic in Belo Horizonte, Minas Gerais, Brazil. METHODS: The associations of demographic characteristics (age and sex) and clinical characteristics (frailty, multimorbidity, number of medications with long-term use, obesity, smoking, diabetes mellitus, pulmonary diseases, cardiovascular diseases, cerebrovascular disease, and chronic kidney disease) with the risk of hospitalization and death due to COVID-19 were explored using a multivariable logistic regression model. RESULTS: 5,295 patients (mean age 78.6 ± 9.4 years; 72.6% females) were included. After adjustments, the number of medications with long-term use was found to increase the odds of hospitalization due to COVID-19 (odds ratio, OR: 1.13; 95% confidence interval, CI: 1.06-1.22). Frailty, multimorbidity and diabetes mellitus also increased the odds of hospitalization (OR: 1.06, 95% CI: 1.02-1.09; OR: 1.17, 95% CI: 1.09-1.26; and OR: 2.27, 95% CI: 1.45-3.54, respectively) and the odds of death due to COVID-19 (OR: 1.07, 95% CI: 1.00-1.14; OR: 1.16, 95% CI: 1.03-1.32; and OR: 2.69, 95% CI: 1.79-6.14, respectively). CONCLUSIONS: Multimorbidity, frailty and diabetes mellitus increased the odds of hospitalization and death due to COVID-19 and the number of medications with long-term use increased the odds of hospitalization due to COVID-19 among frail community-dwelling elderly people.

Efficient management of the nitritation-anammox microbiome through intermittent aeration: absence of the NOB guild and expansion and diversity of the NOx reducing guild suggests a highly reticulated nitrogen cycle.

Obtaining efficient autotrophic ammonia removal (aka partial nitritation-anammox, or PNA) requires a balanced microbiome with abundant aerobic and anaerobic ammonia oxidizing bacteria and scarce nitrite oxidizing bacteria. Here, we analyzed the microbiome of an efficient PNA process that was obtained by sequential feeding and periodic aeration. The genomes of the dominant community members were inferred from metagenomes obtained over a 6 month period. Three Brocadia spp. genomes and three Nitrosomonas spp. genomes dominated the autotrophic community; no NOB genomes were retrieved. Two of the Brocadia spp. genomes lacked the genomic potential for nitrite reduction. A diverse set of heterotrophic genomes was retrieved, each with genomic potential for only a fraction of the denitrification pathway. A mutual dependency in amino acid and vitamin synthesis was noted between autotrophic and heterotrophic community members. Our analysis suggests a highly-reticulated nitrogen cycle in the examined PNA microbiome with nitric oxide exchange between the heterotrophs and the anammox guild.