Influence of trophic overlaps and trophic niche amplitude on microplastic intake of fish species in shallow areas of a neotropical coastal lagoon.

Plastic pollution is a global challenge that affects all marine ecosystems, and reflects all types of uses and activities of human society in these environments. In marine ecosystems, microplastics and mesoplastics interact with invertebrates and become available to higher predators, such as fish, which can ingest these contaminants. This study aimed to analyze how ecological food interactions (diet overlap and trophic niche amplitude) among fish species contribute to the ingestion of plastic particles. The gastrointestinal contents of six fish species (Atherinella brasiliensis, Eucinostomus melanopterus, Eucinostomus argenteus, Genidens genidens, Coptodon rendalli, and Geophagus brasiliensis) were analyzed to identify prey items and plastic ingestion. Based on the ontogenetic classification, A. brasiliensis, E. melanopterus, and G. genidens were divided into juveniles and adults, and the six fish species analyzed were divided into nine predator groups. Most of the plastics ingested by the fish species were blue microplastic (MP) fibers (< 0.05 mm) classified as polyester terephthalate, polyethylene, and polybutadiene. Considering all the analyzed predators, the average number and weight of plastics ingested per individual were 2.01 and 0.0005 g, respectively. We observed that predators with a high trophic overlap could present a relationship with the intake of MP fibers owing to predation on the same resources. In addition, we observed the general pattern that when a species expands its trophic diversity and niche, it can become more susceptible to plastic ingestion. For example, the species with the highest Levin niche amplitude, E. argenteus juveniles, had the highest mean number (2.9) of ingested MP fibers. Understanding the feeding ecology and interactions among species, considering how each predator uses habitats and food resources, can provide a better understanding of how plastic particle contamination occurs and which habitats are contaminated with these polluting substances.

Clinical nutrition in primary care: ESPEN position paper.

Primary care healthcare professionals (PCHPs) are pivotal in managing chronic diseases and present a unique opportunity for nutrition-related disease prevention. However, the active involvement of PCHPs in nutritional care is limited, influenced by factors like insufficient education, lack of resources, and time constraints. In this position paper The European Society for Clinical Nutrition and Metabolism (ESPEN) promotes the active engagement of PCHPs in nutritional care. We emphasize the importance of early detection of malnutrition by screening and diagnosis, particularly in all individuals presenting with risk factors such as older age, chronic disease, post-acute disease conditions and after hospitalization for any cause. ESPEN proposes a strategic roadmap to empower PCHPs in clinical nutrition, focusing on education, tools, and multidisciplinary collaboration. The aim is to integrate nutrition into medical curricula, provide simple screening tools for primary care, and establish referral pathways to address malnutrition systematically. In conclusion, we urge for collaboration with PCHP organizations to raise awareness, enhance nutrition skills, facilitate dietitian accessibility, establish multidisciplinary teams, and promote referral pathways, thereby addressing the underestimated clinical challenge of malnutrition in primary care.

Estimating Public Economic Gains from Early Breast Cancer and Curative Treatment: A Case Study in Human Epidermal Growth Factor Receptor (HER-2) Positive Targeted Therapies.

INTRODUCTION: Cancer diagnosis influences the choices that patients make regarding current and future labor market activity. These choices have implications for governments based on resulting changes in taxes paid and benefits received. In this analysis we explore how human growth receptor 2 (HER2)-positive residual invasive breast cancer and different treatments influence government accounts excluding health costs. METHODS: HER2-positive early breast cancer (eBC) health states from a published disease model were used to establish likelihood of working and wage impact at different stages of disease. The indirect productivity losses for an average woman aged 49 years were translated into fiscal consequences to government by applying an established government perspective-modeling framework. The fiscal projections (discounted) include gross tax revenue by disease stage, government transfer costs related to time off work and early retirement ,and net fiscal balance (e.g., gross taxes-transfers) in three countries Canada, Portugal, and Brazil. RESULTS: The net fiscal balance in Canada for a healthy woman was C$109,551 compared with a HER2-positive eBC woman treated with trastuzumab emtansine (C$69,767) or trastuzumab (C$62,971). A similar pattern was observed in the three countries but reflecting the overall tax burden in each country, labor force activity, and available public benefits. Age at diagnosis was an important determinant of the likely net fiscal balance, as this influences the remaining working years. DISCUSSION: Women diagnosed with HER2-positive eBC were estimated to pay less lifetime gross taxes and receive more in sickness benefits compared with healthy women. Treatments that improve outcomes are likely to offer fiscal gains for government from improved work force participation.

Challenges in Managing a Case of Neonatal Listeriosis in Portugal.

A male neonate was born at 34 weeks due to spontaneous labor with associated fetal distress and meconium-stained amniotic fluid. The neonate presented with septic shock and congenital pneumonia shortly after birth and later neurological symptoms. Listeria monocytogenes was identified in blood samples, but with negative urine and cerebrospinal fluid cultures. The neonate required assisted ventilation for a period of 10 days and received high-dose and long-term antibiotic therapy. Despite the fact that the mother denied an infectious risk for listeriosis infection, she developed mild respiratory symptoms. Her microbiological investigation was negative, although it did not include placental samples. Vertical transmission in this case was presumed but not confirmed. The newborn was discharged asymptomatic at day 26 of life and has presented normal developmental evolution until present, at eight months old. Listeria monocytogenes is a classic but relatively rare cause of neonatal sepsis and meningitis. This case describes a clinically successfully managed case with no possible epidemiological link and illustrates the challenges in managing cases of a public health disease. In neonatal listeriosis, communication between Neonatology and Obstetrics departments, as well as with public health, is vital, and long-term follow-up is crucial to identify possible neurological sequelae.

Cost-effectiveness Analysis of Ocrelizumab for the Treatment of Relapsing and Primary Progressive Multiple Sclerosis in Portugal.

OBJECTIVES: Ocrelizumab demonstrated significant clinical benefit for the treatment of relapsing (RMS) and primary progressive (PPMS) multiple sclerosis (MS), an incurable disease characterized by disability progression. This study evaluated the clinical and economic impact of ocrelizumab relative to current clinical practice, including other disease-modifying therapies (DMT), available in Portugal. METHODS: Markov models for MS were adapted to estimate the impact of ocrelizumab across three patient populations: treatment-naïve RMS, previously treated RMS, and PPMS. Health states were defined according to the Expanded Disability Status Scale. For RMS, the model further captured the occurrence of relapses and progression to secondary progressive multiple sclerosis (SPMS). A lifetime time-horizon and Portuguese societal perspective were adopted. RESULTS: For RMS patients, ocrelizumab was estimated to maximize the expected time (years) without progression to SPMS (10.50) relative to natalizumab (10.10), dimethyl fumarate (8.64), teriflunomide (8.39), fingolimod (8.38), interferon ß-1a (8.33) and glatiramer acetate (8.18). As the most effective option, with quality-adjusted life year (QALY) gains between 0.3 and 1.2, ocrelizumab was found to be cost-saving relative to natalizumab and fingolimod, and presented incremental cost-effectiveness ratios (ICER) below €16,720/QALY relative to the remaining DMT. For PPMS patients, the ICER of ocrelizumab versus best supportive care was estimated at €78,858/QALY. CONCLUSIONS: Ocrelizumab provides important health benefits for RMS and PPMS patients, comparing favourably with other widely used therapies. In RMS, ocrelizumab was revealed to be either cost-saving or have costs-per-QALY likely below commonly accepted cost-effectiveness thresholds. In PPMS, ocrelizumab fills a clear clinical gap in the current clinical practice. Overall, ocrelizumab is expected to provide good value for money in addressing the need of MS patients.

Assessment of the Concurrent Validity of the ICF Core Set to Classify the Physical Health of Community-Dwelling Older Adults in Relation to Self-Rated Health.

BACKGROUND AND PURPOSE: The present study aimed to assess the concurrent validity of the International Classification of Functioning, Disability and Health (ICF) core set to classify physical health of older adults in relation to self-rated health. METHODS: This is a methodological study conducted in Santa Cruz, Rio Grande do Norte (RN) state, in Northeastern Brazil, with 101 community-dwelling older adults. The participants rated their health status, which was classified into 3 groups: very good, fair, and poor/very poor. An interview was then conducted using self-reported and objective measurements to classify physical health according to the ICF core set. It consists of 30 categories, 14 of which belong to the body function (b) component, 4 to body structures (s), 9 to activities and participation (d), and 3 related to environmental factors (e). To analyze the compromised and problematic categories in the ICF, an impairment index was created for each component. The relationship between self-rated health and the impairment indexes was assessed using the multinomial logistic regression test adjusted for age, sex, schooling, and perception of income sufficiency. RESULTS: A greater likelihood of poor or very poor self-rated health was found in older individuals with the highest impairment index in (b) (odds ratio [OR] = 1.18; P < .001); (s) (OR = 1.11; P ≤ .001); (d) capacity (OR = 1.09; P = .02); and (d) performance (OR = 1.08; p = 0.01). CONCLUSION: The results suggest that the ICF core set is a valid instrument to assess the physical health of older adults, since it is associated with self-rated health and shows potential for use in clinical practice and scientific research, with universal language regarding functionality and physical health in older adults.

Fever in a Patient with a Central Venous Catheter Colonized by Pandoraea pnomenusa.

Pandoraea species are a newly described genus of multidrug-resistant, non-fermentative Gram-negative bacilli, mainly isolated from sputum samples of cystic fibrosis patients. In immunocompromised patients or with high antibiotic selective pressure, these pathogens are generally opportunistic and invasive. Although Pandoraea spp. are rare, the true incidence of these infections may be underestimated due to difficulties in microbial identification by phenotypic methods. We present the case of a 51-year-old woman, with new-onset fever after a prolonged hospitalization and multiple courses of antibiotics. Mass spectrometry assays identified Pandoraea pnomenusa in the blood cultures taken from the central venous catheter and in the catheter tip. Fever cessation after catheter removal suggests a catheter-related bloodstream infection. To the best of our knowledge, this is the first isolation of a Pandoraea spp. in Portugal, which should raise awareness to the emergence of these opportunistic and multidrug-resistant microorganisms, and the importance of its prompt identification.

O género Pandoraea é constituído por bacilos Gram-negativo não fermentadores multirresistentes, maioritariamente isolados em amostras respiratórias de doentes com fibrose quística. No entanto, em doentes imunodeprimidos e/ou sujeitos a elevada pressão antibiótica, podem ser agentes invasivos e oportunistas. Apesar de estas infeções serem raras, a incidência pode estar subestimada por dificuldades na sua identificação por métodos fenotípicos. Apresentamos um caso clínico de uma mulher de 51 anos, com febre de novo após um internamento complexo e múltiplos ciclos de antibioterapia. Nas hemoculturas colhidas do cateter venoso central e na ponta do cateter foi identificada, por espectrometria de massa, uma Pandoraea pnomenusa. A resolução da febre após retirada do cateter sugere uma bacteriemia associada a cateter. Tanto quanto é do nosso conhecimento, este é o primeiro caso reportado de Pandoraea spp. em Portugal, pondo em evidência a necessidade de se estar alerta para a emergência de agentes de infeção multirresistentes, bem como a necessidade da sua identificação precoce.

Hip abductor versus adductor strengthening for clinical outcomes in knee symptomatic osteoarthritis: A randomized controlled trial.

BACKGROUND: Hip adductors and abductors are weak in patients with knee osteoarthritis (KOA). However, most studies have not investigated selective adductor strengthening. OBJECTIVE: To compare the effects of adding selective hip abductors versus adductors strengthening to lower limb multimodal exercise program for pain, self-reported function, knee-related quality of life, medication ingested and performance-based tests in patients with symptomatic KOA. DESING: Randomized controlled trial. METHODS: Sixty-six patients with KOA were randomly assigned to two treatment groups: hip abductor group (HABG) or hip adductor group (HADG). Both groups performed a lower limb multimodal exercise program. HABG and HADG groups added three hip abduction and three hip adduction exercises, respectively. Intensity of pain through numeric pain scale, Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, Lequesne questionnaire, global perceived effect scale, medication ingested, performance-based tests were assessed at baseline, after 6 weeks, and 6 months. RESULTS: No significant between-group differences were found in primary outcomes: pain intensity (mean difference = -1.15, 95%CI -2.44 - 0.12, P = 0.07), KOOS-pain (mean difference = 1.64, 95%CI -6.79 - 10.07, P = 0.70) and KOOS-function in daily living (mean difference = -0.12, 95%CI, -8.78 - 8.54, P = 0.97) in 6 weeks. Groups did not differ in any secondary outcome after 6 weeks or after 6 months (P > 0.05). CONCLUSIONS: There is no difference between adding hip abductors or adductors strengthening to lower limb multimodal exercise program in improving pain, self-reported function, quality of life, medication ingested and performance-based tests in patients with KOA.

Composition and spatial distribution of floating plastic debris along the estuarine ecocline of a subtropical coastal lagoon in the Western Atlantic.

With the objective of characterizing the composition and spatial distribution of plastic fragments in a subtropical lagoon system, five sample areas affected by various anthropogenic impacts were chosen in the southern part of the Estuarine Lagoon System in Laguna, Santa Catarina, Brazil. The total density of the floating meso- and microplastics encountered was 7.32/m3, with the greatest density in the access channel and external area of the lagoon. Plastic filament was the most abundant and mainly comprised polyester (PET), polypropylene (PP) and polyethylene (PE) from 0.05 to 0.71 mm2. Fishing and urbanization were the main sources of the meso- and microplastics in the environment. This is the first study to evaluate contamination by meso- and microplastics in the southern part of the Estuarine Lagoon System and provides information about the nature and extent of contamination by plastics in this estuarine ecosystem.

Reliability, validity and responsiveness of the Step Up and Down (StUD) test for individuals with symptomatic knee osteoarthritis.

BACKGROUND: Stair climbing test (SCT) has been suggested as the first task affected in individuals with symptomatic knee osteoarthritis (KOA). However, there are environmental barriers for the execution of the 9- to 12-step SCT. Thus, we developed a feasible one-step SCT that could be completed in 15s. OBJECTIVE: To check the clinimetric properties of the 15s Step Up and Down (StUD) test in individuals with KOA. DESIGN: Prospective validity study. METHOD: Eighty-two individuals with KOA participated in this study. The test-retest reliability of the StUD test was measured with a 1-week interval. The construct validity and responsiveness were assessed by testing predefined hypotheses. For this, the 30s Chair Stand Test (30CS), Timed Up and Go Test (TUG), quadriceps strength, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lequesne Algofunctional Index were used as comparator instruments. RESULTS: The StUD test presented good test-retest reliability (ICC = 0.87; 95% CI = 0.79-0.91) and showed a moderate to good correlation with the 30CS (r = 0.65), TUG (r = -0.56), and quadriceps strength (r = 0.41). We found a higher correlation between the StUD test and the performance-based tests than the patient-reported outcome measures. The StUD test was responsive, with five out of the six (83.3%) hypotheses confirmed. CONCLUSION: StUD test showed good reliability, adequate validity and responsiveness. Our findings suggest that StUD is a useful performance-based test for individuals with KOA.

Outcomes on Social and Classic Cognition in adults with Pediatric-onset Multiple Sclerosis.

BACKGROUND: Cognitive impairment affecting classic and social domains has been consistently reported in patients with Multiple Sclerosis (MS). However, little is known about the cognitive outcomes, particularly on social cognition, in adults with pediatric-onset multiple sclerosis (POMS). OBJECTIVES: To compare the performance in classic and social cognitive domains between adults with POMS and adult-onset MS (AOMS). METHODS: A group of 30 patients with POMS (age onset <18 years) was compared with age-matched (AOAMS, n=30) and disease duration-matched (AODMS, n= 30) patients who developed MS after the age of 18 years. Cognitive performance was assessed using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and Theory of Mind (ToM) tests. RESULTS: Cognitive impairment was more prevalent in POMS patients (40% vs. 16.7%, p=0.045), independently of age or disease duration, affecting more severely information-processing speed and visual memory domains. No statistically significant differences were found in ToM performance between patients with POMS and AOMS. When analyzing ToM performance according to age of disease onset (≤15 years; 15-20 years; ≥20 years), patients with disease onset ≤15 years old had significantly lower scores on ToM tests when compared to the other groups. CONCLUSION: Patients with POMS were more prone to develop impairment on classic cognitive domains than on ToM ability, when compared with AOMS patients. The interference of POMS with critical neurodevelopmental periods, specific for each cognitive domain, may explain different outcomes at adulthood on social and classic cognition.

Convergent validity and reproducibility of the International classification of functioning, disability and health (ICF) core set for the physical health of community-dwelling older adults.

BACKGROUND: Physical health is an important factor for what is considered successful aging. Using valid and reproducible tools to classify PH of older adults may help to develop appropriate rehabilitation protocols for this population. OBJECTIVE: To evaluate the convergent validity and reproducibility of the International Classification of Functioning, Disability and Health (ICF) core set to classify the physical health of older adults. METHODS: A total of 101 older adults were evaluated for handgrip strength, physical performance (Short Physical Performance Battery), and physical activity level (International Physical Activity Questionnaire). Physical health was classified with the ICF core set (14 categories of body functions, 4 of body structures, 9 of activity and participation, and 3 environmental factors) and an impairment index was calculated for each component. RESULTS: Higher levels of physical activity were associated to lower impairment index in the body function and activity and participation components, but was not associated to environmental factors. Better physical performance and handgrip strength were also related to lower impairment index in all components. The Intraclass Correlation Coefficient analysis indicated good reproducibility for body function, body structure, the capacity component of the activity and participation, and for two environmental factors (use of medications and assistive devices), but moderate reproducibility for the performance component of activity and participation, and poor reproducibility for the environmental factor related to access to health services. CONCLUSION: The ICF core set for the physical health of older adults is a valid and reproducible tool and can be used in clinical practice and research.

A saúde do idoso na graduação em fisioterapia no Brasil: um estudo transversal / La salud del anciano en el grado en fisioterapia en Brasil: un estudio transversal / The health of older people in the physical therapy undergraduate program in Brazil: a cross-sectional study

RESUMO O envelhecimento populacional vem ocorrendo rapidamente em todo o mundo, levando à necessidade de capacitação dos profissionais de saúde envolvidos no cuidado ao idoso, dentre eles o fisioterapeuta. O objetivo deste estudo foi descrever o perfil dos cursos de fisioterapia de instituições do ensino superior (IES) do Brasil quanto ao ensino direcionado à saúde do idoso. Trata-se de um estudo observacional e transversal. Foi realizado um levantamento de informações sobre os cursos de fisioterapia do Brasil através de análise da grade curricular, projetos pedagógicos e formulário específico. Foram analisadas 525 IES, das quais 91,3% oferecem uma disciplina que aborda a saúde do idoso, sendo 98,4% de caráter obrigatório e 91,3% do tipo teórico-prático. Nas práticas, 25,6% são em campo de estágio, sendo 81,9% realizadas com idosos voluntários e 54,9% direcionadas a todos os níveis de atenção. Ao analisar a distribuição da disciplina por região, observou-se que esta está mais presente na região Sudeste (40,2%) (p=0,03). As IES do Brasil abordam, em sua maioria, a saúde do idoso na grade curricular do curso de fisioterapia. No entanto, a distribuição dessa disciplina no país é desigual, podendo trazer divergências na conduta terapêutica e representar prejuízos na qualidade da assistência ao idoso.

RESUMEN El envejecimiento de la población ha estado ocurriendo rápidamente en el mundo, lo que resulta necesaria la capacitación de los profesionales de la salud involucrados en el cuidado del anciano, incluido el fisioterapeuta. El presente estudio tuvo el objetivo de describir el perfil de los cursos de fisioterapia en las instituciones de educación superior (IES) en Brasil con respecto a la enseñanza sobre la salud del anciano. Es un estudio observacional y transversal. Se realizó una recopilación de informaciones sobre los cursos de fisioterapia en Brasil mediante el análisis del plan de estudios, los proyectos pedagógicos y un formulario específico. Se analizaron 525 IES, de las cuales el 91,3% ofertan una materia que aborda la salud del anciano, de esta, el 98,4% son obligatorias y el 91,3% del tipo teórico-prácticas. En las del tipo prácticas, el 25,6% están en el ámbito de pasantías, siendo que el 81,9% se realizan con ancianos voluntarios y el 54,9% están dirigidas a todos los niveles de atención. En el análisis de la distribución de la materia por región, se observó una mayor presencia en la región Sudeste (40,2%) (p=0,03). La mayoría de las IES en Brasil abordan la salud de los ancianos en el plan de estudios del curso de fisioterapia. No obstante, la distribución de la materia es desigual en el país, lo que puede resultar en divergencias en la conducta terapéutica e influir negativamente en la calidad de la asistencia a los ancianos.

ABSTRACT Population aging has been occurring rapidly around the world, leading to the need for training for health professionals involved in caring for older adults, including the physical therapist. The aim of this study was to describe the profile of physical therapy courses in higher education institutions (HEIs) in Brazil regarding teaching directed to the health of older adults. This is an observational, cross-sectional study. A survey of information on physical therapy courses in Brazil was carried out through analysis of the curriculum, pedagogical projects and specific form. We analyzed 525 HEIs, of which 91.3% offer a discipline that addresses the health of older people, 98.4% of which is mandatory and 91.3% is the theoretical-practical type. In practice, 25.6% are in the internship field, with 81.9% carried out with older volunteers and 54.9% directed to all levels of care. When analyzing the distribution of the discipline by region, it was observed that it is more present in the Southeast (40.2%) (p=0.03). Most HEIs in Brazil address the health of older adults in the curriculum of the physical therapy course. However, the distribution of this discipline in the country is uneven, which can lead to divergences in therapeutic practice and represent losses in the quality of care for older people.

Changes in employment status up to 5 years after breast cancer diagnosis: A prospective cohort study.

AIM: To assess how sociodemographic, clinical and treatment characteristics impact employment status five-years following a breast cancer diagnosis, and to compare the incidence rate of changes with the general population. METHODS: A total of 462 women with incident breast cancer were evaluated before treatment and three- and five-years later. Adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) were computed through multinomial logistic regression. Data for comparisons were retrieved from the SHARE Project. Incidence rate ratios (IRRs) with 95%CIs were calculated using Poisson regression. RESULTS: Among the 242 employed women prior to diagnosis, 162 remained employed, 26 became unemployed, 27 entered early retirement, 14 entered normal retirement and 13 were on sick leave at five-years. Unemployment increased with age (≥55 vs < 55 years: OR = 4.49, 95%CI:1.56-12.92; OR = 3.40, 95%CI:1.05-10.97 at three- and five-years, respectively) and decreased with education (>4 vs ≤ 4 years: OR = 0.36, 95%CI:0.13-0.97; OR = 0.27, 95%CI:0.10-0.71 at three- and five-years, respectively). Axillary surgery (unemployment at five-years: OR = 5.13, 95%CI:1.30-20.27), hormonal therapy (unemployment at three-years: OR = 0.28, 95%CI:0.10-0.83) and targeted therapy (sick leave at three-years: OR = 3.79, 95%CI:1.14-12.63) also influenced employment status. Five-years post diagnosis, women with breast cancer had a lower incidence of unemployment (IRR = 0.51, 95%CI:0.30-0.89) than the general population, while, among older women, there was a higher tendency to enter early retirement (IRR = 1.72, 95%CI:0.82-3.61). CONCLUSIONS: Although not all women may want to pursue or continue a professional life following their breast cancer experience; those who do may benefit from social and employer support when returning to work.

Two Year Outcomes, Cognitive and Behavioral Markers of Decline in Healthy, Cognitively Normal Older Persons with Global Deterioration Scale Stage 2 (Subjective Cognitive Decline with Impairment).

BACKGROUND: Little is known with respect to behavioral markers of subjective cognitive decline (SCD), a condition initially described in association with Global Deterioration Scale (GDS) stage 2. OBJECTIVE: Two-year interval behavioral markers were investigated herein. METHODS: Subjects from a published 7-year outcome study of GDS stage 2 subjects were selected. This study had demonstrated a hazard ratio of 4.5 for progression of GDS stage 2, in comparison with GDS stage 1 (no subjective or objective cognitive decline) subjects, after controlling for demographic and temporal variables. Because GDS 2 subjects have previously demonstrated impairment in comparison with healthy persons free of complaints, we herein suggest the terminology "SCD(I)" for these persons. 98 SCD(I) persons, 63 women and 35 men, mean baseline age, 67.12±8.75 years, with a mean educational background of 15.55±2.60 years, and mean baseline MMSE scores of 28.9±1.24 were followed for 2.13±0.30 years. RESULTS: Observed annual decline on the GDS was 6.701% per annum, very close to a 1986 published estimate. At follow up, the MMSE, and 7 of 8 psychometric tests did not decline significantly. Of 21 Hamilton Depression Scale items, 2 improved and the remainder were unchanged. Anxieties declined from multiple perspectives. The Brief Cognitive Rating Scale (BCRS) declined significantly (p < 0.001), with component declines in Remote memory (p < 0.01), and Functioning/self-care (p = 0.01). CONCLUSION: SCD(I) persons decline at an annual rate of approximately 6.7% /year from several recent studies. The BCRS assessments and the Digit Symbol Substitution Test can be sensitive measures for future studies of progression mitigation.

Light chain cardiac amyloidosis - a rare cause of heart failure in a young adult

SUMMARY Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic. In the first visit, he showed signs and symptoms of overt congestive heart failure and was referred to the emergency department. The electrocardiogram showed sinus tachycardia and low voltage criteria. Echocardiography showed biventricular hypertrophy with preserved ejection fraction, restrictive physiology with elevated filling pressures, thickened interatrial septum and atrioventricular valves, small pericardial effusion and relative "apical sparing" on 2D longitudinal strain. Cardiac MRI showed diffuse subendocardial late enhancement. Serum protein electrophoresis was inconclusive, however urine analysis revealed nephrotic range proteinuria, positive Bence Jones protein and an immunofixation test with a monoclonal lambda protein band. Abdominal fat biopsy was negative for Congo red stain, nevertheless a bone marrow biopsy was performed, revealing lambda protein monoclonal plasmocytosis, confirming the diagnosis of primary systemic amyloidosis. This case represents a rare cause of heart failure in a young adult. Low-voltage QRS complexes and typical echocardiography features should raise the suspicion for cardiac amyloidosis. Prognosis is dictated by the level of cardiac involvement; therefore, early diagnosis and treatment are crucial.

RESUMO A amiloidose cardíaca corresponde a uma miocardiopatia infiltrativa, resultante do depósito da proteína amiloide no miocárdio. Na amiloidose sistêmica primária (tipo AL), a proteína amiloide é composta por cadeias leves que resultam de discrasia dos plasmócitos, havendo envolvimento cardíaco em até 50% dos doentes. Apresentamos o caso de um homem de 43 anos, com queixas de edema periódico da língua e xerostomia, hemorragia gengival e hematúria há dois meses. Analiticamente havia a destacar anemia normocítica, trombocitopenia e um INR alto espontâneo, pelo que foi referenciado à consulta de Medicina Interna. Na primeira consulta, apresentou-se com sinais de insuficiência cardíaca congestiva franca, pelo que foi referenciado ao Serviço de Urgência. O eletrocardiograma demonstrou taquicardia sinusal e critérios de baixa voltagem. O ecocardiograma revelou hipertrofia biventricular com fração de ejeção preservada, fisiologia restritiva com elevação das pressões de enchimento, espessamento do septo interauricular e das válvulas auriculoventriculares, derrame pericárdico ligeiro e padrão de apical sparing no strain longitudinal 2D. Realizou ainda ressonância magnética cardíaca, que mostrou realce tardio subendocárdico difuso. A eletroforese das proteínas foi inconclusiva, contudo a análise da urina revelou proteinúria no espectro nefrótico, presença de proteína de Bence Jones e um teste de imunofixação com uma banda monoclonal de cadeias lambda. A biópsia da gordura abdominal foi negativa. Não obstante, foi realizada uma biópsia da medula óssea, verificando-se plasmocitose monoclonal lambda, o que confirmou o diagnóstico de amiloidose primária sistêmica. Este caso representa uma causa rara de insuficiência cardíaca no jovem adulto. A baixa voltagem no eletrocardiograma e os achados ecocardiográficos típicos devem fazer suspeitar de amiloidose cardíaca. O prognóstico é ditado pelo nível de envolvimento cardíaco, motivo pelo qual o diagnóstico e o tratamento precoces são essenciais.

Light chain cardiac amyloidosis - a rare cause of heart failure in a young adult.

Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic. In the first visit, he showed signs and symptoms of overt congestive heart failure and was referred to the emergency department. The electrocardiogram showed sinus tachycardia and low voltage criteria. Echocardiography showed biventricular hypertrophy with preserved ejection fraction, restrictive physiology with elevated filling pressures, thickened interatrial septum and atrioventricular valves, small pericardial effusion and relative "apical sparing" on 2D longitudinal strain. Cardiac MRI showed diffuse subendocardial late enhancement. Serum protein electrophoresis was inconclusive, however urine analysis revealed nephrotic range proteinuria, positive Bence Jones protein and an immunofixation test with a monoclonal lambda protein band. Abdominal fat biopsy was negative for Congo red stain, nevertheless a bone marrow biopsy was performed, revealing lambda protein monoclonal plasmocytosis, confirming the diagnosis of primary systemic amyloidosis. This case represents a rare cause of heart failure in a young adult. Low-voltage QRS complexes and typical echocardiography features should raise the suspicion for cardiac amyloidosis. Prognosis is dictated by the level of cardiac involvement; therefore, early diagnosis and treatment are crucial.

Y balance test has no correlation with the Stability Index of the Biodex Balance System.

STUDY DESIGN: A cross-sectional study design. BACKGROUND: The Stability Index of the Biodex Balance System (SI-BBS) and Y Balance Test (YBT) has been used in studies assessing postural stability but no studies have verified the association of the YBT with the SI-BBS. OBJECTIVE: To analyze the association of the Y Balance Test (YBT) with the Stability Index of the Biodex Balance System (SI-BBS) to evaluate postural stability. METHODS: Forty participants who engaged in recreational physical activities, 12 of whom had a history of injury to the lower limbs. Was used the SI-BBS and the anterior, posterolateral, posteromedial, and composite measures of the YBT. The order of execution of the tests and of the lower limbs evaluated was randomized and blind tested by two evaluators. RESULTS: Pearson's correlation coefficient was used to check the strength of the relationship between the distances achieved on the YBT and the SI-BBS. The YBT showed excellent reliability in the anterior, posteromedial, and posterolateral directions. However, the YBT showed no statistically significant correlation with any variables in the SI-BBS, indicating poor validity between YBT and SI-BBS assessments of postural stability in people with and without history of lower limb injuries. CONCLUSIONS: The results of this study showed the YBT is not correlated with the SI-BBS as an assessment of postural stability. This finding has implications for researchers and clinicians using YBT results as the only measure of postural stability.