Predictive and concurrent validity of the Malnutrition Universal Screening Tool using mid-upper arm circumference instead of body mass index.

BACKGROUND: Considering the difficulty in obtaining weight and height measurements of patients at hospital admission, the Malnutrition Universal Screening Tool (MUST) proposes the use of mid-upper arm circumference (MUAC) instead of body mass index (BMI) as an alternative for screening of malnutrition risk. The present study aimed to evaluate the performance of MUST with MUAC in place of BMI to identify nutritional risk and predict prolonged hospitalisation and mortality in hospitalised patients. METHODS: The prospective cohort study involved ambulant patients aged ≥18 years who were admitted to the emergency department of a public hospital. A questionnaire concerning clinical and socio-demographic data was applied and anthropometric measurements were performed (weight, height, BMI and MUAC). Nutritional risk screening was performed using the original MUST (BMI) and MUST-MUAC tools. The outcomes were length of hospital stay and death. RESULTS: Seven hundred and fifty-two patients were included and followed-up for 13.5 (interquartile range 3.00-19.00) days. The frequency of patients at nutritional risk was higher according to MUST-MUAC (48.9%) compared to the original MUST (37.1%). MUST-MUAC showed concurrent validity, demonstrating good agreement with the original MUST (k = 0.690), high sensitivity (95.3%) and accuracy (area under the curve = 0.868; 95% confidence interval = 0.841-0.895) with respect to identifying nutritional risk. The presence of nutritional risk detected by the MUST-MUAC increased the chance of prolonged hospital stay by 1.9 (95% CI. 1.4-2.7)-fold and mortality by 3.2 (95% CI. 1.1-9.4)-fold. CONCLUSIONS: MUST-MUAC showed satisfactory concurrent and predictive validity. Considering that MUAC measurement is easier to perform than BMI, the MUST-MUAC should be used for screening of nutritional risk in hospitalised patients.

Nutrition screening in public hospital emergency rooms: Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002 can be applied.

OBJECTIVE: To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. STUDY DESIGN: Cross-sectional study. METHODS: Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48 h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. RESULTS: The study included 577 patients, with an average age of 53.9 ± 15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. CONCLUSION: MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.

Resposta reprodutiva de vacas de corte associada a marcadores moleculares relacionados à fertilidade / Reproductive performance of beef cattle cows associated with molecular markers related to the fertility

O objetivo deste estudo foi buscar associação entre a taxa de prenhez após inseminação e natalidade com marcadores moleculares ligados aos genes do receptor para IGF-1, LHβ, Leptina e receptores do FSH e LH. Utilizaram-se 249 vacas adultas Aberdeen Angus, das quais 199 foram submetidas a protocolos distintos para a IATF, seguida pelo repasse com touros, e 50 vacas formaram o grupo controle representado pelo acasalamento com touros. Foram avaliados o escore de condição corporal (ECC) e o escore de condição ovariana (ECO) ao início da estação reprodutiva. O ECC influenciou a taxa de natalidade, respectivamente de 55,6%, 75,8% e 82,4% (P<0,05) para os animais com ECC menor que 2,5, entre 2,5 a 2,9, e maior ou igual a 3,0, por ocasião da estação reprodutiva. Os marcadores relacionados ao gene do receptor para o IGF-1 (AFZ-1 e HEL5) mostraram associação com a taxa de natalidade. Vacas homozigóticas para o marcador AFZ-1 apresentaram 84,4% de natalidade em comparação às heterozigóticas, com 71,5% (P<0,05). A presença do alelo*161 para o marcador HEL5 foi negativa sobre a natalidade, respectivamente de 33,3% e 76,5% para vacas com e sem esse alelo (P<0,05). Esses resultados demonstram uma importante associação entre os marcadores envolvidos com o receptor para o IGF-1 e desempenho reprodutivo de vacas Angus.

The association between the reproductive performance, expressed by pregnancy rate at fixed timed artificial insemination and birth rate in the subsequent season in beef cows, and molecular markers linked to genes for IGF-1 receptor, LHβ, leptin, and FSH and LH receptors were evaluated. Data from 249 Aberdeen Angus adult cows were used in this study. One hundred and ninety-nine cows were subjected to four different protocols for FTAI, followed by clean-up bulls and 50 cows formed the control group, matted only with bulls for 90 days during the mating season. Body condition score (BCS) and ovarian condition score (OCE) were evaluated at the beginning of the breeding season. The birth rate in the following year was 75.5%, with no treatments influence. The BCS has influenced the birth rate, respectively 55.6%, 75.8% and 82.4% (P<0.05) for animals with BCS less than 2.5; 2.5 to 2.9; and greater than or equal to 3.0, at the beginning of the breeding season. The markers related to IGF-1 receptor gene (AFZ-1 and HEL5) were associated with the birth rate in beef cows. Cows homozygous for AFZ-1 marker showed 84.4% of birth rate, while heterozygous cows showed 71.5% (P <0.05). The presence of allele *161 to the HEL5 marker was negative on birth rate. Cows with this allele had only 33.3% of birth rate, while cows without this allele had 76.5% of birth rate (P <0.05). These results demonstrate a significant association between the markers involved with the IGF-1 receptor and reproductive performance of Aberdeen Angus beef cows.

Retardo da realização da IATF sobre o desempenho reprodutivo na estação de acasalamento de vacas de corte lactantes / Delay of beginning to FTAI on reproductive performance during to mating season of beef lactating cows

Compararam-se efeitos de diferentes protocolos para a IATF com o acasalamento natural (Controle) sobre o desempenho reprodutivo de 249 vacas Aberdeen Angus, distribuídas em cinco grupos: Controle (n=50); Crestar 2º uso (n=64); OvSynch (n=65); Primer 1ºuso (n=35) e Primer 2º uso (n=35). A IATF dos animais dos grupos Crestar 2º uso, OvSynch, e Primer 1º uso foi realizada 27 dias após o início da estação do grupo controle e a IATF do grupo Primer 2º uso ocorreu 38 dias após o início da estação do grupo-controle. A partir de sete dias após a IATF, os animais foram submetidos ao repasse por touros até o término da estação de acasalamento, que foi de 91 dias para o grupo-controle, 64 dias para os grupos Crestar 2º uso, OvSynch e Primer 1º uso e de 53 dias para o grupo Primer 2º uso. A taxa de gestação ao final da estação de acasalamento não se diferenciou entre os grupos (P>0,05), sendo de 85,9%; 83,1%; 82,9%; 88,6% e 80,0%, respectivamente, para Crestar 2º uso; OvSynch; Primer 1º uso; Primer 2º uso e Controle. A taxa de parição resultante da IATF foi de 23,4%; 29,2%; 48,6% e 62,9% para os grupos Crestar 2º uso, OvSynch, Primer 1º uso, Primer 2º uso, respectivamente, com diferença significativa (P<0,05) entre Crestar e Primer 1º e 2º uso. OvSynch não se diferenciou de Crestar e Primer 1º uso. Primer 1º uso não se diferenciou de Primer 2º uso. A perda gestacional, do diagnóstico de gestação ao nascimento, foi de 10,5%. O intervalo de partos estimado (IEP) não apresentou diferenças, com média de 478 dias. O escore de condição corporal (ECC) de fêmeas gestantes ao final da estação reprodutiva foi diferente do de fêmeas não gestantes (controle), mas não dos demais grupos, possivelmente pela influência do tratamento em induzir a ciclicidade dos animais com ECC inferior. O atraso da realização da IATF após 27 ou 38 dias do início da estação de acasalamento não afetou a taxa de gestação final e o IEP dos animais, quando comparado ao acasalamento por touros.

The effects of different FTAI protocols were compared to the natural mating of bulls on the reproductive performance of 249 Aberdeen Angus cows. Five groups were formed: Control (n=50); Crestar 2nd use (n=64); OvSynch (n=65); Primer 1st use (n=35) and Primer 2nd use (n=35). The FTAI of the animals in the Crestar 2nd use, OvSynch and Primer 1st use groups was accomplished 27 days after the beginning of the mating season for the control group and the FTAI in the Primer 2nd use group happened 38 days after the beginning of the mating season of the control group. From seven days after the FTAI cows were exposed to bulls until the end of the mating season. The mating season was of 91 days for the control group, 64 days for the Crestar 2nd use, OvSynch and Primer 1st use groups and 53 days for the Primer 2nd use group. The pregnancy rate at the end of the mating season didn't differ among the groups (P>0.05), being 85.9; 83.1; 82.9; 88.6 and 80.0% respectively, for Crestar 2nd use, OvSynch, Primer 1st use, Primer 2nd use and Control. The birth rate resulting from FTAI was 23.4; 29.2; 48.6 and 62.9% for the Crestar 2nd use, OvSynch, Primer 1st use, Primer 2nd use groups, with significant difference (P<0.05) among Crestar and Primer 1st and 2nd use. OvSynch didn't differ in Crestar and Primer 1st use. Primer 1st use didn't differ from Primer 2nd use. The average reproductive losses between the gestation diagnosis and the birth were10.5%. The estimated calving interval (CI) didn't present differences among the animal groups, with an average of 478 days. The body condition score (BCS) of pregnant cows at the end of the reproductive station differed from BCS of empty cows in the control group, but it didn't differ in the other groups, possibly due to the hormonal treatment influence in inducing the oestrus and ovulation in animals with lower BCS. The delay of the accomplishment of FTAI after 27 or 38 days of the beginning of the mating season didn't affect the final pregnancy rate and CI of the cows, when compared to natural mating.

Perdas reprodutivas e reconcepção em bovinos de corte segundo a idade ao acasalamento / Reproductive disorders and reconception of beef cows according to of mating age

Avaliou-se o desempenho reprodutivo de novilhas de corte acasaladas aos 14 meses (14M), aos 24 meses (24 M) e de vacas multíparas (V), totalizando 4.012 animais. As perdas reprodutivas (PR) foram de 19,3 por cento, 11,6 por cento e 7,6 por cento para 14M, 24M e V, respectivamente, sendo que 14M diferiu de V (P<0,01). A ocorrência de distocia foi de 20,7 por cento, 5,1 por cento e 0,8 por cento para as categorias 14M, 24M e V, respectivamente, sendo que 14M diferiu de V (P<0,01). Ocorreu maior mortalidade causada por distocia entre os animais do grupo 14M que entre os do grupo V (P<0,01), 7,4 por cento e 0,4 por cento, respectivamente. A reconcepção foi maior nos animais de 14M (85,3 por cento) e V (81,1 por cento), comparada à dos de 24M (70,7 por cento) (P<0,01). A categoria que teve maior concentração de parição no primeiro período, 52,3 por cento (até 19/09), foi a de 24M (P<0,01). Animais acasalados mais jovens tendem a apresentar maiores perdas reprodutivas e ocorrências de distocia.

Reproductive performances of beef heifers mated at 14 months of age (14M), at 24 months of age (24M) and pluriparous cows (C), based on data from 4.012 animals were evaluated. The reproductive disorders were 19.3 percent, 11.6 percent and 7.6 percent, respectively, at 14M, 24M and for C; 14M was different from C (P<0.01). The occurrence of dystocia was 20.7 percent, 5.1 percent and 0.8 percent for the 14M, 24M and C, respectively. The 14M group was different from C (P<0.01). The mortality caused by dystocia was higher for 14M group 7.4 percent than for the C group 0.4 percent (P<0.01), respectively. The reconception rate was higher for the 14M (85.3 percent) and V (81.1 percent) than for the 24M group (70.7 percent) (P<0.01). The category which concentrated the parturition in the first period (until 09/19) (52.3 percent) was the 24M. Animals mated earlier tended to show high reproductive disorders and incidence of dystocia.

Effectiveness of primary angioplasty in the treatment of acute myocardial infarction. Analysis of in-hospital and late outcomes in 135 consecutive cases.

OBJECTIVE: Evaluate early and late evolution of patients submitted to primary coronary angioplasty for acute myocardial infarction. METHODS: A prospective study of 135 patients with acute myocardial infarction submitted to primary transcutaneous coronary angioplasty (PTCA). Success was defined as TIMI 3 flow and residual lesion <50%. We performed statistical analyses by univariated, multivariated methods and survival analyze by Kaplan-Meier. RESULTS: PTCA success rate was 78% and early mortality 18,5%. Killip classes III and IV was associated to higher mortality, odds ratio 22.9 (95% CI: 5,7 to 91,8) and inversely related to age <75 years (OR = 0,93; 95% CI: 0.88 to 0.98). If we had chosen success flow as TIMI 2 and had excluded patients in Killip III/IV classes, success rate would be 86% and mortality 8%. The survival probability at the end or study, follow-up time 142 +/- 114 days, was 80% and event free survival 35%. Greater survival was associated to stenting (OR = 0.09; 0.01 to 0.75) and univessel disease (OR = 0.21; 0.07 to 0.61). CONCLUSION: The success rate was lower and mortality was higher than randomized trials, however similar to that of non randomized studies. This demonstrated the efficacy of primary PTCA in our local conditions.

Protective effect of left ventricular hypertrophy in right coronary artery occlusions.

OBJECTIVE: To test the hypothesis that left ventricular hypertrophy (LVH) reduces the electrocardiographic and functional effects of right coronary artery occlusion. METHODS: We analysed 215 patients (166 males and 49 women, age of 58.9 +/- 10.6 years), with occlusion of the right coronary artery without other associated lesions. There was no significant difference (p > 0.05) in age and gender distribution between the 78 patients with LVH (left ventricular mass > 100 g/m2) (Group A) when compared with the 137 patients without LVH (left ventricular mass < 100 g/m2) (Group B). RESULTS: The electrocardiographic finding of transmural necrosis was more often found in group B patients than in group A patients (56.9% and 30.8%, respectively; p < 0.05). The left ventricular function parameters of group A were better than those of group B: the ratio end-diastolic pressure/systolic pressure (EDP/SP) (A: 0.108 +/- 0.036; B: 0.121 +/- 0.050; p < 0.05); the end-diastolic volume index (A: 75.9 +/- 31.3 ml/m2; B: 88.0 +/- 31.0 ml/m2; p < 0.01); the end-systolic volume index (A: 16.0 +/- 10.0 ml/m2; B: 27.0 +/- 20.0 ml/m2; p < 0.001); the ejection fraction (A 78.6 +/- 10.8%; B 67.7 +/- 17.9%; p < 0.001); the anteroinferior shortening (A: 43.9 +/- 10.3%; B: 35.1 +/- 12.8%; p < 0.001). A higher degree of coronary tortuosity was observed in group A than in group B (78.2% and 24.1%; p < 0.001) and also a more frequent absent or minimal diaphragmatic hypokinetic area (A: 80.8%; B: 54.0%; p < 0.05). CONCLUSION: LVH reduces the effects of myocardial sequela and protects LV function when right coronary occlusion develops.

Detection of angiographic coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA): usefulness of angina combined with rest electrocardiogram.

PURPOSE: To evaluate the value of recurrent anginal symptoms combined with seriation of conventional EKG in detecting coronary restenosis (renarrowing > or = 50% at the site dilated) after PTCA. Two hundred and seventy patients (204 men, mean age 53.1 +/- 9.4 years) with angina who submitted to successful PTCA of single-vessel coronary disease were followed and restudied angiographically 5.2 +/- 1.6 months after the procedure. At any moment from PTCA to follow-up: 1) typical angina pectoris was classified as either absent or present; 2) a 12-lead EKG was classified as improved, unchanged or worsened in comparison with the EKG either before or early after PTCA on the basis of ST-T alterations; 3) all patients underwent coronariography and were then classified as either having or lacking restenosis. The sensitivity and predictive positive value of recurrent angina, worsened EKG, or both, in detecting restenosis were respectively: 74.6% and 68.6%, 44.3% and 85.3%, and 55.9 and 91.7%. The specificity and predictive negative value of no recurrence of angina, improved EKG, or both, in detecting the absence of restenosis were respectively: 85.8% and 89.1%; 69.6% and 91.0%; and 75.6% and 93.9%. CONCLUSION: In single-vessel coronary disease, the detection of coronary restenosis after PTCA based on behavior of the symptoms plus rest EKG seriation shows acceptable degrees of sensitivity, specificity and mainly of predictive values when comparison with respective historical values of the ergometric test is considered.

[State of the art in coronary angioplasty]. / Estado da arte em angioplastia coronariana.

Based on a literature overview and on his personal experience with the method, the author analyzes the different phases in the evolution of coronary angioplasty, its indications and limitations in the contemporary setting, as well as the impact of new devices. He emphasizes: the value of the balloon as a basic instrument, followed by the stent; the various attitudes related to the technique; prevention and management of complications during and after the procedure; development, prediction and management of coronary restenosis.

[Blood cell count, sodium, potassium, calcium, osmolality and viscosity during pediatric angiocardiography with ioxaglate]. / Hemograma, sódia, potássio, cálcio, osmolalidade e viscosidade durante angiocardiografia pediátrica com ioxaglato.

PURPOSE: Children's blood changes during angiocardiography may not be only due to the contrast media (CM). METHODS: We studied the presence and severity of changes in those parameters in 35 pediatric patients undergoing angiocardiography with ioxaglate aiming to identify independent variable responsible for those changes. Blood samples were taken at the beginning of the procedure (SI), at the end (S2) and two hours later (S3). RESULTS: Hematocrit: S1 = 47.3 +/- 6.9%; S2 = 40.7 +/- 7.4% (p < 0.001), (related to the CM volume r=0.37, (p < 0.05). Hemoglobin: S1 = 15 +/- 2.1g%; S2 = 13.2 +/- 2.4g% (p < 0.001), and S3 = 12.7 +/- 2.5g% (NS). White blood cell count: S1 = 7940 +/- 3040 leukocytes/mm3; S2 = 6950 +/- 2700/mm3 (NS); S3 = 10830 +/- 4690 leukocytes/mm3 (p < 0.001). Procedure duration (r = 0.83, p < 0.05) and 5% glucose fluid given between S2 and S3 (r = 0.49, p < 0.05) were isolated. Sodium: S1 = 134.5 +/- 0.4mEq/L, S2 = 130.7 +/- 0.4mEq/L (p < 0.001) (due to 5% glucose fluid injected, r = 0.61, p < 0.01). Potassium: S1 = 4.22 +/- 0.45mEq/L, S2 = 300.6 +/- 13.3mOsm/kg (p < 0.001). Calcium: S1 = 9.13 +/- 1.03mg%; S2 = 8.4 +/- 0.91 mg/dL. (related to the CM, r = 0.43, p < 0.01.) Osmolality: S1= 293.3 +/- 12.5mOsm/kg; S2 = 3.83 +/- 0.4mEq/L (p<0.001). Viscosity: S1 = 3.36 +/- 0.81; S2 = 3.09 +/- 0.74 (p < 0.01); S3 = 3.87 +/- 0.89, p < 0.001. There was an indirect linear regression with the CM. CONCLUSION: There were profound differences among the dependent variables observed but the ioxaglate was partially related to changes in hematocrit/hemoglobin, total calcium and viscosity. We failed to demonstrate significant regression coefficient between CM and changes in leukocytes, sodium, potassium, and osmolality.

Hemograma, sódio, potássio, cálcio, osmolalidade e viscosidade durante angiocardiografia pediátrica com ioxaglato / Blood cell count, sodium, potassium, calcium, osmolality and viscosity, during pediatric angiocardiography with ioxaglate

OBJETIVO - Os meios de contraste (MC) introduzem alteraçöes em alguns parâmetros sangüíneos, adquirindo, assim, mais importância na angiocardiografia pediátrica. MÉTODOS - Estudamos a presença e a severidade das mudanças no hematócrito, hemoglobina, leucócitos, sódio, potássio, cálcio, osmolalidade e viscosidade, em 35 crianças submetidas a angiocardiografia com ioxaglato, identificando, também, as variáveis independentes responsáveis por essas alteraçöes. As amostras sangüíneas foram colhidas no início do procedimento (S1), no fim (S2) e 2h após (S3). RESULTADOS - (...fórmula...). CONCLUSÄO - Variaçöes significativas nas variáveis dependentes medidas foram observadas durante e após o procedimento. O uso do ioxaglato foi parcialmente relacionado a mudanças no hematócrito/hemoglobina, cálcio total e viscosidade mas näo as das variáveis restantes.

[Evaluation of post-intracoronary stent implant. Intravascular ultrasound versus quantitative angiography]. / Avaliação após implante de stent intracoronário. Ultra-som intravascular versus angiografia quantitativa.

PURPOSE: To verify the minimal proximal and distal residual diameters by quantitative digital angiography and intravascular ultrasound, after the implantation of the intracoronary prosthesis. METHODS: We studied twenty patients with coronary atherosclerosis, ages ranging from 40 to 77 (56.7 +/- 10) years, 13 (65%) were male. Patients with eccentric obstructive atherosclerotic lesions of 70% or more in the proximal third of the anterior descendent, circumflex, or right coronary arteries received a stent implant as treatment for the obstruction. RESULTS: The mean proximal minimal residual diameters assessed by digital angiography were 3.32 +/- 0.33 mm and by ultrasound 3.08 +/- 0.31 mm (p < 0.05); the distal diameters by angiography were 3.33 +/- 0.37 mm and by ultrasound 3.05 +/- 0.39 mm (p < 0.05). Therefore, the measurements by ultrasound were always smaller. There is a significant linear correlation between measurements by angiography and ultrasound for both proximal (r = 0.92; p < 0.0001) and distal diameters (r = 0.91; p < 0.0001). The determination coefficient was 84% for proximal diameters and 87% for distal diameters. Therefore, the proximal diameters variate 16% and distal diameters 13% between both methods, due to the peculiarities of each method. CONCLUSION: Both methods correlate adequately, concerning to the measurements; the methods are interdependent, determining with the same accuracy intracoronary diameters in most cases studied; ultrasound is a safe and feasible technical resource for the evaluation of intravascular structures; the intravascular ultrasound system can contribute for the direct analysis inside the vascular structure, immediately after intracoronary stent implanting.