Use of the serratus anterior fascia in immediate implant-based breast reconstruction

Using the serratus anterior fascia may be a safe and effective option to recreate the lateral breast profile during subpectoral breast reconstruction, with minimal functional impact on the donor site. However, the literature is scarce when it comes to studies on this fascia flap in implant-based reconstruction. This article aimed to review the use of the serratus anterior fascia in immediate implant-based breast reconstruction, searching the electronic databases PubMed, Embase, Lilacs, and SciELO. The search was carried out by combining the following keywords: 'breast reconstruction' and 'serratus anterior fascia'. In the Pubmed and Embase databases, the search yielded a total of 12 and 15 articles, respectively, of which seven were selected according to the scope of this article. We found no studies on serratus anterior fascia and breast reconstruction in the Lilacs and SciELO databases. All works have results favorable for the use of the serratus anterior fascia flap and agree that this technique can be considered in the algorithm for the coverage of the inferolateral portion during subpectoral breast reconstruction

Phase angle as a screening method for sarcopenia in community-dwelling older adults / Ângulo de fase como método de triagem para sarcopenia em idosas ativas de comunidade

ABSTRACT Objective We investigated the utility of the phase angle as a screening tool for sarcopenia. Methods We performed a cross-sectional study that included 169 active community-dwelling elderly women. The phase angle was determined using tetrapolar bioelectrical impedance, and sarcopenia was diagnosed based on skeletal muscle mass, muscle strength, and physical performance using bioelectrical impedance analysis, a handheld dynamometer, and the gait speed test, respectively. Receiver operating characteristic curve analysis was performed to investigate the role of the phase angle as a predictor of sarcopenia. Results The prevalence of sarcopenia was 12.4%. The median phase angle was 5.30°; elderly women with sarcopenia had lower phase angles than those without sarcopenia (p=0.006). The phase angle cutoff for the detection of sarcopenia was ≤5.15°, with an area under the curve of 0.685, sensitivity 81.0%, specificity 60.8%, and accuracy 63.31%. Elderly women with a low phase angle show a high risk of presenting with reduced muscle mass. Conclusions The phase angle was shown to be a useful screening tool in elderly women with sarcopenia.

RESUMO Objetivo Avaliar o ângulo de fase como método de triagem para sarcopenia. Métodos Estudo transversal realizado com 169 idosas ativas de comunidade. O ângulo de fase foi obtido por bioimpedância elétrica tetrapolar e a sarcopenia foi diagnosticada a partir da massa muscular esquelética, força muscular e performance física utilizando bioimpedância elétrica, dinamometria manual e o teste de velocidade de marcha, respectivamente. A curva Receiver Operating Characteristic foi construída para avaliar o ângulo de fase como preditor de sarcopenia. Resultados A prevalência de sarcopenia foi de 12,4%. A mediana do ângulo de fase foi de 5,30°; idosas com sarcopenia apresentaram valores menores do ângulo de fase em relação às não sarcopênicas (p=0,024). O ponto de corte do ângulo de fase para identificar sarcopenia foi ≤5,15°, com área sob a curva de 0,685, sensibilidade de 81,0%, especificidade de 60,8% e acurácia de 63,31%. Observou-se que idosas com ângulo de fase reduzido apresentaram maior chance de terem massa muscular reduzida e sarcopenia. Conclusão O ângulo de fase se mostrou útil para triagem de idosas com sarcopenia.

A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients.

RATIONALE: Quality of Life (QoL) is impaired in cancer, and the elderly are particularly vulnerable to malnutrition. A diagnosis of cancer in elderly patients further exacerbates risks of negative health outcomes. Here we investigated associations between QoL and nutritional status in a sample population of mostly socially deprived elderly cancer patients. METHOD: 432 cancer patients were recruited for this cross-sectional study at point of admission to a tertiary referral hospital for cancer treatment. Patient-generated subjective global assessment (PG-SGA) assessed nutritional status. Functional assessment of cancer therapy- general (FACT-G) quantified QoL. Relationship between PG-SGA and QoL was assessed by Spearman correlation. PG-SGA outcomes were compared against FACT-G scores employing Mann-Whitney test. Bivariate Linear Regression Model was employed to investigate influences of sociodemographic, clinical and nutritional status upon QoL. RESULTS: 37.5% of participants were malnourished or at risk. 39% were illiterate and 54.6% had family income lower than minimum wage. Malnourished patients showed lower FACT-G scores (76.8 vs. 84.7; p = 0.000). Poor nutritional diagnosis was inversely correlated with all QoL domains. Bivariate regression analysis showed that lower PG-SGA scores (ßo = - 1.00; p = 0.000) contributed to FACT-G score deterioration, the male gender showed better QoL scores, and other clinical and sociodemographic variables did not show relationship. CONCLUSION: Poorer nutritional status was significantly associated with worsened physical, social, emotional and functional well-being QoL domains in elderly cancer patients. Poorer nutritional status is an independent risk factor for worsened QoL. Future policies aimed at particularly vulnerable populations may improve QoL and health outcomes.

Comparison of calorie and nutrient intake among elderly with and without sarcopenia: A systematic review and meta-analysis.

CONTEXT: Sarcopenia, besides having an impact on functional capacity, has been associated with increased hospitalization and mortality, and stands out as an essential cause of disability among older people. OBJECTIVE: We conducted a systematic review and meta-analysis of published studies comparing the calories and nutrients ingested by elderly people with and without sarcopenia. DATA SOURCES: MEDLINE/PubMed, Scopus, LILACS, Cochrane Library, and Scielo databases were searched. STUDY SELECTION: Studies comparing calories and nutrient intake among elderly people diagnosed with sarcopenia and people without sarcopenia were included. DATA ANALYSIS: Mean differences and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using I2 test. RESULTS: A total of 23 studies fulfilled the inclusion criteria. The average number of calories and nutrients ingested were significantly lower in elderly study participants with sarcopenia compared with those without sarcopenia. The meta-analyses showed that the average number of calories ingested (n = 19 studies; mean difference, -156.7 kcal; 95%CI, -194.8 to -118.7) were significantly lower in those with sarcopenia than in elderly participants without sarcopenia. Compared to those without sarcopenia, elderly people with sarcopenia consumed lower amounts of proteins; carbohydrates; saturated fatty acids; vitamins A, B12, C, and D; and minerals such as calcium, magnesium, sodium, and selenium. CONCLUSIONS: The evidence so far available suggests a difference in caloric, macronutrient (ie, proteins, carbohydrates, saturated fatty acids), and micronutrient (ie calcium, magnesium, sodium, selenium, and vitamins A, B12, C, and D) intake among the elderly with and without sarcopenia. Additional studies are needed to define the best interventions to improve the consumption of calories and nutrients by the aging population.

Phase angle and metabolic parameters in severely obese patients / Ángulo de fase y parámetros metabólicos en pacientes con obesidad severa

INTRODUCTION: obese patients present an inflammatory and metabolic profile that leads to oxidative stress and cellular damage. Phase angle is an indicator of cellular integrity and has been proposed as a prognostic parameter for changes in the metabolic profile. OBJECTIVE: to investigate the possible association between phase angle and metabolic parameters in obese patients. MATERIAL AND METHOD: this was a cross-sectional study of adult obese patients who attended a specialized clinic between 2014 and 2016. All patients were ≥ 18 years of age, with a body mass index ≥ 35 kg/m2. All data were obtained from medical records and made part of the clinical protocol. Patients were divided into two groups using a cutoff point for phase angle, and the groups were compared using the Kruskal-Wallis or Chi-squared test for quantitative and categorical variables, respectively. Correlations were identified by Spearman's and Pearson's correlation analyses. All between-group differences were considered statistically significant at p ≤ 0.05. RESULTS: a low phase angle was present in 30.5 % of the 141 patients enrolled in the study. We found an association between low phase angle and presence of hyperuricemia (p = 0.018) when adjusted for waist circumference, dysglycemia, arterial hypertension, and hyperuricemia. There was no correlation between phase angle and the components of body composition. CONCLUSIONS: there is an association of phase angle with uric acid levels, but not with other metabolic parameters

INTRODUCCIÓN: los pacientes obesos presentan un perfil inflamatorio y metabólico que provoca estrés oxidativo y daño celular. El ángulo de fase es un indicador de integridad celular que se ha propuesto como parámetro pronóstico de los cambios del perfil metabólico. OBJETIVO: investigar la posible asociación entre el ángulo de fase y los parámetros metabólicos en pacientes obesos. MATERIAL Y MÉTODO: estudio transversal de pacientes obesos adultos que asistieron a una clínica especializada entre 2014 y 2016. Todos los pacientes tenían ≥ 18 años de edad y un índice de masa corporal ≥ 35 kg/m2. Todos los datos se obtuvieron de los registros médicos y formaron parte del protocolo clínico. Los pacientes se dividieron en dos grupos usando un punto de corte para el ángulo de fase, y los grupos se compararon usando la prueba de Kruskal-Wallis o del chi cuadrado para las variables cuantitativas y categóricas, respectivamente. Las correlaciones se identificaron mediante el análisis de correlación de Spearman y el de Pearson. Todas las diferencias entre grupos se consideraron estadísticamente significativas si p ≤ 0.05. RESULTADOS: se observó un ángulo de fase bajo en el 30,5 % de los 141 pacientes incluidos en el estudio. Encontramos una asociación entre el ángulo de fase bajo y la presencia de hiperuricemia (p = 0.018) cuando se ajustó para la circunferencia de la cintura, la disglucemia, la hipertensión arterial y la hiperuricemia. No hubo correlación entre el ángulo de fase y los componentes de la composición corporal. CONCLUSIONES: el ángulo de fase presenta asociación con los niveles plasmáticos de ácido úrico pero no con otros parámetros metabólicos

Phase angle and metabolic parameters in severely obese patients.

INTRODUCTION: Introduction: obese patients present an inflammatory and metabolic profile that leads to oxidative stress and cellular damage. Phase angle is an indicator of cellular integrity and has been proposed as a prognostic parameter for changes in the metabolic profile. Objective: to investigate the possible association between phase angle and metabolic parameters in obese patients. Material and method: this was a cross-sectional study of adult obese patients who attended a specialized clinic between 2014 and 2016. All patients were ≥ 18 years of age, with a body mass index ≥ 35 kg/m2. All data were obtained from medical records and made part of the clinical protocol. Patients were divided into two groups using a cutoff point for phase angle, and the groups were compared using the Kruskal-Wallis or Chi-squared test for quantitative and categorical variables, respectively. Correlations were identified by Spearman's and Pearson's correlation analyses. All between-group differences were considered statistically significant at p ≤ 0.05. Results: a low phase angle was present in 30.5 % of the 141 patients enrolled in the study. We found an association between low phase angle and presence of hyperuricemia (p = 0.018) when adjusted for waist circumference, dysglycemia, arterial hypertension, and hyperuricemia. There was no correlation between phase angle and the components of body composition. Conclusions: there is an association of phase angle with uric acid levels, but not with other metabolic parameters.

INTRODUCCIÓN: Introducción: los pacientes obesos presentan un perfil inflamatorio y metabólico que provoca estrés oxidativo y daño celular. El ángulo de fase es un indicador de integridad celular que se ha propuesto como parámetro pronóstico de los cambios del perfil metabólico. Objetivo: investigar la posible asociación entre el ángulo de fase y los parámetros metabólicos en pacientes obesos. Material y método: este fue un estudio transversal de pacientes obesos adultos que asistieron a una clínica especializada entre 2014 y 2016. Todos los pacientes tenían ≥ 18 años de edad y un índice de masa corporal ≥ 35 kg/m2. Todos los datos se obtuvieron de los registros médicos y formaron parte del protocolo clínico. Los pacientes se dividieron en dos grupos usando un punto de corte para el ángulo de fase, y los grupos se compararon usando la prueba de Kruskal-Wallis o del chi cuadrado para las variables cuantitativas y categóricas, respectivamente. Las correlaciones se identificaron mediante el análisis de correlación de Spearman y el de Pearson. Todas las diferencias entre grupos se consideraron estadísticamente significativas si p ≤ 0.05. Resultados: se observó un ángulo de fase bajo en el 30,5 % de los 141 pacientes incluidos en el estudio. Encontramos una asociación entre el ángulo de fase bajo y la presencia de hiperuricemia (p = 0.018) cuando se ajustó para la circunferencia de la cintura, la disglucemia, la hipertensión arterial y la hiperuricemia. No hubo correlación entre el ángulo de fase y los componentes de la composición corporal. Conclusiones: el ángulo de fase presenta asociación con los niveles plasmáticos de ácido úrico pero no con otros parámetros metabólicos.

Sarcopenic obesity in community-dwelling older women, determined by different diagnostic methods / Obesidad sarcopénica en mujeres mayores que viven en la comunidad, determinada por diferentes métodos de diagnóstico

Background: sarcopenic obesity (SO) decreases functional capacity, favors loss of autonomy, and is associated with increased mortality in the elderly. The prevalence of sarcopenic obesity differs according to the chosen diagnostic method and/or the population studied. Objective: to identify sarcopenic obesity in community-dwelling elderly women using different diagnostic methods. Methods: this is a cross-sectional study involving 138 elderly women enrolled in an Open University of the Third Age. Sarcopenia was defined according to three criteria: a skeletal muscle index (SMI) = 6.42 kg/m²; reduced muscle strength, defined by handgrip strength (HS) < 20 kg/f; and reduced physical performance, determined by a usual gait speed (GS) < 0.8 m/s. Obesity was diagnosed when body mass index (BMI)  > 28 kg/m², waist circumference (WC)  > 88 cm, total body fat percentage (TBF%) determined by bioelectric impedance analysis (BIA) = 38%, and value for triceps skinfold (TS) = 85th percentile. Sarcopenic obesity is the coexistence of sarcopenia and obesity. Results: the prevalence of sarcopenia and severe sarcopenia was 14.5% and 3.6%, respectively. The highest prevalence of obesity was found using WC (69.6%) and TBF% (52.9%) (p < 0.001). The highest prevalence of sarcopenic obesity was found using TBF% (9.4%) and WC (6.5%) (p < 0.001). Sarcopenic obesity according to BMI was only 0.7%. Conclusion: the prevalence of sarcopenic obesity was high and depended on the diagnostic criteria applied. The association of TBF% with the diagnosis of sarcopenia was the method that identified the highest prevalence of sarcopenic obesity

Antecedentes: la obesidad sarcopénica (SO) disminuye la capacidad funcional, favorece la pérdida de autonomía y se asocia a mayor mortalidad en los ancianos. La prevalencia de la obesidad sarcopénica difiere según el método de diagnóstico elegido y/o la población estudiada. Objetivo: identificar la obesidad sarcopénica en mujeres ancianas que viven en la comunidad utilizando diferentes métodos de diagnóstico. Métodos: este es un estudio transversal en el que participaron 138 mujeres ancianas inscritas en una Universidad Abierta de la Tercera Edad. La sarcopenia se definió de acuerdo con tres criterios: un índice de músculo esquelético (SMI) = 6.42 kg/m²; fuerza muscular reducida, definida por una fuerza de empuñadura (HS) < 20 kg/f, y rendimiento físico reducido, determinado por una velocidad de marcha habitual (GS) < 0,8 m/s. La obesidad se diagnosticó si: índice de masa corporal (IMC)  > 28 kg/m², perímetro de la cintura (WC)  > 88 cm, porcentaje de grasa corporal total (TBF%) determinado por análisis de impedancia bioeléctrica (BIA) = 38%, y valor de pliegue cutáneo del tríceps (TS) = percentil 85. La obesidad sarcopénica es la coexistencia de sarcopenia y obesidad. Resultados: la prevalencia de la sarcopenia y la sarcopenia severa fue del 14,5% y 3,6%, respectivamente. La mayor prevalencia de obesidad se encontró mediante el WC (69,6%) y el porcentaje de TBF (52,9%) (p < 0,001). La prevalencia más alta de obesidad sarcopénica se encontró utilizando el % de TBF (9,4%) y el WC (6,5%) (p < 0,001). La obesidad sarcopénica según el IMC fue solo del 0,7%. Conclusión: la prevalencia de la obesidad sarcopénica fue alta y dependió de los criterios diagnósticos aplicados. La asociación del TBF% con el diagnóstico de sarcopenia fue el método que identificó la prevalencia más alta de obesidad sarcopénica

Sarcopenic obesity in community-dwelling older women, determined by different diagnostic methods.

INTRODUCTION: Background: sarcopenic obesity (SO) decreases functional capacity, favors loss of autonomy, and is associated with increased mortality in the elderly. The prevalence of sarcopenic obesity differs according to the chosen diagnostic method and/or the population studied. Objective: to identify sarcopenic obesity in community-dwelling elderly women using different diagnostic methods. Methods: this is a cross-sectional study involving 138 elderly women enrolled in an Open University of the Third Age. Sarcopenia was defined according to three criteria: a skeletal muscle index (SMI) ≤ 6.42 kg/m²; reduced muscle strength, defined by handgrip strength (HS) < 20 kg/f; and reduced physical performance, determined by a usual gait speed (GS) < 0.8 m/s. Obesity was diagnosed when body mass index (BMI) > 28 kg/m², waist circumference (WC) > 88 cm, total body fat percentage (TBF%) determined by bioelectric impedance analysis (BIA) ≥ 38%, and value for triceps skinfold (TS) ≥ 85th percentile. Sarcopenic obesity is the coexistence of sarcopenia and obesity. Results: the prevalence of sarcopenia and severe sarcopenia was 14.5% and 3.6%, respectively. The highest prevalence of obesity was found using WC (69.6%) and TBF% (52.9%) (p < 0.001). The highest prevalence of sarcopenic obesity was found using TBF% (9.4%) and WC (6.5%) (p < 0.001). Sarcopenic obesity according to BMI was only 0.7%. Conclusion: the prevalence of sarcopenic obesity was high and depended on the diagnostic criteria applied. The association of TBF% with the diagnosis of sarcopenia was the method that identified the highest prevalence of sarcopenic obesity.

INTRODUCCIÓN: Antecedentes: la obesidad sarcopénica (SO) disminuye la capacidad funcional, favorece la pérdida de autonomía y se asocia a mayor mortalidad en los ancianos. La prevalencia de la obesidad sarcopénica difiere según el método de diagnóstico elegido y/o la población estudiada. Objetivo: identificar la obesidad sarcopénica en mujeres ancianas que viven en la comunidad utilizando diferentes métodos de diagnóstico. Métodos: este es un estudio transversal en el que participaron 138 mujeres ancianas inscritas en una Universidad Abierta de la Tercera Edad. La sarcopenia se definió de acuerdo con tres criterios: un índice de músculo esquelético (SMI) ≤ 6.42 kg/m²; fuerza muscular reducida, definida por una fuerza de empuñadura (HS) < 20 kg/f, y rendimiento físico reducido, determinado por una velocidad de marcha habitual (GS) < 0,8 m/s. La obesidad se diagnosticó si: índice de masa corporal (IMC) > 28 kg/m², perímetro de la cintura (WC) > 88 cm, porcentaje de grasa corporal total (TBF%) determinado por análisis de impedancia bioeléctrica (BIA) ≥ 38%, y valor de pliegue cutáneo del tríceps (TS) ≥ percentil 85. La obesidad sarcopénica es la coexistencia de sarcopenia y obesidad. Resultados: la prevalencia de la sarcopenia y la sarcopenia severa fue del 14,5% y 3,6%, respectivamente. La mayor prevalencia de obesidad se encontró mediante el WC (69,6%) y el porcentaje de TBF (52,9%) (p < 0,001). La prevalencia más alta de obesidad sarcopénica se encontró utilizando el % de TBF (9,4%) y el WC (6,5%) (p < 0,001). La obesidad sarcopénica según el IMC fue solo del 0,7%. Conclusión: la prevalencia de la obesidad sarcopénica fue alta y dependió de los criterios diagnósticos aplicados. La asociación del TBF% con el diagnóstico de sarcopenia fue el método que identificó la prevalencia más alta de obesidad sarcopénica.

Reduction of relative handgrip strength and cardiometabolic risk in individuals with HIV/AIDS.

INTRODUCTION: Low handgrip strength (HS) is associated with cardiometabolic alterations that have affected people with HIV/AIDS. METHODS: This was a cross-sectional study performed in adults receiving antiretroviral treatment. HS was evaluated using a dynamometer and divided by body weight to obtain the relative strength. The association between relative HS and overweight, increased waist circumference (WC), high body fat percentage, glycemia, and lipid ratios were assessed using logistic regression. RESULTS: Low relative HS was identified in 35% of participants and associated with increased WC (odds ratio = 9.7; 95% confidence interval = 2.8-33.0). CONCLUSIONS: The prevalence of low HS was high and associated with increased WC.

Reduction of relative handgrip strength and cardiometabolic risk in individuals with HIV/AIDS

Abstract INTRODUCTION: Low handgrip strength (HS) is associated with cardiometabolic alterations that have affected people with HIV/AIDS. METHODS: This was a cross-sectional study performed in adults receiving antiretroviral treatment. HS was evaluated using a dynamometer and divided by body weight to obtain the relative strength. The association between relative HS and overweight, increased waist circumference (WC), high body fat percentage, glycemia, and lipid ratios were assessed using logistic regression. RESULTS: Low relative HS was identified in 35% of participants and associated with increased WC (odds ratio = 9.7; 95% confidence interval = 2.8-33.0). CONCLUSIONS: The prevalence of low HS was high and associated with increased WC.

Micronutrient intake in elderly living in nursing homes.

OBJECTIVE: The aim of this study was to evaluate the ingestion of micronutrients in elderly living in nursing homes. METHODS: This is a cross-sectional study, conducted with 216 individuals of both sexes, age equal or greater than 60 years, living in nursing homes for elderly in Salvador, Bahia, Brazil. Direct weighing of the food was used to get food intake, and prevalence of inadequacy was obtained using the software Multiple Source Method (MSM) and evaluated by estimated average requirement (EAR). RESULTS: A high prevalence of inadequate intake of micronutrients was observed, being over 90% for vitamins E, folate, pyridoxine and calcium, in both sexes and between 50 and 70% for selenium, retinol, riboflavin, cyanocobalamin and vitamin C. CONCLUSION: The high prevalence of inadequate intake of micronutrients in elderly living on nursing homes observed in this study may be used for planning public health strategies aiming to improve the nutritional context of this population and their quality of life, reducing the costs of health care.

Micronutrient intake in elderly living in nursing homes / Ingesta de micronutrientes en ancianos residentes en instituciones de larga permanencia

Objective: The aim of this study was to evaluate the ingestion of micronutrients in elderly living in nursing homes. Methods: This is a cross-sectional study, conducted with 216 individuals of both sexes, age equal or greater than 60 years, living in nursing homes for elderly in Salvador, Bahia, Brazil. Direct weighing of the food was used to get food intake, and prevalence of inadequacy was obtained using the software Multiple Source Method (MSM) and evaluated by estimated average requirement (EAR). Results: A high prevalence of inadequate intake of micronutrients was observed, being over 90% for vitamins E, folate, pyridoxine and calcium, in both sexes and between 50 and 70% for selenium, retinol, riboflavin, cyanocobalamin and vitamin C. Conclusion: The high prevalence of inadequate intake of micronutrients in elderly living on nursing homes observed in this study may be used for planning public health strategies aiming to improve the nutritional context of this population and their quality of life, reducing the costs of health care (AU)

Objetivo: el objetivo de este estudio fue evaluar la ingesta de micronutrientes en ancianos residentes en instituciones de larga permanencia. Métodos: se trata de un estudio transversal, realizado con 216 individuos de ambos sexos, con edad igual o superior a 60 años y residentes en instituciones de larga permanencia en la ciudad de Salvador, Bahía, Brasil. Para la evaluación del consumo alimentario se utilizó el pesaje directo del alimento y la comparación con los valores de referencia del requerimiento promedio estimado (RPE). La prevalencia de ingesta inadecuada fue obtenida a través del software Multiple Source Method (MSM). Resultados: se observó una alta prevalencia de ingesta inadecuada de micronutrientes por encima de 90% para las vitaminas E, folato, piridoxina y calcio, en ambos sexos, y entre el 50% y el 70% para selenio, retinol, riboflavina, cianocobalamina y vitamina C. Conclusión: la elevada prevalencia de ingesta inadecuada de micronutrientes en los ancianos residentes en instituciones de larga permanencia observada en este estudio puede ser utilizada para la planificación de estrategias en salud pública, con el objetivo de mejorar la situación nutricional de esta población y su calidad de vida, reduciendo los costes derivados de la asistencia sanitaria (AU)

Associação Entre Força Muscular Relativa e Risco Cardiometabólico em Pacientes Hipertensos / Association between Relative Muscular Strength and Cardiometabolic Risk in Hypertensive Patients

Introdução: A força muscular tem sido considerada bom preditor de risco para doenças cardiovasculares. Objetivo: Avaliar a associação entre força muscular relativa com fatores de risco cardiometabólicos em pacientes hipertensos. Métodos: Estudo transversal realizado com 115 pacientes hipertensos atendidos em um hospital universitário. Foram coletadas variáveis antropométricas e bioquímicas (glicemia de jejum, colesterol total e frações e triglicerídeos). Foram calculados os indicadores razão cintura/altura e Índice de massa corporal. A força muscular relativa foi avaliada a partir da força de preensão palmar, medida pelo dinamômetro, e dividida pelo peso corporal. A correlação de Pearson e o modelo de regressão linear foram utilizados para estimar a relação entre as variáveis de risco e a força muscular relativa. Foram adotados um nível de significância de 5% e intervalo de confiança de 95%. Resultados: A maioria da população (82,6%) foi do sexo feminino, 64,3% adultos, 56,5% sedentários e 93,0% com excesso de peso. Foram observadas correlações inversas significantes entre a força muscular relativa com a razão cintura/ altura e Índice de massa corporal (p=0,000). O modelo de regressão mostrou que o aumento na razão cintura/altura contribuiu significativamente para a redução da força de preensão palmar relativa (p=0,023), assim como ser do sexo feminino (p=0,000). Conclusão: O presente estudo identificou associação entre a força de preensão palmar relativa e variáveis de risco cardiometabólico

Introduction: Muscle strength has been considered a good predictor of risk for cardiovascular diseases. Objective: To evaluate the association between relative muscular strength and cardiometabolic risk factors in hypertensive patients. Methods: A cross-sectional study was carried out with 115 hypertensive patients attended at a university hospital. Anthropometric and biochemical variables (fasting glycemia, total cholesterol and fractions and triglycerides) were collected. The Waist / height ratio and body mass index were calculated. Relative muscle strength was assessed from the palmar grip strength, measured by the dynamometer, and divided by body weight. Pearson's correlation was used and the linear regression model to estimate the relationship between risk variables and relative muscle strength. A significance level of 5% and a 95% confidence interval were adopted. Results: The majority of the population (82.6%) were female, 64.3% were adults, 56.5% were sedentary and 93.0% were overweight. Significant inverse correlations were observed between relative muscle strength with waist / height ratio and body mass index (p=0.000). The regression model showed that the increase in waist / height ratio contributed significantly to the reduction of relative muscle strength (p = 0.023), as well as being female (p = 0.000). Conclusion: The present study identified an association between relative muscle strength and cardiometabolic risk variables

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Candida albicans: The Ability to Invade Epithelial Cells and Survive under Oxidative Stress Is Unlinked to Hyphal Length.

In its hyphal form, Candida albicans invades epithelial and endothelial cells by two distinct mechanisms: active penetration and induced endocytosis. The latter is dependent on a reorganization of the host cytoskeleton (actin/cortactin recruitment), whilst active penetration does not rely on the host's cellular machinery. The first obstacle for the fungus to reach deep tissues is the epithelial barrier and this interaction is crucial for commensal growth, fungal pathogenicity and host defense. This study aimed to characterize in vitro epithelial HeLa cell invasion by four different isolates of C. albicans with distinct clinical backgrounds, including a C. albicans SC5314 reference strain. All isolates invaded HeLa cells, recruited actin and cortactin, and induced the phosphorylation of both Src-family kinases (SFK) and cortactin. Curiously, L3881 isolated from blood culture of a patient exhibited the highest resistance to oxidative stress, although this isolate showed reduced hyphal length and displayed the lowest cell damage and invasion rates. Collectively, these data suggest that the ability of C. albicans to invade HeLa cells, and to reach and adapt to the host's blood, including resistance to oxidative stress, may be independent of hyphal length.

Blood count parameters as a marker for metabolic syndrome in older adults.

BACKGROUND AND AIM: Blood count parameters are associated with the metabolic syndrome (MS). However, few studies have evaluated the precision of blood count components to identify MS in older adults. We evaluated the accuracy of blood count components as a screening method and a marker of MS in older adults. METHODS AND RESULTS: A cross-sectional study with 203 older adults of both sexes was conducted. The following variables were used: MS as defined by harmonized criteria, hemoglobin, hematocrit, leukocytes and platelets. Area under the receiver operating characteristic (ROC) curve, sensitivity (sens), specificity (spec) and logistic regression were adjusted for age and sex. Leukocyte count showed the highest Youden's index value for MS screening, with an optimal cut-off point of 7.514103/mm3 (sens: 66.7%; spec: 72.0%) for men and 5.626103/mm3 (sens: 73.1%; spec: 42.4%) for women. Older adults with leukocyte count higher than these cut-off points presented a 2.4 times greater chance of developing MS. CONCLUSION: Leukocyte count can be used as a screening indicator to identify individuals with a higher risk of developing MS. Older adults with high leukocyte count and no associated chronic diseases should receive attention, as they are individuals with a potential risk for MS.

Factors associated with sarcopenia in institutionalized elderly.

INTRODUCTION: The sarcopenia is a negative aspect for the health of the elderly, increased the risk for disease and mortality. Additionally can contributes greatly to functional reducing capacity and quality of life. OBJECTIVE: To identify the prevalence and factors associated with sarcopenia in institutionalized elderly. METHODS: This is a cross-sectional study, conducted with 216 elderly people, aged ≥ 60 years, of both sexes, residents in long-term care facilities in Salvador-Bahia, Brazil. To identify sarcopenia was used the skeletal muscle Index. Covariates were considered: gender, age, time of institutionalization, type of institution, body mass index and functional capacity. The Association between sarcopenia and covariates was evaluated using the Poisson regression model with robust variance. RESULTS: The prevalence of sarcopenia in the elderly was 72.2% and this condition was associated with male sex (PR = 1,33; CI 95% = 1,081,65), thinness (PR = 1,29; CI 95% = 1,16-1,43) and obesity (PR = 0,37; CI 95% = 0,23-0,61). CONCLUSION: The prevalence of sarcopenia was high among the elderly living in long-term institutions, especially among men. Elderly with thinness showed greater impairment of muscle reserves, while the state of obesity was protective.

Factors associated with sarcopenia in institutionalized elderly / Factores asociados con la presencia de sarcopenia en ancianos institucionalizados

Introduction: The sarcopenia is a negative aspect for the health of the elderly, increased the risk for disease and mortality. Additionally can contributes greatly to functional reducing capacity and quality of life. Objective: To identify the prevalence and factors associated with sarcopenia in institutionalized elderly. Methods: This is a cross-sectional study, conducted with 216 elderly people, aged ≥ 60 years, of both sexes, residents in long-term care facilities in Salvador-Bahia, Brazil. To identify sarcopenia was used the skeletal muscle Index. Covariates were considered: gender, age, time of institutionalization, type of institution, body mass index and functional capacity. The Association between sarcopenia and covariates was evaluated using the Poisson regression model with robust variance. Results: The prevalence of sarcopenia in the elderly was 72.2% and this condition was associated with male sex (PR = 1,33; CI 95% = 1,08- 1,65), thinness (PR = 1,29; CI 95% = 1,16-1,43) and obesity (PR = 0,37; CI 95% = 0,23-0,61). Conclusion: The prevalence of sarcopenia was high among the elderly living in long-term institutions, especially among men. Elderly with thinness showed greater impairment of muscle reserves, while the state of obesity was protective (AU)

Introducción: la sarcopenia es un aspecto negativo para la salud de las personas mayores, aumenta el riesgo de enfermedad y mortalidad. Además puede contribuir en gran medida a la reducción de la capacidad funcional y calidad de vida. Objetivo: identificar la prevalencia y los factores asociados con la sarcopenia en los ancianos institucionalizados. Métodos: se trata de un estudio transversal, realizado con 216 personas de edad avanzada (≥ 60 años), de ambos sexos, residentes en centros de atención a largo plazo en Salvador-Bahia, Brasil. Para identifi car la sarcopenia se utilizó el índice musculoesquelético. Se consideraron covariables: género, edad, tiempo de institucionalización, tipo de institución, índice de masa corporal y la capacidad funcional. La asociación entre la sarcopenia y covariables se evaluó utilizando el modelo de regresión de Poisson con varianza robusta. Resultados: la prevalencia de la sarcopenia en los ancianos fue de 72,2% y esta condición se asocia con el sexo masculino (RP = 1,33; IC del 95% = 1,08-1,65), la delgadez (RP = 1,29; IC del 95 % = 1,16-1,43) y la obesidad (RP = 0,37; IC del 95% = 0,23-0,61). Conclusión: la prevalencia de la sarcopenia fue alta entre los ancianos que viven en instituciones de larga duración, especialmente entre los hombres. Los ancianos con delgadez mostraron un mayor deterioro en las reservas musculares, mientras que los obesos mostraban una mayor protección muscular (AU)

Indicators of Adiposity Predictors of Metabolic Syndrome in the Elderly.

BACKGROUND: Adiposity indicators can be used as predictors of cardiovascular risk in the elderly. However, there are only a very few studies that deal with the accuracy of adiposity indicators as predictors of metabolic syndrome (MS) in the elderly. We evaluated the performance of adiposity indicators of MS prediction in the elderly. METHODS: A cross-sectional study with 203 elderly people of both genders. VARIABLES: MS defined by harmonized criteria, waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), lipid accumulation product (LAP), and visceral adiposity index (VAI). Area under the receiver operating characteristic curve (AUC), sensitivity (sens) and specificity (spec). RESULTS: The WC, WHtR, and LAP indicators showed the highest AUC, with values greater than 0.84. For the general population, WHtR and LAP had the highest Youden index values, identifying a point of approximately 0.55 (sens: 85.6%; spec: 80.4%) for WHtR and 32.3 (sens: 81.1%; spec: 75.0%) for LAP. When analyzed by gender, it was observed that the WC and WHtR had the highest Youden index values for prediction of MS in both genders. The CI and VAI showed the lowest discriminatory power for MS. CONCLUSION: Both the adiposity indicators, WC and WHtR, as well as LAP, had high accuracy in MS discrimination. Therefore, they are effective in MS assessment in the elderly and during follow-up for individual and collective clinical practice.

Razão TG/HDL-c, indicadores antropométricos e bioquímicos de risco cardiovascular no renal crônico em tratamento conservador / TG/HDL-c reason, anthropometrics and biochemical indicators of cardiovascular risk in chronic renal in conservative treatment

Introdução: As doenças cardiovasculares (DCV) representam no Brasil a principal causa de morbimortalidade e sua prevalência cresce em todo o mundo. O paciente com doença renal crônica apresenta alto risco de desenvolvimento da doença e este risco eleva-se na presença de dislipidemia. Triglicérides (TG) elevado e lipoproteína de alta densidade (HDL-c) reduzida são preditores independentes de eventos cardiometabólicos. O excesso de tecido adiposo também está envolvida com risco de DCV. Portanto a utilização de preditores do desenvolvimento de DCV, como a razão triglicerídeos/HDL colesterol (TG/HDL-c) e indicadores antropométricos de avaliação de gordura corporal são importantes na prática clínica. Objetivo: Avaliar a associação entre a razão TG/HDL e indicadores antropométricos de risco cardiovascular em pacientes renais crônicos em tratamento conservador. Métodos: Estudo transversal, envolvendo 90 pacientes clinicamente estáveis atendidos ambulatorialmente. A razão TG/HDL-c foi definida de acordo com equação preestabelecida, sendo considerado risco para DCV valores >2,5 para mulheres e >3,5 para homens. Os parâmetros antropométricos utilizados foram o índice de massa corporal (IMC) e a circunferência da cintura (CC). Dados sociais, de estilo de vida, clínicos e bioquímicos também foram coletados. Na comparação entre os dois grupos (razão TG/HDL-c elevado e razão TG/HDL adequado) foi utilizado o teste t de Student para os dados paramétricos e de Mann-Whitney para os dados não paramétricos. As proporções foram comparadas pelo teste do quiquadrado. Os ajustes entre Razão TG/HDL, IMC e CC foram realizadas através da análise de regressão logística. Resultados: Da amostra avaliada, 50 pacientes (55,6%) apresentaram razão TG/HDL elevada. Pacientes com IMC e CC alterada apresentavam maior risco de DCV, avaliado através da razão TG/HDL-c. Houve diferença estatisticamente significante entre os indicadores antropométricos utilizados, IMC e CC, e razão TG/HDL-c quando estratificado em elevado e adequado. Entretanto, na análise ajustada, não foi observada associação entre o IMC ou a CC e a razão TG/HDL. Conclusão: Os resultados demonstram que após ajustes com possíveis variáveis de confusão não houve associação entre os valores da razão TG / HDL-C e indicadores antropométricos de adiposidade, IMC e CC. Os resultados deste estudo levam a questionar a real influência do excesso de peso e da obesidade central na razão TG/HDL-c (AU)

Introduction: Cardiovascular diseases (CVD) are a major cause of morbidity and mortality, and its prevalence is growing worldwide. Patients with chronic kidney disease (CKD) are at high risk of group, especially those with dyslipidemia. Triglycerides (TG) and high-density lipoprotein (HDL-c) are independent predictors of cardiovascular events. Excessive adipose tissue also increases the cardiovascular risk. Therefore, CVD predictors, such as the Triglycerides / HDL cholesterol (TG / HDL-c) ratio and the anthropometric measurements for assessing body fat are important in clinical practice. Objective: To evaluate the association between TG / HDL ratio, anthropometric measurements and the cardiovascular risk in CKD patients on dialysis. Methods: A cross-sectional study involving 90 clinically stable outpatients. The TG / HDL-c ratio was defined according to a predetermined equation, considering high CVD risk values greater than 2.5 for women and greater than 3.5 for men. The anthropometric parameters used were the body mass index (BMI) and the waist circumference (WC). Social data, lifestyle, clinical and biochemical data were also collected. Results: Fifty patients (55.6%) had a high TG / HDL ratio. Patients with abnormal BMI and WC were at a higher cardiovascular risk, as measured by the TG / HDL-c ratio. There was a statistically significant difference between the anthropometric measurements (BMI and the WC), and the TG / HDL-c ratio in the stratified analysis. However, in the adjusted analysis no association between the BMI or the WC and the TG/HDL ratio was observed. Conclusion: There was no association between the TG / HDL-C ratio and the adiposity measurements (BMI and WC) in the adjusted analysis. The results of this study question the real influence of overweight and central obesity in the TG / HDL-c ratio (AU)

Ângulo de fase e marcadores tradicionais do estado nutricional em pacientes renais crônicos antes e após a hemodiálise / Phase angle and traditional markers of nutritional status in patients with chronic renal failure before and after hemodialysis

Introdução: Na prática clínica são muitos os métodos utilizados na avaliação de pacientes em hemodiálise, a maioria com limitações. O ângulo de fase, uma variável da bioimpedância elétrica, vem se destacando como importante indicador prognóstico, mas sua relação com marcadores nutricionais é controversa. Objetivo: Avaliar a existência de correlação e concordância entre o ângulo de fase padronizado e marcadores tradicionais do estado nutricional em pacientes renais crônicos, antes e após o tratamento dialítico. Métodos: Estudo transversal com 57 pacientes em hemodiálise, de ambos os sexos, em uma unidade de tratamento dialítico, Salvador, Bahia, Brasil. Os participantes foram avaliados por antropometria, bioimpedância e dinamometria, antes e após a hemodiálise. Foram realizadas análises descritivas, teste T de Student, correlação de Pearson e concordância a partir do coeficiente Kappa. Resultados: Não houve diferença significante no período pré e pós-diálise para as variáveis: circunferência muscular do braço, força do aperto de mão e percentual de massa celular corporal. No período pré-diálise, a correlação foi positiva e fraca entre o ângulo de fase padronizado e o índice de massa corporal, a circunferência muscular do braço, a força do aperto de mão e o percentual de massa celular corporal. No período pós-diálise o percentual de massa celular corporal foi a única variável que não teve correlação estatisticamente significante. A análise de concordância entre o ângulo de fase padronizado e demais parâmetros, no período pré-diálise, mostrou concordâncias pobres ou fracas. No período pós-diálise houve discordância com a percentual de massa celular corporal e concordância moderada com a força do aperto de mão. Conclusão: O ângulo de fase padronizado apresentou correlações fracas com os indicadores antropométricos e moderada concordância com a força do aperto de mão (AU)

Introducion: In clinical practice there are many methods used to assess patients on hemodialysis, most with limitations. The phase angle, a variable of the electric bioimpedance, has been excelling as an important prognostic indicator, but its relation to nutritional markers is controversial. Objective: To evaluate the existence of correlations and concordances between the standard phase angle and traditional markers of nutritional status in patients with chronic renal failure, prior to and following dialysis treatment. Methods: A transversal study with fifty-seven hemodialysis patients, of both sexes, in a dialysis treatment unit, in Salvador, Bahia (Brazil). The participants were evaluated for anthropometry, bioimpedance, and dynamometry, before and after hemodialysis. We performed a descriptive analysis, Student’s t test, Pearson correlation and agreement from the kappa coefficient. Results: There was no significant difference between the pre- and post-dialysis period for the following variables: muscular circumference of the arm, handgrip force, and percentage of cellular body mass. In the pre-dialysis period, the correlation was positive and weak between the standard phase angle and the body mass index, the muscular circumference of the arm, handgrip force, and cellular body mass. In the post-dialysis period the percentage of cellular body mass was the only variable that had no statistically significant correlation. The analysis of concordance between the standard phase angle and other parameters, in the pre-dialysis period, showed poor or weak concordances. In the post-dialysis period there were discordances for the percentage of cellular body mass and moderate concordance for handgrip force. Conclusion: The standard phase angle presented weak correlations with the anthropométric indicators and moderate concordance for handgrip force (AU)