Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study

ABSTRACT BACKGROUND: Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES: This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING: Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS: Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS: A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25-19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00-28.32), comorbidity (OR: 5.11; CI 3.44-7.81), pain (OR: 4.56; CI 3.33-6.28), total walking (OR: 0.99; CI 0.99-1.00), SB of 8-10 hours (OR: 1.85; CI 1.15-2.93), and SB of > 10 hours (OR: 3.93; CI 2.48-6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96-0.98). P < 0.05. CONCLUSIONS: During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study.

BACKGROUND: Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES: This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING: Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS: Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS: A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25-19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00-28.32), comorbidity (OR: 5.11; CI 3.44-7.81), pain (OR: 4.56; CI 3.33-6.28), total walking (OR: 0.99; CI 0.99-1.00), SB of 8-10 hours (OR: 1.85; CI 1.15-2.93), and SB of > 10 hours (OR: 3.93; CI 2.48-6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96-0.98). P < 0.05. CONCLUSIONS: During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

Are foot deformity and plantar sensitivity impairment associated with physical function of community-dwelling older adults?

BACKGROUND: Foot deformities are highly prevalent in older adults and negatively impact their mobility and quality of life. However, the association between foot problems and physical function is still unclear. OBJECTIVE: To investigate whether structural foot deformities and plantar tactile sensitivity are associated with lower extremity physical function impairment in community-dwelling older adults. METHODS: We included 200 men and women aged 60 years and older from a community-based program. The foot assessment included toe deformities and calluses inspection and evaluation of plantar tactile sensitivity using monofilaments. The Short Physical Performance Battery (SPPB) was used to assess lower extremity physical function. We conducted a multivariate logistic regression analysis to investigate the association between foot problems and lower extremity physical function. RESULTS: Hallux valgus was the most prevalent deformity among older adults. Those participants with reduced plantar tactile sensitivity (OR= 2.77; 95% CI: 1.38, 5.55) and a hallux valgus (OR= 2.23; 95% CI: 1.10, 4.52) were more likely to present poor lower extremity physical function. CONCLUSION: Hallux valgus and impaired plantar sensitivity were associated with reduced lower extremity physical function in older adults. Further studies are necessary to identify this causality and to what extent management of these foot problems can improve general mobility and quality of life of older adults.

Malignant bone tumors (other than Ewing's): clinical practice guidelines for diagnosis, treatment and follow-up by Spanish Group for Research on Sarcomas (GEIS).

Primary malignant bone tumors are uncommon and heterogeneous malignancies. This document is a guideline developed by the Spanish Group for Research on Sarcoma with the participation of different specialists involved in the diagnosis and treatment of bone sarcomas. The aim is to provide practical recommendations with the intention of helping in the clinical decision-making process. The diagnosis and treatment of bone tumors requires a multidisciplinary approach, involving as a minimum pathologists, radiologists, surgeons, and radiation and medical oncologists. Early referral to a specialist center could improve patients' survival. The multidisciplinary management of osteosarcoma, chondrosarcoma, chordoma, giant cell tumor of bone and other rare bone tumors is reviewed in this guideline. Ewing's sarcoma will be the focus of a separate guideline because of its specific biological, clinical and therapeutic features. Each statement has been accompanied by the level of evidence and grade of recommendation on the basis of the available data. Surgical excision is the mainstay of treatment of a localized bone tumor, with various techniques available depending on the histologic type, grade and location of the tumor. Chemotherapy plays an important role in some chemosensitive subtypes (such as high-grade osteosarcoma). In other subtypes, historically considered chemoresistant (such as chordoma or giant cell tumor of bone), new targeted therapies have emerged recently, with a very significant efficacy in the case of denosumab. Radiation therapy is usually necessary in the treatment of chordoma and sometimes of other bone tumors.

Efeito da restrição espacial do ambiente na preferência manual em tarefa de alcance em adultos jovens / Effect of spatial constraint of the environment on the hand preference in reaching task in young adults / Efecto de la restricción espacial del entorno en la preferencia manual en una tarea de alcance en adultos jóvenes

Resumo A preferência manual (direção e magnitude) na tarefa de alcançar em adultos foi analisada em função da localização espacial de um objeto no ambiente. Trinta participantes fizeram a tarefa de alcançar um cilindro, devendo-se escolher apenas uma das mãos para fazer a tarefa, a 50 cm de distância em cinco posições diferentes em relação ao plano sagital do participante. Duas condições foram cumpridas: conforto (sem restrição da velocidade) e velocidade (movimento feito o mais rapidamente possível). Anova de Friedman apontou diferença (X230,9 = 122,17; p < 0,001) e o teste de Wilcoxon apontou maiores escores nas posições de 90°, 120° e 150° em comparação com 30° e 60° para ambas as condições (p < 0,01) demonstrando alcances ipsilaterais. Tais resultados foram explicados pela restrição biomecânica para fazer a tarefa, modulando a preferência manual, de acordo com a localização espacial dos objetos no ambiente.

Abstract The manual preference in a reaching task in adults was analyzed according to the spatial location of an object in the environment. Thirty participants performed the task of reaching a cylinder, with one hand, at 50 cm distance in five different positions in relation to the sagittal plane of the participant. Two conditions were performed: comfort and speed. Friedman' s ANOVA showed difference (X230,9 = 122.17; p < 0.001) and the Wilcoxon' s test showed higher scores at positions 90°, 120° and 150° in comparison 30° and 60°, for both conditions (p < 0.01) showing ipsilateral reaches. These results were explained by the biomechanics restriction to perform the task, modulating the manual preference, according to the spatial location of objects in the environment.

Resumen Se analizó la preferencia manual en una tarea de alcance en adultos en función de la ubicación espacial de un objeto en el entorno. Treinta participantes realizaron la tarea de alcanzar un cilindro, con una sola mano, a una distancia de 50 cm en cinco posiciones diferentes en relación con el plano sagital del participante. Dos condiciones se cumplieron: comodidad y velocidad. La prueba ANOVA de Friedman mostró una diferencia (χ230,9 = 122,17; p < 0,001) y la prueba de Wilcoxon mostró puntuaciones más altas en las posiciones de 90̊, 120̊ y 150̊ en comparación con las de 30̊ y 60̊, en ambas condiciones (p < 0,01), lo que demostró alcances ipsilaterales. Estos resultados se debieron a la biomecánica de restricción para realizar la tarea mediante la modulación de la preferencia manual, de acuerdo con la ubicación espacial de los objetos en el entorno.

Equilíbrio dinâmico em adolescentes com Síndrome de Down e adolescentes com desenvolvimento típico / Dynamic Balance in teenagers with Down Syndrome and teenagers with typical development

O presente estudo analisou o equilíbrio dinâmico de adolescentes com síndrome de Down (SD) e adolescentes com desenvolvimento típico (DT). Participaram do estudo 14 adolescentes com SD e 22 com DT que tinham que manter o equilíbrio sobre uma plataforma instável. O equilíbrio foi analisado em condições com e sem visão, em apoio bipodal nas posições com os pés paralelos e em semi-tandem. Ambos os grupos apresentaram um desempenho inferior nas condições em que a visão foi ocluída. Porém, os adolescentes com SD apresentaram maior instabilidade no equilíbrio dinâmico em relação aos adolescentes com DT, tanto nas condições com visão quanto nas sem visão. Esses resultados foram explicados pelas características normalmente verificadas em pessoas com SD, tais como: hipotonia muscular, frouxidão ligamentar e a dificuldade na integração percepção-ação.

The present study analyzed the dynamic balance of teenagers with Down syndrome (DS) and teenagers with typical development (TD). Fourteen 14 teenagers with DS and 22 teenagers with typical development (TD) performed the task of trying to keep their balance on a unstable platform. Balance was analyzed in conditions with and without vision, in the bipodal basis of support with the parallels feet and semi-tandem. Both groups showed a worse performance in the conditions with no vision. However, the teenagers with DS showed greater instability in the dynamic balance in comparison to the teenagers with TD for both, vision and non-vision conditions. Such results were explained by the characteristics normally verified in people with DS, such as: muscular hypotonic, ligamentous laxity, and the difficulty in the action-perception integration.

Combination immunosuppressant therapy for patients with chronic refractory immune thrombocytopenic purpura.

Treatment options for patients with chronic refractory immune thrombocytopenic purpura (ITP) are limited. Because combination immunosuppressant therapy appeared to be effective in ITP and other disorders, we used this approach in patients with particularly severe and refractory ITP. In this retrospective, observational study, we determined the response (platelet count above 30 x 10(9)/L and doubling of baseline) among 19 refractory ITP patients. Treatment consisted of azathioprine, mycophenolate mofetil, and cyclosporine. The patients had failed a median of 6 prior treatments, including splenectomy (in all except 1). Of 19 patients, 14 (73.7%) achieved a response lasting a median of 24 months, after which time 8 (57.1%) relapsed. Of the 8 relapsing patients, 6 responded to additional treatments. Of the 14 patients who achieved an initial response, 2 (14.3%) remained in remission after eventually stopping all medications. Severe adverse events did not occur. Combination immunosuppressant therapy can produce a rise in the platelet count that is sometimes sustained in refractory ITP patients.

Analyses of cellular multimerin 1 receptors: in vitro evidence of binding mediated by alphaIIbbeta3 and alphavbeta3.

Multimerin 1 (MMRN1) is a large, soluble, polymeric, factor V binding protein and member of the EMILIN protein family. In vivo, MMRN1 is found in platelets, megakaryocytes, endothelium and extracellular matrix fibers, but not in plasma. To address the mechanism of MMRN1 binding to activated platelets and endothelial cells, we investigated the identity of the major MMRN1 receptors on these cells using wild-type and RGE-forms of recombinant MMRN1. Ligand capture, cell adhesion, ELISA and flow cytometry analyses of platelet-MMRN1 binding, indicated that MMRN1 binds to integrins alphaIIbbeta3 and alphavbeta3. Endothelial cell binding to MMRN1 was predominantly mediated by alphavbeta3 and did not require the MMRN1 RGD site or cellular activation. Like many other alphavbeta3 ligands, MMRN1 had the ability to support adhesion of additional cell types, including stimulated neutrophils. Expression studies, using a cell line capable of endothelial-like MMRN1 processing, indicated that MMRN1 adhesion to cellular receptors enhanced its extracellular matrix fiber assembly. These studies implicate integrin-mediated binding in MMRN1 attachment to cells and indicate that MMRN1 is a ligand for alphaIIbbeta3 and alphavbeta3.

Anastomose sistêmio-pulmonar tipo Blalock-Taussig: comparaçäo entre a operaçäo original e a modificada / Systemic-pulmonary anastomosis type Blalock-Taussig: comparison between the original and the modified surgery

No período de Jan 80 a Jul 86, foram submetidos a cirurgia de derivaçäo sistêmico-pulmonar, tipo Blalock-Taussig e modificado, 57 pacientes portadores de cardiopatia congênita cianótica com hipofluxo pulmonar. A idade variou de 4 dias e 8 anos, com média de 13 meses, e sendo que 6 (10,5%) estavam com menos de 1 mês, 18 se situavam na faixa de 1 a 6 meses (31,6%), e 13 (22,8%) de 7 a 12 meses. Eram do sexo masculino 54,4% das crianças. Quanto à patologia cardíaca básica a Tétrade de Fallot teve 18 casos (31,6%), 11 pacientes (19,4%) tinham atresia tricúspide, a atresia pulmonar teve 8 casos (14,0%) bem como o ventrículo único com estenose pulmonar; os restantes 21 por cento relacionavam-se a transposiçäo das grandes artérias, canal atrio-ventricular, dupla via de saída de VD e VE, cardiopatia complexa e estenose pulmonar associada em todos. A cirurgia de Blalock-Taussig original foi realizada em 28 casos, enquanto que o tubo de PTFE foi usado em 29 pacientes numa distribuiçäo relativamente homogênea. A mortalidade hospitalar global foi de 7 casos (12,3%) nenhum relacionado à tétrade de Fallot. Seis pacientes já foram submetidos à correçäo cirúrgica definitiva. Ambas as técnicas se mostraram efetivas em nossas mäos