Calf Circumference: A Marker of Muscle Mass as a Predictor of Hospital Readmission.

Hospital readmissions (HRs) are common, potentially preventable, and a marker of poor quality in health services. This study aimed to identify risk factors for HR in clinical patients, with an emphasis on nutrition aspects, especially calf circumference (CC), as a marker of muscle mass. A prospective cohort study of patients admitted to the internal medicine ward was conducted. The short form of the Patient-Generated Subjective Global Assessment was performed in the first 24 hours of hospitalization. In addition, single-frequency bioelectrical impedance analysis was used to estimate the phase angle, CC as a surrogate of muscle mass, and handgrip strength as a marker of strength. The Charlson Comorbidity Index (CCI) was used to assess the severity of the comorbidities. Reassessments were performed every 7 days during hospitalization. HR was evaluated 30 days after discharge by phone contact. A sample of 161 patients was assessed; 54.6% were male, with a mean age of 59.2 ± 17.8 years. The median CCI was 2.76 (interquartile range: 1-4), and nutrition risk and low CC were present in 77.6% and 46% of the patients, respectively. The readmission rate was 16.8% after 30 days. After controlling for sex and age, a CCI > 2 (odds ratio [OR]: 3.29; 95% confidence interval [CI]: 1.21-8.97), the presence of cancer (OR: 4.52; 95% CI: 1.11-18.42), nutrition risk (OR: 9.53; 95% CI: 1.16-77.9), and a low CC (OR: 3.89; 95% CI: 1.34-11.31) were significantly associated with 30 day HR. In conclusion, muscle mass loss, identified by CC, can be a good predictor of 30-day HR, even after controlling for other well-known risk factors.

Duodenal strongyloidiasis and hyperinfection syndrome: case report and literature review

Strongyloides stercoralis is an intestinal nematode that commonly causes chronic or asymptomatic infection, but in some situations, especially in immunosuppressed patients, infection by this parasite can manifest with extreme severity and high mortality. Hyperinfection syndrome and disseminated strongyloidiasis are two serious, life-threatening presentations associated with immunosuppression. This paper aims to report a case of duodenal strongyloidiasis that was associated with malabsorption syndrome and evolved to hyperinfection.

Pseudomixoma peritoneal: relato de caso e revisão da literatura / Pseudomyxoma peritonei: case report and literature review

Pseudomixoma peritoneal (PMP) é uma doença incomum, caracterizada pela presença de coleções líquidas gelatinosas em abdome e pelve, com implantes mucinosos na superfície peritoneal. A maioria dos casos é associada a neoplasias apendiculares. Os sintomas mais importantes são aumento de volume abdominal, emagrecimento, dor abdominal e sintomas mimetizando apendicite aguda. Esta condição clínica progride com disseminação peritoneal, obstrução intestinal e comprometimento nutricional. O caso relatado é de uma paciente feminina, 68 anos, com emagrecimento, aumento de volume abdominal e massa anexial, causando hidronefrose bilateral. Laparotomia exploradora evidenciou massa ocupando cavidades intraperitonial e retroperitonial, originária de tumor apendicular. Após análise histopatológica, o diagnóstico final foi de pseudomixoma peritoneal secundário a neoplasia de apêndice

Pseudomyxoma peritonei (PMP) is an uncommon disease, characterized by the presence of gelatinous collections in abdominal and pelvic cavities, with mucinous implants on peritoneal surface. The majority of PMP cases are associated with appendiceal carcinomas. The most important symptoms are increasing abdominal girth, weight loss, abdominal pain, and symptoms mimicking an acute appendicitis. This entity has a borderline behavior with progression to peritoneal seeding, intestinal obstruction, and nutritional compromise. The case reported is of a 68-year-old woman with weight loss, increasing abdominal girth, and an adnexal mass. Exploratory laparotomy demonstrated a mass occupying intraperitonial and retroperitonial spaces, originating in an appendiceal tumor. After histopathology examination, the final diagnosis was pseudomyxoma peritonei, due to appendiceal tumor