Effects of 174 G/C polymorphism in the promoter region of the interleukin-6 gene on plasma IL-6 levels and muscle strength in elderly women

We investigated the effect of -174 G/C single-nucleotide polymorphism in the promoter region of the IL6 gene on plasma IL-6 levels and muscle strength, and the relationship between IL-6 levels and muscle strength in elderly women. The sample consisted of 199 elderly residents (73.0 ± 7.8 years old) from rest homes and the community in Belo Horizonte, MG, Brazil. -174 G/C polymorphism was determined by direct sequencing of the product by PCR, and plasma IL-6 concentrations were measured by ELISA. Muscle strength in the knee joint was evaluated using a Biodex System 3 Pro® isokinetic dynamometer. ANCOVA was used to determine the effect of polymorphism on IL-6 levels and muscle strength, and the Pearson correlation coefficient to assess the relationship between IL-6 levels and muscle strength. -174 G/C polymorphism was associated with the plasma IL-6 levels of elderly women (P < 0.01) since homozygotes for the G allele showed high IL-6 levels (GG 3.85 pg/mL, GC + CC 2.13 pg/mL). There was no association of polymorphism on muscle strength (P > 0.05). No association was found between IL-6 levels and knee extensor muscle (r = 0.087, P = 0.306) or flexor (r = -0.011, P = 0.894) strength. An interaction between -174 G/C polymorphism and housing conditions of the sample of elderly women was identified, with the effect of genotype on IL-6 levels being higher in the institutionalized elderly. These results support the evidence that -174 G/C polymorphism of the IL6 gene associates with individual variability of plasma IL-6 levels in elderly women.

Muscle strength but not functional capacity is associated with plasma interleukin-6 levels of community-dwelling elderly women

The association of plasma interleukin-6 (IL-6) levels, muscle strength and functional capacity was investigated in a cross-sectional study of community-dwelling elderly women from Belo Horizonte, Brazil. Elderly people who present controlled chronic diseases with no negative impact on physical, psychosocial and mental functionality are considered to be community-dwelling. Psychological and social stress due to unsuccessfully aging can represent a risk for immune system disfunctions. IL-6 levels, isokinetic muscle strength of knee flexion/extension, and functional tests to determine time required to rise from a chair and gait velocity were measured in 57 participants (71.21 ± 7.38 years). Serum levels of IL-6 were measured in duplicate and were performed within one single assay (mouse monoclonal antibody against IL-6; High-Sensitivity, Quantikine®, R & D Systems, USA; intra-assay coefficient of variance = 6.9-7.4 percent; interassay coefficient of variance = 9.6-6.5 percent; sensitivity = 0.016-0.110 pg/mL; mean = 0.039 pg/mL). Muscle strength was assessed with the isokinetic dynamometer Biodex System 3 Pro®. After the Shapiro-Wilk normality test was applied, correlations were investigated using Spearman and Kruskal-Wallis tests. Post hoc analysis was performed using the Dunn test. A significant negative correlation was observed between plasma IL-6 levels (1.95 ± 1.77 pg/mL) and muscle strength for knee flexion (70.70 ± 21.14 percent; r = -0.265; P = 0.047) and extension (271.84 ± 67.85 percent; r = -0.315; P = 0.017). No significant correlation was observed between IL-6 levels and the functional tests (time to rise from a chair = 14.65 ± 2.82 s and gait velocity = 0.95 ± 0.14 m/s). These results suggest that IL-6 is associated with reduced muscle strength.

Avaliação das atividades de vida diária de idosos com diferentes níveis de demência / Evaluation of the activities of daily living of elderly people with different levels of dementia

OBJETIVOS: Comparar o desempenho de idosos com diferentes níveis de gravidade de demência em questionários de atividades básicas de vida diária (ABVDs) e atividades instrumentais de vida diária (AIVDs). Verificar se existe correlação entre os questionários de AIVDs aplicados. METODOLOGIA: Foram aleatorizados 90 idosos (75,46 ± 7,66 anos) atendidos no Centro de Referência do Idoso-MG, com diagnóstico clínico de demência (DSM-IV/APA) e classificados quanto ao nível de gravidade da demência (Clinical Dementia Rating). As ABVDs foram avaliadas pelo índice de Katz, e as AIVDs, pelo índice de Lawton-Brody e de Pfeffer. Os testes de Kruskal-Wallis e de Mann-Whitney foram utilizados para verificar o desempenho dos idosos nas ABVDs, e a correlação de Spearman, para investigar a relação entre os instrumentos de AIVDs (alfa< 0,05). RESULTADOS: Foram encontradas diferenças estatisticamente significativas entre o desempenho dos idosos com diferentes níveis de gravidade de demência avaliados pelos instrumentos de ABVDs e AIVDs (p< 0,001). Os questionários de AIVDs apresentaram correlação significativa na amostra total (p< 0,0001; r= -0,818), nos grupos com demência leve (p= 0,007; r= -0,530) e grave (p< 0,0001; r= -0,723). CONCLUSÃO: A gravidade do processo demencial interferiu no desempenho dos idosos nas atividades básicas e instrumentais de vida diária. As AIVDs foram mais comprometidas nos estágios iniciais das demências, e as ABVDs, nos estágios mais avançados. Os questionários de AIVDs utilizados, apesar de sua particularidade estrutural, parecem medir um construto comum. A variabilidade do quadro clínico nos indivíduos com demência moderada pode explicar a ausência de correlação dos questionários usados nesse grupo específico.

OBJECTIVE: To compare the performance of elderly people with different levels of severity of dementia using questionnaires on basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). Also, to verify whether there were any association between the IADL questionnaires applied. METHOD: Ninety elderly people, aged 75.46 ± 7.66 years with a clinical diagnosis of dementia (DSM-IV/APA) who were seen at the Minas Gerais Reference Center for the Elderly, were randomized selected and classified according to the level of severity of their dementia (Clinical Dementia Rating). Their BADLs were assessed using the Katz Index and their IADLs by the Lawton-Brody and Pfeffer indexes. The Kruskal-Wallis and Mann-Whitney tests were used in order to investigate the elderly people's performance regarding BADLs, while the Spearman correlation was used to investigate the relationships among the IADL (alpha< 0.05). RESULTS: Statistically significant differences in performance were found between the elderly people with different levels of severity of dementia, as assessed by the BADL and IADL questionnaires (p< 0.001). The IADL questionnaires presented significant correlation for the total sample (p< 0.0001; r = -0.818) as well as for the groups with mild dementia (p= 0.007; r = -0.530) and severe dementia (p< 0.0001; r = -0.723). CONCLUSION: The severity of the dementia process interfered with the elderly people's performance of the elderly in BADLs and IADLs. The IADLs were more affected in the early stages of dementia whereas the BADLs were more affected in the more advanced stages. Despite structural particularities, the IADL questionnaires utilized seemed to be measuring a common construct. The variability in the clinical condition of the individuals with moderate dementia may be an explanation for the lack of correlation between the questionnaires in this specific group.

Muscular function and functional mobility of faller and non-faller elderly women with osteoarthritis of the knee

Falls are a major concern in the elderly population with chronic joint disease. To compare muscular function and functional mobility among older women with knee osteoarthritis with and without a history of falls, 15 elderly women with a history of falls (74.20 ± 4.46 years) and 15 without a history of falls (71.73 ± 4.73 years) were studied. Muscular function, at the angular speed of 60, 120, and 180°/s, was evaluated using the Biodex Isokinetic Dynamometer. The sit-to-stand task was performed using the Balance Master System and the Timed Up and Go test was used to determine functional mobility. After collection of these data, the history of falls was investigated. A statistically significant difference was detected in the time taken to transfer the center of gravity during the sit-to-stand test (means ± SD; non-fallers: 0.35 ± 0.16 s; fallers: 0.55 ± 0.32 s; P = 0.049, Student t-test) and in the Timed Up and Go test (medians; non-fallers: 10.08 s; fallers: 11.59 s; P = 0.038, Mann-Whitney U-test). The results indicated that elderly osteoarthritic women with a history of falls presented altered functional mobility and needed more time to transfer the center of gravity in the sit-to-stand test. It is important to implement strategies to guarantee a better functional performance of elderly patients to reduce fall risks.

Redução do efeito analgésico da estimulação elétrica nervosa transcutânea de baixa freqüência em ratos tolerantes à morfina / Reduction in analgesic effect from low-frequency transcutaneous electrical nerve stimulation in morphine-tolerant rats

OBJETIVO: Investigar o efeito da TENS de baixa (10 Hz) e alta freqüência(130 Hz) aplicadas na pata inflamada do rato após tratamento crônico com morfina. MÉTODO: Foram utilizados 140 ratos Holtzman fêmeas, nos quais a carragenina (Cg 250 æg/0,1ml) foi administrada na pata posterior direita para a indução da inflamação. TENS de baixa e alta freqüência foi aplicada por 20 min, após 2 h e 30 min da Cg e seu efeito medido através do método de Randall-Selitto. O antagonista opióide Naltrexona (3mg/kg,sc), foi administrado 30 minutos antes da TENS para verificar a liberação de substâncias opióides endógenas. A tolerância foi obtida após administração da morfina (10 mg/kg,sc), duas vezes ao dia, durante sete dias. O tratamento com TENS de baixa e alta freqüência foi realizado no oitavo dia às 2 h e 30 min após Cg. A análise estatística foi feita pelo método da análise de variância ANOVA (One Way) seguido de um teste "post hoc" (Teste de Bonferroni), com nível de significância quando p < 0,05. RESULTADOS: TENS de baixa e alta freqüência inibiu em 100 por cento a hiperalgesia induzida pela Cg. Animais tratados previamente com naltrexona mostraram completa reversão da analgesia induzida pela baixa freqüência mas não pela alta freqüência. Após tolerância à morfina, os valores da TENS de baixa freqüência indicaram total ausência de analgesia, ao contrário da TENS de alta freqüência que induziu anti-hiperalgesia. CONCLUSÃO: Conclui-se que a atividade analgésica da TENS de baixa freqüência é reduzida após o desenvolvimento de tolerância a morfina.

OBJECTIVE: To investigate the effects of low (10 Hz) and high-frequency (130 Hz) transcutaneous electrical nerve stimulation (TENS) applied to inflamed paws of rats following chronic treatment with morphine. METHOD: 140 female Holtzman rats were utilized. Carrageenan (250 æg/0.1 ml) was administered to the right hind paws to induce inflammation. Two and a half hours after carrageenan injection, low and high frequency TENS was applied to the inflamed paw for 20 min, and its effect was measured via the Randall-Selitto method. The opioid antagonist naltrexone (3.0 mg/kg, subcutaneously) was administered 30 min before TENS, to verify the release of endogenous opioids. Morphine tolerance (10 mg/kg, subcutaneously) was induced by twice-daily injection over seven days. Low and high frequency TENS treatment was carried out on the eighth day, 2.5 hours after carrageenan injection. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by the post hoc Bonferroni test, with a significance level of p < 0.05. RESULTS: Both low and high frequency produced 100 percent inhibition of carrageenan-induced hyperalgesia. Naltrexone-treated animals showed complete reversion of analgesia induced by low but not high-frequency TENS. After attaining morphine tolerance, the low-frequency TENS values indicated complete absence of analgesia, whereas high-frequency TENS induced anti-hyperalgesia. CONCLUSION: The analgesic activity of low-frequency TENS is reduced following the development of morphine tolerance.

O desempenho de idosos institucionalizados com alterações cognitivas em atividades de vida diaria e mobilidade: estudo piloto / Performance in daily living activities and mobility among institutionalized elderly people with cognitive impairments: pilot study

Comparar o desempenho funcional de idosos institucionalizados, portadores de alteracoes cognitivas selecionados atraves do Mini-Exame do Estado Mental (MEEM) em um teste de mobilidade (TUG) a partir do indice de Katz. Metodo: participaram dessa pesquisa 28 sujeitos(82+-9,06 anos), os quais foram submetidos ao teste `Timed Up and Go-TUG` e as atividades de vida diaria foram avaliadas atraves do indice de Kartz. Resultados: nao foi encontrada correlacao estatisticamente significativa entre a mobilidade avaliada pelo TUG e o desempenho no MEEM(r=0,234 e p=0,232, Pearson). Uma associacao positiva foi detectada entre o desempenho dos idosos no TUG e a realizacao das tarefas banho, vestuario e transferencia do Indice de Kartz (p=0,039; p=0,000; p=0,001, respectivamente, ANOVA). Nao foi encontrada associacao significativa entre as alteracoes cognitivas detectadas pelo MEEM e o desempenho dos idosos nas 5 atividades propostas pelo indice de kartz (banho: p=0,774; vestuario: p=0,567; higiene: p=0,857; transferencia: p=0,824; continencia: p=0,947, ANOVA). O aumento da idade nao demonstrou correlacao significativa com o desempenho em nenhum dos testes aplicados (TUG p=0,466 e r=0,144; MEEM p=0,841 e r=0,0,040, Pearson). Conclusao: concluiu-se que as alteracoes cognitivas detectadas atraves do MEEM nao tiveram associacao com o desempenho dos idosos nos testes de mobilidade e na realizacao das atividades de banho, vestuario e transferencia

Role of endogenous glucocorticoids in hyperalgesia and edema in old arthritic rats

We compared the intensity and frequency of arthritis in old (8-12 months, N = 12) and juvenile (2 months, N = 10) rats and determined the role played by adrenal glands in this disorder. Arthritis was induced by subcutaneous injection of Mycobacterium butyricum at the base of the tail of female Holtzman rats at day zero. Paw edema and hyperalgesia were monitored from day zero to day 21 after induction as signs of arthritis development. Some (N = 11) old animals were adrenalectomized bilaterally and treated with dexamethasone or celecoxib immediately following surgery. All bilaterally adrenalectomized old animals became susceptible to arthritis and the onset of disease was shortened from the 10th to the 5th day. Hyperalgesia and paw edema responses were less frequent in older animals (50 and 25 percent compared to control juvenile rats, respectively), although old responder animals showed responses of similar intensity to those of their juvenile counterparts: by the 14th day the data for hyperalgesia were juvenile = 0.8 ± 0.07/old = 0.8 ± 0.09, and for paw edema juvenile = 56.6 ± 6.04/old = 32.24 ± 12.7, reported as delta percent increase in paw edema. Chronic treatment of adrenalectomized old animals with dexamethasone (0.01 or 0.1 mg/kg) but not celecoxib (3 mg/kg), once daily for 21 days by gavage, abolished the effects of adrenalectomy, in particular those related to the hyperalgesia response (old = 0.95 ± 0.03/dexamethasone = 0 ± 0; 14th day), thus suggesting a specific participation of circulating corticosteroids in the modulation of pain in old arthritic rats

Novas contribuiçöes do eletrocardiograma ao diagnóstico diferencial das taquicardias paroxísticas com complexo QRS alargado / New contributions of the electrocardiogram to the differential diagnosis of wide QRS complex tachycardias

Os autores indicam as principais dificuldades em se diagnosticar as taquicardias com complexos QRS alargados através do eletrocardiograma convencional, bem como a terapêutica mais aceita para a sua reversão a ritmo sinusal. O algoritmo de Brugada é o critério de escolha por apresentar alta sensibilidade e especificidade para o diagnóstico diferencial entre TV e TPSV com aberrância. O Advanced Cardiac Life Support (ACLS) utiliza um algoritmo para tratamento das taquicardias com complexos QRS alargasdos com alta eficácia e segurança.

Cyclosporin inhibits hyperalgesia and edema in arthritic rats: role of the central nervous system

Since arthritis induced by Mycobacterium products (adjuvant) in rats is considered to be immunologically driven, the objective of the present study was to determine if the immunosuppressor drug cyclosporin could affect hindpaw edema and joint hyperalgesia simultaneously. Female Holtzman rats (140-170 g) presented hyperalgesia and edema on the 8th and 12th day following adjuvant injection. Daily systemic (oral or intramuscular) administration of cyclosporin (0.5-5.0 mg Kg-1 day-1) or dexamethasone (0.01-0.1 mg Kg-1 day-1) for 15 days starting on day zero dose-dependently inhibited the hindpaw edema and hyperalgesia in arthritic rats. However, hyperalgesia but not edema could be detected two days after cyclosporin withdrawal. We concluded that a) the continuous presence of cyclosporin is essential to reduce the development of joint hyperalgesia and that b) different mechanisms underlie the apperance of hyperalgesia and edema in this model. The intracerebroventricular (icv) administration of 5-50-fold smaller doses of cyclosporin (1.5-150 mug/day) or dexamethasone (15mug/day) also reduced the arthritic hindpaw edema and hyperalgesia. Peripheral blood from animals injected with effective systemic cyclosporin doses showed detectable levels of the drug, whereas peripheral blood from those injected with icv cyclosporin did not, as measured by specific RIA. Our results indicate that cyclosporin administered by the central route is as effective as by the systemic route to reduce joint hyperalgesia and hindpaw edema in arthritic rats. The antiarthritic effect induced by low doses of cyclosporin in the central nervous system (CNS) could be explored to avoid its often associated systemic side effects during chronic therapy. However, the mechanisms(s) involved in the antiarthritic response to cyclosporin in the CNS remain to be elucidated.