Ângulo de fase como preditor de massa muscular em pacientes com doença inflamatória intestinal / Phase angle as a predictor of muscle mass in patients with inflammatory bowel disease

ABSTRACT Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. Objective: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. Methods: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. Results: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. Conclusion: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition.

RESUMO A desnutrição/sarcopenia é frequente em pacientes com doenças inflamatórias intestinais (DII), resultando em catabolismo muscular, com impacto nas respostas aos tratamentos, complicações cirúrgicas e na qualidade de vida. Objetivo: Este estudo tem como objetivo, avaliar se o ângulo de fase (AF) é um parâmetro para a predição de redução de massa muscular em pacientes com DII. Métodos: Pacientes adultos com DII foram incluídos neste estudo transversal. A estimativa da massa muscular e o cálculo do AF foram realizados a partir do exame de bioimpedância elétrica (BIA). As atividades da doença de Crohn e retocolite ulcerativa foram definidas pelo índice Harvey-Bradshaw e escore parcial de Mayo, respectivamente. A área de curva ROC foi calculada para identificar o ponto de corte do AF para a massa muscular reduzida. Resultados: A amostra foi composta por 145 pacientes, sendo 39 (26.9%) com DII em fase ativa. Houve correlação do AF com massa muscular esquelética (MME) (rs 0.35, P<0.001) e com o índice de massa muscular esquelética (IMME) (rs 0.427, P<0.001), mantendo-se as associações na forma mais ativa (moderada ou grave) da DII. A análise da curva ROC indicou que os pontos de corte de AF ≤5.042 para mulheres e ≤6.079 para homens podem ser usados para prever a redução da massa muscular. Conclusão: O AF pode ser considerado um preditor de redução de massa muscular nos pacientes com DII e ser utilizado para triagem e acompanhamento da evolução da desnutrição.

Lifestyle Intervention in Reducing Cardiometabolic Risk Factors in Students with Dyslipidemia and Abdominal Obesity: A Randomized Study

Abstract Background The long incubation periods of cardiovascular diseases offer opportunities for controlling risk factors. In addition, preventive interventions in childhood are more likely to succeed because lifestyle habits become ingrained as they are repeated. Objective To investigate the effects of recreational physical activities, in combination or not with a qualitative nutritional counseling, in cardiometabolic risk factors of students with dyslipidemia and abdominal obesity. Methods Students (8-14 years old) were randomly divided into three groups (n=23 each): i ) Control; ii ) PANC, students undergoing Physical Activity and Nutritional Counseling, and iii ) PA, students submitted to Physical Activity, only. Blood samples (12-h fasting) were collected for biochemical analysis and anthropometric markers were also assessed. Two-Way RM-ANOVA and Holm-Sidak's test, and Friedman ANOVA on Ranks and Dunn's test were applied. P ≤ 0.05 was considered significant. Effect sizes were evaluated by Hedges' g and Cliff's δ for normal and non-Gaussian data, respectively. Results Compared to the control group and to baseline values, both interventions caused significant average reductions in total cholesterol (11%; p <0.001), LDL-c (19%; p=0.002), and non-HDL-c (19%; p=0.003). Furthermore, students in the PANC group also experienced a significant decrease in body fat compared to baseline (p=0.005) and to control (5.2%; g=0.541). Conclusions The proposed strategies were effective to reduce cardiometabolic risk factors in children and adolescents. The low cost of these interventions allows the implementation of health care programs in schools to improve the students' quality of life.

Prevalence of HCV infection in a prison population of the greater Florianópolis area

Abstract INTRODUCTION The present study aimed to estimate the prevalence of Hepatitis C virus (HCV) infection in a prison population. METHODS: A total of 147 individuals were interviewed and subjected to venipuncture for collection of blood sample. The study population consisted of male individuals who attended the health unit of the state penitentiary of Florianópolis. RESULTS: The prevalence of HCV infection was 5.4%. Regarding behavioral variables, 95 (64.6%, p<0.0507) subjects reported consuming alcohol and 7 (4.8%, p<0.0476) reported having already used injectable drugs. CONCLUSIONS: The prevalence of HCV infection in the studied population was higher than that in the general populations.

Serum uric acid in children and adolescents / Valores de referência do ácido úrico em crianças e adolescentes

ABSTRACT Introduction: Uric acid (UrA) is a product of purine catabolism, and hyperuricemia (hUrA) is associated with risk factors for cardiometabolic diseases. Objective: To evaluate the concentration of UrA in children and adolescents. Methods: Cross-sectional study with 623 eutrophic students (5 to 15 years old, aged 9.9 ± 2.7 years, 52% girls). Blood was collected (fasting 12-14 h) for analysis of laboratory parameters, and blood pressure and anthropometric measures were verified. UrA was stratified according to sex and age ranges (5 to < 10, ≥ 10 to < 13 and ≥ 13 to 15 years, male; and 5 to < 9, ≥ 9 to < 12 and ≥ 12 to 15 years, female), and the percentiles 2.5 (2.5th) and 97.5 (97.5th) were calculated. Results: The mean UrA was 3.7 ± 1.03 mg/dl (boys) and 3.58 ± 0.91 mg/dl (girls) (p = 0.0113). Considering the age ranges, the mean UrA was increasing and higher for boys (p = 0.0024, for the 3rd age range). For girls, the UrA increased progressively and significantly in the age ranges (p ≤ 0.005). According to the 97.5th, there was statistical difference only in the third range between sexes (p = 0.002). For comparisons between age ranges, UrA 97.5th also increased for boys and girls (p ≤ 0.05). According to the 97.5th, 26 students presented hUrA. Conclusion: According to the results, stratification by age ranges and sex, in addition to the 97.5th as concentration threshold, was important for evaluation of serum levels of UrA in children and adolescents.

RESUMO Introdução: O ácido úrico (AUr) é um produto do catabolismo das purinas, e a hiperuricemia (hAUr) associa-se a fatores de risco para doenças cardiometabólicas. Objetivo: Avaliar a concentração de AUr em crianças e adolescentes. Métodos: Estudo transversal com 623 estudantes eutróficos (5 a 15 anos de idade; 9,9 ± 2,7 anos; 52% meninas). Foi coletado sangue (jejum 12-14 h) para análise de parâmetros laboratoriais e foram aferidas pressão arterial e medidas antropométricas. AUr foi estratificado segundo sexo e faixas etárias (5 a < 10, ≥ 10 a < 13 e ≥ 13 a 15 anos, masculino; 5 a < 9, ≥ 9 a < 12 e ≥ 12 a 15 anos, feminino) e foram calculados os percentis 2,5 (2,5th) e 97,5 (97,5th). Resultados: A média de AUr foi de 3,7 ± 1,03 mg/dl (meninos) e 3,58 ± 0,91 mg/dl (meninas) (p = 0,0113). Considerando as faixas etárias, a média de AUr foi crescente e superior nos meninos (p = 0,0024, para terceira faixa). Nas meninas, o AUr aumentou progressiva e significativamente nas faixas etárias (p ≤ 0,005). Segundo o 97,5th, houve diferença estatística somente na terceira faixa entre os sexos (p = 0,002). Nas comparações entre faixas etárias, o 97,5th do AUr também aumentou para meninos e meninas (p ≤ 0,05). Segundo o 97,5th, 26 estudantes apresentaram hAUR. Conclusão: A estratificação por faixas etárias e sexo, além do 97,5th como limiar de concentração, foi importante para avaliação da concentração sérica do AUr em crianças e adolescentes.

Queixa subjetiva de memória e a relação com a fluência verbal em idosos ativos / Subjective memory complaints and their relation with verbal fluency in active older people

RESUMO Objetivo Verificar a queixa subjetiva de memória relacionada com a fluência verbal em idosos participantes de grupos de convivência. Método Trata-se de um estudo epidemiológico, quantitativo, realizado em grupos de convivência de idosos do município de Florianópolis, Estado de Santa Catarina. Os dados foram coletados por meio de entrevista estruturada utilizando-se o Questionário de Queixas de Memória (MAC-Q) e o Teste de Fluência Verbal (TFV) por categorias semânticas animais/minuto. Para a análise descritiva inferencial, consideraram-se os dados com p < 5%. Resultados Foi encontrada a queixa de memória autodeclarada em 35,7% da amostra. Não houve associação e correlação do TFV com a percepção da memória obtida pelo MAC-Q bem como com o seu escore. A análise do TFV com os indivíduos que referiram percepção negativa de memória apresentou significância estatística. Salienta-se que foi encontrada associação significativa entre a percepção (escore do MAC-Q) e a presença da queixa de memória (referida pelos idosos em questão acrescida ao questionário). Conclusão Não houve relação entre a queixa subjetiva de memória e a fluência verbal de idosos ativos, sendo as queixas mnemônicas correlacionadas à percepção negativa da memória e ao tempo de queixa apresentada. Porém a queixa subjetiva da memória se mostrou um indicativo para aqueles indivíduos com percepção negativa da memória, sendo um aspecto que deve ser considerado na fala dos idosos ao se investigar um possível declínio cognitivo. Tais dados podem auxiliar no direcionamento das ações de políticas públicas de assistência às pessoas idosas no município, salientando-se a importância em se verificar a queixa subjetiva de memória dos idosos.

ABSTRACT Purpose To verify subjective memory complaints and their relation to verbal fluency in older people participating in community groups. Methods An epidemiological quantitative study performed in community groups for older people in Florianópolis, state of Santa Catarina, Brazil. Data were collected by structured interview using the Memory Complaint Questionnaire (MAC-Q) and the Verbal Fluency Test (VFT) by semantic categories “animals/minute”. For an inferential descriptive analysis, data with p < 5% were considered. Results Self-reported memory complaints were found in 35.7% of the sample. No association or correlation of VFT with the perception of memory obtained by MAC-Q, nor with its score was found. The VFT analysis of in individuals who reported negative perception of memory presented statistical significance. We found significant association between the perception (MAC-Q score) and presence of memory lapses (reported by the older people in question and added to the questionnaire). Conclusion We found no relation between subjective memory complaints and verbal fluency of active older people. Mnemonic complaints were correlated to the negative perception of memory and to the duration of the complaint. However, subjective memory complaints were an indicator for those individuals with negative perception of memory, being one aspect that must be considered in older people’s speech when investigating a possible cognitive deterioration. Such data can assist in formulating public health care policies aimed at older people in the city, which emphasizes the importance of verifying subjective memory complaints in this population.

Metabolic Syndrome and Importance of Associated Variables in Children and Adolescents in Guabiruba - SC, Brazil / Síndrome Metabólica e Importância das Variáveis Associadas em Crianças e Adolescentes de Guabiruba - SC, Brasil

The risk factors that characterize metabolic syndrome (MetS) may be present in childhood and adolescence, increasing the risk of cardiovascular disease in adulthood.

Os fatores de risco que caracterizam a síndrome metabólica (SM) podem estar presentes na infância e adolescência, agravando o risco para as doenças cardiovasculares na idade adulta.

Vaccination coverage and immunity against hepatitis B among HIV-infected patients in South Brazil

Evidence-based strategies to improve the hepatitis B virus (HBV) vaccination coverage rates might help to reduce the burden caused by co-infection with HBV and human immuno-deficiency virus (HIV). In this study, the aim was to evaluate the vaccination coverage and immunity against HBV among HIV-infected individuals in South Brazil, and identify factors that are associated with compliance patterns and antibody reactivity. Three hundred HIV-infected men and women were included in this survey. The patients answered a standardized questionnaire, and vaccination cards were checked in order to assess hepatitis B vaccine status. A blood sample was collected for quantitative determination of antibody to hepatitis B virus surface antigen (anti-HBs). Participants were also evaluated for their CD4 cell count and HIV viral load. The overall vaccination coverage of HBV vaccination found in this study (57.4%) was lower than that was previously reported in South Brazil. Anti-HBs levels >10 IU/L were observed in 47.0% of the studied population. A significant inequality in the coverage rates and antibody reactivity was found in favor of patients with better economic status. In conclusion, the results indicate the need for improvement in the HBV vaccination coverage among HIV carriers, in particular focusing on low-income individuals.

The prevalence of hepatitis B virus infection markers and socio-demographic risk factors in HIV-infected patients in Southern Brazil

Introduction Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections are two of the world's most important infectious diseases. Our objective was to determine the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalences among adult HIV-infected patients and identify the associations between socio-demographic variables and these HBV infection markers. Methods This study was performed from October 2012 to March 2013. Three hundred HIV-seropositive patients were monitored by the Clinical Analysis Laboratory of Professor Polydoro Ernani de São Thiago University Hospital, Santa Catarina, Brazil. The blood tests included HBsAg, anti-HBc immunoglobulin M (IgM) and total anti-HBc. Patients reported their HIV viral loads and CD4+ T-cell counts using a questionnaire designed to collect sociodemographic data. Results The mean patient age was 44.6 years, the mean CD4 T-cell count was 525/mm3, the mean time since beginning antiretroviral therapy was 7.6 years, and the mean time since HIV diagnosis was 9.6 years. The overall prevalences of HBsAg and total anti-HBc were 2.3% and 29.3%, respectively. Among the individuals analyzed, 0.3% were positive for HBsAg, 27.3% were positive for total anti-HBc, and 2.0% were positive either for HBsAg or total anti-HBc and were classified as chronically HBV-infected. Furthermore, 70.3% of the patients were classified as never having been infected. Male gender, age >40 years and Caucasian ethnicity were associated with an anti-HBc positive test. Conclusions The results showed an intermediate prevalence of HBsAg among the studied patients. Moreover, the associations between the anti-HBc marker and socio-demographic factors suggest a need for HBV immunization among these HIV-positive individuals, who are likely to have HIV/HBV coinfection. .

Identification of risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital / Identificação de grupos de risco para disfagia orofaríngea em pacientes internados em um hospital universitário

Purpose: To identify risk groups for oropharyngeal dysphagia in hospitalized patients in a university hospital. Methods: The study was design as an exploratory cross-sectional with quantitative data analysis. The researched population consisted of 32 patients admitted to the medical clinic at the university hospital. Patient history data were collected, followed by a universal swallowing screening which included functional feeding assessment, to observe clinical signs and symptoms of dysphagia, and assessment of nutritional status through anthropometric data and laboratory tests. Results: Of the total sample, the majority of patients was male over 60 years. The most common comorbidities related to patients with signs and symptoms of dysphagia were chronic obstructive pulmonary disease, systemic arterial hypertension, congestive heart failure, diabetes mellitus and acute myocardial infarction. The food consistency that showed higher presence of clinical signs of aspiration was pudding and the predominant sign was wet voice. Conclusion: There is a high incidence of risk for oropharyngeal dysphagia in hospitalized patients and an even higher rate of hospitalized patients with nutritional deficits or already malnourished. Hospitalized patients with respiratory diseases, chronic obstructive pulmonary disease, congestive heart failure and patients with xerostomia were indicated as risk group for oropharyngeal dysphagia. .

Objetivo: Identificar os grupos de risco para disfagia orofaríngea em pacientes internados em um hospital universitário. Métodos: O estudo foi transversal do tipo exploratório com análise quantitativa dos resultados. A população pesquisada foi formada por 32 pacientes internados nas clínicas médicas do hospital. Foram coletados dados da história do paciente e realizada a triagem universal de deglutição, avaliação funcional da alimentação para observação de sinais e sintomas de disfagia e avaliação do estado nutricional por dados antropométricos e exames laboratoriais. Resultados: Da amostra total, a maioria dos pacientes era homens acima de 60 anos. As comorbidades mais associadas a pacientes com sintomas e sinais de disfagia foram doença pulmonar obstrutiva crônica, hipertensão arterial sistêmica, insuficiência cardíaca congestiva, diabetes melitus e infarto agudo do miocárdio. A consistência alimentar em que foi observada a maior presença de sinal clínico de aspiração foi o pudim, e o sinal predominante, a voz molhada. Conclusão: Há grande incidência de risco para disfagia orofaríngea nos pacientes internados e um índice ainda maior de pacientes internados em comprometimento nutricional ou já desnutridos. Pacientes internados com doenças respiratórias, doença pulmonar obstrutiva crônica, insuficiência cardíaca congestiva e pacientes com xerostomia foram apontados como grupo de risco para disfagia orofaríngea. .

Presença de hiper-homocisteinemia em pacientes portadores de três fatores de risco para doença cardiovascular: hipertensão, tabagismo e histórico familiar / The presence of homocysteinemia in patients carrying three risk factors for cardiovascular diseases: hypertension, smoking habit and family history

A hiper-homocisteinemia é um fator de risco independente para desenvolvimento de doença cardiovascular e na presença de outros fatores de risco (FR) poderá acarretar em risco adicional para o surgimento do evento. Foram realizadas dosagens séricas de homocisteína e creatinina em 146 pacientes (51 homens e 95 mulheres) cadastrados no programa HIPERDIA/MS sendo todos portadores de três FR associados: hipertensão, tabagismo e histórico familiar para doença cardiovascular. A média geral foi de 14,48 µmol/L ± 5,98 (15,38 µmol/L ± 6,77 e 13,99 µmol/L ± 5,48, homens e mulheres respectivamente). A hiper-homocisteinemia esteve presente em 34,90% (39,20% e 32,60%, homens e mulheres respectivamente), de acordo com o intervalo de referência entre 5 - 15 µmol/L. Entretanto, segundo recomendações da DACH-LIGA Homocysteine, valores entre 12 - 30 µmol/L são considerados como moderada hiper-homocisteinemia. O estudo revelou que 60,30% (70,60% e 54,70%, homens e mulheres respectivamente) estavam acima de 12 µmol/L. Na avaliação do estudo, a dosagem de homocisteína sérica deve ser realizada em pacientes cadastrados no programa HIPERDIA/MS, pois além de hipertensos e/ou diabéticos, a presença de hiper-homocisteinemia pode ser um risco adicional para o desenvolvimento de doença cardiovascular.

Hiper-homocysteinemia is an independent risk factor in the development of cardiovascular diseases and in the presence of other risk factors (RF) may bring about an additional risk for the occurrence of the event. Serum dosages of homocysteine and creatinine in 146 patients (51 men and 95 women), registered at the HIPERDIA/MS Program, all presenting three associated RF's; hypertension, smoking habit and family history for cardiovascular diseases. The general average has been 14.48 µmol/L ± 5,98 (15,38 µmol/L ±6,77 and 13,99 µmol/L ± 5,48, for men and women respectively). Hiper-homocysteinemia had been present in 34.90% (39.20% and 32.60%, men and women, respectively), according to the reference interval between 5 - 15 µmol/L. Although, according to Homocysteine DACH-LIGA recommendations, values between 12 - 30 µmol/L are considered being a moderate hiper-homocysteinemia. The study has revealed that 60.30% (70.60% and 54.70%, men and women, respectively) had been above 12 µmol/L. In the evaluation of the study, the serum dosage of homocysteine has to be performed in patients registered at the HIPERDIA/MS Program for, besides being hypertense and/or diabetic, the presence of hiper-homocisteinemia may be an additional risk for the development of cardiovascular disease.

Estudo de prevalência e multiplicidade de fatores de risco cardiovascular em hipertensos do Município de Brusque, SC / Study of the prevalence and multiplicity of cardiovascular risk factors in hypertensive individuals from the city of Brusque, SC, Brazil

OBJETIVO: Investigar a prevalência e a multiplicidade de fatores de risco (FR) adicionais em uma amostra populacional de indivíduos hipertensos e tabagistas, diagnosticados e inscritos no Programa Hipertensos e Diabéticos do MS (HIPERDIA/Ministério da Saúde), no Município de Brusque, SC, Brasil. MÉTODOS: Determinação de parâmetros antropométricos e variáveis laboratoriais reconhecidas como fatores de risco cardiovascular. RESULTADO: Elevada prevalência de FR adicionais à hipertensão arterial (HAS) e ao tabagismo, configurando a multiplicidade que concorre com uma elevação acentuada do risco de eventos cardiovasculares nessa amostra populacional. CONCLUSÃO: Em populações de hipertensos, medidas de prevenção, identificação e controle de FR devem ser implementadas e programas informatizados, como o Hiperdia/MS, podem auxiliar no seguimento dos pacientes, possibilitando uma abordagem multidisciplinar mais criteriosa, sobretudo na análise do alcance das metas de tratamento e conseqüente redução de risco cardiovascular.

Presença de hiper-homocisteinemia em pacientes portadores de três fatores de risco para doença cardiovascular: hipertensão, tabagismo e histórico familiar / The presence of homocysteinemia in patients carrying three risk factors for cardiovascular diseases: hypertension, smoking habit and family history

A hiper-homocisteinemia é um fator de risco independente para desenvolvimento de doença cardiovascular e na presença de outros fatores de risco (FR) poderá acarretar em risco adicional para o surgimento do evento. Foram realizadas dosagens séricas de homocisteína e creatinina em 146 pacientes (51 homens e 95 mulheres) cadastrados no programa HIPERDIA/MS sendo todos portadores de três FR associados: hipertensão, tabagismo e histórico familiar para doença cardiovascular. A média geral foi de 14,48 μmol/L ± 5,98 (15,38 μmol/L ± 6,77 e 13,99 μmol/L ± 5,48, homens e mulheres respectivamente). A hiper-homocisteinemia esteve presente em 34,90 por cento (39,20).

Efeito postural sobre valores de referência / The posture effect upon the reference values

Análises Clínicas assume especial atenção a postura do indivíduo no momento da coleta do espécime, interferindo de maneira significativa nos resultados laboratoriais. A bibliografia disponível identifica as variações e partimos então para um estudo paralelo. Constatou-se a necessidade da verificação do efeito postural sobre os valores de referência e sua aplicação. Para tanto elaborou-se a presente pesquisa, culminando nas conclusões expressas.

Efeito da turbidez do plasma na determinacao de glicose pelo metodo da ortotoluidina e glicose-oxidase / Effects of the turbidity of the blood plasma in the determination of glucose through the O-toluidine and glucose-oxydase method

Avaliou-se a interferencia da turbidez do plasma nas determinacoes de glicose em amostras biologicas com concentracoes de triglicerides entre 181 a 394 mg/dL. As dosagens de glicose foram realizadas empregando-se os metodos da ortotoluidina e o da glicose-oxidase. Procedeu-se a metodologia usual, acrescida de determinacoes de referencia ou em "branco". A analise dos resultados indica que a turbidez do plasma causada por concentracoes inferiores a 400 mg/dl de triglicerides nao interfere nas dosagens de glicose pelos dois metodos. A forte correlacao existente entre os resultados obtidos pelas duas metodologias utilizando-se ou nao as determinacoes de referencia e a fraca correlacao entre esses valores e as concentracoes de triglicerides corrobora com esta afirmacao.