Are quality of life, functional capacity, and urinary incontinence associated with fecal incontinence? The Fibra-BR Study / Cuidados de saúde, capacidade funcional e incontinência urinária estão associados à incontinência fecal? Estudo Fibra-BR

OBJECTIVE: To assess the prevalence of fecal incontinence and its association with clinical, functional, and cognitive-behavioral variables, medication use, frailty, falls, and quality of life in community-dwelling older adults (aged 65 years or older). METHODS: Cross-sectional, multicenter study carried out across 16 Brazilian cities. The question "In the last 12 months, did you experience fecal incontinence or involuntary passage of stool?" was defined as the indicator variable for fecal incontinence. Bivariate analyses were carried out to assess the prevalence of fecal incontinence and sociodemographic characteristics, comorbidities, cognition, functional capacity, depression, frailty, quality of life, and falls. Logistic regression analysis was also performed, with fecal incontinence as the dependent variable. RESULTS: Overall, 6855 subjects were evaluated; 66.56% were female, 52.93% white, and the mean age was 73.51 years. The prevalence of fecal incontinence was 5.93%. It was associated with worse self-care (OR 1.78 [1.08­2.96]), dependence for basic activities of daily living (OR 1.29 [1.01­1.95]), and urinary incontinence (OR 4.22 [3.28­5.41]). Furthermore, the absence of polypharmacy was identified as a protective factor (OR 0.61 [0.44­0.85]). CONCLUSION: The overall prevalence of fecal incontinence was 5.93%. On logistic regression, one quality of life variable, dependence for basic activities of daily living, and polypharmacy were significantly associated with fecal incontinence

OBJETIVO: Avaliar a prevalência de incontinência fecal e sua associação com variáveis clínicas, funcionais, cognitivo-comportamentais, uso de fármacos, fragilidade, quedas e qualidade de vida em indivíduos com 65 anos ou mais que vivem na comunidade. METODOLOGIA: Estudo transversal e multicêntrico, realizado em 16 cidades brasileiras. A pergunta "Nos últimos 12 meses o(a) senhor(a) apresentou incontinência fecal ou perda de fezes de forma involuntária?'' foi a variável indicadora de incontinência fecal. Análises bivariadas avaliaram a prevalência de incontinência fecal e suas características sociodemográficas, comorbidades, cognição, funcionalidade, depressão, fragilidade, qualidade de vida e quedas. Também realizou-se análise de regressão logística tendo a incontinência fecal como variável dependente. RESULTADOS: No total, 6855 indivíduos foram avaliados; 66,56% eram do sexo feminino, 52,93% brancos e a média de idade de 73,51 anos. A prevalência de incontinência fecal foi de 5,93% e estava associada com pior cuidado com a própria saúde [OR 1,78 (1,08­2,96)], dependência para as atividades básicas de vida diária [OR 1,29 (1,01­1,95)] e incontinência urinária [OR 4,22 (3,28­5,41)]. Além disso, observou-se que a ausência de polifarmácia [OR 0,61 (0,44­0,85)] foi identificada como associação de proteção. CONCLUSÃO: A prevalência de incontinência fecal foi de 5,93%. Na regressão logística, uma variável de qualidade de vida, dependência para atividades básicas de vida diária e polifarmácia mostrou-se significativamente associada à incontinência fecal

Demência rapidamente progressiva por linfoma primário do sistema nervoso central: um relato de caso / Rapidly progressive dementia due to primary central nervous system lymphoma: a case report

As demências rapidamente progressivas são condições que impactam a vida do paciente, entretanto nem sempre são consideradas durante a investigação da síndrome demencial. Este relato descreve uma paciente portadora de artrite reumatoide em uso crônico de corticoterapia que evoluiu com um quadro de demência rapidamente progressiva no período de cinco meses. Durante a investigação, evidenciou-se o linfoma primário de sistema nervoso central como causa de sua síndrome demencial. Faz-se importante destacar que o uso prolongado de corticoide pode estar associado a um estado de imunossupressão, o que é fator de risco para o surgimento do linfoma de sistema nervoso central.

Rapidly progressive dementias are conditions that worsening the patient's life; however they are not always considered during the investigation of dementia syndrome. This report describes the case of a patient with rheumatoid arthritis and chronic use of corticosteroid therapy, who developed rapidly progressive dementia within 5 months. During the investigation, the primary lymphoma of the central nervous system was evidenced as the cause of its dementia syndrome. Importantly, prolonged use of corticosteroids may be associated with a state of immunosuppression, which is a risk factor for the onset of central nervous system lymphoma.

Experiencia inicial en la adaptación del instrumental del tratamiento video asistido modificado de las fistulas perianales complejas (VAMAFT) / Initial experience in the adaptation of the instruments of the modified assisted video treatment of complex perianal fistulas (VAMAFT)

Introducción: Las fístulas perianales tienen dos problemas fundamentales, la tasa de recurrencia y de incontinencia fecal postoperatoria, complicaciones que varían en frecuencia dependiendo de varios factores como el tipo de fistula, la técnica quirúrgica usada y la experiencia del cirujano. Debido a esto existen técnicas quirúrgicas no conservadoras y conservadoras de esfínteres donde se incluye el tratamiento video asistido que aparece desde el año 2006 y en la cual se utiliza un sistema de video endoscopio sofisticado y de alto valor económico el cual hemos adaptado a nuestro medio. Pacientes y método: De septiembre del 2015 al 2017 en la Unidad de Coloproctología del Hospital Domingo Luciani IVSS se realizó un estudio prospectivo experimental, donde se incluyeron 18 pacientes con fístulas perianales complejas diagnosticadas previamente con Ecofistulografía 3D y los cuales se operaron con un sistema adaptado usando citoscopio pediátrico de 4 mm y energía láser. Se evaluaron parámetros referentes a la técnica así como la tasa de éxito y riesgo de incontinencia. Resultados: Tiempo quirúrgico de 40 a 80 minutos, con tasa de éxito de 89%, recidiva en 2 pacientes, con tiempo de seguimiento entre 12 a 36 meses y sin cambios en la escala de incontinencia pre y post quirúrgica. Conclusión: El tratamiento video asistido modificado para fistulas anales (VAMAFT) es una técnica innovadora y factible de realizar al adaptar algunos instrumentos, con una tasa de éxito adecuada y sin riesgo de incontinencia, pero más trabajos aleatorizados con mayor números de pacientes deben ser realizados.

Introduction: Anal fistulas have two basic problems, rate of recurrence and postoperative anal incontinence. These complications vary according to several factors such as type of anal fistula, surgical technique and the surgeon´s experience. For each cases there are different surgical techniques with and without conservation of anal sphincters like conservative video assisted anal fistula treatment, described in 2006, this technique uses a sophisticated and expensive endoscope system but that we modified to use in our hospitals. Patients and method: Between September 2015 to 2017 in the Unit of Coloproctology of Domingo Luciani Hospital, was perfomed a prospective and experimental trial in 18 patients with anal complex fistulas previously diagnosed using tridimensional anal ultrasound and operated with a modified system consisting of pediatric cystoscope of 4 mm and laser energy. Some parameters were evaluated including surgical technique, recurrence and anal incontinence rate. Results: Surgical times were between 40 to 80 minutes, success rate of 89%, recurrence in two patients with follow up of 12 to 36 months and no changes in pre and post surgical anal incontinence scale. Conclusion: Video assited modified anal fistula treatment (VAMAFT) is an innovative and feasible surgical technique to do adapting some instruments, with suitable success rate and without anal incontinence risk but many randomized research with more patients have to be perfomed.

Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies

OBJECTIVES: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia. METHODS: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia. RESULTS: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3). CONCLUSION: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Rede FIBRA-RJ: fragilidade e risco de hospitalização em idosos da cidade do Rio de Janeiro, Brasil / FIBRA-RJ Network: frailty and risk of hospitalization in the elderly in Rio de Janeiro, Brazil / Red FIBRA-RJ: la fragilidad y el riesgo de hospitalización para las personas mayores en la ciudad de Río de Janeiro, Brasil

O objetivo do estudo foi determinar o perfil de risco e fatores associados à fragilidade em idosos da comunidade. A população-fonte constituiu-se de indivíduos com 65 anos ou mais, residentes nos bairros da zona norte da cidade do Rio de Janeiro, Brasil, e clientes de uma operadora de saúde. O estudo foi transversal, na linha de base de uma coorte, com amostra estratificada por sexo e idade, composta por 764 indivíduos. Para a estratificação de risco, utilizou-se o instrumento de rastreio probabilidade de internações repetidas (PIR). A análise de regressão logística foi realizada para estudar a associação entre a PIR e um conjunto de variáveis sociodemográficas, de estado de saúde, funcionais e cognitivas, após a análise bivariada. Encontraram-se 6,7% de idosos com alto risco de internação. Associaram-se ao risco de internação câncer, quedas, doença pulmonar obstrutiva crônica e medicamentos usados, bem como as seguintes condições: receber visita de profissional da saúde, ter estado acamado no domicílio, morar só e praticar as atividades de vida diária. O instrumento parece ser útil na estratificação de risco dos idosos.

The objective of this study was to determine the risk profile and factors associated with frailty in elderly community residents. The population consisted of individuals 65 years or older living in the northern districts of the city of Rio de Janeiro, Brazil, and who held private health insurance policies. The cross-sectional study was done at baseline in a cohort with a sample (N = 764) stratified by gender and age. Risk stratification used probability of repeated admissions (PRA) as the screening instrument. Following bivariate analyses, logistic regression analyses were performed to study associations between probability of repeated admissions and socio-demographic, health-status, functional, and cognitive variables. Of the total sample, 6.7% were classified as high risk. Cancer, falls, chronic obstructive pulmonary disease, use of medication, receiving a visit from a health professional, being bedridden at home, living alone, and level of activities of daily living were statistically associated with risk of hospitalization. The instrument appeared to be useful for stratifying risk in the elderly.

El objetivo del estudio fue determinar el perfil de riesgo y los factores asociados con la fragilidad en la tercera edad. El origen de la población, compuesta por personas de 65 años o más, son los diferentes barrios de la ciudad de Río de Janeiro, Brasil, y clientes de planes de salud. El estudio fue transversal en una cohorte con una muestra estratificada por sexo y edad, compuesta de 764 individuos. Para la estratificación de riesgo se utilizó como instrumento la probabilidad de hospitalizaciones repetidas. Se realizó un análisis de regresión logística para estudiar la asociación entre el riesgo y un conjunto de variables sociodemográficas, estado de salud, funcionales y cognitivas. Se halló un 6,7% de los pacientes ancianos con alto riesgo de hospitalización. El cáncer, caídas, enfermedad pulmonar obstructiva crónica, los medicamentos utilizados, recibir visitas de profesionales de la salud, estar postrado en cama en su casa, vivir solo y actividades de la vida diaria se asociaron con el riesgo de hospitalización. El instrumento parece ser útil para estratificar el riesgo en ancianos.