Association between frailty phenotype, quantification of plasma HIV-1 RNA, CD4 cell count and HAART in HIV-positive subjects: a systematic review and meta-analysis of observational studies.

HIV infection causes a constant activation of the immune system and contributes to an enhanced systemic pro-inflammatory cytokine milieu, which has been associated with premature aging and frailty. We performed a systematic review and meta-analysis to analyze whether the HIV-1 RNA load, CD4+ T-lymphocyte counts and exposure to HAART in HIV-positive subjects are associated with frailty phenotype. Searches were performed in PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar, and OpenThesis databases. We used the odds ratio as a measure of the association. We used either a fixed or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. Eleven studies were included in the review. Data from 8035 HIV-positive subjects were analyzed; 2413 of the subjects had viral load detectable, 981 had a CD4T-cell count <350 cells/µL, and 1342 had HAART exposure information. We found an association between frailty and CD4T-cell count <350 cells/µL (OR 2.68, CI 95% 1.68-4.26, I2 = 46%), HIV-1 RNA load detectable (OR 1.71, CI 95% 1.38-2.12, I2 = 0%), and protease inhibitor-containing HAART regimen (OR 2.21, CI 95% 1.26-3.89, I2 = 0%). Further studies are necessary to evaluate the effects of other factors on the development of clinical features related to frailty.

Survival time and distance to access specialized treatment among people living with HIV/Aids in the state of Alagoas, Brazil.

OBJECTIVE: To evaluate the effect of the distance between the place of residence and the specialized treatment service on the survival time of people living with HIV/Aids in Alagoas, Northeast Brazil. METHODS: Data from the notification and mortality systems related to individuals aged 13 years or older diagnosed with the infection between 2007 and 2013 were used. The cases were observed for a period of follow-up until December 2017. For the analyses, the Pearson's χ2 test, Kaplan-Meier method, and Cox regression were adopted according to the outcome of the case, place of residence, distance to the health unit, population size of the municipality of residence, sex, skin color/ethnicity, and age. RESULTS: Of the 2,732 analyzed cases, 760 individuals died of Aids-related causes. The average estimate of survival time for individuals residing in the capital was 98.6 months (95%CI 96.1-101). Among residents of inland cities, the estimate was 92.7 months (95%CI 89.3-96.1). There was a significant difference in curves throughout the period. The group residing in inland municipalities and those traveling a distance of >70 km had a higher average relative risk of death (RR=1.21, 95%CI 1.05-1.4 and RR=1.18, 95%CI 1.01-1.39, respectively). CONCLUSION: Living in or near the capital decreases the average relative risk of death. In order to increase the survival time of HIV/Aids patients in Alagoas, it is suggested to decentralize specialized health care, that is, to create regional centers to care for these people.

Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil.

OBJECTIVES: Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants. METHODS: A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model. RESULTS: Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26-18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables. CONCLUSIONS: Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.

Influence of isostretching on patients with chronic low back pain. A randomized controlled trial.

Objective: This study investigated the influence of isostretching on patients with chronic low back pain. Methods: It was a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blind assessment. Fifty-four patients with chronic low back pain were randomized to an experimental group and a control group. The experimental group performed isostretching twice a week for 45 days, while the control group remained on the waiting list for physical therapy. Patients were submitted to evaluations at baseline, after 20 and 45 days of treatment with regard to pain, quality of life, functional capacity, and satisfaction. Results: The experimental group exhibited statistically significant improvements in comparison to the control group with regard to pain (p = .003), functional capacity (p = .026), patient satisfaction (p < .001), and quality of life as determined by the functional capacity (p = .012), physical aspects (p = .011) and pain (p = .006) subscales of the SF-36. The experimental group used a significantly lesser amount of pain medication than the control group (p = .03). Conclusion: Isostretching was effective in reducing pain and in improving function, patient satisfaction and some aspects of quality of life in patients with chronic low back pain.

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis.

BACKGROUND: Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this meta-analysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants. METHODS: Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model. RESULTS: Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity. CONCLUSIONS: The SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.

Survival time and distance to access specialized treatment among people living with HIV/Aids in the state of Alagoas, Brazil / Tempo de sobrevida e distância para acesso a tratamento especializado por pessoas vivendo com HIV/Aids no estado de Alagoas, Brasil

ABSTRACT: Objective: To evaluate the effect of the distance between the place of residence and the specialized treatment service on the survival time of people living with HIV/Aids in Alagoas, Northeast Brazil. Methods: Data from the notification and mortality systems related to individuals aged 13 years or older diagnosed with the infection between 2007 and 2013 were used. The cases were observed for a period of follow-up until December 2017. For the analyses, the Pearson's χ2 test, Kaplan-Meier method, and Cox regression were adopted according to the outcome of the case, place of residence, distance to the health unit, population size of the municipality of residence, sex, skin color/ethnicity, and age. Results: Of the 2,732 analyzed cases, 760 individuals died of Aids-related causes. The average estimate of survival time for individuals residing in the capital was 98.6 months (95%CI 96.1-101). Among residents of inland cities, the estimate was 92.7 months (95%CI 89.3-96.1). There was a significant difference in curves throughout the period. The group residing in inland municipalities and those traveling a distance of >70 km had a higher average relative risk of death (RR=1.21, 95%CI 1.05-1.4 and RR=1.18, 95%CI 1.01-1.39, respectively). Conclusion: Living in or near the capital decreases the average relative risk of death. In order to increase the survival time of HIV/Aids patients in Alagoas, it is suggested to decentralize specialized health care, that is, to create regional centers to care for these people.

RESUMO: Objetivo: Avaliar o efeito da distância entre o local de residência e de tratamento especializado sobre o tempo de sobrevida de pessoas vivendo com HIV/Aids em Alagoas, Nordeste do Brasil. Métodos: Utilizaram-se dados dos sistemas de notificação e mortalidade relacionados a indivíduos com idade ≥ 13 anos diagnosticados com a infecção entre 2007 e 2013. Os casos foram observados por um tempo de seguimento até dezembro de 2017. Para as análises, foram adotados o teste χ2 de Pearson, o método Kaplan Meier e a regressão de Cox, de acordo com o desfecho do caso, o local da moradia, a distância até a unidade de saúde, o tamanho populacional do município de residência, o sexo, a cor/etnia e a idade. Resultados: Dos 2.732 casos analisados, 760 evoluíram para óbito por causas relacionadas à Aids. A estimativa média do tempo de sobrevida dos indivíduos residentes na capital foi de 98,6 meses (intervalo de confiança de 95% — IC95% 96,1 - 101). Entre os residentes nos municípios do interior, a estimativa foi de 92,7 meses (IC95% 89,3 - 96,1). Houve diferença significativa nas curvas em todo o período. O grupo residente no interior e o daqueles que viajavam a uma distância > 70 km apresentaram razão de risco (RR) médio de óbito maior (RR = 1,21, IC95% 1,05 - 1,4; e RR = 1,18, IC95% 1,01 - 1,39, respectivamente). Conclusão: Residir na capital ou próximo dela diminui o risco relativo médio de óbito. A fim de aumentar o tempo de sobrevida dos pacientes com HIV/Aids em Alagoas, sugere-se descentralizar a assistência especializada, ou seja, criar centros regionais para atendimento dessas pessoas.

Changes in Occupational Roles and Common Mental Disorders in Mothers of Children With Congenital Zika Syndrome.

IMPORTANCE: The functional limitations and long-term dependence of children with congenital Zika syndrome (CZS) may lead to changes in maternal occupational roles, which can have a negative impact on mothers' well-being and mental health. OBJECTIVE: To investigate changes in occupational roles and their effects on the mental health of mothers who have a child with CZS. DESIGN: Cross-sectional study. SETTING: Rehabilitation centers of the Brazilian Unified Health System in Alagoas, Northeast Brazil. PARTICIPANTS: Forty mothers of children with CZS. OUTCOMES AND MEASURES: The Role Checklist and the Self-Reporting Questionnaire-20 were used to assess the mothers' involvement in occupational roles and common mental disorders (CMDs), respectively. The relationship between changes in occupational roles and CMDs was analyzed using a logistic regression model. RESULTS: Our study showed that loss of paid work (p = .026) is associated with poor mental health of mothers of children with CZS. CONCLUSIONS AND RELEVANCE: Strengthening public policies to reduce the economic impact of CZS on families, offering multidisciplinary counseling, and implementing psychoeducational strategies for promoting maternal psychological adjustment are needed. WHAT THIS ARTICLE ADDS: The time and money spent by mothers in daily care activities for children with CZS contribute to a reduction in family income and social well-being and have a negative impact on mothers' mental health.

Telomere length and frailty in older adults-A systematic review and meta-analysis.

Telomere shortening has been proposed as a potentially useful biomarker of human ageing and age-related morbidity and mortality. We performed a systematic review and meta-analysis to summarize results from individual studies on the telomere length according to the frailty status and frailty index in older adults. We searched the PubMed, SCOPUS and Web of Science databases to identify studies that evaluated the telomere length in frail and non-frail older adults and the relationship between telomere length and frailty index score. We used the base pairs (bp) as a measure of the telomere length. Summary estimates were calculated using random-effects models. Nine studies were included in the present systematic review and a total of 10,079 older adults were analyzed. We found that the frail older adults (n = 355) had shorter telomeres than the non-frail (n = 1894) (Standardized Mean Difference [SMD] -0.41; 95% CI -0.73 to -0.09; P = 0.01; I2 = 82%). Significant differences in telomere length between frail and non-frail older adults were identified in Hispanic (SMD -1.31; 95% CI -1.71 to -0.92; P < 0.0001; I2 = 0%) but not in Non-Hispanic countries (SMD -0.13; 95% CI -0.26 to 0.00; P = 0.06; I2 = 0%). Similar results were found in the adjusted meta-analysis (SMD -0.56; 95% -1.12 to 0.00; P = 0.05; I2 = 85%). A significant but weak relationship was found between telomere length and frailty index analyzing 8244 individuals (SMD -0.06; 95% IC -0.10 to 0.01; P = 0.01; I2 = 0%). The current available evidence suggests that telomere length may be not a meaningful biomarker for frailty. Because the potential influence of ethnicity in shortening of telomeres and decline in physiologic reserves associated with aging, additional multiethnic studies are needed.

Association between human herpes virus seropositivity and frailty in the elderly: A systematic review and meta-analysis.

Frailty is an emerging geriatric syndrome characterized by decreased physiologic reserve and increased vulnerability to environmental factors. Several studies have examined the association between persistent cytomegalovirus (CMV) infection and poor clinical outcomes in the elderly, but the results are often contradictory. Here, we performed a systematic review and meta-analysis to analyze the association between human herpesvirus seropositivity [CMV, Epstein-Barr virus (EBV), Varicella zoster virus (VZV), and Herpes simplex virus (HSV)] and frailty in elderly people. Searches were performed in PubMed, SCOPUS, Lilacs, IBECS, and Web of Science databases. We used the odds ratio (OR) as a measure of the association between herpesvirus infections and frailty. Summary estimates were calculated using random-effects models. Six studies were included in the present systematic review. The data from 2559 elderly subjects were analyzed; 1571 of the subjects had ages between 60 and 79 years, and 988 of the subjects were older than 80. We found an association between CMV seropositivity and frailty in the elderly aged 60-79 years (OR 2.33, CI 95% 1.48-3.67) but not in the oldest-old subjects (OR 0.67, CI 95% 0.42-1.05). Moreover, no association was found between EBV, VZV, and HSV infections and frailty. Current evidence suggests an association between CMV seropositivity and frailty in individuals aged 60-79 years old.

Estimulação elétrica nervosa transcutânea após cirurgia de revascularização miocárdica / Transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery

INTRODUÇÃO: Após a cirurgia cardíaca, os pacientes apresentam limitação na força muscular respiratória, o que favorece a instalação de complicações pulmonares. OBJETIVO: Analisar a eficácia da estimulação elétrica nervosa transcutânea sobre o processo doloroso e força muscular respiratória em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM). MÉTODOS: Foram inclusos pacientes em pós-operatório de CRM por meio de esternotomia, com uso de circulação extracorpórea, anestesia geral, sem estar sob efeito de bloqueio neuromuscular, uso de drenos de tórax e mediastino, extubados até 6 horas pós-procedimento e apresentando índice igual ou superior a três na escala analógica visual da dor (EVA), estando no primeiro dia de pós-operatório (1º DPO). Foram recrutados 20 pacientes, divididos em dois grupos, sem predomínio de sexo: Grupo Controle (n=10), que recebeu terapia analgésica mais fisioterapia; e Grupo TENS, que recebeu terapia analgésica, fisioterapia e TENS. A TENS foi aplicada por 30 minutos, três vezes ao dia, num intervalo de 3 horas cada aplicação. RESULTADOS: Para o grau de dor, houve uma média inicial e final, respectivamente, de 7,0 e 1,0 para o Grupo TENS e 7,0 e 8,0 para o Grupo Controle. Para a Pimáx, a média inicial e final foi de, respectivamente, -102,5 cmH2O e -141,17 cmH2O para o Grupo TENS e -97,0 cmH2O e -100,3 cmH2O para o Controle. Quanto a Pemáx, a média inicial e final foi de, respectivamente, 63 cmH2O e 125 cmH2O para o Grupo TENS e 55,3 cmH2O e 53,2 cmH2O para o Grupo Controle. CONCLUSÃO: A TENS demonstrou eficácia significativa na redução da algia e no aumento das forças musculares respiratórias no 1º DPO de CRM.

INTRODUCTION: After cardiac surgery, patients have a limitation in respiratory muscle strength, which favors the appearing of pulmonary complications. OBJECTIVE: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) on the painful process and respiratory muscle strength in patients undergoing coronary artery bypass graft (CABG). METHODS: The study included patients after on-pump CABG through sternotomy, general anesthesia, without being under the influence of neuromuscular blockade, with use of chest and mediastinal tubes, and extubation within 6 hours after the procedure and presenting index equal to or greater than three visual analog scale (VAS) of pain being on the first day after surgery. We recruited 20 patients divided into two groups with no predominance of sex: the control group (n = 10), who received more physiotherapy analgesic therapy, and TENS group received analgesic therapy, physiotherapy and TENS. The TENS was applied for 30 minutes, three times a day, a 3-hour period each application. RESULTS: For the degree of pain, there was an average start and end, respectively, 7.0 / 1.0 for the TENS group and 7.0 / 8.0 for the control group. For inspiratory muscle strength, - 102.5 cmH2O / - 141.17 cm H2O to the TENS group and - 97.0 cmH2O / - 100.3 cm H2O for control. The expiratory muscle strength, 63cmH2O/125 cmH2O for the TENS group and 55.3 cmH2O/53, 2 cmH2O for the control group. CONCLUSIONS: TENS has shown significant effectiveness in reducing pain, and the increase in respiratory muscle strength at first-day after CABG surgery.

Efeito do método Isostretching na flexibilidade e nível de atividade física em indivíduos sedentários saudáveis / Effect of Isostretching in flexibility and physical activity level in healthy sedentary subjects

Existem várias técnicas fisioterapêuticas que promovem melhora na aptidão física e no condicionamento musculoesquelético. Objetivou-se verificar o efeito do método de Isostretching na flexibilidade e no nível de atividade física de indivíduos saudáveis sedentários. A amostra foi composta por 14 indivíduos sedentários e saudáveis, com idade média de 24,8±6,5 anos, peso médio de 58,7±12,9 kg e altura média de 161,7±8,0 cm. Os sujeitos foram submetidos a 15 sessões de Isostretching, com freqüência de três vezes por semana e com duração de 40 minutos por sessão. Em cada sessão foi realizado um total de três séries de nove exercícios. A flexibilidade foi avaliada pela goniometria de flexão e extensão do tronco e com o banco de Wells. A avaliação do nível de atividade física foi feita com o Questionário Internacional de Atividade Física (IPAQ). A análise dos dados foi realizada com o teste t dependente e o teste de Wilcoxon, adotando-se um α=0,05. A flexão e extensão do tronco apresentaram diferenças estatisticamente significantes entre a avaliação inicial e a final, com flexão de 78,6º antes e de 93,4º depois da intervenção (p<0,0001), e extensão de 27,9º antes e 36,8º depois (p<0,001). Na avaliação com o Banco de Wells houve uma alteração de 25,5 cm para 31,2 cm após a intervenção (p<0,0001). Na análise do nível de atividade física feita com o IPAC os indivíduos não apresentaram diferenças entre a avaliação inicial e final (p=0,058). Foi possível observar que o método Isostretching aumentou a flexibilidade em indivíduos saudáveis sedentários, mas não acarretou alteração significativa no nível de atividade física.

There are several physical therapy techniques that improve musculoskeletal and physical fitness. The purpose of this study was investigate the effect of Isostretching in flexibility and level of physical activity in sedentary healthy subjects. The sample consisted of 14 sedentary and healthy subjects with mean age of 24.8±6.5 years, mean weight of 58.7±12.9 kg and mean height of 161.7±8.0 cm. The subjects did 15 sessions of Isostretching, three times per week and duration of 40 minutes per session. Each session had three sets of nine exercises. The trunk extension and flexion flexibility was evaluated by goniometry and Wells bench. The assessment of physical activity was performed using the International Physical Activity Questionnaire (IPAQ). The data analysis was performed with paired t-test and Wilcoxon test, adopting α=0.05. The trunk flexion and extension was statically significant between initial and final measurements with flexion of 78.6° before and 93.4° after the intervention (p<0.0001), and with extension of 27.9° before and 36.8° after (p<0.001). The evaluation with the Wells Bench changed from 25.5 cm to 31.2 cm after the intervention (p<0.0001). In assessment of level of physical activity (IPAC) the subjects showed no difference between baseline and final measurements (p=0.058). It was observed that the Isostretching increased flexibility in healthy sedentary subjects, but it was not observed any significative modification in physical activity level.

Transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery.

INTRODUCTION: After cardiac surgery, patients have a limitation in respiratory muscle strength, which favors the appearing of pulmonary complications. OBJECTIVE: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) on the painful process and respiratory muscle strength in patients undergoing coronary artery bypass graft (CABG). METHODS: The study included patients after on-pump CABG through sternotomy, general anesthesia, without being under the influence of neuromuscular blockade, with use of chest and mediastinal tubes, and extubation within 6 hours after the procedure and presenting index equal to or greater than three visual analog scale (VAS) of pain being on the first day after surgery. We recruited 20 patients divided into two groups with no predominance of sex: the control group (n = 10), who received more physiotherapy analgesic therapy, and TENS group received analgesic therapy, physiotherapy and TENS. The TENS was applied for 30 minutes, three times a day, a 3-hour period each application. RESULTS: For the degree of pain, there was an average start and end, respectively, 7.0 / 1.0 for the TENS group and 7.0 / 8.0 for the control group. For inspiratory muscle strength, - 102.5 cmH2O / - 141.17 cm H2O to the TENS group and - 97.0 cmH2O / - 100.3 cm H2O for control. The expiratory muscle strength, 63cmH2O/125 cmH2O for the TENS group and 55.3 cmH2O/53, 2 cmH2O for the control group. CONCLUSIONS: TENS has shown significant effectiveness in reducing pain, and the increase in respiratory muscle strength at first-day after CABG surgery.

Incidência de atitudes escolióticas em atletas de judô com idade a partir de 18 anos / Incidence of scoliosis in judo athletes from 18 years old

A escoliose é um desvio postural causado por desequilíbrios da musculatura paravertebral. É caracterizada pela flexão lateral e rotação das vértebras, ou seja, é uma deformidade tridimensional. Estas curvaturas anormais são freqüentemente encontradas em atletas de judô devido aos movimentos de flexão e rotação da coluna vertebral realizados nos golpes. Os desvios posturais aumentam a tensão das fibras musculares acarretando em mais lesões ao atleta reduzindo seu potencial físico. O presente estudo tem caráter prospectivo, avaliativo, epidemiológico e informativo e tem como objetivo analisar a incidência das escolioses em atletas competidores de judô do Estado de Alagoas. O estudo possui uma amostra de 31 atletas do sexo masculino com 23,3 ± 1,6 anos, no qual, após análise de dados, observou-se uma alta incidência de escoliose.

Scoliosis is a postural shunting line caused by alterations of the spinal cord. It is characterized by the lateral bend and rotation of the vertebrae, so is a three-dimensional deformity. These abnormal curves frequently are found in judo athletes, by the movements of bend and carried through rotation of the vertebral column in the blows. The postural shunting lines increase the tension of muscular staple fibers causing more injuries to the athlete reducing its physical potential. This study has a prospective, evaluative, epidemiologist and informative approach and has as objective to analyze the incidence of scoliosis in competitive judo athletes of Alagoas city. The sample was composed by 31 males athletes, with 23,3 ± 1,6 years old, which, after data analysis it was observed a high incidence of scoliosis.