Appendicular lean mass index and motor function in ambulatory patients with Duchenne muscular dystrophy.

INTRODUCTION/AIMS: Appendicular lean mass index (ALMI) has been linked to motor function in patients with Duchenne muscular dystrophy (DMD). However, quantification of the relationship between ALMI and disease-specific clinical outcome assessment trajectories is needed. The purpose of this study was to determine associations between dual-energy x-ray absorptiometry (DXA) derived estimates of ALMI and motor function in ambulatory patients with DMD. METHODS: A retrospective analysis of longitudinal clinical visit data from 137 glucocorticoid-treated patients with DMD collected via structured motor assessment protocol evaluated associations between ALMI and motor function indexed by the North Star Ambulatory Assessment (NSAA) and 10 Meter Walk/run Test (10MWT). Body composition was assessed using DXA. ALMI was calculated by dividing arm and leg lean mass by height in m2; fat mass index (FMI) was calculated by dividing whole body fat mass by height in m2. Linear mixed-effects models were used to estimate associations between ALMI and motor function, controlling for age and FMI. RESULTS: The full prediction model (age, age,2 ALMI, and FMI) explained 57% of the variance in NSAA scores and 63% of the variance in 10MWT speed. A 1 kg/m2 higher ALMI value predicted a 5.4-point higher NSAA score (p < .001) and 0.45 m/s faster 10MWT speed (p < .001). A 1 kg/m2 higher FMI value predicted a 1.5-point lower NSAA score (p < .001) and 0.14 meters/second slower 10MWT speed (p < .001). DISCUSSION: DXA-derived estimates of ALMI and FMI are associated with motor function in DMD and may explain variation in DMD disease progression.

Purpura Fulminans as a Rare Manifestation of Invasive Haemophilus influenzae Disease: A Case Report.

Haemophilus influenzae (Hi) is a bacterium usually found in the upper respiratory tract of humans. Though it is recognized as a naturally occurring element in the human bacterial reservoir, Hi infections have the potential to be severe and even fatal, particularly when they result in conditions such as meningitis or epiglottitis. Because of this, Hi invasive infections are considered a reportable disease in Portugal. We report a case of a 58-year-old female, chronically adrenally suppressed on long-term steroids, who developed an invasive Hi type b infection that led to purpura fulminans and multiorgan failure after an acute episode of epiglottitis. According to our review of the literature, only three previous cases of invasive Hi type b disease-causing purpura fulminans have been described.

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections.

Coronavirus disease 2019 (COVID-19) is often linked to a broad range of opportunistic bacterial and fungal infections. The second wave of the COVID-19 pandemic has witnessed an unprecedented surge in mucormycosis cases, predominantly in India, while the disease remained relatively rare in Europe. The authors describe the case of a 62-year-old female patient admitted to the hospital for consolidation therapy with chemotherapy as a part of the treatment protocol for acute myeloid leukemia. During hospitalization, she was diagnosed with nosocomial COVID-19, which later progressed to respiratory deterioration. COVID-19 with bacterial superinfection was presumed, leading to the initiation of empirical antibiotic therapy. A bronchoscopy was performed several days later due to a lack of improvement, revealing an infection by the Rhizopus microsporus complex. Despite antifungal treatment, the patient experienced an unfavorable clinical course and ultimately died. Given the high index of suspicion required to diagnose pulmonary mucormycosis, which can lead to delays in appropriate treatment and increase the burden of disease, the authors are aiming to enhance its awareness.

A Case of Cerebral Air Embolism After Dental Procedure.

Air embolism is a rare and life-threatening event that occurs when air enters the cardiovascular system, usually secondary to iatrogenic vascular procedures. We present a 58-year-old woman who underwent a dental procedure (devitalization of a tooth) under local anesthesia, with a sudden onset of coma during manipulation and documentation of air in the vessels of the right frontal convexity sulci. After cerebral air embolism was confirmed, she received hyperbaric oxygen therapy, with resorption of the gas, but clinically she developed a super-refractory status epilepticus with a persistent coma. The slow clinical course required the exclusion of other etiologies of coma. The pathophysiology is not well known; however, it appears to be related to the injection of air by the high-speed dental drill through the soft tissue adjacent to the roots of the teeth, nearby the bloodstream. We highlight this event because of this unlikely association, which may delay diagnosis and the good results of hyperbaric medicine on prognosis.

Validity and Reliability of a Wearable Fitness Technology Scale in Portugal.

Currently, the use of technological devices for monitoring physical activity and in other mobile applications is widespread among sports users and is continuously growing. The aim of this study was the validation of the reliability of the use of Wearable Fitness Technology (WFT) in the context of fitness through quantitative analysis. Data collection was conducted online during the COVID-19 pandemic period. The sample consisted of 177 members of fitness centres who used MYZONE technology in Portugal. An Exploratory Factor Analysis (EFA) (Factor v10) and a Confirmatory Factor Analysis (CFA) (AMOS v22.0) were used to test the item fit. The results showed adequate fits, identifying a total of 14 items in a single factor to assess WFT in MYZONE users in fitness centres. The reliability of the scale showed adequate indices within the indicated limits. This study extends the current literature on WFT; provides information for providers, managers, and members; and aims to improve the fitness experience by developing a valid and reliable tool to assess the characteristics and incidence of WFT in fitness centres. The complexity of the WFT will affect the degree of user engagement with the fitness centre, highlighting the importance of using staff skills to generate motivational and innovative challenges to improve the service experience. Furthermore, this scale could be used to examine the influences of WFT on managers' and members' perceptions of the service experience in the Portuguese context.

Nosocomial meningitis in intensive care: a 10-year retrospective study and literature review.

BACKGROUND: Nosocomial meningitis is a medical emergency that requires early diagnosis, prompt initiation of therapy, and frequent admission to the intensive care unit (ICU). METHODS: A retrospective study was conducted in adult patients diagnosed with nosocomial meningitis who required admission to the ICU between April 2010 and March 2020. Meningitis/ventriculitis and intracranial infection were defined according to Centers for Disease Control and Prevention guidelines. RESULTS: An incidence of 0.75% of nosocomial meningitis was observed among 70 patients. The mean patient age was 59 years and 34% were ≥65 years. Twenty-two percent of patients were in an immunocompromised state. A clear predisposing factor for nosocomial meningitis (traumatic brain injury, basal skull fracture, brain hemorrhage, central nervous system [CNS] invasive procedure or device) was present in 93% of patients. Fever was the most frequent clinical feature. A microbiological agent was identified in 30% of cases, of which 27% were bacteria, with a predominance of Gram-negative over Gram-positive. Complications developed in 47% of cases, 24% of patients were discharged with a Glasgow coma scale <14, and 37% died. There were no clear clinical predictors of complications. Advanced age (≥65 years old) and the presence of complications were associated with higher hospital mortality. CONCLUSIONS: Nosocomial meningitis in critical care has a low incidence rate but high mortality and morbidity. In critical care patients with CNS-related risk factors, a high level of suspicion for meningitis is warranted, but diagnosis can be hindered by several confounding factors.

Management of child camps: a structured literature review and new directions / Gestão de campos de férias para crianças: uma revisão estruturada da literatura e novas direções / Gestión de campamentos infantiles: una revisión estructurada de la literatura y nuevas direcciones

The study of child camps has grown over the last years. Still, the common use of different terminology and the dispersion of the information in literature regarding camps management, makes it difficult to clarify research and hinder the improvement of managerial practices. This study aims to synthetise existent knowledge in child camps' management, identify inconsistencies and gaps in the literature, and set directions for future research and practice on child camps. A structured review of peer-reviewed articles published between 1950-2021 was conducted. Results indicate that half of the studies used the term "summer camp"; but other ten different terms were also used. Five different management areas were identified: safety, consumer behaviour, human resources, event planning and camp research. Gaps were also identified in the literature. These findings are important to set new research avenues and to improve practice. (AU)

O estudo dos campos de férias para crianças aumentou nos últimos anos. Todavia, a utilização de diferentes termos e a dispersão da informação na literatura acerca da gestão destes eventos dificulta o esclarecimento das diretrizes de pesquisa, por um lado, e dificulta a melhoria das práticas de gestão, por outro. Este estudo visa sintetizar o conhecimento existente na gestão destes eventos, identificar inconsistências e lacunas na literatura, e definir direções para futuras pesquisas e práticas. Foi realizada uma revisão estruturada de estudos publicados entre 1950-2021. Metade dos estudos utilizou o termo "campos de verão"; mas também foram utilizados outros dez termos diferentes. Foram identificadas cinco áreas de gestão: segurança, comportamento do consumidor, recursos humanos, organização de eventos e pesquisa em campos de férias. Foram ainda identificadas lacunas na literatura. Estes resultados são importantes para definir novos caminhos de pesquisa e melhorar a gestão destes eventos. (AU)

El estudio de los campamentos de verano para niños se ha incrementado en los últimos años. Pero, el uso de términos diferentes, y la dispersión de información en la literatura, sobre la gestión de estos eventos, dificulta la clarificación de las directrices de investigación, e impide que los gestores mejoren sus prácticas. Este estudio buscó sintetizar el conocimiento existente en la gestión de estos eventos, identificar inconsistencias y lagunas en la literatura y definir direcciones para futuras investigaciones y prácticas. Se realizó una revisión estructurada de estudios publicados entre 1950-2021. La mitad de los estudios utilizaron "campamento de verano"; pero también se utilizaron otros diez términos diferentes. Se identificaron cinco áreas de gestión: seguridad, comportamiento del consumidor, recursos humanos, organización de eventos y investigación en campamentos de verano. También se identificaron lagunas en la literatura. Estos resultados son importantes para definir nuevos caminos de investigación y mejorar la gestión de estos eventos. (AU)

Predicting Fitness Centre Dropout.

The phenomenon of dropout is often found among customers of sports services. In this study we intend to evaluate the performance of machine learning algorithms in predicting dropout using available data about their historic use of facilities. The data relating to a sample of 5209 members was taken from a Portuguese fitness centre and included the variables registration data, payments and frequency, age, sex, non-attendance days, amount billed, average weekly visits, total number of visits, visits hired per week, number of registration renewals, number of members referrals, total monthly registrations, and total member enrolment time, which may be indicative of members' commitment. Whilst the Gradient Boosting Classifier had the best performance in predicting dropout (sensitivity = 0.986), the Random Forest Classifier was the best at predicting non-dropout (specificity = 0.790); the overall performance of the Gradient Boosting Classifier was superior to the Random Forest Classifier (accuracy 0.955 against 0.920). The most relevant variables predicting dropout were "non-attendance days", "total length of stay", and "total amount billed". The use of decision trees provides information that can be readily acted upon to identify member profiles of those at risk of dropout, giving also guidelines for measures and policies to reduce it.

Oral ulcer as presentation of cavitating pulmonary tuberculosis.

Tuberculosis is an indolent infection that can invade any organ. Although the most frequent form of presentation is pulmonary, it can have an extra-pulmonary presentation, including rare cases of oral tuberculosis. We present a clinical case of a 44 year-old man, active smoker, with an ulcerated lesion on the posterior third of the tongue, initially interpreted as a probable neoplasm. The pathological study of the biopsy performed on the lesion, showed alterations compatible with a chronic granulomatous process and the presence of acid-fast bacilli. The concomitant diagnosis of pulmonary tuberculosis was made in a subsequent study. The patient started therapy with isoniazid, rifampin, pyrazinamide and ethambutol with complete resolution of the oral lesion and pulmonary tuberculosis. This case exemplifies the importance of including tuberculosis in the differential diagnosis of ulcerated and neoformative lesions and the value of performing a microbiological study alongside the pathological one.

Infection and colonization by Corynebacterium pseudodiphtheriticum: a 9-year observational study in a university central hospital.

Despite constituting part of the human commensal flora, Corynebacterium pseudodiphtheriticum has been recognized as a potentially infectious agent, most frequently in immunocompromised patients or individuals with other morbidity factors, but significant association to comorbid states remains unproven. This study's purpose was to assess clinical significance, risk factors for infection and antimicrobial susceptibility of C. pseudodiphtheriticum isolates. A retrospective observational study was conducted. Relevance of isolation was determined by clinical, laboratory, and imaging criteria. Forty-nine isolates occurred in 47 episodes. Colonization was assumed in 12% and infection in 78%, of which 51% were nosocomial. Patients with infection were older, with male predominance; both age and gender were statistically significant (p < 0.05) between infection and colonization groups. Although dyslipidemia (58%), arterial hypertension (58%), invasive procedures (56%), and chronic lung disease (50%) were prevalent in the infection group, no comorbidity was a significant risk factor for infection compared with colonization. Charlson comorbidity index showed no statistically difference between groups. Mortality rate was 14% in infection. Respiratory samples were the main isolation product; all tested strains were susceptible to amoxicillin/clavulanate and vancomycin. Resistant strains were observed for clindamycin (77%) and erythromycin (48%). C. pseudodiphtheriticum isolation was associated with infection in most cases. Despite the high prevalence of comorbidities and invasive procedures, no factors other than age and gender were significantly associated with infection. Although C. pseudodiphtheriticum may constitute a contaminant or colonizer in clinical samples, positive cultures in patients with signs and symptoms consistent with infection should not be neglected.

Nontravel-related invasive Entamoeba histolytica infection with probable heterosexual transmission.

INTRODUCTION: In industrialized countries, amebiasis usually occurs in migrants and travelers returning from areas where the disease is endemic, primarily by ingestion of contaminated food or water. Person-to-person transmission can occur, mainly by fecal-oral contact, but sexual transmission has also been described [1,[3], [4], [5]]. PRESENTATION OF CASE: We report a man with Entamoeba histolytica colitis and a large liver abscess (16.5 × 14 cm) in Portugal, who had no relevant travel history and whose only risk factor was his heterosexual partner. The abscess required drainage of 1950 mL of "chocolate-milk" purulent fluid, with rapid symptomatic improvement. The diagnosis was established by real-time reverse transcription PCR for Entamoeba histolytica in the liver aspirate, with positive IgG antibodies. He received a total of 16 days of ceftriaxone and metronidazole followed by 7 days of paromomycin. CONCLUSION: As enteric infections may be sexually transmitted, in industrialized countries, even in the absence of travel, sexual history should not be neglected.

Cytomegalovirus acute infection with pulmonary involvement in an immunocompetent patient.

Introduction: Cytomegalovirus (CMV) infection in healthy adults is usually asymptomatic or causes a mild mononucleosis syndrome, while severe infections are rare in immunocompetent patients and poorly documented. When described, gastrointestinal tract and the central nervous systems are the most frequent sites of severe CMV infection. Lung disease can occur, but it's rare. Clinical case: A 29 years old man presenting with a 2-weeks history of fever, headache, malaise, dry non-productive cough and thoracic pleuritic pain, without improvement after one-week therapy with levofloxacin. Blood exams showed lymphocytosis of almost 50%, nine percent of atypical lymphocytes and elevated transaminases. Thoracic CT-scan showed bilateral infiltrate with internal air bronchogram. Blood serology showed positivity for CMV IgG and IgM, with low CMV IgG avidity. Serum and bronchoalveolar detection of CMV by polymerase chain reaction (PCR) technique was also positive. Cultures were all negative. The patient became increasingly hypoxemic and the liver transaminases worsening, the reason for which ganciclovir was started. He made a full recovery and was discharged seven days later with oral valganciclovir, completing a 3 weeks antiviral course at home. Discussion: CMV pneumonia is a rare condition, however it's one of the three most common cause of severe viral community acquired pneumonia (CAP), along with influenza and adenovirus. CMV pneumonia should be considered in patients with atypical lymphocytes and mildly elevated serum transaminases. Conclusion: In immunocompetent hosts, even with severe CMV-CAP, the prognosis is good. However, antiviral treatment should be considered in the rare occasion of severe CMV infection. Nevertheless, more studies are needed to clarify the clinical benefit of antiviral treatment.

Glomerular filtration rate change during chronic hepatitis C treatment with Sofosbuvir/Ledipasvir in HCV/HIV Coinfected patients treated with Tenofovir and a boosted protease inhibitor: an observational prospective study.

INTRODUCTION: Concomitant use of ledipasvir and boosted protease inhibitors (PIs) may increase the risk of tenofovir (TDF) nephrotoxicity, since both these drugs increase TDF levels. Our aim was to evaluate glomerular filtration rate (eGFR) evolution during HCV treatment with sofosbuvir/ledipasvir (SOF/LDV) in HCV/HIV coinfected patients, according to their antiretroviral treatment (ARV). METHODS: Observational prospective study of HCV/HIV coinfected patients treated with SOF/LDV. eGFR evolution was evaluated during and 12 weeks after HCV treatment. Patients were categorized in three groups based on ARV regimen: non TDF, non-boosted TDF and TDF + boosted PI. RESULTS: We included 273 patients: 145 were receiving a non-TDF regimen, 78 a non-boosted TDF scheme and 50 were receiving TDF + boosted PI. We observed a statistically significant decrease in eGFR during treatment in all groups (non TDF p = 0.03, 95%CI [0.23-3.86], non-boosted TDF p < 0.01, 95%CI [3.36-7.44], TDF + PI p = 0.01, 95%CI [1.09-7.53]). The decrease was more pronounced in those receiving unboosted TDF (- 5.40 ml/min/1.73m2), but differences in eGFR decrease between the three groups were small and not statistically different (p = 0.06). eGFR decrease was greater in patients treated for 24 weeks (p = 0.009) and in cirrhotic patients (p = 0.036). At the end of follow up a recovery of eGFR was observed in all groups. CONCLUSION: We observed a significant decrease in eGFR during treatment in all study groups, that was small and reversible after SOF/LDV discontinuation. TDF was not associated with an increase in renal toxicity.

2D:4D digit ratio is associated with cognitive decline but not frailty in community-dwelling older adults.

OBJECTIVES: To understand the relation between 2D:4D ratio, frailty, and cognitive decline in community-dwelling elderly people. METHODS: A total of 175 community-dwelling elderly people were included. To determine frailty, participants completed the Tilburg Frailty Indicator (TFI) and the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). Cognitive functioning was determined using the Mini-Mental State Examination (MMSE). 2D and 4D finger lengths of each hand were measured using a scanner. Barthel Index, Lawton, and Brody scale were also completed for each participant to determine the level of daily living functioning. RESULTS: We did not find any correlations between 2D:4D ratio and frailty measures. We found a significant correlation between 2D:4D ratio and MMSE scores in the women sampled. CONCLUSIONS: We cannot ascertain any contribution of prenatal exposure to androgens to the frailty status of community-dwelling elderly people. We found that reduced prenatal exposure to testosterone in women may contribute to the prevention of cognitive decline in elderly women.

An examination of intentions of recommending fitness centers by user members / Uma análise das intenções de usuários em recomedar serviços de centros de atividade fisica / Un análisis a las intenciones de los socios para recomendar gimnasios

The goal of this study was to examine what experiences members have with fitness centers that influence their intentions for recommendation. After item generation and content validity, as well as a pilot test, a survey was conducted among members of five different clubs (n=1750). The questionnaire included measures of service quality attributes, accessibility, well-being in life, well-being in a club, and intentions to recommend a fitness center. Results using a structural equation model provide evidence that only service quality attributes and well-being in a club have positive effect on intentions of users to recommend it. Well-being in life has a negative effect on the intentions for recommendation, while accessibility shows no predictive effect. These findings suggest implications for the management of a club, such as the need to create a pleasant environment and to provide a personalized service directed towards the members' goals in order to improve well-being in a club and contribute to increase the intentions to recommend the fitness centers to others...

"Uma análise das intenções de usuários em recomedar serviços de centros de atividade fisica." O objetivo deste estudo foi examinar como as experiências de usuários de centros de atividade física interferem nas intenções em recomendar serviços. Depois de gerar itens e validar o conteúdo, aplicou-se um pré-teste, o questionário final foi aplicado a sócios de cinco clubes de fitness (n=1.750). O questionário incluiu atributos da qualidade do serviço, acessibilidade, bem-estar na vida, bem-estar no clube e intenção de recomendar. O modelo de equações estruturais mostrou que apenas os atributos da qualidade do serviço e bem-estar no clube têm um efeito positivo sobre as intenções de recomendar. O bem-estar na vida tem um efeito negativo sobre as intenções para recomendar, enquanto que a acessibilidade não mostra nenhum efeito preditivo. Estas conclusões sugerem a necessidade de criar um ambiente agradável nos clubes e de oferecer um serviço personalizado para os objetivos dos sócios, a fim de melhorar o bem-estar no clube e contribuir para a intenção de recomendar o ginásio...

"Un análisis a las intenciones de los socios para recomendar gimnasios." El objetivo de este estudio fue examinar los antecedentes de las intenciones de los socios para recomendar su gimnasio. Después de generar ítems y validar el contenido, se aplicó un pre-test, el cuestionario final fue aplicado a socios de cinco clubes de fitness (n=1.750). El cuestionario incluyó atributos de la cualidad del servicio, accesibilidad, bienestar en la vida, bienestar en el club e intención de recomendar. El modelo de ecuaciones estructurales mostró que solo los atributos de la cualidad del servicio y bienestar en el club tiene un efecto positivo sobre las intenciones de recomendar. El bienestar en la vida tiene un efecto negativo sobre las intenciones para recomendar, mientras que la accesibilidad no muestra ningún efecto predictivo. Estas conclusiones sugieren la necesidad de crear un ambiente agradable en los clubes y de ofrecer un servicio personalizado para los objetivos de los socios, con el fin de mejorar el bienestar en el club y contribuir a la intención de recomendar el gimnasio...