Functionality and 25-hydroxyvitamin D levels in institutionalized older adults / Funcionalidade e níveis de 25-hidroxivitamina D em idosos institucionalizados

OBJECTIVES: To evaluate the frequency of hypovitaminosis D among older adults and its association with the level of functionality. METHODS: This cross-sectional observational study of older adults residing in a non-profit long-term care facility assessed functionality with the Katz Index of Independence in Activities of Daily Living. Vitamin D levels were classified as: deficient (< 20 ng/mL), insufficient (21-29 ng/mL), or normal (≥ 30 ng/mL). We used the chi-square test and Student's t-test to compare dichotomous and continuous variables, respectively. Analysis of variance with Tukey's post hoc test was used to assess differences between groups. RESULTS: The sample consisted of 63 individuals whose mean age was 81 (61-113) years: 36 (55.4%) women and 27 (44.6%) men. The mean vitamin D level was 18.6 ng/mL, being < 30 ng/mL in 84.1%. The level was normal in 10 (15.9%), insufficient in 17 (27%), and deficient in 36 (57.1%). Vitamin D deficiency was present in 76.5% of those with total functional dependence (Katz = 5-6). CONCLUSIONS: We observed a high frequency of hypovitaminosis D, especially vitamin D deficiency, which was very common among those with significant functional dependence.

OBJETIVOS: Avaliar a frequência de hipovitaminose D em idosos de uma instituição filantrópica de longa permanência e sua associação com grau de funcionalidade. METODOLOGIA: Estudo transversal, observacional e analítico de idosos de uma instituição filantrópica de longa permanência. A funcionalidade foi avaliada pela Escala de Katz. Os níveis de vitamina D foram classificados em: deficiência (valores menores que 20 ng/mL); insuficiência (valores entre 21 - 29 ng/mL) e normais (valores igual ou superior a 30 ng/mL). Empregamos teste qui-quadrado e t de student, para compararmos variáveis dicotômicas e contínuas, respectivamente; e análise de variância (ANOVA) com teste post hoc de Tukey, para avaliarmos as diferenças entre os grupos. RESULTADOS: Sessenta e três indivíduos foram analisados com média de idade de 81 anos (61 - 113), sendo 36 (55,4%) mulheres e 27 (44,6%) homens. A média de vitamina D foi 18,6 ng/mL, 84,1% com níveis menores que 30 ng/mL; dez apresentaram níveis normais (15,9%), 17 com insuficiência (27%) e 36 com deficiência (57,1%); ainda, 76,5% dos portadores de dependência funcional total (Katz = 5 - 6) apresentam deficiência de vitamina D. CONCLUSÕES: Observamos uma alta frequência de hipovitaminose D, especialmente deficiência, muito frequentes naqueles com dependência funcional importante

Association of inflammatory and coagulation biomarkers with mortality in patients aged 60 years or older and hospitalized with COVID-19 / Associação entre biomarcadores inflamatórios e da coagulação com mortalidade em pacientes com 60 anos de idade ou mais hospitalizados com COVID-19

Objectives: To analyze the association of inflammatory and coagulation biomarkers with mortality in geriatric patients with COVID-19. Methods: This is a retrospective cohort study of 206 patients aged 60 years or older who were hospitalized with COVID-19 at an intensive care unit. The analyzed variables were age, sex, length of hospital stay, and inflammatory biomarkers (C-reactive protein, neutrophil-to-lymphocyte ratio, procalcitonin, fibrinogen, ferritin, and d-dimer). We constructed a receiver operating characteristic curve and analyzed the area under the curve to evaluate the accuracy of biomarkers associated with mortality in patients with COVID-19. Results: Mean age was 72 (± 8) years. There were 101 deaths (49% of the total sample), which were significantly more frequent (p = 0.006) in the older age groups and were distributed as follows: 37.50% (60 ­ 69 years old); 50% (70 ­ 79 years old); 67.50% (80 ­ 89 years old); and 75% (over 90 years old). Mortality was associated with increased serum levels of procalcitonin, neutrophil-to-lymphocyte ratio, C-reactive protein, and d-dimer, and decreased fibrinogen levels. Neutrophil-to-lymphocyte ratio occupied the largest area under the receiver operating characteristic curve (area under the curve 0.859) in this group. Conclusions: In this study, inflammatory biomarkers neutrophil-to-lymphocyte ratio, procalcitonin, C-reactive protein, and d-dimer were associated with mortality in older patients with COVID-19 hospitalized at an intensive care unit, and neutrophil-to-lymphocyte ratio presented the best accuracy.

Objetivos: Analisar associação de biomarcadores inflamatórios e da coagulação com mortalidade em pacientes geriátricos com COVID-19. Metodologia: Estudo do tipo coorte retrospectiva de 206 pacientes com 60 anos de idade ou mais internados em unidade de terapia intensiva (UTI) com COVID-19. As variáveis analisadas foram idade, sexo, tempo de permanência hospitalar e biomarcadores inflamatórios, sendo esses proteína C reativa (PCR), relação neutrófilo-linfócitos (RNL), procalcitonina, fibrinogênio, ferritina e D-dímero. Empregou-se a curva ROC, com análise da área sob a curva (ACR), para avaliar a acurácia dos biomarcadores associados à mortalidade nos pacientes com COVID-19. Resultados: A média de idade foi de 72 (± 8) anos. Ocorreram 101 óbitos (49,02% da amostra total), significativamente mais frequente (p = 0,006) nas faixas etárias mais elevadas, distribuídos por faixa etária: 37,50% (60 ­ 69 anos); 50% (70 ­ 79 anos); 67,50% (80 ­ 89 anos); e 75% (nos maiores de 90 anos). A mortalidade foi associada a aumento dos níveis séricos dos biomarcadores procalcitonina, relação neutrófiloslinfócitos (RNL), proteína C reativa (PCR) e D-dímero, bem como diminuição dos níveis de fibrinogênio. A RNL ocupou a maior área sob a curva ROC (ACR 0,859) nesse grupo. Conclusões: Neste estudo, os biomarcadores inflamatórios RNL, procalcitonina, PCR e D-dímero foram associados com mortalidade em pacientes idosos portadores de COVID-19 internados em UTI, e a RNL foi a que apresentou a melhor acurácia.

Positive association of a Sirt1 variant and parameters of oxidative stress on Alzheimer's disease.

Alzheimer's disease (AD) is a complex neurodegenerative disorder and the most common type of dementia in the elderly. Although its cause is not completely known, several studies suggest that oxidative stress plays an important role in the etiology of this disease. The SIRT1 and SOD2 proteins are linked to pathways that may impair oxidative stress. In this study, we analyzed the association between polymorphisms in these genes and in the APOE gene, through RT-PCR, as well as between environmental factors and the risk of AD. Additionally, the thiobarbituric acid reactive substance assay was performed to estimate the plasma level of malondialdehyde (MDA), a biomarker of lipid peroxidation. Furthermore, some cytogenetic studies indicate that cells of AD patients show increased chromosomal damage; thus, we performed the micronucleus cytome assay to assess cytogenetic damage in AD patients. As expected, the APOE polymorphisms were found to be highly associated with AD. Additionally, the CT genotype of the SIRT1 gene showed a positive association with the disease. The frequencies of genomic damage (micronucleus, buds, nucleoplasmic bridges and binucleated cells), the presence of cell death biomarkers (condensed chromatin, karyorrhexis and pyknosis), and the plasma level of MDA were significantly greater in AD patients than in controls. Our results support the hypothesis that AD is a condition with increased oxidative stress and genomic instability, which may contribute to the neurodegeneration in AD.

The combined risk effect among BIN1, CLU, and APOE genes in Alzheimer's disease.

Genome-wide associations studies (GWAS) are detecting new variants associated with late-onset of Alzheimer's disease (LOAD), a multifactorial neurodegenerative disorder. The variants rs744373 BIN1, rs11136000 CLU and rs3764650 ABCA7 uncovered by GWAS led to different AD pathways, such as metabolism, trafficking and endocytosis of lipids and inflammation. However, most of the association studies did not replicate these variants with significance. This could be due to a small power effect evident when these variants are tested independently with LOAD. Therefore, we aimed to investigate whether the combination of different variants would additively modify the risk of association with LOAD that is observed in GWAS. We performed an association study testing pairwise variants in metabolism, trafficking and endocytosis of lipid (rs429358 and rs7412 APOE, rs744373 BIN1, rs3764650 ABCA7 and rs11136000 CLU) pathways with LOAD in samples from southeastern Brazil. Our data suggest a risk effect for LOAD between APOE with CLU and APOE with BIN1 genes.

Deficiência de vitamina B12 e fatores associados em idosos institucionalizados / Vitamin B12 deficiency and associated factors in institutionalized

Resumo Objetivo Avaliar a frequência de deficiência de vitamina B12 e fatores associados em idosos institucionalizados. Método Analisamos 65 idosos, com idade média de 80±9 anos (61-113), de uma instituição geriátrica filantrópica de longa permanência. A dosagem sérica de vitamina B12 foi analisada e classificada em: normal (≥299 pg/mL), limítrofe (200-298 pg/mL) e deficiência (<200 pg/mL). Foi analisada a associação com tempo de permanência na instituição, declínio cognitivo e funcional, uso regular de biguanidas e inibidores de bomba de prótons, considerados fatores de risco para hipovitaminose B12, utilizando os testes de análise bivariada (paramétrica e não paramétrica) e regressão de Poisson. Resultados A deficiência de vitamina B12 estava presente em 21,5% e valores limítrofes em 32,3% da amostra. Dentre os idosos, 52,9% apresentavam demência de causas diversas, 49,2% hipertensão arterial, 29,2% com anemia (21,5% normocítica, 4,6% microcítica e 3,1% macrocítica), 18,5% diabéticos; 27,7% faziam uso de polifarmácia, com 12,3% em uso de metformina e 16,9% com inibidores de bomba de prótons. No modelo multivariado não houve associação entre a deficiência de vitamina B12 com as variáveis estudadas. Conclusão Observamos uma frequência importante de valores limítrofes e baixos de vitamina B12 nos pacientes dessa instuição geriátrica de cuidados permanentes, porém sem associação com os fatores de risco para sua deficiência estudado, o que torna importante a inclusão da dosagem sérica dessa vitamina na rotina de exames laboratoriais desse grupo.

Abstract Objective To assess the frequency of vitamin B12 deficiency and associated factors in institutionalized old people. Method We analyzed 65 old people, with an average age of 80±9 years (61-113), from a long-term philanthropic geriatric institution. The serum dosage of vitamin B12 was analyzed and classified as: normal (≥299 pg/mL), borderline (200-298 pg/mL) and deficiency (<200 pg/mL). The association with length of stay in the institution, cognitive and functional decline, regular use of biguanides and proton pump inhibitors, considered risk factors for B12 hypovitaminosis, was analyzed using the bivariate analysis tests (parametric and non-parametric) and Poisson regression. Results Vitamin B12 deficiency was present in 21.5% and borderline values in 32.3% of the sample. Among the old people, 52.9% had dementia of different causes, 49.2% had arterial hypertension, 29.2% with anemia (21.5% normocytic, 4.6% microcytic and 3.1% macrocytic), 18.5 % diabetics; 27.7% used polypharmacy, with 12.3% using metformin and 16.9% using proton pump inhibitors. In the multivariate model, there was no association between vitamin B12 deficiency and the variables studied. Conclusion We observed an important frequency of borderline and low values of vitamin B12 in the patients of this geriatric institution of permanent care, but without association with the risk factors for their deficiency studied, which makes it important to include the serum dosage of this vitamin in the laboratory tests routine of that group.

Sundown syndrome in patients with Alzheimer's disease dementia.

The sundown syndrome is a complex neurobehavioral disorder in patients with dementia associated with high financial cost and significant caregiver burden. It is a multifactorial phenomenon with unclear pathophysiology, characterized by the presence of neuropsychiatric symptoms in the evening period. OBJECTIVE: To analyze the main neuropsychiatric symptoms, their correlation with one another, with comorbidities, and with time of day of greatest symptom intensity in patients with Alzheimer's disease dementia. METHODS: This is a cross-sectional, observational and explanatory study in which caregivers/relatives of elderly patients with dementia were interviewed using a structured tool called the Neuropsychiatric Inventory (NPI). RESULTS: The sample studied was composed of 38 patients, 60.5% female and 39.5% male, with mean age of 81±6 (67-94) years. A high frequency of neuropsychiatric symptoms in the evening period was observed, predominantly irritability (55.3%), nocturnal behavior (47.4%), and aggressiveness (42.1%). Only 36.8% of the family caregivers used non-pharmacological strategies. CONCLUSION: The frequency of neuropsychiatric symptoms was exacerbated in the evening among patients with Alzheimer's disease, especially for those behavioral symptoms that had a positive correlation with one another.

A síndrome do entardecer ou "pôr do sol" - "sundown syndrome" - é uma alteração neurocomportamental complexa em pacientes portadores de demência que geram custos financeiros excessivos e desgaste importante a seus cuidadores. Trata-se de um fenômeno multifatorial com fisiopatologia incerta, que caracteriza-se pela presença de sintomas neuropsiquiátricos no período vespertino. OBJETIVO: Analisar os principais sintomas neuropsiquiátricos, sua correlação entre si, com comorbidades e o horário do dia de maior intensidade destes em pacientes portadores de demência da doença de Alzheimer. MÉTODOS: Trata-se de um estudo analítico transversal, observacional e explanatório no qual foram entrevistados cuidadores/familiares de pacientes idosos portadores de demência utilizando uma ferramenta estruturada denominada Neuropsychiatric Inventory (NPI). RESULTADOS: A amostra estudada foi de 38 pacientes, 60,5% feminino e 39,5% masculino, com 81±6 (67-94) anos de idade. Foi observada uma alta frequência de sintomas neuropsiquiátricos no período vespertino, principalmente irritabilidade (55,3%), comportamento noturno (47,4%), agressividade (42,1%). Apenas 36,8% dos cuidadores familiares empregavam estratégias não farmacológicas. CONCLUSÃO: A frequência dos sintomas neuropsiquiátricos são exacerbados ao entardecer em pacientes com doença de Alzheimer; principalmente os sintomas comportamentais com correlação positiva entre si.

Sundown syndrome in patients with Alzheimer's disease dementia / Síndrome do entardecer em pacientes portadores de demência da doença de alzheimer

ABSTRACT The sundown syndrome is a complex neurobehavioral disorder in patients with dementia associated with high financial cost and significant caregiver burden. It is a multifactorial phenomenon with unclear pathophysiology, characterized by the presence of neuropsychiatric symptoms in the evening period. Objective: To analyze the main neuropsychiatric symptoms, their correlation with one another, with comorbidities, and with time of day of greatest symptom intensity in patients with Alzheimer's disease dementia. Methods: This is a cross-sectional, observational and explanatory study in which caregivers/relatives of elderly patients with dementia were interviewed using a structured tool called the Neuropsychiatric Inventory (NPI). Results: The sample studied was composed of 38 patients, 60.5% female and 39.5% male, with mean age of 81±6 (67-94) years. A high frequency of neuropsychiatric symptoms in the evening period was observed, predominantly irritability (55.3%), nocturnal behavior (47.4%), and aggressiveness (42.1%). Only 36.8% of the family caregivers used non-pharmacological strategies. Conclusion: The frequency of neuropsychiatric symptoms was exacerbated in the evening among patients with Alzheimer's disease, especially for those behavioral symptoms that had a positive correlation with one another.

RESUMO A síndrome do entardecer ou "pôr do sol" - "sundown syndrome" - é uma alteração neurocomportamental complexa em pacientes portadores de demência que geram custos financeiros excessivos e desgaste importante a seus cuidadores. Trata-se de um fenômeno multifatorial com fisiopatologia incerta, que caracteriza-se pela presença de sintomas neuropsiquiátricos no período vespertino. Objetivo: Analisar os principais sintomas neuropsiquiátricos, sua correlação entre si, com comorbidades e o horário do dia de maior intensidade destes em pacientes portadores de demência da doença de Alzheimer. Métodos: Trata-se de um estudo analítico transversal, observacional e explanatório no qual foram entrevistados cuidadores/familiares de pacientes idosos portadores de demência utilizando uma ferramenta estruturada denominada Neuropsychiatric Inventory (NPI). Resultados: A amostra estudada foi de 38 pacientes, 60,5% feminino e 39,5% masculino, com 81±6 (67-94) anos de idade. Foi observada uma alta frequência de sintomas neuropsiquiátricos no período vespertino, principalmente irritabilidade (55,3%), comportamento noturno (47,4%), agressividade (42,1%). Apenas 36,8% dos cuidadores familiares empregavam estratégias não farmacológicas. Conclusão: A frequência dos sintomas neuropsiquiátricos são exacerbados ao entardecer em pacientes com doença de Alzheimer; principalmente os sintomas comportamentais com correlação positiva entre si.

Maior risco de delirium no pós-operatório está associado à idade avançada, anemia e baixa reserva cognitiva / Greater risk of postoperative delirium is associated with advanced age, anemia, and low cognitive reserve

INTRODUÇÃO: Delirium é uma mudança aguda na cognição e atenção, comum no período pós-operatório em pessoas idosas, associada ao aumento de custos e à permanência hospitalar. OBJETIVO: Avaliar frequência, fatores de risco e influência no período de permanência hospitalar de delirium pós-operatório em pacientes idosos submetidos a cirurgias não cardíacas eletivas. MÉTODO: Estudo do tipo transversal, observacional, de pessoas idosas (65 anos de idade ou mais), internadas para realização de cirurgia eletiva não cardíaca. Durante o período pré-operatório imediato (24 horas) foram avaliados os fatores de risco: idade, gênero, cognição (MiniCog), funcionalidade (Katz e time up and go), fármacos e aspectos clínicos. O delirium, no pós-operatório imediato (até 72 horas), foi avaliado através do Confusion Assesment Method (CAM). RESULTADOS: Oitenta e três pacientes foram incluídos na pesquisa, sendo 44,6% (n = 37) de cirurgia ortopédica, 42,16% (n = 35) de cirurgia geral e 13,3% (n = 11) de cirurgia urológica. Predominou o sexo masculino (53%), com idade média de 73 anos (65 a 94) anos. Na amostra de pacientes, 9,6% (n = 8) apresentaram delirium pós-operatório: 6% do tipo hiperativo (n = 5), 2,4% do tipo hipoativo (n = 2) e 1,2% do tipo misto (n = 1). Eram mais idosos (p = 0,02), com maior declínio cognitivo (p = 0,01), anemia (p = 0,04) e prolongamento na permanência hospitalar (p = 0,001). CONCLUSÃO: O delirium pós-operatório foi observado com maior frequência nos pacientes mais idosos, portadores de declínio cognitivo e anemia, com influência no período de hospitalização, demonstrando a importância de uma avaliação preventiva mais abrangente no período pré-operatório.

INTRODUCTION: Delirium is an acute change in cognition and attention, common in the postoperative period in older patients, associated with increased costs and longer hospital stay. OBJECTIVE: To evaluate the frequency, risk factors, and influence of postoperative delirium in older patients submitted to elective noncardiac surgery. METHOD: This was a cross-sectional, observational study of older adults (65 years or older) hospitalized for elective noncardiac surgery. During the immediate preoperative period (24 hours), risk factors such as age, sex, cognition (MiniCog), functional status (Katz and Timed Up and Go), medications, and clinical aspects were evaluated. Delirium, in the immediate postoperative period (up to 72 hours), was evaluated using the Confusion Assessment Method (CAM). RESULTS: A total of 83 patients were included in the study. Of these, 44.6% (n = 37) had undergone orthopedic surgery, 42.16% (n = 35), general surgery, and 13.3% (n = 11), urological surgery. Most participants were men (53%), with a mean age of 73 (65­94) years. Overall, 9.6% (n = 8) had postoperative delirium: 6% of the hyperactive subtype (n = 5), 2.4% of the hypoactive subtype (n = 2), and 1.2% of the mixed subtype (n = 1). These patients were older (p = 0.02), had greater cognitive decline (p = 0.01), anemia (p = 0.04), and prolonged hospital stay (p = 0.001). CONCLUSION: Postoperative delirium was more commonly observed in the older old with cognitive decline and anemia, with an impact on hospital length of stay, highlighting the importance of a more comprehensive preventive evaluation in the preoperative period.

Hiponatremia em idosos internados está associada à polifarmácia, maior permanência hospitalar e maior mortalidade / Hyponatremia in hospitalized older adults is associated with polypharmacy, longer hospital stay, and higher mortality

OBJETIVO: Avaliar a hiponatremia em pacientes idosos durante o período de internação e sua associação com polifarmácia, permanência hospitalar e mortalidade. MÉTODO: Estudo observacional, transversal e analítico, de pacientes com mais de 65 anos de idade durante o período de internação. A primeira amostra de sódio solicitada pelo médico foi considerada para análise. A hiponatremia foi classificada quanto à gravidade em: leve (130 ­ 135 mEq/L), moderada (125 ­ 129 mEq/L) e grave (< 125 mEq/L); quanto à osmolaridade em: isotônica (275 ­ 295 mOsm/L), hipotônica (< 275 mOsm/L) e hipertônica (> 295 mOsm/L). Empregamos o teste do χ2 e a análise de variância (ANOVA a uma via), com teste post hoc de Tukey, para analisar o período de permanência entre os grupos (normonatremia, hiponatremia leve/moderada e grave), e o teste do χ2, para comparar a mortalidade entre os grupos. RESULTADOS: Cento e setenta e quatro pacientes com idade média de 74 ± 7 anos (65 ­ 95 anos), sendo 52,3% do sexo masculino, foram avaliados. Do total, 44,8% apresentaram normonatremia; 37,8%, hiponatremia leve; 9,2%, hiponatremia moderada; e 8%, hiponatremia grave. Houve aumento do período de permanência hospitalar nos pacientes com hiponatremia, sendo mais acentuado em portadores de hiponatremia grave. Polifarmácia esteve presente em 39,3% dos pacientes. Entre aqueles com hiponatremia grave, 71,4% apresentavam polifarmácia (p = 0,01). CONCLUSÕES: Idosos hospitalizados apresentam alta frequência de hiponatremia e associação importante com polifarmácia e prolongamento da permanência hospitalar

OBJECTIVE: To evaluate hyponatremia in older patients during hospital stay and determine its association with polypharmacy, length of hospital stay, and mortality. METHOD: This was an observational, analytical, cross-sectional study of patients aged 65 years and older during hospitalization. The first sodium sample requested by the physician was considered for analysis. Hyponatremia was classified according to severity as mild (130­135 mEq/L), moderate (125­129 mEq/L), or severe (< 125 mEq/L) and according to osmolarity as isotonic (275­295 mOsm/L), hypotonic (< 275 mOsm/L), or hypertonic (> 295 mOsm/L). The χ2 test and oneway analysis of variance followed by Tukey's post hoc test were used to analyze length of hospital stay between the groups (normonatremia and mild, moderate, and severe hyponatremia). The χ2 test was also used to compare mortality between the groups. RESULTS: We included 174 patients, with a mean age of 74 (SD, 7; range, 65­95) years; 52.3% were men. Overall, 44.8% had normonatremia, 37.8% had mild hyponatremia, 9.2% had moderate hyponatremia, and 8.0% had severe hyponatremia. Increased hospital stay was observed in patients with hyponatremia, being longer in those with severe hyponatremia. Polypharmacy occurred in 39.3% of patients. Of patients with severe hyponatremia, 71.4% had polypharmacy (p = 0.01). CONCLUSIONS: Hospitalized older adults showed a high rate of hyponatremia and an important association with polypharmacy and prolonged hospital stay.

An association study of FOXO3 variant and longevity.

Human longevity is a polygenic and multifactorial trait. Pathways related to lifespan are complex and involve molecular, cellular, and environmental processes. In this analytical observational study, we evaluated the relationship between environment factors, oxidative stress status, DNA integrity level, and the association of FOXO3 (rs2802292), SOD2 (rs4880), APOE (rs429358 and rs7412), and SIRT1 (rs2273773) polymorphisms with longevity in oldest-old individuals from southeastern Brazil. We found an association between the FOXO3 GG genotype and gender. While lifestyle, anthropometric, and biochemical characteristics showed significant results, DNA damage and oxidative stress were not related to lifespan. We found that long-lived individuals with FOXO3 GT genotype had low levels of triglycerides. This study is the first to demonstrate that FOXO3 could be a candidate gene for longevity in the Brazilian population. These results are important in terms of provisions of health care for age-related diseases and lifespan, and provide insight for further research on epigenetic, gene regulation, and expression in oldest-old individuals.

Doença arterial obstrutiva assintomática e Índice Tornozelo-Braquial em pacientes com diabetes mellitus tipo 2 / Assintomatic peripheral obstructive arterial disease and Ankle-Brachial Index in patients with diabetes mellitus type 2

OBJETIVO: Rastrear a presença de doença arterial obstrutiva periférica assintomática em portadores de diabetes. MÉTODOS: Estudo observacional, descritivo e transversal de uma amostra composta por 50 pacientes de um ambulatórios de endocrinologia e geriatria, portadores de diabetes mellitus tipo 2, com mais de 5 anos de diagnóstico. O Índice Tornozelo-Braquial foi aferido por meio de esfigmomanômetro oscilométrico automático. A análise de dados foi obtida do software SSPS, versão 22. RESULTADOS: Dos 50 pacientes avaliados, com média de idade de 70 anos (50 a 91 anos de idade), 44% apresentavam Índice Tornozelo-Braquial normal e 16% tinham valores anormais. Como fatores associados de risco, apresentavam hipertensão arterial sistêmica (84%), sedentarismo (78%), dislipidemia (72%) e história de tabagismo (34%), porém sem associação estatística com doença arterial obstrutiva periférica assintomática. CONCLUSÃO: Foi alta a frequência do Índice Tornozelo-Braquial em relação anormal na amostra estudada. Ressalta-se a importância desse índice como método de baixo custo, fácil operacionalidade, não invasivo e de alta aceitabilidade na prática clínica da Atenção Primária de pacientes com risco cardiovascular aumentado.(AU)

OBJECTIVE: To track the presence of asymptomatic peripheral obstructive arterial disease in patients with diabetes. METHODS: This is an observational, descriptive, cross-sectional study with 50 patients of an endocrinology and geriatrics outpatient's department with more than five years of diabetes mellitus type 2 diagnosis. The ankle-brachial index was measured through an automatic oscillometric sphygmomanometer. Data analysis was obtained with SSPS Software, version 22. RESULTS: Of the 50 patients evaluated, with a mean age of 70 years (50-91 years of age), 44% presented with normal ankle-brachial index, and 16% had abnormal values. They had , systemic arterial hypertension (84%), sedentarism (78%), dyslipidemia (72%), and smoking history (34%) as associated risk factors, but no statistical association with asymptomatic peripheral obstructive arterial disease. CONCLUSION: This study found a high frequency of abnormal ankle-brachial index in the sample studied. The importance of this index is highlighted as a low-cost, easy-to-operate, non-invasive, highly accepted method in the clinical practice of primary care of patients with increased cardiovascular risk.(AU)

Análise do prolongamento do intervalo QT e fármacos em pacientes idosos em atendimento ambulatorial / Analysis of the QT interval prolongation and pharmaceuticals in elderly patients in ambulatory care

Objetivos: O objetivo deste estudo foi avaliar a frequência de síndrome do intervalo QT longo (SQTL) no traçado eletrocardiográfico de pessoas idosas e o uso concomitante de fármacos que possam agravá-la. Métodos: Trata-se de um estudo observacional, do tipo corte transversal, de pacientes idosos atendidos nos ambulatórios de especialidades do Hospital Santa Casa de Misericórdia de Vitória (ES), durante o período de seis meses.Resultados: Participaram do estudo 163 pacientes com 75 ± 8 (60­94) anos de idade, 60,7% (n = 99) dos quais eram do sexo feminino. Do total de pacientes, 33,1% (n = 54) faziam uso regular de pelo menos um fármaco de risco para prolongamento de intervalo QT corrigido (QTc). Trinta e quatro pacientes (20,9%) apresentaram QTc longo e 15 (9,2%), QTc de risco. Dos pacientes com QTc de risco, 4 (23,5%) faziam uso de pelo menos 1 fármaco de risco para prolongamento do intervalo QT (p = 0,07). Conclusão: Nesta amostra, observou-se alta frequência de SQTL, bem como o uso de fármacos potencialmente causadores de SQTL e arritmias.

Objectives: The objective of this study was to evaluate the frequency of long QT syndrome (LQTS) in the electrocardiographic tracing of elderly people and the concomitant use of drugs that can aggravate this condition. Methods: This is a crosssectional, observational study of elderly patients in outpatient services at Hospital Santa Casa de Misericórdia de Vitória, over a six-month period. Results: A total of 163 patients with 75 ± 8 (60­94) years of age, 60.7% (n = 99) of whom were female, participated in the study. Of the total number of patients, 33.1% (n = 54) were regularly taking at least one pharmaceutical that increased the risk of QTc prolongation; 34 patients (20.9%) had prolonged QTc and 15 (9,2%) had at-risk QTc. Of these patients with at-risk QTc, 4 (23.4%) were using at least 1 1 pharmaceutical that increases the risk of QT prolongation (p = 0.07). Conclusion: In this sample, a high frequency of LQTS was observed, as well as the use of pharmaceuticals that potentially cause LQTS and arrhythmias.

Validating GWAS Variants from Microglial Genes Implicated in Alzheimer's Disease.

Late-onset Alzheimer's disease (LOAD) is a multifactorial neurodegenerative disorder that corresponds to most Alzheimer's disease (AD) cases. Inflammation is frequently related to AD, whereas microglial cells are the major phagocytes in the brain and mediate the removal of Aß peptides. Microglial cell dsyregulation might contribute to the formation of amyloid plaques, a hallmark of AD. Genome-wide association studies have reported genetic loci associated with the inflammatory pathway involved in AD. Among them, rs3865444 CD33, rs3764650 ABCA7, rs6656401 CR1, and rs610932 MS4A6A variants in microglial genes are associated with LOAD. These variants are proposed to participate in the clearance of Aß peptides. However, their association with LOAD was not validated in all case-control studies. Thus, the present work aimed to assess the involvement of CD33 (rs3865444), ABCA7 (rs3764650), CR1 (rs6656401), and MS4A6A (rs610932) with LOAD in a sample from southeastern Brazil. The genotype frequencies were assessed in 79 AD patients and 145 healthy elders matched for sex and age. We found that rs3865444 CD33 acts as a protective factor against LOAD. These results support a role for the inflammatory pathway in LOAD.

Functional disability and associated factors in elderly stroke survivors in Vitória, Brazil / Incapacidade funcional e fatores associados em idosos após o Acidente Vascular Cerebral em Vitória - ES, Brasil

Abstract Objective: The aim of the present study was to estimate the prevalence of disability and associated factors in elderly stroke survivors. Methods: A cross-sectional study of 230 elderly persons was conducted in the 22 territories of the Estratégia de Saúde da Família (the Family Health Strategy) of Vitória, in the state of Espirito Santo. Patients were assessed using the modified Rankin Scale. Poisson regression with robust variance in crude and adjusted analyses was employed. Results: The majority of subjects were men (52.1%) aged between 60 to 98 years, with a mean age of 75.8 (sd±9.2). The prevalence of disability was 66%. Age ≥80 years, self-perceived limitations in bodily function, considering the physical structure of the street to be a barrier to leaving home and believing street lighting to be insufficient were positively associated with functional disability. Possessing 12 or more years of schooling was inversely associated with the outcome. Conclusions: The high prevalence of disability and associated factors in elderly stroke survivors reinforce the need for a health system that operates continuously and proactively, promoting active aging. AU

Resumo Objetivo: Estimar a prevalência da incapacidade funcional e os fatores associados em idosos que sofreram o Acidente Vascular Cerebral (AVC). Método: Estudo transversal, realizado nos vinte e dois territórios da Estratégia de Saúde da Família no município de Vitória, ES. Participaram 230 indivíduos com idade igual ou superior a 60 anos. Os dados foram coletados em entrevistas domiciliares e a incapacidade funcional foi avaliada por meio da Escala de Rankin modificada. Empregou-se a regressão de Poisson com variância robusta nas análises bruta e ajustada. Resultado: A maioria dos participantes eram homens (52,1%) entre 60 a 98 anos, a média de idade foi de 75,8, com desvio padrão de 9,2. A prevalência da incapacidade funcional foi de 66%. Na análise ajustada, uma maior prevalência da incapacidade associou-se a ter 80 anos ou mais de idade, autoperceber limitações em funções do corpo, perceber a estrutura física da rua como barreira e achar a sinalização das vias insuficiente. Já ter 12 anos ou mais de estudo, associou-se a uma menor prevalência do desfecho. Conclusão: A alta prevalência da incapacidade funcional nos idosos após o AVC, bem como a identificação dos seus fatores associados reforçam a necessidade de um sistema de saúde que atue de forma contínua e proativa investindo em práticas que promovam o envelhecimento ativo. AU

The use of biomarkers in clinical osteoporosis.

Osteoporosis is a disease of ascending character in the world population; in this context, bone biomarkers are being increasingly studied in order to aid in the diagnosis and monitoring of these patients. The main objective of this study was a literature review of articles whose main theme was the use of biomarkers for bone formation and degradation, and to evaluate their possible applicability in clinical practice. Literature review was performed through articles indexed and published in the last five years in the PubMed database. The findings of this study showed that most of the previously selected articles were published in the last two years, and the most cited markers were bone resorption, C-terminal collagen telopeptide (CTX), showing the highest correlation with the dynamics of bone, and the biomarker of bone formation, bone-specific alkaline phosphatase (BAP), which is increased in the event of fracture or may suggest another bone disease. There was an increase in published articles, associating different bone biomarkers and their clinical applicability, especially for treatment control. Our findings suggest that in recent years there has been significant increase in publications evaluating the use of bone turnover biomarkers for bone formation and resorption and their possible clinical applicability, especially in the monitoring of treatment. Still, we believe that further studies need to be conducted to confirm these findings, given the advantages that bone biomarkers can deliver in the clinical management of the disease.

The use of biomarkers in clinical osteoporosis / O uso dos biomarcadores na clínica da osteoporose

Summary Osteoporosis is a disease of ascending character in the world population; in this context, bone biomarkers are being increasingly studied in order to aid in the diagnosis and monitoring of these patients. The main objective of this study was a literature review of articles whose main theme was the use of biomarkers for bone formation and degradation, and to evaluate their possible applicability in clinical practice. Literature review was performed through articles indexed and published in the last five years in the PubMed database. The findings of this study showed that most of the previously selected articles were published in the last two years, and the most cited markers were bone resorption, C-terminal collagen telopeptide (CTX), showing the highest correlation with the dynamics of bone, and the biomarker of bone formation, bone-specific alkaline phosphatase (BAP), which is increased in the event of fracture or may suggest another bone disease. There was an increase in published articles, associating different bone biomarkers and their clinical applicability, especially for treatment control. Our findings suggest that in recent years there has been significant increase in publications evaluating the use of bone turnover biomarkers for bone formation and resorption and their possible clinical applicability, especially in the monitoring of treatment. Still, we believe that further studies need to be conducted to confirm these findings, given the advantages that bone biomarkers can deliver in the clinical management of the disease.

Resumo A osteoporose é uma doença de caráter ascendente na população mundial. Nesse contexto, os biomarcadores ósseos vêm sendo cada vez mais estudados com o propósito de auxiliar no diagnóstico e acompanhamento desses pacientes. Os principais objetivos deste estudo incluem realizar uma revisão da literatura dos artigos cujo principal tema estudado foi a utilização dos biomarcadores de formação e degradação óssea, e avaliar uma possível aplicabilidade desses biomarcadores na prática clínica. A revisão da literatura foi realizada com artigos indexados e publicados nos últimos cinco anos, utilizando a base de dados PubMed. Os achados deste trabalho mostraram que a maioria dos artigos previamente selecionados foram publicados nos últimos dois anos, e os marcadores mais citados foram o de reabsorção óssea, o C-telopeptídeo do colágeno (CTX), que mostra maior correlação com a dinâmica do osso, e o biomarcador de formação óssea, a fosfatase alcalina específica do osso (BAP), cujos valores aumentados estão relacionados à vigência de fratura ou sugerem uma outra doença óssea. Foi observado um aumento dos artigos publicados associando os diferentes biomarcadores ósseos e uma possível aplicabilidade clínica, principalmente no controle do tratamento. As nossas conclusões sugerem que nos últimos anos houve aumento significativo das publicações avaliando o uso dos biomarcadores de remodelação óssea de formação e reabsorção e uma possível aplicabilidade clínica, principalmente na monitorização do tratamento. No entanto, acreditamos que novos estudos precisam ser conduzidos a fim de confirmar esses achados, tendo em vista as vantagens que os biomarcadores ósseos apresentam no manejo clínico da doença.

Human immunodeficiency virus infection and its association with sarcopenia.

Presarcopenia and sarcopenia were evaluated in HIV-infected individuals and in healthy elderly controls according to the consensus definitions of the European Working Group on Sarcopenia in Older People. Bioelectrical impedance, a hydraulic hand dynamometer, and gait speed were used to evaluate muscle mass, muscle strength, and physical performance, respectively. Adjusted and unadjusted binary logistic regression predicted the risk of sarcopenia. Predictor contribution was assessed by the Wald test. Significance was established at p≤0.05. The HIV-infected group consisted of 33 patients on treatment (42.4% women; mean age 59±7 years; mean BMI 25±6kg/m(2); viral load undetectable in 30 cases). The HIV-uninfected group consisted of 60 individuals (71.7% women; mean age 70±7 years; mean BMI 28±6kg/m(2)). Of the controls, 4 (6.7%) individuals had presarcopenia and 4 (6.7%) sarcopenia compared to 4 (12.1%) and 8 (24.2%), respectively, in the HIV-infected group. The HIV-infected patients had a 4.95 higher risk (95% CI: 1.34-18.23) for sarcopenia compared to the controls. It should be pointed out that the control group was on average 10 years older. This risk increased further (RR=5.20; 95% CI: 1.40-19.20) after adjusting for age and BMI. HIV-infected patients were shown to be at a greater risk of sarcopenia, an indicator of frailty, even following adjustment for age and BMI.

Disability after stroke: a systematic review / Incapacidade após acidente vascular cerebral: uma revisão sistemática

Introduction Stroke is the most common cause of disability in Western countries, yet there is no consensus in the literature on how to measure and describe disability from stroke. Objective To conduct a systematic literature review on disability in stroke survivors. Method Observational studies published in the PubMed, LILACS and SciELO online databases were selected, to evaluate disability in adults and in the elderly after stroke in the period 2002–2012. The Downs and Black checklist for non-randomized studies was used to assess the quality of the articles. Results 212 articles were found from which 16 were selected to compose the study. The mean age of participants was 67 years, and disability affected 24% to 49% of the population evaluated. With regard to measurement instruments, 31% of the studies analyzed presented results of disability by means of the modified Rankin Scale; 19% by means of the World Health Organization’s International Classification of Functioning, Disability and Health; 19% by means of Katz’ Index of Independence in Activities of Daily Living; 12.5% by means of the London Handicap Scale; 12.5 % by means of the Barthel Index; and 6.25% by means of the Functional Independence Measure. Conclusion Literature is not uniform as regards means of measuring disability after stroke, but considering the preference of articles in assessing physical performance in activities of daily living, it can be concluded that a quarter to half of the population that survives stroke has some degree of disability. .

Introdução O acidente vascular cerebral (AVC) é a causa mais comum de incapacidade nos países ocidentais, e ainda não existe na literatura um consenso na forma de mensurar e descrever tal incapacidade. Objetivo Realizar uma revisão sistemática da literatura sobre a incapacidade nos sobreviventes do AVC. Métodos Foram selecionados estudos observacionais que avaliaram incapacidade na população adulta e idosa após AVC publicados na base de dados LILACS e nas bibliotecas virtuais PubMed e SciELO no período de 2002 a 2012. Para avaliação da qualidade dos artigos foi utilizado o critério de Downs e Black. Resultados Foram encontrados 212 artigos e selecionados 16 para compor o banco de dados. A média de idade dos participantes foi de 67 anos e a incapacidade atingiu de 24% a 49% da população avaliada. Com relação aos instrumentos de mensuração, 31% dos estudos analisados apresentaram os resultados de incapacidade por meio do Modified Rankin Scale, 19% por meio da Classificação Internacional de Funcionalidade, 19% por meio do Katz, 12,5% por meio do London Handicap Scale, 12,5% por meio do Barthel e 6,25% por meio da Medida de Independência Funcional. Conclusão A literatura não é uniforme quanto à forma de mensurar a incapacidade após AVC, mas considerando a preferência dos artigos em avaliar o desempenho físico nas atividades de vida diária, pode-se concluir que de um quarto à metade da população que sobrevive ao AVC apresenta algum grau de incapacidade. .

Fatores associados a não adesão medicamentosa entre idosos de um ambulatório filantrópico do Espírito Santo / Pharmacological non-adherence therapy and associated factors among elderly from a philanthropic outpatient unit of Espírito Santo state, Brazil

OBJETIVOS: Estimar a frequência da não adesão ao tratamento medicamentoso entre idosos acompanhados ambulatorialmente, bem como analisar seus fatores associados. METODOLOGIA: Foi conduzido estudo transversal com 263 idosos atendidos no ambulatório de especialidades médicas de um hospital filantrópico, localizado no município de Vitória-ES. Foi realizada entrevista utilizando roteiro estruturado em três blocos que contemplavam questões sociodemográficas, condições de saúde e estilo de vida e medicamentos em uso. Para verificar a não adesão ao tratamento medicamentoso, foi aplicado o instrumento de Medida de Adesão Terapêutica (MAT). Os dados foram analisados por meio do teste Qui-quadrado para variáveis categóricas. Foram consideradas significativas as variáveis com valor de p<0,05 no modelo final de regressão múltipla de Poisson. RESULTADOS: Os resultados mostraram uma frequência de não adesão ao tratamento medicamentoso de 26,7% da amostra. A não adesão ao tratamento medicamentoso nessa população se mostrou positivamente associada à ausência de vínculo empregatício anterior a aposentadoria (RP=1,12; p<0,010); presença de declínio cognitivo (RP=1,13; p<0,010) e hábitos alimentares inadequados (RP=1,12; p<0,005). CONCLUSÃO: Com o estudo, foi possível identificar os fatores associados à não adesão medicamentosa nos idosos investigados e assim contribuir para o conhecimento do perfil sociodemográfico, condições de saúde e estilo de vida e características relacionadas à utilização de medicamentos por parte dessa população.

OBJECTIVES: To estimate the non-adherence frequency of drug treatment among elderly outpatients and to analyze associated factors. METHODS: A cross-sectional study was conducted with 263 elderly patients from the medical specialties outpatient of a philanthropic hospital, located in the city of Vitoria, Espirito Santo state, Brazil. Interview was conducted using a structured script in three blocks that contemplated sociodemographic, health and lifestyle and medications used. To check the non-adherence to drug treatment, Measurement of Treatment Adherence (MTA) was applied. Data were analyzed using the chi-square test for categorical variables. The variables with p<0.05 in the final model of multiple Poisson regression were considered significant. RESULTS: The results showed a frequency of non-adherence to drug treatment in 26.7% of the sample. Non-adherence to drug treatment in this population was positively associated with lack of employment prior to retirement (PR=1.12; p<0.010); the presence of cognitive decline (PR=1.13; p<0.010) and poor eating habits (PR=1.12; p<0.005). CONCLUSION: With this study, it was possible to identify the factors associated with non-adherence to drug treatment in the investigated elderly and thus contribute to the knowledge of the socio-demographic profile, health and lifestyle and characteristics related to the use of drugs by this population.

Proteína-C reativa como biomarcador no diagnóstico precoce de infecção bacteriana na pessoa idosa / C-reactive protein as a biomarker for the early diagnosis of bacterial infections in the elderly

INTRODUÇÃO: A proteína C reativa (PCR) para o diagnostico de infecção bacteriana na população idosa não esta bem estabelecida. O objetivo deste estudo foi avaliar a importância da Proteína C reativa como biomarcador no diagnóstico precoce de infecções bacterianas em pessoas idosas. MÉTODOS: Foram avaliados idosos internados no Hospital Santa Casa de Misericórdia de Vitória-ES em um período de seis meses. Os níveis de PCR foram medidos em até 48 horas de internação e sua importância na predição de infecções bacterianas foi analisada. RESULTADOS: Incluímos para análise 141 indivíduos, sendo 50,4% (71) do sexo feminino, com 77±9 (60-97) anos de idade, 78 (55,3%) sem infecção, 36 (25,5%) infecção estabelecida por critérios clínicos e microbiológicos e 27 (19,1%) com diagnóstico provável com evidência radiológica, totalizando 63 pacientes (44,7%) com infecção. Dentre as causas não infecciosas, as mais frequentes foram insuficiência cardíaca (24,3%), acidente vascular cerebral (6,41%), cirrose hepática (6,76%), e nas infecciosas 44,4% pneumonia, 12,69% sepse e 7,92% infecção urinária. A proteína C reativa apresentou-se com ponto de corte em 49,20mg/L com sensibilidade de 68,3% e especificidade de 69,07% em área da curva de ROC 0,758 (0,67-0,83; p=0,001). CONCLUSÃO: A elevação da proteína C reativa , com ponto de corte ≥49,20mg/L, em pacientes analisados em até 48 horas de admissão hospitalar, mostrou-se um bom preditor de infecção bacteriana em idosos, dentro de um contexto clínico, visto que neste grupo populacional as manifestações clínicas de infecções são frequentemente atípicas.

BACKGROUND AND OBJECTIVE: The C-reactive protein (CRP) for the diagnosis of bacterial infection in the elderly population is not well established. The objective of this study was to evaluate the importance of C-reactive Protein as a biomarker in the early diagnosis of bacterial infections in elderly people. METHODS: Elderly patients hospitalized in the Santa Casa de Misericordia Hospital in Vitoria-ES on a six-month period were evaluated. C-reactive protein P levels were measured within 48 hours of admission and its importance in predicting bacterial infections was analyzed. RESULTS: We included 141 individuals for analysis, with 50.4% (71) were female, with 77±9 (60-97) years, 78 (55.3%) without infection, 36 (25.5%) infection established by clinical and microbiological criteria and 27 (19.1%) with probable diagnosis with radiological evidence, totaling 63 patients (44.7%) with infection. Among the non-infectious causes, the most frequent was heart failure (24.3%), stroke (6.41%), liver cirrhosis (6.76%) and, among the infectious causes 44.4% pneumonia, 12.69% sepsis, and 7.92% urinary tract infection. The C-reactive protein presented with the cutoff point at 49.20mg/L with a sensitivity of 68.3% and specificity of 69.07% in area of the ROC curve 0.758 (0,67-0,83; p=0,001). CONCLUSION: Elevated C-reactive protein, with a cutoff ≥49.20mg/L in patients examined within 48 hours of hospital admission, proved to be a good predictor of bacterial infection in the elderly, within a clinical context, since clinical manifestations of infection are often a typical in this population group.