ABSTRACT
INTRODUCTION: The brain is the most complex organ in the human body, with a high and constant demand for inputs. Adequate nutrition is essential for the complete functioning of the brain, not only due to the energy supply, mainly from carbohydrates, but also due to the adequate supply of other macronutrients and micronutrients for the synthesis of neurotransmitters and protein components. Vitamins, minerals, and other components of the diet also constitute the so-called "neuro-nutrients". OBJECTIVE: It was to develop a systematic review to highlight key neuro-nutrients and clinical studies that direct strategies for adequate nutritional status. METHODS: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from October 2021 to February 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. RESULTS: A total of 234 articles were found and 167 articles were evaluated in full, and 118 were included and evaluated in the present study. According to the GRADE instrument, most studies (>50%) followed a controlled clinical study model and had a good methodological design. The overall assessment resulted in 54 studies with a high risk of bias to the small sample size. The most important macronutrients in neuro-nutrition are phosphatidylserine and tryptophan. Micronutrients are methyl folate, vitamins B6 and B12, magnesium, arginine, choline, and niacin. CONCLUSION: The areas of neurology and psychiatry have shown great advances regarding the deepening of knowledge in prophylaxis and pathophysiology, as well as in the treatment of established diseases. The recognition of the role of nutrition as an adjunct to these processes is currently growing. The search in scientific bases for neuro nutrients reveals a great growth of publications related to this theme. In the present text, some of these nutrients were explored to verify the current state of knowledge.
Subject(s)
Minerals , Vitamins , Humans , Vitamins/metabolism , Minerals/metabolism , Micronutrients/metabolism , Nutrients , Brain/metabolismABSTRACT
Objective: The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field. Methods: A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure. Conclusion: Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended. Level of Evidence V, Expert Opinion.
Objetivo: O Consenso Brasileiro de Viscossuplementação do Quadril visa gerar uma fonte referencial a partir do conhecimento teórico e da experiência clínica de especialistas da área. Métodos: Um painel multidisciplinar foi formado com quinze especialistas (médicos do esporte, ortopedistas, fisiatras e reumatologistas), com base na experiência clínica e acadêmica no uso da viscossuplementação do quadril. Foram elaboradas, discutidas e votadas doze afirmativas. Cada membro do painel deu um valor entre 0 e 10 numa escala tipo Likert, especificando seu nível de concordância com a afirmação. Resultados: O painel chegou a um consenso sobre diversos aspectos da viscossuplementação do quadril, destacando-se: a melhor indicação é para tratar artrose de quadril leve a moderada; pode ser indicada para casos graves; os resultados podem variar de acordo com o viscossuplemento utilizado; não deve ser realizada como procedimento isolado, mas em conjunto com outras medidas reabilitadoras e farmacológicas; a melhor técnica para infiltração no quadril deve se basear nas referências anatômicas combinadas com guiagem por imagem; a viscossuplementação do quadril é um procedimento custo-efetivo. Conclusão: A viscossuplementação é uma alternativa terapêutica segura e eficaz na osteoartrite do quadril, mesmo em casos graves. Recomenda-se o uso de métodos guiados. Nível de Evidência V, Opinião do Especialista.
ABSTRACT
ABSTRACT Objective: The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field. Methods: A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure. Conclusion: Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended. Level of Evidence V, Expert Opinion.
RESUMO Objetivo: O Consenso Brasileiro de Viscossuplementação do Quadril visa gerar uma fonte referencial a partir do conhecimento teórico e da experiência clínica de especialistas da área. Métodos: Um painel multidisciplinar foi formado com quinze especialistas (médicos do esporte, ortopedistas, fisiatras e reumatologistas), com base na experiência clínica e acadêmica no uso da viscossuplementação do quadril. Foram elaboradas, discutidas e votadas doze afirmativas. Cada membro do painel deu um valor entre 0 e 10 numa escala tipo Likert, especificando seu nível de concordância com a afirmação. Resultados: O painel chegou a um consenso sobre diversos aspectos da viscossuplementação do quadril, destacando-se: a melhor indicação é para tratar artrose de quadril leve a moderada; pode ser indicada para casos graves; os resultados podem variar de acordo com o viscossuplemento utilizado; não deve ser realizada como procedimento isolado, mas em conjunto com outras medidas reabilitadoras e farmacológicas; a melhor técnica para infiltração no quadril deve se basear nas referências anatômicas combinadas com guiagem por imagem; a viscossuplementação do quadril é um procedimento custo-efetivo. Conclusão: A viscossuplementação é uma alternativa terapêutica segura e eficaz na osteoartrite do quadril, mesmo em casos graves. Recomenda-se o uso de métodos guiados. Nível de Evidência V, Opinião do Especialista.
ABSTRACT
The Brazilian population is aging and the prevalence of chronic degenerative diseases, including osteoporosis, is increasing. The diagnosis and treatment of osteoporosis have made significant advances in the last decade. The orthopedist and traumatologist can no longer be detained only in the surgical treatment of osteoporotic fracture. It is extremely important that we know: 1) what risk factors to evaluate, and the Fracture Risk Assesment Tool (FRAX) can be used; 2) which complementary tests should be requested, such as densitometry, radiography of the spine and pelvis, blood and urine tests, and even bone biopsy; 3) which supplements to use, such as calcium and magnesium, vitamins D and K; 4) which medications to prescribe, antiresorptives or trainers, therapeutic windows and adverse events.
ABSTRACT
Sarcopenia has been acquiring a growing importance in the scientific literature and in doctors' offices. As the population ages, it becomes increasingly essential to know, prevent, and treat this clinical condition. The purpose of the present review is to bring up the current evidence on the diagnosis of this pathology, in a practical way, as well as the main current treatment options.
ABSTRACT
Abstract Sarcopenia has been acquiring a growing importance in the scientific literature and in doctors' offices. As the population ages, it becomes increasingly essential to know, prevent, and treat this clinical condition. The purpose of the present review is to bring up the current evidence on the diagnosis of this pathology, in a practical way, as well as the main current treatment options.
Resumo A sarcopenia vem ganhando cada vez mais importância na literatura científica e nos consultórios médicos. Com o envelhecimento da população, essa condição clínica se torna cada vez mais imprescindível de se conhecer, se prevenir e de se tratar. O objetivo desta revisão é trazer as evidências atuais sobre o diagnóstico dessa patologia, de forma prática, bem como as principais opções atuais de tratamento.
Subject(s)
Humans , Testosterone , Creatine , Sarcopenia/diagnosis , Sarcopenia/therapy , LeucineABSTRACT
OBJECTIVE: To determine, through bone histomorphometry in femoral neck, whether there are differences in the cancellous bone of the proximal femur from female patients over 60 years old who had femoral neck fracture and similar patients who did not have such fracture. METHODS: We analyzed the trabecular part of the femur of 13 female patients, aged over 60 years old, by the bone histomorphometry method. Seven of these patients had femoral neck fracture. All of them were subjected to hip arthroplasty. RESULTS: Bone densitometry showed no significant difference. There was no significant difference on the average thickness of the trabecular bone (124.38µm versus 147.09µm). The number of bone trabeculae was lower (1.52, versus 1.88) and the separation between them was larger (541,19µm versus 391,14µm) in the fracture group. CONCLUSION: A difference in histomorphometric parameters of cancellous bone of the femur neck was observed among patients who had fractures as compared to patients who had not.
ABSTRACT
OBJECTIVE: To determine whether there is a difference on the bone architecture in patients with femoral neck fracture compared to patients with intertrochanteric fractures and assess the importance of aging on bone microarchitecture in patients with proximal femoral fracture. METHODS: Biopsy of the iliac crest was made in seventeen patients between 55 and 90 years old who were admitted to the emergency room with fractures of the proximal end of the femur. After a small fragment was removed, we made a histomorphometric analysis of it. RESULTS: There was no significant difference between patients with femoral neck fracture and trochanteric fracture in structural parameters, formation and resorption. Comparing age groups we also did not find any significant change between the groups in the parameters volume and trabecular separation. CONCLUSION: There are no difference in the morphometric parameters analyzed between the different types of fracture and age is not a significant factor in the alteration of these parameters.
ABSTRACT
OBJECTIVE: To determine whether there is a difference on the bone architecture in patients with femoral neck fracture compared to patients with intertrochanteric fractures and assess the importance of aging on bone microarchitecture in patients with proximal femoral fracture. METHODS: Biopsy of the iliac crest was made in seventeen patients between 55 and 90 years old who were admitted to the emergency room with fractures of the proximal end of the femur. After a small fragment was removed, we made a histomorphometric analysis of it. RESULTS: There was no significant difference between patients with femoral neck fracture and trochanteric fracture in structural parameters, formation and resorption. Comparing age groups we also did not find any significant change between the groups in the parameters volume and trabecular separation. CONCLUSION: There are no difference in the morphometric parameters analyzed between the different types of fracture and age is not a significant factor in the alteration of these parameters. Level of Evidence II, Diagnostic Studies.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Osteoporosis , Bone and Bones/anatomy & histology , Densitometry , Femoral Neck Fractures , Hip FracturesABSTRACT
OBJECTIVE: To determine, through bone histomorphometry in femoral neck, whether there are differences in the cancellous bone of the proximal femur from female patients over 60 years old who had femoral neck fracture and similar patients who did not have such fracture. METHODS: We analyzed the trabecular part of the femur of 13 female patients, aged over 60 years old, by the bone histomorphometry method. Seven of these patients had femoral neck fracture. All of them were subjected to hip arthroplasty. RESULTS: Bone densitometry showed no significant difference. There was no significant difference on the average thickness of the trabecular bone (124.38µm versus 147.09µm). The number of bone trabeculae was lower (1.52, versus 1.88) and the separation between them was larger (541,19µm versus 391,14µm) in the fracture group. CONCLUSION: A difference in histomorphometric parameters of cancellous bone of the femur neck was observed among patients who had fractures as compared to patients who had not. Level of Evidence II, Diagnostic Studies.
Subject(s)
Humans , Female , Middle Aged , Aged , Aged, 80 and over , Osteoporosis , Arthroplasty , Bone and Bones/anatomy & histology , Bone Remodeling , Densitometry , Femoral Neck Fractures , Femur Neck , Hip FracturesABSTRACT
Foi analisada a parte trabecular do colo do fêmur de 13 pacientes do sexo feminino, com idade acima dos 60 anos, com o método da histomorfometria óssea. Sete destas pacientes tiveram fratura do colo do fêmur. Todas foram submetidas a artroplastia do quadril. O exame de densitometria óssea não mostrou diferença significativa. Na espessura média das trabéculas não houve diferença significativa, porém o número de trabéculas foi menor e a separação entre elas foi maior no grupo com fraturas.
A histomorphometry evaluation of the trabecular part of the femoral neck was performed in 13 women over 60 years old submitted to hip arthroplasty. Seven of these patients had a femoral neck fracture. The bone mineral density showed no difference between both groups. The average thickness did not have significant between both groups, but the trabecular separation was higher and the number of trabecular bone was lower in the fracture group.
Subject(s)
Humans , Female , Aged , Aged, 80 and over , Bone Remodeling , Densitometry , Femoral Neck Fractures , Hip Fractures , Osteoporosis , Bone and Bones/anatomy & histologyABSTRACT
Através de dissecçao macro e microscópica das colunas de cinco cadaveres, previamente fixados por infusao intra-arterial de soluçao de aldeido fórmico, com exposiçao do psoas maior, esquerdo e direito, e da plastinaçao de secçoes, com 2 mm de espessura, paralelas e transversais ao eixo do segmento das colunas vertebrais, de T4 ao nível S3-S4, de outros sete cadaveres conservados sob congelamento a-20 graus Celsius, estudou-se a origem do psoas maior, a disposiçao de seus feixes musculares e sua possível relaçao com o forame intervertebral. Confirmou-se a origem das duas cabeças do músculo, a anterior ou principal, na face ântero-lateral dos corpos vertebrais e discos intervertebrais, e a posterior ou acessória, nos processos costais de L3 e L4. Observou-se comunicaçao entre as fibras musculares das duas cabeças e o envolvimentos dos forames intervertebrais. Os autores concluíram pela utilidade da técnica de plastinaçao para o estudo da anatomia seccional e possível correlaçao com os métodos de imagem.
