Practical screening tools for sarcopenia in patients with systemic sclerosis.

INTRODUCTION: In view of the method of diagnosing sarcopenia being complex and considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends the use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice. Only recently, some studies have turned their attention to the presence of sarcopenia in systemic sclerosis (SSc).There is no data about performance of SARC-F and other screening tests for sarcopenia in this population. OBJECTIVE: To compare the accuracy of SARC-F, SARC-CalF, SARC-F+EBM, and Ishii test as screening tools for sarcopenia in patients with SSc. METHODS: Cross-sectional study of 94 patients with SSc assessed by clinical and physical evaluation. Sarcopenia was defined according to the revised 2019 EWGSOP diagnostic criteria (EWGSOP2) with assessments of dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB). As case finding tools, SARC-F, SARC-CalF, SARC-F+EBM and Ishii test were applied, including data on calf circumference, body mass index, limitations in strength, walking ability, rising from a chair, stair climbing, and self reported number of falls in the last year. The screening tests were evaluated through receiver operating characteristic (ROC) curves. Standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia. RESULTS: Sarcopenia was identified in 15 (15.9%) patients with SSc by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.420-0.756, p = 0.283). The results of sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic Odds Ratio (DOR) with the EWGSOP2 criteria as the gold standard were 40.0% (95% CI, 19.8-64.2), 81.0% (95% CI, 71.0-88.1), 2.11 (95% CI, 0.98-4.55), 0.74 (95% CI, 0.48-1.13) and 2.84 (95% CI, 0.88-9.22), respectively. SARC-CalF and SARC-F+EBM showed better sensitivity (53.3%, 95% CI 30.1-75.2 and 60.0%, 95% CI 35.7-80.2, respectively) and specificity (84.8%, 95% CI 75.3-91.1 and 86.1%, 95% CI 76.8-92.0, respectively) compared with SARC-F. The best sensitivity was obtained with the Ishii test (86.7%, 95% CI 62.1-96.3), at the expense of a small loss of specificity (73.4%, 95% CI 62.7-81.9). Comparing the ROC curves, SARC-F performed worse than SARC-CalF, SARC-F+EBM and Ishii test as a sarcopenia screening tool in this population (AUCs 0.588 vs. 0.718, 0.832, and 0.862, respectively). Direct comparisons between tests revealed differences only between SARC-F and Ishii test for sensitivity (p = 0.013) and AUC (p = 0.031). CONCLUSION: SARC-CalF, SARC-F+EBM, and Ishii test performed better than SARC-F alone as screening tools for sarcopenia in patients with SSc. Considering diagnostic accuracy and feasibility aspects, SARC-F+EBM seems to be the most suitable screening tool to be adopted in routine care of patients with SSc.

Suicide risk in the elderly: data from Brazilian public health care program.

OBJECTIVE: Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. METHODS: A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). RESULTS: Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. LIMITATIONS: The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. CONCLUSIONS: A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment.

Abordagem e manejo do acidente botrópico / Approach and management of botropic accident

Acidentes ofídicos são comuns no Brasil, sendo as serpentes do gênero Bothrops as responsáveis pela maioria dos acidentes. Se não tratados de forma adequada, estes acidentes podem determinar alta morbimortalidade. O presente artigo tem como objetivo auxiliar a identificação, abordagem diagnóstica e manejo terapêutico dos acidentes botrópicos.

Snakebites are common in Brazil and Bothrops snakes are responsible for most accidents. If not properly treated, these accidents can result in serious morbidity and mortality to the patient. This article aims to assist the identification, diagnosis and therapeutic management of Bothrops snakebites.

Neutropenia febril: manejo para o clínico na emergência / Febrile neutropenia: emergency management for the clinician

As infecções constituem uma causa comum e agravante de morbi-mortalidade em pacientes que apresentam uma ampla variedade de neoplasias malignas. Isto ocorre devido à imunodeficiência gerada tanto por aspectos intrínsecos ao crescimento tumoral como pelo tratamento quimioterápico, que facilita assim a ocorrência de quadros infecciosos graves e muitas vezes de difícil manejo. Orientar a suspeita diagnóstica e o manejo inicial do paciente neutropênico febril são os objetivos desse artigo de revisão.

Infections are a common cause and aggravating factor of morbidity and mortality in patients with a wide variety of malignancies. This occurs because of the immunodeficiency generated either by intrinsic tumor growth by as chemotherapy aspects, so facilitates the occurrence of serious infectious conditions and often difficult to manage. Guide the suspected diagnosis and initial management of febrile neutropenic patients are the aims of this review article.

Efeito de fatores neurotróficos sobre o reparo de nervo periférico: [revisão] / Effect of neurotrophic factors on peripheral nerve repair: [review]

Objetivos: esta revisão teve como objetivo analisar e discutir estudos sobre os principais fatores de crescimento testados in vitro e in vivo na regeneração de nervos periféricos.Fonte de dados: os artigos foram selecionados nas bases de dados LILACS, Medline e SciELO, utilizando os seguintes descritores: regeneração nervosa, fatores de crescimento, fator de crescimento neural, fator neurotrófico derivado do cérebro, neurotrofina 3, neurotrofina 4/5, fator neurotrófico ciliar, fator neurotrófico derivado de linhagem de célula glial, fator de crescimento do endotélio vascular, fator de crescimento similar à insulina, sistema nervoso periférico, lesões, neurônios sensoriais, neurônios motores, enxerto autólogo e ratos.Síntese dos dados: diversos fatores tróficos, também conhecidos como fatores de crescimento, são utilizados e testados in vitro e in vivo na regeneração de nervos periféricos. Essas proteínas atuam diretamente na proliferação e diferenciação de diferentes tipos celulares, sendo capazes de promover reparo tecidual e recuperação funcional. Geralmente o modelo ideal para a aplicação dessas substâncias é um sistema de entrega contínua através de condutos biodegradáveis.Conclusões: é possível concluir que a combinação de dois ou mais fatores de crescimento provavelmente exerça um efeito sinérgico na regeneração do nervo, principalmente quando associada a biomateriais absorvíveis com liberação controlada. Apesar do conhecimento obtido sobre essas proteínas apontar para um melhora da regeneração nervosa, ainda são necessários mais estudos experimentais antes de transpô-los para a aplicação clínica.

Aims: This review aimed to analyze and discuss studies about the main growth factors tested in vitro and in vivo on peripheral nerves regeneration.Source of data: Articles were selected from the databases LILACS, Medline, and SciELO, using the following key words: nerve regeneration, nerve growth factor, brain-derived neurotrophic factor, neurotrophin 3, neurotrophin 4/5, ciliary neurotrophic factor, glial cell line-derived neurotrophic factor, vascular endothelial growth factor, insulin-like growth factor, peripheral nervous system, injury, sensory neurons, motor neurons, autologous graft, and rats.Summary of findings: Several trophic factors, also known as growth factors, are used and tested in vitro and in vivo regeneration of peripheral nerves. These proteins act directly on the proliferation and differentiation of different cell types, being able to promote tissue repair and functional recovery. Usually the ideal model for the application of these substances is a continuous delivery system via biodegradable conduits.Conclusions: It is possible to conclude that the combination of two or more growth factors probably exercise a synergistic effect on nerve regeneration, especially when associated with absorble biomaterials with controlled release. Although the knowledge obtained about these proteins indicate an improvement in nerve regeneration, further experimental studies are needed before transpose them into clinical application.