Longitudinal association of sleep quality with physical performance measures: SABE cohort study, Brazil.

OBJECTIVES: The aim of this study was to investigate the longitudinal association of sleep with physical performance in a representative sample of non-institutionalised older adults residing in the municipality of São Paulo, Brazil. STUDY DESIGN: Prospective cohort study. METHODS: The current longitudinal study used data extracted from the Health, Well-being, and Aging Study (Estudo Saúde Bem-Estar e Envelhecimento [SABE]). The study population consisted of individuals aged ≥60 years who participated in the study in 2010 or 2015. Dependent variables included the Short Physical Performance Battery (SPPB) and gait speed. Independent variables of interest were self-reported sleep difficulty, daytime sleepiness and sleep quality. The longitudinal association between sleep variables and the outcomes was evaluated using Generalised Estimating Equations (GEE) Models adjusted for covariates. All the variables, except age, sex and schooling, were assessed at baseline and follow-up visits (2010 and 2015). RESULTS: The analyses included 2205 observations from 1559 individuals. The population mean age was 72 years in 2010 and 71 years in 2015, with a higher prevalence of women in both years. Between 2010 and 2015, there was a decline in the SPPB score and gait speed. Daytime sleepiness was negatively associated with the SPPB score [Coef.: -0.38 (95% confidence interval {CI}: -0.56, -0.21)] and gait speed [Coef.: -0.03 (95% CI: -0.05, -0.01)]. Poor sleep quality was negatively associated with the SPPB score [Coef.: -0.29 (95% CI: -0.57, -0.01)] and gait speed [Coef.: -0.03 (95% CI: -0.06, -0.00)]. CONCLUSIONS: Daytime sleepiness and poor sleep quality are associated with compromised physical performance in non-institutionalised older adults, and this association remained consistent over time.

Effect of education and multimorbidity on mortality among older adults: findings from the health, well-being and ageing cohort study (SABE).

OBJECTIVES: This study assessed the moderating role of education on the relationship between multimorbidity and mortality among older adults in Brazil. STUDY DESIGN: This was a cohort study. METHODS: This study used data from 1768 participants of the Health, Well-Being and Ageing Cohort Study (SABE) who were assessed between 2006 and 2015. The Cox Proportional Risks Model was used to evaluate the association between multimorbidity (two or more chronic diseases) and mortality. An interaction term between education and multimorbidity was included to test the moderating role of education in this association. RESULTS: The average follow-up time was 4.5 years, with a total of 589 deaths in the period. Multimorbidity increased the risk of mortality (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.27-1.91), and this association was not moderated by education (HR 1.06, 95% CI 1.00-1.13; P value = 0.07). CONCLUSIONS: The impact of education and multimorbidity on mortality emphasises the need for an integrated approach directed towards the social determinants of health to prevent multimorbidity and its burden among older adults.

Labor de proyeccion humanitaria de la FILACP. Campaña 2019 / FILACP humanitarian projection work. Campaign 2019

Introducción y objetivo: La Federación Ibero Latinoamericana de Cirugía Plástica (FILACP), como organización internacional de especialistas en Cirugía Plástica, Estética y Reparadora unidos por una lengua común, incentiva la participación de sus cirujanos en campañas de labor humanitaria que, prestando ayuda médica con cirugías de alta complejidad a pacientes de entornos sociales o geográficos menos favorecidos, pueden mejorar su calidad de vida y su integración en la sociedad. Presentamos en este trabajo, a modo de ejemplo de una labor iniciada ya hace años, la desarrollada por los equipos que han participado en la III Jornada Altruista de Cirugía Plástica de la FILACP correspondiente al año 2019. Material y método: La campaña fue convocada desde FILACP a través de su página web, la página de Facebook y el canal de Youtube en redes sociales y mediante cartas enviadas a los delegados de sus Comités Médico Social y de Difusión y a los presidentes de las sociedades nacionales de Cirugía Plástica de los 22 países miembros. Las jornadas de trabajo se desarrollaron durante los meses de julio y agosto de 2019 con equipos quirúrgicos compuestos por cirujanos plásticos, anestesiólogos y personal de enfermería que trabajaron voluntariamente, de forma altruista, y tanto a título personal como apoyados por las instituciones sanitarias en las que habitualmente trabajan o por fundaciones con las que colaboran. Resultados: En total fueron intervenidos quirúrgicamente 1008 pacientes (78.75% de los vistos en consulta), con una media de edad de 6.9 años, 51% varones y 49% mujeres. Los 3 grupos principales de patologías atendidas fueron: fisuras labiopalatinas (31%), reconstrucción mamaria postmastectomía (24%) y quemaduras (17%). Conclusiones: A través de este trabajo La FILACP agradece a todos y cada uno de los cirujanos que participaron en esta III Jornada Altruista y reconoce a los que lo hicieron en campañas anteriores, da a conocer datos de la actividad quirúrgica realizada en esta ocasión y contribuye a difundir la vertiente reconstructiva de la especialidad y su importante contribución a la mejora de la calidad de vida de los pacientes más desfavorecidos

Background and objective: The Ibero Latinamerican Federation of Plastic Surgery (FILACP), as an international organization of Plastic, Aesthetic and Reconstructive Surgery specialists with a common language, encourages their collaboration in humanitarian campaigns where with their work in highly complex surgeries on patients in disadvantaged environments, try to improve their quality of life and their social integration. In this paper we present, as an example of the last years work, the activities developed by the teams enrolled in the III Plastic Surgery Altruist Campaign of FILACP in 2019. Methods: This campaign was convened from FILACP web, Fecebook and Youtube social networks and through letters sent to delegates in Social Medical and Communications Committees and to the presidents of national societies in the 22 member countries. The surgical working days were developed during July and August with teams composed by plastic surgeons, anesthesiologists and nursing staff who worked voluntarily, altruistically, and both in personal capacity or supported by the health institutions in which they usually work or by foundations with which they collaborate. Results: A total of 1008 patients were operated (78.75% of those visited in the consultation), with an average age of 6.9 years, 51% men and 49% women. The 3 main groups of attended pathologies were: lip and palate cleft (31%), post mastectomy breast reconstruction (24%) and burns (17%). Conclusions: With this paper FILACP wants to thank each and every surgeon who participated in this III Altruist Campaign and recognize those who did it in previous campaigns, presents data from surgical activity conducted this time and contributes to the knowledge of the reconstructive aspect of the specialty and its important contribution to the improvement of the quality of life of the most disadvantaged patients

Body Composition Changes and 10-Year Mortality Risk in Older Brazilian Adults: Analysis of Prospective Data from the SABE Study.

INTRODUCTION: Aging related alterations in body composition are associated with higher all-cause mortality risk. OBJECTIVE: To examine the associations between 10-year mortality risk with both BMI and body composition, as well as to establish whether these relationships are modified by age and gender, using data from community-dwelling older Brazilian adults. METHODS: We used data from two waves i.e., 2000 and 2010 of the SABE (Health, Well-being, and Aging) study conducted in São Paulo, Brazil, involving a probabilistic sample of community-dwelling older adults aged 60 years and older. The variables of the study were: mortality (in 10-year follow-up period), body mass index (BMI), body composition (waist circumference, waist hip ratio, triceps skinfold thickness, mid-upper arm circumference, calf circumference, and arm muscle area) and covariables (sociodemographic characteristics, life style, self-reported health conditions, number of chronic diseases, Mini mental state exam, and Geriatric depression scale). Poisson regression estimates with STATA statistical software were used for statistical analyses, considering all p-values < 0.05. RESULTS: Over the 10-year follow-up period, there were 769 deaths (40.2%). The mortality rate was 61.0 for men and 111.8 for the ≥80 age group. In the fully adjusted model, statistically significant hazard ratios were found for low muscle mass (IRR: 1.33), underweight (IRR: 1.29), and low fat mass (IRR: 1.31) with mortality. Men in extreme BMI categories (underweight - IRR: 1.47; obesity I - IRR: 1.66; and obesity II - IRR: 1.91) and women with low muscle and low fat mass were significantly associated with mortality risk. In the ≥80 age group it was observed that low muscle mass (IRR: 168.7), inadequate body reserves (IRR: 1.63), low fat mass (IRR: 140.7), and underweight (IRR: 142.9) were associated with mortality risk. Waist circumference demonstrated protection for mortality in the high-risk categorization for the ≥80 age group. CONCLUSION: Our results showed that underweight, low fat mass, and low muscle mass were associated with mortality risk, presenting different roles considering gender and age in older Brazilian adults over a 10-year follow-up period.

Dynapenic Abdominal Obesity Increases Mortality Risk among English and Brazilian Older Adults: A 10-Year Follow-Up of the ELSA and SABE Studies.

BACKGROUND/OBJECTIVE: There is little epidemiological evidence demonstrating that dynapenic abdominal obesity has higher mortality risk than dynapenia and abdominal obesity alone. Our main aim was to investigate whether dynapenia combined with abdominal obesity increases mortality risk among English and Brazilian older adults over ten-year follow-up. DESIGN: Cohort study. SETTING: United Kingdom and Brazil. PARTICIPANTS: Data came from 4,683 individuals from the English Longitudinal Study of Ageing (ELSA) and 1,490 from the Brazilian Health, Well-being and Aging study (SABE), hence the final sample of this study was 6,173 older adults. MEASUREMENTS: The study population was categorized into the following groups: non-dynapenic/non-abdominal obese, abdominal obese, dynapenic, and dynapenic abdominal obese according to their handgrip strength (< 26 kg for men and < 16 kg for women) and waist circumference (> 102 cm for men and > 88 cm for women). The outcome was all-cause mortality over a ten-year follow-up. Adjusted hazard ratios by sociodemographic, behavioural and clinical characteristics were estimated using Cox proportional hazards models. RESULTS: The fully adjusted model showed that dynapenic abdominal obesity has a higher mortality risk among the groups. The hazard ratios (HR) were 1.37 for dynapenic abdominal obesity (95% CI = 1.12 - 1.68), 1.15 for abdominal obesity (95% CI = 0.98 - 1.35), and 1.23 for dynapenia (95% CI = 1.04 - 1.45). CONCLUSIONS: Dynapenia is an important risk factor for mortality but dynapenic abdominal obesity has the highest mortality risk among English and Brazilian older adults.

Complicación tardía tras infiltración de biopolímeros en glúteos / Late complication after biopolymers injection in buttocks

Los biopolímeros son macromoléculas sintéticas que en ocasiones se utilizan de forma ilegal en el campo de la Medicina Estética como material de relleno tisular provocando múltiples complicaciones tanto locales como sistémicas que se pueden manifestar de forma inmediata o años después, e incluso pueden llegar a poner en peligro la vida de los pacientes. Presentamos el caso de una paciente que, 3 años después de la infiltración de biopolímeros en glúteos, presentó abscesos y siliconomas que precisaron extracción y lavados quirúrgicos seriados hasta que pudo hacerse el cierre final de las heridas sin complicaciones. La evolución posterior fue satisfactoria y en momento actual, la paciente se encuentra en seguimiento periódico para posterior remodelación glútea (AU)

Biopolymers are synthetic macromolecules when used illegally in the field of Cosmetic Medicine as tissular fillers, they produce multiple local and systemic complications that may appear immediately or years later, and sometimes even endangering the lives of patients. We report the case of a patient who 3 years after buttocks infiltration with biopolymers, suffered gluteal abscess and siliconomas, meriting surgical extraction and serial washed till getting final wound closure. The evolution was satisfactory and currently, she is in monitoring for posterior gluteal remodeling (AU)

La cirugía plástica y su labor humanitaria en México / Plastic surgery and its humanitarian labor in Mexico

La mayoría del gasto público en salud en México se enfoca hacia las patologías causantes de la mayor mortalidad: enfermedades circulatorias, metabólicas y neoplasias. Así pues, las malformaciones congénitas, secuelas de quemaduras o secuelas de cáncer, no se encuentran al alcance de la población que vive en pobreza. Es por ello que desde hace más de 50 años se iniciaron en nuestro país las Cirugías Extramuros y en el 2012 se creó la Fundación para Asistencia e Investigación en Cirugía Plástica Reconstructiva (FUNCIPLAS), con el objetivo de ayudar a los más necesitados mediante la aplicación de nuestra especialidad. En coordinación con diferentes organizaciones se planeó realizar Campañas de Cirugía Extramuros en diferentes estados de la República Mexicana con la participación de cirujanos plásticos y reconstructivos, residentes en formación, anestesiólogos y personal de enfermería. De 2013 a 2015 se realizaron 10 campañas altruistas en diversas ciudades mexicanas. Se valoraron 784 pacientes, de los que fueron candidatos a cirugía 439 en los que se realizaron 774 procedimientos. El 52,5% de las cirugías correspondió a patología congénita; el 16,4%a secuelas de quemaduras; el 15,76% a secuelas de cáncer y el 15,5%a secuelas de trauma en cara o extremidades. La atención de padecimientos relacionados con la Cirugía Plástica Reconstructiva es insuficiente en una población de casi 120 millones de habitantes. Si a ello agregamos el atraso educativo y la pobreza, nos encontramos ante personas que son condenadas a vivir con una alteración estético-funcional y un estigma social. La FUNCIPLAS, como asociación sin fines de lucro, surge como alternativa para ayudar a los sectores más vulnerables de la población mexicana. Desde hace varias décadas se ha fomentado un mayor altruismo en el área quirúrgica. Hoy la contribución humanitaria de la Cirugía Plástica en México es una realidad (AU)

Most of the public health investment in Mexico is destined to the prevention and treatment of the principal mortality causes: circulatory diseases, metabolic disorders and neoplasms. Therefore, people with low socio-economic resources don´t have the accessibility to medical attention in case of present a congenital abnormality, post burn or cancer sequelae .In consequence, since more than 50 years ago, extramural surgery campaigns started working. Then in 2012 a Foundation to the Assistance and Investigation in Plastic and Reconstructive Surgery was created(Fundación para la Asistencia e Investigación en Cirugía Plástica y Reconstructiva A. C FUNCIPLAS). Its general purpose was to help the most affected sector of mexican population. In coordination with other social groups, the aims of FUNCIPLAS was to perform Extramural Surgery Campaigns in different states of the country with the participation of plastic reconstructive surgeons and residents of this specialty, anaesthesiologist and nursing personal. Since 2013 to 2015, 10 campaigns were performed in diverse cities of Mexico. A total of 784 patients were clinically evaluated and439 were operated. In global numbers, 774 procedures were performed,52,5% were congenital abnormalities; 16,4% post burn sequelae;15,76% cancer sequelae; and 15,5% trauma sequelae in face or limbs. The clinical care for people with diseases related to Plastic and Reconstructive Surgery is not enough in a country with almost 120million inhabitants. Furthermore, the educational deficit and poverty aggravate the situation and we have as a result people with aesthetic functional alteration and with social stigma. FUNCIPLAS emerges as a non-profit association and as a support alternative to the most vulnerable people in Mexico. For several decades, it has fostered a greater altruism in the surgical area. Today the humanitarian contribution of Plastic Surgery in Mexico is a reality (AU)

The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults.

OBJECTIVE: to explore the relationship between anemia, hemoglobin concentration and frailty syndrome in older adults. RESEARCH METHODS AND PROCEDURES: This was a cross-sectional population-based study, with adults ≥60 years (n=1,256) from the third wave of the SABE Cohort Study (Health, Well-being and Aging) conducted in 2010 in São Paulo, Brazil. Frailty syndrome was evaluated according to Fried´s phenotype. Anemia was defined using the WHO criteria (hemoglobin concentration <12 g/dL for women and <13 g/dL for men). Four approaches were used to verify the associations between anemia, hemoglobin concentration and frailty status or number of frailty criteria. We used logistic regression and Poisson regression in the analyses, and they were adjusted in three hierarchical models using three blocks of variables: basic characteristics; clinical characteristics; cognitive status. RESULTS: Mean hemoglobin concentration was significantly lower in frail elderly (13.3g/dL, versus 14.3g/dL in non-frail; p<0.001). Prevalence of anemia was also significantly higher in frail when compared to non-frail elderly (24.2% and 3.8%; p<0.001). Anemia was significantly associated to low physical activity, weakness and slowness. In the fully adjusted regression models, anemia was strongly associated to frailty (OR=3.27, 95%IC=1.89,5.65; p<0.001), and lower levels of hemoglobin were associated to higher number of frailty criteria. CONCLUSIONS: We found important associations between anemia, hemoglobin concentration and frailty; anemic older adults were more likely to be frail, and lower levels of hemoglobin were associated to higher number of frailty criteria showing a clear dose-response effect.

Pulgarización en Síndrome de Nager. Caso clínico / Pollicization in Nager Syndrome. A case report

El tratamiento de las hipoplasias del pulgar, independientemente del síndrome clínico en el que estén incluidas, se basa en su severidad. La pulgarización, migración quirúrgica del índice hacia la posición del pulgar para sustituir su función, se reserva para los casos más severos. Presentamos el caso de un varón de 4 años de edad con Síndrome de Nager. Entre las características clínicas más significativas del caso destacamos: paladar hendido, microtia bilateral, fisura palpebral antimongoloide, hipoplasia malar, hipoplasia mandibular, coloboma del párpado inferior, así como hipoplasia severa bilateral de pulgares y ausencia parcial de tibia. Realizamos procedimiento de pulgarización en mano derecha sin complicaciones, con evolución satisfactoria. Tras 18 meses de seguimiento, el paciente presenta prensión esférica y cilíndrica adecuada, prensión lateral, así como oposición al quinto dedo (AU)

Treatment paradigm for a child with thumb deficiency or hypoplasia is based on severity, apart from other clinical features. Pollicization or surgical substitution of the thumb, most commonly using the index finger, is reserved for the most severe cases. We present the case of a 4-year-old male with Nager Syndrome. Among the most notable clinical characteristics we found: cleft palate, bilateral microtia, downslanting palpebral fissure, malar hypoplasia, mandibular hypoplasia, lower eyelid coloboma, partial tibial agenesis as well as bilateral hypoplastic/absent thumbs. Pollicization was performed for the right hand without complications. After 18 months follow-up, adequate cilyndrical and spherical grasp was achieved, as well as lateral prehension and opposition to fifth finger (AU)

Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly.

BACKGROUND: Sarcopenia and dynapenia have been associated with poorer physical performance, disability and death. The aim of this study was to compare the association between sarcopenia and dynapenia with mortality. METHODS: We studied 1,149 Brazilians aged 60 years or older residing in São Paulo. Sarcopenia was defined according to the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP), which includes three components: low muscle mass (LMM) assessed by skeletal muscle mass index ≤ 8.90kg/m2 (men) and ≤ 6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and < 20kg (women); and low physical performance (LPP) assessed by walking speed ≤ 0.8m/s. Diagnosis of sarcopenia required presence of LMM plus LMS or LPP. Dynapenia was defined as handgrip strength < 30kg (men) and < 20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, and disability in activities of daily living or instrumental activities of daily living. The outcome was all-cause mortality over five-year follow-up. RESULTS: During the five-year follow-up, 187 subjects died. The mortality rate for those with or without sarcopenia were 65.9/1,000 person/years and 20.1/1,000 person/years and for dynapenia were 44.3/1,000 person/years and 14.9/1,000 person/years. The adjusted model showed that sarcopenia (HR=1.52, 95%CI: 1.06 - 2.19) and dynapenia (HR=2.04, 95%CI: 1.24 - 3.37) are independent risk factors for death. CONCLUSIONS: The EWGSOP definition of sarcopenia and dynapenia can help to determine risk for mortality and can be used as a screening instrument in public health.

Sarcopenia according to the european working group on sarcopenia in older people (EWGSOP) versus Dynapenia as a risk factor for disability in the elderly.

BACKGROUND: Sarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly. OBJECTIVE: Contrast the association of sarcopenia versus dynapenia with incidence of disability. DESIGN: A four-year prospective study (2006-2010). SETTING: São Paulo, Brazil. PARTICIPANTS: 478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline. MEASUREMENTS: Sarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index. OUTCOMES: Disability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL. RESULTS: The incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03-4.85). Dynapenia was not associated with disability. CONCLUSIONS: Sarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).

Prevalence and associated factors of sarcopenia among elderly in Brazil: findings from the SABE study.

OBJECTIVES: The aim of the present study was to examine the prevalence and factors associated with sarcopenia in older residents in São Paulo, Brazil. DESIGN: Cross-sectional study. SETTING: São Paulo, Brazil. PARTICIPANTS: 1,149 older individuals from the second wave of the Saúde, Bem-Estar e Envelhecimento (SABE) study from 2006. MEASUREMENTS: The definition of sarcopenia was based on the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP), which include three components: low muscle mass, assessed by a skeletal muscle mass index of ≤8.90 kg/m2 for men and ≤6.37 kg/m2 for women; low muscle strength, assessed by handgrip strength <30 kg for men and <20 kg for women; and low physical performance, assessed by gait speed <0.8 m/s. Diagnosis of sarcopenia required presence of low muscle mass plus low muscle strength or low physical performance. Socio-demographic and behavioral characteristics, medical conditions and nutritional status were considered as independent variables to determine the associated factors using a logistic regression model. RESULTS: The prevalence of sarcopenia was 16.1% in women and 14.4% in men. Advanced age with a dose response effect, cognitive impairment, lower income, smoking, undernutrition and risk for undernutrition (p<0.05) were factors associated with sarcopenia. CONCLUSIONS: The EWGSOP algorithm is useful to define sarcopenia. The prevalence of sarcopenia in the Brazilian elderly population is high and several associated factors show that this syndrome is affected by multiple domains. No differences were observed by gender in any age groups.

The association of hemoglobin concentration with disability and decreased mobility among older Brazilians.

OBJECTIVE: To examine the association between hemoglobin concentration and disability and mobility difficulty among older adults living in São Paulo, Brazil. DESIGN: Cross-sectional study. SETTING: Population-based study conducted in São Paulo, Brazil. PARTICIPANTS: Adults age 60 and over (n=1,256) from the third data collection wave of the SABE Study (Health, Well-being, and Aging) conducted in 2010. MEASUREMENTS: Two outcome measures were included in the analyses: 1) a difficulty to perform at least one of the instrumental activities of daily living (IADL) and 2) mobility difficulty, which was assessed using the Short Physical Performance Battery (SPPB). Logistic regression models assessed the association between hemoglobin and each of the outcome measures. All analyses were adjusted for sociodemographic and health characteristics. RESULTS: The prevalence of IADL disability was 26.8% and 10.7% of participants had mobility difficulty. The mean hemoglobin concentration was significantly lower in older adults who already presented disability (13.7g/dL versus 14.4g/dL among independent elderly) or decreased mobility (13.4g/dL versus 14.3g/dL among elderly with preserved mobility). Higher values of hemoglobin concentration were associated with lower the risk of IADL disability (OR=0.88; p=0.04) and mobility difficulty (OR=0.81; p=0.02). Hemoglobin concentrations showed a dose-response effect in the probability of each outcome. CONCLUSIONS: Lower hemoglobin concentration was associated with a higher probability of IADL disability and mobility difficulty, showing a clear dose-response effect.

Appendicular Lean Soft Tissue: Development and Cross-Validation of Predictive Models for Older Men and Women.

BACKGROUND: Sarcopenia may explain, in a large proportion, physical disability, falls and fractures, especially in aged elderly. However, a diagnosis in an operationally systematic, simple and low cost way is extremely important, particularly for home-based, epidemiological studies. OBJECTIVE: The purpose of this study was to develop and validate predictive equations of appendicular lean soft tissue (ALST) in elderly older than 80 years. DESIGN AND SETTINGS: A validation study was performed in 106 elderly (men and women) aged 80 years and older. MEASUREMENTS: Body weight, height, circumference (arm, midcalf, hip and waist) and triceps skinfold were measured in the elderly. ALST were measured using as the reference method dual-energy X-ray absorptiometry (DXA). RESULTS: Two models were predicted. The first model (ALST, in kg = 0.074*height + 0.277*weight - 0.144*triceps skinfold - 0.103*waist circumference + 1.831*gender -0.966), which considered all possible variables in stepwise multiple regression, presented better statistical performance (r2 = 0.82; SEE = 1.67 kg), compared to the second model (ALST, in kg = 0.138*height + 0.103*weight + 3.061*gender - 12.489), a more practical equation, due to a lesser quantity of predictive variables (r2 = 0.75; SEE = 1.94 kg). Both models were validated, however, it was verified trend (p<0.05) for overestimation of predicted ALST. CONCLUSION: In summary, two models for predicting ALST in men and women with age ≥ 80 years were developed and cross-validated. Model 1, with a greater number of predictive variables, presented a better accuracy than did the model with only three variables (height, weight, and gender). Validation studies are needed to test the usefulness of both models in other populations.

Insuficiencia renal secundaria a litiasis urinaria en niños / Renal failure related to urolithiasis in children

Introducción. Debido a que la litiasis urinaria (LU) es endémica en Yucatán, es deseable conocer la prevalencia, cuadro clínico y alteraciones metabólicas de la insuficiencia renal (IR) secundaria a LU en niños. Material y métodos. Se registraron en forma prospectiva, pacientes con edad menor o igual a 15 años y diagnóstico de IR, ingresados de marzo de 2001 a febrero de 2006. Se seleccionaron los casos asociados a LU. Se registró la edad, sexo, condiciones de ingreso, localización de los litos, tratamiento médico y quirúrgico, complicaciones y evolución; aquéllos en los que revirtió la IR se les efectuaron pruebas metabólicas, al recuperarse la función renal. Resultados. Se captaron 104 pacientes con IR, en 13 se observó la asociación de IR con LU (8 mujeres y 5 hombres). La edad osciló entre 8 meses y 12 años; 10 pacientes fueron menores a 3 años. El signo predominante (9/13) fue anuria. Todos tuvieron litos múltiples. Diez pacientes sufrían algún grado de desnutrición. Un caso tuvo hipouricemia e hipouricosuria, 1 con hiperuricosuria (HUU) e hipercalciuria, 8 con HUU, en 3 no se pudo determinar la causa metabólica de la LU. Dos casos requirieron diálisis; 2, instalación de sondas de nefrostomía. Todos requirieron litotomía. Diez evolucionaron en forma satisfactoria, 2 con IR crónica y 1 falleció por urosepsis a pocas horas de su ingreso a urgencias. Conclusiones. La LU puede causar IR en niños y eventualmente llevar a la muerte. La HUU es la alteración metabólica predominante.

Introduction. Because urolithiasis (UL) in an endemic disease in the Yucatan peninsula, we carried out a prospective to study over a 5 year period to determine the prevalence, clinical course and metabolic disturbances of renal failure (RF) secondary to UL in children admitted to our institution. Material and methods. Patients 15 years old and younger, diagnosed with RF, and hospitalized from March 2001 to February 2006, were prospectively examined. Cases associated to UL were selected. Age, sex, hospitalization conditions, litho locus, medical and surgical treatment, complications, and evolution, were registered. Metabolic tests were performed in those in whom RF reverted, posterior to the recovery of renal function. Results. One hundred four patients with RF were detected; 13 cases (8 females and 5 males) had RF and UL. Age was between 8 months and 12 years old and 10 patients were registered to be less than 3 years old. Anuria was the principal clinical data. Every case had multiple stones. Some undernourishment degree was diagnosed in 10 patients. Hypouricemia and hypouricosuria were present in one case whereas hyperuricosuria and hypercalciuria were present in another; hyperuricosuria was found in 8 cases and the metabolic cause for UL in 3 cases could not be identified. Dialysis was required in 2 cases and nephrostomy probes were used in 2 more cases. All cases needed lithotomy. A satisfactory evolution was achieved in 10 patients and chronic RF developed in 2; one patient died due to urosepsis after few hours of been hospitalized in the emergency room. Conclusions. RF in children can be caused by UL and in some cases irreversible damage and even death can occur. Hyperuricosuria was the predominant metabolic alteration.

Pitiriasis versicolor en niños. Estudio epidemiológico y micológico de 797 casos estudiados en la república dominicana / Pityriasis versicolor in children. Epidemiological and mycological data of 797 cases in the dominican republic

Antecedentes: La pitiriasis versicolor es una micosis cosmopolita causada por Malassezia spp. y sensu lato por M. furfur. Se afectan desde lactantes hasta ancianos, pero hay pocos reportes de su frecuencia en niños. Objetivos: Estudiar los datos clínicos y epidemiológicos de la pitiriasis versicolor en la población pediátrica. Metodología: Estudio retrospectivo y transversal de los pacientes infantiles con pitiriasis versicolor confirmada por estudio micológico de enero a diciembre de 1999. Resultados: Entre 5.160 casos de pitiriasis versicolor se encontraron 797 en menores de 15 años (13,5 per cent) (promedio 8 años) y, de éstos, 92 en lactantes. La localización más frecuente fue la cara, en el 50,2 per cent, el tronco en el 25,68 per cent y las extremidades en el 19,4 per cent, pero también en el cuello en el 4,8 per cent. Conclusiones: La pitiriasis versicolor en niños es frecuente en climas cálidos y húmedos, y predomina en la cara y el tronco. El diagnóstico con hidróxido de potasio es sencillo y barato, y pone en evidencia a Malassezia spp. (AU)

[Pityriasis versicolor in infants under one year of age. A report of 92 cases]. / Pitiriasis versicolor en lactantes. Estudio de 92 casos.

BACKGROUND: Pityriasis versicolor is a common world wide mycosis caused by Malassezia spp. and by Malassezia furfur sensu lato. It is uncommon in children and almost always with atypical clinical manifestations. It has been reported as exceptional in children under one year of age. OBJECTIVES: To determine the clinical and epidemiological data of pityriasis versicolor in infants under one year of age. METHODOLOGY: This is a restrospective and transversal study of pityriasis versicolor in the pediatric population studied during one year at the Instituto Dermatologico y Cirugia de Piel in Dominican Republic. Everyone with a Malassezia spp. positive scotch tape test with methylene blue were included. RESULTS: Among 5160 cases of pityriasis versicolor where 797 were children, we found 92 (11%) cases under one year of age. The clinical manifestations were atypical and the most commonly affected zone was the face (81%) and thorax (16%). Less frequently the neck (8.6%) and upper and lower limbs (5%) were affected. CONCLUSIONS: Pityriasis versicolor in children under one year of age is not exceptional in humid and hot climates. The hypochromic lesions are the main clinical manifestation and the most affected site is the face. Diagnosis is easy and cheap with a positive Malassezia spp. scotch tape test with methylene blue.

[Aging and the elderly in the undergraduate nursing courses in Brazil: from the current situation to a proposal for the content of the program]. / O envelhecimento e o idoso no ensino de graduação em enfermagem no Brasil: do panorama atual à uma proposta de conteúdo programático.

The teaching nursing undergraduate was verified in 77 courses in Brazil about elderly's attention, hourly load and time of insert of this content in the curriculum. The authors suggest fundamental themes to the nurses' formation to act with elderly in the different contexts in their health's attention.