RESUMO
Chronic wounds are characterized by prolonged non-healing, significantly affecting patients' quality of life. Oral formulas may enhance the wound healing process and contribute to cost reduction in care. This review aimed to evaluate the effects of oral nutritional supplementation on chronic wound healing and provide insights into formula characteristics. A comprehensive search across Cinahl, Embase, PubMed, and Web of Science databases yielded nine studies from the past decade involving 741 patients ages 52 to 81.7 across various care settings: hospitals, long-term care facilities, and home care. Primary wound types included pressure injuries (58%), diabetic foot ulcers (40%), and venous ulcers (2%). The intervention duration ranged from 2 to 16 wk, with sample sizes varying from 24 to 270 patients. Notably, four studies reported a reduction in wound area and an increased healing rate with a hypercaloric, hyperproteic formula enriched with zinc and vitamins A, C, and E. However, two studies found no significant differences compared with control groups. Two other studies investigated a combination of arginine, glutamine, and ß-hydroxy-ß-methylbutyrate; however, they did not yield significant results, and one study favored a hyperproteic formula instead of a hyperproteic formula with arginine. This review provides evidence supporting the potential of oral nutritional supplementation to enhance the healing process of chronic wounds. Based on our findings, a desirable formula should be characterized by a high calorie and protein content and the inclusion of antioxidant micronutrients, including, but not limited to, vitamins A, E, C, and zinc.
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Suplementos Nutricionais , Úlcera por Pressão , Cicatrização , Humanos , Cicatrização/efeitos dos fármacos , Doença Crônica , Pé Diabético/terapia , Zinco/administração & dosagem , Úlcera Varicosa/dietoterapia , Úlcera Varicosa/terapia , Idoso , Arginina/administração & dosagem , Arginina/farmacologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Valeratos/administração & dosagem , Valeratos/farmacologia , Vitamina A/administração & dosagem , Glutamina/administração & dosagem , Vitamina E/administração & dosagem , Vitamina E/farmacologia , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/farmacologia , Feminino , Vitaminas/administração & dosagem , Masculino , Administração OralRESUMO
OBJECTIVES: Evaluate associations between triceps braqui muscle ultrasound measures (TB US) and handgrip strength (HGS), and the sensibility of TB US for low HGS in non-dialysis-dependent chronic kidney disease (nd-CKD) patients. PARTICIPANTS AND METHODS: This pilot, cross-sectional, and exploratory study evaluated TB cross-sectional images from A-mode US and processed by FIJI-Image J to obtain muscle thickness (MT), echogenicity (EI), cross-sectional area (CSA), pennation angle (PA), and fascicle length (Lf) associating them with absolute HGS by simple and, multiple linear regression. The HGS was normalized to body mass index (BMI) and separated into low HGS (HGS/BMI≤10p according to sex and age) and adequate HGS (HGS/BMI>10p) groups. The body composition was from multifrequency bioimpedance. ROC analysis verified the TB US diagnostic accuracy to low HGS. RESULTS: Were included 42 (21M/21F) adults with 65.5 (60-70) y median age, 47.22% in 3b CKD stage. The low HGS group (45.23%) showed a higher fat mass (FM), TB muscle medium head's PA, and EI than adequate HGS (p<0.05). In crude model, a pixels increase in EI was associated with a 0.452kgf HGS reduction (p=0.019); adjusted for sex, age, and FM, a one-unit increase in EI was associated with a 0.510kgf HGS reduction (p=0.011). The EI also showed moderate diagnostic accuracy (AUC=0.730; CI 95%=0.589; 0.919) to low HGS and a sensitivity of 86.9% (cutoff≥13.52 pixels). CONCLUSION: In nd-CKD patients, of all measurements from US, the EI was the most associated with HGS, and the only one sensitive to low HGS diagnosis.
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Força da Mão , Insuficiência Renal Crônica , Ultrassonografia , Humanos , Estudos Transversais , Força da Mão/fisiologia , Projetos Piloto , Masculino , Feminino , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/fisiopatologia , Idoso , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologiaRESUMO
BACKGROUND: The association between obesity and infectious diseases is increasingly reported in the literature. There are scarce studies on the association between obesity and urinary tract infection after kidney transplantation (KTx). These studies defined obesity based on body mass index, and their results were conflicting. The present study aimed to evaluate this association using bioelectrical impedance analysis for body composition evaluation, and obesity definition. METHODS: A single-center cohort study was conducted. Demographic, clinical, anthropometric, and laboratory data were collected at KTx admission, and bioelectrical impedance analysis was performed to measure the visceral fat area, waist circumference, and total fat mass. The occurrence of urinary tract infection (symptomatic bacteriuria and/or histological evidence of pyelonephritis) was evaluated within three months after KTx. RESULTS: Seventy-seven patients were included in the cohort, and 67 were included in the final analysis. Urinary tract infection was diagnosed in 23.9% of the transplanted patients. Waist circumference (HR: 1.053; 95% CI 1.005-1.104; p = 0.032), visceral fat area (HR: 1.015; 95% CI 1.003-1.027; p = 0.014), and total fat mass (HR: 1.075; 95% CI 1.008-1.146; p = 0.028) were associated with urinary tract infection occurrence after KTx, using Cox regression models. Patients with high waist circumference (above 102 cm for men and above 88 cm for women) had a 4.7 times higher risk of a urinary tract infection than those with normal waist circumference (HR: 4.726; 95% CI 1.267-17.630; p = 0.021). Kaplan-Meier curves showed that patients with high waist circumference, high visceral fat area, and high total fat mass had more urinary tract infections (Log-rank test p = 0.014, p = 0.020, and p = 0.018, respectively). Body mass index was not able to predict urinary tract infection in the study sample. CONCLUSIONS: Waist circumference, visceral fat area, and total fat mass, assessed by bioelectrical impedance analysis, were predictors of urinary tract infection risk within the first three months after KTx.
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Impedância Elétrica , Transplante de Rim , Infecções Urinárias , Circunferência da Cintura , Humanos , Transplante de Rim/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Fatores de Risco , Obesidade/complicações , Gordura Intra-Abdominal/fisiopatologia , Índice de Massa Corporal , AdiposidadeRESUMO
BACKGROUND: This study aimed to compare the diagnostic yield of the FRAIL scale with respect to the physical frailty phenotype measure and their association with mortality in non-dialysis-dependent patients. METHODS: In this prospective cohort study, non-dialysis dependent patients with chronic kidney disease (CKD) stages 3b-5 seen in the nephrology outpatient clinics of two university hospitals were included. The presence of frailty was evaluated by physical frailty phenotype measure and the FRAIL scale. Patients were evaluated for six months, and mortality was recorded. The Kappa test was used to evaluate the diagnostic properties between the methods, and logistic regression to test the association between frailty and mortality. RESULTS: One hundred fifty-three patients were evaluated; average age was 65 (56-70) years, 50.9% were women, and the all-cause mortality rate was 2.6%. Forty-six patients were classified as living with frailty according to the physical frailty phenotype while 36 patients were rated frail by the FRAIL scale. In adults < 60 years of age, the FRAIL scale showed good accuracy (84.9%) and specificity (93.2%) but had low sensitivity (41.3%) and moderate agreement (Kappa = 0.41; p < 0.001) compared to the definition of the physical frailty phenotype. The adjusted logistic regression model showed that the patients with frailty assessed by the FRAIL scale had a greater chance of mortality than the non-frail patients (OR: 6.8; CI95%:1.477-31.513; p = 0.014). CONCLUSION: Physical frailty phenotype identifies more patients as having pre-frailty and frailty in non-dialysis dependent patients as compared to the FRAIL scale. However, the FRAIL scale is a simple bedside tool that can be useful for screening for frailty and whose results were associated with mortality.
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Fragilidade , Insuficiência Renal Crônica , Humanos , Feminino , Masculino , Idoso , Fragilidade/diagnóstico , Fragilidade/mortalidade , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/complicações , Valor Preditivo dos Testes , Avaliação Geriátrica/métodos , Modelos Logísticos , Idoso Fragilizado , Fatores de Risco , Fenótipo , PrognósticoRESUMO
Abdominal obesity, regardless of overall obesity, is associated with metabolic abnormalities and with direct impact on cardiovascular risk. The aim of this study was to compare body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) to estimate cardiovascular disease (CVD) prevalence in individuals with chronic kidney disease (CKD). The data analyzed is from 2005-2016 cycles of the NHANES. A total of 2,825 participants with CKD were included in this study, and most of them had a high BMI, 66.1%, to be exact (BMI ≥ 25.0 kg/m² if age <65 or >27.0 if age ≥ 65). The prevalence rates of high WC (≥102 cm for men or ≥88 cm for women) and high WHtR (WHtR>0.5) in the study population were 70.0% and 91.0%, respectively. The results of this study suggest that BMI is a good indicator of the risk of CVDs in individuals with CKD. In addition, the results show that WC and WHtR are associated with CVDs in non-overweight individuals of both sexes. These results indicate that the assessment of abdominal fat is essential even in non-overweight patients because the risk of CVDs cannot be identified in this subpopulation using only BMI.
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Índice de Massa Corporal , Doenças Cardiovasculares , Inquéritos Nutricionais , Obesidade Abdominal , Insuficiência Renal Crônica , Circunferência da Cintura , Humanos , Masculino , Feminino , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/complicações , Pessoa de Meia-Idade , Prevalência , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/complicações , Adulto , Idoso , Obesidade/epidemiologia , Obesidade/complicações , Razão Cintura-Estatura , Adiposidade , Fatores de Risco , Estudos TransversaisRESUMO
BACKGROUND: To assess the prevalence of frailty by the Clinical Frailty Scale (CFS) and the 5-item FRAIL scale and their association with hospitalization in hemodialysis (HD) patients. METHODS: This was a prospective observational study. We included patients of both genders ≥ 18 years old in HD treatment for at least 3 months. Demographic, clinical, and routine laboratory data were retrieved from the medical charts. Two different frailty assessment tools were used, the CFS and the FRAIL scale. Participants were followed up for 9 months and hospitalizations for all causes were evaluated. A Venn diagram was constructed to show the overlap of possible frailty and pre-frailty. Cox regression was used to identify the association between frailty and hospitalization. The significance level was 5%. RESULTS: A total of 137 subjects were included in the analysis. The median age was 61 (52-67) years and 60% were male. The hospitalization rate and mortality in 9 months were 22.6% and 7.29%, respectively. Regarding frailty, the overall prevalence was 13.8% assessed by CFS and 36.5% according to the FRAIL scale. In the Cox regression, frailty by FRAIL scale was associated with a 2.8-fold increase in the risk of hospitalization (OR = 2.880; 95% CI = 1.361-6.096; p = 0.006), but frailty assessed by the CFS was not associated with the need for hospitalization. CONCLUSION: In HD patients, the FRAIL scale proved to be an easy-to-apply tool, identifying a high prevalence of frailty and being a predictor of hospital admission.
Assuntos
Fragilidade , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Adolescente , Fragilidade/epidemiologia , Idoso Fragilizado , Hospitalização , Estudos Prospectivos , Diálise RenalRESUMO
BACKGROUND: The muscle quality index (MQI) has proven to be an interesting clinical measurement in hemodialysis (HD) patients. In clinical practice, its interpretation can be biased by fat mass (FM) distribution. This study aims to explore the arm MQI association with body composition, clinical factors, and mortality. METHODS: It was analytical longitudinal and exploratory, that included patients from two-center, over 18 years old, of both genders in treatment by HD. The follow-up period was 32 months, and mortality was the clinical outcome. Demographical and clinical data were collected in the patient's medical records. Body composition was evaluated using octopolar multi-frequency bioelectrical impedance analysis (MF-BIA). Handgrip strength (HGS) was measured by a dynamometer and the time required to walk 3 m was applied to obtain gait speed. The baseline associations with MQI (HGS/arm muscle mass) were examined by multivariate linear regression. Cox regressions evaluated the associations with mortality. RESULTS: A total of 97 patients in HD were included. Mean age was 50.93 ± 14.10 years, 71.13 % were male. Age (ß = -0,096, p = 0.024), HD time (ß = -0.023, p = 0.032), total skeletal muscle mass (ß = -0.475, p < 0.001) were inversely associated with MQI and gait speed had a direct association with MQI (ß = 8514, p = 0.002). The prevalence of mortality was 29.76 %, of which 37.29 % were men (p = 0.020). Low MQI was not associated with mortality (Hz = 0.80, CI95 % = 0.34; 1.91, p = 0.629). CONCLUSION: The arm MQI was associated with an indicator of general functional capacity (gait speed), but was not associated with fat measures in baseline and mortality after 32 months of follow-up.
Assuntos
Força da Mão , Falência Renal Crônica , Humanos , Masculino , Feminino , Idoso , Força da Mão/fisiologia , Velocidade de Caminhada , Diálise Renal , Falência Renal Crônica/terapia , Músculo Esquelético/fisiologiaRESUMO
Objetivo: identificar a prevalência de presenteísmo em profissionais de saúde e analisar a influência de variáveis sociodemográficas e ocupacionais sobre esse fenômeno, bem como sua influência sobre o índice de capacidade para o trabalho. Método: estudo observacional, transversal com abordagem quantitativa, realizado com 299 profissionais de saúde de um hospital público de ensino. Utilizou-se os instrumentos: Índice de Capacidade para o Trabalho e a Escala de Presenteísmo de Stanford. Aplicaram-se testes de Regressão linear múltipla e de regressão logística. Resultados: a análise de regressão logística revelou que as mulheres tiveram chance 1,88 vezes maior (1,06-3,32 e p=0,03) de apresentar presenteísmo. A regressão linear múltipla mostrou influência dos seguintes preditores na capacidade para o trabalho: presenteísmo (ß=-0,35, p<0,001), sexo (ß=-0,28, p<0,001) e categoria profissional (ß=-0,12, p=0,03). Conclusão: o presenteísmo prevaleceu entre os profissionais de saúde e exerceu influência na sua capacidade para o trabalho.
Objective: to identify the prevalence of presenteeism among health personnel and to examine the influence of sociodemographic and occupational variables on this phenomenon, as well as its influence on the work ability index. Method: this quantitative, observational, cross-sectional study was conducted with 299 health personnel from a public teaching hospital. The Work Ability Index and the Stanford Presenteeism Scale were used. Multiple linear regression and logistic regression tests were applied. Results: logistic regression analysis revealed that women were 1.88 times more likely (1.06-3.32 and p=0.03) to display presenteeism. Multiple linear regression showed following predictors influenced work ability: presenteeism (ß ¬= 0.35, p<0.001), gender (ß= 0.28, p<0.001) and professional category (ß= 0.12, p=0.03). Conclusion: presenteeism was prevalent among health personnel and influenced their ability to work.
Objetivo: identificar la prevalencia del presentismo entre profesionales de la salud y analizar la influencia de variables sociodemográficas y ocupacionales sobre este fenómeno, así como su influencia en el índice de capacidad para el trabajo. Método: estudio observacional transversal con enfoque cuantitativo, realizado con 299 profesionales de la salud de un hospital público de enseñanza. Se utilizaron los siguientes instrumentos: Índice de Capacidad para el Trabajo y la Escala de Presentismo de Stanford. Se aplicaron pruebas de regresión lineal múltiple y regresión logística. Resultados: El análisis de regresión logística reveló que las mujeres tenían 1,88 veces más probabilidades (1,06-3,32 y p=0,03) de presentismo. La regresión lineal múltiple mostró la influencia de los siguientes predictores sobre la capacidad laboral: presentismo (ß=-0.35, p<0.001), género (ß=-0.28, p<0.001) y categoría profesional (ß=-0,12, p=0.03). Conclusión: el presentismo prevaleció entre los profesionales de la salud e influyó en su capacidad de trabajo.
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BACKGROUND: Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx. METHODS: In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods. RESULTS: Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001). CONCLUSIONS: There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.
Assuntos
Fragilidade , Transplante de Rim , Humanos , Idoso , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Idoso Fragilizado , Estudos Prospectivos , Transplante de Rim/efeitos adversos , Estudos de Coortes , Redução de Peso , Avaliação GeriátricaRESUMO
Abstract Introduction: Bioelectrical impedance vector analysis (BIVA) is a non-invasive and low-cost strategy. The methods used to assess malnutrition in patients undergoing HD are still a challenge. The aim of the present study was to compare BIVA to 7-Point Subjective Global Assessment (7-point SGA) to identify malnutrition. We also investigated the sensitivity and specificity of the previously proposed cutoffs point for BIVA parameters. Methods: Patients of both sexes, over 20 years of age, on HD treatment were included. Anthropometric parameters, laboratory data, and bioelectrical impedance analysis (BIA) were evaluated. Values of resistance (R) and reactance (Xc) obtained by mono-frequency BIA were normalized to body height (H) to generate a graph of the bioimpedance vector with the BIVA software. The analysis of the area under the receiver operating curve ROC (AUC) was performed. Results: Among the included 104 patients, the mean age was 51.70 (±15.10) years, and 52% were male. The BIVA had a sensitivity of 35% for diagnosing malnutrition. The specificity of BIVA for identifying the well-nourished patients was 85.7%. The diagnostic accuracy between the BIVA and 7-point SGA was AUC=0.604; 95%CI 0.490-0.726, higher than the previously established cutoff values (AUC=0.514; 95%CI: 0.369-0.631). The 95% confidence ellipses did not overlap (p<0.05). Conclusion: Our study showed low accuracy of BIVA for diagnosing malnutrition using a 7-point SGA as a reference standard. However, it is a complementary method for assessing nutritional status as it provides data on cellularity and hydration, which are important aspects for the HD population.
Resumo Introdução: Análise vetorial de impedância bioelétrica (BIVA) é uma estratégia não invasiva e de baixo custo. Os métodos usados para avaliar desnutrição em pacientes em HD ainda são um desafio. O objetivo do presente estudo foi comparar BIVA com Avaliação Subjetiva Global de 7 pontos (ASG de 7 pontos) para identificar desnutrição. Também investigamos sensibilidade e especificidade do ponto de corte proposto anteriormente para parâmetros de BIVA. Métodos: Foram incluídos pacientes de ambos os sexos, acima de 20 anos, em HD. Foram avaliados parâmetros antropométricos, dados laboratoriais e análise de impedância bioelétrica (BIA). Valores de resistência (R) e reatância (Xc) obtidos por BIA de mono-frequência foram normalizados para altura corporal (H) gerando um gráfico do vetor de bioimpedância com a ajuda do software BIVA. Foi realizada uma análise da área sob a curva ROC (AUC). Resultados: Entre 104 pacientes incluídos, a idade média foi 51,70 (±15,10) anos, e 52% eram homens. BIVA demonstrou sensibilidade de 35% para diagnosticar desnutrição. A especificidade da BIVA para identificar pacientes bem nutridos foi 85,7%. A precisão diagnóstica entre BIVA e ASG de 7 pontos foi AUC=0,604; IC95%: 0,490-0,726, superior aos valores de corte estabelecidos anteriormente (AUC=0,514; IC95%: 0,369-0,631). Elipses de confiança de 95% não se sobrepuseram (p<0,05). Conclusão: Nosso estudo mostrou baixa precisão da BIVA para diagnóstico de desnutrição usando ASG-7 pontos como padrão de referência. Entretanto, é um método complementar para avaliar estado nutricional, pois fornece dados sobre celularidade e hidratação, aspectos importantes para a população em HD.
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OBJECTIVES: to describe the organizational climate perceived by nurses of a hospital linked to the Brazilian Hospital Services Company and the reasons for the turnover intention. METHODS: mixed, concomitant triangulation type. Qualitative data were analyzed according to the discourse of the collective subject, in addition to quantitative data analysis, descriptive analysis, Pearson correlation, and multiple linear regression. Data collection was carried through a semi-structured interview with 116 nurses. RESULTS: the study presented the speeches in five categories: Leadership and organization support; Reward; Physical comfort; Control/pressure; and Cohesion among colleagues. It showed that, with increased Reward factor, there is a decrease in turnover intention; and, with decreased Physical comfort, there is an increase in turnover intention. CONCLUSIONS: there is a dichotomy in the organizational climate perceived by nurses, and personal reasons mainly justify the turnover intention. The reason could be the current processes of institutional reorganization and the hiring of experienced staff.
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Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem Hospitalar , Estudos Transversais , Humanos , Satisfação no Emprego , Cultura Organizacional , Inquéritos e QuestionáriosRESUMO
The objective of this study was to evaluate the association between frailty, evaluated by the Clinical Frailty Scale (CFS) and FRAIL scale, and C-terminal agrin fragment (CAF) levels with 3-month mortality following ST-segment elevation myocardial infarction (STEMI). This was a prospective observational study that included patients over the age of 18â¯years with STEMI admitted to the coronary intensive care unit. Within 48â¯h of admission, the CFS and FRAIL scale were applied and blood samples collected for serum CAF evaluation. Patients were followed for 3â¯months after hospital discharge, and mortality was recorded. One hundred and eleven patients were included; mean age was 62.3⯱â¯12.4â¯years, 61.3% were male and 11.7% died during the 3â¯months of follow-up. According to the CFS, 79.3% of the patients were classified as not frail, 12.6% as pre-frail and 8.1% as frail. According to the FRAIL scale, 31.5% of the patients were classified as not frail, 53.2% as pre-frail and 15.3% as frail. In univariate analysis, the CFS but not FRAIL scale was associated with mortality. In multiple logistic regression analysis, pre-frail/frail according to CFS (odds ratio [OR]: 6.118; CI 95%: 1.344-27.848; pâ¯=â¯0.019) and CAF levels (OR: 0.943; CI 95%: 0.896-0.992; pâ¯=â¯0.024) were associated with increased 3-month mortality. In a sub-analysis of 53 patients ≥65â¯years, CFS and CAF levels were associated with 3-month mortality. In conclusion, CAF levels and frailty determined by the CFS were associated with 3-month mortality after STEMI in the general and older population.
Assuntos
Fragilidade , Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Idoso , Agrina , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos , Estudos ProspectivosRESUMO
AIM: This study aimed to evaluate the association between serum myostatin levels, hospital mortality, and muscle mass and strength following ST-segment elevation myocardial infarction (STEMI). METHODS: This was a prospective observational study. Within 48 hours of admission, bioelectrical impedance and handgrip strength were assessed and blood samples collected for myostatin evaluation. Hospital mortality was recorded. A multiple logistic regression model was also constructed, adjusted by parameters that exhibited significant differences in the univariate analysis, to evaluate the association between myostatin levels and hospital mortality. RESULTS: One hundred and two (102) patients were included: mean age was 60.5±10.6 years, 67.6% were male, and 6.9% died during hospital stay. Univariate analysis showed that patients with lower myostatin levels had higher mortality rates. Serum myostatin levels positively correlated with handgrip strength (r=0.355; p<0.001) and appendicular skeletal muscle mass index (r=0.268; p=0.007). Receiver operating characteristic (ROC) curve analysis revealed that lower myostatin levels were associated with hospital mortality at the <2.20 ng/mL cut-off. Multiple logistic regression showed that higher serum myostatin levels were associated with reduced hospital mortality when adjusted by ß blocker use (OR, 0.228; 95% CI, 0.054-0.974; p=0.046). CONCLUSIONS: Serum myostatin concentrations positively correlated with muscle mass and strength in STEMI patients. Further assessment of serum myostatin association with mortality should be conducted using a larger sample and assessing the additive value to the Global Registry of Acute Coronary Events (GRACE) or thrombolysis in myocardial infarction (TIMI) risk scores.
Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Força da Mão , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Músculos , Miostatina , Prognóstico , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnósticoRESUMO
INTRODUCTION: Bioelectrical impedance vector analysis (BIVA) is a non-invasive and low-cost strategy. The methods used to assess malnutrition in patients undergoing HD are still a challenge. The aim of the present study was to compare BIVA to 7-Point Subjective Global Assessment (7-point SGA) to identify malnutrition. We also investigated the sensitivity and specificity of the previously proposed cutoffs point for BIVA parameters. METHODS: Patients of both sexes, over 20 years of age, on HD treatment were included. Anthropometric parameters, laboratory data, and bioelectrical impedance analysis (BIA) were evaluated. Values of resistance (R) and reactance (Xc) obtained by mono-frequency BIA were normalized to body height (H) to generate a graph of the bioimpedance vector with the BIVA software. The analysis of the area under the receiver operating curve ROC (AUC) was performed. RESULTS: Among the included 104 patients, the mean age was 51.70 (±15.10) years, and 52% were male. The BIVA had a sensitivity of 35% for diagnosing malnutrition. The specificity of BIVA for identifying the well-nourished patients was 85.7%. The diagnostic accuracy between the BIVA and 7-point SGA was AUC=0.604; 95%CI 0.490-0.726, higher than the previously established cutoff values (AUC=0.514; 95%CI: 0.369-0.631). The 95% confidence ellipses did not overlap (p<0.05). CONCLUSION: Our study showed low accuracy of BIVA for diagnosing malnutrition using a 7-point SGA as a reference standard. However, it is a complementary method for assessing nutritional status as it provides data on cellularity and hydration, which are important aspects for the HD population.
Assuntos
Desnutrição , Adulto , Antropometria , Estatura , Impedância Elétrica , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Pessoa de Meia-Idade , Estado NutricionalRESUMO
Purpose: Hemodialysis (HD) is a therapeutic modality that enables the highest survival for individuals with chronic kidney disease (CKD). In contrast, HD contributes to the pro-inflammatory state and may negatively affect the muscle strength and quality of life (QoL) of these individuals. To date, few studies have evaluated the association between decrease in strength and QoL in HD patients. Thus, our objective was to assess whether diminished muscle strength is associated with worse health related QoL and mortality. Methods: We included patients aged ≥ 18 years on HD. Clinical and demographic data were collected from patients' medical records. Clinical data, nutritional status (laboratory, anthropometry, bioimpedance analysis) and health-related QoL (World Health Organization's quality of life questionnaire, WHOQOL-Bref) were analyzed at baseline. Mortality was recorded for 32 months. Results: Among the 105 patients evaluated, the median age was 52 (43-64) years, and males were predominant (n = 73; 70%). The general median of QoL was 66.8 ± 11.9. Approximately 30% of patients were considered to have a worse QoL and 12,4% to have low muscle strength. This was not associated with QoL and mortality. HD vintage greater then to 5 years was associated with higher dissatisfaction in the perception of the environmental domain and overall QoL. Conclusion: Our data suggest that low muscle strength was not associated with health-related QoL using the WHOQOL-Bref instrument and mortality.
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ABSTRACT Objectives: to describe the organizational climate perceived by nurses of a hospital linked to the Brazilian Hospital Services Company and the reasons for the turnover intention. Methods: mixed, concomitant triangulation type. Qualitative data were analyzed according to the discourse of the collective subject, in addition to quantitative data analysis, descriptive analysis, Pearson correlation, and multiple linear regression. Data collection was carried through a semi-structured interview with 116 nurses. Results: the study presented the speeches in five categories: Leadership and organization support; Reward; Physical comfort; Control/pressure; and Cohesion among colleagues. It showed that, with increased Reward factor, there is a decrease in turnover intention; and, with decreased Physical comfort, there is an increase in turnover intention. Conclusions: there is a dichotomy in the organizational climate perceived by nurses, and personal reasons mainly justify the turnover intention. The reason could be the current processes of institutional reorganization and the hiring of experienced staff.
RESUMEN Objetivos: describir el clima organizacional percibido por enfermeros de un hospital vinculado a la Empresa Brasileña de Servicios Hospitalarios y los motivos de intención de reemplazo. Métodos: mixtos, del tipo triangulación concomitante. Datos cualitativos analizados según el Discurso del Sujeto Colectivo; y datos cuantitativos, análisis descriptivo, correlación de Pearson y regresión lineal múltiple. Recolecta de datos ocurrió mediante entrevista semiestructurada con 116 enfermeros. Resultados: discursos presentados en cinco categorías: Apoyo de la jefatura y organización; Recompensa; Conforto físico; Control/presión; y Cohesión entre los colegas. Evidenciado que, con aumento del factor Recompensa, hay una disminución de la intención de reemplazo; y, con la disminución del Conforto físico, hay un aumento de la intención de reemplazo. Conclusiones: el clima organizacional percibido por enfermeros está dicótomo, y la intención de reemplazo fue justificada, principalmente, por motivos personales. Cree que eso suceda de los recientes procesos de reorganización institucional y contratación de personal experimentados.
RESUMO Objetivos: descrever o clima organizacional percebido pelos enfermeiros de um hospital vinculado à Empresa Brasileira de Serviços Hospitalares e os motivos de intenção de rotatividade. Métodos: mistos, do tipo triangulação concomitante. Dados qualitativos analisados segundo o Discurso do Sujeito Coletivo; e dados quantitativos, análise descritiva, correlação de Pearson e regressão linear múltipla. A coleta de dados ocorreu mediante entrevista semiestruturada com 116 enfermeiros. Resultados: os discursos foram apresentados em cinco categorias: Apoio da chefia e organização; Recompensa; Conforto físico; Controle/pressão; e Coesão entre os colegas. Evidenciou-se que, com aumento do fator Recompensa, há uma diminuição da intenção de rotatividade; e, com a diminuição do Conforto físico, há um aumento da intenção de rotatividade. Conclusões: o clima organizacional percebido pelos enfermeiros encontra-se dicotomizado, e a intenção de rotatividade foi justificada, principalmente, por motivos pessoais. Acredita-se que isso decorra dos recentes processos de reorganização institucional e contratação de pessoal vivenciados.
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Septic shock is associated with unacceptably high mortality rates, mainly in developing countries. New adjunctive therapies have been explored to reduce global mortality related to sepsis. Considering that metabolic changes, mitochondrial dysfunction and increased oxidative stress are specific disorders within the path of septic shock, several micronutrients that could act in cellular homeostasis have been studied in recent decades. Thiamine, also known as vitamin B1, plays critical roles in several biological processes, including the metabolism of glucose, synthesis of nucleic acids and reduction of oxidative stress. Thiamine deficiency could affect up to 70% of critically ill patients, and thiamine supplementation appears to increase lactate clearance and decrease the vasopressor dose. However, there is no evident improvement in the survival of septic patients. Other micronutrients such as vitamin C and D, selenium and zinc have been tested in the same context but have not been shown to improve the outcomes of these patients. Some problems related to the neutrality of these clinical trials are the study design, doses, route, timing, length of intervention and the choice of endpoints. Recently, the concept that multi-micronutrient administration may be better than single-micronutrient administration has gained strength. In general, clinical trials consider the administration of a single micronutrient as a drug. However, the antioxidant defense is a complex system of endogenous agents in which micronutrients act as cofactors, and the physiological interactions between micronutrients are little discussed. In this context, the association of thiamine, vitamin C and corticoids was tested as an adjunctive therapy in septic shock resulting in a significant decrease in mortality. However, after these initial results, no other study conducted with this combination could reproduce those benefits. In addition, the use of low-dose corticosteroids is recommended in patients with septic shock who do not respond to vasopressors, which can affect the action of thiamine. Therefore, given the excellent safety profile, good biologic rationale and promising clinical studies, this review aims to discuss the mechanisms behind and the evidence for single or combined thiamine supplementation improving the prognosis of patients with septic shock.