Medo de quedas associado a fatores sociodemográficos e de saúde em mulheres na pós-menopausa / Fear of falling associated to sociodemographic and health factors in postmenopausal women

O medo de quedas é um problema frequente entre mulheres, entretanto são escassos os estudos que investigam os possíveis fatores associados ao medo de cair com a pós-menopausa. O objetivo deste estudo foi avaliar o medo de quedas em mulheres na pós-menopausa e a associação com aspectos sociodemográficos e de condição de saúde. Foi realizado estudo transversal e os dados foram coletados por meio de entrevista com 286 mulheres na pós-menopausa, entre 50 e 65 anos, e em amenorreia há pelo menos 12 meses, que responderam a questionários contendo aspectos sociodemográficos, antropométricos, de condição de saúde, ocorrência de quedas nos últimos doze meses e de medo de quedas. Do total, 123 (43%) apresentaram medo de quedas e foram encontradas associações significantes com o Índice de Massa Corpórea (IMC) (p=0,039), presença de Hipertensão Arterial Sistêmica (HAS) (p=0,001), de doenças reumáticas (p=0,005), de depressão (p=0,013), uso de cinco ou mais medicamentos (p=0,047), com o uso de psicotrópico (p=0,001), de anti-hipertensivo (p<0,001) e de anti-inflamatório (p=0,002) e com ocorrência de quedas nos últimos 12 meses (p=0,004).  Verificou-se a necessidade de implantação de medidas preventivas para essa população

TELESSAÚDE E TELEMEDICINA: UMA AÇÃO DE EXTENSÃO DURANTE A PANDEMIA

Os efeitos da doença do novo coronavírus 2019 (Covid-19) no sistema de saúde brasileiro pode ser amenizado por meio de medidas de tecnologia em saúde. Nesse sentido, objetiva-se relatar a experiência da implementação de um serviço de Telessaúde em um projeto de Extensão. Trata-se de relato de experiência por parte dos atores envolvidos no projeto “UEL pela vida, contra o novo coronavírus”, com ênfase nas frentes relacionadas à central de informações (Disk Coronavírus) e atendimento na plataforma estadual (Telemedicina Paraná). As atividades, que se iniciaram no dia 30 de março, constam de atendimentos para orientação da população em geral, proteção individual e coletiva, uso correto de equipamentos de proteção individual, triagem de sintomáticos, atendimento de dúvidas relacionadas a leis e decretos, além de encaminhamento a atendimento médico de acordo com o fluxo municipal e estadual. O projeto tem demonstrado a importância da relação universidade-comunidade, bem como da intensificação de ferramentas tecnológicas no enfrentamento da pandemia e na saúde em geral, sendo a telessaúde como um canal de comunicação eficaz e de fácil utilização no acolhimento do usuário. PALAVRAS-CHAVE: Telemedicina; Relações comunidade-instituição; Pandemi

Influence of Insulin Resistance and TNF- α

The aim of this study was to evaluate the involvement of TNF-α and insulin resistance (IR) in the inflammatory process, oxidative stress, and disease activity in patients with rheumatoid arthritis (RA). This cross-sectional study included 270 subjects (control group, n=97) and RA patients (n=173). RA patients were divided into four groups: the first group without IR and not using antitumor necrosis factor-α (TNF-) (G1, IR− TNF−); the second group without IR and using anti-TNF-α (G2, IR- TNF+); the third group with IR and not using anti-TNF-α (G3, IR+ TNF-); and the fourth group with IR and using anti-TNF-α (G4, IR+ TNF+). G3 and G4 had higher (p<0.05) advanced oxidation protein products (AOPPs) and oxidative stress index (OSI) compared to G1. G4 group presented higher (p<0.05) AOPPs and OSI than G2. TRAP was significantly lower in G3 compared to G1. Plasma TNF-α levels were significantly higher in G4 and G2 compared to G1 (p<0.0001) and G3 (p<0.0001 and p<0.01, resp.). The presence of insulin resistance was robustly associated with both oxidative stress and TNF-α levels. More studies are warranted to verify if IR can be involved in therapeutic failure with TNF-α inhibitors. This trial is registered with Brazilian Clinical Trials Registry Register number RBR-2jvj92

New Drug Targets to Prevent Death Due to Stroke: A Review Based on Results of Protein-Protein Interaction Network, Enrichment, and Annotation Analyses

This study used established biomarkers of death from ischemic stroke (IS) versus stroke survival to perform network, enrichment, and annotation analyses. Protein-protein interaction (PPI) network analysis revealed that the backbone of the highly connective network of IS death consisted of IL6, ALB, TNF, SERPINE1, VWF, VCAM1, TGFB1, and SELE. Cluster analysis revealed immune and hemostasis subnetworks, which were strongly interconnected through the major switches ALB and VWF. Enrichment analysis revealed that the PPI immune subnetwork of death due to IS was highly associated with TLR2/4, TNF, JAK-STAT, NOD, IL10, IL13, IL4, and TGF-β1/SMAD pathways. The top biological and molecular functions and pathways enriched in the hemostasis network of death due to IS were platelet degranulation and activation, the intrinsic pathway of fibrin clot formation, the urokinase-type plasminogen activator pathway, post-translational protein phosphorylation, integrin cell-surface interactions, and the proteoglycan-integrin extracellular matrix complex (ECM). Regulation Explorer analysis of transcriptional factors shows: (a) that NFKB1, RELA and SP1 were the major regulating actors of the PPI network; and (b) hsa-mir-26-5p and hsa-16-5p were the major regulating microRNA actors. In conclusion, prevention of death due to IS should consider that current IS treatments may be improved by targeting VWF, the proteoglycan-integrin-ECM complex, TGF-β1/SMAD, NF-κB/RELA and SP1

Genetic polymorphisms associated with lipid metabolism involved in the pathophysiology of ischemic stroke

The stroke is a complex, multifactorial, and polygenic disorder that results from the interaction between the individual genetic components and environmental factors. Previous studies have established hypertension, smoking, diabetes mellitus, dyslipidemia, elevated body mass index, disturbances of coagulation and increasing age as predictors of stroke risk factors. The stroke is a more crippling than deadly disease that requires long-term institutionalization, as it decreases the quality of life of patients, resulting in higher costs to social and economic levels. It thus becomes increasingly important to emphasize the Preventive Medicine strategies. Dyslipidemia has been associated with pathophysiology of ischemic stroke and genetic polymorphisms that occur in the metabolic pathway, such as lipids metabolism, has been one of the hereditary factors related to ischemic stroke. The identification of the genetic component in the cause of dyslipidemia has been intensively investigated in recent years. Among the several genetic polymorphisms, the gene of the low-density lipoprotein receptor has been the object of many studies in the population worldwide. Data on lipid profile and study of polymorphisms of genes encoding structural proteins and enzymes related to lipid metabolism may reveal the prevalence of dyslipidemia in a population, enabling a targeted intervention for the control and prevention of atherosclerotic diseases such as ischemic stroke

ASSOCIAÇÃO DA MORTALIDADE EM IDOSOS ACOMETIDOS PELA COVID19 E AS DOENÇAS CRÔNICAS NÃO TRANSMISSÍVEIS

Introdução: No início da pandemia, como observado em todo mundo, a COVID-19 afetou desproporcionalmente as populações mais velhas. Sabe-se que a população idosa pertence ao chamado grupo de risco, seja pelas condições de saúde subjacentes, seja pela imunossenescência natural do envelhecimento, apresenta maior risco de doença grave. Assim, indivíduos idosos que contraíram o vírus inspiram maior vigilância e cuidado no tratamento e acompanhamento da infecção, visando sempre diminuir as complicações e a mortalidade. Objetivo: analisar a associação da mortalidade de idosos hospitalizados e as doenças crônicas não transmissíveis em pacientes que contraíram o Sars-Cov-2. Método: Pesquisa pertencente a um grupo de trabalho envolvendo 4 Universidades no Paraná (UEPG, UEL, UNICENTRO E UFPR) sobre a temática Covid19, com fomento da Fundação Araucária – Paraná. Esta pesquisa faz parte de um projeto guarda-chuva e este estudo está vinculada a fase 2 do projeto maior. Estudo quantitativo, transversal, descritivo, de caráter documental, realizado de março a dezembro de 2020, com idosos hospitalizados que contraíram Covid19 no Estado do Paraná. A amostra foi constituída por 8447 pacientes, as variáveis foram analisadas por software estatístico e a pesquisa foi aprovada pelo comitê de ética, sob número 39108020.0.0000.010. Resultados: A amostra foi composta em sua maioria por idosos do sexo masculino, com idade média de 73 anos e brancos, com prevalência de óbito de 47,3%. Conforme dados apresentados pode-se perceber que as doenças crônicas não transmissíveis (DCNT) como cardiovasculares (p valor &lt;0,001), Hipertensão arterial sistêmica (HAS) (p valor &lt;0,001), diabetes (p valor &lt;0,001), pulmonares (p valor &lt;0,001), hepáticas (p valor 0,005), neoplasias (p valor &lt;0,001), renal (p valor &lt;0,001) e obesidade (p valor &lt;0,001) foram determinantes no desfecho os idosos. Verificou-se que idosos com COVID-19 apresentaram mais chance de vir a óbito quando dispunham de doença cardiovascular, Diabetes, Doença Neurológica, renal e pulmonar, a presença destas doenças aumentou 1,78, 1,34, 2,79, 2,02 e 1,48 vezes (respectivamente) a chance do indivíduo vir a óbito em decorrência da Covid19. Conclusão: o perfil de saúde da população idosa brasileira a torna de alto risco à gravidade da COVID-19, já que a prevalência de doenças crônicas é alta. Este estudo apontou que os pacientes idosos, do sexo masculino e com doenças de bases associadas predominaram na análise deste estudo. Este estudo tem algumas limitações. Seria interessante repetir este estudo com mais pacientes para melhorar a representatividade e o poder estatístico. Recomenda-se o desenvolvimento de novas pesquisas que sejam representativas da população idosa e estudos mais aprofundados sobre o impacto da pandemia na saúde desta população

Safety of monitoring antiretroviral therapy response in HIV-1 infection using CD4+ T cell count at long-term intervals

Abstract: The latest Brazilian guideline recommended the reduction of routine CD4+ T cell counts for the monitoring of patients with human immunodeficiency virus type 1 (HIV-1) under combination antiretroviral therapy (cART). The aim of this study was to evaluate the safety of monitoring response to cART in HIV-1 infection using routine viral load at shorter intervals and CD4+ T cell count at longer intervals. CD4+ T cell counts and HIV-1 viral load were evaluated in 1,906 HIV-1-infected patients under cART during a three-year follow-up. Patients were stratified as sustained, non-sustained and non-responders. The proportion of patients who showed a CD4+ T > 350cells/µL at study entry among those with sustained, non-sustained and non-responders to cART and who remained with values above this threshold during follow-up was 94.1%, 81.8% and 71.9%, respectively. HIV-1-infected patients who are sustained virologic responders and have initial CD4+ T cell counts > 350cells/µL showed a higher chance of maintaining the counts of these cells above this threshold during follow-up than those presenting CD4+ T ≤ 350cells/µL (OR = 39.9; 95%CI: 26.5-60.2; p 350cells/µL were more likely to maintain CD4+ T cell counts above this threshold during the next three-year follow-up. This result underscores that the evaluation of CD4+ T cell counts in longer intervals does not impair the safety of monitoring cART response when routine viral load assessment is performed in HIV-1-infected patients with sustained virologic response

Evaluation of genetic polymorphism pvuii of low density lipoprotein receptor (LDLR) in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of connective tissue related to changes in lipid profile and lipoprotein metabolism. Studies show that the genetic polymorphism of PvuII low density lipoprotein receptor (LDLR) is associated with different concentrations of low density lipoprotein (LDL) in general population. The present study evaluated the genetic polymorphism of PvuII LDLR and lipid profile in patients with SLE in southern Brazilian population. We included 72 patients with SLE and 154 blood donors. In assessing the lipid profile, SLE patients had elevated serum triglycerides (TG) levels compared with the control group (p 0.05). Patients with SLE and P1P1 genotype tended to have higher levels of TG compared with patients with SLE and P1P2 + P2P2 genotype (p = 0.0687). We conclude that genetic polymorphism may contribute to increased cardiovascular risk, however, the complexity of genetic components and disease evaluated should be taken into consideration. Further investigations are needed for other genes that may be involved in altering the lipid profile in this population

Relationship between anticholinergic load and self-perceived health in a population aged 44 years or older

Objective: To investigate the relationship between anticholinergic load (ACL) and self-perceived general health in adults in a medium-sized municipality in southern Brazil. Methods: This cross-sectional study was based on 2015 data from a medium-sized municipality in southern Brazil. All respondents aged 44 years or older who reported using drugs in the 2 weeks before the interview were included (n = 662). The Anticholinergic Drug Scale was used to measure the ACL. Self-perceived health was categorized as positive self-perception (PSP) or negative self-perception (NSP). Crude and adjusted Poisson regression analyses were conducted to investigate the association between ACL and self-perceived health. Results: NSP was found in 50.91% of 662 respondents. Significant ACL, older age, lower economic status, lower education, polypharmacy, and depression correlated with a higher frequency of NSP. Individuals with significant ACL had a prevalence of NSP of 1.27 (95% confidence interval: 1.02 - 1.58), and each additional ACL level represented a 6.10% higher chance of worse self-perceived health, regardless of confounding factors. Conclusions: An association was found between significant ACL and NSP, with an effect dependent on ACL level

Association between vitamin D deficiency, adiposity and solar exposure in participants with arterial hypertension and diabetes mellitus

Currently, several studies have shown a relationship between vitamin D deficiency and type 2 diabetes mellitus, obesity and hypertension. The major cause of vitamin D deficiency is the lack of adequate sun exposure. The objective of the study was to evaluate serum vitamin D level and to verify its association with vitamin D ingestion, body composition and solar exposure in patients participating in the Hypertension and Diabetes System in Cascavel, PR. A total of 304 adult and elder patients from both genders participated in the study. Demographic and anthropometric data, lifestyle, presence of previous diseases, dietary and serum levels of vitamin D were evaluated. We used the chi square test for association verification and compliance and the Kruskal-Wallis test to compare medians between variables. It was verified serum 25-hydroxyvitamin D (25(OH)D) deficiency (&lt;20ng/mL) in 52.6%, overweight and obesity in 73.4%, increase in abdominal circumference in 77.6% and in body fat percentage in 95.6% of the patients. There was no association between ingestion and serum vitamin D levels. Significant association was found between abdominal circumference (p</p