Using trace element and halide isotopes to understand salinization mechanisms of groundwaters from an arid aquifer

Saline groundwaters are common to inland Australia, yet many aspects of their hydrochemical evolution remain uncertain. The saline groundwaters in the alluvial aquifers of the Darling River have previously been found to exhibit broad similarity in traditional hydrochemical and isotopic tracers. By contrast, trace element isotopes (δ7Li, δ11B and 87Sr/86Sr) and halide isotopes (δ37Cl and δ81Br) provide evidence of more complex hydrogeochemical processes.Hydrochemical evolution was found to be dependent on proximity to theDarling River and depth even though all groundwaters from this aquifer were found to be saline. The differing signatures highlighted the discovery of adeeper palaeo-groundwater system containing heavier trace element and halide isotope values. The measurement of these isotopes has permitted delineation of groundwater end-members and salinization mechanisms that would have otherwise not been identified

Balance and aerobic capacity of independent elderly: a longitudinal cohort study

OBJETIVO: Avaliar a variação da capacidade aeróbica e do equilíbrio postural em idosos independentes por um período de três anos. MÉTODOS: A capacidade aeróbica dos voluntários foi avaliada por meio do Teste de Caminhada de 6 minutos (TC6); o equilíbrio postural, por meio da Escala de Equilíbrio de Berg (EEB); o número de quedas foi registrado por autorrelato e o nível de atividade física, pelo Questionário Internacional de Atividade Física (IPAQ - versão longa). As avaliações realizadas em 2008 foram comparadas às realizadas em 2005. RESULTADOS: Não houve diferença na pontuação da EEB e no número de quedas dos idosos avaliados (p>0,05). Houve diminuição da distância percorrida entre as duas avaliações, sendo que os voluntários percorreram 52,46±8,4 metros a menos na segunda avaliação. O IPAQ evidenciou aumento de indivíduos considerados ativos na segunda avaliação (83,3%). CONCLUSÃO: O presente estudo demonstrou que o equilíbrio postural, avaliado pela EEB, não se alterou nos idosos independentes e ativos no período de três anos. Nesse mesmo momento, observou-se uma redução da distância percorrida, avaliada pelo TC6.OBJECTIVE: To evaluate the variation in aerobic capacity and postural balance of independents elderly for a period of three years. METHODS: The aerobic capacity of the volunteers was assessed using a six minutes walk test (6MWT), the postural balance was assessed using the Berg Balance Scale (BBS), the number of falls was self-reported and physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ - long version). Evaluations undertaken in 2008 were compared to those performed in 2005. RESULTS: There were no differences in balance and number of falls between 2008 and 2005 (p>0.05). There was a decrease in aerobic capacity over time of 52.46±8.4 meters walked. The IPAQ showed an increase in physical activity on the second evaluation (83.3%). CONCLUSION: The present study demonstrated that balance, evaluated using BBS did not change in the active independent elderly for a period of three years. However, over the there year period there was a decrease in aerobic capacity evaluated using the 6MWT

Nutritional support in geriatric patients: definition, diagnosis, assessment and therapeutic

Atualmente, vem ocorrendo um aumento importante no número de pacientes idosos submetidos a internação hospitalar, mantidos em casas de repouso ou atendidos em regime ambulatorial, cujo estado nutricional pode ser considerado crítico. Assim, é fundamental que as alterações próprias do envelhecimento sejam o mais precocemente possível diferenciadas dos sinais clínicos de desnutrição. Um alto grau de suspeita clínica de pacientes idosos desnutridos, e que, conseqüentemente, necessitam de terapêutica nutricional, pode ser obtido por meio da história clínica, exame físico e dados laboratorias apropriados. A má nutrição que ocorre no idoso pode ser devida às alterações fisiológicas do envelhecimento, às condições sócio-econômicas, às doenças e à interação entre nutrientes e medicamentos. Assim sendo, as principais causas de má nutrição podem ser catalogadas como secundárias ao envelhecimento, menor rendimento econômico, isolamento, a morte de entes queridos, doenças e outros fatores relacionados. Como resultado, o idoso apresenta sério comprometimento do estado geral e uma maior morbidade e mortalidade em geral. A intervenção nutricional utiliza nutrientes, como fármacos, visando o tratamento de doenças. Por fim, as recomendações têm por objetivo indicar a quantidade mínima de nutrientes que seria adequada para a maioria das pessoas em seu ambiente usual, sem traumas ou doenças. No entanto, as recomendações, para o idoso são extrapoladas das recomendações obtidas para crianças e adultos jovens, nem sempre próprias para o idoso.Increasing numbers of elderly patients are being admitted to hospital and nursing homes. Clinicians face the challenging task of developing optimal plans for individual treatment and rehabilitation for these patients. Because of the insidious nature of malnutrition in the elderly and of its mimicking of the usual aging process, it is important to recognize early warning signs of the risks of malnutrition. The physician needs to know the triggers or alerts of poor nutritional health during history/physical examination. Those in need of more comprehensive nutrition screen, which encompass not only the routine medical and dietary history and a physical exam but also a broad look at the elderly individual’s psychosocial, functional, socioeconomic, and drug use aspects that are more related to malnutrition. This review paper provides a summary of the accumulated information about these matters, with the purpose of promoting active management of undernutrition of elderly people

O impacto da obesidade abdominal sobre os níveis plasmáticos de lípides nos idosos

Model of the study: cross-sectional. Introduction : There are reports of an increase in the prevalence of dislipidemias with aging. It is necessary to determine the true impact of centripetal obesity on plasma levels lipids of older people. Objectives : To verify the possible association between the abdominal circumference, a marker of visceral fat, with the levels of blood lipids. Methods  : The study included 98 patients with 60 to 79 years of age, residents in the western district of the city of Ribeirão Preto, 58 women. The mean age of the volunteers was 66.3 years. The following data were analyzed: abdominal circumference, hip circumference, triglycerides, total cholesterol and HDL cholesterol. The abdominal circumference was measured as a surrogate for centripetal obesity. Results : There was no association between total cholesterol and abdominal circumference (p = 0.88). There was also no association with different types of obesity (p=0.73 and p=0.60 for men and women, respectively). The association between triglycerides and abdominal circumference was significant (p <0.0001), but when obesity was classified according to types, there was association between triglycerides and abdominal circumference in women (p=0.002) but not in men (p=0.07). There was negative association between HDL cholesterol and abdominal circumference (p=0.018), however when obesity types were analyzed separately the association between HDL and abdominal circumference was not significant (p=0.40 and p=0.07 for men and women, respectively). Conclusion : Probably, in the old population, the cardiovascular risk resulting from centripetal obesity has not, in its etiology, the increase of lipids of the blood only.  Modelo do Estudo: estudo de prevalência. Introdução : Há relatos do aumento da prevalência de dislipidemias com o envelhecimento. Há poucos estudos associando a obesidade centrípeta com a dislipidemia e há, ainda, que se determinar a real influência da obesidade abdominal sobre os níveis plasmáticos de lípides em idosos. Objetivo : Avaliar a possível associação entre a medida da circunferência abdominal, marcadora de gordura visceral, e os níveis de lípides no sangue. Métodos: O estudo foi realizado em 98 pacientes com 60 a 79 anos de idade, moradores do Distrito Oeste da cidade de Ribeirão Preto, sendo que 58 eram mulheres. A idade média dos voluntários foi de 66,3 anos. Foram colhidos os seguintes dados: circunferência abdominal, circunferência do quadril, triglicérides, colesterol total e HDL colesterol. A circunferência abdominal foi o parâmetro para a obesidade centrípeta.Resultados:  Não houve associação entre colesterol total e circunferência abdominal (p = 0,88). Quando separamos pelo gênero verificamos que também não houve associação (p=0,73 e p=0,60 para homens e mulheres, respectivamente). A associação entre triglicérides e circunferência abdominal foi significativa (p<0,0001), mas ao separar por gêneros, houve associação entre triglicérides e circunferência abdominal nas mulheres (p=0,002) enquanto que nos homens não houve associação (p=0,07). Houve associação negativa entre HDL e circunferência abdominal (p=0,018), porém quando os gêneros foram analisados separadamente a associação entre HDL e circunferência abdominal não foi significativa (p=0,40 e p=0,07 para homens e mulheres, respectivamente). Conclusão: Provavelmente, em idosos, o risco cardiovascular advindo da obesidade centrípeta não tem na sua etiologia, exclusivamente, o aumento de lípides do sangue

Combined aerobic and resistance training: are there additional benefits for older hypertensive adults?

OBJECTIVES: The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults. METHOD: Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week. RESULTS: Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group. CONCLUSIONS: The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass

Exacerbação da doença pulmonar obstrutiva crônica

A doença pulmonar obstrutiva crônica (DPOC) é altamente prevalente e permanece como grande problema de saúde pública em todo o mundo. Exacerbações são eventos característicos da história natural desta doença e estão associados com significante morbidade e mortalidade. A presente revisão aborda aspectos diagnósticos e terapêuticos da exacerbação aguda da DPOC.Chronic obstructive pulmonary disease (COPD) is highly prevalent and remains a major public health problem worldwide. Exacerbations are characteristic events in the natural course of this disease associated with significant morbidity and mortality. This article reviews diagnostic and therapeutic aspects of acute exacerbations of COPD

Condutas no paciente com insuficiência cardíaca internado em enfermarias de medicina interna

A crescente prevalência da Insuficiência Cardíaca na população, e a constante má-aderência aos tratamentos propostos em nível ambulatorial, fazem com que o quadro de descompensação desta doença esteja entre as recordistas em número de internações, causando grande impacto na saúde pública do Brasil. O propósito deste estudo é o de estabelecer um protocolo de condutas a ser aplicado em pacientes com Insuficiência Cardíaca internados em enfermaria de Clínica Médica Geral, como o Hospital Estadual de Ribeirão Preto (SP, Brasil), com o objetivo de garantir a recuperação de um quadro de descompensação recente, assim como reorientar o paciente quanto à importância da aderência ao tratamento instituído. Para tanto, serão propostas a utilização e otimização de ferramentas farmacológicas, além de reintrodução de medidas não-farmacológicas, de modo que se reduza o tempo de internação,o número de recorrências, e favoreça o melhor seguimento ambulatorial destes pacientes.The increasing prevalence in heart failure and associated nonadherence of patients to the proposed ambulatory-treatment regimen cause the decompensate clinical picture to be the cornerstone of the high incidence of hospitalization found in such disorder, which brings a greater impact in public health. The purpose of the present study is to establish a protocol to be applied to heart failure inpatients at an internal medicine ward, such as the Hospital Estadual de Ribeirão Preto (SP, Brazil), in order to guarantee complete recovery from acute decompensated heart failure, as well as to reassure that patients understand the importance of following the proposed treatment protocols. Accordingly, pharmacological therapy and nonpharmacological strategies will be either reintroduced or optimized, in order to reduce the period of hospitalization, rate of infirmary readmission, and also to favor a better ambulatory follow-up of these patients

Effect of a single session of aerobic walking exercise on arterial pressure in community-living elderly individuals

Several studies have demonstrated that one exercise session (ES) on a cycloergometer or ergometric treadmill causes a reduction in blood pressure (BP). However, there are few similar studies on walking, which is the exercise modality most available to the elderly. We investigated the immediate and 24-h effects of walking on BP in independent, community-living elderly individuals. Volunteers participated in a single ES and resting control session (CS). Before and after each session, BP was measured by auscultatory and oscillometric methods. After each session, 24-h ambulatory blood pressure monitoring was conducted. An accelerometer was installed 48 h before the sessions and left in place for 5 days. The mean volunteer age was 67.7 +/- 3.5 years; 11 were hypertensive patients under treatment, and 12 were normotensive. In the total sample, there were immediate 14mm Hg and 12 mm Hg reductions in systolic BP (SBP) after the ES according to the auscultatory and oscillometric methods, respectively. Diastolic BP (DBP) was reduced by 4 mm Hg after the ES according to both methods. SBP during wakefulness and sleep and DBP during wakefulness were lower after the ES than after the CS (P<0.01), when wakefulness and sleep were determined individually (variable-time pattern) using data from the activity monitors and provided by the volunteers. The variable-time pattern was more effective in detecting reductions in BP than the fixed-time pattern. Hypertension Research (2012) 35, 457-462; doi: 10.1038/hr.2011.227; published online 9 February 2012National Council for Scientific and Technological Development (CNPq)Foundation for the Support of Teaching, Research and Care - Clinics Hospital, Faculty of Medicine of Ribeirao Preto, University of Sao Paul

Bioelectrical impedance with different equations versus deuterium oxide dilution method for the inference of body composition in healthy older persons

There is no consensus regarding the accuracy of bioimpedance for the determination of body composition in older persons. This study aimed to compare the assessment of lean body mass of healthy older volunteers obtained by the deuterium dilution method (reference) with those obtained by two frequently used bioelectrical impedance formulas and one formula specifically developed for a Latin-American population. A cross-sectional study. Twenty one volunteers were studied, 12 women, with mean age 72 +/- 6.7 years. Urban community, Ribeiro Preto, Brazil. Fat free mass was determined, simultaneously, by the deuterium dilution method and bioelectrical impedance; results were compared. In bioelectrical impedance, body composition was calculated by the formulas of Deuremberg, Lukaski and Bolonchuck and Valencia et al. Lean body mass of the studied volunteers, as determined by bioelectrical impedance was 37.8 +/- 9.2 kg by the application of the Lukaski e Bolonchuk formula, 37.4 +/- 9.3 kg (Deuremberg) and 43.2 +/- 8.9 kg (Valencia et. al.). The results were significantly correlated to those obtained by the deuterium dilution method (41.6 +/- 9.3 Kg), with r=0.963, 0.932 and 0.971, respectively. Lean body mass obtained by the Valencia formula was the most accurate. In this study, lean body mass of older persons obtained by the bioelectrical impedance method showed good correlation with the values obtained by the deuterium dilution method. The formula of Valencia et al., developed for a Latin-American population, showed the best accuracy.FAPESP - Fundacao de Amparo a Pesquisa do Estado de Sao Paulo [98/12696-8]FAEPA - Fundacao de Apoio ao Ensino, PesquisaInternational Atomic Energy Agency [92.696