Postural control parameters in elderly female fallers and non-fallers diagnosed or not with knee osteoarthritis

OBJECTIVES: To compare stabilometric parameters of elderly female fallers and non-fallers associated or not with knee osteoarthritis (OA). METHODS: Fifty-six elderly female fallers and non-fallers diagnosed or not with unilateral or bilateral knee OA were divided into the following groups: FOA (n = 10), elderly female fallers with knee OA; FNOA (n = 11), elderly female fallers without knee OA; NFOA (n = 14), elderly female non-fallers with knee OA; and NFNOA (n = 21), elderly female non-fallers without knee OA. For analyzing semi-static balance on a force platform with the elderly females standing, the following parameters were assessed in four conditions: center of pressure (COP), anterior-posterior and mediolateral displacements (APD and MLD, respectively); and COP anterior-posterior and mediolateral displacement velocities (APV and MLV, respectively). The following conditions were assessed: 1) standing on a firm wooden surface with eyes open (WSEO); 2) standing on a firm wooden surface with eyes closed (WSEC); 3) standing on a foam surface with eyes open (FSEO); 4) standing on a foam surface with eyes closed (FSEC). RESULTS: The elderly females with knee OA showed greater APD in all four conditions assessed (P < 0.05), while the elderly female fallers showed greater MLD (P < 0.05). No difference between the groups was observed for APV and MLV (P &gt; 0.05). CONCLUSIONS: Knee OA per se increases APD of the COP, while the history of falls, regardless of the presence of knee OA, hinders postural control in the ML direction.OBJETIVOS: Comparar parâmetros estabilométricos de mulheres idosas com ou sem histórico de quedas associadas ou não à osteoartrite (OA) de joelhos. MÉTODOS: Cinquenta e seis idosas apresentando ou não histórico de quedas (Q) e OA de joelho unilateral e bilateral foram distribuídas da seguinte maneira: grupo QOA (n = 10), idosas com histórico de queda e OA de joelho; grupo QSOA (n = 11), idosas com histórico de queda e sem OA de joelho; grupo SQOA (n = 14), idosas sem histórico de quedas (SQ) e com OA de joelho; e grupo SQSOA (n = 21), idosas sem histórico de quedas e sem OA de joelho. Para análise do equilíbrio semiestático usando uma plataforma de força, foram avaliados os deslocamentos anteroposterior (DAP) e mediolateral (DML), as velocidades de oscilação anteroposterior (VAP) e mediolateral (VML) em quatro situações na postura ereta. As situações avaliadas foram as seguintes: 1) PFOA: sobre superfície fixa e olhos abertos; 2) PFOF: sobre superfície fixa e olhos fechados; 3) PIOA: sobre superfície instável e olhos abertos; 4) PIOF: sobre superfície instável e os olhos fechados. RESULTADOS: As idosas com OA de joelho apresentaram maior DAP em todas as situações analisadas (P < 0,05), ao passo que idosas com histórico de quedas apresentaram maior DML (P < 0,05). Não houve diferenças entre os grupos para VAP e VML (P &gt; 0,05). CONCLUSÕES: A OA de joelho, por si, é um fator prejudicial no aumento de oscilação do centro de pressão (COP) na direção anteroposterior, enquanto o histórico de quedas, independente da presença de OA de joelhos, traz prejuízos ao controle postural na direção mediolateral.51251

Depression as a determinant of frailty in late life

Objectives Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. Method Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. Results Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. Conclusion Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status

Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL):unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression

BACKGROUND: To explore the mutual relationship between multimorbidity, mental illness and frailty, we have set-up the Multimorbidity and Mental health Cohort Study in FRAILty and Aging (MiMiCS-FRAIL) cohort. At the population level, multimorbidity, frailty and late-life depression are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors, and partly overlap in their clinical presentation. Moreover, these three variables may share a common underlying pathophysiological mechanism like immune-metabolic dysregulation. The overall objectives of MiMiCS-FRAIL are 1) to explore (determinants of) the cross-sectional and longitudinal relationship between multimorbidity, depression, and frailty among non-demented geriatric outpatients; 2) to evaluate molecular levels of senoinflammation as a broad pathophysiological process underlying these conditions; and 3) to examine adverse outcomes of multimorbidity, frailty and depression and their interconnectedness. METHODS: MiMiCS-FRAIL is an ongoing observational cohort study of geriatric outpatients in Brazil, with an extensive baseline assessment and yearly follow-up assessments. Each assessment includes a comprehensive geriatric assessment to identify multimorbidity and geriatric syndromes, a structured psychiatric diagnostic interview and administration of the PHQ-9 to measure depression, and several frailty measures (FRAIL, Physical Phenotype criteria, 36-item Frailty Index). Fasten blood samples are collected at baseline to assess circulating inflammatory and anti-inflammatory cytokines, leukocytes' subpopulations, and to perform immune-metabolic-paired miRome analyses. The primary outcome is death and secondary outcomes are the number of falls, hospital admissions, functional ability, well-being, and dementia. Assuming a 5-year mortality rate between 25 and 40% and a hazard rate varying between 1.6 and 2.3 for the primary determinants require a sample size between 136 and 711 patients to detect a statistically significant effect with a power of 80% (beta = 0.2), an alpha of 5% (0.05), and an R2 between the predictor (death) and all covariates of 0.20. Local ethical board approved this study. DISCUSSION: Frailty might be hypothesized as a final common pathway by which many clinical conditions like depression and chronic diseases (multimorbidity) culminate in many adverse effects. The MiMiCS-FRAIL cohort will help us to understand the interrelationship between these variables, from a clinical perspective as well as their underlying molecular signature

Cellular Prion Protein Expression in the Brain Tissue from Brucella ceti-Infected Striped Dolphins (Stenella coeruleoalba)

Brucella ceti, a zoonotic pathogen of major concern to cetacean health and conservation, is responsible for severe meningo-encephalitic/myelitic lesions in striped dolphins (Stenella coeruleoalba), often leading to their stranding and death. This study investigated, for the first time, the cellular prion protein (PrPc) expression in the brain tissue from B. ceti-infected, neurobrucellosis-affected striped dolphins. Seven B. ceti-infected, neurobrucellosis-affected striped dolphins, found stranded along the Italian coastline (6) and in the Canary Islands (1), were investigated, along with five B. ceti-uninfected striped dolphins from the coast of Italy, carrying no brain lesions, which served as negative controls. Western Blot (WB) and immunohistochemistry (IHC) with an anti-PrP murine monoclonal antibody were carried out on the brain parenchyma of these dolphins. While PrPc IHC yielded inconclusive results, a clear-cut PrPc expression of different intensity was found by means of WB analyses in the brain tissue of all the seven herein investigated, B. ceti-infected and neurobrucellosis-affected cetacean specimens, with two dolphins stranded along the Italian coastline and one dolphin beached in Canary Islands also exhibiting a statistically significant increase in cerebral PrPc expression as compared to the five Brucella spp.-negative control specimens. The significantly increased PrPc expression found in three out of seven B. ceti-infected, neurobrucellosis-affected striped dolphins does not allow us to draw any firm conclusion(s) about the putative role of PrPc as a host cell receptor for B. ceti. Should this be the case, an upregulation of PrPc mRNA in the brain tissue of neurobrucellosis-affected striped dolphins could be hypothesized during the different stages of B. ceti infection, as previously shown in murine bone marrow cells challenged with Escherichia coli. Noteworthy, the inflammatory infiltrates seen in the brain and in the cervico-thoracic spinal cord segments from the herein investigated, B. ceti-infected and neurobrucellosis-affected striped dolphins were densely populated by macrophage/histiocyte cells, often harboring Brucella spp. antigen in their cytoplasm, similarly to what was reported in macrophages from mice experimentally challenged with B. abortus. Notwithstanding the above, much more work is needed in order to properly assess the role of PrPc, if any, as a host cell receptor for B. ceti in striped dolphins

The concept of anorexia of aging in late life depression:A cross-sectional analysis of a cohort study.

INTRODUCTION: Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. METHODS: We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. RESULTS: Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). CONCLUSIONS: Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings

The association between cardiovascular risk factors and major cardiovascular diseases decreases with increasing frailty levels in geriatric outpatients

BACKGROUND: Frailty marks a process of increasing dysregulation of physiological systems which increases the risk of adverse health outcomes. This study examines the hypothesis that the association between multiple cardiovascular risk factors (CVRF) and cardiovascular diseases (CVD) becomes stronger with increasing frailty severity. METHODS: Cross-sectional analysis of 339 older adults (55.2% women; aged 75.2 ± 9.1 years) from an outpatient geriatric clinic from a middle-income country. The frailty index (FI) was calculated as the proportion of 30 possible health deficits. We assessed hypertension, diabetes, obesity, dyslipidemia, sedentarism and smoking as CVRF (determinants) and myocardial infarction, stroke, heart failure as CVD. Poisson regression models adjusted for age, sex, and education was applied to estimate the association between frailty as well as CVRF (independent variables) with CVD (dependent variable). RESULTS: Of the 339 patients, 18,3% were frail (FI ≥ 0.25) and 32.7% had at least one CVD. Both frailty and CVRF were significantly associated with CVD (PR = 1.03, 95% CI 1.01 to 1.05; p = 0.001, and PR = 1.46, 95% 1.24 to 1.71; p < 0.001, respectively) adjusted for covariates. The strength of the association between CVRF and CVD decreased with increasing frailty levels, as indicated by a significant interaction term of frailty and CVRF (p < 0.001). CONCLUSION: Frailty and CVRF are both associated with CVD, but the impact of CVRF decreases in the presence of frailty. When confirmed in longitudinal studies, randomized controlled trials or causal inference methods like Mendelian randomization should be applied to assess whether a shift from traditional CVRF to frailty would improve cardiovascular outcome in the oldest old

Influence of virtual reality on pain, fatigue, functional capacity and quality of life in fibromyalgia: a case study

Objetivo: Avaliar o efeito da Realidade Virtual (RV) associado a exercícios físicos na qualidade de vida, fadiga, níveis de dor e capacidade funcional em uma mulher com Fibromialgia (FM). Métodos: Trata-se de um estudo de caso que avaliou uma paciente com diagnóstico de FM, antes e após a intervenção com a RV associada a prática de exercícios físicos. Os instrumentos de avaliação utilizadas foram: Questionário de Impacto da Fibromialgia, Questionário de Capacidade Funcional, a Escala Visual analógica de Dor, Escala de Pensamento catastrófico sobre a dor, Escala de severidade da fadiga e avaliação do limiar de dor à pressão sobre os 18 tender points por meio de um algômetro de pressão digital. O tratamento ocorreu durante 6 semanas, com 2 sessões de tratamento por semana, totalizando 12 sessões. Resultados: O estudo proposto mostrou que o tratamento associado a RV promoveu uma melhora no impacto da FM na qualidade de vida da voluntária, uma diminuição na catastrofização da dor e uma diminuição da fadiga. Também foi possível notar uma melhora no limiar de dor a pressão em 16 tender points. Conclusão: Um programa de reabilitação para pessoas com FM que envolva a RV somado a prática de exercícios físicos contribuiu para melhora dos aspectos cognitivo e físico. A associação destas duas terapias foi benéfica, uma vez que estímulos cognitivos e a prática de uma atividade física foi capaz de promover melhora na função, na fadiga, na qualidade de vida e na percepção de dor desses.Objective: The objective of this study was to evaluate the effect of Virtual Reality (VR) associated with physical exercises on quality of life, fatigue, pain levels, and functional capacity in a woman with Fibromyalgia. Methods: This is a case report that evaluated one patient diagnosed with FM before and after the intervention with RV associated with physical exercise. The evaluation scales used were: Fibromyalgia Impact Questionnaire, Health Assessment Questionnaire, Visual Analogue Scale for Pain, Pain Catastrophizing Scale, Fatigue Severity Scale and pressure pain threshold evaluation at the 18 tender points with a digital pressure algometer. Treatment was conducted for 6 weeks, with 2 sessions per week, totaling 12 treatment sessions. Results: The study showed that treatment with VR promoted an improvement in the impact of FM in the volunteer's quality life, a decrease in catastrophic sensation of pain and a decrease in fatigue. It was also possible to notice an improvement in the pressure pain threshold at 16 tender points. Conclusion: A rehabilitation program for people with FM that involves VR combined with the practice of physical exercises contributed to the improvement of cognitive and physical aspects. The association of these two therapies was beneficial, since cognitive stimuli and the practice of a physical activity could promote improvements in function, fatigue, quality of life, and pain perception of these individuals

Immunohistochemical investigations on Brucella ceti-infected, neurobrucellosis-affected striped dolphins (Stenella coeruleoalba)

Bacteria of the genus Brucella cause brucellosis, an infectious disease common to humans as well as to terrestrial and aquatic mammals. Since 1994 several cases of Brucella spp. infection have been reported in marine mammals worldwide. Indeed, since human brucellosis ranks as one of the most common bacterial zoonotic infections on a global scale, it is necessary to increase our knowledge about it also in the marine environment. Brucella ceti, which is phenotypically similar to other smooth brucellae as B. abortus and B. melitensis, shares with the latter two the same surface antigens that are routinely used for the serological diagnosis of Brucella spp. infection. Marine mammal Brucella spp. infections are characterized by a pathogenicity similar to their terrestrial counterparts, with the occurrence of abortion, stillbirth and orchitis and an involvement of the host’s central nervous system (CNS), similarly to what happens in mankind. While sero-epidemiological data suggest that Brucella spp. infection is widespread globally, detecting Brucella spp.-associated antigens by immunohistochemistry (IHC) in tissues from infected animals is often troublesome. The present study was aimed at investigating, by means of IHC based upon the utilization of an anti-Brucella LPS monoclonal antibody (MAb), the CNS immunoreactivity (IR) shown by B. ceti-infected, neurobrucellosis-affected striped dolphins

The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis

Purpose: External knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle coactivation and external knee moments during walking in subjects with medial knee osteoarthritis. Methods: 19 controls (11 males, aged 56.6 ±5, and BMI 25.2 ± 3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3 ± 5.3, and BMI 28.2 ± 4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups. Findings: subjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments. Interpretation: Muscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population