Associaton between anthropometric indicators of adiposity and risk factors for cardiovascular disease in elderly

According to the World Health Organization (WHO). Portugal remains one of the European countries with the highest rates of children and adults with overweight/obesity and it is estimated that 24% of the adult Portuguese population is obese. Dyslipidemias are the main risk factors for cardiovascular diseases, which are the leading cause of death in developed countries. Numerous studies have been conducted to establish the anthropometric measures as screening tools in clinical practice instead of using laboratory tests. The use of body mass index (BMI) as indicator of nutritional and metabolic status in elderly has difficulties due to the decrease in height, lean body mass, amount of body water and fat accumulation and the presence of certain conditions age-related that can cause bias in body composition (1,2). Some authors state that, in the absence of specific cutoff points for BMI according to age and gender limits the use of this indicator (3). This study aims to investigate the association between anthropometric measurements and the cardiovascular risk factors (lipid profile) in the elderly. A random sample of 70 elderly subjects, 43 women (mean age= 88.2 + 5.5) and 27 men (mean age = 87.7 + 7.7) institutionalized in 3 different nursing homes of Braganza was studied. The lipid profile was estimated from fasting blood samples of all participants. The selected parameters were Total Cholesterol (TC), High Density Lipoprotein Cholesterol(HDL-c), Low Density Lipoprotein Cholesterol (LDL-c), triglycerides (TRG), apolipoprotein - A. (APO-A) and apolipoprotein B (APO-B). Lipids and lipoproteins plasma concentration were determinate using a biochemical autoanalyzer (Cobas 400 plus, Roche). Some anthropometric parameters (metabolic age, visceral fat, muscle mass, body fat percentage -% BF) were performed by bioimpedance, using a specific scale (Tanita BC model: 545). The height (to calculate BMI) was considered according to the identity card. After performing descriptive analysis of anthropometric and lipid profile variables, comparing the elderly values according the gender, we used Spearman correlation coefficient to determine the relationship between biochemical and anthropometric parameters. In the analyzed sample, 4.2% of subjects had an underweight BMI (≤18.4), 35.2% of subjects normal BMI (18.5-24.9) and 59.2% overweight (25-29.9) and obesity (≥30). As expected, statistically significant differences between men and women were found in regard to muscle mass (50.6 + 5.9 vs. 39.6 + 6; p <0.000), visceral fat (17.5 + 3.4 vs. 10.9 + 2.2, p <0.000) and % BF (26.5 + 6.4 vs. 33.3 + 6.5; p = 0.002). It was found that in the women group there is a strong positive correlation between BMI and % BF (men = 0.73; p <0.000 and women = 0.85; p <0.000). Correlation analysis between anthropometric measurements and lipid profile parameters showed a positive association between BMI and TRG concentration (r = 0:26; p = 0.03) and a negative association between BMI and HDL-c concentration (r = -0.24; p = 0.048). The same results were observed in other studies, the main lipid/lipoprotein abnormalities related to obesity were a decrease in serum HDL-c concentration and an increase in serum TRG concentration (4). As described in the literature, the average in % BF difference, between men and women, increases with age, where women accumulate more body fat than men. In this context, it would be important to define new limits to anthropometric indicators, according to age and gender, which allows them to replicate more accurately the metabolic and nutritional status. In this study, there were no significant correlations between anthropometric parameters and lipid parameters. However, we can confirm, despite the limitations of BMI already mentioned, this was the anthropometric indicator with the highest correlation with lipid profile parameters. Keywords: BMI, anthropometric measurements, cardiovascular risk factors, lipid profile, dyslipidemiasinfo:eu-repo/semantics/publishedVersio

Association between bilirubin and lipid profile in Portuguese elderly individuals

Several studies showed that mildly elevated bilirubin blood concentration is inversely associated to coronary artery disease (CAD). The most commonly mechanism contributing to CAD prevention is the bilirubin antioxidant effect, protecting several macromolecules from oxidation. Recently, other studies have found that higher serum bilirubin levels (BL) are associated with beneficial effects improving lipid profile and that might contribute to decrease cholesterol and triacylglycerol. In the meantime, a consistently negative association between BL and body mass index (BMI) was observed. The aim of this study was evaluate the cardiovascular risk protection by bilirubin analyzing the association between bilirubin levels and lipid profile in elderly. Clinical data, anthropometric measurements (BMI, Visceral Fat and Body Fat Percentage), lipid profile (total cholesterol-TC; triglycerides-TG; high-density lipoprotein cholesterol-HDL-c; low-density lipoprotein cholesterol-LDL-c; apoliprotein A-Apo-A; apoliprotein B-Apo-B) were evaluated in 70 institutionalized elderly, 43 females (mean age= 88.2±5.5 years old) and 27 males (mean age= 87.7±7.7 years old). Anthropometric measurements were obtained by bioimpedance, using specific scale (Tanita BC Model: 545). The lipid parameters were performed in autoanalyzer (Cobas Mira S, Roche, Switzerland) using available commercial kits. Correlation analysis revealed positive associations between BL and the HDL-c in males (total bilirubin: r=0.51; p<0.007) and no association in females (r=0.40; p<0.50). Positive associations were also found to TB levels and Apo-A (males: r=0.40; p<0.50 and females: r=0.270; p<0.013). Interestingly, the conjugated bilirubin present a stronger positive association with this two parameters (male: r=0.64; p<0.000; female: r=0.29; p<0.052). No associations were found between bilirubin and triglycerides; total cholesterol and anthropometric measurements. Low levels of HDL-c are a risk factor for coronary heart disease. A similar association has been shown for Apo-A1. These results suggest higher bilirubin is associated with higher cardioprotective agents, which indicates that the determination of total bilirubin should be included for more accurate cardiovascular disease risk assessment.info:eu-repo/semantics/publishedVersio

A Lactoferrina como marcador da activação do neutrófilo na gravidez normal e na pré-eclâmptica

Dissertação de Doutoramento em Farmácia, área de especialização em Bioquímica, apresentada à Faculdade de Farmácia da Universidade do Port

CITIZEN RELATIONSHIP MANAGEMENT (CZRM): UM ESTUDO DE CASO EM UM HOSPITAL PÚBLICO PORTUGUÊS

The Citizen Relationship Management (CzRM) is a strategy of public organizations seeking to improve relationships with their citizens. This strategy is inspired by the initiatives of Customer Relationship Management (CRM) of pri­vate companies. For so values of relationship marketing are implemented in conjunction with a set of Information Systems (IS) that assist in the individualized treatment of citizens. This article examines how an IS can improve the relationship between a public hospital and its patients. The method used was the case study. This study took place in a large public Portuguese hospital that adopted a tool paper-free. Data collection was conducted through interviews, secondary document analysis and direct observation. The results demonstrate that the adoption of an IS, despite considerable resistance from employees, enhances internal organizational processes reducing the waiting time in service, resulting in an improvement of service quality and, consequently, in the increased satisfaction of patients.O Citizen Relationship Management (CzRM) é uma estratégia das organizações públicas que procura melhorar o relacionamento com os seus cidadãos. Esta estratégia é inspirada nas iniciativas de Customer Relationship Management (CRM) das empresas privadas. Para tanto, são implementados valores do marketing relacionamento em articulação com um conjunto de Sistemas de Informação (SI) que auxiliam no tratamento individualizado do cidadão. Este artigo analisa como um SI pode contribuir para melhorar a relação entre um hospital público e os seus pacientes. O método utilizado foi o estudo de caso. Este estudo decorreu em um hospital público português de grande porte que passou pela adoção de uma ferramenta paper-free. A coleta de dados foi realizada por meio de entrevistas, análise de documentos secundários e observação direta. Os resultados demonstram que a adoção de um SI, apesar da grande resistência dos funcionários, aprimora os processos internos organizacionais reduzindo o tempo de espera no atendimento, o que resulta numa melhoria da qualidade do serviço prestado e, consequentemente, no aumento da satisfação dos pacientes

Inflammatory Disturbances in Preeclampsia: Relationship between Maternal and Umbilical Cord Blood

Preeclampsia (PE) is one of the main causes of maternal and fetal mortality and morbidity. PE is associated with an inflammatory state and with oxidative stress, in maternal circulation. Our aim was to evaluate and compare the levels of oxidative stress and inflammatory markers in maternal and umbilical cord blood (UCB), in normal and PE pregnancies. We measured acute-phase proteins (CRP and α1-antitrypsin), proinflammatory cytokines (IL-6 and TNF-α), leukocyte activation (elastase, lactoferrin, sL-selectin, sVCAM, sPECAM), total antioxidant status (TAS), thiobarbituric acid reactive substances (TBARS), and uric acid levels. We studied 42 healthy pregnant women, 46 PE women, and their neonates. The concentrations of IL-6, TNF-α, α1-antitrypsin, CRP, sVCAM, uric acid, and TBARS were significantly higher, and sL-selectin was significantly lower in PE pregnant women as compared with normotensive pregnant women. In newborns uric acid, α1-antitrypsin, and CRP values were significantly higher in PE; leukocyte count, sL-selectin, lactoferrin, and the ratio elastase/α1-antitrypsin were significantly lower. Our data suggest that PE pregnancy is associated with an enhanced maternal inflammatory condition, which is reflected in fetal circulation. This enhanced inflammatory state seems to be related to endothelial dysfunction and increased cytokine synthesis, rather than with neutrophil activation

Association between bilirubin and lipid profile in Portuguese elderly individuals

Several studies showed that mildly elevated bilirubin blood concentration is inversely associated with coronary artery disease (CAD). The most commonly mechanism contributing to CAD prevention is the bilirubin antioxidant effect, protecting several macromolecules from oxidation. Recently, other studies have found that higher serum bilirubin levels (BL) are associated with beneficial effects improving lipid profile and that might contribute to decrease cholesterol and triacylglycerol. In the meantime, a consistently negative association between BL and body mass index (BMI) was observed. The aim of this study was evaluate the cardiovascular risk protection by bilirubin analyzing the association between bilirubin levels and lipid profile in elderly. Clinical data, anthropometric measurements (BMI, Visceral Fat and Body Fat Percentage), lipid profile (total cholesterol-TC; triglycerides-TG; high-density lipoprotein cholesterol-HDL-c; low-density lipoprotein cholesterol-LDL-c; apoliprotein A-Apo-A; apoliprotein B-Apo-B) were evaluated in 70 institutionalized elderly, 43 females (mean age= 88.2±5.5 years old) and 27 males (mean age= 87.7±7.7 years old). Anthropometric measurements were obtained by bioimpedance, using specific scale (Tanita BC Model: 545). The lipid parameters were performed in autoanalyzer (Cobas Mira S, Roche, Switzerland) using available commercial kits. Correlation analysis revealed positive associations between BL and the HDL-c in males (total bilirubin: r=0.51; p<0.007) and no association in females (r=0.40; p<0.50). Positive associations were also found to TB levels and Apo-A (males: r=0.40; p<0.50 and females: r=0.270; p<0.013). Interestingly, the conjugated bilirubin present a stronger positive association with this two parameters (male: r=0.64; p<0.000; female: r=0.29; p<0.052). No associations were found between bilirubin and triglycerides; total cholesterol and anthropometric measurements. Low levels of HDL-c are a risk factor for coronary heart disease. A similar association has been shown for Apo-A1. These results suggest higher bilirubin is associated with higher cardioprotective agents, which indicates that the determination of total bilirubin should be included for more accurate cardiovascular disease risk assessment.info:eu-repo/semantics/publishedVersio

Spectrum of molecular alterations detected in the CYP21A2 gene associated with 21-hydroxylase deficiency

A maioria dos doentes com hiperplasia suprarrenal congénita (HSC) apresenta alterações moleculares no gene CYP21A2, o qual codifica a enzima 21-hidroxilase (21-OH). Os doentes com a forma clássica de deficiência em 21-OH (21-OHD) apresentam a síntese de cortisol diminuída no córtex adrenal e, os casos mais graves, também apresentam deficiência de aldosterona. As mulheres com 21-OHD grave apresentam excesso de andrógenos desde a sua vida fetal conduzindo à virilização dos órgãos genitais externos. Tanto homens como mulheres com 21-OHD completa não sintetizam a aldosterona e, consequentemente, logo após o nascimento, podem desenvolver crises de perda de sal se não forem corretamente diagnosticados e tratados. A 21- OHD não clássica é devida à deficiência parcial em 21-OH, os fenótipos clínicos são menos graves, as mulheres não apresentam virilização dos genitais externos ao nascimento, e geralmente os sinais relativos a excesso de androgénios podem surgir durante a infância ou até mais tarde (durante ou após a puberdade). Neste trabalho descrevem-se as alterações e os genótipos mais frequentes encontrados em doentes portugueses não adultos com 21-OHD. As alterações mais frequentes encontradas na forma clássica da HSC são c.293-13C> G, diferentes deleções/quimeras/conversões génicas do gene CYP21A2 e c.518T> A, enquanto na 21-OHD não-clássica a variante c.844G> T é a mais frequente. Estes resultados contribuem para um diagnóstico correto e uma melhor gestão clínica dos doentes, para o seu aconselhamento genético e para oferecer o diagnóstico pré-natal a casais com risco de ter filhos afetados com a forma clássica de 21-OHD.Most of the patients with congenital adrenal hyperplasia (CAH) have molecular alterations in the CYP21A2 gene, which encodes the enzyme 21-hydroxylase (21-OH). Patients with the classic form of 21-OH deficiency (21-OHD) have the synthesis of cor tisol impaired in the adrenal cor tex and, the most severe cases also have aldosterone deficiency. Females with severe 21-OHD, star ting their fetal life have excess of androgens leading to external genitalia virilization at bir th. Both males and females with complete 21-OHD are not able to synthesize aldosterone, consequently soon af ter bir th may develop salt wasting crises if not correctly diagnosed and treated. Non-classic 21-OHD is due to par tial deficiency of 21-OH, the clinical phenotypes are less severe, females don’t present ambiguity of the external genitalia at bir th, usually signs of androgen excess may be present during childhood or even later in life (during or af ter puber ty). We present here the most frequent alterations and genotypes found in non adult Por tuguese patients with 21-OHD. The most frequent alterations found in the classic form of CAH are c.293-13C>G, dif ferent CYP21A2 deletions/quimeras/gene conversions and c.518T>A, while in non-classic 21-OHD the variant c.844G>T is the most frequent. These results contribute to a correct patient diagnosis, to a better clinical care, genetic counseling and to of fer pre-natal diagnosis to couples at risk of having af fected babies with the classic form of 21-OHD.info:eu-repo/semantics/publishedVersio