Determinants of bone mineral density in post-menopause

Pós-menopausa é período de maior perda óssea e faz-se necessário instituir medidas preventivas que amenizem sua progressão. Objetivo: correlacionar o escore da densidade mineral óssea (DMO) e seus fatores de risco, buscando determinar aqueles que mais a influenciam. Método: estudo transversal, descritivo de 62 mulheres na pós-menopausa, saudáveis, idade média de 56,82 ± 4,02 anos, avaliadas quanto aos fatores de risco para osteoporose e nível de atividade física. Absorção de dupla energia de raios-X (DXA) avaliou coluna lombar e fêmur proximal. Os grupos, DMO normal e diminuída, foram analisados pelos testes T de Student, qui-quadrado e correlações. Resultados: Mulheres com menor índice de massa corporal (IMC), maior idade e maior tempo de menopausa apresentaram menor DMO em fêmur. Raça negra e ausência de história familiar correlacionaram-se com maior DMO. Conclusão: IMC, idade, peso, história familiar de osteoporose, raça e tempo de menopausa foram os principais fatores determinantes da DMO em mulheres na pós-menopausaPost-menopause is the period of greatest bone loss and it is necessary to introduce preventative measures to mitigate its progression. Aim: compare the score of bone mineral density (BMD) and their risk factors and to determine those most influencing. Method: Cross-sectional, descriptive study of 62 postmenopausal women, healthy, average age 56.82 ± 4.02 years, evaluated for risk factors for osteoporosis and physical activity level. Absorption dual energy X-ray absorptiometry (DXA) evaluated lumbar spine and proximal femur. Groups, normal and reduced BMD were analyzed by Student’s t test, chisquare and correlations. Results: Women with lower body mass index (BMI), older age and longer duration of menopause had lower BMD at the femur. Black race and absence of family history correlated with higher BMD. Conclusion: BMI, age, weight, family history of osteoporosis, race, and time since menopause were the main determinants of BMD in postmenopausal wome

High rates of physical inactivity and cardiovascular risk factors in patients with resistant hypertension

Background: Hypertension.is a multifactorial disease of high prevalence in Brazil and the world’s population and is the major treatable risk factor for cardiovascular disease. Objectives: To investigate the prevalence, according to sex, of risk behaviors and comorbidities associated with Hypertension.in the treated patients in Hiperdia Center Viçosa, MG. Methods: Cross-sectional study that evaluated 172 medical records of hypertensive patients greater than 18 years, nondiabetic, referred to the center of Viçosa Hiperdia. Among the data evaluated from analysis of medical records are the factors and behaviors of cardiovascular risk as overweight / obesity, dyslipidemia, smoking, drinking and physical inactivity, as well as medical conditions or comorbidities associated with hypertension. For data analysis were used the Kolmogorov-Smirnov test, Mann-Whitney test and the Pearson correlation test. The level of significance was 5%. Results: There was a higher prevalence of men among the patients and rates of alcoholism and smoking were significantly higher in this group. Women had a higher rate of obesity. Physical inactivity and dyslipidemia were present in 77% and 44% of patients, respectively, with no difference between sexes. Resistant Hypertension.was found in 71% of patients. Lower education was also very present among the hypertensive. Among the clinical conditions related to hypertension, there was a predominance of left ventricular hypertrophy, followed by kidney disease and cerebrovascular disease. Conclusions: The study showed that 71% of patients were classified as resistant Hypertension.and that, beyond this serious condition, they still showed a combination of behaviors and risk factors that confer a high risk of cardiovascular complicationsFundamento: A hipertensão arterial sistêmica é uma doença multifatorial, de alta prevalência na população brasileira e mundial e constitui o principal fator de risco tratável para as doenças cardiovasculares. Objetivos: Verificar a prevalência, de acordo com o sexo, dos comportamentos de risco e das comorbidades associadas à hipertensão nos pacientes atendidos no Centro Hiperdia de Viçosa, MG Métodos: Estudo transversal que avaliou 172 prontuários de hipertensos maiores de 18 anos, não diabéticos, encaminhados ao Centro Hiperdia de Viçosa. Entre os dados avaliados a partir de análise de prontuários estão os fatores e comportamentos de risco cardiovascular como sobrepeso/obesidade, dislipidemia, tabagismo, etilismo e sedentarismo, bem como condições clínicas ou comorbidades associadas à HAS. Para análise dos dados foram empregados os testes de Kolmogorov-Smirnov, o teste de Mann-Whitney e o teste de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados: Observou-se uma prevalência maior de homens entre os hipertensos analisados e as taxas de etilismo e tabagismo foram significativamente maiores neste grupo. As mulheres apresentaram uma taxa maior de obesidade. O sedentarismo e a dislipidemia estiveram presentes em 77% e 44% dos pacientes, respectivamente, sem diferença entre os sexos. Hipertensão arterial resistente foi encontrada em 71% dos pacientes. Dentre as condições clínicas relacionadas à hipertensão, houve um predomínio da hipertrofia do ventrículo esquerdo, seguida pela doença renal e pela doença cerebrovascular. Conclusões: O estudo mostrou que 71 % dos pacientes eram classificados como hipertensos resistentes e que, além desta séria condição, os mesmos ainda apresentavam uma combinação de comportamentos e fatores de risco que conferem um alto risco de complicações cardiovasculare

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council