Comportamento dos níveis plasmáticos do Peptídeo Natriurético tipo-B em idosos com função sistólica do ventrículo esquerdo preservada

A contribuição do peptídeo natriurético tipo B (BNP) para a definição da etiologia cardíaca nos casos de dispnéia aguda têm sido amplamente validada, porém, quando a função sistólica está preservada, especialmente em idosos, o papel do peptídeo ainda não está bem estabelecido. Verificar o comportamento dos valores de BNP em idosos com função sistólica preservada. Também foi proposto associar os valores de BNP a variáveis clínicas e Doppler- ecocardiográficas e avaliar desfechos clínicos após 12 meses de seguimento. A casuística de 76 indivíduos com 60 anos ou mais foi submetida a avaliação clínica, ecocardiográfica e dosagem do BNP. As associações entre o BNP e as variáveis clínicas e ecocardiográficas foram verificadas pelo Teste do x2, Coeficiente de Correlação de Pearson e Modelo logístico com resposta multinomial e logits acumulados. Em todos os casos foi adotado o nível de significância p<0,05. Os valores do BNP em idosos com função sistólica preservada apresentaram distribuição ampla e não normal, com mediana(percentil 25 e 75) de 74,32 pg/mL (39,2 - 157,7). Usando os valores transformados por função logarítmica, houve significante correlação entre os níveis do peptídeo e a idade (Pearson=0,280; p=O,O1). Os níveis de BNP correlacionaram-se com a massa miocárdica (Pearson=0,287; p=0,013) e a pós-carga (Pearson=0,321; p=0,005). A regressão logística univariada mostrou que a elevação do BNP aumentou o risco de disfunção diastólica (OR: 2,78; IC95%:1,36- 5,68, p=0,004). De acordo com o modelo logístico multinomial com logits acumulados de chances proporcionais a presença de disfunção renal aumentou a chance de encontrar-se BNP elevado (OR: 2,62; IC95%: 1,002 - 6,893). Neste mesmo modelo, vericou-se que a presença de aumento de volume do átrio esquerdo quase triplicou a chance de BNP elevado (OR: 2,917; IC95%: 1,067 - 7,973)...The contribution from B-type natriuretic peptide (BNP) for defining cardiac etiology in cases of acute dyspnea has been amply validated, however when systolic function is preserved, especially in the elderly, the role of this peptide has still not been established. To verify the behaviour of BNP values in elderly individuals with preserved systolic function; also to associate BNP values with clinical variables and Doppler echocardiographs, and evaluate clinical outcomes after 12 months follow-up. Seventy-six individuals of 60 years or over were submitted to clinical evaluation, echocardiograph, and BNP levels. Associations between BNP and clinical variables and echocardiographs were verified by the x2 test, Pearson coefficient of correlation, and logistic model with multinomial response and accumulated logits. In all cases significance level was p<0.05. BNP values in elderly individuals with preserved systolic function presented wide non-normal distribution with median (25th, 75th percentiles) of 74,34 pg(ml (39,2 - 157,7). Using log function of the values, there was a significant correlation between peptide levels and age (Pearson coeficient=0.280; p=O.OI). BNP levels correlated with myocardial mass (Pearson=0.287; p=0.013) and afterload (Pearson=0.321; p=0.005). Univariate logistic regression showed that elevated BNP increased the risk of diastolic dysfunction (OR: 2.78; IC95%:1.36-5.68; p=0.004). According to the multinomial logistic model with accumulated logits of proportional chances, the presence of renal dysfunction increased the chance of finding high BNP (OR: 2,62; IC95%:1,002 - 6,863). In the same model, increased left atrium volume almost tripled the chance of elevated BNP (OR: 2,91; IC95%:1,067 - 7,9730). There were no relevant clinical outcomes after 12 months follow-up, independent of BNP values. BNP levels in the elderly with preserved systolic function... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Recommendations for clinic prevention: relevant aspects in elderly people

The American Academy of Family Physicians (AAFP) released a summary of the "Recommendations for Clinical Preventive Services". It is a publication based on "Recommendations for Clinical Preventive Services" published by the United States Preventive Services Task Force (USPSTF). These recommendations are provided only as an aid to physicians in making clinical decisions about the care of their patients. They reflect the clinic references existing at the time of publication. But its only should be used with the clear understanding that continued research may result in new knowledge and consequently there is a need for updates. Some recommendations of the USPSTF are important in clinical practice with the elderly.</p

Infecção do trato urinário adquirida em ambiente hospitalar em idosos

Introduction: Hospital-acquired urinary tract infection (HAUTI) is an important cause of morbidity in the elderly population. Objective: Evaluate the occurrence of HAUTI and risk factors associated with it. Method: This is a prospective study of a sample of 332 elderly people, interned in a university hospital. Criteria for defining infection were established by the Center for Diseases and Prevention Control. Statistical analysis of data used calculation of frequencies, odds ratio and logistic regression. The rate of hospital infection was 23.6%. The prevalent topographies of infection were respiratory infections (27.6%), urinary tract infections (26.4%) and surgical wound infections (23.6%, with 21, 20 and 19 episodes, respectively. The HAUTI incidence density associated with urinary catheterization was 24.2 infections by 1,000 catheter-days. The length of hospital stay of patients without nosocomial infection was 6.9 days and with HAUTI was increased in 10.4 (p<0.05).The rate of mortality of patients with HAUTI was 20%. Pathogens were isolated in 75% of episodes of HAUTI and the prevalent were: Escherichia coli (33%) and Pseudomonas aeruginosa (20%). Risk factors found for HAUTI were urinary catheterization implementation (odds ratio (OR) = 43.1; 95% confidence interval (95 CI%) = 3.9 – 311.1), hospitalization with community infection (OR= 21.9; 95% CI = 4.9 – 97.9); vascular diseases (OR=14; 95% CI = 2 – 98); diabetes mellitus (OR= 5.5; 95% CI = 1.4 – 21) and urinary catheterization by more than three days (OR=3.7; 95% CI = 1 – 13.8). Conclusions: HAUTI presented elevated incidence and it increased the length of hospital stay.Introdução: A infecção do trato urinário adquirida no hospital (ITUH) é uma importante causa de morbidade em idosos. Objetivo: Avaliar a ocorrência e os fatores de risco de ITUH. Métodos: Estudo prospectivo em amostra de 322 idosos, internados em hospital universitário. Os critérios para definição de infecção foram do Centers for Disease Control and Prevention. Na análise estatística dos dados foram utilizados cálculo de frequências, odds ratio e regressão logística. Resultados: A taxa de infecção hospitalar foi de 23,6%. As topografias prevalentes foram: pneumonia (27,6%), trato urinário (26,4%) e sítio cirúrgico (23,6%), com 21, 20 e 19 episódios, respectivamente. A densidade de incidência de ITUH associada ao cateterismo urinário foi de 24,2 infecções por 1.000 cateteres-dia. O tempo de internação dos pacientes sem infecção hospitalar foi de 6,9 dias e com ITUH foi acrescido em 10,4 (p < 0,05). A letalidade dos pacientes com ITUH foi de 20%. Foram isolados patógenos em 75% dos episódios de ITUH, sendo os prevalentes: Escherichia coli (33%) e Pseudomonas aeruginosa (20%). Os fatores de risco encontrados para ITUH foram: realização de cateterismo urinário (odds ratio (OR) = 43,1; intervalo de confiança de 95% (IC 95%) = 3,9 – 311,1), internação com infecção comunitária (OR = 21,9; IC 95% = 4,9 – 97,9), doença vascular (OR = 14; IC 95% = 2 – 98), diabetes mellitus (OR = 5,5; IC 95% =1,4 – 21) e cateterismo urinário por mais que três dias (OR = 3,7; IC 95% = 1 – 13,8). Conclusões: A ITUH apresentou incidência elevada e aumentou o tempo de internação

Intrinsic capacity as proposed by the World Health Organization and 30-month mortality among older adults in long-term care facilities

OBJECTIVE: To analyze the impact of intrinsic capacity on 30-month mortality among older adults living in long-term care facilities (LTCFs). METHODS: Prospective cohort study with survival analysis conducted from July 2020 to December 2022 among older adults living in Brazilian LTCFs. At baseline (T0), 209 older residents were evaluated for demographic profile, clinical data (diagnosed diseases and current medications), intrinsic capacity according to ICOPE (cognitive capacity, psychological capacity, hearing capacity, visual capacity, vitality, and locomotor capacity domains), functional capacity (Katz Index of Independence in Activities of Daily Living), and frailty (FRAIL scale). At 30 months, mortality in the sample was assessed. RESULTS: At T0, the mean age of residents was 82 (SD, 11.21) years; 65.07% were female, 94.26% were white, and 88.04% had multimorbidity. Overall, 54.07% (n = 113) of residents exhibited changes in four or more domains of intrinsic capacity, with locomotor capacity being the most commonly impaired domain (82.78%); 43.54% were completely dependent for basic activities of daily living, and 42.58% were frail. At 30-month follow-up, 33.49% (n = 70) of residents had died. Survival analysis revealed a statistically significant association between death and impairment in four or more domains of intrinsic capacity (p = 0.044). CONCLUSION: Impairment in four or more domains of intrinsic capacity is associated with death in LTCF residents.</p

Prevalence and Incidence of Falls among Institutionalized Older Adults: A Systematic Review Protocol

Systematic review of prevalence and incidence will be conducted to assess falls in elderly residents of long-term care facilities. The following databases will be searched: Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Implementation Reports, LILACS, Web of Science, Scopus, EMBASE, PubMed, BVS: Virtual Health Library, BDENF: Nursing Database, IBECS: Spanish Bibliographic Index in Health Sciences, Index Psychology - Periodicals, BINACIS - Argentina, CUMED-Cuba, WPRIM - Western Pacific, Scielo via Web of Science. Identified studies will be imported into the Rayyan software and selected based on pre-established eligibility criteria (CoCoPop). The main variables of interest will be the "prevalence" and/or the "incidence" of "Falls" (Condition) reported in studies developed in long-term care facilities (Context), with participants aged 60 or more (Population). Data such as average age, gender, sample size, study methods, setting/location, prevalence and incidence estimates, and risk factors will be extracted from the selected studies using data extraction tools adapted from the JBI System. All steps will be performed by two independent and blinded reviewers, and in case of disagreements, a third reviewer will be involved. Quantitative data, whenever possible, will be grouped in statistical meta-analyses using the JBI SUMARI software for data analysis. Where data can be grouped, the resulting meta-analysis will provide the relevant summary of fall statistics and 95% confidence intervals (CI), and list individual proportions with their 95% CI values from individual studies