Serum Metalloproteinases 2 and 9 as Predictors of Gait Status, Pressure Ulcer and Mortality after Hip Fracture

Introduction: The aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture. Methods: Eighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient's admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded. Results: Two patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture. Conclusions: In conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture. © 2013 Gumieiro et al.

Mini Nutritional Assessment predicts gait status and mortality 6 months after hip fracture.

The aim of the present study was to evaluate the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening (NRS) 2002 and the American Society of Anesthesiologists Physical Status Score (ASA) as predictors of gait status and mortality 6 months after hip fracture. A total of eighty-eight consecutive patients over the age of 65 years with hip fracture admitted to an orthopaedic unit were prospectively evaluated. Within the first 72 h of admission, each patient's characteristics were recorded, and the MNA, the NRS 2002 and the ASA were performed. Gait status and mortality were evaluated 6 months after hip fracture. Of the total patients, two were excluded because of pathological fractures. The remaining eighty-six patients (aged 80·2 (sd 7·3) years) were studied. Among these patients 76·7 % were female, 69·8 % walked with or without support and 12·8 % died 6 months after the fracture. In a multivariate analysis, only the MNA was associated with gait status 6 months after hip fracture (OR 0·773, 95 % CI 0·663, 0·901; P= 0·001). In the Cox regression model, only the MNA was associated with mortality 6 months after hip fracture (hazard ratio 0·869, 95 % CI 0·757, 0·998; P= 0·04). In conclusion, the MNA best predicts gait status and mortality 6 months after hip fracture. These results suggest that the MNA should be included in the clinical stratification of patients with hip fracture to identify and treat malnutrition in order to improve the outcomes.

Genetic and non-genetic effects on calf vigor at birth and preweaning mortality in nellore calves

The objective of the present study was to evaluate the genetic and non-genetic effects that influencevigor at birth and preweaning mortality in Nellore calves. A total of 11,727 records of births that occurred between 1978 and 2006, offspring of 363 sires, were analyzed. Poor calf vigor at birth (VB) and preweaning mortality divided into stillbirth (SB), early mortality (EM) and total mortality (TM) were analyzed as binary variables. Generalized linear models were used for the evaluation of non-genetic effects and generalized linear mixed models for genetic effects (sire and animal models). The incidences were 4.75% for VB, 2.66% for SB, 5.28% for EM, and 7.99% for TM. Birth weight was the effect that most influenced the traits studied. Calves weighing less than 22kg(females) and less than 24kg (males) were at a higher risk of low vigor and preweaning mortality. Preweaning mortality was higher among calves born from cows aged .3 and .11 years at calving compared with cows aged 7 to 10 years. Male calves presented less vigor and higher preweaning mortality than female calves. Selection for postweaning weight did not influence preweaning mortality. The heritability estimates ranged between 0.01 and 0.09 for VB, 0.00 and 0.27 for SB, 0.03 and 0.17 for EM and 0.02 and 0.10 for TM. Stillbirth should be included as a selection criterion in breeding programs of Nellore cattle, alone or as part of a selection index, aiming to reduce preweaning mortality. © 2013 Sociedade Brasileira de Zootecnia.

Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients

Purpose: Malnutrition is a strong predictor of mortality in hemodialysis patients. Several scoring systems for evaluating nutritional status have been proposed. However, they rely on different sets of anthropometric and laboratory markers to make a diagnosis of malnutrition and assess its impact on prognosis. To validate them, nutritional scores should be compared with clinical outcomes. Thus, the purpose of this study was to assess malnutrition by three different nutrition scoring systems and determine which best predicts mortality in hemodialysis patients. Methods: This prospective study included 106 adult chronic hemodialysis patients. Their mean age was 56.3 ± 14.9 years and mean body mass index 24.8 (21.8-28.9); 52 % were men and they had been on dialysis for 24 (5-55) months. Nutritional status was classified according to the diagnostic systems proposed by Wolfson et al. (Am J Clin Nutr 39(4):547-555, 1984), International Society of Renal Nutrition and Metabolism (ISRNM) (Fouque et al. in Kidney Int 73(4):391-398, 2008), and Beberashvili et al. (Nephrol Dial Transplant 25(8):2662-2671, 2010). During about 2 years of follow-up, mortality was assessed by Kaplan-Meier curves, log-rank, and Cox's models adjusted for diabetes, sex, C-reactive protein, time on dialysis, age, and fractional urea clearance. Results: Twenty-three deaths (21.5 %) occurred during the study period. According to the systems of Wolfson, Beberashvili, and the ISRNM, 54, 32, and 20 % of patients, respectively, had malnutrition. Both univariate and multivariate analyses showed that the ISRNM system was the only one that predicted poorer survival (fourfold higher death risk) in malnourished patients. Conclusions: The scoring system proposed by the ISRNM most accurately identifies patients at higher risk of death. © 2013 Springer Science+Business Media Dordrecht.

Diarréia em bezerros da raça Nelore criados extensivamente: estudo clínico e etiológico

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Verificação da produção de anticorpos específicos em éguas prenhes vacinadas contra Rhodococcus equi e avaliação da transferência passiva destes anticorpos para os potros

Pós-graduação em Medicina Veterinária - FMVZ

Hemograma, proteinograma e enzima gama-glutamil transferase de cães neonatos, do 3º ao 45º dia de vida, sob a ação da idade e da suplementação com luteína

Pós-graduação em Medicina Veterinária - FMVZ

Estudo genético prospectivo de recém-nascidos e natimortos com defeitos congênitos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Resultados perinatais de gêmeos com pesos discordantes ao nascer

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Análise clínica e laboratorial da sepse com hemocultura positiva em recém-nascidos internados em Unidade de Terapia Intensiva Neonatal durante 5 anos

Pós-graduação em Pediatria - FMB

Identificação das áreas com maior risco de morbimortalidade neonatal a partir de geoprocessamento

Pós-graduação em Saúde Coletiva - FMB

Estresse oxidativo em recém-nascidos de mães hipertensas: relação com prognóstico neonatal no curto prazo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Alterações do fluxo sanguíneo em artéria umbilical na síndrome hipertensiva gestacional e suas implicações no período neonatal

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Diagnóstico das infecções relacionadas a cateter em recém-nascidos e epidemiologia molecular dos Staphylococcus spp. isolados

Pós-graduação em Biologia Geral e Aplicada - IBB

Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review

CONTEXTO E OBJETIVO:Gestações complicadas pelo diabetes estão associadas com aumento das complicações neonatais e maternas. A complicação mais grave materna é o risco de desenvolver diabetes tipo 2 após 10-12 anos do parto. Para o controle rigoroso da glicose no sangue, as mulheres grávidas são tratadas de forma ambulatorial ou com internações hospitalares. O objetivo deste estudo é avaliar a efetividade do tratamento ambulatorial versus hospitalização em gestações complicadas por diabetes ou hiperglicemia.TIPO DE ESTUDO E LOCAL:Revisão sistemática conduzida em hospital universitário público.MÉTODOS:Uma revisão sistemática da literatura foi realizada e as principais bases de dados eletrônicas foram pesquisadas. A data da pesquisa mais recente foi 4 de setembro de 2011. Dois autores selecionaram independentemente os ensaios clínicos relevantes, avaliaram a qualidade metodológica e extraíram os dados.RESULTADOS:Apenas três estudos foram selecionados, com tamanho de amostra pequeno. Não houve diferença estatisticamente significativa entre o tratamento ambulatorial versus hospitalização em relação à mortalidade em nenhuma das subcategorias analisadas: mortes perinatais e neonatais, (risco relativo [RR] 0,65; 95% de intervalo de confiança [IC] 0,11-3,84, P = 0,63); morte neonatal (RR 0,29, IC 95% 0,01-6,07, P = 0,43), e óbitos infantis (RR 0,29, IC 95% 0,01-6,07, P = 0,43).CONCLUSÕES:Com base em estudos com risco de viés alto ou moderado, esta revisão demonstrou que não há diferença estatisticamente significante entre o tratamento ambulatorial comparado com o hospitalar na redução das taxas de mortalidade em gestações complicadas por diabetes ou hiperglicemia. Esta revisão sistemática também sugere a necessidade de mais ensaios clínicos randomizados sobre o assunto.