I Diretriz brasileira de cardio-oncologia pediátrica da Sociedade Brasileira de Cardiologia

Sociedade Brasileira de Oncologia PediátricaUniversidade Federal de São Paulo (UNIFESP) Instituto de Oncologia Pediátrica GRAACCUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo Faculdade de Medicina Instituto do Coração do Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreInstituto Materno-Infantil de PernambucoHospital de Base de BrasíliaUniversidade de Pernambuco Hospital Universitário Oswaldo CruzHospital A.C. CamargoHospital do CoraçãoSociedade Brasileira de Cardiologia Departamento de Cardiopatias Congênitas e Cardiologia PediátricaInstituto Nacional de CâncerHospital Pequeno PríncipeSanta Casa de Misericórdia de São PauloInstituto do Câncer do Estado de São PauloUniversidade Federal de São Paulo (UNIFESP) Departamento de PatologiaHospital Infantil Joana de GusmãoUNIFESP, Instituto de Oncologia Pediátrica GRAACCUNIFESP, Depto. de PatologiaSciEL

Incidencia y características de tuberculosis en trabajadores de salud en cuatro hospitales nivel III de la seguridad social peruana. Reporte de Resultados de Investigación 04-2021

Este reporte pretente estimar la incidencia y describir las características de la tuberculosis (TB) en trabajadores de salud (TS) en hospitales Nivel III de la Seguridad Social Peruana entre los años 2013 y 2018

Poor Lower Extremity Functioning Is Associated with Modest Increased Incidence of Probable Dementia

Lower extremity functioning in older adults provides a measure of poor physical performance and can predict negative health outcomes. The consequences of reduced lower extremity functioning on cognitive decline, measured as time-varying variables, have not been well documented in previous studies. We aimed to evaluate whether lower extremity functioning is associated with an increased incidence rate of probable dementia among older adults using data from the National Health and Aging Trends Study (NHATS). Participants (n = 6457) were followed for 8 years to examine the relationship between lower extremity functioning, as measured by the Short Physical Performance Battery (SPPB), and incident probable dementia. Using weighted data, a multivariable Poisson regression with generalized estimating equations (GEE) was used to calculate incidence rate ratios (IRR), adjusting for covariates and clustering. Participants with low SPPB scores (0–5) had a 5% increase in incident probable dementia when compared with those who had good SPPB scores (10–12) in the adjusted model (IRR = 1.05; 95% CI = 1.04–1.07). Lower extremity functioning is associated with a modest increase in incident probable dementia. The SPPB score may be helpful in identifying subjects at risk of dementia. Efforts aimed at improving physical functioning may lead to better cognitive outcomes.</jats:p

Poor Lower Extremity Functioning Is Associated with Modest Increased Incidence of Probable Dementia

Lower extremity functioning in older adults provides a measure of poor physical performance and can predict negative health outcomes. The consequences of reduced lower extremity functioning on cognitive decline, measured as time-varying variables, have not been well documented in previous studies. We aimed to evaluate whether lower extremity functioning is associated with an increased incidence rate of probable dementia among older adults using data from the National Health and Aging Trends Study (NHATS). Participants (n = 6457) were followed for 8 years to examine the relationship between lower extremity functioning, as measured by the Short Physical Performance Battery (SPPB), and incident probable dementia. Using weighted data, a multivariable Poisson regression with generalized estimating equations (GEE) was used to calculate incidence rate ratios (IRR), adjusting for covariates and clustering. Participants with low SPPB scores (0–5) had a 5% increase in incident probable dementia when compared with those who had good SPPB scores (10–12) in the adjusted model (IRR = 1.05; 95% CI = 1.04–1.07). Lower extremity functioning is associated with a modest increase in incident probable dementia. The SPPB score may be helpful in identifying subjects at risk of dementia. Efforts aimed at improving physical functioning may lead to better cognitive outcomes

Treating Anemia in Older Adults With Heart Failure With a Preserved Ejection Fraction With Epoetin Alfa

Background— Anemia is a common comorbidity in older adults with heart failure and a preserved ejection fraction and is associated with worse outcomes. We hypothesized that treating anemia with subcutaneous epoetin alfa would be associated with reverse ventricular remodeling and improved exercise capacity and health status compared with placebo. Methods and Results— Prospective, randomized, single-blind, 24-week study with blinded end point assessment among anemic (average hemoglobin of 10.4±1 g/dL) older adult patients (n=56; 77±11 years; 68% women) with heart failure and a preserved ejection fraction (ejection fraction=63±15%; B-type natriuretic peptide=431±366 pg/mL) was conducted. Treatment with epoetin alfa resulted in significant increases in hemoglobin ( P &lt;0.0001). Changes in end-diastolic volume (−6±14 versus −4±16 mL; P =0.67) at 6 months did not differ between epoetin alfa and placebo, but declines in stroke volume (−5±8 versus 2±10 mL; P =0.09) without significant changes in left ventricular mass were observed. Changes in 6-minute walk distance (16±11 versus 5±12 m; P =0.52) did not differ. Although quality of life improved by the Kansas City Cardiomyopathy Questionnaire and the Minnesota Living with Heart Failure Questionnaire in both cohorts, there were no significant differences between groups. Conclusions— Administration of epoetin alfa to older adult patients with heart failure and a preserved ejection fraction compared with placebo did not change left ventricular end-diastolic volume and left ventricular mass nor did it improve submaximal exercise capacity or quality of life. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00286182. </jats:sec

Blood volume measurements in patients with heart failure and a preserved ejection fraction: implications for diagnosing anemia.

Racial differences in the prevalence of anemia in patients with heart failure have been noted. The diagnosis of anemia in heart failure patients can be confounded by many factors. Plasma volume expansion is one of the most prominent confounders. The authors investigated the difference of anemia prevalence using two different diagnostic techniques: peripheral hemoglobin recommended by the World Health Organization criteria and blood volume (BV) analysis. Racial disparities in the prevalence of anemia using both measures were compared. Sixty patients with heart failure and preserved ejection fraction (HFPEF) underwent measurement of BV by a radio-labeled albumin technique. Anemia was defined by both WHO criteria and by measured red blood cell volume (RBCV) \u3e10% below ideal. Anemia was found in 67% of patients by the peripheral hemoglobin technique with no racial disparity. Only 35% of the patients had anemia by the BV analysis, with a 2-fold higher prevalence among Hispanics compared with whites and blacks. In patients with HFPEF, the diagnosis of anemia based on hemoglobin is confounded by plasma volume derangements resulting in significant overdiagnosis in this cohort. Racial differences in the rate of anemia were found. Such data could have important implications for the diagnosis and management of anemia in ethnic minorities with HFPEF