Factors associated with the lethality of patients hospitalized with severe acute respiratory syndrome due to COVID-19 in Brazil

Due to the high rates of transmission and deaths due to COVID-19, understanding the factors associated with its occurrence, as well as monitoring and implementing control measures should be priority actions in health surveillance, highlighting the use of epidemiological surveillance information systems as an important ally. Thus, the objectives of this study were to calculate the mortality rate of hospitalized patients with severe acute respiratory syndrome due to COVID-19 and to identify factors associated with death, in the period corresponding to epidemiological weeks 01 to 53 of the year 2020. This was a longitudinal study, using the national influenza epidemiological surveillance information system database, routinely collected by healthcare services. The sociodemographic and clinical characteristics of 563,051 hospitalized patients with severe acute respiratory syndrome due to COVID-19 in the five regions of Brazil were analyzed. Cox regression was performed to assess factors associated with patient death during hospitalization. The national lethality rate was 35.7%, and the highest rates of lethality occurred in the Northeast (44.3%) and North (41.2%) regions. During the hospital stay, death was associated with older age (Hazard Ratio-HR = 1.026; p<0.001); male sex (HR = 1.052; p<0.001); living in the North (HR = 1.429; p<0.001), Northeast (HR = 1.271; p<0.001) or Southeast regions of Brazil (HR = 1.040; p<0.001), presenting any risk factor (HR = 1.129; p< 0.001), the use of invasive (HR = 2.865; p<0.001) or noninvasive (HR = 1.401; p<0.001) mechanical ventilation devices. A high case lethality rate was evidenced in patients with severe acute respiratory syndrome due to COVID-19, however, deaths were not evenly distributed across the country's regions, being heavily concentrated in the Northeast and North regions. Older male patients living in the North, Northeast, or Southeast regions of Brazil, who presented any risk factor and were submitted to the use of invasive or noninvasive mechanical ventilation devices, presented a higher risk of evolving to death.

Hospitalizations and mortality by severe acute respiratory syndrome: comparison between the pre-pandemic and pandemic periods

OBJECTIVE

To analyze the characteristics and the factors associated with mortality of cases hospitalized for severe acute respiratory syndrome in a health region, in pre-pandemic and pandemic periods.

METHODS

A retrospective documentary study of epidemiological surveillance carried out with secondary data from the Influenza Epidemiological Surveillance Information System, regarding the cases of patients belonging to a health region of Minas Gerais, Brazil.

RESULTS

During the pandemic period, there was an increase in the number of hospitalizations and deaths due to severe acute respiratory syndrome, in addition to differences between sociodemographic and clinical-epidemiological characteristics. In both periods, the age and the use of invasive ventilatory support were the predictors of hospital mortality. The mortality in the pandemic period was also associated with male gender, presence of risk factors, admission to an intensive care unit, use of non-invasive ventilatory support, and infection by COVID-19.

CONCLUSIONS

In 2020, the detection rate of severe acute respiratory syndrome was 21 times higher than in 2019 and new symptoms, such as anosmia and ageusia, were included in their investigation. In both periods evaluated, elderly patients and patients on invasive mechanical ventilation had a higher risk of mortality. With the pandemic, there was a greater number of hospitalizations and factors associated with mortality.

Does the relationship between 25-hydroxyvitamin D status and bone mass vary according to skin color in adults? Results of a Brazilian population-based study

Skin color has been indicated as an important factor in determining serum concentrations of 25-hydroxyvitamin D [25(OH)D], and consequently bone health. However, studies are controversial and scarce for mixed populations.

PURPOSE/INTRODUCTION

To analyze the association of 25(OH)D with bone mineral content (BMC) and bone mineral density (BMD); and to investigate the presence of interaction with skin color in Brazilian adults.

METHODS

This is a cross-sectional, population-based study conducted with adult individuals (20-59 years) of both genders. Bone health was assessed by dual energy radiological absortometry. Vitamin D status was measured using serum 25(OH)D. Skin color and other variables in the adjusted model were collected using a questionnaire and anthropometric assessment. Associations and interactions were evaluated using linear regression models stratified according to gender.

RESULTS

Non-white men with vitamin D deficiency (< 20.0 ng/mL) have less bone mass than those with insufficiency and sufficiency for the femoral neck and hip sites. According to the adjusted regression analysis, the deficient status of 25(OH)D in men was associated with worse bone health for the lumbar spine sites (β = - 0.1; p = 0.006), femoral neck (β = - 0.08; p = 0.006), and hip (β = - 0.08; p = 0.009). No statistically significant associations were observed between 25(OH)D and bone health in women. In addition, no statistical interaction was identified between skin color and vitamin D status in relation to bone health (p > 0.05 for all tests) in either gender and for all bone sites evaluated.

CONCLUSION

Deficient vitamin D status is associated with lower bone mass in adults with differences observed according to gender, but not according to skin color.

Association between Skeletal Mass Indices and Metabolic Syndrome in Brazilian Adults

INTRODUCTION

Skeletal muscle is the primary site of glucose uptake and its reduction would increase insulin resistance, which is a determinant factor for diseases such as type 2 diabetes mellitus, hypertension, and metabolic syndrome. However, the role of low skeletal muscle mass as a risk factor for metabolic syndrome and its association with cardiometabolic risk is still uncertain. We aimed to investigate the association between muscle mass (determined by different skeletal mass indices) and metabolic syndrome in Brazilian adults.

METHODOLOGY

We conducted a cross-sectional population-based study with 689 adults of both sexes aged between 20 and 59 years. Data were collected through questionnaires and assessment of body composition through dual-energy X-ray absorptiometry and anthropometric, clinical, and biochemical measurements.

RESULTS

Older individuals, obese and those with metabolic syndrome predominated in the highest tertile of skeletal mass index adjusted by height (SMI_height), whereas using skeletal mass index adjusted by weight (SMI_weight) and skeletal mass index adjusted by body mass index (SMI_BMI) these individuals were the majority in the lowest tertile of these indices. In men and women, the adjusted logistic regression model revealed that the highest tertile of SMI_weight (odds ratio [OR]: 0.06; 95% confidence interval [CI]: 0.02-0.21 and OR: 0.27, 95% CI: 0.10-0.74) and SMI_BMI (OR: 0.14, 95% CI: 0.05-0.37 and OR: 0.34, 95% CI: 0.12-0.94) were negatively associated with metabolic syndrome. On the other hand, the highest tertile of SMI_height was positively associated with metabolic syndrome in both sexes (OR: 4.17, 95% CI: 1.80-9.66 and OR: 6.15, 95% CI: 2.31-16.37, respectively in men and women).

CONCLUSION

In adults, the muscle mass assessed from the skeletal mass index adjusted for body weight and body mass index is inversely associated with metabolic syndrome in both sexes.

Factors associated with bone mineral density in adults: a cross-sectional population-based study

OBJECTIVE

This study aimed to analyze the association between lumbar spine, femoral neck, total hip bone mineral density (biophysical bone health assessment parameter), and sociodemographic, anthropometric, behavioral, and health condition factors in Brazilian adults.

METHOD

This is a cross-sectional, population-based study performed with individuals of both genders, aged between 20 and 59 (n=701). The dependent variables were evaluated by Dual Energy X-ray Absorptiometry. The independent variables were evaluated through a questionnaire, anthropometric evaluation and blood collection. The association between bone mineral density and the independent variables was evaluated by linear regression analysis. All analyses were stratified by gender.

RESULTS

Men presented higher bone mineral density than women. Bone mineral density was inversely associated with age range and directly associated with nutritional status in both genders and in the three bone sites analyzed. In addition, 25 Hydroxyvitamin D deficient status among men and contraceptive use among women were associated with lower bone mineral density, and a significant association was only found with lumbar spine bone mineral density in women.

CONCLUSION

The factors associated with bone health among men were age, skin color, nutritional status, and vitamin D status. For women, the associated factors with bone health were age, skin color, nutritional status and contraceptive use.

Vitamin D and bone health in adults: a systematic review and meta-analysis

Low bone health is associated with vitamin D deficiency in older individuals; however, this association is not well established in adults. The aim of the study was to analyze the association between serum concentrations of 25-hydroxyvitamin D and bone health in adults by systematic review and meta-analysis. The search was carried out in the LILACS, PubMed, Scopus, Web of Science, ScienceDirect databases from March 2017 to October 2018 with adult individuals (20-59 years). Bone health was evaluation performed through dual X-ray absorptiometry and serum concentrations of 25(OH)D. The random effect model was used to analyze data from bone mineral content and bone mineral. Random effects models were used and the sources of heterogeneity were explored by means of meta-regression. Thirty-five articles were selected. There was positive correlation between vitamin D and bone health in most of the evaluated sites. Correlation was observed in the analysis of subgroups for lumbar spine among men. When stratified, the studies presented high heterogeneity, which was explained by the sample size, mean serum vitamin D levels and risk of bias. Vitamin D is positively correlated to bone health in adult individuals.

Factors associated with bone mineral content in adults: a population-based study

OBJECTIVE

To determine the association among bone mineral content, sociodemographic, anthropometric and behavioral factors, and health status of Brazilian adults.

METHODS

This was a cross-sectional, population-based study including 701 individuals from both sexes aged between 20 and 59 years. DEXA was used to evaluate dependent variable. The associations were evaluated using linear regression models stratified by sex.

RESULTS

When mean bone mineral content values were compared, we found significant differences related to sex and all the independent variables evaluated. In the adjusted models, we identified an inverse association between bone mineral content and age in both sexes. Among men, to be overweight and/or obese, be highly educated, and have almost sufficiency of 25(OH)D were associated with higher bone mineral content values. On the other hand, among women, to be non-white skin color, overweight and/or obese were associated with better bone health. The main factors associated with low total bone mineral density were advanced age, white skin color, low level of formal education, eutrophy, and 25(OH)D deficiency.

CONCLUSION

Our results may help to identify adults who are at higher risk, and these findings should be used as guidelines for prevention and early diagnosis.

Body composition indices in Brazilian adults: age-specific and sex-specific percentile curves

OBJECTIVE

To establish percentile curves for measures and indices of body composition by age and sex and compare them with data from other ethnic groups.

SUBJECTS AND METHODS

Cross-sectional, population-based study with adults aged 20-59 years (n = 689). Percentile curves adjusted by a third degree polynomial function were constructed for skeletal mass index (SMI), fat mass index, body fat, and load-capacity metabolic indices (LCMI) based on dual-energy X-ray absorptiometry (DXA).

RESULTS

SMIweight and SMIBMI showed decline from the third decade of life in both sexes, whereas SMIheight was not able to identify lean mass loss over the ages studied. There was a slight drop at the end of the fifth decade (50-59 years) in men. Among Americans and Chinese, the 50th percentile curve of SMIheight showed an earlier decline. The estimates of adiposity and LCMI curves peaked between 40-49 years and Americans and Chinese maintained an upward curve throughout adulthood.

CONCLUSION

The data and curves showed that the SMI adjusted for BMI and body weight were more adequate in detecting the decline of lean mass in adults due to aging. In contrast, SMIheight had a positive correlation with age and its curve increased throughout the evaluated age groups. The results contribute to the evaluation to the nutritional status of adults and to the prevention and treatment of outcomes related to adiposity and deficit lean mass.

AEROBIC AND RESISTANCE EXERCISE IN PATIENTS WITH RESISTANT HYPERTENSION

ABSTRACT Introduction: Physical training is recommended by current guidelines as a preventive measure and as a tool to supplement pharmacological therapy in the treatment of hypertension and its pathological manifestations. However, there is considerable uncertainty regarding the best training prescription for blood pressure control in patients with resistant hypertension. Objective: To evaluate the effect, over twelve weeks, of an aerobic and resistance exercise program on blood pressure, anthropometric and biochemical parameters of patients with resistant hypertension. Methods: Eleven patients with resistant hypertension were randomly divided into two groups: resistance training and aerobic training. Blood pressure was recorded by 24-hour outpatient monitoring before and after 12-week training. The Student t-test was used to compare resistance and aerobic exercise groups, while the paired t and Wilcoxon tests were used to analyze pre- and post-exercise data. The level of significance was 0.05. Results: In the group that underwent aerobic training, mean systolic, diastolic and total blood pressure readings were significantly lower over the 24 hours analyzed, dropping by 14 mmHg, 7 mmHg and 10 mmHg, respectively, and in the waking period. The resistance training group showed no significant change in blood pressure, despite the significant improvement in HDL levels. Conclusion: Twelve weeks of aerobic exercises resulted in significantly lowered blood pressure in individuals with resistant hypertension, while resistance exercises were more effective in increasing HDL. Level of evidence II, Therapeutic study.

DENSITOMETRIA ÓSSEA, CTX, NÍVEL DE ATIVIDADE FÍSICA E FORÇA NA PÓS-MENOPAUSA

RESUMO Introdução: O tecido ósseo pode ser avaliado quantitativamente pela densitometria, porém ao associar os biomarcadores ósseos é possível predizer fragilidade óssea mais precocemente. Contudo, pouco se sabe sobre correlação entre ambos, como também sobre o nível de atividade física atual e a força muscular. Objetivo: Avaliar a correlação dos valores da densidade mineral óssea (DMO) aos do biomarcador sanguíneo ósseo (CTX) e também com o nível de atividade física mensurada pelo pedômetro e o questionário IPAQ, versão longa e com os testes de força em mulheres na pós-menopausa. Método: Estudo transversal e descritivo de 62 mulheres na pós-menopausa, saudáveis, média de idade de 56,82 ± 4,02 anos, avaliadas quanto ao nível de atividade física atual, força, DMO e CTX. Foi realizada densitometria óssea corporal total, de coluna lombar, fêmur e antebraços, além de mensuração de CTX, cálcio iônico, fósforo e PTH. Dois grupos foram formados: controle com DMO normal e grupo com DMO diminuída. Utilizou-se teste t de Student, qui-quadrado e Pearson. Resultados: Não houve diferenças estatisticamente significativas entre os dois grupos para testes de força, nível de atividade física atual e força muscular com relação ao CTX, porém houve associação do valor deste à DMO. Conclusão: Foi demonstrada dependência do CTX com relação aos valores de DMO total e da coluna lombar, ocorrendo baixa DMO quando o CTX estava entre moderado e alto. Isso indica que esse biomarcador talvez possa ser utilizado como forma de triagem de indivíduos com risco de baixa DMO e maior risco de fraturas.

Effects of different exercise programs and minimal detectable changes in hemoglobin A1c in patients with type 2 diabetes

BACKGROUND

The incidence of diabetes mellitus is increasing worldwide, resulting in a global epidemic. The most common type, the type 2 diabetes mellitus, constitutes of 90-95 % of the cases and is characterized by the action of and/or impaired insulin secretion. Regular exercise is a recommended strategy in several studies and guidelines for type 2 diabetes control and complications associated with it. Therefore, we evaluated and compared the effects of aerobic and strength exercise programs on the glycemic control in patients with type 2 diabetes.

METHODS

The selected patients were divided into groups which performed moderate strength training (ST) and aerobic training (AT). The study lasted 20 weeks and was divided into two 10 week phases with anthropometric (body mass index, waist, abdomen and hips circumferences, waist/hip ratio) and biochemical (glycemic and lipid profile) assessments at baseline, 10 weeks and 20 weeks. For intra and inter analyses a mixed ANOVA model was used. Individual changes were calculated using the minimum detectable change, based on a 90 % confidence interval.

RESULTS

Eleven patients (five men and six women) completed the 20 weeks of training; five from the ST group and six from the AT. No significant changes were observed in any anthropometric variable in either group. Statistically significant differences were found in mean hemoglobin A1c in both groups between baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 10 weeks (AT: 7.2 ± 1.7; ST: 7.9 ± 1.2) (p = 0.03), and baseline (AT: 8.6 ± 2.5; ST: 9.2 ± 1.9) and 20 weeks (AT: 7.5 ± 1.7; ST: 7.4 ± 0.9) (p = 0.01). For the minimal detectable changes, 40 % of the ST and 33 % of AT achieved these changes for hemoglobin A1c.

CONCLUSION

Both aerobic and strength exercises can help the metabolic control in patients with type 2 diabetes, even without significant changes in anthropometry over the 20 weeks of training. However, this period was sufficient to cause changes in hemoglobin A1c values and the estimated average glucose, which are important parameters in controlling diabetes, thus signaling an important consequence of adhering to an exercise routine for type 2 diabetic patients.

Improved cognitive, affective and anxiety measures in patients with chronic systemic disorders following structured physical activity

Mental illnesses are frequent co-morbid conditions in chronic systemic diseases. High incidences of depression, anxiety and cognitive impairment complicate cardiovascular and metabolic disorders such as hypertension and diabetes mellitus. Lifestyle changes including regular exercise have been advocated to reduce blood pressure and improve glycaemic control. The purpose of this project was to evaluate the effect of physical training on the most prevalent corollary psychiatric problems in patients with chronic organic ailments. This longitudinal study assessed the mental health of hypertensive (age: 57 ± 8 years) and/or diabetic (age: 53 ± 8 years) patients using mini-mental state examination, Beck's depression inventory, Beck's anxiety inventory and self-reporting questionnaire-20 before and after a 3-month supervised resistance and aerobic exercise programme comprising structured physical activity three times a week. Clinically relevant improvement was observed in the Beck's depression inventory and Beck's anxiety inventory scores following the 12-week training (61%, p = 0.001, and 53%, p = 0.02, respectively). Even though statistically not significant (p = 0.398), the cognitive performance of this relatively young patient population also benefited from the programme. These results demonstrate positive effects of active lifestyle on non-psychotic mental disorders in patients with chronic systemic diseases, recommending exercise as an alternative treatment option.

Associação de força e nível de atividade física à densidade mineral óssea na pós-menopausa

INTRODUÇÃO: o exercício físico atua melhorando a densidade mineral óssea DMO por gerar deformidades nesse tecido e estimular remodelação.OBJETIVO: verificar a associação entre força muscular e nível de atividade física à densidade mineral óssea DMO utilizando testes de força de bíceps, de sentar e levantar, dinamometria de mãos, história pregressa de atividade física e nível de atividade física, avaliado pelo pedômetro com a DMO em mulheres na pós-menopausa.MÉTODOS: estudo transversal, descritivo que mensurou a densidade mineral óssea pela absorção de dupla energia de raios X DXA da coluna lombar L1-L4, fêmur e antebraços em 62 mulheres saudáveis no pós-menopausa, com média de 56,82 ± 4,02 anos de idade. Foi aplicado questionário para atividade física pregressa e realizada contagem diária de passos pedômetro. A força muscular foi medida pelos testes de dinamometria de mãos, de 30 segundos de bíceps bilateral e de sentar e levantar da cadeira em 30 segundos. Realizou-se registro alimentar de três dias para mensuração da ingestão diária de cálcio e vitamina D.RESULTADOS: os indivíduos apresentaram altos níveis de atividade física, porém baixa ingestão diária de cálcio e vitamina D. Não foi verificada diferença estatisticamente significativa entre força muscular nos dois grupos estudados, com DMO diminuída e DMO normal. O grupo com DMO diminuída apresentou maior número de passos diários e menor peso quando comparado com o grupo com DMO normal. Foram observadas várias correlações positivas de baixa magnitude, embora significantes, entre a densitometria e a força muscular p < 0,50.CONCLUSÃO: os autores descreveram risco cinco vezes e meia maior em mulheres não praticantes de atividade física da adolescência até a idade adulta e de apresentarem redução da DMO em comparação com as mulheres que apresentaram DMO normal.