Risultati per: Dalla presbifagia alla sarcopenia, il trattamento in medicina generale

Circulation, Volume 150, Issue Suppl_1, Page A4145958-A4145958, November 12, 2024. Background:Sarcopenia is an objective and comprehensive marker of frailty and an important predictor of outcomes after cardiac surgery. Its utility is challenging due to difficulty in its assessment.Hypothesis:We hypothesize that sarcopenia defined as pectoralis major cross-sectional area (PMA) from CT Chest is a useful predictor of cardiac surgery outcomes.Aim:The aim of this study is to develop Gender Specific Cut-off Points for PMA as a marker for sarcopenia and to evaluate the associations between sarcopenia and post-operative cardiac surgery outcomes.Methods:This study includes 237 subjects with pre-operative CT Chest scans who underwent any Cardiac Surgery involving sternotomy from 2019 to 2023 at the Townsville University Hospital, Australia. The Pectoralis Major Muscle Area, Density and Thickness measurements were performed at the level of 4th thoracic vertebra in Axial view. The sarcopenia cut-off value was defined as the lowest sex-specific quartile in PMA. Intra and post-operative outcomes up to 30-days, were collected.Results:The Cut-off values for PMA were set at 1045mm2for males and 609mm2for females, with 59 subjects meeting the criteria for sarcopenia. Sarcopenic patients required longer hospitalization (10.8±6.93 vs 8.37±5.26 days; P=0.006), longer intubation and stay in ICU, and experienced more post-operative complications within the first 30 days after surgery (p=0.002). Post-operative mortality was similar in both groups.Logistic regression analysis revealed that sarcopenia is associated with increased risk in days of extended hospital stays (OR=5.08, 95% CI: 2.35-10.96, p

Objectives
To identify and map the available evidence for whether a test of handgrip strength (HGS) and/or the chair stand test (CST) have been used as screening tools for the detection of sarcopenia in elderly individuals within primary care settings.

Design
This study was designed as a scoping review, in accordance with the methodological framework for scoping reviews, developed by Arksey and O’Malley, and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.

Data sources
A literature search was conducted to identify relevant articles listed in PubMed and Scopus databases up to 16 October 2023.

Eligibility criteria
Studies including individuals aged ≥60 years who had undergone assessments of HGS and/or the CST in primary care settings were included.

Data extraction and synthesis
Following the article selection process, based on predetermined criteria for inclusion and exclusion, the selected articles were analysed regarding population demographics, the setting in which the research was conducted, the study design, used diagnostic tools and reported results.

Results
The search yielded 282 unique articles, of which 7 were included in the final analysis. All seven included articles had a cross-sectional study design, whereof one also had a longitudinal 3-year follow-up. The number of participants ranged from 75 to 719. Three of the articles used the diagnostic criteria presented by European Working Group on Sarcopenia in Older People (EWGSOP), two used the criteria by Asian Working Group for Sarcopenia 2019, one used the EWGSOP2 criteria and one applied both the EWGSOP and EWGSOP2 criteria to their data. All the articles used HGS to assess muscle strength. CST was not used for this purpose in any of the articles, although it was used to estimate physical performance or as part of the short physical performance battery. The prevalence of sarcopenia in the included articles was 12.0%–20.7%, while the prevalence of possible sarcopenia was 69.9%–73.3% and that of probable sarcopenia was 25.5%–94%.

Conclusion
None of the included articles aimed to study a test of HGS and/or the CST as screening tools for the detection of sarcopenia. However, four of the articles diagnosed possible or probable sarcopenia by using a test of HGS and/or the CST among elderly patients in a primary care setting. There is a need for more research to elucidate whether a test of HGS and/or the CST might be used for screening of sarcopenia in primary care.

Objectives
To examine the association between the sarcopenia index (SI) and the risk of intraprocedural events and post-discharge death during percutaneous coronary intervention (PCI).

Design
A retrospective cohort study.

Setting
The study was conducted at a teaching hospital in Western China.

Participants
The participants were patients aged 45 years and older who underwent PCI at the hospital and had an estimated glomerular filtration rate (eGFR) of ≥15 mL/min/1.73 m2. Patients who died during hospitalisation, as well as those with unknown death dates, those lost to follow-up and those with missing information for the SI calculation, were excluded.

Primary and secondary outcome measures
The SI was calculated as serum creatinine/cystatin C (Cr/CysC) x 100. The high-SI group was defined as the highest quartile, while the remaining participants were included in the low-SI group. Intraprocedural events included intraprocedural coronary slow flow (CSF)/coronary artery no-reflow (CNR) and malignant ventricular arrhythmia (MVA). In the event of death, the date of death was recorded.

Results
The study included 497 patients who underwent PCI in our hospital, of whom 369 (74.25%) were males. A total of 57 (11.47%) patients developed CSF, 100 (20.12%) developed CNR and 4 (0.8%) developed MVA. Forty-four (8.85%) patients died post-discharge. The proportion of patients in the low-SI group who developed CSF was higher than those who did not (16.94% vs 9.65%, p=0.027). In addition, the average SI was lower in patients who developed CSF than in those who did not (81.99 vs 87.11, p=0.043). After adjusting for possible confounding factors, logistic regression analysis showed that the risk of CSF in the low-SI group was higher than that in the high-SI group (OR = 2.01, 95% CI: 1.04 to 3.89). In addition, it was found that the lower the SI, the higher the risk of CSF (OR = 0.983, 95% CI: 0.967 to 0.999).

Conclusions
Patients with lower SI had a greater risk of developing CSF, and the lower the SI, the higher the risk of CSF. However, these data suggest that SI is not associated with CNR and the risk of post-discharge death in patients after PCI.

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Introduction
Sarcopenia is characterised by the progressive weakening of muscle function that occurs with age. This condition frequently leads to frailty, disability and even death. Research on sarcopenia prevention is growing. Digital health exercise interventions are increasingly gaining attention in this field, with the rapid advancement of the internet and the influence of the COVID-19. However, there is a lack of empirical support for their effectiveness. Our study aims to assess the effect of digital health exercise intervention on sarcopenia in older persons, specifically focusing on its ability to improve muscle strength, muscle mass and physical performance.

Methods and analysis
Searching will be performed in the following 11 databases (Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, WOS, Scopus, CBM, CNKI, WANFANG and VIP) for published trials and 2 trial registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform) for unpublished trials. Google Scholar will be used to find grey literature. The criterion of inclusion will be clinical trials involving digital health exercise interventions in older adults (≥60 years) diagnosed with sarcopenia (possible, confirmed or severe sarcopenia). For data synthesis, we will use a summary table to show the major characteristics of selected trials and a summary graph to demonstrate the risk of bias for each outcome using RoB 2, which will be further discussed in a narrative synthesis. The possibility of meta-analysis for quantitative data will be assessed according to the homogeneity analysis of the trials, using the methods of fixed or random effects model. If meta-analysis is possible, subgroup analysis and sensitivity analysis will be performed as well. Publication bias will be assessed through the use of the funnel plot and Egger’s linear regression test when an adequate number of trials are available. Finally, the Grading of Recommendations, Assessment, Development and Evaluation approach will be used to classify the certainty of evidence body into four categories (high, moderate, low and very low).

Ethics and dissemination
The findings of the systematic review will be shared through publishing in a peer-reviewed journal and presentation at appropriate conferences. Since we will not be using specific patient data, ethical approval is unnecessary.

PROSPERO registration number
CRD42024516930.

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