Background: Cytomegalovirus (CMV) is a common opportunistic infection among HIV-infected individuals, a major source of serious complications among organ-transplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Women infected for the first time during pregnancy are especially likely to transmit CMV to their fetuses. More children suffer serious disabilities caused by congenital CMV than by several better-known childhood maladies such as Down syndrome or fetal alcohol syndrome

IntroductionSarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications.ObjectivesTo investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers.MethodsA total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6.ResultsThe prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022).ConclusionsSarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis.

As avaliações de dietas e o planejamento de consumo são atividades tradicionalmente realizadas por meio da comparação de médias de ingestão contra valores de referência de energia e nutrientes, seja para indivíduos ou grupos. Limitações de ordem técnica devem ser levadas em conta, sem as quais se pode chegar a conclusões equivocadas quanto ao atendimento das necessidades nutricionais. As Recomendações Nutricionais propostas pelo Institute of Medicine dos Estados Unidos, em conjunto com a agência Health Canada, a partir de 1997, conhecidas como Dietary Reference Intakes, representam um novo paradigma para o estabelecimento de indicadores nutricionais de consumo, ao aperfeiçoarem o uso do conceito de risco na avaliação de dietas. Fontes de erro intra ou interindividuais, devidas à variabilidade de padrão de consumo e decorrentes da distribuição das necessidades na população, aliadas a um pequeno número de dias de observação, têm grande impacto sobre a confiabilidade da análise. Por esta razão devem orientar a utilização dos valores, que foram organizados em tabelas com as quatro categorias de nutrientes, publicadas entre 1997 e 2005. O presente trabalho teve por objetivo destacar algumas características de aplicação e consolidar os valores diários de Tolerable Upper Intake Level, Adequate Intake e Recommended Dietary Allowance, facilitando a consulta por parte de profissionais e estudantes da área de nutrição.Termos de indexação: avaliação nutricional; nutrientes; planejamento alimentar; recomendações nutricionais. A B S T R A C TDiet planning and food intake evaluation are professional activities classically performed by comparing mean values of ingestion against reference values of nutrient and energy intakes, for either groups or individuals. 742 | R.M. PADOVANI et al. Rev. Nutr., Campinas, 19(6):741-760, nov./dez., 2006 Revista de Nutrição

BackgroundTransplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients.MethodsThe BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach’s alpha) and validity (content, criterion, and construct validities).ResultsThe final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach’s alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65).ConclusionsThe BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

Drug associations in individuals with CKD were related to high prevalence of serious DIs, especially in the later stages of the disease.

PurposeChronic kidney disease (CKD) induces frailty and worsens quality of life (QOL), even in the early stages of the disease and in young patients. However, there is a lack of knowledge about the relationship between frailty and QOL in CKD patients. Thus, we investigated this relationship in a sample of CKD patients.MethodsA cross-observational study was conducted, in which 61 CKD patients receiving pre-dialysis treatment were assessed. All participants completed the Short Form-36 Health Survey (SF-36). We used valid and reliable methods to classify subjects as frail or non-frail according to Johansen’s et al. (2007) criteria. A one-way analysis of variance (ANOVA) and chi-square tests were used to compare the groups. In addition, Spearman’s correlation analysis was conducted to measure associations between identified variables and frailty. We also performed simple linear regression using the SF-36 physical and mental composite scores.ResultsAlmost half of the sample (42.6%) exhibited evidence of frailty. The groups differed significantly in terms of age, gender, and all SF-36 domains, excluding Social Functioning and Role Emotional. Frailty was significantly associated with all SF-36 domains, again excluding Social Functioning and Role Emotional. Regression analysis revealed no significant between-group differences in composite physical and mental health scores generated by the SF-36 (p > 0.05).ConclusionFrail and non-frail CKD patients differed significantly in seven of the eight SF-36 domains. The frail group displayed diminished physical and mental functioning when their SF-36 scores were divided by their physical and mental composite scores. Frailty was correlated with QOL domains, with the exception of the social domain. There is a need for interventions targeting the characteristics of frailty, to provide better treatment and optimize overall QOL.

This study extends research on hospital-initiated smoking cessation by establishing the feasibility of a novel text-messaging approach for post-discharge follow up. Text messaging is a low-cost alternative to proactive telephone counseling that could help overcome resource barriers in middle and lower income countries. This hybrid texting/counseling intervention identified smokers in hospitals, established rapport through a single telephone follow-up, and expanded acceptability and reach of later support by using text-messaging, which is free of charge in this and other low-income countries. The favorable cessation outcomes achieved by the hybrid intervention provide support for a fully powered effectiveness trial.

A B S T R A C T ObjectiveThe objective of this article was to analyze the development, implementation and impact of a nutrition education program on the knowledge and attitudes associated with healthy eating habits. MethodsControlled randomized trial comprising teachers and children of eight public schools; three of them were submitted to educational activities and the remaining ones were kept as controls. Effects of nutrition education were measured in terms of knowledge and attitudes. ResultsThe results revealed an improvement in the food choice among students and a reduction in the intake of foods with high energy density. An improvement in the knowledge and attitudes of the teachers towards the prevention of obesity was also observed.