Patients with clinically metabolically healthy obesity are not necessarily healthy subclinically: further support for bariatric surgery in patients without metabolic disease?

Background

Nonalcoholic fatty liver disease (NAFLD) increases the risk of liver cirrhosis and hepatocellular carcinoma and is also strongly correlated with extrahepatic diseases, including cardiovascular disease and type 2 diabetes. This risk of NAFLD among obese individuals who are otherwise metabolically healthy is not well characterized.

Does scapular elevation accompany glenohumeral abduction in healthy subjects?

Introduction Although it is used in clinical practice, there are no data concerning scapular elevation during glenohumeral abduction.Materials and methods Scapular elevation of 30 healthy volunteers in supine and sitting positions were measured at 90–180 deg of glenohumeral abduction by two examiners. In addition, radiographs of the ten subjects were taken in supine position at 0–180 deg of glenohumeral abduction, and the scapular elevation measurements were repeated. Also, the movements of five anatomical landmarks (acromioclavicular joint, center of glenoid cavity, scapular notch, angulus superior and inferior) were measured with regard to transverse and vertical axes.Results The values obtained for scapular elevation during 90, 120, 150, and 180 deg of glenohumeral abduction were (mean and SD) 26.63 and 3.96, 31.77 and 4.36, 35.97 and 5.15, 40.10 and 5.18 deg, respectively. There were no significant differences with regard to side, gender, and position of the subject. No correlation was found between the clinical and radiological measurements. Movements of certain points did not reveal progressive upward motion.Conclusion There is no scapular elevation but rather rotation during glenohumeral joint abduction. Normal values given in the present study can be used in clinical examinations.     

Necrotizing soft tissue infections--are they different in healthy vs immunocompromised children?

Purpose

Necrotizing soft tissue infection (NSTI) is rare and often devastating. We sought to define our experience and determine if differences in immune status influenced outcome.

Methods

A retrospective review (1993-2004), with institutional review board approval, was undertaken on children with NSTI. Presentation, laboratory results, and outcome were assessed.

Results

There were 19 cases; the median age was 5.9 years (range, 6 days-14 years). Eight were immunocompromised (IC). At presentation, 95% had pain and swelling; fever and tachycardia occurred in 84% and 74%, respectively. Severe tenderness was found in 100% of healthy vs 25% of IC patients. Compared with the healthy, in IC patients, more infections were perineal/buttock (75% vs 32%), polymicrobial (75% vs 58%), and fungal (38% vs 0%). Median intensive care unit stay and length of hospital stay in IC vs healthy were 4 vs 2 and 27 vs 16.5 days, respectively. Mortality rate was 16% (2 healthy and 1 IC).

Conclusions

Most children with NSTI present with fever, tachycardia, pain, and swelling. Compared with healthy children, IC patients are less likely to have severe tenderness and more likely to have polymicrobial perineal/buttock infections. Although IC patients had a longer length of intensive care unit and hospital stay, their mortality (12%) was actually better than that seen in the otherwise healthy children (18%). Coagulopathy developed in 64% of the patients and may be an early marker for the presence of necrotizing soft tissue infections.     

Electrocardiographic monitoring in healthy young adult outpatients: mandatory or optional?

Purpose

To determine the incidence and duration of ECG abnormalities in healthy adults during short duration outpatient surgery and their relationship to important clinical events.

Method

In 381, ASA Class I, day surgery patients undergoing short surgical procedures the ECG was monitored prospectively for evidence of abnormalities. The attending anaesthetist administered the anaesthetic and made all clinical decisions while relying on routine monitors (ECG, oximeter, BR capnometer, oxygen analyser, low pressure alarm and anaesthetic gas monitors). Intra-operative events of clinical significance (e.g., light anaesthesia, regurgitation, coughing, hypotension, arterial desaturation, hiccoughs etc), ECG abnormalities and their duration were documented.

Results

Electrocardiographic abnormalities were detected in 21 % of patients as follows: sinus tachycardia (11 %), artifacts (7%), premature atrial contractions (1.6%), lead disconnects (1%), sinus bradycardia (0.5%) and premature ventricular contractions (0.3%). All abnormalities resolved spontaneously within three minutes. Intra-operative incidents of consequence occurred in only 2.6%: light anaesthesia (5), arterial desaturation > 5% (2), hypotension (1), hiccough (1) and régurgitation (1). All incidents were detected clinically and by pulse oximetry. The ECG did not detect any of the incidents and was normal during the events.

Conclusion

Routine ECG monitoring did not detect intra-operative incidents in healthy adults during short outpatient procedures. Detected ECG abnormalities were benign and resolved spontaneously within three minutes. Firm conclusions as to the safety implications of withdrawing ECG monitoring cannot be drawn from this study. Guidelines may need to be reviewed to determine whether ECG monitoring in such cases should be optional rather than mandatory.     

Bone health in healthy Indian population aged 50?years and above

Summary  

One thousand six hundred healthy subjects aged more than 50 years, residing in Delhi, were evaluated for bone mineral metabolic parameters. High prevalence of osteoporosis (35.1% subjects) was observed in this population. Bone mineral density (BMD) correlated positively with body mass index (BMI) and negatively with PTH levels. No correlation was observed with serum 25(OH)D levels.     

Urine sodium composition in ambulatory healthy children: hypotonic or isotonic?

A controversy exists in the literature as to the most appropriate sodium concentration for maintenance parenteral fluids. The purpose of this study was to evaluate urinary sodium composition in otherwise healthy children in order to help determine if 0.9% sodium chloride (NaCl) would be an appropriate parenteral fluid. The composition of urinary sodium was evaluated over 24 h in 100 otherwise healthy children aged 3–18 years referred to a pediatric nephrology outpatient clinic for hematuria or proteinuria. The average urine sodium concentration was 158 ± 59 mEq/l, similar to that of 0.9% NaCl (154 mEq/l). Urine sodium excretion was 2.9 ± 1.3 mEq/kg per 24 hours, and urine flow rate was 0.9 ± 0.4 ml/kg per hour. It was concluded that healthy children generate free water via the excretion of a hypertonic urine. It is unlikely that 0.9% NaCl would result in hypernatremia when administered in parenteral fluids.     

How to toilet train healthy children? A review of the literature

AIMS: To review the literature on toilet training (TT) in healthy children. METHODS: Through an extended literature search, all data on developmental signs of readiness for TT, TT methods, definitions of being toilet trained, TT problems, and predictive factors for success were reviewed. RESULTS: Specific studies on this topic are few. Two main methods for TT have been described so far in the last decades: the gradual child-oriented training and the structured, endpoint-oriented training. In the former method parents mainly respond to the child's signals of toileting "readiness". The latter method consists of actively teaching several independent toileting behaviors. Data are too few to be able to compare the methods. Literature does not give a consensus about the optimal age for starting nor on the expected mean age of completing TT. Recent studies show most children to start training between 24 and 36 months of age with a current trend toward a later completion than in previous generations. The consequence of this can be stress for the parents and more use of diapers, with its negative effect on the environment. CONCLUSION: There are as yet little data to be found on this important topic, only few studies have been published in peer-reviewed journals. Standardization of terminology and critical evaluation of the described techniques in large sample sizes is needed. With this approach, general principles of training, evidence based and easy to use in the majority of children, may become available to parents.     

Serum sclerostin levels in healthy men over 50 years of age

The aim of this study is to evaluate the relationship of serum sclerostin levels with age, cystatin C, bone mineral density (BMD) and biochemical markers of bone turnover in healthy Hungarian men >50 years of age. We determined serum levels of sclerostin and examined its relationship to age, cystatin C, osteocalcin, C-terminal telopeptides of type-I collagen, procollagen type 1 amino-terminal propeptide, 25-hydroxyvitamin D, parathyroid hormone, and L1–L4 (LS) and femur neck (FN) BMD data available from 194 randomly selected ambulatory men belonging to the HunMen cohort. In the study population as a whole [n = 194; age (median, range) 59 (51–81) years], statistically significant correlation was found between sclerostin and age (r = 0.211; p = 0.003), cystatin C (r = 0.246; p = 0.001), FN BMD (r = 0.147; p = 0.041) and LS BMD (r = 0.169; p = 0.019). Compared to middle-aged men (age ≤59 years, n = 98), elderly men (age >59 years, n = 96) had significantly higher serum sclerostin levels (67.8 ± 15.9 vs 63.5 ± 14 pmol/L; p = 0.047). Among men with normal (T score >?1.0) FN BMD, the elderly had significantly higher serum sclerostin levels compared to the middle-aged men (70.4 ± 17 vs 63.9 ± 11.5 pmol/L; p = 0.019). Furthermore, among the elderly men cystatin C was the only significant predictor of serum sclerostin levels (standardized regression coefficient (β) = 0.487; p < 0.001). In the studied healthy elderly cohort, this study reports a significant increase in sclerostin levels with increasing age and deteriorating kidney function as determined by plasma cystatin C levels.     

Lower-limbs’ muscle coordination mechanism of healthy preschoolers while walking across obstacles

Research backgroundThe obstacle-crossing task is a complex gait task, it requires an advance predict of the obstacle for posture adjustment and accurate control of bilateral legs to ensure crossing the obstacles successfully. By monitoring the activated intensity and duration of muscles in this process, preschoolers' motor ability could be assessed objectively and quantitatively, as well as disclose their potential pathogenesis quality eventually.Scientific questionwhat are the patterns and characteristics of lower limb muscles when they are facing the obstacle-crossing walking (OW) tasks, and how they coordinate their individual muscle or muscle groups of lower-limbs muscles while walking across obstacles? Thereby, the purpose of this study was first to portray the patterns and characteristics of lower limb muscles of healthy preschoolers while OW motion and second to assess the muscles’ coordination mechanism.Method35 healthy preschoolers and 35 healthy adults’ lower limbs' surface electromyography (sEMG) were collected while left and right OW and four muscle groups (Tibialis Anterior, Lateral Gastrocnemius, Rectus Femoris, and Biceps Femoris) were recorded. sEMG variables such as Muscle Activation Time, Total Duration of Activity Time, Average Muscle Activation Rate, and Average Rate of Change were calculated. The paired sample-t-test was used to explore the differences of sEMG variables between preschoolers and adults when obstacle-crossing.ResultsPreschoolers would adjust the gait by changing the activation time and activation rate to fulfill the obstacle crossing tasks, but they also showed variations by contrasting to adults. Further, synergy between muscles in leg and thigh were also found.ConclusionAlthough preschoolers performed well enough to finish the OW tasks, ability gaps were still apparent when compared to adults. Hence, with the help of a deeply recognizable muscle coordination mechanism in OW, motor dysfunction in the lower limbs of preschool children can be effectively identified.     

Causes of secondary hyperparathyroidism in a healthy population: the Tromsø study

Secondary hyperparathyroidism (SHPT) develops as a compensatory mechanism when the body is in calcium deficit. SHPT may be harmful and has been associated with elevated blood pressure. The cause of SHPT could be low calcium intake, reduced intestinal calcium absorption, or increased excretion. However, the relative importance of these factors for the development of SHPT is not known. During the 5th Tromsø study, serum PTH and calcium were measured in 7954 subjects. Then 96 subjects with SHPT (defined as serum PTH above 6.4?pmol/l together with serum calcium below 2.40?mmol/l) and 106 control subjects were examined at follow-up with a food frequency questionnaire, calcium absorption test, measurement of 24-h urinary calcium excretion, and serum vitamin D status. The statistical analyses showed several interactions necessitating subgroup analysis. It was found that the calcium intake was significantly lower in the SHPT group, but only in nonsmoking males; the calcium absorption was nonsignificantly higher in the SHPT group; the serum 25-hydroxyvitamin D levels were significantly lower in the SHPT group but only in nonsmokers; and the 24-h urinary calcium excretion was significantly lower in the SHPT group but only in those not on blood pressure medication. The most frequent cause of SHPT appeared to be low calcium intake (18%) and a low serum 25-hydroxyvitamin D level (18%). However, in most subjects with SHPT all tests were within the normal range, and the cause is therefore probably a combination of several factors.