Non-acid gastro-oesophageal reflux in children with suspected pulmonary aspiration

Background & aimsIn a group of children with suspected pulmonary aspiration, we aimed to describe the type and physical characteristics of gastro-oesophageal reflux (GOR) episodes, and to determine their correlation with the lipid-laden macrophage (LLM) content in bronchoalveolar lavage (BAL).Patients and methodsTwenty-one children with a diagnosis of bronchial asthma, recurrent lung consolidations and recurrent laryngotracheitis underwent 24-h multichannel intraluminal impedance and pH (MII-pH) monitoring, fibreoptic bronchoscopy and BAL. The following parameters were evaluated: total number of reflux episodes, number of acid reflux [AR; pH < 4] and non-acid reflux [NAR] episodes [pH > 4], height of reflux episodes, LLM content and percentage of neutrophils in the BAL.ResultsThe number of NAR episodes and the number of those reaching the proximal oesophagus were significantly higher in patients with recurrent lung consolidations than in those with bronchial asthma and laryngotracheitis (p < 0.01 and p < 0.01). BAL studies showed a significantly higher LLM content in children with recurrent lung consolidations than in those with bronchial asthma and laryngotracheitis (p < 0.01). The LLM content correlated significantly with the total number of reflux episodes (r = 0.73; p < 0.001) and with those reaching the proximal oesophagus (r = 0.67; p < 0.001). Finally, the LLM content correlated with the number of NAR episodes (r = 0.61; p < 0.01), with those reaching the proximal oesophagus (r = 0.64; p < 0.01) and with the percentage of BAL neutrophils (r = 0.7; p < 0.01).ConclusionNAR episodes reaching the proximal oesophagus correlate with diagnostic marker for pulmonary micro-aspiration. MII-pH monitoring increases the yield in identifying types and proximal extension of reflux episodes, that discriminate between patients with and without pulmonary aspiration.     

Association between post-dinner dietary intakes and nocturnal hypoglycemic risk in adult patients with type 1 diabetes

AimsTo describe (i) current bedtime nutritional practices and (ii) the association between post-dinner dietary intake and the occurrence of non-severe nocturnal hypoglycemia (NH) in real-life conditions among adult patients with type 1 diabetes using insulin analogs.MethodsOne hundred adults (median [interquartile range]: age 46.4 [36.0–55.8] years, HbA1c 7.9 [7.3–8.6] % (63 [56–70] mmol/mol)) using multiple daily injections (n = 67) or insulin pump (n = 33) wore a blinded continuous glucose monitoring system and completed a food diary for 72-h.ResultsNH occurred on 28% of 282 nights analyzed. (i) Patients reported post-dinner dietary intakes on 63% of the evenings. They injected rapid-acting insulin boluses on 64 occasions (23% of 282 evenings). These insulin boluses were mostly injected with (n = 37) dietary intakes. (ii) Post-dinner dietary intake was not associated with NH occurrence in univariate analyses. In multivariate analyses, the injection of rapid-acting insulin modulated the association between post-dinner dietary intake and NH: with insulin, post-dinner carbohydrate intake was positively associated with NH (odds ratio (OR): 1.16 [95% confidence interval, CI: 1.04–1.29] per 5 g increase, p = 0.008); without insulin, post-dinner protein intake was inversely associated with NH occurrence (OR [95% CI]: 0.88 [0.78–1.00] per 2 g increase, p = 0.048).ConclusionsNH remains frequent in adults with type 1 diabetes. There is a complex relationship between post-dinner dietary intake and NH occurrence, including the significant role of nutrient content and rapid-acting insulin injection that requires further investigation.     

Ferroportin Q248H mutation,hyperferritinemia and atypical type 2 diabetes mellitus in South Kivu

BackgroundThe ferroportin Q248H mutation is relatively common in sub-Saharan Africa. No previous study examined its relationship with atypical diabetes mellitus (DM) in this area.ObjectiveTo determine the potential interactions between ferroportin Q248H mutation, hyperferritinemia and DM in South Kivu (RDC).MethodologyPresence of ferroportin Q248H mutation and iron status were investigated in diabetic patients (n = 179, age (mean) 57.7 years, CRP (median) 0.16 mg/L) and non-diabetic subjects (n = 86, age 44.5 years, CRP 0.07 mg/L) living in the city of Bukavu. Hyperferritinemia was considered for values greater than 200 and 300 μg/L in women and in men, respectively.ResultsThe prevalence of ferroportin Q248H mutation [12.1%] was non-significantly higher in diabetics than non-diabetics [14.0% vs. 8.1%, p = 0.17]. Similarly, hyperferritinemia frequency was higher in diabetic patients with Q248H mutation [44.0% vs. 14.3%, p = 0.16] and in mutation carriers [37.0% vs 16.5%, p = 0.001] than in the control groups, respectively. The association between Q248H mutation and DM was nevertheless not significant [adjusted OR 1.70 (95% CI: 0.52–5.58), p = 0.37], whereas hyperferritinemia [OR 2.72 (1.24–5.98), p = 0.01] showed an independent effect after adjustment for age and metabolic syndrome.ConclusionsThe present work suggests a potential association between abnormal iron metabolism, ferroportin Q248H mutation and atypical DM in Africans, which may be modulated by environmental factors.     

A new index predicts early allograft dysfunction following living donor liver transplantation: A propensity score analysis

Objective/AimThe aim of this study was to identify a new index to predict early allograft dysfunction following living donor liver transplantation.MethodsThe study enrolled 260 adult living donor liver transplantation recipients. Postoperative laboratory variables were assessed for their association with the prevalence of early allograft dysfunction using the inverse probability of treatment weighting and propensity-score matching (n = 93 pairs) analysis.ResultsForty-seven recipients (18.1%) developed early allograft dysfunction. In multivariable analysis, the alanine aminotransferase and gamma-glutamyl transpeptidase levels on postoperative day 1 were independent predictors of early allograft dysfunction. The alanine aminotransferase to gamma-glutamyl transpeptidase ratio (AGR) was developed. All cases were divided into two groups (Group 1 [AGR ≥ 8.47, n = 103] and Group 2 [AGR < 8.47, n = 157]). AGR ≥ 8.47 (OR 10.345, 95%CI 4.502–23.772, p < 0.001), hepatorenal syndrome (OR 3.016, 95%CI 1.119–8.125, p = 0.029), and graft to recipient weight ratio <0.8% (OR 2.155, 95%CI 1.004–4.624, p = 0.049) were independent risk factors for early allograft dysfunction. The prevalence of early allograft dysfunction was higher in group 1 (after adjusting for inverse probability of treatment weighting [n = 39; 37.9% vs n = 8; 5.1%] and propensity-score matching [n = 33; 35.5% vs n = 2; 2.2%]) than that in group 2 (p < 0.001).ConclusionsThe postoperative AGR is a practical index for predicting early allograft dysfunction after living donor liver transplantation.     

Comparison of manual compression and vascular hemostasis devices after coronary angiography or percutaneous coronary intervention through femoral artery access: A meta-analysis of randomized controlled trials

ObjectivesTo compare the efficacy and safety of manual compression (MC) with vascular hemostasis devices (VHD) in patients undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) through femoral artery access.IntroductionThe use of femoral artery access for coronary procedures may result in access-related complications, prolonged immobility and discomfort for the patients. MC results in longer time-to-hemostasis (TTH) and time-to-ambulation (TTA) compared to VHDs but its role in access-related complications remains unclear in patients undergoing coronary procedures.MethodsWe searched MEDLINE, EMBASE, Cochrane CENTRAL and relevant references for English language randomized controlled trials (RCT) from inception through September 30, 2016. We performed the meta-analysis using random effects model. The outcomes were time-to-hemostasis, time-to-ambulation, major bleeding, large hematoma > 5 cm, pseudoaneurysm and other adverse events.ResultsThe electronic database search resulted in a total of 44 RCTs with a total of 18,802 patients for analysis. MC, compared to VHD resulted in longer TTH [mean difference (MD): 11.21 min; 95% confidence interval (CI) 8.13–14.29; P < 0.00001] and TTA [standardized mean difference: 1.2 (0.79–1.62); P < 0.00001] along with excess risk of hematoma > 5 cm formation [risk ratio (RR): 1.38 (1.15–1.67); P = 0.0008]. MC resulted in similar risk of major bleeding [1.01 (0.64–1.60); P = 0.95] pseudoaneurysm [0.99 (0.75–1.29); P = 0.92], infections [0.52 (0.25–1.10); P = 0.09], need of surgery [0.60 (0.29–1.22); P = 0.16), AV fistula [0.93 (0.68–1.27); P = 0.63] and ipsilateral leg ischemia [0.95 (0.57–1.60); P = 0.86] compared to VHD.ConclusionManual compression increase time-to-hemostasis, time-to-ambulation and risk of hematoma formation compared vascular hemostasis devices.     

Visual impairment,but not hearing impairment,is independently associated with lower subjective well-being among individuals over 95 years of age: A population-based study

BackgroundSensory impairment affects an increasing number of elderly adults, with a negative psychological impact. Our objective was to examine the associations of visual and hearing impairment with subjective well-being (SWB), an important psychological concept defined by life satisfaction [LS], positive affect [PA], negative affect [NA], and affect balance [AB] among long-lived individuals (LLIs) over 95 years of age.MethodsData on 442 LLIs from the Rugao longevity cohort, a population-based study in Rugao, China, were analyzed. Graded classifications of visual and hearing impairment (none, mild, moderate, and severe) were constructed from self-reported items. Bivariate correlation and multiple regression analysis were performed to test the associations.ResultsApproximately 66.1% and 87.3% of the subjects reported varying degrees of visual and hearing impairment. Following the degree of vision impairment, LS, PA, and AB decreased linearly, whereas NA increased linearly (all p for trend<0.05). Vision was significantly related to LS (r = 0.238, p < 0.001), PA (r = 0.142, p < 0.01), NA (r = −0.157, p < 0.001), and AB (r = 0.206, p < 0.001). After adjustment for multiple variables including functional ability, an important factor of SWB, the associations of vision impairment with LS, NA, and AB, while diminished, still existed.ConclusionsVisual impairment, but not hearing impairment, was independently associated with low SWB among LLIs, and functional ability may play a mediating role in the observed relationship. The findings indicate that rehabilitation targeted for those with reduced vision and functioning in long-lived populations may be important for promoting well-being and quality of life.     

Development of pouchitis following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis: A role for serological markers and microbial pattern recognition receptor genes

Background and AimsPouchitis, the most common complication after proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, has been attributed to altered composition of faecal flora. We investigated the role of antimicrobial and antiglycan antibodies and polymorphisms in microbial pattern recognition receptor genes.MethodsClinical charts of all 184 patients with ulcerative colitis who underwent IPAA between 1990–2004 were reviewed for pre- and post-operative disease course.ResultsFollow-up data were available in 172 patients [67 female, median age at proctocolectomy 39.1 years]. During a median follow-up of 6.7 (interquartile range 3.7–10.5) years, 80 patients (47%) developed at least one episode of pouchitis. Cox proportional-hazard regression identified extra-intestinal manifestations [HR 1.78 (95%CI 1.10–2.88), p = 0.020], a GT/TT genotype at Toll-like-receptor-1 S87I [HR 1.64 (1.01–2.66), p = 0.047], anti-chitobioside carbohydrate antibodies [HR 2.03 (1.11–3.70), p = 0.021] and young age at diagnosis [p = 0.003] to be independently associated with pouchitis. Factors associated with chronic pouchitis, diagnosed in 33 patients (19%), were extra-intestinal manifestations [HR 2.45 (1.07–5.62), p = 0.034], backwash ileitis [HR 3.15 (1.10–9.00), p = 0.032], outer-membrane porin antibodies [HR 2.67 (1.20–5.94), p = 0.016] and young age at proctocolectomy [p = 0.008].Conclusions:The reported association with antibodies and Toll-like-receptor-1 supports the pathophysiological role of the faecal flora in the development of pouchitis.     

Dietary factors related to the increase of cardiovascular risk factors in traditional Tepehuanos communities from Mexico. A 10 year follow-up study

Background and aimsTepehuanos Indians, a traditional Mexican ethnic group, followed a vegetarian diet exhibiting a low prevalence of obesity and the absence of diabetes. However, from the year 2000 the traditional diet of the Tepehuanos was modified by the introduction of western food. In this study we examine the changes in their customary diet and its impact on the prevalence of cardiovascular risk factors in this group.Methods and resultsIndividuals from 12 Tepehuanos communities were randomly enrolled during 1995–1996 and 2006–2007. Using a 64-item semiquantitative food frequency questionnaire macronutrient intakes were calculated from values of Mexican food-composition tables. Cardiovascular risk factors such as obesity, hypertension, hyperglycemia and dyslipidemia were determined.The median (25, 75 percentile) of total caloric intake (1476 [1083, 1842]–2100 [1366, 2680] kcal/day, p < 0.001) as well as the percentage of energy consumed from saturated fat (3.0 [2.7,4.1]–7.2 [3.9,7.4], p < 0.0001) and protein (8.2 [7.8,8.9]–16.8 [16.3,17.1], p < 0.0001) increased, whereas the percentage of total calorie intake from carbohydrates (66.4 [61.3,69.5]–61.3 [61,68.8], p < 0.0001), polyunsaturated fat (11.2 [10.3,12.1]–4.0 [3.9,4.3], p < 0.0001), and the polyunsaturated:saturated fat ratio (3.84–0.53%, p < 0.0001) decreased during the period of study. The prevalence of obesity (11.1–21.9%, p = 0.04), impaired fasting glucose (5.9–14.9%, p = 0.04), diabetes (0.0–0.88%, p = 0.48), hypertension (1.7–3.4%, p = 0.43), triglycerides (2.6–16.7%, p = 0.0006), and low HDL-cholesterol (10.2–71.1%, p < 0.0001) increased.ConclusionsChanges in the customary diet introduced in the Tepehuanos communities are related to the increase of cardiovascular risk factors.     

Effect of maternal use of flaxseed oil during pregnancy and lactation on glucose metabolism and pancreas histomorphometry of male offspring from diabetic rats

AimInvestigate if the maternal use of flaxseed oil prevents pancreatic alterations in the offspring of diabetic mothers.MethodsDiabetes was induced in female wistar rats (n = 12) by a high-fat diet and low-dose of streptozotocin. After the confirmation of the diabetes (glucose >300 mg/dL), rats were mated and once pregnancy was confirmed, they were allocated into three groups (n = 6): high-fat group (HFG); flaxseed oil group (FOG); and control group (CG) (nondiabetic rats). At weaning, male offspring (n = 12/group) received a standard chow diet. The animals were euthanized in two phases: at 100 and at 180 days, (n = 6/group). The pancreas was collected for histomorphometric and immunohistochemistry analysis.ResultsHFG showed hypertrophy of pancreatic islets at 100 and at 180 days (p < 0.0001), while the FOG offspring had islets with smaller diameters compared to HFG at both phases of sacrifice (p < 0.0001). HFG had a lower percentage of small islets when compared to CG and FOG, which had a higher percentage when compared to HFG (p = 0.0053) at 100 days. At 180 days HFG showed higher percentage of larger islets (p = 0.00137) and lower percentage of smaller islets (p = 0.00112), when compared to FOG. HFG showed lower islet insulin immunodensity at 100 days (p < 0.0001) and 180 days (p < 0.0001), whereas FOG was similar to CG (p < 0.0001) at 100 days and higher at 180 days (p < 0.0001).ConclusionsFlaxseed oil reduced the damage caused by maternal hyperglycemia, promoting normal pancreas histomorphometry and β cell mass.     

Macrophage stimulating protein variation enhances the risk of sporadic extrahepatic cholangiocarcinoma

BackgroundPrimary sclerosing cholangitis confers risk of cholangiocarcinoma. Here, we assessed the primary sclerosing cholangitis-associated variant rs3197999 in the MST1 gene, coding for RON receptor tyrosine kinase ligand macrophage stimulating protein, in a large European cholangiocarcinoma cohort.Materials and methods223 cholangiocarcinoma patients including three primary sclerosing cholangitis individuals and 355 cancer- and primary sclerosing cholangitis-free controls were genotyped for MST1 rs3197999.ResultsThe cancer group departed from Hardy–Weinberg equilibrium (p = 0.022) and exhibited a trend for rs3197999 [A] overrepresentation (31% vs. 26%: p = 0.10). Homozygous rs3197999 [AA] carrier status significantly increased overall (OR = 1.97; p = 0.023) and primary sclerosing cholangitis-unrelated biliary tract cancer risk (OR = 1.84; p = 0.044), relative to homozygous common allele carriers. The association was most pronounced in patients with extrahepatic tumours. This finding was robust to multivariate analysis (p < 0.05), validating the [AA] genotype as an independent cholangiocarcinoma risk factor.ConclusionsThese results suggest that the [AA] genotype of the common MST1 variant rs3197999 enhances genetic risk of sporadic extrahepatic cholangiocarcinoma irrespective of primary sclerosing cholangitis status, presumably by modulating inflammatory responses and/or altered MSP/RON signalling.     

Ergometer-cycling with strict versus minimal contact supervision among the oldest adults: A cluster-randomised controlled trial

ObjectiveTo evaluate the feasibility and short- and long-term effects of two 10-wk structured ergometer-cycling programs among elderly in assisted-living residences.Design, setting, and participantsEight assisted-living residences (N = 95; age = 81.2 ± 5.9 years) were randomly assigned to one of three conditions: 1) ergometer-cycling with strict coach-supervision (STRICT, N = 3; n = 35); 2) ergometer-cycling with autonomy-supportive minimal contact coach-supervision (AUT; N = 3; n = 36); or 3) control condition (CON; N = 2, n = 24).InterventionThree-weekly progressive ergometer-cycling sessions for 10 weeks.Main outcome measuresFeasibility, physical activity (PA), muscular strength, functional performance and quality of life (baseline, post-intervention (10weeks) and 6-month follow-up).Results83 participants were analyzed post-intervention, 75 at follow-up. Adherence was higher in STRICT than AUT during the intervention (p = 0.001), but not during follow-up. Compared with CON, both programs showed positive short- and long-term effects on moderate-intensity PA (p = 0.034). With regard to strength, functional performance and well-being, no time-by-group interaction effects were found. When comparing high-adherers (adherence ≥ 80%) to low-adherers, a greater increase in functional performance and in well-being and a trend towards a lower decrease in strength were found in the short-term (p = 0.047, p < 0.001 and p = 0.054, respectively).ConclusionBoth interventions were feasible and equally effective to increase long-term engagement in PA, irrespective of the type of supervision. When adherence is high, positive effects on strength, performance and well-being can be expected.     

Comparing hepatic steatosis distribution patterns between non-alcoholic fatty liver disease and fatty liver disease with chronic hepatitis B by second-harmonic generation/two-photon excited fluorescence method

Introduction and objectivesHepatitis B virus (HBV) might be an etiological factor modulating fat distribution in steatotic livers. We aim to compare hepatic steatosis distribution patterns between NAFLD and FL&CHB patients with second-harmonic generation (SHG)/two-photon excited fluorescence (TPEF) method.Patients and methods42 patients with NAFLD, 46 with FL&CHB and 55 without steatosis were enrolled in the study. Overall and regional steatosis in liver sections were quantified by SHG/TPEF method. The accuracy of which was validated by pathologist evaluation and magnetic resonance spectroscopy (MRS). Difference in degree of overall and regional steatosis between NAFLD and FL&CHB groups was analyzed by Mann–Whitney U test. Multivariable linear regression analysis was used to model factors contributing to steatosis distribution.ResultsThe hepatic steatosis measured by SHG/TPEF method was highly correlated with pathologist grading (r = 0.83, p < 0.001) and MRS measurement (r = 0.82, p < 0.001). The level of overall steatosis in FL&CHB group is significantly lower than that in NAFLD group (p < 0.001). In NAFLD group, periportal region has significantly lower steatosis percentage than lobule region and overall region (p < 0.001); while in FL&CHB group there is no difference among regions. The ratio of steatosis at periportal region to lobule region is significantly higher in FL&CHB group than that in NAFLD group (p < 0.05). Multivariable linear regression analysis shows that HBV infection is the major contributing factor (β = 0.322, p < 0.01).ConclusionsSHG/TPEF method is an accurate and objective method in hepatic steatosis quantification. By quantifying steatosis in different histological regions, we found steatosis distribution patterns are different between FL&CHB and NAFLD patients.     

Relationship between renal capacity to reabsorb glucose and renal status in patients with diabetes

AimsInterindividual variability in capacity to reabsorb glucose at the proximal renal tubule could contribute to risk of diabetic kidney disease. Our present study investigated, in patients with diabetes, the association between fractional reabsorption of glucose (FR_GLU) and degree of renal disease as assessed by urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR).MethodsFR_GLU [1-(glucose clearance/creatinine clearance)] was assessed in 637 diabetes patients attending our tertiary referral centre, looking for correlations between FR_GLU and UAE (normo-, micro-, macro-albuminuria) and Kidney Disease: Improving Global Outcomes (KDIGO) eGFR categories: >90 (G1); 90–60 (G2); 59–30 (G3); and < 30–16 (G4) mL/min/1.73 m². Patients were stratified by admission fasting plasma glucose (FPG) into three groups: low (<6 mmol/L); intermediate (6–11 mmol/L); and high (>11 mmol/L).ResultsMedian (interquartile range, IQR) FR_GLU levels were blood glucose-dependent: 99.90% (0.05) for low (n = 106); 99.90% (0.41) for intermediate (n = 288); and 96.36% (12.57) for high (n = 243) blood glucose categories (P < 0.0001). Also, FR_GLU increased with renal disease severity in patients in the high FPG group: normoalbuminuria, 93.50% (17.74) (n = 135); microalbuminuria, 96.56% (5.94) (n = 77); macroalbuminuria, 99.12% (5.44) (n = 31; P < 0.001); eGFR G1, 94.13% (16.24) (n = 111); G2, 96.35% (11.94) (n = 72); G3 98.88% (7.59) (n = 46); and G4, 99.11% (2.20) (n = 14; P < 0.01). On multiple regression analyses, FR_GLU remained significantly and independently associated with UAE and eGFR in patients in the high blood glucose group.ConclusionHigh glucose reabsorption capacity in renal proximal tubules is associated with high UAE and low eGFR in patients with diabetes and blood glucose levels > 11 mmol/L.     

Development and Validation of the OSA-CPAP Perceived Competence Evaluation Interview

IntroductionContinuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients’ levels of adherence with CPAP treatment.MethodsA questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated.Results5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r = .986; p < .001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173] = 8.097, p < .001); CPAP treatment information (t[173] = 15.170, p < .001); and CPAP use (t[173] = 14.642, p < .001). The final 12-item version was reliable (CRI = .793) and its internal structure was adequate (χ²[51] = 72.073; p = .027, CFI = .967, RMSEA = .020 [.000, .030]). Women had a better general knowledge of OSA (t[1,018] = 2.190, p = .029), CPAP treatment information (t[1,018] = 2.920, p = .004), and higher overall OSA-CPAP scores (t[1,018] = 3.093, p = .002). Scores were positively related to quality of life and motivation, adherence was positively related to CPAP use and monitoring, and the total score was negatively related to daytime sleepiness.ConclusionsThe interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.     

Central nervous system infection following allogeneic hematopoietic stem cell transplantation

Objective/backgroundHere, we described the clinical characteristics and outcomes of central nervous system (CNS) infections occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a single institution over the previous 6 years.MethodsCharts of 353 consecutive allogeneic transplant recipients were retrospectively reviewed for CNS infection.ResultsA total of 17 cases of CNS infection were identified at a median of 38 days (range, 10–1028 days) after allo-HSCT. Causative pathogens were human herpesvirus-6 (n = 6), enterococcus (n = 2), staphylococcus (n = 2), streptococcus (n = 2), varicella zoster virus (n = 1), cytomegalovirus (n = 1), John Cunningham virus (n = 1), adenovirus (n = 1), and Toxoplasma gondii (n = 1). The cumulative incidence of CNS infection was 4.1% at 1 year and 5.5% at 5 years.ConclusionMultivariate analysis revealed that high-risk disease status was a risk factor for developing CNS infection (p = .02), and that overall survival at 3 years after allo-HSCT was 33% in patients with CNS infection and 53% in those without CNS infection (p = .04).     

Assessment of nasal obstruction: Correlation between subjective and objective techniques

BackgroundNasal sensation of airflow describes the perception of the passage of air through the nose. Nasal obstruction can be assessed using subjective techniques (symptom scores and visual analogue scales [VAS]) and objective techniques (anterior rhinomanometry [RMN], acoustic rhinometry [AR], and peak nasal inspiratory flow [PNIF]). Few studies have evaluated the correlation between these techniques.ObjectiveThe primary objective of our study was to determine the degree of correlation between subjective and objective techniques to assess nasal obstruction.Materials and methodsNasal obstruction was assessed using a symptom score, VAS, RMN, AR (minimal cross-sectional area [MCSA] and volume), and PNIF in 184 volunteer physicians. Spearman's rho was recorded. Correlations were considered weak if r ≤ 0.4, moderate if 0.4 < r < 0.8, and strong if r > 0.8.ResultsMean (SD) age was 37.1 (6.9) years (range, 25–56 years); 61% were women. We found a strong correlation (r > 0.8; p = 0.001) between the different parameters of RMN and a moderate correlation between symptom score and VAS (r = 0.686; p = 0.001) and between MCSA and RMN (resistance) (r = 0.496; p = 0.001) and PNIF (r = 0.459; p = 0.001). The correlations were weak or non-significant for the remaining comparisons.ConclusionNasal obstruction can be assessed using subjective and objective approaches. The correlations between objective techniques were moderate to strong. In addition, between subjective techniques we reported a moderate correlation. Finally, the correlations between the subjective and objective techniques were weak and absent. These findings suggest that each of the techniques assesses different aspects of nasal obstruction, thus making them complementary.     

Factors predicting cardiovascular events in statin-treated diabetic and non-diabetic patients with coronary atherosclerosis

ObjectiveWe aimed at identifying which lipid factors drive vascular risk in statin-treated patients with coronary artery disease (CAD).MethodsWe recorded vascular events over 5.6 years in 491 consecutive statin-treated patients with angiographically proven stable CAD, covering 2750 patient-years.ResultsIn the total population, low high-density lipoprotein (HDL) cholesterol (standardized adjusted HR 0.73 [0.60–0.89]; p = 0.001), low apolipoprotein A1 (0.77 [0.65–0.92]; p = 0.003), a small low-density lipoprotein (LDL) particle diameter (0.76 [0.64–0.91]; p = 0.002), and high triglycerides (1.20 [1.05–1.38]; p = 0.007) predicted vascular events, but not total cholesterol, LDL cholesterol, or apolipoprotein B. Factor analysis in the lipid profiles of our patients revealed an HDL-related factor and an LDL-related factor. Concordant with the results for individual lipid parameters, the HDL-related factor (0.69 [0.58–0.83]; p < 0.001) but not the LDL-related factor (p = 0.455) predicted vascular events. Patients with type 2 diabetes (T2DM; n = 116) were at a higher vascular risk than non-diabetic subjects (38.6% vs. 24.1%; p < 0.001), and like in the total population the HDL-related factor (0.59 [0.44–0.77]; p < 0.001) but not the LDL-related factor (p = 0.591) predicted vascular risk in diabetic patients.ConclusionsThe pattern of low HDL cholesterol, low apolipoprotein A1, small LDL particles, and high triglycerides drives vascular risk in statin-treated coronary patients, particularly in those with T2DM.     

Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children

ObjectiveThis study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group.MethodsA cross-sectional study was carried out with prepubertal HIV-infected children (n = 51) and their healthy siblings (n = 32). All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte superoxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters.ResultsCompared to the control group, the HIV-infected children had lower z-score values for height-for-age (p = 0.0006), higher prevalence of stunting (11.8%) (p = 0.047), lower selenium levels (p = 0.0006) and higher copper levels (p = 0.019). No difference was found concerning superoxide dismutase activity (p > 0.05). The HIV-infected group presented a higher proportion (45.1%) of children with zinc intakes below the estimated average requirement (p = 0.014); however, no association with zinc biochemical parameters was found.ConclusionHIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress.     

Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea

BackgroundDyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources.Study design and methodsThe role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81 ± 9 years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as “cardiac” (n = 80), “respiratory” (n = 36) or “mixed” (n = 14), according to the discharge diagnosis (congestive heart failure either alone [n = 80] or associated with pneumonia [n = 14], pneumonia [n = 24], and obstructive disventilatory syndrome [n = 12]). An 8-window LUS protocol was applied to evaluate B-line distribution, “interstitial syndrome” pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation.ResultsThe presence of a generalized “interstitial syndrome” at the initial LUS evaluation allowed to discriminate “cardiac” from “pulmonary” Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%–97.94%) and specificity (86.11%; 70.50%–95.33%). Positive and negative predictive values were 93.76% (86.03%–97.94%) and 86.09% (70.47%–95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray.ConclusionsBedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.     

Incidence of severe nocturnal hypoglycemia in patients with type 1 diabetes treated with insulin lispro or regular human insulin in addition to basal insulin glargine

Background and aimsOnce-daily (OD) basal insulin glargine (GLA) can be used as part of a multiple daily injection regimen in patients with type 1 diabetes mellitus. This randomized, multicenter study compared GLA + prandial regular human insulin (RHI) with GLA + prandial insulin lispro (LIS) in reducing the incidence of severe nocturnal hypoglycemia at endpoint. In addition, the effects on glycemic control of both treatments were investigated.Methods and resultsPatients (489) previously on neutral protamine Hagedorn (NPH) insulin or GLAR plus RHI/LIS were switched to, or continued on GLA (target fasting blood glucose [FBG] = 5.0–6.7 mmol/L [90–120 mg/dL]) for 8 weeks (qualification phase) prior to randomization; patients continued with their previous bolus insulin. Patients (n = 395) were then randomized to LIS (n = 193) or RHI (n = 202) and treated for 16 weeks. The proportion of patients experiencing severe nocturnal hypoglycemia at the end of the study was 1.55% (n = 3) in the RHI group and 1.11% (n = 2) in the LIS group (p = 0.938 between groups); the mean difference was 0.44% (95% CI: ?1.77, 2.21), suggesting non-inferiority of RHI versus LIS. At the end of the study, both treatments did not differ with respect to glycemic control, as measured by hemoglobin A_1c and FBG.ConclusionThese results suggest that GLA + LIS and GLA + RHI treatments were associated with a similar and low rate of severe nocturnal hypoglycemia. Further studies with greater patient sizes are necessary to verify the findings from the current study.