Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment

BACKGROUND: Highly active antiretroviral treatment (HAART) reduces the risk of wasting in HIV infection and may alter the prognostic weight of wasting. The phase angle from bioelectrical impedance analysis (BIA) can be interpreted as a surrogate marker for the catabolic reaction to chronic HIV infection and opportunistic disease. OBJECTIVE: Our objective was to assess the prognostic ability of the phase angle in HIV-infected patients in the era of HAART. DESIGN: Two cross-sectional observation studies were conducted in 1996 and 1997 at a German university outpatient HIV clinic. In the 1996 and 1997 cohorts, HAART was prescribed to 17 of 212 and 168 of 257 patients at baseline and to 179 of 212 and 234 of 257 patients during observation, respectively. Whole-body BIA was assessed at 50 KHz. Time to clinical progression and survival were calculated by using Cox proportional hazard models with time-dependent covariates. Median observation times were 1000 and 515 d for the 1996 and 1997 cohorts, respectively. RESULTS: Higher phase angle was associated with a lower relative mortality risk, adjusted for viral load and CD4(+) cell count, of 0.49 (95% CI: 0.30, 0.81) per degree in 1996 and of 0.33 (95% CI: 0.18, 0.61) in 1997. The influence of phase angle on time to clinical progression, adjusted for viral load and CD4(+) cell count, was not significant in 1996 but the relative risk was 0.58 (0.36, 0.83) in 1997. CONCLUSION: Despite the favorable effects of HAART on the nutritional status of HIV-infected persons, low phase angle remains an independent adverse prognostic marker of clinical progression and survival.     

Work Place Health Promotion

This article deals with the question of whether and how much workplace health promotion measures have infiltrated the working world and which factors determined the results of health promotion programs for the enterprises. To answer this question we conducted a longitudinal study (measuring times: 1997 and 2003) in 150 enterprises in Hessen and Thueringen of the service sector and metal branch. A standardized questionnaire was used to collect the data. One of the results was that the high level of occupational safety and health (OSH) obtained was greatly appreciated by the enterprises interviewed. Many of the enterprises (82.7%) were able to implement at least one workplace health promotion (WHP) measure, mostly assessments of occupational health risks and behavior-oriented offers. The portion of businesses with a very good to sufficient level of workplace health promotion increased clearly from 16.0% in 1997 to 27.4% in 2003. Half of the enterprises interviewed confirmed the need for information and consultation in questions about occupational safety and health issues and workplace health promotion. They expected support particularly from the institutions for statutory occupational accident insurance, health insurance companies, public institutions for labor protection and safety engineering, as well as from the advisory boards of the trade unions. These institutions definitely need to address the consultation requests from the enterprises, as the lack of information and contact persons was one of the reasons why workplace health promotion measures could not be implemented.This study was commissioned by the Hans Boeckler Foundation and the SMBG and translated by Evelyn Jäck     

Nutrition for patients with cystic fibrosis.

Cystic fibrosis (CF) is the most frequent, lethal genetic disorder among northern Europeans. The etiology of this autosomal recessive disease is known to be a defect in the cAMP activation of chloride (Cl-) channels in secretory cells in many organs of the body. Although this defect usually leads to severe lung disease, many of these patients also have nutritional deficiencies. Nutrition is one of the key components in the management of CF. Patients are at high risk for malnutrition, which may result in accelerated progression of the disease and increased morbidity. This review will discuss nutrition recommendations for calories, protein, vitamins and minerals, and enteral and parenteral nutrition support practices.     

Real-Time Sonoelastography of Salivary Glands for Diagnosis and Functional Assessment of Primary Sjögren’s Syndrome

The purpose of this study was to investigate the value of real-time sonoelastography (RTS) of salivary glands for the diagnosis and assessment of glandular damage in primary Sjögren’s syndrome (pSS). After institutional review board approval, 45 pSS patients, 24 sicca patients and 11 healthy controls were investigated prospectively. Questionnaires were completed and Saxon and Schirmer tests and routine blood tests carried out in all patients. All patients underwent B-mode ultrasonography and RTS of parotid and submandibular glands. Abnormal findings were graded from 0 to 48 and from 0 to 16, respectively. Sialoscintigraphy was done according to a routine protocol; scoring ranged from 0 to 12. Statistical analysis comprised receiver operating characteristic curve and multivariate regression analysis. Patients with pSS had higher B-mode (median score = 25 [range: 2–44] vs. 9 [1–20], p < 0.001) and RTS (6.5 [2–13] versus 4 [1–9], p < 0.001) scores than controls with sicca syndrome, yielding areas under the curve of 0.83 and 0.85 (p < 0.05 each), respectively for pSS diagnosis. In cases with an inconclusive B-mode ultrasonography result, RTS (cutoff score: ≥6) led to a sensitive (66.7%) and specific (85.7%) classification of patients and sicca controls. In multivariate regression analysis, RTS (regression coefficient = –0.48, p = 0.005), but not B-mode ultrasonography, reflected impaired salivary gland function according to the Saxon test, whereas none of the subjective measures of dryness or discomfort were related to ultrasonography results. B-mode and RTS results were both associated with sialoscintigraphy scores (regression coefficient = 0.66, p < 0.001, and regression coefficient = 0.55, p = 0.001, respectively). Reproducibility of B-mode ultrasonography and RTS was good, with intra-class correlation coefficients of 0.93 (95% confidence interval: 0.57–0.98) and 0.93 (95% confidence interval: 0.79–0.98), respectively. In summary, RTS might be a useful adjunct to B-mode ultrasonography for diagnosis and assessment of salivary gland impairment in primary Sjögren’s syndrome.     

Rapid development of microsatellite markers for the critically endangered Saiga (Saiga tatarica) using Illumina® Miseq next generation sequencing technology

We developed 17 variable microsatellite markers for the threatened Saiga antelope. Using one Illumina Miseq lane resulted in 105,948 unique fragments containing a microsatellite motif. Eighty-one ordered primer pairs resulted in 26 analyzable fragments, of which 17 markers showed variability in at least one population from Kazakhstan. Number of alleles ranged from 2 to 11 and values of heterozygosity varied from 0.08 to 0.91 (H_O) and 0.08 to 0.88 (H_E). The markers are currently used to delineate conservation units and to help understanding annual migration dynamics in this species.     

Analrandkarzinom bei Rezidivrektumprolaps

Surgery for third degree rectal prolapse and its sequelae in the elderly still represents a challenge. We report the case of a 92-year-old patient with a history of recurrent third degree rectal prolapse of at least 2?years?? standing. The patient had already had abdominal rectopexy for the same disease 16 years previously. In addition, she now suffered a large perianal ulcer. The patient underwent abdominal rectopexy and biopsy from the ulcer. The histology from the ulcer margin revealed a squamous cell anal cancer. In conclusion, we postulate that the anal cancer can be considered as a consequence of the long-standing rectal prolapse. The patient had previously been informed by her family practitioner that the prolapse could not be operated due to her advanced age. This case highlights that a third degree rectal prolapse should be operated regardless of age in order to avoid late sequelae.