Simple two-part tool for screening of malnutrition

OBJECTIVE: Malnutrition in hospitalized patients is a major problem that is underdiagnosed. Early recognition of malnutrition is important for nutritional support to be effective. Our aims were to determine the malnutrition rate at our center and to devise an effective screening tool for identifying patients at risk for malnutrition. METHODS: This prospective study included 2211 patients. Each subject was assessed for malnutrition by the Subjective Global Assessment (SGA), and combination criteria (CC), which included anthropometric measurements and laboratory testing. Findings based on these methods were compared with findings in a series of malnutrition screening tests (malnutrition screening tool, self-assessment portion of a mini-nutritional assessment, a question about unintentional weight loss, evaluation of loss of subcutaneous fat, and various combinations of these). RESULTS: The SGA and CC methods identified 242 (11.0%) and 345 (15.6%) patients as malnourished, respectively. Of the screening methods that were tested, the combination of unintentional weight loss and loss of subcutaneous fat proved to be the most valuable, with 93% accuracy for predicting malnutrition according to the SGA, and 82.9% accuracy for predicting malnutrition according to CC. The corresponding negative predictive values were 95.5% and 87.3%. CONCLUSIONS: The results show that this simple two-part nutritional screening tool (unintentional weight loss and loss of subcutaneous fat) is valuable for identifying malnutrition according to the SGA and CC at our institution; however, its validity must be confirmed at other centers.     

Glycosaminoglycan excretion in children with nephrotic syndrome

Although most childhood nephrotic syndromes respond to steroid treatment, steroid resistant nephrotic syndrome (SRNS) is also common and is particularly difficult to treat. This study investigated the role of glycosaminoglycans (GAG) in the pathogenesis and clinical course of nephrotic syndrome in children. Thirty-four children (21 males and 13 females, mean age 3.7±1.6 years) with steroid-sensitive nephrotic syndrome and 20 children with steroid-resistant nephrotic syndrome (12 males and 8 females, mean age 10.9±3.8 years; of the twenty, four had primary SRNS (FSGS) and the others had secondary SRNS) were included the study. Mean urine levels of GAG relative to creatinine (U_GAG/U_Cr) in patients with SRNS (n=20, 113.01±78.46 mg g^–1 Cr) and in patients experiencing the nephrotic period of steroid-sensitive nephrotic syndrome (n=34, 132.15±101.55 mg g^–1 Cr) were both significantly higher than mean U_GAG/U_Cr for control subjects (n=30, 51.83±47.66 mg g^–1 Cr) (P<0.01 for both). Patients excreted significantly more GAG during the nephrotic period of steroid-sensitive nephrotic syndrome than during remission (132.15±101.55 vs 39.11±42.73 mg g^–1 Cr, respectively; P<0.01). There was, however, no significant difference between U_GAG/U_Cr for patients with steroid-resistant nephrotic syndrome and U_GAG/U_Cr in the nephrotic period of steroid-sensitive nephrotic syndrome. Urine GAG excretion correlated significantly with the severity of proteinuria. The results suggest that GAG play a significant role in the pathogenesis of nephrotic syndrome but that GAG excretion is not a marker for response to steroid treatment in pediatric patients with this condition.     

Mitral annular calcification and brown tumor of the rib in a child with chronic renal failure

Mitral annular calcification and liquefaction necrosis of this lesion mimicking intracardiac tumor because of secondary hyperparathyriodism have been described in adult patients with chronic renal failure, but have not been reported in children. Chronic renal failure is one of the predisposing factors of this condition. We report the case of a 13-year-old patient with continuous ambulatory peritoneal dialysis with severe hyperparathyroidism who was found to have intracardiac and rib lesions considered to be brown tumors.     

End-to-side nerve coaptation: is an additional proximal coaptation useful when available?

The aim of this experimental study was to evaluate the effects of end-to-side coaptation of the proximal end of a severed nerve to the same intact nerve, in addition to traditional end-to-side coaptation of the distal end, with an aim to use the intact nerve as a nerve conduit in a rat model and to compare the functional and histologic results of this modality to those obtained after nerve grafting and traditional end-to-side nerve coaptation. In group A, a peroneal nerve defect measuring 1 cm was created in the left hind limb, and a nerve graft 1 cm long was used to bridge the defect. In group B, only the distal stump of the peroneal nerve was coapted to the intact tibial nerve. In group C, both ends of the peroneal nerve defect were coapted to the intact tibial nerve in an end-to-side fashion 1.5 cm apart from each other, and in group D, the peroneal nerve defect was left unrepaired. Group E was consisted of nonoperated peroneal nerves that were used to obtain normative data. Although significantly higher myelinated axon densities were observed in groups B and C compared with group A and group E, total number of the myelinated axons was significantly higher only in group C. Peroneal functional index assessments demonstrated that nerve recovery in the peroneal nerve was similar in groups A and C, and both were better than those observed in groups B and D. Collectively, these results suggest that end-to-side coaptation of both ends of a severed nerve to an intact nerve, in case of a nerve defect in this length, may serve as an alternative for nerve grafting.     

Neonatal lupus erythematosus presenting with cholestatic hepatitis: a case report and review of the literature

Neonatal lupus erythematosus (NLE) is a disease primarily characterized by cardiac and/or cutaneous involvement. Hepatic, hematological, neurological and pulmonary involvement are rare manifestations and normally considered as mild and transient complications. But recent studies have shown more frequent hepatic involvement in NLE. We report a two month-old male infant, born to a clinically asymptomatic mother, presenting with significant hepatic involvement and annular, erythematous plaques with hyperkeratotic borders at the eyebrow region and anterior surface of trunk. Both the infant and his mother were positive for anti-Ro (SS-A) and anti-La (SS-B).     

Symptomatic kidney involvement in a child with tuberous sclerosis

Tuberous sclerosis complex is an autosomal dominant disorder of cellular proliferation and differentiation with variable penetrance and a high spontaneous mutation rate that affects multiple organs, including the kidney. Kidney involvement is commonly asymptomatic and bilateral, and rare in childhood, especially under 10 years. Herein, we report a case of unilateral renal angiomyolipoma in a nine-year-old girl with tuberous sclerosis who had symptoms of pain and macroscopic hematuria.     

Cytotoxin associated gene A-positive Helicobacter pylori strains in dyspeptic pregnant women

OBJECTIVE: The aim of the present study was to compare the Helicobacter pylori (HP) seropositivity and cytotoxin associated gene A (cagA) status in pregnant women with dyspeptic complaints and pregnant women with no gastrointestinal symptoms. STUDY DESIGN: Seventy-one consecutive pregnant women with gastrointestinal complaints and 72 age-matched pregnant women without any gastrointestinal symptoms or a history of gastrointestinal disease were included in the study. Demographic characteristics and H. pylori and cytotoxin associated gene A status of the groups were analysed. RESULTS: The prevalence of H. pylori seropositivity was slightly but not significantly higher in patients with dyspeptic complaints compared to the controls (74.6% versus 63.8%, respectively, P > 0.05). The incidence of dyspeptic complaints were 53.5% in HP-seropositive and 40.9% in HP-seronegative women (P > 0.05). The prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls (75.5% versus 45.7%, respectively, P = 0.002). Among HP-seropositive women, the incidence of dyspeptic complaints was significantly higher in cagA-positive patients compared to the cagA-negative ones (65.6% versus 34.2%, respectively, P = 0.002). When analysed according to the trimesters, the prevalence of cytotoxin associated gene A positivity among H. pylori-seropositive women was significantly higher in dyspeptic pregnants compared to the controls in the first trimester (68.0% versus 34.8%, respectively, P = 0.021). CONCLUSION: Cytotoxin associated gene A-positive, virulent H. pylori strains were found to be more frequently associated with dyspeptic complaints in pregnant women.     

The association of androgenic sex steroids with serum lipid levels in postmenopausal women

BACKGROUND: The aim of the present study was to examine the correlations between androgenic sex steroids and serum lipid levels in postmenopausal women. Methods. The study group included 72 postmenopausal women. Correlation analysis between serum hormone [dehydroepiandrosterone sulfate (DHEA-S), androstenedione, free testosterone and sex hormone binding globulin (SHBG)] and lipid [total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), lipoprotein (a) [Lp (a)], apolipoprotein A-1 (apo A-1) and apolipoprotein B (apo B)] levels was performed. RESULTS: DHEA-S was found to be positively correlated with HDL-C (r = 0.231, p = 0.049) and negatively correlated with Lp (a) (r = - 0.355, p = 0.002). These correlations were statistically significant even after adjustment for age and body mass index (BMI) (r = 0.332, p = 0.005 and r = -0.362, p = 0.002, respectively). SHBG was positively correlated with HDL-C (r = 0.352, p = 0.002). There was a significant but weaker correlation between SHBG and HDL-C levels after controlling for age and BMI (r = 0.243, p = 0.041). No other correlations were found between sex hormone and lipid levels. CONCLUSION: DHEA-S was found to be associated with a less atherogenic lipid profile in postmenopausal women.