Body mass index and bioelectrical vector distribution in 8-year-old children

ObjectiveTo describe bioelectrical impedance vector distribution in relation to BMI (body mass index; body weight/stature²) in a population of healthy children in order to detect possible changes in body composition status.DesignObservational study involving 464 healthy 8-year-old children. The subjects were divided into three groups based on their BMI: 218 normal weight (NW) children with BMI < 18.4 for male and BMI < 18.3 for female; 135 overweight (OW) children with BMI 18.4 to <21.6 for male and with BMI 18.3 to <21.6 for female; 111 obese (OB) children with BMI ≥ 21.6. Skinfold thickness was measured at the triceps using a Holtain caliper. Bioelectrical impedance analysis (BIA) measurements were performed. Total body water (TBW), fat-mass (FM), fat-free mass (FFM), body cell mass (BCM) and extra-cellular water (ECW) were estimated using conventional BIA regression equations. The resistance–reactance graph (RXc graph) method was used for vector BIA using as reference population the set of 353 children with BMI 14.0–21.5 kg/m².ResultsMean vector displacement followed a definite pattern, with progressive vector shortening in groups with increasing BMI class, and along a fixed phase angle. This pattern indicates an increase in TBW due to an increase in soft tissue mass with an average, normal hydration. In NW children, vectors out of the right and upper half of the 75% tolerance ellipse indicating leanness, and vectors falling out of the right and lower half of the tolerance ellipse indicating undernutrition, show a significantly reduced value of BCM but no significant differences in FM or triceps skinfold thickness (TST), respectively, compared to vectors falling within the 75% tolerance ellipse.ConclusionsAlthough BMI is a reliable measure to grade overweight, it cannot differentiate whether weight change is due to variation of FM, FFM or water. In our study a different impedance vector pattern has been associated with normal weight to obesity, and we have established the trajectory followed by the impedance vector of standardized age, healthy children grouped by BMI. This BIVA may be useful for clinical purposes due to ability to detect changes in hydration or body composition in children.     

Cardiac morphology and performance alterations and analysis of determinant factors of left ventricular hypertrophy in 40 patients with acromegaly

Acromegaly has a high mortality rate due mainly to cardiovascular complications. The aim was to evaluate the determinant factors of left ventricular hypertrophy (LVH) and cardiac alterations in 40 acromegalic patients submitted to clinical-laboratorial studies and echocardiogram. The variables analyzed were age, sex, disease duration, arterial hypertension (AH), impaired glucose tolerance/DM, previous treatment with octreotide, GH and %IGF-I. Univaried analysis showed that patients with LVH were older (p= 0.031), had higher prevalence of AH (p= 0.009) and higher %IGF-I (p= 0.002), than those without LVH. Multivaried analysis showed AH and %IGF-I as determinants of LVH (p= 0.035 and p= 0.016). After dichotomizing of %IGF-I, a score was created and the frequency of LVH was 9%, 65%, 92% x 0, 1, 2; p< 0.0001. Prevalence of aortic ectasia was higher and valvar disease was smaller than reported in the literature. We conclude that AH and %IGF-I were determinants of LVH.     

How do cancer patients receiving palliative care at home die? A descriptive study

Context

Data regarding the circumstances of the process of death of terminally ill patients followed at home are lacking.

Objectives

The aim of this study was to describe the characteristics and assess the circumstances of the process of death of terminally ill patients followed at home.

Methods

This was a prospective survey to assess the dying process of advanced cancer patients followed at home. Within a week after death, the principal caregiver was interviewed. Information from the palliative home care team and the caregiver about expectation of death, time of death, professional and nonprofessional people present at time of death, emergency admission to hospital, and administration of drugs to resuscitate was gathered. The principal clinical issues in the last two hours also were recorded.

Results

In total, 181 of 222 caregivers provided information. Most deaths were expected. Palliative home care team physicians and nurses visited the patient on the day of death but were occasionally present at the moment of death. More than three people were generally present at time of death. More than two-thirds of patients died peacefully, without apparent suffering, and 35.7% of them received palliative sedation before dying. In the last two hours, the most frequent clinical issues were ranked as death rattle, dyspnea, and agitation. In 10 cases, emergency drugs for resuscitation were administered.

Conclusion

This study has shown how advanced cancer patients die at home and that palliative home care may be helpful in allowing a death at home, particularly when relatives are actively involved.     

Hepatic effects of flunixin‐meglumin in LPS‐induced sepsis

The aim of this study was to evaluate the actions of the non‐steroidal anti‐inflammatory drug flunixin‐meglumin (FM) on the changes caused by lipopolysaccharide (LPS)‐induced sepsis in the rat liver. Eight groups of five adult male Wistar rats were analysed: (1) saline injected (controls), (2) FM treated with 1.1 mg/kg, (3) FM treated with 2.2 mg/kg, (4) LPS‐injected (10 mg/kg), (5) LPS‐injected with 1.1 mg/kg FM pretreatment, (6) LPS‐injected with 2.2 mg/kg FM pretreatment, (7) LPS‐injected with 1.1 mg/kg FM post‐treatment and (8) LPS‐injected with 2.2 mg/kg FM post‐treatment. All drugs were intraperitoneally injected. The following parameters were evaluated: plasma levels of hepatic enzymes and urea, hepatic histological characteristics, antioxidant enzymes and several metabolic fluxes. The latter comprised gluconeogenesis, ureagenesis and oxygen consumption. Liver damage in LPS‐induced sepsis was characterized by histological changes, increased plasma levels of alanine aminotransferase and aspartate aminotransferase (P < 0.001) and diminished gluconeogenesis (P < 0.001) and ureagenesis (P < 0.01). LPS also induced oxidative stress as evidenced by increased catalase (P < 0.05) and superoxide dismutase activities and enhanced lipid peroxidation (P < 0.001). Pretreatment of the animals with FM minimized the histological changes and normalized, in part, all enzymatic activities. Pretreatment of the animals with FM also normalized gluconeogenesis and partly restored ureagenesis (P < 0.05). These and other results show that LPS‐induced sepsis may lead to severe liver damage, affecting both structure and function. Treatment with FM can be used to avoid this damage. The antioxidant properties of FM can be, partly at least, responsible for this protective action.     

A Systematic Review of the Angular Values Obtained by Computerized Photogrammetry in Sagittal Plane: A Proposal for Reference Values

Objective

Reference values for postural alignment in the coronal plane, as measured by computerized photogrammetry, have been established but not for the sagittal plane. The objective of this study is to propose reference values for angular measurements used for postural analysis in the sagittal plane for healthy adults.

Methods

Electronic databases (PubMed, BVS, Cochrane, Scielo, and Science Direct) were searched using the following key words: evaluation, posture, photogrammetry, and software. Articles published between 2006 and 2012 that used the PAS/SAPO (postural assessment software) were selected. Another inclusion criterion was the presentation of, at least, one of the following measurements: head horizontal alignment, pelvic horizontal alignment, hip angle, vertical alignment of the body, thoracic kyphosis, and lumbar lordosis. Angle samples of the selected articles were grouped 2 by 2 in relation to an overall average, which made possible total average, variance, and SD calculations.

Results

Six articles were included, and the following average angular values were found: 51.42° ± 4.87° (head horizontal alignment), − 12.26° ± 5.81° (pelvic horizontal alignment), − 6.40° ± 3.86° (hip angle), and 1.73° ± 0.94° (vertical alignment of the body). None of the articles contained the measurements for thoracic kyphosis and lumbar lordosis.

Conclusion

The reference values can be adopted as reference for postural assessment in future researches if the same anatomical points are considered.     

Relationship among Oxidative DNA Damage, Gastric Mucosal Density and the Relevance of cagA, vacA and iceA Genotypes of Helicobacter pylori

The aim of this study was to evaluate the relationship among oxidative DNA damage, density of Helicobacter pylori and the relevance of cagA, vacA and iceA genotypes of H. pylori. Gastric epithelial cells were isolated from 24 uninfected patients, 42 H. pylori infected patients with gastritis, and 61 patients with gastric cancer. Oxidative DNA damage was analyzed by the Comet assay, the density of H. pylori was measured by real-time polymerase chain reaction (PCR), and allelic variants of cagA, vacA and iceA were identified using the PCR. Infected patients by Helicobacter pylori cagA(+), vacAs1 m1 and iceA1 genotype showed higher levels of oxidative DNA damage than infected patients with H. pylori cagA(-), vacAs2 m2 and iceA2 genotypes and uninfected patients. Density of H. pylori did not influence oxidative DNA damage. Our results indicate that H. pylori genotype is more relevant than density for oxidative DNA damage.     

Sirtuins: the molecular basis of beneficial effects of physical activity

Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation. Recent knowledge on important pathogenetic mechanisms that may lead to DIC has resulted in novel preventive and therapeutic approaches to patients with DIC. The diagnosis of DIC can be made by sensitive laboratory tests; however, most of these tests are not readily available in a clinical setting. A reliable diagnosis can also be made on the basis of a small series of laboratory tests that can be combined in a scoring algorithm. The cornerstone of the management of DIC is the specific and vigorous treatment of the underlying disorder. Strategies aimed at the inhibition of coagulation activation may theoretically be justified and have been found beneficial in experimental and clinical studies. These strategies comprise inhibition of tissue factor-mediated activation of coagulation or restoration of physiological anticoagulant pathways.