Validation of the Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition and mortality prediction for people living with HIV or AIDS.

OBJECTIVES: To validate the Global Leadership Initiative on Malnutrition (GLIM) criteria to diagnose malnutrition in hospitalized people living with HIV or AIDS (HA) considering different combinations, using the Subjective Global Assessment (SGA) as the semi-gold standard, and to assess the predictive effects of malnutrition according to the GLIM criteria on hospital length of stay and mortality. METHODS: Retrospective observational study including hospitalized people living with HA aged >18 y. Forty GLIM combinations were obtained by combining the different phenotypic and etiologic criteria. The concurrent validity was assessed according to the sensitivity and specificity values, and the agreement with the SGA was tested using κ values. Multivariate logistic and Cox regression models were used to test the independent predictors for longer length of stay (LOS) and mortality, respectively. RESULTS: The sample comprised 320 patients (mean age, 44.6 ± 12.1 y; 69.1% were men, and 68.4% were malnourished, according to the SGA). The prevalence of malnutrition, according to GLIM, varied from 10.3% to 69.1%. The combination of any phenotypic criteria with the etiologic criteria of low food intake and the combination of any phenotypic criteria with the etiologic criteria of disease severity were independent predictors for mortality (Hazard Ratio: 2.09 [95% CI, 1.15-3.77] and 2.09 [95% CI, 1.25-3.51], respectively). The combination of low body mass index and reduced absorption was independently associated with LOS higher than the median value (Oodds Ratio; 2.57; 95% CI, 1.21-5.45). CONCLUSIONS: Nine GLIM combinations had satisfactory sensitivity and specificity values to determine concurrent validity, all of them including weight loss and low weight; two combinations were independent predictors of mortality (any phenotypic criteria and low food intake or opportunistic infections), and one combination predicted longer LOS. Combining any phenotypic criteria with low food intake resulted in adequate concurrent and predictive validity.

Metabolic and immunological evaluation of patients with indeterminate and cardiac forms of Chagas disease.

ABSTRACT: Chagas disease affects approximately 7 million people, causing disability and mortality in the most productive life stages of infected individuals. Considering the lifestyle of the world population, metabolic syndrome is a synergistic factor for an increased cardiovascular risk of patients with Chagas disease.This study transversally evaluated the metabolic and immunological profiles of patients with indeterminate (IF) and cardiac (CF) forms of Chagas disease and their correlations with left ventricular dysfunction (LVD).Clinical and electrical bioimpedance analysis, levels of cytokines (interferon [IFN]-γ, tumor necrosis factor [TNF]-α, interleukin [IL]-17, IL-10, and IL-33) and adipocytokines (adiponectin, leptin, and resistin), metabolic syndrome components, and brain natriuretic peptide (BNP) levels were assessed in 57 patients (13 IF and 44 CF) with a mean age of 61.63 ±â€Š12.1 years. Chest x-ray, electrocardiogram, and echocardiogram were performed to classify the clinical forms.The CF group had a higher number of individuals with metabolic syndrome components blood pressure altered, while more participants in the CF group with LVD had low high-density lipoprotein (HDL) levels. The IF group had more participants with a higher waist-to-hip ratio (WHR). No significant difference was observed between metabolic syndrome, cytokine and adipocytokine level, and clinical forms of the disease or in relation to LVD.Individuals with the IF showed metabolic and immunological profiles compatible with increased disease control, whereas those with CF showed marked inflammatory immune response.

Effectiveness of Spiritist Passe (Spiritual Healing) on the Psychophysiological Parameters in Hospitalized Patients.

Context • The coexistence of affective disorders, especially anxiety and depression, with medical illness is a topic of considerable clinical and research interest. Complementary biofield modalities are therapies that involve touch or placement of the hands in or through biofields. Spiritual healing, or Spiritist passe (SP), is a kind of laying on of hands (LOH), and therefore is a biofield therapy. Objective • The current study intended to evaluate the effects of SP on psychological parameters such as anxiety and depression and on the perceptions of muscle tension and wellness as well as physiological parameters, such as pain intensity, heart rate (HR), and oxygen saturation (SpO2). Design • This study was a randomized, controlled trial. Setting • The study took place at the medical clinic of the clinical hospital of the Federal University of Triângulo Mineiro (HC/UFTM) in Uberaba, Brazil. Participants • The participants were patients aged ≥18 y who had been hospitalized in the clinic between August 2014 and June 2015. Intervention • Participants in the no-SP and SP groups were instructed to direct their thoughts to Jesus with wishes to heal during the intervention. In the SP group, the patients underwent application of the SP, and in the no-SP group, workers, students, or volunteers at the Clinical Hospital of Uberaba practiced a kind of LOH in a nonspiritual therapy with intention to healing emitting sincere wishes of improvement to the patients by thought. All procedures in those groups were carried out during a 10-min period on 3 consecutive days. In the control group, the patients lay for 10 min during the same periods on the 3 days, with no intervention occurring. Outcome Measures • The study evaluated depression and anxiety using the Hospital Anxiety and Depression (HAD) scale as well as patients' pain using a visual analog scale (VAS). The study also measured their perceptions of muscle tension and wellness and their physiological parameters: HR and SpO2. Results • Seventy-two patients consented to participate in the study. The SP group showed statistically significant reductions in anxiety (P < .001) and depression (P = .008) between baseline and postintervention, with perceptions of muscle tension significantly decreasing on day 1 (D1) and day 3 (D3) of the study (both < .001) after the interventions and wellness significantly increasing between baseline and postintervention (P = .001) and when compared with the control and no-SP groups, with P = .001. The SP group presented the smallest numbers for HR after the interventions, but no significant differences were found between groups for HR, SpO2, and pain on the VAS. Conclusions • The current research team has concluded that the SP was effective in promoting a state of muscle relaxation, reducing anxiety and depression, decreasing muscle tension, and, consequently, raising the perceptions of wellness in hospitalized patients.

Effects of Isha Hatha Yoga on Core Stability and Standing Balance.

Context • The coexistence of affective disorders, especially anxiety and depression, with medical illness is a topic of considerable clinical and research interest. Complementary biofield modalities are therapies that involve touch or placement of the hands in or through biofields. Spiritual healing, or Spiritist passe (SP), is a kind of laying on of hands (LOH), and therefore is a biofield therapy. Objective • The current study intended to evaluate the effects of SP on psychological parameters such as anxiety and depression and on the perceptions of muscle tension and wellness as well as physiological parameters, such as pain intensity, heart rate (HR), and oxygen saturation (SpO2). Design • This study was a randomized, controlled trial. Setting • The study took place at the medical clinic of the clinical hospital of the Federal University of Triângulo Mineiro (HC/UFTM) in Uberaba, Brazil. Participants • The participants were patients aged ≥18 y who had been hospitalized in the clinic between August 2014 and June 2015. Intervention • Participants in the no-SP and SP groups were instructed to direct their thoughts to Jesus with wishes to heal during the intervention. In the SP group, the patients underwent application of the SP, and in the no-SP group, workers, students, or volunteers at the Clinical Hospital of Uberaba practiced a kind of LOH in a nonspiritual therapy with intention to healing emitting sincere wishes of improvement to the patients by thought. All procedures in those groups were carried out during a 10-min period on 3 consecutive days. In the control group, the patients lay for 10 min during the same periods on the 3 days, with no intervention occurring. Outcome Measures • The study evaluated depression and anxiety using the Hospital Anxiety and Depression (HAD) scale as well as patients' pain using a visual analog scale (VAS). The study also measured their perceptions of muscle tension and wellness and their physiological parameters: HR and SpO2. Results • Seventy-two patients consented to participate in the study. The SP group showed statistically significant reductions in anxiety (P < .001) and depression (P = .008) between baseline and postintervention, with perceptions of muscle tension significantly decreasing on day 1 (D1) and day 3 (D3) of the study (both < .001) after the interventions and wellness significantly increasing between baseline and postintervention (P = .001) and when compared with the control and no-SP groups, with P = .001. The SP group presented the smallest numbers for HR after the interventions, but no significant differences were found between groups for HR, SpO2, and pain on the VAS. Conclusions • The current research team has concluded that the SP was effective in promoting a state of muscle relaxation, reducing anxiety and depression, decreasing muscle tension, and, consequently, raising the perceptions of wellness in hospitalized patients.

Niacin metabolism and indoleamine 2,3-dioxygenase activation in malnourished patients with flaky paint dermatosis.

Flaky paint dermatosis, characterized by extensive, often bilateral areas of flaking and pigmentation, mostly in sun unexposed areas is considered a feature of kwashiorkor in both children and adults, and must be differentiated from other dermatosis, including chapped and xerotica skin, and pellagra. In this case series we provide evidence that malnourished patients with flaky paint dermatosis and infection/inflammation shown laboratory data suggestive of indoleamine 2,3-dioxygenase (IDO) activation, besides decreased urinary excretion of N1-methylnicotinamide (N1 MN), a marker of pellagra. We study nine adult patients showing flaky paint dermatosis and clinical features of infection or inflammation, and increased serum C-reactive protein, characteristic of the presence of acute phase response syndrome. As a group, they had low or deficient urinary N1 MN excretion (0.52 ± 0.39 mg/g creatinine) compatible with pellagra. They also showed low serum tryptophan levels (<29 µmol/L) and a serum kynurenine/tryptophan ratio higher than 0.04, suggesting increased IDO expression and increase in the tryptophan oxidation. Findings suggest that some patients with flaky paint dermatosis showed laboratory data suggestive of IDO activation, besides decreased N1 MN urinary excretion. Taken together, the data support the idea that flaky paint dermatosis could be a skin manifestation of niacin deficiency.