Chronic Aerobic Training at Different Volumes in the Modulation of Macrophage Function and in vivo Infection of BALB/c Mice by Leishmania major.

Physical inactivity is one of the main causes of chronic diseases; however, strenuous exercise can induce immunosuppression. Several studies suggest that moderate amounts of exercise lead to a Th1 response, favoring the resolution of infections caused by intracellular microorganisms, while high volumes of exercise tend to direct the response to Th2, favoring infection by them. Leishmaniasis is a parasitic disease promoted by parasites of the Leishmania genus, with clinical manifestations that vary according to the species of the parasite and the immune response of the host. The experimental Leishmania major-BALB/C mouse model provides a good model for the resistance (Th1 response) or susceptibility (Th2 response) that determines the progression of this infection. The aim of this study was to evaluate the effect of aerobic training at different volumes on modulation of in vitro macrophage infection by L. major, as well as to assess the effect of high volume (HV) aerobic training on the development of L. major in vivo in BALB/c mice. Uninfected animals were submitted to various exercise volumes: none (SED), light (LV), moderate (MV), high (HV), very high (VHV), and tapering (TAP). The macrophages of these animals were infected by L. major and the LV and MV groups showed a decrease in the infection factor, while the VHV showed an increase in the infection factor, when treated with LPS. The cytokine concentration pattern measured in the supernatants of these macrophages suggested a predominant Th1 response profile in the LV and MV groups, while the Th2 profile predominated in the VHV and TAP groups. Groups of BALB/C mice infected with L. major were subjected to high volume (iHV) or non-periodized high volume (iNPHV) exercise or kept sedentary (iSED). The exercised animals suffered a significant increase in injuries caused by the parasites. The animals in the group submitted to high volume exercise (iHV) showed visceralization of the infection. These data strongly suggest that a very high volume of aerobic training increased the susceptibility of BALB/C mice to L. major infection, while moderate distribution of training loads promoted immunological balance, better controlling the infection by this parasite.

Antimicrobial resistance in Aeromonas species isolated from aquatic environments in Brazil.

AIM: The current study was conducted to determine the antimicrobial resistance profile and genetic relatedness of Aeromonas sp. isolated from healthcare and urban effluents, wastewater treatment plant (WWTP) and river water. METHODS AND RESULTS: We detected the presence of genes conferring resistance to ß-lactam, quinolone and aminoglycoside. Multilocus sequence typing was carried out to differentiate the strains, and multilocus phylogenetic analysis was used to identify the species. A total of 28 cefotaxime-resistant Aeromonas sp. strains were identified, harbouring uncommon Guiana-extended-spectrum (GES)-type ß-lactamases (GES-1, GES-5, GES-7 and GES-16). Multidrug-resistant Aeromonas sp. were found in hospital wastewater, WWTP and sanitary effluent, and A. caviae was identified as the most prevalent species (85·7%). CONCLUSION: The release of untreated healthcare effluents, presence of antimicrobials in the environment, in addition to multidrug-resistant Aeromonas sp., are all potential factors for the spread of resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: We identified a vast repertoire of antimicrobial resistance genes (ARG) in Aeromonas sp. from diverse aquatic ecosystems, including those that encode enzymes degrading broad-spectrum antimicrobials widely used to treat healthcare-associated infections. Hospital and sanitary effluents serve as potential sources of bacteria harbouring ARG and are a threat to public health.

Is birth weight associated with pregestational maternal BMI? BRISA Cohort, Ribeirão Preto, Brazil

Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.

Metabolic profile during pregnancy in BRISA birth cohorts of Ribeirão Preto and São Luís, Brazil

During pregnancy, metabolic changes that develop in women may increase the risk of diseases and conditions that may also harm the life of the growing fetus. The aim of the present study was to identify and compare the metabolic profile (MP) during pregnancy in two birth cohorts in 2010 in the cities of Ribeirão Preto (RP) and São Luís (SL), Brazil. Pregnant women (1393 in RP and 1413 in SL) were studied; information was obtained through questionnaires in addition to anthropometric, biochemical, and blood pressure measurements. Data are presented as means and proportions. To compare the characteristics of pregnant women in both cities, chi-squared and Student's t-tests were applied, with 5% significance level. Ribeirão Preto presented higher mean values than SL for pre-gestational body mass index (24.5 vs 23 kg/m2, P<0.001), systolic (108.4 vs 102.8 mmHg, P<0.001) and diastolic (65.9 vs 61.8 mmHg, P<0.001) blood pressure, total cholesterol (226.3 vs 213.7 mg/dL, P<0.001) and fractions, and glycemia (84.5 vs 80.2 mg/dL, P<0.001), except for triglycerides (P=0.135). Women from RP also showed higher rates of pre-gestational overweight and obesity compared with SL (40.1 vs 25.8%). In the present study, pregnant women in RP had a worse gestational metabolic profile than those in SL, with higher pre-gestational excess weight, indicating that nutritional transition was more advanced in the more developed city.

Is birth weight associated with pregestational maternal BMI? BRISA Cohort, Ribeirão Preto, Brazil.

Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.

Metabolic profile during pregnancy in BRISA birth cohorts of Ribeirão Preto and São Luís, Brazil.

During pregnancy, metabolic changes that develop in women may increase the risk of diseases and conditions that may also harm the life of the growing fetus. The aim of the present study was to identify and compare the metabolic profile (MP) during pregnancy in two birth cohorts in 2010 in the cities of Ribeirão Preto (RP) and São Luís (SL), Brazil. Pregnant women (1393 in RP and 1413 in SL) were studied; information was obtained through questionnaires in addition to anthropometric, biochemical, and blood pressure measurements. Data are presented as means and proportions. To compare the characteristics of pregnant women in both cities, chi-squared and Student's t-tests were applied, with 5% significance level. Ribeirão Preto presented higher mean values than SL for pre-gestational body mass index (24.5 vs 23 kg/m2, P<0.001), systolic (108.4 vs 102.8 mmHg, P<0.001) and diastolic (65.9 vs 61.8 mmHg, P<0.001) blood pressure, total cholesterol (226.3 vs 213.7 mg/dL, P<0.001) and fractions, and glycemia (84.5 vs 80.2 mg/dL, P<0.001), except for triglycerides (P=0.135). Women from RP also showed higher rates of pre-gestational overweight and obesity compared with SL (40.1 vs 25.8%). In the present study, pregnant women in RP had a worse gestational metabolic profile than those in SL, with higher pre-gestational excess weight, indicating that nutritional transition was more advanced in the more developed city.

Comportamento ingestivo de novilhas de corte em pastagem de sorgo forrageiro implantada com diferentes arranjos populacionais / Ingestive behavior of heifers in sorghum implanted with different population arrangements

O objetivo do presente estudo foi avaliar os efeitos da implantação de pastagem de sorgo forrageiro com diferentes arranjos populacionais no comportamento animal e na estrutura do pasto e de suas relações. Os tratamentos foram a combinação de dois espaçamentos entrelinhas e duas densidades de sementes ha-1, sendo 22 ou 44cm entrelinhas e 12 ou 24kg de sementes ha-1. Foram utilizadas 36 novilhas, com idade e peso corporal inicial de 15 meses e 262kg, respectivamente. Os tratamentos E44D24 e E22D12 apresentaram maior tempo de pastejo (469,33 e 467,78 minutos, respectivamente). Os animais do tratamento E44D24 apresentaram menor taxa de bocado (23,99 bocados minuto-1) em relação ao tratamento E22D24 (32,45 bocados minuto-1). Os animais do tratamento E44D12 apresentaram maior número de estações alimentares minuto-1 (9,21) e maior taxa de deslocamento (11,76 passos minuto-1). O espaçamento entrelinhas de plantio de 22cm aumenta o número de bocados estação-1. O aumento na densidade de sementes (24kg ha-1) e a utilização de maiores espaçamentos entrelinhas de plantio aumentam a densidade de folhas nos estratos inferior (0-30cm) e superior (acima de 60cm) do pasto. Os tratamentos E44D12 e E22D24 apresentaram maiores quantidades de colmos no estrato superior do pasto.(AU)

The objective of the study was to evaluate the effects of sorghum pasture implantation with different population arrangements in animal behavior and pasture structure and their relationships. The treatments were the combination of two row lines and two seeds per hectare densities, 22 or 44cm between rows and 12 or 24kg ha -1 of seed. 36 heifers at 15 months of age and 262kg body weight were used. The E44D24 and E22D12 treatments showed higher time of grazing (469.33 and 467.78 minutes, respectively). The animals in E44D24 treatment had lower bit rate (23.99 bites minute -1 ) compared to treatment with E22D24, a higher bit rate (32.45 bits min -1 ). The animals in E44D12 treatment presented the largest number of stations minute -1 (9.21) and higher displacement rate (11.76 steps min -1 ). The row spacing of 22cm increases the number of bits station -1 . The increase in seed density and the use of larger planting row spacing's increase the leaf density of the lower (0-30cm) and higher stratum (above 60cm) of pasture. The E44D12 and E22D24 treatment have higher amounts of stems in the upper stratum of the pasture.(AU)

Variáveis morfogênicas e estruturais de sorgo forrageiro implantado com diferentes arranjos populacionais sob pastoreio contínuo / Morphogenetic and structural variables of sorghum implanted with different population arrangements under continuous grazing

O objetivo do estudo foi avaliar os efeitos da utilização de diferentes arranjos populacionais na implantação de sorgo forrageiro nas características morfogênicas e estruturais do pasto. Os tratamentos foram 22 ou 44cm entrelinhas e 12 ou 24kg de sementes ha-1. O método de pastoreio foi contínuo. Foram utilizadas 36 novilhas, com idade e peso corporal médios de 15 meses de 262kg. As variáveis morfogênicas não foram influenciadas significativamente (P>0,05) pelos arranjos populacionais e pelos períodos de avaliação, sendo obtidos taxa de alongamento e senescência foliar de 1,43 e 1,11cm dia-1afilho-1, respectivamente, taxa de aparecimento foliar e intervalo de surgimento de folhas de 0,28 folhas dia-1afilho-1 e 3,81 dias, filocrono e duração de vida foliar de 72,99 e 351,68 graus dia, nessa ordem. As características estruturais do pasto foram influenciadas pelos períodos de avaliação. Do primeiro para o terceiro período de avaliação, foi verificada uma redução de 65,53% no número de folhas em alongamento e de 47,79% no número de folhas vivas.(AU)

The objective of the study was to evaluate the effects of using different population arrangements in the implementation of sorghum in the morphogenetic and structural characteristics of the pasture. The treatments were 22 or 44cm between rows and 12 or 24kg ha-1 of seed. The grazing method was continuous. The sample consisted of 36 heifers with an average age of 15 months and average body weight of 262kg. Morphogenic variables were not significantly influenced (P>0.05) by population arrangements and evaluation periods, elongation rate and leaf senescence of 1.43 and 1.11cm afilho-1 day-1 being obtained, respectively, and leaf appearance rate of leaf appearance leaves the range of 0.28 day-1 and 1afilho 3.81 days, phyllochron and leaf duration of life of 72.99 and 351.68 degree day, in that order. The structural characteristics of the pasture were influenced by evaluation periods. From the first to the third evaluation period, a reduction of 65.53% in the number of leaves in stretching and 47.79% in the number of living leaves was verified.(AU)

Relationship between -889 C/T polymorphism in interleukin-1A gene and risk of chronic periodontitis: Evidence from a meta-analysis with new published findings.

BACKGROUND: Periodontitis results from an inflammatory response caused by accumulative microorganisms in periodontal sites. Several factors are involved in pathogenesis of periodontitis, for example the -889 C/T polymorphism in interleukin-1A gene. This study aimed to evaluate the relationship between this polymorphism and risk of development of chronic periodontitis by a meta-analysis based in new published findings. MATERIAL AND METHODS: Thereunto a review in literature was performed in the electronic biomedical and education databases (Cochrane Library, Google Scholar, MEDLINE and PubMed) to studies published before August 2, 2015, the abstracts were evaluated and the data extraction performed by two calibrated examiners. The calculations of the meta-analysis were obtained through statistical software Review Manager version 5.2 with calculation of Odds Ratio (OR), heterogeneity (I²) and Funnel plots with P < 0.05. RESULTS: In overall, twenty-one case/control studies were selected with 2,174 patients with chronic periodontitis and 1, 756 controls. The meta-analysis showed T allele was associated with chronic periodontitis (OR = 1.22, 95% CI: 1.09, 1.36, P = 0.0004) with decreased value to heterogeneity (I² = 15%, P = 0.28). TT genotype was associated to patients with chronic periodontitis (OR = 1.40, 95% CI: 1.07, 1.83, P = 0.01). No publication bias was found in this meta-analysis by asymmetry in Funnel plots. CONCLUSIONS: This meta-analysis with 2,174 patients with chronic periodontitis and 1, 756 controls evidenced the -889 C/T polymorphism is associated to risk of development of chronic periodontitis with no significant value to heterogeneity to allelic evaluation.

Tratamento de efluentes de abatedouro de frangos por meio de reator UASB seguido de filtro anaeróbio / Treatment of waste water poultry slaughter house through UASB reactor followed by anaerobic filter

O Brasil é um dos maiores produtores de aves do mundo e se destaca na exportação de carne de frango, que tem papel relevante na economia do país. Como resultado do crescimento da indústria de processamento do frango, há também um significativo aumento na geração de efluentes. Uma alternativa interessante para o tratamento desses resíduos são os reatores anaeróbios. Este trabalho teve como objetivo avaliar o desempenho do sistema reator UASB-Filtro anaeróbio no tratamento de efluentes de abate de frangos. O estudo foi desenvolvido em um abatedouro avícola, situado na região metropolitana de Belo Horizonte, Minas Gerais. O sistema de tratamento foi composto por peneira estática, caixa de gordura, reator UASB e filtro anaeróbio. A vazão média diária de efluentes do abatedouro foi de 30m³/dia. A carga orgânica aplicada no reator UASB foi de 0,71kg DQO/m³.d. O monitoramento do sistema foi realizado por meio de análises físico-químicas do afluente e dos efluentes da caixa de gordura, reator UASB e filtro anaeróbio. Os parâmetros avaliados foram: temperatura, pH, demanda química de oxigênio (DQO), demanda bioquímica de oxigênio (DBO), sólidos suspensos totais (SST), e sólidos suspensos voláteis (SSV). Os valores efluentes médios encontrados para DBO, DQO e SST foram 106, 290 e 56mg/L, respectivamente. A eficiência de remoção do sistema para DBO variou de 83 a 99%, e para DQO de 50 a 98%. A eficiência de remoção média de SST e SSV foi de 92%. Conclui-se que o sistema reator UASB seguido de filtro anaeróbio apresentou alto desempenho na remoção de sólidos e carga orgânica. Dessa forma, esses reatores tornam-se uma alternativa viável para o tratamento de águas residuárias de frigoríficos, já que oferecem bons resultados de remoção de poluentes.

Brazil is one of the largest poultry producers in the world and stands out in exportation of chicken meat, which plays an important role in the economy. As a result of the growth of the poultry processing industry, there is also a significant increase in the generation of wastewater. An interesting alternative for the treatment of such wastes is anaerobic. This study aimed to evaluate the performance of the system UASB reactor-anaerobic filter on wastewater treatment of slaughtering chickens. The study was conducted in a poultry slaughterhouse located in the metropolitan region of Belo Horizonte, Minas Gerais. The treatment system was composed of static sieve, grease trap, UASB reactor and anaerobic filter. The daily average flow of effluent from the abattoir was 30m³/day. The organic load applied to the UASB reactor was 0.71kg COD/m³.d. The monitoring system was performed by means of physico-chemical analysis of the influent and effluent of fat, UASB reactor and anaerobic filter. The parameters evaluated were: temperature, pH, chemical oxygen demand (COD), biochemical oxygen demand (BOD), total suspended solids (SS) and volatile suspended solids (VSS). The mean values for effluent BOD, COD and SS were 106, 290 and 56mg/L, respectively. The removal efficiency of BOD to the system ranged 83-99% for COD and 50-98%. The average removal efficiency of SS and SSV were 92%. We conclude that the system UASB reactor followed by anaerobic filter showed high performance in removing solids and organic load. Thus, these reactors become a viable alternative for treating wastewater slaughterhouses, offering good results in removing pollutants.

Eficiência de lagoas de polimento no pós-tratamento de reator UASB no tratamento de águas residuárias de suinocultura / Efficiency of a polishing pond for the post-treatment of the effluent from UASB reactor treating swine wastewater

Avaliou-se o desempenho de um sistema de lagoas seriadas que recebeu efluentes de reator UASB, no tratamento de águas residuárias de suinocultura. O sistema foi composto de reator anaeróbio de chicanas (RAC), reator UASB, em escala real, e uma série de lagoas (uma lagoa facultativa e três de maturação), em escala piloto. As análises físico-químicas realizadas foram: pH, demanda bioquímica de oxigênio (DBO), demanda química de oxigênio (DQO), sólidos suspensos totais (SST), sólidos suspensos voláteis (SSV), nitrogênio amoniacal (N-am.), fósforo total (Pt), coliformes totais (CT) e Escherichia coli (EC). As lagoas de pós-tratamento contribuíram eficientemente para remoção de nutrientes, matéria orgânica e sólidos, fornecendo um efluente com qualidade para o reuso agrícola ou lançamento em corpos d'água...

The performance of a post-treatment pond for treating swine wastewater from an UASB reactor was evaluated. The system was assembled with an anaerobic baffle reactor (RAC), followed by an UASB reactor (UASB) on a real scale, and a post-treatment pond on a demonstration scale. The following parameters were analyzed: pH, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), volatile suspended solids (VSS), ammonia nitrogen (N-am.), total phosphorus (Pt), total coliforms (CT) and Escherichia coli (E coli.). The post-treatment lagoons contributed efficiently to remove nutrients, organic matter and solids, providing an effluent quality for agricultural reuse or discharge into a body of water...

Avaliação de desempenho de lagoa de polimento para pós-tratamento de reator anaeróbio de manta de lodo (UASB) no tratamento de águas residuárias de suinocultura / Evaluation of the performance of a polishing pond for the post-treatment of the effluent from an upflow anaerobic sludge blanket (UASB) reactor treating swine wastewater

Avaliou-se o desempenho de uma lagoa de polimento, no tratamento de efluentes de águas residuárias de suinocultura de um reator anaeróbio de manta de lodo (UASB). O sistema foi composto de decantador, reator UASB, em escala real, e lagoa de polimento em escala experimental. As análises físico-químicas realizadas foram: temperatura, pH, demanda bioquímica de oxigênio (DBO), demanda química de oxigênio (DQO), sólidos suspensos totais (SST) e sólidos suspensos voláteis (SSV), nitrogênio total kjedhal (NTK), nitrogênio amoniacal (N-am.) e orgânico (N-org.), fósforo total (Pt), coliformes totais e termotolerantes. A lagoa de polimento apresentou alto desempenho, com remoção média de 58,9 por cento de DBO, 60,1 por cento de NTK, 57 por cento de N-am. e 95,34 por cento de coliformes termotolerantes.

The performance of a polishing pond for treating swine wastewater from an upflow anaerobic sludge blanket (UASB) reactor was evaluated. The system was assembled with a slat settler, followed by an UASB reactor, on a real scale, and a post-treatment pond, on a demonstration scale. The following parameters were analyzed: temperature, pH, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), volatile suspended solids (VSS), total Kjedahl nitrogen (NTK), ammonia nitrogen (N-am.), organic nitrogen, total phosphorus, and total and thermotolerant coliforms. The polishing pond was highly efficient, removing an average of 58.9 percent of BOD, 60.1 percent of NTK, 57 percent of N-am., and 95.34 percent of thermotolerant coliforms.

Avaliação in vitro da eficiência de inóculos no tratamento anaeróbio de efluentes líquidos de suinocultura / Efficiency of seeding material in anaerobic treatment of swine liquid waste: an in vitro trial

Avaliou-se o efeito de inóculos (tratamentos) na degradação dos dejetos líquidos de suínos, em diferentes tempos de detenção hidráulica (0, 30, 60, 90, 120, 150, 180 horas). Foram utilizados um inóculo comercial, na dose recomendada pelo fabricante, três inóculos alternativos à base de esterco bovino, cama de frango e esgoto doméstico, todos aplicados na dose de 5ml/l, e um tratamento-controle, sem inóculo. Foi utilizado o delineamento inteiramente ao acaso, em esquema de parcelas subdivididas, empregando-se três repetições. Após cada tempo de detenção foram realizadas as seguintes análises: pH, demanda bioquímica de oxigênio (DBO), demanda química de oxigênio, sólidos totais, sólidos totais voláteis e sólidos sedimentáveis, temperaturas do ar e do líquido. Os inóculos comercial e alternativo à base de cama de frango promoveram maior redução de DBO que os demais, 68,5 por cento e 67,5 por cento, respectivamente.

Prolonged QTc intervals on the electrocardiograms of hospitalized malnourished adults.

We investigated whether hospitalized malnourished adults would have longer QTc intervals on their electrocardiograms (ECGs) than non-malnourished adults. Seventy-five consecutive adults hospitalized in the Internal Medicine wards of our teaching hospital were prospectively studied. Main diagnoses, anthropometry, including body mass index (kg/m(2)), ECGs, and simultaneous serum levels of sodium, potassium, magnesium, phosphorus, and calcium were recorded. All QT intervals on ECGs were measured in a semiautomatic image analysis system; and QTc intervals were determined with the Bazett formula. Protein-energy malnutrition (PEM) was diagnosed with body mass index below 18.5 kg/m(2). There was no statistical difference between malnourished (n = 30) and non-malnourished (n = 45) with regard to age (40.7 +/- 18.9 y versus 41.4 +/- 16.2 y), male predominance (66.7% versus 80%), or associated diagnoses. Compared with non-malnourished, malnourished patients had higher percentages of positive C-reactive protein (66.7 versus 23.8%), lower serum levels of albumin (2.51 +/- 0.89 g/dL versus 3.41 +/- 0.74 g/dL) and potassium (3.64 +/- 0.65 mEq/L versus 4.12 +/- 0.65 mEq/L), and increased QTc lengths on ECGs (0.423 +/- 0.033 ms versus 0.396 +/- 0.031 ms). Malnourished adults hospitalized in general clinical wards are more likely to have longer QTc intervals on their ECGs, a phenomenon possibly linked to malnutrition and associated electrolyte disturbances.