Reference values for cerebral and peripheral tissue oximetry in children: A clinical TD-NIRS study.

AIM: Current non-invasive near-infrared spectroscopy (NIRS) tissue oximetry suffers from suboptimal reproducibility over probe repositioning, hindering clinical threshold establishment. Time Domain-NIRS (TD-NIRS) offers higher precision but lacks sufficient paediatric data, preventing effective clinical application. We aimed to establish reference ranges for cerebral and mid-upper arm (MUA) tissue haemodynamics in paediatric subjects using TD-NIRS and explore correlations with auxological variables. METHODS: TD-NIRS measurements were conducted acquiring data from cerebral and MUA regions with the NIRSBOX tissue oximeter. Morphological and clinically relevant information were collected to explore potential correlations with TD-NIRS derived parameters. RESULTS: TD-NIRS assessment was applied in 350 children (8.4 ± 5.0 years). Precision of TD-NIRS was demonstrated with standard deviations of 0.9% (StO2) and 4.2 µM (tHb) for frontotemporal cerebral cortex, and 0.8% (StO2) and 3.7 µM (tHb) for MUA. No user dependency was observed. The trends of values for cerebral and peripheral regions vary differently according to age and auxological parameters. CONCLUSION: This study reports resting-state optical and haemodynamic values for a healthy paediatric population, providing a foundation for future investigations into clinically relevant deviations in these parameters. Furthermore, correlations with anthropometric and demographic values provide valuable insights for a deeper understanding of tissue haemodynamic evolution in childhood.

Utility of mid-upper arm circumference in pediatric malnutrition: An Australasian Society of Parenteral and Enteral Nutrition consensus statement using the Delphi method.

BACKGROUND: Mid-upper arm circumference (MUAC) is a simple anthropometric tool used to screen for childhood undernutrition in humanitarian settings or low-income and middle-income countries. However, there is conflicting evidence and a lack of consensus with regard to its diagnostic use in clinical settings or population groups beyond this context. In 2023, a project officer was appointed by the Australasian Society of Parenteral and Enteral Nutrition (AuSPEN) to lead the development of a consensus review into the use of MUAC in the pediatric clinical setting. METHODS: An AuSPEN appointed multidisciplinary group of informed clinicians used the Delphi method to critically appraise the evidence and develop a series of consensus statements. Delphi surveys were anonymous and distributed electronically. Members were asked to rate their level of agreement with each consensus statement using a 5-point Likert scale. A priori definition of consensus was established as ≥80% responses "agree" or "strongly agree." RESULTS: Three Delphi rounds were required to reach consensus. A total of 18 consensus statements, including rationale, were developed across the topics 'assessment and diagnosis', 'screening and monitoring' and 'clinical settings'. CONCLUSION: An evidence-based, region-specific consensus approach to the use of MUAC in pediatric malnutrition is a valuable tool for clinicians. MUAC is a straightforward, non-invasive and cost-effective tool, and may provide an advantage over traditional anthropometric tools in some clinical settings. There are limitations to the utility of MUAC and this consensus paper provides an empirical summary of advantages and limitations as they apply to the screening, assessment, diagnosis, and monitoring of pediatric malnutrition.

Mid-upper arm circumference as a screening tool for identifying physical frailty in community-dwelling older adults: The Korean Frailty and Aging Cohort Study.

AIMS: Frailty in older adults is influenced by various factors, such as poor nutritional status. Mid-upper arm circumference (MUAC) is a validated, simple, and non-invasive tool for assessing nutritional status. Despite its potential, no study has explored the association between MUAC and physical frailty in older adults. This study aims to investigate this association and assess whether MUAC can be used as a screening tool in community and primary clinical practice. METHODS: A cross-sectional study was conducted with 1178 participants aged 71.8 to 86.7 years from the 2019 Korean Frailty and Aging Cohort Study (KFACS). Physical frailty was defined using the Fried frailty phenotype criteria. MUAC was measured as the average circumference of both upper arms without compressing the subcutaneous tissue. Odds ratios (ORs) and 95% confidence intervals (CIs) for physical frailty, stratified by sex, were estimated using multiple logistic regression analysis after adjustments. RESULTS: MUAC was lower in physically frail men compared with non-frail men (28.0 ± 2.9 vs. 29.4 ± 2.6 cm, P < 0.001). MUAC was negatively correlated with the Frailty Index (r = -0.155, P < 0.001). Multiple logistic regression analysis revealed that MUAC was an independent factor for physical frailty in men (OR 0.986, 95% CI 0.973-1.000, P = 0.049). The optimal MUAC cutoff for identifying physical frailty in men was 28.2 cm (sensitivity 60.7%, specificity 71.4%, AUC 0.672, 95% CI 0.595-0.749, P < 0.001). No significant results were found for women. CONCLUSION: Low MUAC is significantly associated with physical frailty in older men, suggesting the potential for MUAC to be utilized as a screening tool for physical frailty in community and primary clinical settings. Geriatr Gerontol Int 2024; ••: ••-••.

Perceptions of stakeholders on the use of a simplified, combined protocol for treatment of acute malnutrition in Central African Republic.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas.

Feasibility of totally implantable venous access ports in the upper arm for patients with head and neck cancer in the modern era of chemotherapy.

BACKGROUNDS: With recent developments in chemotherapy, the prognosis of head and neck cancer patients has been prolonged, and it is expected that totally implantable venous access devices will be developed for use as feasible and safe chemotherapy routes. We investigated the feasibility of implanting totally implantable venous access ports in the upper arms of head and neck cancer patients in this modern era of chemotherapy. METHODS: Relevant data of a cohort of 210 patients with head and neck cancer who had had totally implantable venous access devices implanted between January 2013 and December 2022 were investigated retrospectively. The totally implantable venous access ports were used for chemoradiotherapy, chemotherapy, radiotherapy, and palliative treatment. Adverse events related to totally implantable venous access devices were investigated and the associated variables subjected to statistical analysis. RESULTS: There were 22 (10.5%) adverse events, representing 0.201 adverse events per 1000 catheter days. Non-ultrasound-guided puncture (p = 0.015) and forearm implantation (p = 0.005) were associated with higher risk of adverse events according to univariate analysis. According to multiple logistic analysis, non-ultrasound-guided puncture was significantly associated with age and sex (OR = 2.89; 95% CI, 1.14, 7.36; p = 0.026). CONCLUSION: Peripherally implanted totally implantable venous access devices in the upper arm are feasible and safe for head and neck cancer patients. Ultrasound-guided implantation of totally implantable venous access ports into the upper arms of head and neck cancer patients may reduce the adverse event rate.

Clinical and biochemical responses to treatment of uncomplicated severe acute malnutrition: a multicenter observational cohort from the OptiDiag study.

BACKGROUND: Severe acute malnutrition (SAM) can be diagnosed using weight-for-height Z-score (WHZ) and/or mid-upper arm circumference (MUAC). Although some favor using MUAC alone, valuing its presumed ability to identify children at greatest need for nutritional care, the functional severity and physiological responses to treatment in children with varying deficits in WHZ and MUAC remain inadequately characterized. OBJECTIVE: We aimed to compare clinical and biochemical responses to treatment in children with 1) both low MUAC and low WHZ, 2) low MUAC-only, and 3) low WHZ-only. METHODS: A multicenter, observational cohort study was conducted in children aged 6-59 mo with nonedematous, uncomplicated SAM in Bangladesh, Burkina Faso, and Liberia. Anthropometric measurements and critical indicators were collected 3 times during treatment; metrics included clinical status, nutritional status, viability, and serum leptin, a biomarker of mortality risk in SAM. RESULTS: Children with combined MUAC and WHZ deficits had greater increases in leptin levels during treatment than those with low MUAC alone, showing a 34.4% greater increase on the second visit (95% confidence interval [CI]: 7.6%, 43.6%; P = 0.02) and a 34.3% greater increase on the third visit (95% CI: 13.2%, 50.3%; P = 0.01). Similarly, weight gain velocity was higher by 1.56 g/kg/d in the combined deficit group (95% CI: 0.38, 2.75; P = 0.03) compared with children with low MUAC-only. Children with combined deficits had higher rates of iron deficiency and wasting while those with low WHZ alone and combined deficits had higher rates of tachypnea and pneumonia during treatment. CONCLUSIONS: Given the comparable treatment responses of children with low WHZ alone and those with low MUAC alone, and the greater vulnerability at admission and during treatment in those with combined deficits, our findings support retaining WHZ as an independent diagnostic and admission criterion of SAM, alongside MUAC. This trial was registered at www. CLINICALTRIALS: gov/study/NCT03400930 as NCT03400930.

Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations.

Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.

Performance of Mid-Upper Arm Circumference (MUAC) in Detection of Severe Acute Malnutrition (SAM), in Young Infants Aged 1 to 6 Months.

Infants are more vulnerable to malnutrition as compared with older children. Prevalence of severe wasting in Indian infants under 6 months of age (U6M) is 14.8% (National Family Health Survey 4, 2015-2016). Weight for length z-score (WLZ) and mid-upper arm circumference (MUAC) are 2 anthropometric parameters for detecting severe acute malnutrition (SAM) in children aged 6 months to 5 years. But in infants U6M, currently no accepted MUAC criteria are present for SAM. Calculating WLZ is practically difficult and cumbersome as compared with measuring MUAC. We tried to find out whether MUAC can be used in detecting SAM in infants aged 1 to 6 months also. The area under ROC curve was computed to evaluate the accuracy of MUAC in detecting SAM (taking WLZ as reference test). Level of accuracy was found out to be "good." Optimal MUAC cut-off with best diagnostic accuracy was identified as ≤11.5 cm, using the highest Youden index of 0.55.

Factors associated with non-response and nutrional status of non-responders at 6-month post-discharge: a cohort study nested in a MUAC-based nutrition programme for acutely malnourished children in Mirriah, Niger.

Background: In the treatment of acute malnutrition (AM), non-response is considered a treatment failure for not meeting recovery criteria within a therapeutic window of 12-16 weeks, but this category of children is misunderstood. As current research emphasizes ways to simplify and optimize treatment protocols, non-response emerges as a new issue to enhance program efficiency. Methods: A prospective cohort study was conducted from 2019 to 2020 at two health centres in Mirriah, Niger among children aged 6-59 months with uncomplicated AM treated under the Optimising treatment for Acute MAlnutrition (OptiMA) protocol. Children who did not meet recovery criteria by 12 weeks (mid-upper arm circumference (MUAC) ≥125 mm without oedema for two consecutive weeks) were classified as non-responders. Non-responders received a home visit six-months post-discharge. Logistic regression was used to analyze factors associated with non-responders compared with children who recovered. Results: Of the 1,112 children enrolled, 909 recovered and 139 were non-responders, of which 127 (80.6%) had significant MUAC gain (mean: +9.6 mm, sd = 5.1) at discharge. Girls (adjusted hazard ratio (aHR) = 2.07, 95% CI 1.33-3.25), children <12 months of age (aHr = 4.23, 95% CI 2.02-9.67), those with a MUAC <115 mm (aHR = 11.1, 95% CI 7.23-17.4) or severe stunting (aHR = 2.5, 1.38-4.83) at admission and a negative or flat MUAC trajectory between admission and week 4 (aHR = 4.66, 95% CI 2.54-9.13) were more likely to be non-responders. The nutritional status of non-responders had generally improved 6 months after discharge, but only 40% had achieved MUAC ≥125 mm. Conclusion: Non-responders are not a homogeneous group; while most children ultimately show significant nutritional improvement, rapid hospital referral is crucial for those not gaining MUAC early in treatment. As efforts to expand MUAC-based programming progress, adapting exit criterion and/or providing additional food supplementation with smaller daily ration for children with risk factors discussed here may help improve programme efficiency without adding to the cost of treatment.

Prevalence of Acute Bacterial Infections and Their Antibiotic Sensitivity Pattern in Children With Severe Acute Malnutrition From a Tertiary Care Hospital of Odisha.

Background and objective Malnutrition remains a significant cause of childhood morbidity and mortality worldwide. Severe acute malnutrition (SAM) profoundly affects immune development, physiological functions, and metabolic processes, increasing susceptibility to infections. This study aimed to investigate the prevalence of acute bacterial infections and their antibiotic sensitivity patterns among SAM children admitted to a tertiary care hospital. Methodology This prospective observational study was conducted at the pediatric department of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, from November 2020 to October 2023. The study included 95 children aged 6-59 months meeting WHO criteria for SAM. Participants underwent comprehensive demographic assessments, clinical evaluations, and relevant laboratory tests, including blood and urine cultures with sensitivity testing. Results The study found that 82.1% of children had weight-for-height below -3 standard deviations, and 84.21% had mid-upper arm circumference below 115 mm, confirming SAM diagnosis. The most prevalent infections were acute gastroenteritis (47.3%), respiratory tract infections (46.3%), bacteremia (27.4%), and urinary tract infections (26.3%). Positive urine cultures were observed in 25 cases (26.3%), predominantly among females (68%). Escherichia coli (40%) and Klebsiella pneumoniae (24%) were the most common organisms isolated from urine, with high sensitivity to gentamicin (76%) and meropenem (72%). Blood cultures were positive in 26 cases (27.36%), with Staphylococcus aureus ​​​​​​(30.76%) and Klebsiella pneumoniae (23%) being predominant. Blood isolates showed significant sensitivity to vancomycin (73%), meropenem (69.2%), and linezolid (65.3%).  Conclusion Acute gastroenteritis, respiratory tract infections, bacteremia, and urinary tract infections are prevalent among SAM children. Staphylococcus aureus was frequently isolated from blood cultures, while Escherichia coli were predominant in urine cultures. High sensitivity of urinary isolates to gentamicin and meropenem, and of blood isolates to vancomycin, meropenem, and linezolid, highlights effective antibiotic choices. These findings emphasize the importance of tailored antimicrobial therapy based on local sensitivity patterns to improve clinical outcomes in SAM children.

Using mid-upper arm circumference z -score measurement to support youth malnutrition screening as part of a global sports and wellness program and improve access to nutrition care.

Objective: Historically, mid-upper arm circumference (MUAC) has been instrumental to identifying malnutrition in children under 5 years living in resource restricted settings. Less attention is directed to at-risk, school-aged youth. Updated and validated pediatric age- and gender-specific MUAC growth curves expand malnutrition screening opportunities (2 months-18 years) including overweight/obesity. An innovative partnership was created to integrate MUAC z-score measurement trainings and screenings in the Real Madrid Foundation's (RMF) Social Sports Schools (S3) program, which provide sports and wellness programming to under-resourced communities. This work aimed to investigate the feasibility of leveraging non-healthcare professionals (non-HCPs) to identify malnutrition risk as part of RMF S3. Methods: This global, two-part program on malnutrition risk identification included training adult facilitators and screening children attending RMF S3. RMF facilitators were trained with didactic lectures on malnutrition, and practical hands-on learning of proper MUAC z-score tape measurement. Aggregate data on facilitators and the number of times to correctly administer the MUAC z-tape were recorded. Aggregate data on child malnutrition risk screenings were collected. Results: Nine countries participated representing Europe, Pacific Asia, Africa, Latin America, and North America. In total, 143 RMF facilitators were trained, and 318 children were screened across 11 sites. More than half of facilitators were male (56%, n = 80), and majority were coaches (41.3%, n = 59), followed by staff (25.2%, n = 36), and volunteers (16.1%, n = 23). Facilitator attempts ranged from 1 to 4 times for proper MUAC z-score administration with mean 2.12 (± 0.86). There were no significant differences for attempts among RMF facilitator types (p = 0.10). Sixteen percent (n = 51) of children screened were recommended for HCP referral, with concentrations in Pacific Asia (68%, n = 35), Latin America (24%, n = 12), and Africa (8%, n = 4). Conclusions: Findings from our sample demonstrate that integration of MUAC z-score based malnutrition risk screening within community sports and wellness programming among non-HCPs is feasible, and that some regions with less frequent access to routine health care may experience greater benefit from these programs. Equipping non-HCP facilitators in community sports and wellness programs with training on malnutrition screening provides a means to meet under-resourced families where they live to begin conversations around malnutrition risk with the hope of establishing additional pathways to care.

Comparison of forearm and intra-arterial blood pressure measurements according to body and arm positions in obese patients.

RATIONALE: Noninvasive blood pressure (BP) monitoring is very important also difficult for accurate diagnosis and monitor of obese patients. AIMS: The study aimed to assess the agreement between forearm arm BP and intra-arterial BP values in a different body and arm positions in obese patients. METHODS: The descriptive study was carried out on 60 intensive care patients with a body mass index above 30 kg/m2 who were monitored with invasive radial BP in the general and surgical intensive care units. BP values obtained from the upper arm and forearm with different arm and body positions were compared with intra-arterial BP results. Bland-Altman analysis and correlation coefficient were used for the accuracy of upper and forearm noninvasive BP reading in different positions. RESULTS: The best agreement was found between the forearm systolic BP in the supine and half-sitting position with the arm down and intra-arterial BP values. Also, the best agreement in diastolic BP was found between the half-sitting and half-sitting position with the arm down and intra-arterial BP. CONCLUSIONS: Forearm systolic BP measurement, especially in the supine and half-sitting position with the arm below the heart level position, was best agreement with intra-arterial measurement, regarded as the gold standard. For this reason, it is more appropriate to use forearm BP measurement in obese patients monitored in intensive care to obtain accurate results.

Ultrasound-guided localization of the radial nerve along the humerus: providing reference points for safer upper arm surgery.

PURPOSE: The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy. METHODS: A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10 MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle. RESULTS: The distance from the lateral epicondyle to RD was on average 15.5 cm ± 1.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7 cm ± 0.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37° to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side. CONCLUSION: The radial nerve can typically be identified by employing a 1/2 and 1/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.

The Optimal Cut-off Value of Upper Arm Circumference and Calf Circumference for Assessing Sarcopenia Among Chinese Community-Dwelling Older Adults.

Objective: To explore the cut-off values and health evaluations of upper arm circumference (AC) and calf circumference (CC) on sarcopenia in Chinese community-dwelling older people. Methods: In this cross-sectional study, AC, CC, handgrip strength, muscle mass and gait speed were measured in 1537 Chinese community-dwelling older people in Sub-study 1. Correlation analysis, receiver operator characteristic curve (ROC curve) analysis, and consistency analysis were used for determination of AC and CC cut-off values for sarcopenia diagnosis (sarcopenia-AC and CC). Thereafter, 269 participants accepted additional assessments on physical function, body composition and muscle strength in Sub-study 2. T-test or Mann-Whitney U-test was used to explore the differential effects of sarcopenia-AC and CC on health indicators between sarcopenic and non-sarcopenic participants. Results: In Sub-study 1, the Area Under ROC (AUC) of AC and CC for sarcopenia screening were greater than 0.700 (P<0.05). The cut-off values, sensitivity and specificity of AC and CC on sarcopenia in males were 25.9 cm (86.0%, 83.6%) and 33.7 cm (90.7%, 81.4%) whereas in females were 26.5 cm (70.8%, 69.7%) and 33.0 cm (86.5%, 69.4%), respectively. In Sub-study 2, the participants with sarcopenia-AC or sarcopenia-CC showed lower muscle strength and lower fat and muscle mass than the ones without (P<0.05). Additionally, males instead of females with sarcopenia-AC or sarcopenia-CC showed worse performance in time-up and go test and 6-Minute Walk Test (P<0.05). However, the 30-second chair stand test was not different between participants with and without sarcopenia-AC or sarcopenia-CC in both sexes. Conclusion: We found accurate and Chinese population targeted cut-off values of AC and CC on sarcopenia diagnosis (25.9 cm and 33.7 cm in males; 26.5 cm and 33.0 cm in females) and a good evaluation effect of AC and CC on fat and muscle mass, muscle strength and physical functions in males, not females.

Mid-Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study.

Background: Mortality among adults diagnosed with HIV-associated cryptococcal meningitis remains high (24%-40%). We hypothesized that nutritional state, as measured by mid-upper arm circumference (MUAC), is a potentially modifiable risk factor for mortality. Methods: Ugandan adults hospitalized with HIV-associated cryptococcal meningitis had MUAC measurements performed at baseline. We compared MUAC measurements with baseline clinical and demographic variables and investigated associations with survival using Cox regression. Results: Of 433 participants enrolled, 41% were female, the median CD4 T-cell count (interquartile range [IQR]) was 15 (6-41) cells/µL, and 37% were antiretroviral therapy naïve. The median MUAC (IQR) was 24 (22-26) cm, the median weight (IQR) was 53 (50-60) kg, and MUAC correlated with weight (Pearson r = 0.6; P < .001). Overall, 46% (200/433) died during the 18-week follow-up. Participants in the lowest MUAC quartile (≤22 cm) had the highest mortality: 39% (46/118) at 2 weeks and 62% (73/118) at 18 weeks. A baseline MUAC ≤22 cm was associated with an 82% increased risk of 18-week mortality as compared with participants with an MUAC >22 cm (unadjusted hazard ratio, 1.82; 95% CI, 1.36-2.42; P < .001). Following adjustment for antiretroviral therapy status, CD4 count, hemoglobin, amphotericin dose, and tuberculosis status, the adjusted hazard ratio was 1.84 (95% CI, 1.27-2.65; P < .001). As a continuous variable, 18-week mortality was reduced by 10% for every 1-cm increase in MUAC. CSF Th17 immune responses were positively associated with MUAC quartile. Conclusions: MUAC measurement is a simple bedside tool that can identify adults with HIV-associated cryptococcal meningitis at high risk for mortality for whom an enhanced bundle of care, including nutritional supplementation, should be further investigated.

Mid-upper arm circumference predicts the risk of gestational diabetes in early pregnancy.

BACKGROUND: The present work aimed to assess the value of mid-upper arm circumference (MUAC) at 8 to 12 weeks in predicting the occurrence of gestational diabetes mellitus (GDM). METHODS: According to eligibility criteria, 328 women with singleton pregnancies who underwent routine antenatal check-ups at Qinhuangdao Maternal and Child Health Hospital from September 2017 to September 2020 were included. The patients were divided into the gestational diabetes mellitus (GDM) and non-GDM groups according to oral glucose tolerance test (OGTT) data from gestation weeks 24 to 28. Clinical data were compared between the two groups. Logistic regression analysis was performed to determine factors independently predicting GDM. Receiver operating characteristic (ROC) curve analysis was employed to analyze the value of MUAC in predicting the occurrence of GDM. The optimal cut-off points were calculated. RESULTS: In logistic regression analysis, pre-pregnancy weight, waist circumference, MUAC, UA, TG, and HDL-C independently predicted the occurrence of GDM (P < 0.05). MUAC retained statistical significance upon adjustment for various confounders (OR = 8.851, 95%CI: 3.907-20.048; P < 0.001). ROC curve analysis revealed good diagnostic potential for MUAC in GDM (AUC = 0.742, 95%CI: 0.684-0.800, P < 0.001), with a cut-off of 28.5 cm, sensitivity and specificity were 61% and 77%, respectively. CONCLUSION: Pregnant women with MUAC >28.5 cm are prone to develop GDM during pregnancy, indicating that MUAC as an important predictive factor of GDM in early pregnancy.

Mandibular revascularization using a humeral periosteal free flap: A technical note.

The vascularized periosteal free flap transposes a non-irradiated soft tissue with neoangiogenesis, bone induction, and osteogenesis qualities. A surgical technique using a humeral periosteal free flap is described for the treatment of recurrent osteoradionecrosis of the lower jaw. The humeral periosteal free flap is a technique associated with low morbidity. The procedure described avoids sacrificing major vessels as seen in other common flap procedures. Hence, this revascularization approach is equivalent to a prevention technique that should be considered early in the development of osteoradionecrosis to avoid further damage and challenging reconstruction.

Effectiveness of acute malnutrition treatment with a simplified, combined protocol in Central African Republic: An observational cohort study.

A simplified, combined protocol admitting children with a mid-upper-arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready-to-use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115-<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango-Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition (SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context.

Outcomes of prosthetic upper arm arteriovenous graft vs brachiobasilic fistula for hemodialysis access.

OBJECTIVE: Primary arteriovenous access such as radiocephalic and brachiocephalic fistulas are initial choices for creating vascular access in dialysis patients. When neither of these choices is an option, upper arm arteriovenous graft or brachiobasilic transposition is recommended. Although primary fistula is better than prosthetic graft for suitable patients, there is little data to guide the best treatment strategy in the absence of suitable vein for primary access creation. This study identifies factors that influence patency rates and compares outcomes of patients treated with brachiobasilic fistula vs upper arm graft in patients who have failed forearm access or are not candidates for primary access. METHODS: A prospectively maintained database of patients with dialysis-dependent renal failure from 2010 to 2022 was analyzed. Primary, primary assisted, and secondary patency rates were calculated. Incidence rates of complications and reinterventions were compared. RESULTS: There were 148 patients with brachiobasilic fistulas and 157 patients with upper arm grafts. The graft group was older (70.1 ± 14.7 vs 62.5 ± 14.6 years; P = .003) and had a higher incidence of pacemakers (11.9% vs 4.1%; P = .005). Brachiobasilic fistulas had higher 6-month (77.0% vs 64.3%; P = .02) and 1-year (68.2% vs 55.4%; P = .03) primary-assisted patency. Secondary patency rates were better for upper arm grafts at 1-year (82.2% vs 72.3%; P = .05). Access complications of non-maturation and aneurysm were higher in basilic vein transposition (21.6% vs 1.3%; P < .0001; 15.5% vs 6.4%; P = .017). Grafts had higher rates of occlusion (58.0% vs 25.7%; P < .0001). In terms of interventions, upper arm grafts had higher rates of thrombectomy (50.3% vs 18.9%; P < .0001), but there was no difference seen in angioplasty, stent, surgical revision, or steal procedures. Basilic vein transpositions had longer time to cannulation (104.6 ± 81.1 vs 32.5 ± 22.4 days; P < .0001), longer total catheter days (251.1 ± 181.7 vs 72.9 ± 56.3 days; P < .0001), and higher number of procedures to aid maturity (0.7 ± 0.7 vs 0.1 ± 0.3; P < .0001). CONCLUSIONS: In this retrospective analysis, when forearm access or primary arteriovenous access is not an option, basilic vein transposition and upper arm grafts have fairly equivalent primary patency. Primary assisted patency is slightly better in basilic vein fistulas, but secondary patency is better in upper arm grafts at 1 year. Basilic fistulas also had longer time to cannulation, longer total catheter days, and more procedures to aid maturity.

Trajectory of mid-arm subcutaneous fat, muscle mass predicts mortality in hemodialysis patients independent of body mass index.

Although decreasing body mass index (BMI) is associated with higher mortality risk in patients undergoing hemodialysis (HD), BMI neither differentiates muscle and fat mass nor provides information about the variations of fat distribution. It remains unclear whether changes over time in fat and muscle mass are associated with mortality. We examined the prognostic significance of trajectory in the triceps skinfold (TSF) thickness and mid-upper arm circumference (MUAC). In this multicenter prospective cohort study, 972 outpatients (mean age, 54.5 years; 55.3% men) undergoing maintenance HD at 22 treatment centers were included. We calculated the relative change in TSF and MUAC over a 1-year period. The outcome was all-cause mortality. Kaplan-Meier, Cox proportional hazard analyses, restricted cubic splines, and Fine and Gray sub-distribution hazards models were performed to examine whether TSF and MUAC trajectories were associated with all-cause mortality. During follow-up (median, 48.0 months), 206 (21.2%) HD patients died. Compared with the lowest trajectory group, the highest trajectories of TSF and MUAC were independently associated with lower risk for all-cause mortality (HR = 0.405, 95% CI 0.257-0.640; HR = 0.537; 95% CI 0.345-0.837; respectively), even adjusting for BMI trajectory. Increasing TSF and MUAC over time, measured as continuous variables and expressed per 1-standard deviation decrease, were associated with a 55.7% (HR = 0.443, 95% CI 0.302-0.649), and 97.8% (HR = 0.022, 95% CI 0.005-0.102) decreased risk of all-cause mortality. Reduction of TSF and MUAC are independently associated with lower all-cause mortality, independent of change in BMI. Our study revealed that the trajectory of TSF thickness and MUAC provides additional prognostic information to the BMI trajectory in HD patients.