Immune responses and clinical outcomes after COVID-19 vaccination in patients with liver disease and liver transplant recipients.

BACKGROUND & AIMS: Comparative assessments of immunogenicity following different COVID-19 vaccines in patients with distinct liver diseases are lacking. SARS-CoV-2-specific T-cell and antibody responses were evaluated longitudinally after one to three vaccine doses, with long-term follow-up for COVID-19-related clinical outcomes. METHODS: A total of 849 participants (355 with cirrhosis, 74 with autoimmune hepatitis [AIH], 36 with vascular liver disease [VLD], 257 liver transplant recipients [LTRs] and 127 healthy controls [HCs]) were recruited from four countries. Standardised immune assays were performed pre and post three vaccine doses (V1-3). RESULTS: In the total cohort, there were incremental increases in antibody titres after each vaccine dose (p <0.0001). Factors associated with reduced antibody responses were age and LT, whereas heterologous vaccination, prior COVID-19 and mRNA platforms were associated with greater responses. Although antibody titres decreased between post-V2 and pre-V3 (p = 0.012), patients with AIH, VLD, and cirrhosis had equivalent antibody responses to HCs post-V3. LTRs had lower and more heterogenous antibody titres than other groups, including post-V3 where 9% had no detectable antibodies; this was heavily influenced by intensity of immunosuppression. Vaccination increased T-cell IFNγ responses in all groups except LTRs. Patients with liver disease had lower functional antibody responses against nine Omicron subvariants and reduced T-cell responses to Omicron BA.1-specific peptides compared to wild-type. 122 cases of breakthrough COVID-19 were reported of which 5/122 (4%) were severe. Of the severe cases, 4/5 (80%) occurred in LTRs and 2/5 (40%) had no serological response post-V2. CONCLUSION: After three COVID-19 vaccines, patients with liver disease generally develop robust antibody and T-cell responses to vaccination and have mild COVID-19. However, LTRs have sustained no/low antibody titres and appear most vulnerable to severe disease. IMPACT AND IMPLICATIONS: Standardised assessments of the immune response to different COVID-19 vaccines in patients with liver disease are lacking. We performed antibody and T-cell assays at multiple timepoints following up to three vaccine doses in a large cohort of patients with a range of liver conditions. Overall, the three most widely available vaccine platforms were immunogenic and appeared to protect against severe breakthrough COVID-19. This will provide reassurance to patients with chronic liver disease who were deemed at high risk of severe COVID-19 during the pre-vaccination era, however, liver transplant recipients had the lowest antibody titres and remained vulnerable to severe breakthrough infection. We also characterise the immune response to multiple SARS-CoV-2 variants and describe the interaction between disease type, severity, and vaccine platform. These insights may prove useful in the event of future viral infections which also require rapid vaccine development and delivery to patients with liver disease.

Antipyretic Efficacy of Bromocriptine in Central Fever: an Exploratory Analysis.

BACKGROUND: 'Central' fevers are thought to result from disruption of hypothalamic thermoregulatory pathways following severe brain injuries. Bromocriptine, due to its central dopamine receptor agonism, has been hypothesized to have antipyretic effect in this setting. However, clinical evidence for this off-label use is limited to a few case reports. In this retrospective cohort study, we analyzed the effect of bromocriptine administration on body temperature in acute brain injury patients with suspected central fever. METHODS: We screened a cohort of adult patients that received bromocriptine in the neurologic-intensive care unit of a tertiary care hospital between January 2018 and December 2021. Indication of central fever was ascertained by review of clinical documentation. A generalized additive mixed model (GAMM) was used to model temperature as a function of time relative to bromocriptine initiation. We adjusted for potential confounding due to the following covariates: temperature recording method (invasive vs surface), concurrent antipyretic administration within 8 h, and surface cooling device use within 4 h of temperature measurement. Temperature-time function was modeled using a cubic spline with k = 10 knots. RESULTS: A total of 33 patients were included in the analysis (14 women; mean age: 50 y, standard deviation 14 y). Median dose of bromocriptine was 7.5 mg (range 2.5-40) for a median of 13 d (range 5-160). Age and sex did not impact the function of temperature over time. Predicted temperatures were significantly (p < 0.05) higher by 0.4 °C with invasive compared to surface recording methods, lower by 0.2 °C in the presence of cooling device use and lower by 0.1 °C with concurrent antipyretic use. On adjusted analysis with the GAMM, there was decline (p < 0.05) in temperature following bromocriptine initiation by - 0.3 °C at 24 h, - 0.5 °C at 48 h, and - 0.7 °C at 72 h. CONCLUSIONS: Bromocriptine use was associated with modest but statistically significant decline in temperature, with nadir at 72 h post initiation. The findings provide a data driven basis for prospective evaluation.

Variation of the feeding/resting period in modified vertical treatment wetlands (depth, zeolite as medium) employed for treating rural domestic wastewater in tourist areas.

This work aimed to evaluate the performance of modified vertical flow treatment wetlands (VF-TWs) in terms of depth and medium to assess the effect of the feeding/resting periods and footprint (FP). The modifications were proposed for treating domestic wastewater in rural areas with flow variations such as tourist sites. The experimental setup included six laboratory-scale VF-TWs: (a) normal (VF-N), bed depth 1.0 m, filled with sand and (b) modified (VF-M), bed depth 0.5 m, filled with sand (upper) and zeolite (bottom, saturated). The operation was divided into three phases (3 months each), varying the feeding/resting period and FP: phase I, 5 d/10 d, 2.6 m2/person-equivalent (PE); phase II, 3.5 d/3.5 d, 1.7 m2/PE; and phase III, only feeding no resting, 0.85 m2/PE. Influent and effluent grab samples were taken every 2 weeks. The results showed effective removal (above 60%) of total solids, organic matter, and pathogens for both VF-N and VF-M. Regarding nutrients, VF-M showed a phosphate removal below 60%, but no consistent removal (15-60%) of total nitrogen. Thus, the results suggest that proposed modifications can be an option to be established in tourist sites, but further work should be conducted to improve and optimize total nitrogen removal.

Effectiveness of an Intravenous Insulin-Based Treatment Protocol for the Management of Hypertriglyceridemia-Associated Acute Pancreatitis.

Background: There is burgeoning interest in intravenous insulin for hypertriglyceridemia-induced acute pancreatitis (HTG-AP) as a less invasive alternative to plasmapheresis; however, there are few published descriptions of disease-specific insulin protocols. Objective: To compare the efficacy and safety of an insulin infusion-based protocol with nonstandardized medical therapy for HTG-AP. Methods: This is a retrospective analysis before and after creation of an HTG-AP-specific insulin infusion treatment protocol. Inclusion criteria were age ≥18 years, an initial triglyceride level >1000 mg/dL, and a diagnosis of AP. The primary outcome of the study was time to a triglyceride level ≤1000 mg/dL. Results: Sixty-seven patients were included in this study (26 pre-protocol and 41 in the HTG-AP insulin protocol group). Baseline characteristics between the groups were similar, with median initial triglyceride levels >3500 mg/dL. There was a trend toward patients treated with the HTG-AP-specific infusion reaching a triglyceride level ≤1000 mg/dL faster (43.3 [24.9-72.1] vs 26.9 [17.7-51.1] hours; P = 0.07). Those treated to ≤500 mg/dL achieved this faster with the disease-specific infusion (49.2 [29.4-67.8] vs 70.9 [36.3-107.2] hours, P = 0.04). Hypoglycemia was numerically lower in the HTG-AP-specific insulin infusion group despite higher insulin infusion rates (7.3% vs 19.2%). No patient in the HTG-AP-specific protocol group required plasmapheresis. Conclusions: The use of an HTG-AP-specific insulin infusion protocol, compared with antecedent nonstandardized care, resulted in prompter achievement of a triglyceride level ≤500 mg/dL and a strong trend toward faster achievement of ≤1000 mg/dL without an increased risk of hypoglycemia. While intravenous insulin may be considered the initial medical therapy for HTG-AP, further studies are needed to determine the optimal dosing.

Pharmacological Analysis of the Anti-inflammatory and Antiallodynic Effects of Zinagrandinolide E from Zinnia grandiflora in Mice.

Zinagrandinolide E (1, ZGE) is an elemanolide with antinociceptive action isolated from Zinnia grandiflora (Asteraceae), valued in North México and southwestern United States for pain relief. Herein, we report the anti-inflammatory and antiallodynic action of ZGE (1) in carrageenan-induced inflammation and tactile allodynia in mice and in a neuropathic pain model in hyperglycemic mice. Local peripheral administration of ZGE (1-30 µg/paw) induced dose-dependent acute anti-inflammatory and antiallodynic effects. The anti-inflammatory effect was comparable to diclofenac (30 µg/paw). Intrathecal (i.t.) administration of ZGE (30 µg) in acute experiments did not affect carrageenan-induced inflammation but significantly reduced tactile allodynia in a dose-dependent fashion. In long-term experiments (15 or 6 days), using two different scheme treatments (pretreatment or post-treatment), ZGE (3-30 µg/paw) showed antiallodynic but not anti-inflammatory action. Local peripheral (3-30 µg/paw) or intrathecal (3-30 µg) administration of ZGE partially reversed tactile allodynia in hyperglycemic mice, better or comparable, respectively, with those of pregabalin (30 µg/paw or 30 µg i.t.). The effects were dose-dependent. According to the pharmacological tools employed, the anti-inflammatory and antiallodynic activities of ZGE are multitarget; these involve the opioidergic, serotoninergic, and GABAergic systems, as well as the NO-cGMP-ATP-sensitive K+ channel signaling pathway.

Antinociceptive effects of ceftriaxone in formalin-induced nociception.

Ceftriaxone (CFX) is a ß-lactam antibiotic with analgesic properties. However, its role in the formalin-induced nociception remains unknown. The purpose of this study was to investigate the antinociceptive effect of CFX in the 1% formalin test in rats. Formalin induced a typical nociceptive response (flinching behavior) of two phases. Local peripheral pretreatment (20 min) with CFX (400-800 µg/paw) slightly attenuated the flinching behavior in phase 2, but not phase 1. Acute intraperitoneal pretreatment (20 min) also reduced phase 2 of the formalin test. In both cases, CFX induced a dose-dependent antinociception. We also tested the effect of CFX 1 day after its administration and in two schedules of repeated administration. One-day pretreatment with CFX (50-400 mg/kg, ip) induced a dose-dependent antinociceptive effect in formalin-treated rats. Repeated administration (daily during 3 or 7 days) with CFX (50-400 mg/kg, ip) diminished formalin-induced nociception. Results suggest that local or systemic as well as single or repeated administration of CFX reduces formalin-induced nociception.

Antinociceptive Potential of Zinnia grandiflora.

An aqueous extract prepared from the aerial parts of Zinnia grandiflora was found not to induce acute toxicity (LD50> 5g/kg, p.o.) in mice when tested by the Lorke method. This extract showed notable antinociceptive and anti-inflammatory actions when evaluated by the formalin- (ED50 = 224.62 ± 38.17 mg/kg, p.o.) and the carrageenan-induced paw edema models in mice, respectively. The organic-soluble fractions obtained by partitioning the infusion with CH2Cl2 and EtOAc were also active in the formalin test. The most important antinociceptive effect was observed with the CH2Cl2 fraction; extensive fractionation of the latter yielded three new elemanolides, namely, zinagranolides D-F (1-3), which were characterized structurally by spectroscopic means. The structure of compound 2 was established unequivocally by an X-ray crystallographic analysis. This compound exerted a significant antinociceptive effect in the formalin assay, better than that of diclofenac used as a positive control.

MRI Using Gadoxetic Acid in the Work-Up of Liver Nodules Not Conclusively Benign in Budd-Chiari Syndrome: A Prospective Long-Term Follow-Up.

Introduction: The incidence of hepatocellular carcinoma (HCC) in Budd-Chiari syndrome (BCS) is unknown and there is no validated diagnostic work-up to define the liver nodules with arterial phase hyperenhancement (APHE), suggesting malignancy. This prospective study evaluates HCC incidence in a Western cohort of patients with BCS and assesses the performance of MRI with hepatobiliary contrast (HB-MRI) for nodule characterization. Methods: Patients with BCS followed in our hospital were prospectively evaluated by MRI with extracellular contrast (EC-MRI). Nodules with APHE categorized as non-conclusively benign by 2 radiologists were studied by HB-MRI and reviewed by 2 radiologists blinded to the EC-MRI results. A new EC-MRI 1 year later and clinical, analytical, and sonographic follow-up every 6 months for a median of 10 years was performed. Results: A total of 55 non-conclusively benign nodules with APHE were detected at EC-MRI in 41 patients. While 32 of them were suggestive of HCC by EC-MRI, all the 55 nodules showed increased uptake of hepatobiliary contrast. An unequivocal central scar was seen in 12/55 nodules at HB-MRI regardless of it was not detected on the EC-MRI. None of the nodules was hypointense in the hepatobiliary phase (HBP). HCC was not detected during a median of 10 years of follow-up. Conclusions: Detection of nodules with APHE is frequent in patients with BCS, but HCC is rare in Western patients with BCS. While EC-MRI may detect nodules suggesting malignancy, the identification of contrast uptake in the HBP at HB-MRI may help categorize them as benign.

Excited Charge Transfer Promoted Electron Transfer in all Perylenediimide Derived, Wide-Band Capturing Conjugates: A Mimicry of the Early Events of Natural Photosynthesis.

Fundamental discoveries in electron transfer advance scientific and technological advancements. It is suggested that in plant and bacterial photosynthesis, the primary donor, a chlorophyll or bacteriochlorophyll dimer, forms an initial excited symmetry-breaking charge transfer state (1CT*) upon photoexcitation that subsequently promotes sequential electron transfer (ET) events. This is unlike monomeric photosensitizer-bearing donor-acceptor dyads where ET occurs from the excited donor or acceptor (1D* or 1A*). In the present study, we successfully demonstrated the former photochemical event using an excited charge transfer molecule as a donor. Electron-deficient perylenediimide (PDI) is functionalized with three electron-rich piperidine entities at the bay positions, resulting in a far-red emitting CT molecule (DCT). Further, this molecule is covalently linked to another PDI (APDI) carrying no substituents at the bay positions, resulting in wide-band capturing DCT-APDI conjugates. Selective excitation of the CT band of DCT in these conjugates leads to an initial 1DCT* that undergoes subsequent ET involving APDI, resulting in DCT +-APDI - charge separation product (kCS~109 s-1). Conversely, when APDI was directly excited, ultrafast energy transfer (ENT) from 1APDI* to DCT (kENT~1011 s-1) followed by ET from 1DCT* to PDI is witnessed. While increasing solvent polarity improved kCS rates, for a given solvent, the magnitude of the kCS values was almost the same, irrespective of the excitation wavelengths. The present findings demonstrate ET from an initial CT state to an acceptor is key to understanding the intricate ET events in complex natural and bacterial photosynthetic systems possessing multiple redox- and photoactive entities.

Softening of PEO-LiTFSI/LLZTO Composite Polymer Electrolytes for Solid-State Batteries under Cyclic Compression.

Composite polymer electrolytes (CPEs) strike an effective balance between ionic conductivity and mechanical flexibility for lithium-ion solid-state batteries. Long-term performance, however, is limited by capacity fading after hundreds of charge and discharge cycles. The causes of performance degradation include multiple contributing factors such as dendrite formation, physicochemical changes in electrolytes, and structural remodeling of porous electrodes. Among the many factors that contribute to performance degradation, the effect of stress specifically on the composite electrolyte is not well understood. This study examines the mechanical changes in a poly(ethylene oxide) electrolyte with bis(trifluoromethane) sulfonimide. Two different sizes of Li6.4La3Zr1.4Ta0.6O12 particles (500 nm and 5 µm) are compared to evaluate the effect of the surface-to-volume ratio of the ion-conducting fillers within the composite. Cyclic compression was applied to mimic stress cycling in the electrolyte, which would be caused by asymmetric volume changes that occur during charging and discharging cycles. The electrolytes exhibited fatigue softening, whereby the compressive modulus gradually decreased with an increase in the number of cycles. When the electrolyte was tested for 500 cycles at 30% compressive strain, the compressive modulus of the electrolyte was reduced to approximately 80% of the modulus before cycling. While the extent of softening was similar regardless of particle size, CPEs with 500 nm particles exhibited a significant reduction in ionic conductivity after cyclic compression (1.4 × 10-7 ± 2.3 × 10-8 vs 1.1 × 10-7 ± 2.0 × 10-8 S/cm, mean ± standard deviation, n = 4), whereas there was no significant change in ionic conductivity for CPEs with 5 µm particles. These observations -performed deliberately in the absence of charge-discharge cycles -show that repetitive mechanical stresses can play a significant role in altering the performance of CPEs, thereby revealing another possible mechanism for performance degradation in all-solid-state batteries.

Harnessing the Reactivity of Duclauxin toward Obtaining hPTP1B1-400 Inhibitors.

Duclauxin (1) from Talaromyces sp. IQ-313 was reported as a putative allosteric modulator of human recombinant protein tyrosine phosphatase 1B (400 amino acids) (hPTP1B1-400), a validated target for the treatment of type II diabetes. Based on these findings, a one-strain-many-compound (OSMAC) experiment on the IQ-313 strain generated derivatives 5a, 6, and 7. Moreover, a one-/two-step semisynthetic approach guided by docking toward hPTP1B1-400 produced 38 analogs, a series (A) incorporating a lactam functionalization at C-1 (8a-15a, 36a, and 37a) and a series (B) containing a lactam at C-1 and an extra unsaturation between C-7 and C-8 (5b, 11b-37b). In vitro evaluation and structure-activity relationship (SAR) analysis revealed that analogs from the B series are up to 10-fold more active than 1 and derivatives from the A series. Furthermore, duclauxin (1) and 36b were assessed for their potential acute toxicity, estimating their LD50 to be higher than 300 mg/kg. Moreover, 36b significantly reduced glycemia in an insulin tolerance test in mice, suggesting that its mechanism of action is through the PTP1B inhibition.

Evaluation of Bed Depth Reduction, Media Change, and Partial Saturation as Combined Strategies to Modify in Vertical Treatment Wetlands.

The aim of this work was to evaluate the performance of vertical subsurface flow treatment wetlands (VSSF TWs) for treating rural domestic wastewater when strategies such as bed depth reduction and media change are used in combination with bottom saturation. Two treatment wetland systems were implemented: normal (VF-N), with a bed depth of 1.0 m, and modified (VF-M), with a bed depth of 0.5 m and a bottom layer of natural zeolite. Schoenoplectus californicus was used as experimental plant. These two treatment systems were operated at a hydraulic loading rate of 120 mm/d in two phases. Phase I did not use bottom saturation, while Phase II involved a bottom saturation of the zeolite layer of the VF-M system. The results show that bed depth reduction did not have a significant effect (p > 0.05) in terms of organic matter, solids, and ammonium removal. Conversely, it had a significant influence (p < 0.05) on phosphate as well as a negative effect on pathogen removal. This influence could be explained by initial media capacity for phosphorus removal and filtration importance in the case of pathogens. Partial saturation only had a positive influence on total nitrogen removal. The addition of a bottom layer of natural zeolite showed no positive effect on nutrient removal. The plant showed adaptation and positive development in both VF-N and VF-M. The water balance showed that water loss was not influenced by bed depth reduction. Therefore, according to the previous results, a combination of the proposal modifications to VSSF TWs can be introduced for treating rural domestic wastewater.

A zinc phthalocyanine-benzoperylenetriimide conjugate for solvent dependent ultrafast energy vs. electron transfer.

A novel zinc phthalocyanine-benzoperylenetriimide conjugate has been synthesized and its ability to undergo ultrafast energy and electron transfer as a function of solvent polarity has been demonstrated using the femtosecond transient absorption (fs-TA) technique operating at a femto- to nanosecond time scale.

The use of ultrasound in the extraction of Ilex paraguariensis leaves: a comparison with maceration.

The objective of this work is to discuss the main parameters that influence the sonication extraction of Ilex paraguariensis leaves. For this purpose, the extraction time, solvent polarity, solvent volume, sample mass and particle size were evaluated. Results showed that the main variable affecting the extraction process was the solvent polarity. Though in a less extent, temperature and extraction time also demonstrated to be important parameters, while the other variables did not present a significant influence on the extraction yield. The extracts at the optimized condition were compared with those obtained by maceration, in terms of mass yield and chemical composition. The major compounds identified in the extracts were caffeine and palmitic acid. Some saturated hydrocarbons such as fatty acids, fatty acid methyl esters, phytosterols, and theobromine were also identified in the fractions.

Infectious pancreatic necrosis virus infection of fish cell lines: Preliminary analysis of gene expressions related to extracellular matrix remodeling and immunity.

The pathogenic infectious pancreatic necrosis virus (IPNV) causes high economic losses in fish farming. This virus can modulate several cellular processes during infection, but little is known about the infection mechanism. To investigate gene activation in response to IPNV, CHSE/F and SHK-1 cell line were infected with a cytopathic Sp field isolate of IPNV, and the expression profiles of proinflammatory, antiviral cytokine, and extracellular matrix markers were analyzed. IPNV induced the production of perlecan, fibulin-1, matrix metalloproteinase-2, 14-3-3ß, interleukin-1ß, Mx1, and interferon regulatory factors-1, -3, and -9. Interestingly, IPNV-mediated activity was blocked by pharmacological inhibitors of the NF-κB signaling pathway. These results, together with in silico analyses showing the presence of several regulatory consensus-target motifs, suggest that IPNV regulates gene expressions in fish through the activation of several key transcription factors. Collectively, these data indicate that IPNV is a viral regulator of expression for extracellular-matrix and immune markers, even during early infection. Finally, this is the first report in fish to find IPNV modulating the activation of interleukin-1ß production primarily through the NF-κB pathway.

Anxiolytic- and antidepressant-like effects of an aqueous extract of Tanacetum parthenium L. Schultz-Bip (Asteraceae) in mice.

AIM: Tanacetum parthenium L. Schultz-Bip (Asteraceae) is widely used worldwide in traditional medicine for the treatment of convulsions and culture-bound syndromes such as susto (fear). The aim of this work was to evaluate the anxiolytic- and antidepressant-like effects of an aqueous extract of T. parthenium in behavioral paradigms in mice. The effects of T. parthenium were compared with those produced by anxiolytic and antidepressant drugs. We carried out the chemical characterization of the main constituents of T. parthenium. The involvement with the GABAergic and serotoninergic neurotransmitter systems were explored be means of synergic and antagonist experiments. MATERIALS AND METHODS: The anxiolytic-like effect was evaluated using the Burying Behavior Test (BBT) and the Elevated Plus-Maze Test (PMT). The antidepressant-like effect was evaluated in the Forced Swimming Test (FST), and ambulatory activity was assessed in the Open Field Test (OFT). Employing the behavioral tests, synergism and antagonism experiments with Alprazolam, Muscimol, and Picrotoxin were carried out in the PMT. In a series of independent experiments, concomitant administration of T. parthenium and Alprazolam, Fluoxetine, or p-chlorophenylalanine were conducted in the FST. For chemical characterization, High-Performance Liquid Chromatography-Electro Spray Ionization-Mass Spectrometry (HPLC-ESI-MS) analysis was performed. RESULTS: T. parthenium exerts clear anxiolytic- and antidepressant-like effects in mice, without affecting the ambulatory activity of the experimental subjects. CONCLUSIONS: Anxiolytic- and antidepressant-like T. parthenium effects result, at least part from the involvement of the GABAergic system. Our results support the use of Tanacetum parthenium in traditional medicine and suggest its therapeutic potential in the comorbid anxiety and depression.

Identification of alkyl carbazoles and alkyl benzocarbazoles in Brazilian petroleum derivatives.

Carbozoles are important compounds in crude oils, as they may be used as geochemical tracers, being the major type of nitrogen compounds in petroleum. At the same time, they are regarded as undesirable due to the problems they may cause in the refining process, such as catalyst poisoning, corrosion, gum or color formation in final products. As separation and identification of carbazoles are challenging goals, this work presents a chromatographic method, made of a pre-fractionation on neutral alumina followed by the separation and identification of two classes of carbazoles using FeCl(3)/Chromossorb W and gas chromatograph with mass spectrometer (GC/MS) (SIM-single ion monitoring mode) analysis. For the first time, a series of alkyl carbazoles and alkyl benzocarbazoles were identified in heavy gas oil (HGO) and atmospheric residue of distillation (ARD) obtained from Brazilian petroleum.

Prevalencia de Síndrome Metabólico en niños de 2 a 13 años en el HIGA Eva Perón / Prevalence of metabolic syndrome in children aged to 13 years in the HIGA Eva Peron

Los niños con obesidad tienen mayor riesgo para desarrollar algunos o todos los factores individuales de Síndrome Metabólico (SM). Su prevención en la infancia podría no sólo disminuir el impacto en etapas tempranas de la vida, sino también disminuir la proporción de adultos que lo desarrollarán.Objetivo: Determinar la prevalencia de SM según Cook et al en niños de 2 a 13 años con IMC elevado para la edad y analizar la frecuencia de aparición de cada uno de los criterios en pacientes atendidos en el Consultorio de Nutrición del Servicio de Pediatría del HIGA Eva Perón, desde el 1 de Junio 2015 al 15 de Marzo 2016. Resultados: Se evaluaron 39 casos: 43,6% eran portadores deSM. De los 5 criterios evaluados, la circunferencia de cintura (CC) se encontró elevada en todos los casos y tanto los triglicéridos (TAG) como el HDL-colesterol (HDL-c), se vieron alterados en 1 de cada 2 niños. La glucemia en ayunas (GeA) fue el criterio de menor aparición (5,1%). Discusión: La alta prevalencia detectada podría deberse al persistente incremento de obesidad en la edad pediátrica.El parámetro de CC pareciera ser uno de los criterios más relevantes para su detección. No sucede lo mismo con GeA que se presentó con baja frecuencia, tanto en la totalidad de la muestra como en el grupo de niños portadores. Conclusión: La prevalencia de SM en niños con sobrepeso u obesidades elevada. Es importante detectarlo para intervenir tempranamente y prevenir la instauración definitiva de diabetes tipo 2 o eventos cardiovasculares en la edad adulta.

JObese children are in greater risk of developing some or all the individual factors of Metabolic Syndrome (MS). Its prevention in childhood could not only reduce the impact in early stages of life but also decrease the proportion of adults who will develop MS. Objective: To determine MS prevalence according to Cook et al. criteria in children aged 2 to 13 years with body mass index unappropriated to their age and to analyze the observed frequency in each of them in patients observed in Pediatrics' Nutrition outpatient office, between June 1 2015 to 1 March 2016. Results: 39 cases were evaluated: 43.6% showed MS. Out of the five criteria evaluated, waist circumference (WC) was elevated in every case and triglycerides as much as HDL-cholesterol appeared altered in 1 of 2 children. Fasting blood glucose test was the less frequent seen criterion (5.1%). Discussion: High prevalence detected may be attributed to persistent increase in pediatric obesity. WC appeared as one of the more relevant criteria to MS detection. (FBGT) was as much infrequent in total population as in MS bearing children. Conclusion: Prevalence of MS in overweighted children is high. It is important to try early detection to install preventive measures of Type 2 diabetes or cardiovascular events in adulthood.

As crianças obesas têm maior risco de desenvolver alguns, ou todos, os fatores individuais de Síndrome Metabólico (SM). Sua prevenção na infância poderia não apenas diminuir o impacto em etapas iniciais da vida, mas também diminuir a proporção de adultos que o desenvolverão. Objetivo: Determinar a prevalência de SM segundo Cook et alii em crianças de 2 a 13 anos com IMC elevado para a idade e analisar a frequência do aparecimento de cada um dos critérios em doentes atendidos no Consultório de Nutrição do Serviço de Pediatria do HIGA Eva Perón, desde 1° de Junho de 2015 até 15 de Março de 2016. Resultados: Avaliaram-se 39 casos: 43,6% eram portadores de SM. Dos 5 critérios avaliados, a circunferência de cintura (CC) achou-se elevada em todos os casos e tanto os triglicérides (TAG) como o HDL-colesterol (HDL-c), estavam alterados em 1 de cada 2 crianças. A glicemia em jejum foi o critério de menor aparecimento (5,1%). Discussão: A alta prevalência detectada poderia relacionar-se com o persistente incremento de obesidade na idade pediátrica. O parâmetro de CC pareceria ser um dos critérios mais relevantes para serem medidos. Isso não acontece com a glicemia em jejum, que se apresentou com baja frequência, tanto na totalidade da amostra quanto no conjunto das crianças portadoras. Conclusão: A maior incidência de SM em crianças com sobrepeso ou obesidade é elevada. Importa detectá-lo para intervir cedo e prever o aparecimento definitivo de diabetes tipo 2 ou eventos cardiovasculares na idade adulta

Tamizaje nutricional en los niños hospitalizados en el Hospital Interzonal General de Agudos Eva Perón / Nutritional screening in hospitalized children at HIGA Eva Perón

La ausencia de información acerca de la prevalencia de riesgo nutricional en niños hospitalizados motivó el presente trabajo. Objetivo. Determinar el riesgo nutricional en niños de 0 a 14 años internados.Materiales y métodos. Estudio descriptivo transversal efectuado en niños de 0 a 14 años internados en el HIGA "Eva Perón" entre el 8 de noviembre de 2016 y el 31 de enero de 2017. Se utilizó la herramienta de tamizaje "Screening Tool for the Assessment of Malnutrition in Paediatrics". Según el puntaje obtenido, se categorizó en bajo, mediano o alto riesgo nutricional. Resultados. Se evaluaron 205 pacientes. De ellos, 51,2%tenía alguna patología que "posiblemente" tuviera implicancia nutricional. El 10,2% demostraron patologías que "definitivamente sí" impactan nutricionalmente. Al ingreso, presentaron alguna alteración en la ingesta 36% de los pacientes. El 28,3% de la población estudiada mostraron disminución de peso o talla. El 74% delos niños exhibió mediano o alto riesgo nutricional (37% en ambos casos). Sólo una cuarta parte de los niños mereció calificación de bajo riesgo. Conclusiones: la prevalencia elevada de riesgo de desnutrición hallada en pacientes internados en la institución destaca la importancia de evaluar su estado dentro de las primeras horas de admisión. Todos deberían ser evaluados al ingreso

The absence of nutritional risk information in hospitalized children suggested this study. Objective: To determine nutritional risk in children aged 0 to 14 years hospitalized in HIGA Eva Perón in the quarter ranging between november 8 2016 and January 31 2017. All were surveyed by means of the "Screening Tool for the Assessment of Malnutrition in Paediatrics" and were categorized as low, medium and high nutritional risk. Results: 205 patients were evaluated: 51,2% showed some pathology "probably" able to have nutritional implicance;10,2% proved pathology that "absolutely" impacts nutritionally. In admission, 36% of the studied population showed some intake disorder, 28,3% decreased weight or height. 74% of children exposed medium or high nutritional risk (37% both of them). Only a quarter of the studied children showed low nutritional risk. Conclusions: high prevalence of nutritional risk found in hospitalized children emphasizes the importance of offering early nutritional evaluation. All deserve evaluation in admission

A ausência de informação relativa à prevalência de risco nutricional em crianças hospitalizadas motivou o presente trabalho. Objetivo. Determinar o risco nutricional em crianças de 0 a 14 anos internadas. Materiais e métodos. Estudo descritivo transverso efetivado em crianças de 0 a 14 anos internadas no HIGA "Eva Perón" entre 8 de novembro de 2016 e 31 de janeiro de 2017. Utilizou-se a ferramenta de triage "Screening Tool for the Assessment of Malnutrition in Paediatrics". Segundo a pontuação obtida, classificou-se em baixo, mediano ou alto risco nutricional. Resultados. Avaliaram-se 205 doentes. Deles, 51,2% tinha alguma patologia que "possivelmente" tivesse causa nutricional. 10,2% apresentaram patologias que sem sombra de dúvida impactam nutricionalmente. De início, apresentaram alguma alteração na ingesta 36% dos pacientes. 28,3% da população estudada apresentou diminuição de peso ou tamanho. 74% das crianças exibiu médio ou alto risco nutricional (37% em ambos casos). Além disso, uma quarta parte das crianças mereceu qualificação de baixo risco. Conclusões: a elevada incidência de risco de desnutrição em pacientes internados na instituição salienta a importância de avaliar seu estado dentro das primeiras horas de admissão. Todos deveriam ser avaliados no ingresso

Determinación del riesgo nutricional en pacientes hospitalizados en el HIGA Eva Perón / Nutritional risk in hospitalized patients at HIGA Eva Peron

Numerosos estudios han demostrado que la desnutrición hospitalaria compromete la recuperación del paciente, prolonga el tiempo de internación y aumenta las probabilidades de infección y morbimortalidad. En Argentina la prevalencia de desnutrición hospitalaria es del 47% según el estudio AANEP 99. Se recomienda realizar una evaluación nutricional más exhaustiva en los individuos en riesgo para profundizar el diagnóstico y determinar un tratamiento precoz, adecuado a sus necesidades. Objetivo. Determinar el riesgo nutricional de los pacientes al ingreso hospitalario durante el periodo comprendido entre el 7 y el 20 de diciembre de 2015. Materiales y Métodos. Estudio descriptivo transversal que admitió sólo pacientes mayores de 14 años. Se utilizó el Nutritional Risk Screening (NRS 2002) como herramienta de recolección de datos. Resultados. Demostraron riesgo nutricional (puntaje ≥ 3 NRS 2002) veinticuatro (31,2%) de los setenta y siete pacientes valorados. Todos los pacientes admitidos en Unidades de Cuidados Críticos estaban en riesgo nutricional, situación que sólo correspondió a 23 % de los internados en Clínica Médica y en Cirugía General. Conclusión. La prevalencia de desnutrición intrahospitalaria en los hospitales modernos es equiparable a la detectada hace más de 50 años. Conocer el estado nutricional de los pacientes es fundamental para instaurar el tratamiento adecuado y optimizar la utilización de recursos orientándolos a los individuos que presenten características que denoten mayor riesgo

Numerosos estudos tem demonstrado que a desnutrição hospitalar compromete a recuperação do paciente, acrescenta o tempo de internação e as probabilidades de infecção bem como a morbimortalidade. Na Argentina la incidência de desnutrição hospitalar é de 47%, de acordo com o estudo AANEP 99.Recomenda-se realizar uma avaliação nutricional mais exaustiva nos casos de risco para aprofundar o diagnóstico e determinar um tratamento precoce, de acordo com suas necessidades.Objetivo. Determinar o risco nutricional dos pacientes no ingresso hospitalar durante o período compreendido entre 7 e 20 de dezembro de 2015. Materiais e Métodos. Estudo descritivo transversal feito apenas sobre pacientes maiores de 14 anos. Foi usado o Nutritional Risk Screening (NRS 2002) como ferramenta para coleta de dados. Resultados. Demonstraram risco nutricional (pontagem ≥ 3 NRS 2002) vinte-e-quatro (31,2%) dos setenta e sete pacientes avaliados. Todos os paciente admitidos em Unidades de Cuidados Críticos estavam em risco nutricional, situação que apenas correspondeu a 23 % dos internados em Clínica Médica e em Cirurgia Geral. Conclusão. A prevalência de desnutrição intra-hospitalar nos hospitais modernos pode ser equiparável à detectada há mais de 50 anos. Conhecer o estado nutricional dos pacientes é fundamental para aplicar o tratamento adequado e otimizar a utilização de recursos orientando-os para aqueles que apresentem características que se encontrem em maior risco

Numerous studies have shown that hospital malnutrition lengthen hospitalization, compromises patients´ recovery and increases infection and morbimortality rates. In Argentine, AANEP 99 studies proved 47% prevalence malnutrition index. It is important to take a close look to detect individuals at risk to offer them more exhausting nutritional evaluation and early treatment in compliance with their needs. Objective. To determine nutritional risks of patients admitted between December 7 up to 20 of 2015. Material and Methods. Transversal and descriptive study that includes patients older than 14 years. Nutritional Risk Screening (NRS 2002) was applied as data recollection tool. Results. Seventy seven inpatients were studied and twenty four (31,2 %) show nutritional risk (≥ 3 NRS 2002). All those admitted in Critical Units showed nutritional risk and only 23% of those admitted in Medicine or General Surgery. Conclusion. Malnutrition prevalence detected in modern hospitals is similar to that detected more than fifty years ago. It is essential to recognize patients nutritional status to establish adequate treatment and optimize resource use driving them to riskier certified individuals