How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study.

BACKGROUND: Achilles tendinopathy (AT) occurs in half of the elite runners. AT is a difficult-to-treat tendon disease, which may progress from new onset to a chronic state. It is unknown how many runners with new-onset AT develop persisting symptoms and which prognostic factors are associated with this course. OBJECTIVE: To describe how many runners develop persisting symptoms 1 year after onset of reactive AT. STUDY DESIGN: Prospective cohort study. METHODS: Runners registering for a Dutch running event (5-42.2 km) were eligible for inclusion. Runners reporting new-onset AT between registration for the running event and 1 month after received a 1-year follow-up questionnaire. The 1-year follow-up questionnaire inquired about persisting symptoms (yes/no), running activity, and metabolic disorders. We calculated the percentage of runners with persisting symptoms and performed a multivariable logistic regression analysis to study the association between potential prognostic factors and persisting symptoms. RESULTS: Of 1929 participants, 100 runners (5%) reported new-onset AT. A total of 62 runners (62%) filled in the 1-year follow-up questionnaire. Persisting symptoms were reported by 20 runners (32%). A higher running distance per week before new-onset AT was associated with a lower risk of developing persisting symptoms (odds ratio (OR): 0.9, 95% confidence interval (CI): [0.9;1.0]). There was a positive trend toward an association between metabolic disorders and persisting symptoms (OR: 5.7, 95% CI: [0.9;36.2]). CONCLUSION: One third of runners develop persisting symptoms 1 year after new-onset AT. Interestingly, a higher running distance per week before new-onset AT potentially lowers the risk of developing persisting symptoms.

Early Hospital Readmission (EHR) in kidney transplantation: a review article.

Early hospital readmission (EHR), defined as all readmissions within 30 days of initial hospital discharge, is a health care quality measure. It is influenced by the demographic characteristics of the population at risk, the multidisciplinary approach for hospital discharge, the access, coverage, and comprehensiveness of the health care system, and reimbursement policies. EHR is associated with higher morbidity, mortality, and increased health care costs. Monitoring EHR enables the identification of hospital and outpatient healthcare weaknesses and the implementation of corrective interventions. Among kidney transplant recipients in the USA, EHR ranges between 18 and 47%, and is associated with one-year increased mortality and graft loss. One study in Brazil showed an incidence of 19.8% of EHR. The main causes of readmission were infections and surgical and metabolic complications. Strategies to reduce early hospital readmission are therefore essential and should consider the local factors, including socio-economic conditions, epidemiology and endemic diseases, and mobility.

Symptoms and Problems in Children with Inherited Metabolic Diseases and Factors Affecting the Caregiver Burden of Mothers.

Parents need to constantly monitor their children with inherited metabolic diseases (IMDs) and have difficulty coordinating care. The aim of this descriptive study was to determine the symptoms and problems in children with IMDs and factors affecting caregiver burden. The study was conducted in a pediatric hospital. The study sample consisted of 47 mothers of children with IMDs. Data were collected using a descriptive characteristics form (DCF), a data collection form related to symptoms and problems (DCFSP), and a caregiver burden inventory (CBI). The most common specific problems were hepatomegaly (36.2%), developmental delay (27.7%), and muscle weakness (14.9%). Mothers' CBI mean total score was 30.23 ± 19.65. Mothers whose children were partially or completely dependent had significantly higher scores than others. Mothers who expressed the family income status as "an expenses more than income" had higher CBI scores. Understanding the problems of children with IMD and factors effecting caregiver burden of mothers can help health-care professionals to identify patients' and their families' needs and facilitate the development of nursing interventions for effective care and reduction of caregiver burden. These results can be used to improve the nursing care of children with IMDs and their families.

Identification of reversible causes of minority inequity in stroke: severity related to race and socio-economic status.

OBJECTIVES: Previous reports of a higher incidence and risk of stroke in minorities were associated primarily with race and ethnicity, yet the relationship between socio-economic status (SES) and racial disparities in stroke is less well known. We have investigated the effects of SES on the incidence of stroke type and its severity in minorities. METHODS: The clinical and demographic data on 140 patients diagnosed with a stroke in the North Lawndale neighbourhood of Chicago, one of the city's poorest communities, were collected prospectively over a 13-month period and then were retrospectively analysed. RESULTS: Overall, haemorrhagic stroke occurred in 31% of cases, differing from the previously reported haemorrhagic stroke incidence of 15%. When accounting for SES, the incidence of haemorrhagic stroke in the uninsured versus the privately or Medicaid-insured increased to 50%. Uninsured African-American patients experienced even higher rates of haemorrhagic stroke at 55%. CONCLUSIONS: Patients who are uninsured minorities may be at an increased risk for severe strokes. This increase in risk appears to be related to the increased incidence of risk factors and lack of treatment. The lack of funds, care access, and limited education in these patients may be related to their increase in risk factors. This paper identifies potentially reversible environmental and societal factors that can lead to improved outcomes in indigent minority patients.

The ability of a limited metabolic assessment to identify pediatric stone formers with metabolic abnormalities.

INTRODUCTION: American Urological Association guidelines recommend a urinary metabolic evaluation after the first stone event in all pediatric stone patients. Prior studies identified hypercalciuria and urine hypovolemia as the most common abnormalities in children with urolithiasis. Recent data suggest that hypocitraturia is most prevalent. It was hypothesized that a limited evaluation would detect the majority of clinically significant metabolic abnormalities in pediatric stone formers. MATERIAL AND METHODS: A retrospective analysis of all children (<18 years of age) with renal/ureteral calculi evaluated at the study institution from 2005 to 2015 was performed. Children with ≥ one 24-h urinary metabolic profile after a clinical visit for renal/ureteral calculi were included. Those with bladder stones and those with undercollection or overcollection or missing urinary creatinine were excluded. Demographics and data from the first urinary metabolic profile and stone analyses were collected. The sensitivity, specificity, and positive and negative predictive value (NPV) of a limited urinary metabolic evaluation consisting of four parameters (24-h calcium, citrate, and oxalate and low urinary volume) were compared to a complete urinary metabolic profile. The number and type of metabolic abnormalities that would have been missed with this limited evaluation weredetermined. RESULTS: Of 410 patients, 21 were excluded for age ≥18 years, 13 for bladder stones, 248 for overcollections, 38 for undercollections, and 10 for missing creatinine. This left 80 patients for inclusion: median age 11.4 years, 60% female, and 96.3% white. Of the entire cohort, 69.6% had hypocitraturia, 52.5% had low urine volume, and 22.5% had hypercalciuria. Sensitivity was 87.5%. Specificity could not be calculated because no patients had a normal complete metabolic evaluation. The NPV was zero, and the positive predictive value was 100%, but these are artifacts resulting from the absence of patients with a normal complete metabolic evaluation. Of the 80 patients, 10 had at least one abnormality missed by a limited metabolic evaluation (Table 1). The missed abnormalities were high pH (n = 6), abnormal 24-h phosphorus (low in 1 patient and high in 1 patient), low 24-h magnesium (n = 3), low 24-h potassium (n = 3), and high 24-h sodium (n = 4). DISCUSSION: A limited urinary metabolic evaluation would have detected the vast majority of clinically significant metabolic abnormalities in the study sample. Approximately two-thirds of the study patients submitted inadequate 24-h urine specimens. CONCLUSIONS: A simplified approach to metabolic evaluation in first-time stone formers with a stone analysis available was proposed. This streamlined approach could simplify the metabolic evaluation and reduce health care costs.

Composición corporal y gasto energético en población de niños y adolescentes con mielomeningocele / Body composition and energy expenditure in a population of children and adolescents with myelomeningocele

Introducción: El mielomeningocele es un defecto congénito con cierre incompleto del tubo neural. Presenta alteraciones en la composición corporal y alta prevalencia de obesidad. Es difícil detectar el indicador más apropiado para diagnóstico nutricional por impresición de las medidas antropométricas. Objetivo: Describir en una población de pacientes con mielomeningocele seguidos en el "Hospital Garrahan", la composición corporal, gasto energético en reposo y trastornos metabólicos, comparando los pacientes con mielomeningocele obesos con una población control con obesidad multifactorial. Población y Métodos: Se realizó antropometría, impedanciometría, pliegues cutáneos, perímetro braquial, calorimetría indirecta y determinaciones bioquímicas a todos los pacientes con mielomeningocele entre junio/2013-abril/2014, previa firma del Consentimiento Informado. Resultados: Se evaluaron 131 pacientes de 0,718,6 años, clasificados según Score-Z de Índice de Masa Corporal en 15% bajo peso, 42% normopeso, 12% sobrepeso y 31% obesidad. Se encontró alta correlación (r²0,74) entre %masa grasa por impedanciometría vs calculado con pliegues cutaneos. Los pacientes con % masa grasa elevada vs %masa grasa normal tuvieron mayor score-Z de Indice de Masa Corporal (1,07 vs -0,27 p0,0001) aunque ambos valores se encontraban dentro de parámetros normales. Hubo menor gasto energético en reposo en los pacientes con mielomeningocele obesos comparado con el esperado y con obesos multifactoriales. Conclusiones: Se encontró alto porcentaje de sobrepeso/obesidad en la población con mielomeningocele. Los pliegues cutáneos serían más apropiados para detectar obesidad. Los pacientes con mielomeningocele obesos presentaron gasto energetico en reposo menor al esperado y a los controles. La indicación de energía debe ser personalizada.

Introduction. Myelomeningocele is a congenital defect that occurs when the neural tube fails to close completely. It causes body composition alterations and a high prevalence of obesity. It is difficult to detect the most adequate indicator for a nutritional diagnosis due to the impossibility of recording accurate anthropometric measurements. Objective. To describe body composition, resting energy expenditure and metabolic disorders in a population of patients with myelomeningocele managed at "Hospital Garrahan" by comparing obese patients with myelomeningocele and a control population with multifactorial obesity. Population and methods. An anthropometry, an impedance analysis, skinfold equations, arm circumference equations, indirect calorimetry, and biochemical determinations were done to all patients with myelomeningocele between June 2013 and April 2014, once the informed consent had been signed. Results. 131 patients aged 0.7-18.6 years were assessed; they were classified according to their body mass index Z-score into low weight (15%), normal weight (42%), overweight (12%), and obese (31%). A high correlation (r: 20.74) was observed between the fat mass % measured by impedance analysis versus that estimated using skinfolds. Patients with a high fat mass % had a higher body mass index Z-score than those with a normal fat mass % (1.07 versus -0.27, p: 0.0001) although both values were within normal parameters. A lower resting energy expenditure was observed among obese patients with myelomeningocele than predicted and in comparison with multifactorial obese controls. Conclusions. A high percentage of overweight/obesity was found in the population with myelomeningocele. Skinfold equations would be more adequate to detect obesity. Obese patients with myelomeningocele had a lower resting energy expenditure than predicted and in comparison with controls. Energy indication should be customized.

Body composition and energy expenditure in a population of children and adolescents with myelomeningocele. / Composición corporal y gasto energético en población de niños y adolescentes con mielomeningocele.

INTRODUCTION: Myelomeningocele is a congenital defect that occurs when the neural tube fails to close completely. It causes body composition alterations and a high prevalence of obesity. It is difficult to detect the most adequate indicator for a nutritional diagnosis due to the impossibility of recording accurate anthropometric measurements. OBJECTIVE: To describe body composition, resting energy expenditure and metabolic disorders in a population of patients with myelomeningocele managed at "Hospital Garrahan" by comparing obese patients with myelomeningocele and a control population with multifactorial obesity. POPULATION AND METHODS: An anthropometry, an impedance analysis, skinfold equations, arm circumference equations, indirect calorimetry, and biochemical determinations were done to all patients with myelomeningocele between June 2013 and April 2014, once the informed consent had been signed. RESULTS: 131 patients aged 0.7-18.6 years were assessed; they were classified according to their body mass index Z-score into low weight (15%), normal weight (42%), overweight (12%), and obese (31%). A high correlation (r: 20.74) was observed between the fat mass % measured by impedance analysis versus that estimated using skinfolds. Patients with a high fat mass % had a higher body mass index Z-score than those with a normal fat mass % (1.07 versus -0.27, p: 0.0001) although both values were within normal parameters. A lower resting energy expenditure was observed among obese patients with myelomeningocele than predicted and in comparison with multifactorial obese controls. CONCLUSIONS: A high percentage of overweight/obesity was found in the population with myelomeningocele. Skinfold equations would be more adequate to detect obesity. Obese patients with myelomeningocele had a lower resting energy expenditure than predicted and in comparison with controls. Energy indication should be customized.

INTRODUCCIÓN: El mielomeningocele es un defecto congénito con cierre incompleto del tubo neural. Presenta alteraciones en la composición corporal y alta prevalencia de obesidad. Es difícil detectar el indicador más apropiado para diagnóstico nutricional por impresición de las medidas antropométricas. OBJETIVO: Describir en una población de pacientes con mielomeningocele seguidos en el "Hospital Garrahan", la composición corporal, gasto energético en reposo y trastornos metabólicos, comparando los pacientes con mielomeningocele obesos con una población control con obesidad multifactorial. POBLACIÓN Y MÉTODOS: Se realizó antropometría, impedanciometría, pliegues cutáneos, perímetro braquial, calorimetría indirecta y determinaciones bioquímicas a todos los pacientes con mielomeningocele entre junio/2013-abril/2014, previa firma del Consentimiento Informado. RESULTADOS: Se evaluaron 131 pacientes de 0,718,6 años, clasificados según Score-Z de Índice de Masa Corporal en 15% bajo peso, 42% normopeso, 12% sobrepeso y 31% obesidad. Se encontró alta correlación (r20,74) entre %masa grasa por impedanciometría vs calculado con pliegues cutaneos. Los pacientes con % masa grasa elevada vs %masa grasa normal tuvieron mayor score-Z de Indice de Masa Corporal (1,07 vs -0,27 p0,0001) aunque ambos valores se encontraban dentro de parámetros normales. Hubo menor gasto energético en reposo en los pacientes con mielomeningocele obesos comparado con el esperado y con obesos multifactoriales. CONCLUSIONES: Se encontró alto porcentaje de sobrepeso/obesidad en la población con mielomeningocele. Los pliegues cutáneos serían más apropiados para detectar obesidad. Los pacientes con mielomeningocele obesos presentaron gasto energetico en reposo menor al esperado y a los controles. La indicación de energía debe ser personalizada.

Skeletal Muscle Metabolic Dysfunction in Patients With Malignant Hyperthermia Susceptibility.

BACKGROUND: Malignant hyperthermia (MH), a pharmacogenetic disorder of skeletal muscle, presents with a potentially lethal hypermetabolic reaction to certain anesthetics. However, some MH-susceptible patients experience muscle weakness, fatigue, and exercise intolerance in the absence of anesthetic triggers. The objective of this exploratory study was to elucidate the pathophysiology of exercise intolerance in patients tested positive for MH with the caffeine-halothane contracture test. To this end, we used phosphorus magnetic resonance spectroscopy, blood oxygen level-dependent functional magnetic resonance imaging (MRI), and traditional exercise testing to compare skeletal muscle metabolism in MH-positive patients and healthy controls. METHODS: Skeletal muscle metabolism was assessed using phosphorus magnetic resonance spectroscopy and blood oxygen level-dependent functional MRI in 29 MH-positive patients and 20 healthy controls. Traditional measures of physical capacity were employed to measure aerobic capacity, anaerobic capacity, and muscle strength. RESULTS: During 30- and 60-second exercise, MH-positive patients had significantly lower ATP production via the oxidative pathway compared to healthy controls. MH-positive patients also had a longer recovery time with blood oxygen level-dependent functional MRI compared to healthy controls. Exercise testing revealed lower aerobic and anaerobic capacity in MH-positive patients compared to healthy controls. CONCLUSIONS: Results of this exploratory study suggest that MH-positive patients have impaired aerobic metabolism compared to healthy individuals. This could explain the exercise intolerance exhibited in MH-susceptible patient population.

Metabolic assessment of recurrent and first renal calcium oxalate stone formers.

OBJECTIVES: This study aimed to demonstrate the dominant role of metabolic disorders in the formation of calcium oxalate stones in patients with recurrent urolithiasis, as well as in patients experiencing their first episode of urolithiasis. PATIENTS AND METHODS: The records of the patients who attended our kidney stone outpatient clinics between 2008 and 2012 were reviewed, and the data of 318 calcium oxalate stone patients who had undergone a metabolic assessment were retrospectively analysed. The patients were divided in two groups. The first group included the patients who presented with their first episode of urolithiasis (Group 1, n = 170), and the second group included patients with recurrent urolithiasis (Group 2, n = 148); intergroup comparisons of metabolic disorders were performed. RESULTS: A significant difference was found between the two groups in mean urine calcium levels (Group 1, 0.25; Group 2, 0.31; p = 0.001); the mean serum calcium level was found to be significantly higher although at less extent in Group 2 (Group 1, 9.4; Group 2, 9.6); p = 0.04). Significant differences were also found in mean urine citrate (Group 1, 481.9; Group 2, 397.2, p < 0.0001) and oxalate levels (Group 1, 22.1; Group 2, 28.5; p < 0.0001) . CONCLUSIONS: This study revealed a metabolic tendency to hypercalciuria in calcium oxalate stone patients, predominantly in those with recurrent calcium oxalate urolithiasis. Urinary oxalate excretion was found to be higher in recurrent urolithiasis in comparison to the first episode of calcium oxalate urolithiasis and urinary citrate excretion lower in recurrent urolithiasis.

[Prevalence of cardiovascular risk factors in a population of health-care workers]. / Prevalencia de factores de riesgo cardiovascular en trabajadores de la salud.

BACKGROUND: To determine the prevalence of cardiovascular risk factors (CVRF) in healthcare workers from two tertiary-care hospitals of the Mexican Institute of Social Security, as well as their association with professional activities (PA). METHODS: Descriptive study. One-thousand eighty-nine health-care workers ≥ 18 years were included. Clinical history, physical exam, and blood tests were performed. RESULTS: Mean age 41 ± 9 years, 76% women. Hypertension prevalence was 19%, diabetes mellitus 9.6%, dyslipidemia 78%, overweight and obesity 73%, metabolic syndrome (MS) 32.5%, and smoking 19%. The following significant associations (p < 0.05) were found: MS with medical asisstants (OR: 2.73, CI 95%: 1.31-5.69) and nutritionist (OR: 2.6, CI 95%: 1.31-5.24); obesity with administrative personnel (OR: 3.64, CI 95%: 1.40-7.46); dyslipidemia with medical asisstants (OR: 2.58, CI 95%: 1.15-6.34). In the whole sample, the probability to have a vascular event in the following 10 years was 10%. CONCLUSION: Prevalence of CVRF was high in this sample of health-care workers and did not seem to be different from those in general population. Medical assistants, nutritionist, and administrative personnel displayed a higher risk. It is necessary to create programs to promote healthy lifestyle and to improve the epidemiological profile of health-care workers.

Introducción: el objetivo de este trabajo es determinar la prevalencia de los factores de riesgo cardiovascular (FRCV) y su asociación con actividad laboral (AL) en trabajadores de dos hospitales de enseñanza de tercer nivel de atención del IMSS. Métodos: estudio descriptivo que incluyó a trabajadores ≥ 18 años. Se realizó historia clínica, examen físico y pruebas de laboratorio para identificar FRCV y asociarlos con AL. Resultados: se estudió un total de 1089 trabajadores, con edad de 41 ± 9 años, el 76% fueron mujeres. La prevalencia de hipertensión fue de 19%, diabetes mellitus 9.6%, dislipidemia 78%, sobrepeso y obesidad 73%; síndrome metabólico (SM) 32.5%, tabaquismo 19%. El SM se asoció con el área de asistentes médicas (OR: 2.73, IC 95%: 1.31-5.69) y nutrición/dietética (OR: 2.6, IC 95%: 1.31-5.24). La obesidad con el área administrativa (OR 3.64 IC 95%: 1.40-7.46). La dislipidemia con el área de asistentes médicas (OR 2.58, IC 95%: 1.15-6.34). La probabilidad de sufrir evento vascular en 10 años fue de 10%. Conclusiones: la prevalencia de FRCV fue alta y no es diferente a la de la población general. Las actividades laborales en riesgo fueron: asistentes médicas, nutricionistas y personal administrativo. Es necesario reorientar programas de promoción de la salud en unidades médicas para mejorar el perfil epidemiológico de los trabajadores.

Comparison of energy expenditure, body composition, metabolic disorders, and energy intake between obese children with a history of craniopharyngioma and children with multifactorial obesity.

UNLABELLED: Craniopharyngioma is a histologically benign brain malformation with a fundamental role in satiety modulation, causing obesity in up to 52% of patients. AIM: To evaluate cardiovascular risk factors, body composition, resting energy expenditure (REE), and energy intake in craniopharyngioma patients and to compare the data with those from children with multifactorial obesity. POPULATION: All obese children and adolescents who underwent craniopharyngioma resection and a control group of children with multifactorial obesity in follow-up between May 2012 and April 2013. MATERIALS AND METHODS: Anthropometric measurements, bioelectrical impedance, indirect calorimetry, energy intake, homeostatic model assessment insulin resistance (HOMA-IR), and dyslipidemia were evaluated. RESULTS: Twenty-three patients with craniopharyngioma and 43 controls were included. Children with craniopharyngioma-related obesity had a lower fat-free mass percentage (62.4 vs. 67.5; p=0.01) and a higher fat mass percentage (37.5 vs. 32.5; p=0.01) compared to those with multifactorial obesity. A positive association was found between %REE and %fat-free mass in subjects with multifactorial obesity (68±1% in normal REE vs. 62.6±1% in low REE; p=0.04), but not in craniopharyngioma patients (62±2.7 in normal REE vs. 61.2±1.8% in low REE; p=0.8). No differences were found in metabolic involvement or energy intake. CONCLUSIONS: REE was lower in craniopharyngioma patients compared to children with multifactorial obesity regardless of the amount of fat-free mass, suggesting that other factors may be responsible for the lower REE.

Yield and cost-effectiveness of laboratory testing to identify metabolic contributors to falls and fractures in older persons.

UNLABELLED: Falls and fractures constitute a major cause of morbidity and mortality among older adults. Although falls and fractures share similar risk factors, there is no integrated approach to identifying secondary causes of both entities. We report a cost-effective approach to identify metabolic causes of falls and fractures in the clinical setting. PURPOSE: Falls and fractures are a major cause of morbidity and mortality among older adults. Metabolic disorders contributing to the combined risk of falls and fractures are frequent but often go undetected. The most efficient and cost-effective laboratory screening strategy to unmask these disorders remains unknown. The purpose of this study was to identify the most cost-effective laboratory tests to detect undiagnosed metabolic contributors and to decide treatment of these disorders in older persons. METHODS: This is a cross-sectional study design, which included all participants attending the Falls & Fractures Clinic, Nepean Hospital (Penrith, Australia) between 2008 and 2013. Chemistry profile included 25(OH) vitamin D, parathyroid hormone (PTH), albumin, creatinine, calcium, phosphate, vitamin B-12, folate, and thyroid-stimulating hormone (TSH) for all patients, and serum testosterone in men. The number of new diagnoses identified and their cost-effectiveness (cost in US$ per patient screened and cost per new diagnosis) were calculated. RESULTS: A total of 739 participants (mean age 79, 71 % female) were assessed. Among 233 participants with complete laboratory tests, previously undiagnosed disorders were identified in 148 (63.5 %). Vitamin D deficiency (27 %) and hyperparathyroidism (21.5 %) were the most frequent diagnoses. A testing strategy including serum vitamin D, calcium, PTH, creatinine/estimated glomerular filtration rate (eGFR), and TSH for all patients and serum testosterone in men would have been sufficient to identify secondary causes of falls and fractures in 94 % of patients at an estimated cost of $190.19 per patient screened and $257.64 per diagnosis. CONCLUSIONS: The minimum cost-effective battery for occult metabolic disorders in older adults at risk of falls and fractures should include serum vitamin D, PTH, TSH, creatinine/eGFR, testosterone (in men), and calcium.

Gasto energético, composición corporal, trastornos metabólicos e ingesta energética en pacientes con antecedentes de craneofaringioma / Energy expenditure, body composition, metabolic disorders, and energy intake in patients with a history of craniopharyngioma

Introducción: Los craneofaringiomas son malformaciones histológicamente benignas que se sitúan entre el hipotálamo y la hipófisis, zonas con un rol determinante en la modulación de la saciedad. Aun siendo tumores benignos, presentan una considerable morbilidad. La obesidad está presente hasta en un 52% de los pacientes. Objetivo: evaluar factores de riesgo cardiovascular, composición corporal y gasto energético en pacientes con craneofaringioma, y compararlos con un grupo de obesos multifactoriales. Material y métodos: Se incluyeron todos los pacientes con resección quirúrgica de craneofaringioma, menores de 21 años, en seguimiento en nuestro centro entre mayo 2012 hasta abril 2013 que aceptaron participar por medio del consentimiento informado. Se realizó valoración antropométrica, composición corporal con impedanciometría, gasto energético con calorimetría indirecta y valoración de ingesta energética y de macronutrientes. Se determinó resistencia a la insulina (HOMA-IR) y dislipemia. Se comparó a los pacientes con craneofaringioma con obesidad, con un grupo de pacientes con obesidad multifactorial. Resultados: se estudiaron 39 pacientes. El 59% era obeso y presentó significativamente menor% de masa magra (62.4 vs 67.5 p=0.01) y mayor% de masa grasa (37.5 vs 32.5 p=0.01) comparados con los obesos multifactoriales. No se encontró diferencias en el compromiso metabólico entre los obesos con y sin antecedente de craneofaringioma. Se dividieron los pacientes en tertilos según% de gasto energético para categorizar en gasto bajo vs normal. Se encontró asociación positiva entre% de gasto energético y% de masa magra en obesos multifactoriales (68±1%; en los gasto normal vs 62.6± 1% en los gasto bajo: p 0,04). Sin diferencias dentro de la población de obesos con antecedente de craneofaringioma (62±2.7 en los gasto normal/alto vs 61.2±1.8% en los gasto bajo: p 0,8). El gasto energético basal (REE) fue menor en los pacientes con antecedente de craneofaringioma vs obesos multifactoriales, independientemente de la masa magra, lo que sustenta que existirían otros factores que actuarían disminuyendo el gasto energético. No hubo diferencia con respecto a la ingesta en ambos grupos estudiados. Conclusiones: los pacientes con antecedente de craneofaringioma presentan menor gasto energético no relacionado a la masa magra y similar ingesta energética comparado con obesos multifactoriales. No hubo diferencias en el compromiso metabólico entre los obesos con y sin antecedentes de craneofaringioma (AU)

Introduction: Craniopharyngiomas are histologically benign malformations located between hypothalamus and the pituitary gland, areas that play an important role in satiety modulation. Although the tumors are benign, they may cause significant morbidity. Obesity is found in up to 52% of patients. Aim: To assess cardiovascular risk factors, body composition, and energy expenditure in patients with craniopharyngioma, and to compare them to results in a group of children with multifactorial obesity. Material and methods: All patients who underwent surgical resection of craniopharyngioma, younger than 21 years of age, who were being followed-up at our center between May 2012 and April 2013 who gave their informed consent to participate were enrolled in the study. Anthropometric measurements, body composition with impedanciometer, energy expenditure with indirect calorimetry, and energy and macronutrient intake were evaluated. Insulin resistance (HOMA-IR) and dyslipidemia were determined. Patients with craniopharyngioma associated with obesity were compared to patients with multifactorial obesity. Results: Of 39 patients studied, 59% were obese and a significantly lower percentage of lean mass (62.4 vs 67.5 p=0.01) and a higher percentage of fat mass (37.5 vs 32.5 p=0.01) compared to multifactorial obese subjects. No differences were found in metabolic involvement between obese subjects with and those without a history of craniopharyngioma. Patients were divided into tertiles according to percentage of energy expenditure to categorize low versus normal expenditure. A positive correlation was found between percentage of energy expenditure and lean mass percentage in subjects with multifactorial obesity (68±1%; in those with normal energy expenditure versus 62.6±1% in those with low energy expenditure: p 0.04). No difference was found within the group of obese patients with a history of craniopharyngioma (62±2.7 in those with normal/high expenditure versus 61.2±1.8% in those with low expenditure: p 0.8). Baseline energy expenditure (BEE) was lower in craniopharyngioma patients than in those with multifactorial obesity, regardless of lean mass percentage, supporting the hypothesis that other factors may be involved in the decrease of energy expenditure. There was no difference in the food intake between both groups. Conclusions: Patients with a history of craniopharyngioma had a lower energy expenditure unrelated to lean mass and a similar energy intake compared to subjects with multifactorial obesity. No differences were found in metabolic involvement between obese subject with and those without a history of craniopharyngioma (AU)

[Cardiac and metabolic risk factors in severe mental disorders. Task of a prevention manager]. / Kardiale und metabolische Risikofaktoren bei schweren psychischen Erkrankungen. Aufgaben eines Präventionsmanagers.

People with severe mental disorders have a reduction in life expectancy of 13-30 % compared with the general population. This severe disadvantage is primarily due to an increased prevalence of cardiac and metabolic disorders, especially coronary heart disease (CHD) and type 2 diabetes mellitus and are the result of untoward health behavior characterized by smoking, low levels of physical activity and unhealthy dietary habits. Obesity, arterial hypertension and lipid disorders are also associated with this behavior and further increase the risk of CHD and type 2 diabetes. Thus, people with mental disorders constitute a population with a high risk of cardiovascular events. Appropriate measures for prevention and therapy are urgently indicated but rarely applied. This article presents new organizational structures to overcome this deficit with a prevention manager playing a central role in organizing and applying preventive and therapeutic care. Results from cardiology and diabetic medicine have shown the effectiveness of pooling this responsibility. The measure has the potential to reduce the increased mortality of people with severe mental disorders.

Hypometabolizers: characteristics of obese patients with abnormally low resting energy expenditure.

Weight gain or loss is determined by the difference between calorie intake and energy expenditure. The Mifflin metabolic equation most accurately predicts resting energy expenditure (REE) in morbidly obese patients. Hypometabolizers have a measured REE that is much less than predicted and pose the greatest challenge for weight loss induced by restriction of calorie intake. We studied 628 morbidly obese patients (467 female and 161 men, aged 52.5 ± 15.7 years, body mass index [BMI] of 42.6 ± 7.6 m/kg(2) [mean ± SD]). REE was measured using the MedGem® device (REEm) and the percentage variance (ΔREE%) from the Mifflin-predicted expenditure (REEp) was calculated. Patients with ΔREE% more than 1 standard deviation from the mean were defined as hypometabolizers (REEm greater than 27% below REEp) and hypermetabolizers (REEm less than 13% above REEp), respectively. Hypometabolizers had greater REEp (1900 ± 301 vs 1719 ± 346 calories, P = 0.005) and lower REEm (1244 ± 278 vs 2161 ± 438 calories, P < 0.0001) than hypermetabolizers. Hypometabolizers, when compared with hypermetabolizers, were taller (167.2 ± 8.4 vs 164.0 ± 10.9 cm, P = 0.04), heavier (123.6 ± 22.2 vs 110.2 ± 23.1 kg, P = 0.006), and had increased BMI (44.1 ± 6.5 vs 40.8 ± 6.5 kg/m(2), P = 0.04). Other measured anthropometrics were not different between hypo- and hypermetabolizers. Hypometabolizers were less likely to be diabetic (23 vs 43%, P = 0.03) and more likely to be black (25 vs 5%, P = 0.002) than hypermetabolizers. This study defines hypometabolizers as having variance in REEm more than 27 per cent below that predicted by the Mifflin equation. We could not identify any distinguishing phenotypic characteristics of hypometabolizers, suggesting an influence unrelated to body composition.

Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients.

BACKGROUND & AIMS: We evaluated the ability of Nutritional Risk Screening 2002 (NRS 2002) and Subjective Global Assessment (SGA) to predict malnutrition related to poor clinical outcomes. METHODS: We assessed 705 patients at a public university hospital within 48 h of admission. Logistic regression and number needed to screen (NNS) were calculated to test the complementarity between the tools and their ability to predict very long length of hospital stay (VLLOS), complications, and death. RESULTS: Of the patients screened, 27.9% were at nutritional risk (NRS+) and 38.9% were malnourished (SGA B or C). Compared to those patients not at nutritional risk, NRS+, SGA B or C patients were at increased risk for complications (p=0.03, 0.02, and 0.003, respectively). NRS+ patients had an increased risk of death (p=0.03), and SGA B and C patients had an increased likelihood of VLLOS (p=0.008 and p<0.0001, respectively). Patients who were both NRS+ and SGA C had lower estimates of NNS than patients who were NRS+ or SGA C only, though their confidence intervals did overlap. CONCLUSIONS: The concurrent application of SGA in NRS+ patients might enhance the ability to predict poor clinical outcomes in hospitalized patients in Brazil.

Subjective global assessment is not sufficient to screen patients with defective hepatic metabolism.

BACKGROUND AND AIMS: Subjective global assessment (SGA) is useful for screening malnourished patients with several diseases, although it has been indicated to underestimate nutritional status for patients with liver disease. Accordingly, the aim of this study was to examine the usefulness of SGA as a nutritional screening tool for patients with liver disease, compared to patients with gastroenterological disease, without bias of personal ability and experience. METHODS: SGA was performed on 129 of hospitalized patients (86 with liver disease and 43 with gastroenterological disease). Nutritional status was categorized as well-nourished or malnourished status, based on nutritional indicators from laboratory data. RESULTS: The SGA screening ratio (sensitivity) for malnourished patients with liver disease was significantly lower than gastroenterological disease, while specificity or efficiency was not significantly different. In nutritional indicators from laboratory data, the difference between SGA-positive and SGA-negative patients with liver disease was significant but not so remarkable compared with the difference between those with other diseases. The positive number of SGA components per patient for the liver disease group was significantly less than gastroenterological disease group. CONCLUSIONS: SGA for patients with liver diseases was not sufficient as a nutritional screening tool because malnutrition induced by defective hepatic metabolism was not characterized fully.

Monitoring metabolic health of dairy cattle in the transition period.

This paper reviews the importance of energy metabolism in transition dairy cows, its associations with disease and reproduction, and strategies for monitoring cows under field conditions during this critical time. Essentially all dairy cattle experience a period of insulin resistance, reduced feed intake, negative energy balance, hypocalcemia, reduced immune function, and bacterial contamination of the uterus soon before, or in the weeks after calving. One-third of dairy cows may be affected by some form of metabolic or infectious disease in early lactation. Routine, proactive actions, observations, or analysis are intended to accurately and efficiently provide early detection of problems, to provide an opportunity for investigation and intervention in order to limit the consequences and costs of health problems and reduced animal performance or welfare. Methods of early detection include monitoring of disease and culling records, feed intake, milk production, body condition, and simple metabolic tests. Methods, strategies, and interpretation of measurement of peripartum concentrations of non-esterified fatty acids (NEFA) and beta-hydroxybutyrate (BHB) as indicators of aspects of energy status and disease risk are reviewed. High NEFA (> 0.4 mmol/l) in the last 7 to 10 days before expected calving is associated with increased risk of displaced abomasum (DA), retained placenta, culling before 60 days in milk, and less milk production in the first 4 months of lactation. Subclinical ketosis (serum BHB >1200 to 1400 micromol/l) in the first or second week after calving is associated with increased risk of DA, metritis, clinical ketosis, endometritis, prolonged postpartum anovulation, increased severity of mastitis, and lower milk production in early lactation. There are several validated and practical tools for cow-side measurement of ketosis.