Heart rate variability in multibacillar leprosy: Linear and nonlinear analysis.

OBJECTIVE: To evaluate the heart rate variability (HRV) in patients with multibacillary leprosy using dynamic linear and nonlinear analysis. MATERIAL AND METHODS: Twenty-one leprosy patients (mean age: 39.14 ±10.58 years) and 21 healthy subjects (mean age: 36.24 ± 12.64 years) completed the sample. Heart rate variability recording was performed by a Polar RS800 CX heart monitor during a period of 15 min in the supine position and 15 min in a sitting position. Analysis of HRV was performed by frequency domain from high frequency (HF) and low frequency (LF) spectral indexes in absolute and normalized units. The nonlinear analysis of HRV was calculated using symbolic analysis (0V%, 1V%, 2LV% and 2UV% indexes), Shannon entropy (SE) and normalized complexity index (NCI). RESULTS: Linear analysis: both groups showed higher HF values (p < 0.05) and smaller LF values (p < 0.05) in supine than in sitting position. The leprosy patients showed higher LF values (p < 0.05) and smaller HF values (p < 0.05) compared to the controls on supine position. Symbolic analysis: leprosy patients had higher 0V% values (p < 0.05), smaller 2LV% values (p < 0.05) and 2UV % values compared to healthy subjects on both positions. The 1V % had higher values (p < 0.05) for leprosy patients than for controls in the sitting position. The control subjects had smaller 0V % values (p < 0.05), and higher 2UV % values (p < 0.05) in the supine position compared to the sitting position. Leprosy patients had higher 2UV index values (p < 0.05) in the supine position compared to the sitting position. In the complexity analysis, leprosy patients had smaller SE and NCI values (p < 0.05) than the control in the supine position. There was no difference between the SE and NCI values of leprosy and the control subjects in the sitting position. The control subjects had higher SE and NCI values (p < 0.05) in the supine position than in the sitting position. CONCLUSION: Leprosy patients had higher sympathetic modulation and smaller vagal modulation than controls, indicating less HRV and cardiac modulation with lower complexity. The control group displayed significant HRV differences in response to position changes while leprosy patients had fewer HRV differences after the same postural change. An analysis of HRV with linear and non-linear dynamics proved to be a reliable method and promising for the investigation of autonomic dysfunction in patients with multibacillary leprosy.

Leptin and its Receptors in Human Placenta of Small, Adequate, and Large for Gestational Age Newborns.

Alterations in birth weight impact postnatal outcome and adult metabolic health. Therefore, fetal growth regulation is crucial for preventing chronic metabolic diseases. Leptin has been suggested to play an important role in placental and fetal growth, albeit its specific mechanisms of action have not been elucidated. The aim of this study was to analyze leptin concentrations in placenta, cord blood, and maternal blood of SGA, AGA, and LGA (small, adequate and large for gestational age, respectively) newborns, as well as placental leptin receptor (LEPRa and LEPRb) protein expression. We performed a cross-sectional comparative study in 3 groups of healthy mothers and their term newborns at delivery (SGA, AGA, and LGA, n=20 per group). Placental, maternal blood, and cord blood leptin content were measured by ELISA. Placental LEPRa and LEPRb protein expression were determined by Western Blot. Maternal leptin concentrations correlated positively with maternal weight before and at the end of gestation, without differences between groups. Cord leptin is higher in LGA and lower in SGA, whereas placental leptin is higher in SGA. Placental leptin was inversely correlated with placental weight, independently from maternal weight and gestational age. Both LEPRa and LEPRb expression are lower in SGA, while LEPRa positively correlated with placental weight and birthweight. The current findings indicate that placental leptin and its receptors are differentially expressed in SGA, AGA, and LGA newborns. We suggest that placental leptin and LEPR protein expression may influence placental growth and thus, birth weight.

A specific prediction equation is necessary to estimate peak oxygen uptake in obese patients with metabolic syndrome.

PURPOSE: The aims were to: (1) compare peak oxygen uptake ([Formula: see text]peak) predicted from four standard equations to actual [Formula: see text]peak measured from a cardiopulmonary exercise test (CPET) in obese patients with metabolic syndrome (MetS), and (2) develop a new equation to accurately estimate [Formula: see text]peak in obese women with MetS. METHODS: Seventy-five obese patients with MetS performed a CPET. Anthropometric data were also collected for each participant. [Formula: see text]peak was predicted from four prediction equations (from Riddle et al., Hansen et al., Wasserman et al. or Gläser et al.) and then compared with the actual [Formula: see text]peak measured during the CPET. The accuracy of the predictions was determined with the Bland-Altman method. When accuracy was low, a new prediction equation including anthropometric variables was proposed. RESULTS: [Formula: see text]peak predicted from the equation of Wasserman et al. was not significantly different from actual [Formula: see text]peak in women. Moreover, a significant correlation was found between the predicted and actual values (p < 0.001, r = 0.69). In men, no significant difference was noted between actual [Formula: see text]peak and [Formula: see text]peak predicted from the prediction equation of Gläser et al., and these two values were also correlated (p = 0.03, r = 0.44). However, the LoA95% was wide, whatever the prediction equation or gender. Regression analysis suggested a new prediction equation derived from age and height for obese women with MetS. CONCLUSIONS: The methods of Wasserman et al. and Gläser et al. are valid to predict [Formula: see text]peak in obese women and men with MetS, respectively. However, the accuracy of the predictions was low for both methods. Consequently, a new prediction equation including age and height was developed for obese women with MetS. However, new prediction equation remains to develop in obese men with MetS.

Comparison of sarcopenic status between elderly leprosy survivors and general population.

Because of chronicity and poor environments, elderly leprosy survivors might be at greater risk of developing obesity and sarcopenia than healthy individuals. This study aimed to investigate whether body composition and the prevalence of obesity and sarcopenia among elderly leprosy survivors with no or mild physical impairment differ from those of the general population. A total of 36 leprosy survivors aged 65-90 years with no or mild physical impairment were recruited. Individuals matched for sex, age, and height were selected as a control group from the Fourth Korea National Health and Nutrition Examination Survey. Anthropometric characteristics, body composition, appendicular skeletal muscle mass (ASM), modified skeletal muscle mass index (SMI), and the prevalence of obesity and sarcopenia were compared between the leprosy survivors and the control group. Compared to the control group, the leprosy survivors had higher body weight, BMI, total fat mass, and total fat percentage. The leprosy survivor group also had lower ASM (P=0.035) and SMI (P<0.001) values. Comparison of the composition of regional body parts showed that the lean body mass of the legs was lower in the leprosy survivor group even though this group had higher body weight. The leprosy survivor group also had a significantly higher prevalence of sarcopenia than the control group (38.7% vs. 5.6%; P=0.002). These findings suggest that leprosy survivors are at greater risk of developing obesity and sarcopenia than healthy individuals. Further researches are required to investigate causes and mechanisms of sarcopenia in leprosy survivors.

Measurement of testicular volume in smaller testes: how accurate is the conventional orchidometer?

The aim of this study was to evaluate the accuracy of different methods, including the Seager orchidometer (SO) and ultrasonography (US), for assessing testicular volume of smaller testes (testes volume less than 18 mL). Moreover, the equations used for the calculations--the Hansen formula (length [L] x width [W](2) x 0.52, equation A), the prolate ellipsoid formula (L x W x height [H] x 0.52, equation B), and the Lambert equation (L x W x H x 0.71, equation C)--were also examined and compared with the gold standard testicular volume obtained by water displacement (Archimedes principle). In this study, 30 testes from 15 men, mean age 75.3 (+/-8.3) years, were included. They all had advanced prostate cancer and were admitted for orchiectomy. Before the procedure, all the testes were assessed using SO and US. The dimensions were then input into each equation to obtain the volume estimates. The testicular volume by water displacement was 8.1 +/- 3.5 mL. Correlation coefficients (R(2)) of the 2 different methods (SO, US) to the gold standard were 0.70 and 0.85, respectively. The calculated testicular volumes were 9.2 +/- 3.9 mL (measured by SO, equation A), 11.9 +/- 5.2 mL (measured by SO, equation C), 7.3 +/- 4.2 mL (measured by US, equation A), 6.5 +/- 3.3 mL (measured by US, equation B) and 8.9 +/- 4.5 mL (measured by US, equation C). Only the mean size measured by US and volume calculated with the Hansen equation (equation A) and the mean size measured by US and volume calculated with the Lambert equation (equation C) showed no significant differences when compared with the volumes estimated by water displacement (mean difference 0.81 mL, P = .053, and 0.81 mL, P = .056, respectively). Based on our measurements, we categorized testicular volume by different cutoff values (7.0 mL, 7.5 mL, 8.0 mL, and 8.5 mL) to calculate a new constant for use in the Hansen equation. The new constant was 0.59. We then reexamined the equations using the new 0.59 constant, and found that the equation Volume (V) = L x W(2) x 0.59 was the best for describing testicular volume among our subjects (difference between the new equation and the gold standard of water displacement = 0.19 mL, P = .726). We also found that US was more precise in measuring testicular dimensions. We propose a new formula, V = L x W(2) x 0.59, to assess the volumes of smaller testes.

A mixed longitudinal study of physical growth in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis is a chronic, relapsing disorder associated with significant morbidity. Growth retardation is known to occur in children affected with atopic dermatitis. However, there is not enough Indian data for this disorder. AIMS: We conducted a longitudinal study to look for the effect of atopic dermatitis on growth attainment of Indian preschool children. METHODS: The growth patterns of 62 children, aged 3-5 years and suffering from atopic dermatitis were studied in terms of body weight, height and head circumference. Sixty-eight normal healthy children matched for age, sex and socioeconomic status were taken as controls. Every child was followed up at intervals of three months following a mixed longitudinal study design for the duration of one year. Severity of the disease was determined by the scoring atopic dermatitis (SCORAD) index. RESULTS: Growth velocities were lower in patients than in controls. Mean changes in body weight of patients of both sexes showed close similarity to controls. Mean values for height and head circumference were found to be significantly lower in girls than in the girls of the control group at majority of the age levels. In contrast, in boys, these values for the patients remained comparable or higher than in the boys of the control group at some of the ages. Girls had comparatively more severe disease than boys and they had lower values than boys for all the growth parameters assessed. CONCLUSION: Growth retardation was observed among children with a more severe form of the disease. Height of the affected children was compromised mostly, though a tendency for catch-up growth was observed. Severe forms of atopic dermatitis may impair a child's linear growth temporarily.

Avaliação nutricional e caracterização sócio-demográfica de portadores de hanseníase - SP / Hansen's patients nutritional assessment and population characteristics - SP

Introdução: A hanseníase é uma doença infecto-contagiosa, de evolução lenta, que se manifesta por meio de lesões na pele e nos nervos periféricos, sendo importante caracterizar o estado nutricional dos pacientes. Objetivo: Avaliar o estado nutricional de indivíduos adultos com hanseníase. Métodos: Trata-se de um estudo epidemiológico observacional do tipo transversal, com coleta de dados primários que foi desenvolvido no Hospital das Clínicas da FMUSP, Centro de Dermatologia Sanitária em São Paulo e Instituto Lauro de Souza Lima em Bauru. Para avaliar o consumo alimentar foi adotado o inquérito Rec 24h e um questionário para caracterização das variáveis sócio-demográficas, clínicas, antropométricas e dos hábitos e práticas alimentares. Resultados: A população nos três locais foi composta por 91 pacientes, com predominância do gênero masculino e idade entre 23 e 79 anos. A maior concentração ocorreu na faixa de 40 a 59 anos que representou 43 por cento dos pacientes. Houve predomínio do estado civil casado. A maior parte da população (41,8 por cento) constituiu-se de trabalhadores ativos e 10 por cento encontrava-se afastada de suas atividades, 70 por cento, possuíam o nível fundamental incompleto e 22 por cento eram analfabetos. Os indivíduos (80,3 por cento) recebiam até 2 salários mínimos. A maioria da população (61,5 por cento) não praticava atividade física. Com relação à prática alimentar 71,4 por cento realizavam entre 3 e 4 refeições diárias. Observou-se 13,1 por cento de obesidade (classes 1 e 2) 3,2 por cento de baixo peso. Após o diagnóstico da doença 16,5 por cento referiram ter deixado de comer carne de pato, porco, peixe, linguiça e ovos, 12,1 por cento referiram acreditar que a alimentação provocava hanseníase e 30,8 por cento que a alimentação poderiam piorar a hanseníase. Conclusões: A população de estudo apresentou-se com baixa renda, baixa escolaridade e predomínio de pré-obesidade. Os pacientes referiram ter mudado a alimentação após o diag...

Bio-cultural effects in medieval populations.

Male skeletons from medieval archaeological sites are analysed to assess differences in stature and body proportions related to the bio-cultural environment, such as social, economic, and health factors. Environmental factors, such as climate change in the course of the Middle Ages, did not have statistically significant effect on body proportions in these samples. The results show a relationship between bio-cultural factors and physique in the analysed populations that indicate stunted growth in height and weight in a leprosarium population with a low socio-economic and health status. A high-status monastic population is characterised by a stocky build, i.e., increased weight for height and relatively shorter limbs, while a medieval parish population has a linear build, i.e., relatively long limbs for height and decreased weight for height. These characteristics, relative weight for height and relative limb length, changed during the course of the Middle Ages, as did stature.

Should nutritional status evaluation be included in the initial needs assessment of leprosy patients with disability prior to socio-economic.

Because of the large numbers of leprosy patients with disability and the limited resources available, it is important that socio-economic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assessments of leprosy patients prior to initiating SER include the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undernutrition reflects poor socio-economic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undernourished using body mass index (kg/m2) derived from body weight and height, and 10% of the patients were severely undernourished (grade III). Undernutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P < 0.05). Total household income, reported amount of money spent on food and estimated cereal intakes were not correlated with the BMI of the patient, possibly due to reporting bias and other methodological issues. We propose the inclusion of nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of economic deprivation or actual economic 'dislocation', and thus help in the prioritization of leprosy patients for SER.

The effect of leprosy-induced deformity on the nutritional status of index cases and their household members in rural South India: a socio-economic perspective.

OBJECTIVES: To determine whether the socioeconomic and nutritional status of cured leprosy patients with residual deformity, and their household members, was lower than that of cured leprosy patients without deformity. DESIGN: Cross-sectional study. SUBJECTS: One hundred and fifty-five index cases with deformity, 100 without deformity. Also 616 household members comprising 48% of the total members enumerated. MEASUREMENTS: Nutritional status was evaluated using anthropometry. Disease characteristics, socio-economic parameters and household information were recorded using a questionnaire. RESULTS: Index cases with deformity had lower community acceptance (P<0.001), and employment (P<0.001) than those cases without deformity. Households of index cases with deformity had a lower income (P<0.01) and a lower expenditure on food (P<0.05). The presence of deformity (odds ratio (OR): 2.1-3.2, P<0.01), unemployment (OR: 2.3-4.3, P<0.01) and female gender (OR: 2.4, P<0. 01) significantly increased the risk of index cases being undernourished, as judged by body mass index (BMI) alone, or BMI and mid-upper arm circumference. A low BMI (<18.5) in the index case significantly increased the odds of other adults (OR 2.2), adolescents (OR 2.9-3.8) and children (OR 2.2) in the household being undernourished. CONCLUSIONS: Cured leprosy index cases with physical deformity are more undernourished than index cases without deformity. This is associated with a reduced expenditure on food, possibly brought on by increased unemployment, and a loss of income. Undernutrition in the index case increases the risk of undernutrition in other members of the family. European Journal of Clinical Nutrition (2000) 54, 643-649.

Wrist involvement in Hansen's disease.

We performed a neurological and radiological study of the wrists of 58 patients with Hansen's disease and 60 age-matched healthy control subjects. Significant differences (p < 0.01) were found between the groups in the carpal glenoid sector, the radial physeal widening index, the carpal ulnar distance, the carpal index and in distal radio-ulnar discrepancy. Comparison of the results in three subgroups of leprous patients with sensory impairment (group A-1), motor deficit (A-2) and no neurological impairment (A-3), showed significant differences (p < 0.01) between group A-1 and the other two. This suggests that in these patients the changes in the carpus and radiocarpal joint may be caused by neuropathic arthropathy of the wrist. Our findings are of particular interest since there are few reports of neuropathic arthropathy in non-weight-bearing joints.

Associaçäo entre hanseníase e infecçäo pelo vírus da hepatite B: estudo de caso-controle / Association between leprosy and hepatitis B virus infection: a case-control study

Um estudo de caso-controle para investigar a associaçäo entre a hanseníase e infecçäo pelo vírus da hepatite B (VHB) foi conduzido no período de 1992/93, na cidade de Goiânia, GO, e municípios contíguos. Para o estudo de caso-controle, 552 pacientes de hanseníase de 10 a 70 anos foram incluídos. Os controles (N=552) foram selecionados de indivíduos com ausência de sinais e sintomas sugestivos de hanseníase oriundos da demanda espontânea de ambulatórios de 7 unidades de saúde. Foram coletadas amostras de sangue para detecçäo de marcadores ao vírus da hepatite B pela técnica de ELISA. Entre os participantes, 18,1 por cento dos casos e 19,6 por cento dos controles foram soropositivos ao anti-HBc. A associaçäo da hanseníase e anti-HBc entre casos e controles apresentou "odds ratio" de 0,9 (IC 95 por cento 0,7 - 1,3) para a categoria de multibacilar; 1,0 (IC 95 por cento 0,7 - 1,3) para a de paucibacilar e 1,1 (IC 95 por cento 0,8 - 1,5) para a de provável. Os resultados mostraram: (i) prevalências semelhantes dos marcadores de exposiçäo, de imunidade e de estado de portador; (ii) capacidade similar para produçäo de anti-corpos protetores avaliados através dos percentuais do marcador anti-HBs e quantitativamente, através do Indice de ELISA e (iii) baixa probabilidade de persistência da antigenemia mensurada pelo PPI. Em conclusäo, näo houve evidências epidemiológicas de uma associaçäo entre hanseníase e infecçäo pelos vírus da hepatite B

Avaliaçäo antropométrica e perfil plasmático de ácidos graxos de recém-nascidos pré-termo submetidos a duas dietas isocalóricas e com diferentes composiçoes lipídicas / Anthropometric evaluation and plasm fatty acids profile of preterm newborn infants subjected 2 isocaloric diets of different lipid composition

Este trabalho analisou o perfil de ácidos graxos plamáticos eo crescimento somático de 20 recém-nascidos pré-termos, com idade gestacional entre 30 a 35 semanas, admitidos no Berçário do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto da Universidade de Säo Paulo, submetidos, por um período de aproximadamente 20 dias, a duas dietas isocalóricas e com diferentes composiçöes liídicas. Um grupo de 10 crianças GRUPO L.D.S. usou uma dieta contendo 0,5% das calorias totais (54,5 mg/100 cal) como ácido linoléico (C18:2) e relaçäo PS=0,053. Os outros 10 recém-nascidos GRUPO L.D.O. foram colocados numa dieta contendo 10,5% das calorias totais (1171mg/100 kcal) como ácido linoléico (C18:2) e a relaçäo P/S = 0,508. Os grupos no período imediato antes da instituiçäo das dietas em estudo apresentaram valores plasmáticos dos ácidos linoléico (C18:2) e aracdônico (20:4) semelhantes entre si e superiores aos limites mínimos normais estabelecidos por WIESE etalii (1958) e HANSEN ET ALII (1963), refletindo reservas corporais e dietas semelhantes previamente ao estudo. Após o uso da dieta no GRUPO L.D.S. houve uma queda significante (p < 0,05) dos níveis plasmáticos ácidos C16:0 (palmítico), C16:1 (palmitoléico) e C18:1 (oléico) se elevaram significantemente (p < 0,05). As alteraçöes encontradas foram semelhantes as relatadas em diversos trabalhos da literatura e poderiam ser considerados como evidências bioquímicas de deficiência de ácidos graxos essenciais. No GRUPO L.D.O. após o uso da dieta verificamos uma queda nos níveis plasmáticos do ácido aracdônico (C20:4 a níveis inferiores aos mínimos normais estabelecidos na literatura em 90% dos recém-nascidos pré-termos, mas a queda foi menor do que a verificada no GRUPO L.D.S. (p < 0,,5). O ácido linoléico (C18:2) apresentou elevaçäo no seu nível plasmático em 50% dos pré-termos estudados e nos outros 50% os valores foram semelhantes ou ligeiramente inferiores ao período prédieta, mas todos apresentaram níveis superiores aos limites mínimos normais e aos do GRUPO L.D.S. (p , 0,05). Os niveis plasmticos elevados de C18:2 no GRUPO L.D.O. após o uso da dieta com elevado conteúdo de ácido linoléico concordam com a melhor absorçäo de gorduras verificada neste grupo em relaçäo ao GRUPO L.D.S. (p < 0,05)...