Estado nutricional y riesgo de malnutrición en pacientes hospitalizados del Hospital Universitario Departamental de Nariño / Nutritional status and risk of malnutrition in hospitalized patients at Hospital Departamental Universitario de Nariño

Objetivo. Estimar el estado nutricional y el riesgo de malnutrición de pacientes hospitalizados en Pasto, Colombia. Metodología. Un estudio transversal fue llevado a cabo en el Hospital Universitario Departamental de Nariño. La muestra comprendió 400 pacientes voluntarios que fueron incorporados prospectivamente. El estado nutricional fue evaluado con el Índice de Masa Corporal (IMC) siguiendo los criterios de la Organización Mundial de la Salud (OMS) (bajo peso, normal, sobrepeso y obesidad). El riesgo de desnutrición fue detectado de acuerdo al Malnutrition Universal Screening Tool (MUST) que incluyeron el IMC, pérdida de peso y enfermedad aguda. Resultados. La prevalencia de desnutrición según el IMC fue de 24,5 %. La malnutrición varió según la edad (≥65 años), régimen de seguridad social, estado civil, hijos y educación. La puntuación del MUST mostró que 55 % de los pacientes estaban en riesgo de malnutrición. Variables como la edad (≥65 años), etnia, residencia, origen, nivel socioeconómico, régimen de seguridad social, hijos, educación y servicios hospitalarios se relacionaron con el riesgo de malnutrición. Conclusiones. El presente estudio sugiere que estos pacientes hospitalizados tenían un alto porcentaje de malnutrición. Individuos de edad igual o superior a 65 años fueron los más afectados teniendo tanto bajo peso como riesgo de malnutrición. Por lo tanto, hay una necesidad de incluir una evaluación nutricional con el fin de prevenir las consecuencias de malnutrición en personas mayores.

Objective. To estimate the nutritional status and risk of malnutrition of hospitalized patients in Pasto, Colombia. Methodology. A cross-sectional study was conducted at Hospital Universitario Departamental de Nariño. The sample comprised 400 voluntary patients that were recruited prospectively. Nutritional status was assessed with Body Mass Index (BMI) following the World Health Organization (WHO) criteria (underweight, normal, overweight and obesity). The risk of malnutrition was screened through the Malnutrition Universal Screening Tool (MUST) that included BMI, weight loss and acute disease. Results. The prevalence of malnutrition according to BMI was 24.5%. Malnutrition differed by age (≥65 years), social security system, civil status, offspring and education. The MUST score showed that 55% of the patients were at risk of malnutrition. Variables such as age (≥65 years), ethnicity, residency, origin, socioeconomic status, social security system, offspring, education and hospital departments were related to the risk of malnutrition. Conclusions. The present study suggests that these hospitalized patients had a high rate of malnutrition. Individuals equal and older than 65 years were the most affected having both underweight and risk of malnutrition. Therefore, there is a need to include nutritional assessment in order to prevent consequences of malnutrition in older individuals.

Complement fragment C3d is colocalized within the lipid rafts of T cells and promotes cytokine production.

UNLABELLED: The complement system plays an important role in tissue inflammation and damage in SLE patients. High levels of C3d were detected on the surface of erythrocytes and lymphocytes of SLE patients. The objective of this study was to assess the functional consequences of C3d fragments deposited on the surface membrane of SLE T cells. METHODS: 46 SLE patients, 43 patients with other autoimmune diseases (OAD) and 33 healthy individuals (N) were enrolled in this study. T cells were isolated from peripheral blood and flow cytometry studies were conducted to assess the levels of C3d fragments, Ca++ influx responses and cytokine production. Confocal microscopy was used to study co-localized molecules. Student's t-test was performed to determine statistical significance among study groups. RESULTS: A significant percentage of the SLE T cells were found to be positive for C3d (13.58 ± 3.92%) when compared with normal T cells (4.52 ± 2.92%) (p < 0.0000547) and T cells from patients with other autoimmune diseases (6.31 ± 4.57%) (p < 0.00513). Peak Ca++ influx responses were significantly higher in C3d- SLE T cells compared with C3d+ SLE T cells (p < 0.011). C3d+ T cells produced significantly more IL-2, IFN-gamma, IL-4 and IL-17. In contrast to the increased production of IL-2 by the C3d+ T cells, the overall SLE T cell population produced less IL-2 when compared with T cells from normal individuals or patients with other autoimmune disease. The C3d fragments were found to be localized within the lipid rafts. CONCLUSION: C3d fragments are localized in the lipid rafts of SLE T cells and contribute to abnormal T cell function by modulating Ca++ influx responses and increased cytokine production.

Autoimmunity following hepatitis B vaccine as part of the spectrum of 'Autoimmune (Auto-inflammatory) Syndrome induced by Adjuvants' (ASIA): analysis of 93 cases.

OBJECTIVES: In this study we analyzed the clinical and demographic manifestations among patients diagnosed with immune/autoimmune-mediated diseases post-hepatitis B vaccination. We aimed to find common denominators for all patients, regardless of different diagnosed diseases, as well as the correlation to the criteria of Autoimmune (Auto-inflammatory) Syndrome induced by Adjuvants (ASIA). PATIENTS AND METHODS: We have retrospectively analyzed the medical records of 114 patients, from different centers in the USA, diagnosed with immune-mediated diseases following immunization with hepatitis-B vaccine (HBVv). All patients in this cohort sought legal consultation. Of these, 93/114 patients diagnosed with disease before applying for legal consultation were included in the study. All medical records were evaluated for demographics, medical history, number of vaccine doses, peri-immunization adverse events and clinical manifestations of diseases. In addition, available blood tests, imaging results, treatments and outcomes were recorded. Signs and symptoms of the different immune-mediated diseases were grouped according to the organ or system involved. ASIA criteria were applied to all patients. RESULTS: The mean age of 93 patients was 26.5 ± 15 years; 69.2% were female and 21% were considered autoimmune susceptible. The mean latency period from the last dose of HBVv and onset of symptoms was 43.2 days. Of note, 47% of patients continued with the immunization program despite experiencing adverse events. Manifestations that were commonly reported included neuro-psychiatric (70%), fatigue (42%) mucocutaneous (30%), musculoskeletal (59%) and gastrointestinal (50%) complaints. Elevated titers of autoantibodies were documented in 80% of sera tested. In this cohort 80/93 patients (86%), comprising 57/59 (96%) adults and 23/34 (68%) children, fulfilled the required criteria for ASIA. CONCLUSIONS: Common clinical characteristics were observed among 93 patients diagnosed with immune-mediated conditions post-HBVv, suggesting a common denominator in these diseases. In addition, risk factors such as history of autoimmune diseases and the appearance of adverse event(s) during immunization may serve to predict the risk of post-immunization diseases. The ASIA criteria were found to be very useful among adults with post-vaccination events. The application of the ASIA criteria to pediatric populations requires further study.

Molecular mimicry in systemic lupus erythematosus.

Systemic lupus erythematosus is a multi-systemic autoimmune disease distinguished by the presence of various autoantibodies. Like most autoimmune diseases, systemic lupus erythematosus is believed to be induced by a combination of genetic, immunologic, and environmental factors, mainly infectious agents. Molecular mimicry between an infectious antigen and self-components is implicated as a pivotal mechanism by which autoimmune diseases such as systemic lupus erythematosus are triggered. Here we review the current evidence of molecular mimicry between different infectious agents and systemic lupus erythematosus.

Ten cases of systemic lupus erythematosus related to hepatitis B vaccine.

The objective of this article is to identify common and atypical features of systemic lupus erythematosus diagnosed following hepatitis B vaccination. We analyzed retrospectively the medical records of 10 systemic lupus erythematosus patients from different centers, who developed the disease following hepatitis B vaccination and determined the prevalence of different manifestations and the time association to vaccination. In this case series, 80% of the patients were female, mean age 35 +/- 9 years, of which 20% received one inoculation, 20% received two doses and 60% received all three inoculations. The mean latency period from the first hepatitis B virus immunization and onset of autoimmune symptoms was 56.3 days. All patients were diagnosed with systemic lupus erythematosus, according to the American College of Rheumatology revised criteria within 1 year. The prevalence of some systemic lupus erythematosus manifestations was typical and included involvement of the joints (100%), skin (80%), muscles (60%) and photosensitivity (30%). Other symptoms differed in this unique group of systemic lupus erythematosus patients such as low rate of kidney and hematologic involvement, and a relatively high rate of hepatitis (20%). Neurological (80%) and pulmonary (70%) symptoms were also common in this group. Data from this case-series, and previously documented cases in the literature could only show a temporal relation between hepatitis B vaccination and the appearance of systemic lupus erythematosus. Systemic lupus erythematosus related to vaccine may differ from idiopathic systemic lupus erythematosus in its clinical presentation and may resemble drug-induced systemic lupus erythematosus. Thus, physicians should be alerted to this potential association, its possible long latency period and unique presentations, and be encouraged to report and analyze these cases.

A tale of three acaropathogenic fungi in Israel: Hirsutella, Meira and Acaromyces.

We review published and unpublished studies conducted in Israel with six acaropathogenic fungi, assayed in order to control the citrus rust mite, Phyllocoptruta oleivora (Ashmead) (CRM). Hirsutella thompsonii Fisher was introduced twice, killed 80-90% of the exposed mites, but due to its requirements for near-saturation humidities was deemed unsuitable for local outdoors conditions. Hirsutella kirchneri (Rostrup) Minter et al. and Hirsutella necatrix Minter et al. were also introduced and assayed against CRM and spider mites, but their efficacy was unsatisfactory. Three indigenous fungi found to be associated with mites, Meira geulakonigii, Meira argovae and Acaromyces ingoldii--all three recently described by Boekhout, Gerson, Scorzetti & Sztejnberg--were assayed against several mites. Meira geulakonigii killed 80-90% of several spider mites and of the CRM, and caused some mortality of Iphiseius degenerans (Berlese), one out of three phytoseiid predators assayed. Mortality was not due to parasitization; extracts from the media in which the fungi had developed caused considerable mite death, suggesting that it was a result of fungal toxins. Data from a field study indicated that spraying blastoconidia of M. geulakonigii on grapefruits infested by CRM significantly reduced pest-incurred damage from 23 to 13%. Applying qRT-PCR methodology indicated that M. geulakonigii was endophytic within sealed grapefruit flowers and in the flavedo of the fruits' peel. Neither in the laboratory nor in the field was any evidence ever obtained that this fungus damaged the plants, leading us to hypothesize that M. geulakonigii serves as a "body guard" of grapefruits (and perhaps other plants as well). All three fungi suffered very little mortality after being exposed to various insecticides and acaricides that are in current local use (with the exception of sulfur). The ability of M. geulakonigii to reduce mite numbers without affecting the host plant, the minimal fungal effect on some predatory mites, its endophytic nature along with the apparent tolerance of M. geulakonigii to many insecticides and acaricides, suggest that this fungus could be suitable for integrated pest management (IPM) program.

Antagonistic effects of the endophytic fungus Meira geulakonigii on the citrus rust mite Phyllocoptruta oleivora.

AIMS: The fungus Meira geulakonigii has been shown to reduce populations of citrus rust mite (CRM; Phyllocoptruta oleivora) on citrus leaves and fruits, in both the field and laboratory. However, attempts to isolate the fungus from leaves and fruits have been unsuccessful. The aims of this study were therefore to determine whether M. geulakonigii is a citrus endophyte, and to assess possible mechanisms involved in its mite-antagonist activity. METHODS AND RESULTS: A quantitative real-time PCR and regular PCR approaches were developed to detect M. geulakonigii in both the field and laboratory. The fungus was detected throughout. Different methods revealed that M. geulakonigii is an endophyte, which colonizes both the peel of grapefruits. Applications of conidia protected the grapefruits against CRM, and fungal secretions extracted from growth media caused 100% CRM mortality. CONCLUSIONS: Meira geulakonigii is a beneficial endophyte of grapefruits that colonizes the fruit's peel, and protects it from CRM. SIGNIFICANCE AND IMPACT OF THE STUDY: Findings from this study demonstrate the endophytic nature of M. geulakonigii in its interaction with grapefruits. In addition, a molecular approach was developed to specifically detect the fungus inside the grapefruit peel. This approach can be used to assess the natural occurrence of M. geulakonigii in grapefruit.

Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis.

The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis (PsA). A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks. Patients were randomly allocated into two groups: group 1 (23 patients) and group 2 (19 patients). Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea. Group 1 was also treated with mud packs and sulfur baths. Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival, at the end of treatment, and at weeks 8, 16, and 28 from the start of treatment. The clinical indices assessed were morning stiffness, right and left hand grip, number of tender joints, number of swollen joints, Schober test, distance from finger to floor when bending forward, patient's self-assessment of disease severity, inflammatory neck and back pain and psoriasis area and severity index (PASI) score. Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI, morning stiffness, patient self-assessment, right and left grip, Schober test and distance from finger to floor when bending forward. For variables such as tender and swollen joints, and inflammatory neck and back pain, improvement over time was statistically significant in group 1. Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain.

Dermatology at the Dead Sea spas.

A background is given to the development of the Dead Sea spas. The treatment and results of the therapy for psoriasis, atopic dermatitis and vitiligo are outlined, especially for psoriasis. The different factors involved in this spa treatment are discussed, and the advantages and disadvantages presented.

Sustained decrease of blood pressure in psoriatic patients during treatment at the Dead Sea.

The diastolic and systolic blood pressure of 1366 psoriatic patients, treated at the Dead Sea for a period of 4 weeks, was monitored from the day following their arrival. The patients were divided into three categories: (a) psoriatics on antihypertensive medication; (b) psoriatics not receiving antihypertensive medication, but whose initial diastolic blood pressure equaled or exceeded 90 mmHg, and (c) psoriatics with normal blood pressure (diastolic pressure lower than 90 mmHg). A paired t-test revealed that the systolic blood pressure of the two hypertensive groups (a and b) dropped by an average of 22 mmHg, and the diastolic blood pressure dropped by 11 and 16 mmHg, respectively. The drop was evident 2 days after their arrival, and leveled off only after 2 weeks. A similar drop in systolic blood pressure was observed in normotensive psoriatics. On the basis of this study it may be concluded that high blood pressure is not a contraindication for the treatment of psoriasis at the Dead Sea.

Dopaminergic drugs influence the intensity of catalepsy induced by microinjections of carbachol into the reticular formation.

Carbachol microinjections into the mesencephalic and pontine reticular formation in rats induced intense and long-lasting catalepsy. Systemically administered haloperidol potentiated, while apomorphine and L-DOPA reduced the cataleptogenic effect of carbachol. These results indicate the existence of functional relations between the cholinergic cataleptogenic mechanism in the reticular formation and the dopaminergic system. They are interpreted in the light of known anatomical ascending and descending interconnections between the reticular formation and basal ganglia.

The human celiac ganglion and its splanchnic nerves.

Forty-six dissections of the celiac ganglion were performed on post-mortem specimens, and the form, location and nervous connections of the ganglion on both sides were studied. The triangular form was the most common observed, the ganglions were found to envelope both the celiac and superior mesenteric arteries, putting them closely together, and forming a celiacomesenteric complex similar to that found in the pig. The splanchnic nerves penetrated the diaphragm through a special triangular opening lateral to the crus, in 70-91%. These findings concerning form and nervous connections are somewhat different from those reported in the literature.

Effect of Dead-Sea brine and its main salts on cell growth in culture.

Diluted Dead-Sea brine and solutions of certain of its salts (chlorides and bromides of Na, K and Mg) were found to reversibly inhibit cell proliferation in culture. Bromides were more powerful as inhibitors than their chloride counterparts, and K salts were more effective than those of Na and Mg. KBr had the strongest inhibitory effect, which equalled that of diluted Dead-Sea brine at the same concentration. The favourable results of the Dead-Sea Spa treatment of psoriasis may thus be partly due to the penetration of minerals into the body, via the skin, with subsequent reinforcement of anti-proliferative mechanisms.

Efficacy of rifampicin and isoniazid in cutaneous leishmaniasis.

Thirty-nine patients with cutaneous leishmaniasis caused by Leishmania major were treated with rifampicin alone or in combination with isoniazid. No significant difference was found between these two therapeutic regimens, and about half of the patients were cured 2 months from the beginning of treatment. A review of rifampicin in cutaneous leishmaniasis is attached.

Topical treatment of cutaneous leishmaniasis.

Sixty-seven patients, 19 females and 48 males, 4-66 years old, suffering from lesions of cutaneous leishmaniasis were treated topically with an ointment comprising 15% paromomycin sulfate and 12% methylbenzethonium chloride in white soft paraffin (P-ointment, U.K. patent GB117237A). After 10 days of treatment, twice daily, the lesions in 72% of the treated patients were free of parasites, 15% became free within an additional 20 days, without further treatment, and 13% failed to respond. Pigmentation developed in 18% of the treated lesions and inflammation of varying degree was associated with the treatment. These developments did not affect the clinical healing process which was generally completed in a period of 10-30 days after termination of treatment. In addition, 94% of the treated lesions healed with little or no scarring. No adverse clinical or laboratory side effects were observed except for a burning sensation at the site of treatment. Parasites isolated from patients who failed to respond to topical treatment were found to be susceptible to PR-MBCl in both in vitro infected macrophages and in vivo in experimentally infected BALB/c mice.