Agreement between different versions of MNA.

UNLABELLED: Malnutrition occurs frequently in the elderly with important clinical and functional consequences. Moreover, the treatment of malnutrition in the elderly may be effective if clinical and nutritional interventions are performed in the early stages. Therefore the early identification of the risk of malnutrition using validated and handy tools plays a pivotal role in terms of clinical outcome. Mini Nutritional Assessment (MNA) was validated for this purpose since many years but it is still ongoing the debate over whether the use of different items in certain clinical conditions can be effective without affecting the validity of the nutritional status evaluation. The aim of this study was to assess the agreement between different versions of MNA in the evaluation of nutritional risk in elderly subjects. METHODS: 522 subjects, 345 women and 177 men, were recruited from nursing homes or were free living in three different regions in Italy. All subjects underwent a multidimensional geriatric evaluation, addressed especially to nutritional status. We compared three different versions of MNA: the "original" version; a "proportional" MNA (MNA- P) in which the total MNA score was replaced by the ratio between the maximum score that each subject could obtain without including the body mass index (BMI) and the total original MNA score; and a third version in which calf circumference (CC) and mid- upper arm circumference (MAC) were used instead of BMI. RESULTS: According to the original MNA, a high prevalence of malnutrition was found out in both genders (26% of women and 16.3% of men); both the versions of MNA, in which BMI was not considered, showed a good predictive value compared to original MNA. In particular, the MNA- P. showed an overall efficiency equal to 89,1% with specificity and positive predictive value respectively equal to 97.5% and 95.2%. MNA- CC- MAC showed even better results in terms of overall efficiency (91.4%), sensitivity (81.1%), specificity (97.1%), positive and negative predictive values (94.2% and 94.4%, respectively). CONCLUSION: The different versions of MNA gave similar results in the classifications of subjects and in comparison with nutritional and biochemical parameters. Moreover MNA versions that did not considered BMI seem to be more effective in singling out subjects with risk factors related to malnutrition (disability, reduced strength and calf circumference, anaemia).

Malnutrition in elderly: social and economic determinants.

UNLABELLED: Malnutrition occurs frequently in the frailest groups of the population, especially in people who are on a low income and elderly subjects, overall if they are institutionalized. The aim of this study was to assess the prevalence of malnutrition in a sample of elderly people living in different settings and to identify the determinants of malnutrition. METHODS: A total of 718 subjects, 472 females (F) and 246 males (M), were recruited from nursing homes or were free living in three different regions in Italy. Nutritional status, depression, social, functional and cognitive status, were evaluated. RESULTS: According to the Mini Nutritional Assessment (MNA), a high prevalence of malnutrition was found out in both genders: 26% of F and 16.3% of M were classified as being malnourished (MNA<17); 40.9% of F and 35% of M were at risk of malnutrition (MNA 17-23,5). The prevalence of malnutrition was significantly higher in NH subjects in both sexes. Moreover, a relationship was shown between malnutrition and inability to shop, prepare and cook meals because of a low income, distance from markets or supermarkets as well as impossibility to drive the car or to use public transportation. This study confirms the necessity to routinely perform nutritional status evaluation in elderly subjects, to carry out training courses for health workers (doctors, nurses, psychologists, dietitians), to implement nutritional education of the geriatric population, to develop tools and guidelines for health workers and caregivers, to identify and reduce clinical, functional, social or economic risk factors for malnutrition.

Serum levels of ochratoxin A in healthy adults in Tuscany: correlation with individual characteristics and between repeat measurements.

Ochratoxin A (OTA), a mycotoxin widely contaminating staple foods and beverages, has been classified as a "possible human carcinogen (Group 2B)" by the IARC. Serum levels of OTA were measured in a group of 138 healthy adults (age, 35-65 years) living in the area surrounding Florence (Tuscany, central Italy) and detected in all but four samples (97%). After the exclusion of one subject with a peak value of 57.2 ng/ml, OTA levels ranged between 0.12 and 2.84 ng/ml, with mean and median values of 0.56 and 0.48 ng/ml, respectively. OTA levels were significantly higher in men than in women (0.64 versus 0.50) and correlated positively with height. A strong association was found with the season in which blood samples were obtained, with summer values higher than autumn values. On the other hand, OTA levels tended to be negatively associated with blood pressure, either systolic or diastolic; no association was evident with age, weight, body mass index, and smoking history. The associations with height and season persisted in a multivariate regression analysis. A subgroup of subjects provided a repeat blood sample approximately 1 year later. The Spearman correlation coefficient between 68 pairs of original and repeat measurements was practically null (r = 0.05). Only two subjects (2.9%) had OTA levels of >1 ng/ml on both occasions. These results suggest that OTA contamination is widespread in foods consumed by this population, in agreement with previous reports from Italy and other countries. A strong seasonal variation, which possibly differs from year to year, was observed. OTA serum levels are a short-term biomarker with a high within-subject variability; therefore they have limited use at the individual level but can be used to characterize populations or subgroups of subjects. Additional analyses are needed to explore the dietary determinants of OTA levels in this population.

Ochratoxin A levels in human milk and related food samples: an exposure assessment.

Ochratoxin A (OA) is a mycotoxin detected in a variety of food and feeds mostly from countries with temperate or continental climate, because the fungi that produce it, mainly Aspergillus ochraceus, Penicillium verrucosum, and Penicillium viridicatum, can grow under a great variety of climate conditions. The aim of this article was, firstly, to confirm the occurrence of OA in human milk in Italy. Then, a preliminary calculation of OA intake via human milk was made, from ingested food. For this investigation, food and milk samples were collected, continuously for a week, from 4 lactating mothers. The obtained results revealed a significant exposure of sucklings and mothers to OA levels higher than the tolerable daily intake as estimated from animal models. On the basis of these data, a major effort in planning surveillance and research programs to control OA contamination in food, feed, and biological fluids should be pursued.

[Contribution of immunocytochemical marking of benign cells to the diagnosis of serous effusions]. / Apport du marquage immunocytochimique des cellules bénignes au diagnostic des épanchements des séreuses.

In pleural and peritoneal effusions, the distinction between mesothelial cells and histiocytic cells is fairly often difficult. This distinction is specially important in malignant effusions, where such reactive cells can be confused with tumoral ones. In order to increase the accuracy of cytological diagnosis, the immunocytochemical reactivity with 13 antibodies was studied. Four antibodies (vimentin, lysozyme, monoclonal keratin, OKM1) realise a panel specially useful for the characterization of mesothelial and histiocytic cells in most cases of benign or malignant effusions.

[Brushings and bronchial biopsies in small-cell cancer. Comparison of results]. / Brossages et biopsies bronchiques dans les cancers à petites cellules. Confrontation des résultats.

The typing of bronchial carcinoma is important for therapeutic decisions and may be made on bronchial brushings. Sixty six small cell and poorly differentiated squamous cancers were studied. Our personal method of preparing brushing is suggested. The cytological criteria which characterise the two tumour types were analysed. The results from the biopsies and particularly the brushings were related to the quality of the technique and the experience of the Pathologist. There is a good correlation between biopsy and brushing such that brushings may be considered reliable. In cases where the biopsy was not feasible or uninterpretable, brushings confirmed a cancer in all the cases and the type of cancer in eleven. The examination is inexpensive and avoids the need for ultrastructural studies in the majority of cases.

Automated cytopathologic diagnosis of bronchial carcinoma. II. Preliminary results of classifying cytocentrifuged bronchial brushings.

An automated discrimination between healthy and neoplastic bronchial cells was performed on eight bronchial smears prepared by cytocentrifugation. An image analyzer was used to examine 415 cells in these smears. The nuclear surface of each cell was measured, as was the total integrated optical density for 25 programmed thresholds. The results show that it is possible to distinguish healthy from cancerous cells in a given subject using these two measured parameters and two new parameters deduced mathematically. It appears difficult, however, to demonstrate a typical healthy and typical cancerous bronchial cell that could be used as a reference for all subjects. It is thus the presence of cell heterogeneity in a given subject that enables him or her to be characterized as healthy or having cancer.

[Statistical approach to cervical and vaginal cytology during contraception]. / Approche statistique de la cytologie cervico-vaginale au cours de la contraception.

PIP: We analyzed 1432 smears in order to check if the usual methods of contraception influence the development of cervical lesions. Several observations have to be made. 1) Given the rarity of certain lesions, a much larger number of samples (x 50) should have been analyzed in order to obtain realistic statistical projections especially for dysplasias and cervical cancers. 2) Significant results could only be obtained when several morphological screening criteria were put together (ectropions, repairs or inflammation) provided that at least 10 cases/sample were observed in order to perform statistical analysis. Therefore, the rate of ectropions observed in a population without contreceptive treatment is 6% higher than in a population taking the pill (correlations coefficient 0.95) and more than 5% repairs are observed in a population using the IUD as compared to oral contraceptives. The rate of clean smears (class 1) and inflammatory smears (class 2 according to Papanicolaou) was found to be the same for all 3 populations studied. Comparing statistical data, it seems to be difficult to provide a correct answer about the influence of contraceptive methods on the development of cervical cancer. Indeed, our work and all other studies present the same difficulty in gathering sufficient samples which are qualitatively equivalent. Volume and present methodology of most of the anatomy and pathological cytology laboratories do not meet the requirements of statistical calculus. However, we think that smears should be routinely done on women taking the pill or wearing an IUD. That is not to say that contraception, regardless of method used, increases the risk of cancer or dysplasia, but that the smears represent a chance for screening and are thus considered preventive medicine. This would also enhance the physician's knowledge about precancerous lesions of the cervix and would, in the near future, boost the number of samples to allow for statistical analysis. (author's)^ieng

Automatic cytopathologic diagnosis of bronchial carcinoma. I. Cytocentrifugation of bronchial brushings for image analysis.

A cytocentrifugation technique for the preparation of monodispersed preparations of bronchial cells collected by brushing is described. First developed with the aim of obtaining slides suitable for automated analysis, it was found to be useful for routine morphologic examinations. This technique requires careful preparation as well as "education" of the pathologist/screener in the appearance of the cellular elements in its samples. However, it is reliable and reproducible and, above all, eliminates a certain number of artifacts found in conventional preparations.

[New trends in the cytodiagnosis of bronchial carcinoma (author's transl)]. / Nouvelles orientations du cytodiagnostic des cancers bronchiques.

Cytological examination of the sputum is nowadays mainly used for mass surveys among high-risk populations and in suspicious cases with normal X-ray films. In all other cases, bronchial brushing and percutaneous puncture-biopsy of the lung are preferred, being much more reliable. Several new bronchial cytology techniques have recently been developed but are not yet widely used. Their respective indications are governed by the facilities available and by the volume, site and characteristic features of the tumour.

[Morphological aspects of non-tumoral bronchial cells recovered by brushing (author's transl)]. / Aspects morphologiques des cellules bronchiques non tumorales recueillies par brossage.

A series of 132 bronchial brushings studied according to a strict protocol, both in obtaining the specimens and their subsequent laboratory preparation, has allowed us to study the cells of the bronchial mucosa in greater detail. Until now the greater part of the work in this field has been on the characteristics of tumour cells and the variability in detecting cancer, slightly neglecting the analysis of normal, inflammatory or dystrophic cells. The brushings were compared to the cytology requests on sputum and/or corresponding aspirations by conventional methods. This work has shown that the different types of normal epithelial cells so recovered, as well as dystrophic cells, have a very different appearance than those same cells when observed using classical cytological methods (on sputa and aspirations). The cyto-pathologist ought to adjust the technique before interpreting the specimens. The differences are due to a better state of conservation of the recovered cells, thanks to improvement in current endoscopic technique. We infer that certain cytological appearances considered pathological until now, using classical expectoration or aspiration, may in reality only be artefacts.

Significant hormonal changes in patterns of lipid granules in vaginal exfoliated cells.

In vaginal exfoliative cytology, the routine Papanicolaou and Shorr's staining procedures do not reliably indicate the post-ovulatory phase. An experimental study of 100 female albino rats and a clinical study of 190 women was initiated to establish an easier method for identifying the post-ovulatory phase. It was found that the appearance of intracytoplasmic lipid granules in vaginal cells stained by Oil Red 0 may serve as a sensitive indicator of the post-ovulatory phase.

Intramural pregnancy with uterine rupture: a case report.

A case of intramural pregnancy is presented which mimicked early abruptio placentae and was associated with placenta percreta. The literature is briefly reviewed.