Beyond Infantile Hemangiomas: A Glimpse into Overlapping Rare Syndromes Emphasizing the Vigilant Screening for PHACE and LUMBAR Syndromes.

Infantile hemangiomas are the most common birthmark in newborns. They are clinically diagnosed and usually self-limited. However, there are several exceptions with aggressive types of hemangiomas that can be associated with extracutaneous anomalies, such as PHACE syndrome (posterior fossa anomalies, upper body hemangiomas, arterial anomalies, cardiac anomalies, and eye anomalies) and LUMBAR syndrome (lower body hemangiomas, ulcerations/urogenital anomalies, myelopathies, bony deformities, anorectal malformations/arterial anomalies, and renal anomalies). These two syndromes, described in the literature with distinct features, have rarely been reported in the same patient. We discuss one of the few cases reported with overlapping features of the PHACE and LUMBAR syndromes that initially presented with infantile hemangiomas, as well as other nonspecific skin and systemic findings. Minimal guidance has been described due to the need for more scientific literature. Our aim is to reinforce awareness of these two syndromes and the possibility of an overlap presentation between them. Furthermore, we emphasize the need for an interdisciplinary approach with screening for all known associations to avoid missing essential components of these syndromes that can lead to significant morbidity and lifetime complications.

Correlación entre el porcentaje de grasa corporal y el índice de masa corporal en adultos mayores: rol del sexo y edad / Correlation between body fat percentage and body mass index in the elderly: role of sex and age

Fundamentos: Dado el aumento de la población mayor, que está predispuesta a padecer enfermedades relacionadas con la obesidad, es necesario disponer de herramientas precisas para medirla. El objetivo de este estudio fue determinar la correlación entre el porcentaje de grasa corporal (%GC) y el índice de masa corporal (IMC) en los adultos mayores, ajustando dicha correlación por edad y sexo. Métodos: Se trata de un estudio retrospectivo, transversal y analítico conformado por datos de 50 adultos mayores atendidos en el "Servicio de Geriatría del Hospital Central de la Fuerza Aérea del Perú" durante los años 2019-2020. El porcentaje de grasa corporal se determinó mediante dos métodos: absorciometría dual de rayos X (DXA) e impedancia bioeléctrica (BIA). Resultados: Utilizando el análisis de regresión logística, se observó que las variables significativas asociadas al IMC eran el %GC, determinado por BIA, tanto en hombres como en mujeres, y determinado por DXA, el %GC en mujeres. Conclusiones: Por lo general, los resultados mostraron una correlación positiva entre el IMC y el %GC, independientemente del dispositivo utilizado. Dicha relación fue mayor en el sexo femenino. La edad tuvo un efecto menos significativo. (AU)

Background: Due to the growing elderly population, more of whom have a predisposition to obesity-related diseases, there is a need for precise tools that measure obesity. The objective of this study was to determine the correlation between body mass index (BMI) and body fat percentage (BF%) in the elderly. Additionally, the correlation would be observed adjusting for age and gender. Methods: This was a retrospective, cross-sectional, analytical study comprised of 50 individuals aged ≥60 attended in the "Geriatric Care of the Central Hospital of the Air Force of Peru" during the years 2019-2020. Body fat percentage was determined by two methods: dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance (BIA). Results: Using logistic regression analysis, the significant variables associated with BMI were BF%, determined by BIA, in both men and women, as well as BF%, determined by DXA in women. Conclusions: Generally, the results showed a positive correlation between BMI and BF%, regardless of the apparatus utilized. The relationship was strongest in females. Age was reported to have a less significanteffect. (AU)

Comparison of Dosing Schemes for Thyroid Hormone Replacement Therapy After Thyroidectomy.

BACKGROUND: Current thyroid hormone replacement therapy (THRT) is built on weight-based standard calculation of dose. A novel Poisson regression model, which accounts for seven clinical variables, was recently proposed to improve accuracy of THRT. We aimed to compare the accuracy of estimated THRT dose to reach euthyroid and the difference in predicted dose between the Poisson (scheme A) and the weight-based standard (scheme B) in patients following total thyroidectomy for benign disease. METHODS: We retrospectively reviewed medical record of patients who underwent total or completion thyroidectomy for benign disease at a single institution between 2011 and 2019. The THRT dose was calculated using both schemes. We compared the difference between calculated THRT and prediction rates for optimal THRT dosing needed to achieve a euthyroid state between dosing schemes. Patients were evaluated for achieving euthyroid state, defined as TSH 0.45-4.5 mIU/L. We also compared dosing error rates (> 25 mcg over- and underdosing) between schemes. Prediction rates were compared by BMI tertiles to account for the effect of BMI extremes in achieving euthyroid state. The difference in predicted dose between schemes was calculated in both the total sample size and patients that met euthyroid. A measure of agreement, Kappa, was used to estimate agreement between dosing schemes. RESULTS: A total of 406 patients underwent total thyroidectomy for benign disease, with 184 having sufficient follow up data confirming euthyroid state. Of the 184 patients, 85.9% (n = 158) were women, 81% (n = 149) were Hispanic, and 56.5% (n = 104) were obese with a median BMI of 30.8 kg/m2. Scheme A resulted in a higher, but not statistically significant, accuracy rate (A: 60.3%, n = 111 versus B: 53.8%, n = 99; P = 0.21). Overdosing errors were lower with Scheme A (A:17.9% versus B: 32.1%; P = 0.0025) and less extreme > 25 µg (A: 17.9% versus B: 26.1%; P = 0.08). A trend in improved accuracy in patients with a BMI > 35 kg/m2 was noted (A: 46.9% versus B: 34.4%; P = 0.20). Scheme A also resulted in less overdosing errors in obese patients compared to Scheme B (A: 19.2% versus 45.2%; P = 0.0006). The average difference in predicted dose between schemes was an entire dose difference, mean of 16.0 µg and 15.8 µg for the total and euthyroid samples respectively. Furthermore, for the majority of patients the predicted dose did not match between the two dosing schemes for total and euthyroid samples, 76% (n = 311) and 76% (n = 141) respectively. In patients that achieved euthyroid, agreement between dosing schemes was low to moderate (Kappa = 0.360). CONCLUSIONS: Lower rates of overdosing were found for scheme A, particularly with obese patients. No statistically significant differences in predicted THRT dose was observed between schemes. The difference in predicted dose between schemes was on average 15 ug, correlating with an entire dose. The consideration of clinical variables other than weight (scheme A) when determining optimal THRT dosing may be of importance to prevent overdoses, with particular clinical relevance in patients with higher BMIs.

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units.

More than one-third of the US adult population and 17% of the youth are now obese, and obesity is associated with more than $147 billion a year in health care costs. Critical care nurses should understand the physiological differences and practice guidelines for patients with a body mass index greater than 30. The ABCD approach encompasses key clinical concepts in the management of critically ill obese and morbidly obese patients, including management of airways and breathing, minimizing nurses' back and other injuries, increasing awareness of bias, circulation problems, risks of decubitus ulcers and other skin breakdown, differences in drug calculations and metabolism, limitations in diagnostic equipment and imaging, diet and nutritional recommendations, and concerns with durable medical equipment.