Low muscle mass index is associated with type 2 diabetes risk in a Latin-American population: a cross-sectional study.

Objective: Diabetes mellitus is a growing disease with severe complications. Various scores predict the risk of developing this pathology. The amount of muscle mass is associated with insulin resistance, yet there is no established evidence linking muscle mass with diabetes risk. This work aims to study that relationship. Research methods and procedures: This cross-sectional study included 1,388 employees. The FINDRISC score was used to assess type 2 diabetes risk, and bioimpedance was used for body composition analysis. Appendicular skeletal muscle mass adjusted by body mass index (ASM/BMI) was analyzed. Sociodemographic, clinical and anthropometric measures were evaluated, logistic regression models with sex stratification were conducted and ROC curves were calculated to determine the ability of ASM/BMI index to predict T2D risk. Results: It was observed that patients with higher ASM/BMI had a lower FINDRISC score in both men and women (p < 0.001). A logistic regression model showed and association between ASM/BMI and diabetes risk in women [OR: 0.000 (0.000-0.900), p = 0.048], but not in men [OR: 0.267 (0.038-1.878), p = 0.185]. However, when the body mass index variable was excluded from the model, an association was found between muscle mass adjusted to BMI and diabetes risk in both men [OR: 0.000 (0.000-0.016), p < 0.001], and women [OR:0.001 (0.000-0.034), p < 0.001]. Other risk factors were having a low level of physical activity, waist circumference, age and sedentary lifestyle. A ROC curve was built and the optimal ASM/BMI cut-of value for predicting T2D risk was 0.82 with a sensitivity of 53.71% and specificity of 69.3% [AUC of 0.665 (0.64-0.69; p < 0.0001)]. Conclusion: When quantifying the risk of type 2 diabetes in both women and men, assessing muscle mass can help detect adult individuals with a high risk of developing type 2 diabetes.

Very Low Calorie Ketogenic Diet: What Effects on Lipid Metabolism?

PURPOSE OF REVIEW: This review aims to critically examine how VLCKD affects plasma lipoprotein, lipid and cholesterol metabolism. Cardiovascular disease is a worldwide health problem affecting millions of people and leading to high rates of mortality and morbidity. There is a well-established association between cardiovascular disease and circulating cholesterol. Various dietary recommendations are currently available for the management of dyslipidemia. RECENT FINDINGS: The very low-calorie ketogenic diet (VLCKD) is becoming increasingly popular as a treatment option for several pathological conditions, including dyslipidemia. In addition to being low in calories, the VLCKD's main feature is its unique calorie distribution, emphasizing a reduction in carbohydrate consumption in favor of fat as the primary calorie source. Lowering calorie intake through a VLCKD can reduce the endogenous production of cholesterol. However, if the foods consumed are from animal sources, dietary cholesterol intake may increase due to the higher fat content of animal products. When combined, these dietary practices may have opposing effects on plasma cholesterol levels. Studies investigating the impact of VLCKD on plasma cholesterol and low-density lipoprotein cholesterol levels report contradictory findings. While some studies found an increase in low-density lipoprotein cholesterol levels, others showed a decrease in total cholesterol and low-density lipoprotein cholesterol, along with an increase in high-density lipoprotein cholesterol.

Lack of correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio and respiratory quotient in patients with septic shock: A prospective observational study.

OBJECTIVE: Central venous-arterial PCO2 to arterial-central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although Pcv-aCO2/Ca-cvO2 might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare Pcv-aCO2/Ca-cvO2 and RQ in patients with septic shock. DESIGN: Prospective, observational study. SETTING: Two adult ICUs. PATIENTS: Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: We measured arterial and central venous gases, Hb, and O2Hb. Pcv-aCO2/Ca-cvO2 and the ratio of central venous-arterial CO2 content to arterial-central venous O2 content (Ccv-aCO2/Ca-cvO2) were calculated. RQ was determined by indirect calorimetry. RESULTS: Pcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2 were not correlated with RQ (R2 = 0.01, P = 0.50 and R2 = 0.01, P = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10-3.27 and 0.42, -1.53-2.37). A multiple linear regression model showed Hb, and central venous PCO2 and O2Hb, but not RQ, as Pcv-aCO2/Ca-cvO2 determinants (R2 = 0.36, P = 0.0007). CONCLUSIONS: In patients with septic shock, Pcv-aCO2/Ca-cvO2 did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO2 from Hb. Pcv-aCO2/Ca-cvO2 seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution.

Obesity and Obesity-Related Thyroid Dysfunction: Any Potential Role for the Very Low-Calorie Ketogenic Diet (VLCKD)?

PURPOSE OF REVIEW: This review aims to explore in-depth the different aspects of the association between very low-calorie ketogenic diet (VLCKD), obesity and obesity-related thyroid dysfunction. RECENT FINDINGS: The VLCKD, proposed as a non-pharmacological strategy for the management of certain chronic diseases, is becoming increasingly popular worldwide. Initially used to treat epilepsy, it has been shown to be effective in controlling body weight gain and addressing various pathophysiological conditions. Research has shown that a low-calorie, high-fat diet can affect thyroid hormone levels. Weight loss can also influence thyroid hormone levels. Studies have suggested that long-term use of VLCKD for refractory epilepsy may be related to the development of hypothyroidism, with an effect seen in various populations. In particular, women with obesity following VLCKD tend to have reduced T3 levels. We propose further research to unravel the underlying mechanisms linking VLCKD to obesity and obesity-related thyroid dysfunction.

The Molecular Mechanisms of the Relationship between Insulin Resistance and Parkinson's Disease Pathogenesis.

Parkinson's disease (PD) is a degenerative condition resulting from the loss of dopaminergic neurons. This neuronal loss leads to motor and non-motor neurological symptoms. Most PD cases are idiopathic, and no cure is available. Recently, it has been proposed that insulin resistance (IR) could be a central factor in PD development. IR has been associated with PD neuropathological features like α-synuclein aggregation, dopaminergic neuronal loss, neuroinflammation, mitochondrial dysfunction, and autophagy. These features are related to impaired neurological metabolism, neuronal death, and the aggravation of PD symptoms. Moreover, pharmacological options that involve insulin signaling improvement and dopaminergic and non-dopaminergic strategies have been under development. These drugs could prevent the metabolic pathways involved in neuronal damage. All these approaches could improve PD outcomes. Also, new biomarker identification may allow for an earlier PD diagnosis in high-risk individuals. This review describes the main pathways implicated in PD development involving IR. Also, it presents several therapeutic options that are directed at insulin signaling improvement and could be used in PD treatment. The understanding of IR molecular mechanisms involved in neurodegenerative development could enhance PD therapeutic options and diagnosis.

The Impact of a Very-Low-Calorie Ketogenic Diet in the Gut Microbiota Composition in Obesity.

The very-low-calorie KD (VLCKD) is characterized by a caloric intake of under 800 kcal/day divided into less than 50 g/day of carbohydrate (13%) and 1 to 1.5 g of protein/kg of body weight (44%) and 43% of fat. This low carbohydrate intake changes the energy source from glucose to ketone bodies. Moreover, clinical trials have consistently shown a beneficial effect of VLCKD in several diseases, such as heart failure, schizophrenia, multiple sclerosis, Parkinson's, and obesity, among others. The gut microbiota has been associated with the metabolic conditions of a person and is regulated by diet interactions; furthermore, it has been shown that the microbiota has a role in body weight homeostasis by regulating metabolism, appetite, and energy. Currently, there is increasing evidence of an association between gut microbiota dysbiosis and the pathophysiology of obesity. In addition, the molecular pathways, the role of metabolites, and how microbiota modulation could be beneficial remain unclear, and more research is needed. The objective of the present article is to contribute with an overview of the impact that VLCKD has on the intestinal microbiota composition of individuals with obesity through a literature review describing the latest research regarding the topic and highlighting which bacteria phyla are associated with obesity and VLCKD.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

INTRODUCTION: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. METHODS: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. INCLUSION CRITERIA: Adult ICU patients>18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48h. Statistical analysis was carried out using IBM-SPSS© 24 programme. RESULTS: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97g/kg/day (CI 0.95-0.99), P<0.001), and lower caloric intake than those who survived (12.94kcal/kg/day (CI 12.48-13.39) vs 16.47kcal/kg/day (CI 16.09-16.8), P<0.001). A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II>18. CONCLUSIONS: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Signals for Muscular Protein Turnover and Insulin Resistance in Critically Ill Patients: A Narrative Review.

Sarcopenia in critically ill patients is a highly prevalent comorbidity. It is associated with a higher mortality rate, length of mechanical ventilation, and probability of being sent to a nursing home after the Intensive Care Unit (ICU). Despite the number of calories and proteins delivered, there is a complex network of signals of hormones and cytokines that affect muscle metabolism and its protein synthesis and breakdown in critically ill and chronic patients. To date, it is known that a higher number of proteins decreases mortality, but the exact amount needs to be clarified. This complex network of signals affects protein synthesis and breakdown. Some hormones regulate metabolism, such as insulin, insulin growth factor glucocorticoids, and growth hormone, whose secretion is affected by feeding states and inflammation. In addition, cytokines are involved, such as TNF-alpha and HIF-1. These hormones and cytokines have common pathways that activate muscle breakdown effectors, such as the ubiquitin-proteasome system, calpain, and caspase-3. These effectors are responsible for protein breakdown in muscles. Many trials have been conducted with hormones with different results but not with nutritional outcomes. This review examines the effect of hormones and cytokines on muscles. Knowing all the signals and pathways that affect protein synthesis and breakdown can be considered for future therapeutics.

Epigenetics in Obesity and Diabetes Mellitus: New Insights.

A long-term complication of obesity is the development of type 2 diabetes (T2D). Patients with T2D have been described as having epigenetic modifications. Epigenetics is the post-transcriptional modification of DNA or associated factors containing genetic information. These environmentally-influenced modifications, maintained during cell division, cause stable changes in gene expression. Epigenetic modifications of T2D are DNA methylation, acetylation, ubiquitylation, SUMOylation, and phosphorylation at the lysine residue at the amino terminus of histones, affecting DNA, histones, and non-coding RNA. DNA methylation has been shown in pancreatic islets, adipose tissue, skeletal muscle, and the liver. Furthermore, epigenetic changes have been observed in chronic complications of T2D, such as diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy. Recently, a new drug has been developed which acts on bromodomains and extraterminal (BET) domain proteins, which operate like epigenetic readers and communicate with chromatin to make DNA accessible for transcription by inhibiting them. This drug (apabetalone) is being studied to prevent major adverse cardiovascular events in people with T2D, low HDL cholesterol, chronic kidney failure, and recent coronary events. This review aims to describe the relationship between obesity, long-term complications such as T2D, and epigenetic modifications and their possible treatments.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

Introduction: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. Methods: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. Inclusion criteria: Adult ICU patients > 18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48 h. Statistical analysis was carried out using IBM-SPSS© 24 programme. Results: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73 g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97 g/kg/day (CI 0.95-0.99), P < 0.001), and lower caloric intake than those who survived (12.94 kcal/kg/day (CI 12.48-13.39) vs 16.47 kcal/kg/day (CI 16.09-16.8), P < 0.001).A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II > 18. Conclusions: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Introducción: En 2020, la pandemia provocada por el SARS-COV-2 demandó una enorme cantidad de recursos sanitarios para garantizar el tratamiento y apoyo adecuado a estos pacientes. Este estudio tiene como objetivo evaluar la ingesta de calorías/proteínas y evaluar sus asociaciones con resultados clínicos relevantes en pacientes críticamente enfermos con enfermedad por coronavirus (COVID-19). Métodos: Se realizó un estudio observacional prospectivo multicéntrico a nivel nacional que incluyó 12 unidades de cuidados intensivos (UCI) argentinas entre marzo y octubre de 2020. Criterios de inclusión: pacientes adultos de la UCI > 18 años ingresados en la UCI con diagnóstico de COVID-19 y ventilación mecánica durante al menos 48 h. El análisis estadístico se realizó mediante el programa IBM-SPSS© 24. Resultados: En el presente estudio se incluyeron 185 pacientes. Entre los que fallecieron se observó un aporte proteico más bajo (0,73 g/kg/día [intervalo de confianza {IC} del 95% 0,70-0,75] vs. 0,97 g/kg/día [IC 0,95-0,99], p < 0,001), y menor aporte calórico que los que sobrevivieron (12,94 kcal/kg/día [IC 12,48-13,39] vs. 16,47 kcal/kg/día [IC 16,09-16,8], p < 0,001).Se construyó un modelo de regresión logística para analizar qué factores estaban asociados con la probabilidad de lograr los objetivos calóricos/proteicos. Se observó una mayor probabilidad de lograr dichos objetivos cuando el inicio del soporte nutricional era precoz, el puntaje NUTRIC modificado era superior a 5 puntos y el paciente tenía diagnóstico de desnutrición mediante la Evaluación Global Subjetiva(B o C). Por otra parte, en los pacientes que necesitaron ventilación mecánica en decúbito prono se observó menor aporte calórico y proteico, situación similar en aquellos con APACHE II > 18. Conclusiones: Los pacientes críticos con insuficiencia respiratoria asociada a la enfermedad por COVID-19 que requerían ventilación mecánica y que fallecieron en la UCI tuvieron una ingesta calórica y proteica menor que los que sobrevivieron. El inicio temprano del soporte nutricional y la desnutrición aumentaron la posibilidad de alcanzar los objetivos calóricos y proteicos, mientras que la gravedad de la enfermedad y la ventilación mecánica en decúbito prono disminuyeron la posibilidad de alcanzar los objetivos calóricos y proteicos.

Coffee consumption, health benefits and side effects: a narrative review and update for dietitians and nutritionists.

Coffee is one of the most popular beverages worldwide; however, its impact on health outcomes and adverse effects is not fully understood. The current review aims to establish an update about the benefits of coffee consumption on health outcomes highlighting its side effects, and finally coming up with an attempt to provide some recommendations on its doses. A literature review using the PubMed/Medline database was carried out and the data were summarized by applying a narrative approach using the available evidence based on the literature. The main findings were the following: first, coffee may contribute to the prevention of inflammatory and oxidative stress-related diseases, such as obesity, metabolic syndrome and type 2 diabetes; second, coffee consumption seems to be associated with a lower incidence of several types of cancer and with a reduction in the risk of all-cause mortality; finally, the consumption of up to 400 mg/day (1-4 cups per day) of caffeine is safe. However, the time gap between coffee consumption and some drugs should be taken into account in order to avoid interaction. However, most of the data were based on cross-sectional or/and observational studies highlighting an association of coffee intake and health outcomes; thus, randomized controlled studies are needed in order to identify a causality link.

Gut microbiota and obesity: New insights.

Obesity is a pathology whose incidence is increasing throughout the world. There are many pathologies associated with obesity. In recent years, the influence of the microbiota on both health and pathological states has been known. There is growing information related to changes in the microbiome and obesity, as well as its associated pathologies. Changes associated with age, exercise, and weight changes have been described. In addition, metabolic changes associated with the microbiota, bariatric surgery, and fecal matter transplantation are described. In this review, we summarize the biology and physiology of microbiota in obese patients, its role in the pathophysiology of several disorders associated, and the emerging therapeutic applications of prebiotics, probiotics, and fecal microbiota transplantation.

Chronotype and Sleep Quality in Obesity: How Do They Change After Menopause?

PURPOSE OF REVIEW: This review primarily provides an overview of the current evidence on chronotype (which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-h period) and sleep quality changes in obesity in postmenopausal women. It also explores possible nutritional strategies to manage these changes in this phase of a woman's life. RECENT FINDINGS: Menopause is a life stage frequently associated with sleep disturbances and changes in circadian rhythms. Sleep disturbances are one of the main symptoms of menopause and are caused by several factors such as hormonal changes, obesity, and melatonin reduction. In addition, the chronotype also changes following menopause. Nutritional strategies are essential because they could help manage menopausal sleep disturbances and circadian misalignment, particularly by tackling obesity and overweight. In the management of postmenopausal women, especially those experiencing obesity, careful assessment of sleep disturbances and chronotype and subsequent development of the most appropriate treatment, including nutritional management, should be part of the treatment routine.

[Prevalence of diarrhea in adult patients in intensive care and its relationship with ready-to-use enteral formulas] / Prevalencia de diarrea en pacientes adultos en terapia intensiva y su relación con las fórmulas enterales listas para utilizar

Introduction: Diarrhea is a frequent complication in critically ill patients. Its origin is multifactorial. The objective of this work is to analyze the relationship between 5 ready-to-use formulas and the development of diarrhea in critically ill patients. Methods: Retrospective study where the volume of the stools of 315 patients and the presence of diarrhea defined with a cut-off point of a volume of 250 ml/day were evaluated. 35.34% of the patients presented diarrhea with said cut-off point. The mean volume of stools was 269.20 ml (95% CI: 255.05-283.06). Results: It was observed that all the formulas analyzed had a slight correlation with the Spearman test between the volume provided and the volume of stools, being: Nutricia Nutrison ® (R: 0.159; P: 0.053), Nutricia Multifibra ® (R: 0.296; <0.001), Nutricia Peptisorb ® (R: 0.323; P<0.001), Nutricia Protison ® (R: 0.108; P<0.001), Fresenius Supportan ® (R: 0.152; P<0.001). Multivariate analysis was performed and it was observed that there were no differences in the incidence of diarrhea between the different enteral formulas during the first 10 days. The change of formulas during hospitalization would be a predisposing factor for diarrhea. Conclusion: Therefore, the formula and the volume provided are factors that could influence whether patients have diarrhoea. Understanding these possible influences in a deeper way will allow the safest choice of enteral formulas for a patient with diarrhea.

Introducción: La diarrea es una complicación frecuente en los pacientes críticos. Su origen es multifactorial. El objetivo de este trabajo es analizar la relación entre 5 fórmulas listas para usar y el desarrollo de diarrea en pacientes críticos. Métodos: Estudio retrospectivo donde se evaluó el volumen de las deposiciones de 315 pacientes y la presencia de diarrea definida con un punto de corte con un volumen de 250 ml/día. Resultados: 35.34% de los pacientes presentaron diarrea con dicho punto de corte. El volumen medio de deposiciones fue de 269.20 ml (IC 95%: 255.05-283.06). Se observó que todas las fórmulas analizadas tenían una correlación leve con la prueba de spearman entre el volumen aportado y el volumen de las deposiciones, siendo:  Nutricia Nutrison ® (R: 0.159; P: 0.053), Nutricia Multifibra ® (R: 0.296; <0.001), Nutricia Peptisorb ® (R: 0.323; P<0.001), Nutricia Protison ® (R: 0.108; P<0.001), Fresenius Supportan ® (R: 0.152; P<0.001). Se realizó análisis multivariado y se observó que no hubo diferencias en la incidencia de diarrea entre las distintas fórmulas enterales durante los primeros 10 días. La fibra soluble sería un factor protector en cambio la fibra mixta y semielemental serían factores que aumentan la incidencia de diarrea. Conclusión: Por lo tanto, la fórmula y el volumen aportado son factores que podrían influenciar en que los pacientes tengan diarrea. Entendiendo estas posibles influencias de una manera mas profunda, permitirá elegir las formulas enterales con mas seguridad para un paciente con diarrea.

N-Acetyl cysteine improves cellular growth in respiratory-deficient yeast.

BACKGROUND: Reactive oxygen species (ROS) is a main factor that alters cellular physiology and functionality. Many strategies are used in order to control excessive oxidative stress. One strategy includes the use of antioxidants like N-acetyl cysteine (NAC). The aim of this study was to compare the effect of this antioxidant on ROS production and cellular growth of a wild-type and a respiratory-deficient Saccharomyces cerevisiae strain. METHODS: Using a simple system such as yeast allows oxidative stress investigations on which numerous factors are more manageable or circumscribed than in a higher organism. We grew cells in a complex medium and incubated them during 72 h. Later, cellular viability and ROS production was evaluated. ROS level was estimated by use of fluorescence signal with 2',7'-dichlorofluorescein diacetate (DCFH-DA). RESULTS: As it is found in the present work, a reducing environment exerted by NAC presence during incubation of the cells allows a respiratory-deficient Saccharomyces cerevisiae strain to improve its cellular growth. CONCLUSIONS: It seems likely that the energy production or the phenotype which characterizes a deficient strain is incapable of palliating ROS growth inhibition while NAC helps to overcome this limitation.

Parenteral succinate reduces levels of reactive oxygen species without changing serum caspase-3 levels in septic rats.

INTRODUCTION: Sepsis is a syndrome of physiological, pathological, and biochemical disorders with several processes co-occurring; reactive oxygen species (ROS) production and apoptosis are 2 of them. Succinate is a Krebs cycle intermediate that is oxydized in complex II of the mitochondria. This study aims to investigate the influence of succinate infusion on these processes. MATERIAL AND METHODS: Sepsis was induced with caecal ligation and puncture in 200 gr Sprague Dawley rats. Four groups were formed with 10 animals (1 - control, 2 - succinate, 3 - sepsis, and 4 - sepsis + succinate). 5 mmol kg-1 of intraperitoneal succinate were administered twice in groups 2 and 4. ROS and caspase-3 levels were measured. RESULTS: Overall, ROS levels (P = 0.017), but not caspase-3 levels (P = 0.89) differed significantly between the groups. The succinate administration reduced serum ROS levels (group 4 vs. 3) in a statistically significant way [0.0623 units (95% CI: 0.0547-0.0699) vs. 0.0835 (0.06-0.106), P = 0.017)], but it did not reduce serum caspase-3 levels (P = 0.39). There was no correlation between serum ROS levels and serum caspase-3 levels. CONCLUSIONS: In this model, ROS levels were reduced with succinate infusion, but caspase-3 levels were not. In addition, ROS levels and apoptosis levels are not correlated, which suggests that those processes occur at different times.

Nasoenteric tube doppler guided insertion. A case report and review of literature.

Nasoenteric tube placement is needed in patients with gastric enteral feeding intolerance or high risk of aspiration. Several techniques are described. Ultrasound is used more commonly for gastric tube placement, but also is described in enteral tube feeding placement. Doppler technique with cold water injection is not described in the literature. We describe a new and easy to realize technique. A case of a 65 years old male patient in the intensive care unit (ICU) with gastroparesis is described. Before beginning a prokinetic drug was administered. In this technique gastric tube placement was bedside assessed with ultrasound, and then the tube was progressed with cold water injection. Duodenal position was confirmed with doppler ultrasound. Ultrasound and doppler technique for nasoenteric tube placement could be a feasible technique to use in the ICU. More studies are needed to assess the effectiveness of the technique.

[Muscle assessment methods for the diagnosis of sarcopenia in cirrhotic patients]. / Métodos de evaluación muscular para el diagnóstico de sarcopenia en pacientes cirróticos.

Sarcopenia is the loss of muscle mass and function. Its presence darkens the prognosis of cirrhotic patients. The gold standard for the description of sarcopenia is the Skeletal Muscle Index (SMI). Thirty-four cirrhotic patients were included. Measurement was carried out through CT of both psoas separately that were then added obtaining the so called "sum of area of 2 psoas", in addition total muscular area, SMI and total area of psoas were measured. Ultrasonography was also performed and the transverse area of the quadriceps rectus anterior was measured by ultrasound and Hand Grip (HG). The correlation between the different measurements was analyzed comparing with the total muscle area, with quadriceps area (r = 0.39; p = 0.019), with total psoas area (r = 0.71; p <0.01), with sum of area of 2 psoas (r = 0.72; p <0.001) and with HG (r = 0.45; p = 0.0069). Compared with SMI, in women HG had 86% sensitivity and 66% specificity (AUC = 0.89). In men, the sum of 2 psoas had 91.7% sensitivity and specificity (AUC = 0.82) and the total area of psoas had 83.3% sensitivity and 76.9% specificity (AUC = 0.8). There was a very good correlation between the tomography methods with the gold standard. The correlation with ultrasound and strength was good. In the evaluation of sensitivity, specificity and AUC, it was not found a useful method when comparing with the SMI.

La sarcopenia es la pérdida de masa y función muscular. Su presencia ensombrece el pronóstico de los pacientes cirróticos. El gold standard para la descripción de sarcopenia es el Skeletal Muscle Index (SMI). Se incluyeron 34 pacientes cirróticos. Se realizó medición a través de tomografía computarizada de ambos psoas por separado, que luego fueron sumados obteniendo lo que se denominó "suma de área de 2 psoas", además se midió área muscular total, SMI y área total de psoas. También se realizó ecografía y se midió el área transversal de recto anterior del cuádriceps por ecografía y Hand Grip (HG). Se analizó la correlación entre las distintas mediciones comparando con el área muscular total, con área de cuádriceps (r = 0.39; P = 0.019), con área total de psoas (r = 0.71; P < 0.01), con suma de área de 2 psoas (r= 0.72; P < 0.001) y con HG (r = 0.45; P = 0.0069). Comparado con el SMI, en mujeres el HG tuvo 86% sensibilidad y 66% especificidad (AUC = 0.89). En hombres la suma de 2 psoas tuvo 91.7% de sensibilidad y especificidad (AUC = 0.82) y el área total de psoas tuvo 83.3% de sensibilidad y 76.9% de especificidad (AUC = 0.8). Hubo muy buena correlación entre los métodos de tomografía con el gold standard, y la correlación con la ecografía y la fuerza fue buena. Evaluando sensibilidad, especificidad y AUC, no se consideró un método útil para ambos sexos, comparado con el SMI.

Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study.

OBJECTIVES: To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). METHODS: Multicenter, prospective, national cohort study. RESULTS: Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively. CONCLUSIONS: Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.