Sagittal Abdominal Diameter as the Best Predictor of Metabolic Syndrome in HIV-Infected Men on Antiretroviral Therapy.

BACKGROUND: The interaction of human immunodeficiency virus (HIV), host and antiretroviral therapy causes a range of metabolic disorders that can be characterized as a metabolic syndrome (MetS) that increases the cardiovascular risk. MetS involves central obesity, which can be detected using different anthropometric parameters. OBJECTIVE: To assess the abilities of different anthropometric parameters in the prediction of MetS in HIV-infected men on ART. METHOD: The study involved 92 male participants (mean age 44.46±10.38 years), divided into two groups: with and without MetS. All subjects underwent biochemical evaluation (triglycerides, HDL-cholesterol, fasting glucose), blood pressure measurement and anthropometric assessment: body mass, body height, body mass index (BMI), body fat mass, body circumferences (chest, upper arm, forearm, waist, hip, proximal and middle thigh and calf), sagittal abdominal diameter (SAD), skinfold thicknesses (subscapular, anterior and posterior upper arm, anterior and lateral forearm, abdominal, supraspinal, thigh and calf), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-thigh ratio (WTR), sagittal abdominal diameter-to-body height ratio (SADH), body adiposity index (BAI) and conicity index. MetS was specified according to IDF criteria. RESULTS: Subjects with MetS had statistically significant higher values of all anthropometric parameters except middle thigh circumference, calf skinfold and body height. According to ROC analysis and Binary Logistic Regression, SAD has been shown as the best predictor of MetS with a predictive value of 21.40 cm (AUC:0.91), followed by WHR with a predictive value of 0.93. CONCLUSION: Sagittal abdominal diameter is the strongest anthropometric indicator of MetS in HIV-infected patients on ART.

Liver Size and its Correlation with Anthropometric Parameters and Age / El Tamaño del Hígado y su Correlación con los Parámetros Antropométricos y la Edad

SUMMARY: The liver has over 500 physiological and biochemical roles in our organism so checking of liver size and function is a part of every clinical examination. Aim of our research was to estimate liver size on computed tomography (CT) of the abdomen images and to determinate relations between liver dimensions and anthropometric parameters. The research included 99 patients, 49 men and 50 women, who were referred for CT of abdomen. We measured body height (BH) and body mass (BM), and calculated body mass index (BMI) and body surface area (BSA). Also, on CT images we measured anteroposterior (AP), laterolateral (LL) and two craniocaudal liver diameters (one at the level of midclavicular line - CCmcl, and the other was maximal - CCmax). Liver volume (LV) was calculated with formula. Our results showed that AP diameter positively correlated with BSA (r=0.30) in women. LL diameter positively correlated with BH (r=0.43), and BSA (0.31) in men. CCmcl diameter positively correlated with BH (r=0.33), BM (r=0.31), and BSA (r=0.34) in men, while in women it correlated only with BH (r=0.38). CCmax diameter positively correlated with BH (r=0.33) and BSA (r=0.33) in men. LV positively correlated with BH and BSA in both men (r=0.36, r=0.33, respectively) and women (r=0.42, r=0.31, respectively), and in men also with BM (r=0.34). LL, CCmcl, CCmax, and LV negatively correlated with aging in both sexes After the age of 60, there was a decrease in size of LL, CC diameters, as well as in LV. We concluded that liver dimensions decrease with aging, regardless of sex at the expanse of LL and CC diameters which are related to the size of body parameters, so that for a precise evaluation of liver size all three diameters should be measured, LV as well as BH, BM, and BSA.

El hígado desempeña más de 500 funciones fisiológicas y bioquímicas en nuestro organismo, por lo que comprobar el tamaño y la función de este órgano es parte de cada examen clínico. El objetivo de nuestra investigación fue estimar el tamaño del hígado mediante tomografía computarizada (TC) de imágenes del abdomen y determinar las relaciones entre las dimensiones del hígado y los parámetros antropométricos. La investigación incluyó a 99 pacientes, 49 hombres y 50 mujeres, que fueron remitidos para TC de abdomen. Medimos la altura corporal (BH) y la masa corporal (BM), y calculamos el índice de masa corporal (IMC) y el área de superficie corporal (BSA). Además, en las imágenes de TC medimos los diámetros hepáticos anteroposterior (AP), laterolateral (LL) y dos craneocaudales (uno a nivel de la línea medioclavicular - CCmcl, y el diámetro máximo - CCmax). El volumen del hígado (VI) se calculó con una fórmula. Nuestros resultados mostraron que el diámetro AP se correlacionó positivamente con BSA (r = 0,30) en mujeres. El diámetro de LL se correlacionó positivamente con BH (r=0,43) y BSA (0,31) en hombres. El diámetro CCmcl se correlacionó positivamente con BH (r=0,33), BM (r=0,31) y BSA (r=0,34) en hombres, mientras que en mujeres se correlacionó solo con BH (r=0,38). El diámetro CCmax se correlacionó positivamente con BH (r=0,33) y BSA (r=0,33) en hombres. El VI se correlacionó positivamente con BH y BSA tanto en hombres (r=0,36, r=0,33, respectivamente) como en mujeres (r=0,42, r=0,31, respectivamente), y en hombres también con BM (r=0,34). LL, CCmcl, CCmax y LV se correlacionaron negativamente con el envejecimiento en ambos sexos. Después de los 60 años, hubo una disminución en el tamaño de los diámetros LL, CC y LV. Concluimos que las dimensiones del hígado disminuyen con la edad, independientemente del sexo, en la extensión de los diámetros LL y CC que están relacionados con el tamaño de los parámetros corporales, por lo que para una evaluación precisa del tamaño del hígado se debe medir LV como BH, BM y BSA.

Second to fourth digit ratio in women with breast cancer / Relación del segundo al cuarto dígito en mujeres con cáncer de mama

SUMMARY: Digit ratio established in utero is positivelly correlated with intrauterine level of estrogen. Since the breast cancer is related to excessive and prolonged exposure to estrogen, digit ratio might be considered as useful marker in breast cancer risk assessment. The aim of the present study was to compare digit ratios in breast cancer patients and healthy controls. The study group consisted of 98 breast cancer patients aged between 29 to 84 years while the control group included 141 healthy women aged between 21 and 67 years. After collecting anamnestic data concerning menopausal status, the length of second and fourth fingers were measured and the digit ratios were calculated for both hands, as well as the difference between right and left digit ratio. Digit ratio was significantly higher on right hand in breast cancer patients compaired to healthy controls (1.003±0.05 vs. 0.990±0.03). Right digit ratio showed better predictive capacity for the breast cancer development then the left (AUC:0.609 vs. 0.541). Negative statistically significant correlation between right digit ratio and the age of breast cancer diagnosis was observed (r=-0.271). Higher values of right digit ratio in women with breast cancer when compared to healthy women suggest their higher prenatal estrogen exposure that confirms the importance of digit ratio determination in breast cancer risk assessment.

La proporción de dígitos establecida en el útero, se correlaciona positivamente con el nivel intrauterino de estrógeno. Dado que el cáncer de mama está relacionado con una exposición excesiva y prolongada a los estrógenos, la proporción de dígitos podría considerarse un marcador útil en la evaluación del riesgo de cáncer de mama. El objetivo del presente estudio fue comparar proporciones de dígitos en pacientes con cáncer de mama y controles sanos. El grupo de estudio consistió en 98 pacientes con cáncer de mama con edades comprendidas entre los 29 y los 84 años, mientras que el grupo de control incluyó a 141 mujeres sanas con edades comprendidas entre los 21 y los 67 años. Después de recopilar datos anamnésticos sobre el estado menopáusico, se midió la longitud de los dedos segundo y anular y se calcularon las proporciones de los dedos para ambas manos, así como la diferencia entre la proporción de los dedos derecho e izquierdo. La proporción de dígitos fue significativamente mayor en la mano derecha en pacientes con cáncer de mama en comparación con controles sanos (1,003 ± 0,05 frente a 0,990 ± 0,03). La proporción del dígito derecho mostró una mejor capacidad predictiva para el desarrollo de cáncer de mama que el izquierdo (AUC: 0.609 vs. 0.541). Se observó una correlación estadísticamente significativa negativa entre la proporción de dígitos derechos y la edad del diagnóstico de cáncer de mama (r=-0,271). Los valores más altos de la proporción de dígitos derechos en mujeres con cáncer de mama en comparación con mujeres sanas sugieren una mayor exposición prenatal a estrógenos que confirma la importancia de la determinación de la proporción de dígitos en la evaluación del riesgo de cáncer de mama.

Relation of Steatosis to Neurocognitive Function in People Living with HIV.

BACKGROUND: In HIV negative population metabolic syndrome and steatosis are related to poorer neurocognitive (NC) performance. We investigated if similar relation exists in people living with HIV (PLWH). METHODS: We included male PLWH aged 20-65, with undetectable viral load for at least 6 months. Data on levels of education, anthropometric measurements, CD4 levels, ART, markers of metabolic syndrome, smoking and concurrent treatment were collected from database. Concentrations of TNF-α and IL-6 were measured. An ultrasound was used to establish the presence of steatosis, visceral fat thickness and carotid intima media thickness. An extensive NC assessment was done by an experienced neuropsychologist. Cognitive domains were defined as executive functions, divergent reasoning, visuo-constructional abilities, delayed recall and working memory and learning and were measured using a battery of 12 tests. RESULTS: 88 PLWH were included (mean age 39,9 years), 51% on PIs, 46% on NNRTI; 20,4% had metabolic syndrome, 42% patients had steatosis. Weak but statistically significant negative correlations were found between the presence of metabolic syndrome, steatosis and VFT and cognitive domains (divergent reasoning, delayed recall and working memory). Poorer perfomrance in the domains of divergent reasoning and in the working memory were found in participants with steatosis (p=0,048 and 0,033 respectively). CONCLUSION: Although the sample size was relatively small, our results show consistent correlations between the observed neurocognitive variables and metabolic parameters. As central obesity is one of the contributors to NCI, it would be one of the modifiable factors to prevent further neurocognitive decline.

Clinical relevance of official anatomical terminology: the significance of using synonyms / Relevancia clínica de la terminología anatómica oficial: la importancia de usar sinónimos

Terminologia Anatomica is a unique collection of technical terms that enable communication in anatomy and medicine across the world. However, current anatomical terminology also contains some internal inconsistencies and discrepancies in regard to clinical terminology. Thus, a number of terms are not logically related to the names of similar anatomical entities, or the names of corresponding physiological and pathological conditions. Moreover, during clinical practice many anatomical terms have commonly been replaced by new, clinical idioms. These terminological discrepancies represent an impediment to learning and teaching in medical and health professions programs. In this paper it is proposed that the relevant synonyms should be introduced into Terminologia Anatomica in the same way as currently the case for the kidney (ren/nephros) and uterine tube (tuba uterina/salpinx). This change would significantly reduce inconsistencies in nomenclature and make anatomical terminology more logical, easier to understand and memorize. Furthermore, it would better align anatomy with other branches of medicine and medical education.

Terminologia Anatomica es una colección única de términos técnicos que permiten la comunicación en anatomía y medicina en todo el mundo. Sin embargo, la terminología anatómica actual también contiene algunas inconsistencias internas y discrepancias con respecto a la terminología clínica. Por lo tanto, varios términos no están lógicamente relacionados con los nombres de entidades anatómicas similares, o los nombres de las correspondientes condiciones fisiológicas y patológicas. Además, durante la práctica clínica muchos términos anatómicos han sido comúnmente reemplazados por nuevos modismos clínicos. Estas discrepancias terminológicas representan un impedimento para el aprendizaje y la enseñanza en los programas médicos y profesionales de la salud. En este trabajo se propone que los sinónimos relevantes se introduzcan en la terminología anatómica de la misma manera que en la actualidad, como en el caso del riñón (ren / nephros) y la tuba uterina (tuba uterina / salpinx). Este cambio reduciría significativamente las inconsistencias en la nomenclatura y haría la terminología anatómica más lógica, más fácil de entender y memorizar. Además, alinearía mejor la anatomía con otras áreas de la medicina y la educación médica.

Attitudes of medical and allied medical students from Serbia toward whole body donation / Atitudes dos estudantes de medicina e áreas médicas afins da Sérvia em relação à doação completa do corpo

Anatomy, one of the key pre-clinical subjects in medical and allied medical disciplines, has traditionally relied on instruction based on the utilization of cadavers. Acquiring cadavers for anatomy education has presented a challenge in many countries. This challenge has been met through the organization of well informed and culturally sensitive body donation programs. Attitudes of the general population, medical professionals and students are important in devising these programs. The aim of this study was to investigate attitudes of medical and allied medical students from the University of Novi Sad toward whole body donation. A survey was carried out on the first and third year students enrolled in all degrees taught at the University and the sixth year medical students. A large number of respondents (87.38%) perceived cadavers as important in anatomy education. The majority of students (51.26%) would support the body donation of a stranger, while a much smaller proportion of respondents would become donors (19.51%) or support their family members (21.67%) to bequeath their body. There were differences in attitudes toward body donation related to respondents' year of study, ethnicity and religion. The main reasons for donation were altruistic, while the main reasons not to donate were lack of information and religious factors. Most of the respondents were in favor of introducing memorial services for the body donors. The results of the study highlight the importance of a culturally sensitive approach to students in the anatomy laboratories and the enrichment of anatomy education through the humanities. They also underscore the significance of well-organised and informative body donation programs.

Anatomia, um dos principais temas pré-clínicos em disciplinas da medicina e áreas médicas afins, tradicionalmente tem contado com a instrução baseada na utilização de cadáveres. A aquisição de cadáveres para o ensino da anatomia tem se mostrado um desafio em muitos países. Este desafio tem sido enfrentado através da organização de programas de doação de corpo bem informados e culturalmente sensíveis. Atitudes da população geral, de profissionais e estudantes de medicina são importantes na elaboração desses programas. O objetivo deste estudo foi investigar as atitudes de estudantes de medicina e áreas médicas afins da Universidade de Novi Sad em relação à doação completa do corpo. A pesquisa foi conduzida com todos os estudantes do primeiro e terceiro anos inscritos em todos os cursos oferecidos pela universidade e com os estudantes do sexto ano de medicina. Uma grande parcela dos entrevistados (87,38%) reconhece a importância dos cadáveres no ensino da anatomia. A maioria dos estudantes (51,26%) apoiaria a doação de corpo de um estranho, enquanto que uma proporção muito menor dos entrevistados se tornariam doadores (19,51%) ou apoiariam seus familiares a doarem os corpos deles (21,67%). Houve diferenças nas atitudes em relação à doação de corpo relacionadas aos anos de estudo, etnia e religião dos entrevistados. As principais razões para as doações foram altruísticas, enquanto que os principais motivos para a não doação foram a falta de informação e fatores religiosos. A maioria dos entrevistados foi a favor da introdução de serviços memoriais para os doadores de corpos. Os resultados do estudo destacam a importância de uma abordagem culturalmente sensível aos estudantes nos laboratórios de anatomia e do enriquecimento do ensino da anatomia através das humanidades. Eles também ressaltam a importância de programas de doação de corpo bem organizados e informativos.

Somatotype characteristics of normal-weight and obese women among different metabolic subtypes.

BACKGROUND: Obesity is a well known risk factor for the development of metabolic abnormalities. However, some obese people are healthy and on the other hand some people with normal weight have adverse metabolic profile, therefore it can be assumed that there is a difference in physical characteristics amongst these people. The aim of this study was to establish whether there are somatotype differences between metabolically healthy and metabolically obese women who are obese or of normal weight. SUBJECTS AND METHODS: Study included 230 women aged 44.76 ± 11.21y. Metabolic status was assessed according to IDF criteria, while somatotype was obtained using Heath & Carter method. RESULTS: Significant somatotype differences were observed in the group of women with normal-weight: metabolically healthy women had significantly lower endomorphy, mesomorphy and higher ectomorphy compared to metabolically obese normal-weight women (5.84-3.97-2.21 vs. 8.69-6.47-0.65). Metabolically healthy obese women had lower values of endomorphy and mesomorphy and higher values of ectomorphy compared to 'at risk' obese women but the differences were not statistically significant (7.59-5.76-0.63 vs. 8.51-6.58-0.5). Ectomorphy was shown as an important determinant of the favorable metabolic profile (cutoff point was 0.80). CONCLUSION: We concluded that, in addition to fat mass, metabolic profile could be predicted by the structure of lean body mass, and in particular by body linearity.