GeneXpert® MTB/RIF assay with transbronchial lung cryobiopsy for Mycobacterium tuberculosis diagnosis.

BACKGROUND: Early tuberculosis (TB) diagnostic is one of the critical steps to TB control. GeneXpert MTB/RIF has been widely proven for a prompt TB diagnosis. The use of GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy samples may increase diagnostic accuracy. We aim to assess the diagnostic of TB with GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy. METHODS: Patients with suspected diagnosis of TB and negative smear microscopies, with TB culture and GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy were included in this cross-sectional study. Participants were enrolled from 2016 to 2018 at National Institute of Respiratory Diseases, Mexico. RESULTS: We included 54 patients (77.8% males) aged 30 to 65 years. The sensitivity of the GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy was 81.3% (95% CI, 62.1-100%), with a specificity of 100% (95% CI, 100-100%) and a negative predictive value of 92.7% (95% CI, 84.7-100%). Twenty-two patients of the total population have HIV, the sensitivity of the test in these patients was 87.5% (95% CI, 64.6-100%). Also, 28 patients with a peripheral localized lesion which had a solid pattern were identified (51.9%). The sensitivity in patients with peripheral localized lesions was 88.9% (68.4-100%). CONCLUSIONS: The GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy test is as efficient as broncho alveolar lavage for TB diagnosis. Transbronchial lung cryobiopsy increases a major diagnostic opportunity when the nature of illness is malignant. Transbronchial lung cryobiopsy is efficient in HIV patients, especially in patients with peripheral localized lesion.

Body composition evaluated by body mass index and bioelectrical impedance vector analysis in women with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a complex inflammatory disease that modifies body composition. Although body mass index (BMI) is one of the clinical nutrition tools widely used to assess indirectly nutritional status, it is not able to identify these body alterations. Bioelectrical Vector Analysis (BIVA) is an alternative method to assess hydration and body cell mass of patients with wasting conditions. OBJECTIVE: To investigate the differences in nutrition status according to BMI groups (normal, overweight and obesity) and BIVA classification (cachectic and non-cachectic) in women with RA. METHODS: Women with confirmed diagnosis of RA were included from January 2015 to June 2016. Whole-body bioelectrical impedance was measured using a tetrapolar and mono-frequency equipment. Patients were classified according to BMI as: low body weight (n = 6, 2.7%), normal (n = 59, 26.3%), overweight (n = 88, 39.3%) and obese (n = 71, 31.7%), and each group was divided into BIVA groups (cachectic 51.8% and non-cachectic 48.2%). RESULTS: A total of 224 RA patients were included, with mean age 52.7 years and median disease duration of 12 years. Significant differences were found in weight, arm circumference, waist, hip, resistance/height, reactance/height and erythrocyte sedimentation rate among all BMI groups. However, serum albumin levels were significantly different between cachectic and non-cachectic patients independently of BMI. In all BMI categories, cachectic groups had lower reactance and phase angle than non-cachectic subjects. CONCLUSION: RA patients with normal or even high BMI have a significantly lower muscle component. Evaluation of body composition with BIVA in RA patients could be an option for cachexia detection.

Prevalence of rheumatoid cachexia assessed by bioelectrical impedance vector analysis and its relation with physical function.

Rheumatoid arthritis (RA) patients frequently have changes in their body composition, with a decrease in muscle mass and an increase in fat mass, a syndrome that is termed rheumatoid cachexia (RC). The prevalence of this nutritional alteration is not well known; there is as yet no consensus, seeing as it depends on the methods, techniques, and cutoff points that are used for its diagnosis. The main aim of this study was to identify RC through assessment by bioelectrical impedance vector analysis (BIVA) and its association with metabolic causes, physical function, and the main disease status, among others. The prevalence of RC was identified in those subjects who fell outside the right lower quadrant of the reference curve of RXc graph of BIVA. Clinical, anthropometric, biochemical and physical activity, emotional status, and diet markers were also evaluated. Ninety-four patients were included (92.55% women). The prevalence of RC assessed by BIVA was 21.28%. BIVA-cachexia patients had a lesser value of handgrip strength vs. patients without BIVA-cachexia 10.2 kg (7.2-13.4) vs. 14.7 kg (9.6-19), p = 0.0062. Disability and folic acid with methotrexate consumption are related to BIVA-cachexia ((OR 4.69, 95% CI 1.33, 16.54, p = 0.016) and (OR 0.19, 95%CI 0.058, 0.651, p = 0.008), respectively). BIVA could represent a valuable tool to assess presence of RC. It is important that RA patients have physical therapy to improve their nutritional status.

The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial.

INTRODUCTION: Nutritional therapy in heart failure (HF) patients has been focused on fluid and sodium restriction with the aim of decreasing volume overload. However, these recommendations are not well established and sometimes controversial. OBJECTIVE: To evaluate the effect of the consumption of a low-carbohydrate diet on oxygen saturation, body composition and clinical variables during two months of follow-up in chronic, stable heart failure patients. METHODS: In a parallel group randomized controlled clinical trial, 88 ambulatory patients were randomly assigned to a low-carbohydrate diet group (40% carbohydrates, 20% protein and 40% fats [12% saturated, 18% monounsaturated and 10% polyunsaturated]) or a standard diet group (50% carbohydrates, 20% protein and 30% fats [10% saturated, 10% monounsaturated and 10% polyunsaturated]) for two months. Diets were normocaloric in both groups. At baseline and at two months of follow-up, the variables evaluated were: oxygen saturation, dietary intake, body composition and handgrip strength. RESULTS: After two months of follow-up, the low-carbohydrate diet group decreased the carbohydrate consumption and had improved oxygen saturation (93.0 ±4.4 to 94.6 ± 3.2, p = 0.02), while the standard diet group had decreased (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). There were also differences between the groups at the end of the study (p = 0.04). No significant differences showed in handgrip strength in both groups, low-carbohydrate diet group (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) and standard diet group (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14). CONCLUSIONS: Low-carbohydrate diet may improve the oxygen saturation in patients with chronic stable heart failure.

The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial / Efecto de una dieta baja en hidratos de carbono sobre la saturación de oxígeno en pacientes con insuficiencia cardiaca: ensayo clínico aleatorizado

Introduction: Nutritional therapy in heart failure (HF) patients has been focused on fluid and sodium restriction with the aim of decreasing volume overload. However, these recommendations are not well established and sometimes controversial. Objective: To evaluate the effect of the consumption of a low-carbohydrate diet on oxygen saturation, body composition and clinical variables during two months of follow-up in chronic, stable heart failure patients. Methods: In a parallel group randomized controlled clinical trial, 88 ambulatory patients were randomly assigned to a low-carbohydrate diet group (40% carbohydrates, 20% protein and 40% fats [12% saturated, 18% monounsaturated and 10% polyunsaturated]) or a standard diet group (50% carbohydrates, 20% protein and 30% fats [10% saturated, 10% monounsaturated and 10% polyunsaturated]) for two months. Diets were normocaloric in both groups. At baseline and at two months of follow-up, the variables evaluated were: oxygen saturation, dietary intake, body composition and handgrip strength. Results: After two months of follow-up, the low-carbohydrate diet group decreased the carbohydrate consumption and had improved oxygen saturation (93.0 ± 4.4 to 94.6 ± 3.2, p = 0.02), while the standard diet group had decreased (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). There were also differences between the groups at the end of the study (p = 0.04). No significant differences showed in handgrip strength in both groups, low-carbohydrate diet group (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) and standard diet group (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14). Conclusions: Low-carbohydrate diet may improve the oxygen saturation in patients with chronic stable heart failure (AU)

Introducción: la terapia nutricional en pacientes con insuficiencia cardiaca (IC) ha sido enfocada en la restricción de líquidos y de sodio con el objetivo de reducir la sobrecarga de volumen. Sin embargo, estas recomendaciones no están bien establecidas y en algunos casos son controvertidas. Objetivo: evaluar el efecto del consumo de una dieta baja en hidratos de carbono sobre la saturación de oxígeno, composición corporal y variables clínicas durante dos meses de seguimiento en pacientes con insuficiencia cardiaca estable. Métodos: ensayo clínico aleatorizado paralelo en 88 pacientes ambulatorios que fueron asignados aleatoriamente al grupo dieta baja en hidratos de carbono (40% hidratos de carbono, 20% proteínas y 40% lípidos [12% saturadas, 18% monoinsaturadas y 10% poliinsaturadas]) o al grupo dieta estándar (50% hidratos de carbono, 20% proteínas y 30% lípidos [10% saturadas, 10% monoinsaturadas y 10% poliinsaturadas]) por dos meses. Las dietas fueron normocalóricas en ambos grupos. En la medición basal y a los dos meses de seguimiento, las variables evaluadas fueron: saturación de oxígeno, ingesta dietética, composición corporal y fuerza de presión de mano. Resultados: después de dos meses de seguimiento, el grupo de dieta baja en hidratos de carbono disminuyó el consumo de hidratos de carbono y mejoró la saturación de oxígeno (93.0 ± 4.4 to 94.6 ± 3.2, p = 0.02), mientras que el grupo de dieta estándar disminuyó (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). También se observó diferencia entre los grupos al fi nal del estudio (p = 0.04). No se observaron diferencias estadísticamente significativas en fuerza de mano en ambos grupos: dieta baja en hidratos de carbono (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) y dieta estándar (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14). Conclusiones: la dieta baja en hidratos de carbono mejora la saturación de oxígeno en pacientes con insuficiencia cardiaca estable (AU)

[Not Available]. / Body composition changes assessed by bioelectrical impedance and their associations with functional class deterioration in stable heart failure patients.

BACKGROUND: Heart failure (HF) patients develop important changes in body composition, but only a small number of studies have evaluated the associations between these changes and functional class deterioration in a prospective manner. OBJECTIVE: The aim of this study was to evaluate whether changes in bioimpedance parameters were associated with NYHA functional class deterioration over six months. METHODS: A total of 275 chronic stable HF patients confirmed by echocardiography were recruited. Body composition measurements were obtained by whole body bioelectrical impedance with multiple frequency equipment (BodyStat QuadScan 4000). We evaluated functional class using the New York Heart Association (NYHA) classification at baseline and after six months. RESULTS: According to our results, 66 (24%) subjects exhibited functional class deterioration, while 209 improved or exhibited no change. A greater proportion of patients exhibited higher extracellular water (> 5%), and these patients developed hypervolemia, according to location on the resistance/reactance graph. A 5% decrease in resistance/height was associated with functional class deterioration with an OR of 1.42 (95% CI 1.01-2.0, p = 0.04). CONCLUSIONS: Body composition assessment through bioelectrical impedance exhibited a valuable performance as a marker of functional class deterioration in stable HF patients.

Body composition changes assessed by bioelectrical impedance and their associations with functional class deterioration in stable heart failure patients / Cambios en la composición corporal por impedancia bioeléctrica y su asociación con el deterioro de la capacidad funcional en pacientes con insuficiencia cardiaca crónica estable

Background: Heart failure (HF) patients develop important changes in body composition, but only a small number of studies have evaluated the associations between these changes and functional class deterioration in a prospective manner. Objective: The aim of this study was to evaluate whether changes in bioimpedance parameters were associated with NYHA functional class deterioration over six months. Methods: A total of 275 chronic stable HF patients confirmed by echocardiography were recruited. Body composition measurements were obtained by whole body bioelectrical impedance with multiple frequency equipment (BodyStat QuadScan 4000). We evaluated functional class using the New York Heart Association (NYHA) classification at baseline and after six months. Results: According to our results, 66 (24%) subjects exhibited functional class deterioration, while 209 improved or exhibited no change. A greater proportion of patients exhibited higher extracellular water (> 5%), and these patients developed hypervolemia, according to location on the resistance/reactance graph. A 5% decrease in resistance/height was associated with functional class deterioration with an OR of 1.42 (95% CI 1.01-2.0, p = 0.04). Conclusions: Body composition assessment through bioelectrical impedance exhibited a valuable performance as a marker of functional class deterioration in stable HF patients (AU)

Introducción: los pacientes con insuficiencia cardiaca (IC) desarrollan cambios importantes en la composición corporal; sin embargo, pocos estudios han evaluado prospectivamente la asociación entre estos cambios y el empeoramiento de la clase funcional en pacientes con IC crónica estable. Objetivo: el objetivo de este estudio fue evaluar si los cambios en los parámetros de la bioimpedancia estaban relacionados con el deterioro de la clase funcional de la clasificación de la New York Heart Association (NYHA) después de 6 meses. Métodos: se incluyeron 275 sujetos con IC crónica estable confirmada por ecocardiograma. Se les realizaron mediciones de composición corporal por impedancia bioeléctrica de cuerpo completo con un equipo de múltiples frecuencias BodyStat QuadScan 4000 y se determinó la clase funcional por la clasificación de la New York Heart Association (NYHA) después de seis meses. Resultados: sesenta y seis (24%) sujetos mostraron deterioro de su clase funcional y 209 la mejoraron o no cambiaron. Se encontró mayor proporción de pacientes que cuya clase funcional se deterioró, en los que aumentó > 5% el agua extracelular y que desarrollaron hipervolemia de acuerdo a su localización en la gráfica resistencia/reactancia. La disminución de > 5% de la resistencia/talla se asoció de forma independiente con el deterioro de la clase funcional con un OR = 1.42 (IC 95% 1.01-2.0, p = 0.04). Conclusiones: la evaluación de la composición corporal a través de bioimpedancia eléctrica en pacientes con IC es un marcador de deterioro funcional (AU)

Cachexia assessed by bioimpedance vector analysis as a prognostic indicator in chronic stable heart failure patients.

BACKGROUND: This study explored whether the cachectic state assessed by bioimpedance vector analysis provides additional prognostic information about mortality from all causes. METHODS: We included 519 consecutive patients with stable chronic heart failure (mean age 62.5 ± 16.4 y; 286 males). Cachexia was identified in those subjects who fell outside the right lower quadrant of the reference curve of 95% on the resistance/reactance graph [bioelectrical impedance vectorial analysis (BIVA)-cachexia]. Clinical, anthropometric, and biochemical data were also evaluated. RESULTS: Patients with BIVA-cachexia (n = 196, 37.8%) were older and had significantly lower ejection fraction, handgrip strength, serum albumin, total cholesterol, and triglycerides. The frequency of patients with body mass index < 20, decreased muscle strength, hypoalbuminemia, anemia, anorexia, New York Heart Association functional classes III/IV and edema, as well as creatinine levels, resistance/height, and impedance index was significantly higher in the cachexia group. During 29 ± 11 mo of follow-up, 39 (19.9%) patients with BIVA-cachexia and 38 (11.7%) patients without BIVA-cachexia (P < 0.0001) died. CONCLUSIONS: The cachectic state is an independent risk factor for mortality in chronic heart failure patients. BIVA could represent a valuable tool to assess presence of cachexia as changes in body cell mass in heart failure patients because provide information additional to weight loss.