Undernutrition risk at hospital admission and length of stay among pulmonology inpatients.

BACKGROUND: There is a lack of evidence regarding the association between the undernutrition risk at hospital admission with adverse clinical outcomes amongst pulmonology inpatients. The aim of this study was to quantify the association between undernutrition risk at hospital admission and time to discharge alive. METHODS: A retrospective cohort study including patients consecutively admitted to a pulmonology unit was conducted. Undernutrition risk at hospital admission was identified using the Malnutrition Universal Screening Tool. Survival analyses (Kaplan-Meier curves and Cox regression) were carried out. RESULTS: The sample was composed of 683 patients. Patients who presented high undernutrition risk on hospital admission had a longer length of hospital stay (approximately 50% were discharged to home after 14 days of hospitalization). In the multivariable Cox regression, high undernutrition risk was shown to be independently associated with a lower probability of discharge alive over time (adjusted hazard ratio=0.70; 95% confidence interval: 0.55-0.90). CONCLUSIONS: Pulmonology inpatients with high undernutrition risk have a longer length of hospital stay and had a lower probability of being discharged to home. In particular, lung cancer patients had a lower probability of being discharged to home, which corroborates a worse prognosis for these patients.

Alpha-1 antitrypsin deficiency caused by a novel mutation (p.Leu263Pro): Pi*ZQ0gaia - Q0gaia allele.

Severe alpha-1 antitrypsin deficiency (AATD) is generally associated with PI*ZZ genotype and less often with combinations of PI*Z, PI*S, and other rarer deficiency or null (Q0) alleles. Severe AATD predisposes patients to various diseases, including pulmonary emphysema. Presented here is a case report of a young man with COPD and AATD. The investigation of the AATD showed a novel mutation p.Leu263Pro (c.860T>C), which was named Q0gaia (Pi*ZQ0gaia). Q0gaia is associated with very low or no detectable serum concentrations of AAT.

The effect of insoles in therapeutic footwear--a finite element approach.

Current practice in the prevention of recurrence of neuropathic foot ulcers is to prescribe accommodative in-shoe orthoses or insoles which reduce plantar pressure levels at locations of bony prominences, particularly under the metatarsal heads. To date, design of these orthoses has largely been a trial and error process. There is little quantitative information available regarding the effects of thickness and the influence of soft tissue characteristics on the cushioning effect of such interventions. The current paper investigated alterations in pressure under the second metatarsal head as a function of insole thickness and tissue thickness. Both experimental and quasi-static plane strain finite element approaches were employed. The orthoses chosen reduced plantar pressure by a maximum of approximately 30% and were more effective (on a percentage basis) in the setting of reduced sub-metatarsal tissue thickness. Peak normal stresses predicted by the FE models were, on average, within 5.9% of experimentally measured values for the normal tissue case and 8.1% for the reduced tissue case. The techniques presented represent a promising approach to understanding plantar cushioning and the principles involved in the design of therapeutic footwear for insensate feet.

Sarcoidosis-tuberculosis association: a case report.

The association of sarcoidosis and tuberculosis is rare and, its differentiation is sometimes very difficult. We report the case of a young man who presented with type III sarcoidosis complicated by pulmonary tuberculosis within 17 months of the diagnosis, leading to a fatal outcome. A change in antimycobacterial antigen complex A60 immunoglobulin G (IgG) titres, as seen in our case, may be helpful in differentiating between the two diseases.

[Pleural effusion infected with Salmonella enteridis]. / Derrame pleural infectado por Salmonella enteritidis.

The authors describe the case of a 49 year-old caucasian male with left pleural effusion. The etiology of the effusion was exsudative with a preponderance of neutrophils. Ten days after admission and on empirical antibiotic therapy, the patient still had fever and the pleural effusion that became purulent. The thoracic echography and computerized tomography showed a subcapsular splenic abcess. The diagnosis was established by the culture of the pleural effusion and the isolation of Salmonella enteritidis enteritidis serotype. According to the antibiogram, a treatment with cotrimoxazole was established with clinical improvement. A splenectomy was performed.

Superquadric modeling of cranial and cerebral shape and asymmetry.

A new method for quantifying cranial and cerebral shape and asymmetry fits symmetric superquadric geometric models to three-dimensional coordinate measurements. Asymmetry is quantified as radial residuals of the surface data points from their best-fit superquadric models. Twenty human crania, 10 magnetic resonance imaging (MRI) exocranial surfaces, and 10 corresponding MRI cerebral surfaces as well as two infant head casts were digitized and modeled using superquadrics. Superquadric parameters have simple geometric interpretation, are very reproducible, and demonstrated statistically significant differences between crania of Amerindian ancestry and MRI exocranial surfaces of European ancestry used in this study. Superquadric models demonstrated strong congruence between MRI exocranial and cerebral surfaces. Typical asymmetry was 1-5 mm. Lastly, polar contour plots of radial residuals for head casts before and after orthotic cranioplasty demonstrated the efficacy of using superquadrics to quantify positional plagiocephaly and synostosis of infant crania.

The nonlinear finite element analysis and plantar pressure measurement for various shoe soles in heel region.

The most influential factor contributing to foot and shoe comfort is underfoot cushioning. The shock absorbing ability of footwear in the heel area is of particular importance in reducing the impact load during athletic activities and in therapeutic footwear prescribed for heel pain. Furthermore, foot care for foot problem patients is an important part of treatment and educational programs. Therefore, a well-designed sport shoe which can provide comfort and protection is essential. In order to design a functional shoe, biomechanics and other new technologies should be considered, and the design process should be examined in the biomechanics laboratory over and over. The design process requires too much time and effort since the entire experimental and test work can only be done after the prototype is manufactured. Therefore, this study tried to introduce the Finite Element Method (FEM) into the shoe design process by building a three-dimensional FE model with various shoe soles and loading conditions. The material properties of shoe materials were tested using an Instron Testing Machine. An in-shoe pressure insole was used to measure the plantar pressure in different ambulation conditions with various shoe constructions. The subject for this study was a healthy young male without any foot problem. The average plantar pressures obtained from approximately 50 steps in the heel region for each of the various conditions were collected. The results showed that the mean peak plantar pressure of the running situation was significantly higher than that of the walking situation as predicted, and that the insole could provide better cushioning compared to the other shoe constructions. The stress strain relationship for shoe materials was approximated better by a second-order nonlinear curve according to the Instron test. The results of the finite element method suggested that only the second-order nonlinear stress strain curve could correctly describe the shoe material, which also confirmed a potential valuable role for FEM in designing functional shoes.

A statistical approach to data analysis and 3-D geometric description of the human head and face.

Many analytical biomechanical methods require extensive three-dimensional statistical description of anatomical geometry. In particular, to design personal protective items for the human head and face, where good fit is critical, it is inevitable that a three-dimensional statistical description of this complicated structure will be needed. The work here offers an approach to this problem. This approach consists of three steps: (1) osteometric scaling, (2) normative specimen accumulation and (3) statistical testing. Three groups of facial data (24 Asian, 29 Black, and 29 White) were digitized. The effectiveness and accuracy of the statistical approach was tested on these three different experimental specimen sets. The method was found to be very accurate in modelling the most complicated human body parts--head and face. The availability of this detailed geometric information will also open many doors for future research and development of muscle controlled prostheses, repair of ligament damage, and in-vivo bone remodelling.