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Nutritional Deficiencies Associated to Bariatric Surgery

long term solution? N Engl J Med 351: 2751-2753, 2004. 12. Davies DJ, Baxter JM, Baxter JN . Nutritional deficiencies after bariatric surgery. Obes Surg 17: 1150-1158, 2007. 13. Buchwald H, Oien DM . Metabolic/bariatric surgery worldwide 2008. Obes Surg 19: 1605-1611, 2009. 14. Sjöström L, Narbro K, Sjöström CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357: 741-752, 2007. 15. Adams TD, Gress RE, Smith SC et al . Longterm mortality after gastric

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Evaluation of Anthropometric and Biochemical Status in Children with Nutritional Deficiency

Abstract

Objective: To evaluate the anthropometric and biochemical status of children with nutritional deficiency. Methods: We have conducted a prospective study on 226 children admitted in Pediatric Clinic I, divided into two groups: one group of 49 children with nutritional deficiency (body-mass-index < -2SD) and one control group (177 children). We have followed demographic data, anthropometric indices evaluated as standard deviations (weight, height, middle upper-arm circumference, tricipital skinfold), biochemical proteic status (Insulin-like Growth Factor 1 IGF-1, albumin, total proteins). We also followed parameters of general nutritional biochemistry. Results: The mean age for underweight children was 5.8 years, lower than in the control group. The weight of the nutritional-deficient group was significantly lower than in the control group, unlike the height (p <0.001). We have also found significant differences in body-mass-index, middle upper-arm circumference and tricipital skinfold, all of them with low SDs in children with nutritional deficiency. Regarding the biochemical markers, we have found significantly higher values of transaminases (p <0.001) and lower IGF-1 (p = 0.02) and total proteins (p = 0.013) in nutritional-deficient group. Most IGF-1 values were in normal range in both groups, but with a higher percent of low values in nutritional deficient children (37.5% vs 14.2%, p = 0.0046). There were no significant differences in height, albumin, cholesterol, triglyceride and glucose levels between the two groups. Conclusions: The anthropometric measurements are the most precise methods in evaluating the nutritional status. Among the studied biochemical markers, IGF-1, total proteins and transaminases are correlated with nutritional deficiencies

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The relationship between micronutrients and anthropometric measurements in malnourished children / Relaţia între micronutrienţi şi măsurătorile antropometrice la copiii malnutriţi

Abstract

Purpose: to evaluate the serum levels of micronutrients in children with nutritional disorders, and to find if there is a direct correlation between them and the anthropometric measurements. Materials and methods: the study was conducted on 125 children (0-18 years); the working group consisted in children with Z-score < -2 standard deviations for at least one anthropometric measurement, while the children without growth disorders were considered as controls. Thus, for each anthropometric measurement, we had different working/control groups that were used for the assessment of correlation with laboratory findings. We followed eight anthropometric parameters and their relation with five of the micronutrients (Ca, Mg, Fe, Zn and Cu). Results: no statistical differences were found in micronutrients serum levels between genders or provenance. Most mean serum levels of micronutrients were lower in the children with Z-scores < -2 standard deviations (except Cu). Mg and Ca were positively correlated with most of the anthropometric measurements. For Fe, Zn and Cu, we found no correlation with any of the anthropometric measures. Differences in mean serum levels were found for Mg, with lower values in children with low weight-forage and triceps-skinfold-thickness, and for Cu, with higher levels in children with low triceps-skinfold-thickness. The red blood cell indices were positively associated with Fe and Zn levels. Conclusions: correlations between the serum level of micronutrients and anthropometric evaluation scores were found for Mg and Ca, but not for Fe and Zn, which were instead directly correlated with red blood cells indices. Mg, Fe and Zn tend to present small serum values in children with growth deficits. Considering the costs, the routine evaluation of Zn and Cu serum levels in growth disorder suspicion is not justified in our geographic area.

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Cutaneous Manifestations of Cystic Fibrosis

Abstract

Cystic fibrosis (CF) is an autosomal recessive affliction triggered by genetic mutations in the cystic fibrosis transmembrane conductance regulator. The lung and pancreas are the most frequently affected organs in cystic fibrosis, cutaneous involvement is undervalued and underdiag-nosed. Skin lesions observed in patients diagnosed with cystic fibrosis are not well known and can create confusions with other dermatological diseases. The diagnosis of cutaneous lesions as signs of cystic fibrosis by pediatricians or dermatologists, despite their overlapping with different nutritional deficiencies, would allow earlier diagnosis and proper treatment and could improve quality of life and outcomes.

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Clinical conundrums in management of sepsis in the elderly

Abstract

In 2012, surviving sepsis campaign came out with updated international guidelines for management of severe sepsis and septic shock. Paradoxically, there are no specific guidelines for management of sepsis in the elderly, although the elderly are more predisposed to sepsis, and morbidity and mortality related to sepsis. Sepsis in the elderly is, more often than not, complicated by clinical conundrums such as congestive heart failure (CHF), atrial fibrillation (AF), chronic kidney disease (CKD), acute kidney injury (AKI), delirium, dementia, ambulatory dysfunction, polypharmacy, malglycemia, nutritional deficiencies, and antibiotic resistance. Also, with recurrent admissions to the hospital and widespread use of antibiotics, the elderly are more susceptible to Clostridium difficile colitis.

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Effect of HMB and 2-Ox administered during pregnancy on bone properties in primiparous and multiparous minks (Neivison vison)

Abstract

The aim of the study was to determine the mechanical and geometric properties as well as bone tissue density of long bones in primiparous and multiparous dams of minks supplemented with β-hydroxy β-methylbutyrate (HMB) and/or 2-oxoketoglutarate (2-Ox) during gestation. Powdered 2-Ox was given at the daily dosage of 0.4 g/kg b.w. separately or simultaneously with HMB, which was administered at the daily dosage of 0.02 g/kg b.w. The study demonstrates for the first time that administration of 2-Ox and/or HMB to dams markedly influences bone tissue density and the mechanical and geometrical properties of mother`s bones in minks. Moreover, it was demonstrated that the supplementation was more effective in the thoracic limb, which was comprehensively used in contrast to the pelvic limb. The mechanical parameters and bone tissue density significantly increased in the humerus in multiparous minks. Only such diet may provide satisfactory production results in the animals. Nutritional deficiencies occurring during pregnancies may trigger body`s own reserves to cover the bone mass increase in developing foetuses and support milk production. This can prevent regeneration of dams’ organisms, which negatively affects their reproductive performance. 2-Ox or HMB may be regarded as a protective metabolite when administered orally to minks, counteracting the negative influences of pregnancy and lactation periods on bones condition. Both simultaneous treatment with 2-Ox and HMB and their separate administration were equally effective.

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Serum vitamin D level was not associated with severity of ventilator associated pneumonia

Abstract

Background and Objective. Vitamin D deficiency is considered one of the most common nutritional deficiencies associated with weakened immune system and increased likelihood of sepsis. The current study was conducted to investigate the association between serum vitamin D level and the severity and prognosis of ventilator associated pneumonia (VAP) in inpatients in intensive care unit (ICU).

Methods. Eighty-four consecutive patients with VAP were enrolled in this observational, prospective study conducted in the ICU of Besat Hospital, Hamadan. The patients were examined for serum 25-hydroxyvitamin D (vitD3) level and VAP severity and prognosis. Clinical pulmonary infection score was used for the diagnosis, and Sequential Organ Failure Assessment (SOFA) Score was used to determine the severity of VAP.

Results. Low level serum vitD3 (under 30 ng/mL) was found in 66 (78.6%) patients. In this series of VAP patients, there were no significant differences in blood culture results, 14 and 28-day sepsis-associated mortality, mechanical ventilation duration, or SOFA Score on days 3, 7, and 14 between the low level and normal level vitD3 patients (p > 0.05).

Conclusion. Serum vitD3 level was not associated with mortality from VAP or complications due to sepsis in the inpatients in the ICU.

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Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance

ABSTRACT

Celiac disease, and, more generally, gluten intolerance, is a growing problem worldwide, but especially in North America and Europe, where an estimated 5% of the population now suffers from it. Symptoms include nausea, diarrhea, skin rashes, macrocytic anemia and depression. It is a multifactorial disease associated with numerous nutritional deficiencies as well as reproductive issues and increased risk to thyroid disease, kidney failure and cancer. Here, we propose that glyphosate, the active ingredient in the herbicide, Roundup®, is the most important causal factor in this epidemic. Fish exposed to glyphosate develop digestive problems that are reminiscent of celiac disease. Celiac disease is associated with imbalances in gut bacteria that can be fully explained by the known effects of glyphosate on gut bacteria. Characteristics of celiac disease point to impairment in many cytochrome P450 enzymes, which are involved with detoxifying environmental toxins, activating vitamin D3, catabolizing vitamin A, and maintaining bile acid production and sulfate supplies to the gut. Glyphosate is known to inhibit cytochrome P450 enzymes. Deficiencies in iron, cobalt, molybdenum, copper and other rare metals associated with celiac disease can be attributed to glyphosate’s strong ability to chelate these elements. Deficiencies in tryptophan, tyrosine, methionine and selenomethionine associated with celiac disease match glyphosate’s known depletion of these amino acids. Celiac disease patients have an increased risk to non-Hodgkin’s lymphoma, which has also been implicated in glyphosate exposure. Reproductive issues associated with celiac disease, such as infertility, miscarriages, and birth defects, can also be explained by glyphosate. Glyphosate residues in wheat and other crops are likely increasing recently due to the growing practice of crop desiccation just prior to the harvest. We argue that the practice of "ripening" sugar cane with glyphosate may explain the recent surge in kidney failure among agricultural workers in Central America. We conclude with a plea to governments to reconsider policies regarding the safety of glyphosate residues in foods

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Osteoskeletal Manifestation of Scurvy in a Male Infant (Case Report)

Trans. 1883;66:159-220. Cheadle W. Three cases of scurvy supervening on rickets in young children. Lancet. 1878;2:685-687. doi:10.1016/S0140-6736(02)43922-0 Stuart-Macadam P. Nutritional deficiency disease: a survey of scurvy, rickets, and iron-deficiency anemia. In: Iscan M, Kennedy K, editors. Reconstruction of life from the skeleton. 1989, New York: Wiley-Liss. p. 201-222. Akikusa JD, Garrick D, Nash MC. Scurvy: forgotten but not gone. J Paediatr Child Health. 2003;39(1):75-77. doi

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Pancrelipase treatment in a patient with the history of Roux-en-Y gastric bypass operation that developed resistant hypocalcemia secondary to total thyroidectomy

References Alfonso B, Jacobson AS, Alon EE, Via MA. Previous gastric bypass surgery complicating total thyroidectomy. Ear Nose Throat J 94, 12–16, 2015. Bischof MG, Heinze G, Vierhapper H. Vitamin D status and its relation to age and body mass index. Horm Res 66, 211–215, 2006. Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: What have we learned? Obes Surg 15, 145–154, 2005. Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S, Bhan A, Talpos GB. Prevalence of vitamin D

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