Sleeve gastrectomy for idiopathic acute gastric dilatation with transmural necrosis

Acute gastric dilatation (AGD) is usually related to eating disorders, postoperative status and mechanical obstruction of the duodenum. When intragastric pressure is augmented, it can lead to alteration of blood flow and result in transmural necrosis. However, there are very few reports on idiopathic AGD and so here we describe the case of a 26-year-old woman diagnosed with AGD without any apparent cause. Conservative treatment was initially conducted, but because of the persistence of dilatation, presence of gastric ulcer and gastric pneumatosis, a surgical approach was necessary. During surgery, gastric necrosis was observed in the greater curvature. A sleeve gastrectomy was conducted from the angle of His to the antrum. No complications were present during the postoperative course. Oeso-gastro-duodenal barium study showed no signs of gastric emptying and psychiatric evaluation ruled out any eating disorder.

[Analysis of the demand for detection of SARSCoV-2 in a health area of Spain]

OBJECTIVE

Since the discovery of the SARS-CoV-2 virus, the polymerase chain reaction technique (RT-PCR) has become the fundamental method for diagnosing the disease in its acute phase. The objective is to describe the demand-based series of RT-PCR determinations received at a Microbiology Service at a third-level reference hospital for a health area for three months spanning from the onset of the epidemic by SARS-CoV-2.

METHODS

A retrospective analysis of the total of the RT-PCR requested in the Microbiology Service analyzed from 02/25/2020 to 05/26/2020 (90 days) has been carried out. They have been grouped by epidemiological weeks and by the petitioner service. A descriptive analysis was carried out by age, gender and number of requests for each patient. In the tests carried out, a confidence level of 95% (p <0.05) was considered significant.

RESULTS

A total of 27,106 requests was received corresponding to 22,037 patients. Median age 53.7 (RIC 40.9-71.7) years, women: 61.3%. Proportion of patients with any positive RT-PCR: 14%. Of the total requests for RT-PCR, positive 3,710. Week 13 had the highest diagnosis performance (39.0%). The primary care has been the service thar has made the most requests (15,953). Patients with 3 or more RT-PCR: 565, of them, 19 patients had a positive result after previously having a negative one.

CONCLUSIONS

Requests have been increasing depending on the evolution of the epidemic. The RT-PCR has a high diagnostic performance in the phases of highest contagiousness and / or transmissibility of the virus.

Diagnosis of Sarcopenia in Long-Term Care Homes for the Elderly: the Sensitivity and Specificity of Two Simplified Algorithms with Respect to the EWGSOP Consensus

OBJECTIVE

To analyze the prevalence of sarcopenia in elderly care homes using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP) and to evaluate the applicability, sensitivity, and specificity of two simplified algorithms that do not include gait speed measurement.

DESIGN

Cross-sectional study.

SETTING

Long-term care homes.

PARTICIPANTS

249 residents (187 females and 62 males) with a mean age of 84.9 ± 6.7 years (range, 70-106 yrs).

MEASUREMENTS

Cognitive impairment was evaluated with the Pfeiffer test, functional capacity with the Barthel index, walking ability by the Functional Ambulation Classification, muscle mass by bioelectrical impedance analysis, muscle strength by handgrip dynamometry and, gait speed over a distance of 4 m. Sarcopenia was assessed using the EWGSOP-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the EWGSOP algorithm using the MacNemar test and obtaining the sensitivity and specificity, kappa coefficient, and area under the receiver operating characteristic curve (AUC).

RESULTS

Total or severe dependence was recorded in 67% of the 249 residents, severe or moderate cognitive impairment in 64%, inability to walk in 49%, and capacity to walk only with the aid of an ambulator or two people in 21%. The prevalence of sarcopenia was 63.0% by the EWGSOP algorithm, 62.9% by algorithm A and 63.2% by algorithm B (P = 1.000); 143 participants were diagnosed with sarcopenia by all three methods (P =1.000, K = 1.000).

CONCLUSION

Further studies that include residents with functional and/or cognitive impairment are required to validate these results, comparing the diagnostic performance of the EGWSOP algorithm with that of the simplified algorithms validated in the present report.

Acalculous cholecystitis in a patient with Plasmodium falciparum infection after a trip to the Dominican Republic

Acalculous cholecystitis has been associated with several infectious agents, but its relation with Plasmodium falciparum infection has not been clearly defined. This is the first case of acalculous cholecystitis produced by Plasmodium falciparum infection that is directly documented and should be included among the differential diagnoses of acalculous cholecystitis.

Silicon-based ceramics from polymer precursors

A hyperbranched polycarbosilane of the type [R3SiCH2−]x[−SiR2CH2−]y[−SiR(CH2−)1.5]z[−Si(CH2−)2]l (R = H, –CH2CH=CH2, or OR) has been prepared, which was used as a source of inorganic/organic hybrid materials and, through pyrolysis, as a precursor to inorganic solids with unusual microstructures and properties. A partially allyl-substituted derivative “AHPCS”, nominally ['Si(allyl)0.1H0.9CH2']n, has been extensively studied as a precursor to silicon carbide (SiC) and is now used commercially as a SiC matrix source for C- and SiC-fiber-reinforced composites and binder for particulate ceramics. The alkoxy derivatives, ['Si(OR)2CH2'], (R = Me, Et) yield, after hydrolysis and condensation, carbosilane/siloxane gels with unusually high surface areas (700–900 m2/g) and microporosity that is retained in the resultant SiOxCy ceramics formed after pyrolysis to 1000 °C. The fully condensed ['Si(O)CH2'] gel in the latter case was obtained as thin, adherent films on Si surfaces by spin coating and was found to exhibit dielectric constants as low as 2.0 after heating to 400 °C. The SiC precursor, AHPCS, has also been used recently, along with other polymeric precursors, to make two-phase (SiC/C and SiC/BN) amorphous ceramics that exhibit unusual microstructures and thermal/mechanical properties. These microstructures are formed during the mixing and thermosetting of the constituent polymers, which undergo phase separation due to their immiscibility. Certain of the SiC/C composites, which have the C phase uniformly distributed as ca.1-µm droplets in a SiCx matrix, exhibit high oxidation resistance, and microindentation tests on the SiC/BN system suggest unusual toughness.

Body composition in institutionalized elderly people in Granada (Spain). Relation with other nutritional parameters

Anthropometric characteristics and body composition were assessed in a group of 93 institutionalized elderly people, mean age 80.9 +/- 7.6 years, in Granada (Spain). The body composition was measured by the bioelectrical impedance technique. The influence of dietary energy intake, lifestyle, physical activity and health data were studied. Forty-five per cent of the women and 17% of the men were obese (BMI > 30 kg/m2) and 78% of the women and 54% of the men were overweight (BMI > 25 kg/m2). Only 12% of men and 4% of women suffered from undernutrition (BMI < 20 kg/m2). No significant correlations (P > 0.05) were found between BMI or body fat percentage and energy intake. Lifestyle and health data do not affect the BMI or body composition, but a significant negative correlation (P < 0.05) was found between the physical handicap level and the energy intake in all the sample (r = -0.26) and in the women (r = -0.16).

Serum concentration and dietary intake of Zn in healthy institutionalized elderly subjects

We determined the serum concentrations and dietary intake of zinc, as indicators of Zn status, in 44 healthy institutionalized elderly subjects in Granada (Spain) (mean age 81.4 +/- 7.9 years). Determination of Zn in serum was carried out by electrothermal atomic absorption spectrophotometry. Serum samples had a mean Zn concentration of 10.49 +/- 3.5 mumol/1. No significant differences were found in the serum levels of Zn as regards the sex of the subjects. However, concerning Zn intake, determined by a 7-day weighted food record, a significant statistical difference (P < 0.001) was found between men and women, with mean values of 10.01 +/- 1.76 mg/day and 7.33 +/- 1.33 mg/day, respectively. Application of regression analysis to the serum concentration of Zn and other nutritional parameters shows a statistically significant correlation (P < 0.05) between serum levels of Zn and the body mass index. The lack of statistical correlation between the serum concentration of zinc and its intake indicates that this index cannot be used as an indicator of zinc status in the elderly.

Serum concentration and dietary intake of Mg and Ca in institutionalized elderly people

We determined the serum levels and the dietary intake of Mg and Ca in 93 institutionalized elderly people (24 men and 69 women) in Granada (Spain). The serum samples had mean concentrations of 21.39 +/- 2.08 mg/l magnesium and 93.39 +/- 9.24 mg/l calcium. No significant differences were found in the serum levels of the two minerals as regards the sex of the subjects. Application of linear regression analysis to the serum Mg and Ca levels showed a statistically significant positive correlation (P < 0.05). A low vitamin D intake of these subjects (51.8% of the recommended dietary allowance) was observed. The intakes of Ca and Mg correlated positively together, as well as with the intakes of energy, protein, fibre (in the case of Mg only), iron and phosphorus (P < 0.05). The Ca and energy intake were adequate to their current recommendations, as too was the Ca:P ratio, whereas the diet had a poor supply of fibre, vitamin D and Mg.

Serum copper in institutionalized elderly subjects: relations with dietary intake of energy, specific nutrients and haematological parameters

The concentrations of serum copper were determined as an indicator of corporal status of Cu and its relation to aging in 93 institutionalized elderly subjects (24 men and 69 women) in Granada (Spain). We found that aging does not affect serum Cu levels in the two age groups included in the study: Group I < 80 years and Group II > or = 80 years. Application of linear regression analysis to the serum Cu levels and the intake of energy, fibre, iron and magnesium showed a statistically significant negative correlation (P < 0.05) among them in all the subjects. However, no correlation was observed when the serum Cu levels were related to the intake of zinc or vitamin C. Therefore, at the daily intake levels of these two nutrients, they do not interfere in the absorption of copper and hence do not affect the corporal status of this element in the elderly. Blood erythrocyte and haemoglobin concentrations do not show any significant correlation with the serum Cu concentrations (P > 0.05).

Nutritional status of vitamin A and E in institutionalized elderly people in Granada (Spain)

A study has been carried out on the nutritional status of vitamin A and E in 93 institutionalized elderly people in Granada (Spain) by studying their vitamin intake and the serum values of retinol and alpha-tocopherol. The influence of lipid intake and lipids in plasma has been also discussed. The vitamin A intake is higher than the recommended amount and represent 209% DR in men and 217% DR in women. The vitamin E intake is deficient in 33% of the men and 27% of the women. The serum values of retinol indicate that 11% of the women have a deficiency (< 0.7 microM), and that 39% of the men and 32% of the women have low values (0.7-1.22 microM). As for the serum values of alpha-tocopherol, 6% of the women have deficient values, and 82% of the men and 37% of the women have low values (11.6-23.2 microM).