Smartphone applications for nutrition Support: A systematic review of the target outcomes and main functionalities

INTRODUCTION

A proper nutrition is essential for human life. Recently, special attention on this topic has been given in relation to three health statuses: obesity, malnutrition and specific diseases that can be related to food or treated with specific diets. Mobile technology is often used to assist users that wish to regulate their eating habits, and identifying which fields of application have been explored the most by the app developers and which main functionalities have been adopted can be useful in view of future app developments.

METHODS

We selected 322 articles mentioning nutrition support apps through a literature database search, all of which have undergone an initial screening. After the exclusion of papers that were already reviews, not presenting apps or not focused on nutrition, not relevant or not developed for human subjects, 100 papers were selected for subsequent analyses that aimed at identifying the main treated conditions, outcome measures and functionalities implemented in the Apps.

RESULTS

Of the selected studies, 33 focus on specific diseases, 24 on obesity, 2 on malnutrition and 41 on other targets (e.g., weight/diet control). Type 2 diabetes is the most targeted disease, followed by gestational diabetes, hypertension, colorectal cancer and CVDs which all were targeted by more than one app. Most Apps include self-monitoring and coaching functionalities, educational content and artificial intelligence (AI) tools are slightly less common, whereas counseling, gamification and questionnaires are the least implemented. Body weight and calories/nutrients were the most common general outcome measures, while glycated hemoglobin (HbA1c) was the most common clinical outcome. No statistically significant differences in the effectiveness of the different functionalities were found.

CONCLUSION

The use of mobile technology to improve nutrition has been widely explored in the last years, especially for weight control and specific diseases like diabetes; however, other food-related conditions such as Irritable Bowel Diseases appear to be less targeted by newly developed smartphone apps and their related studies. All different kinds of functionalities appear to be equally effective, but further specific studies are needed to confirm the results.

Isolation and characterisation of bacterial colonies from seeds and in vitro cultures of Fraxinus spp. from Italian sites

Culturable bacteria were isolated from seeds, embryos and contaminated in vitro cultures of ash (Fraxinus excelsior L., F. ornus L. and F. angustifolia L.) and were identified using morphological and molecular analyses. Fourteen morphologically distinct isolates were recovered from seeds of Fraxinus spp. 16S rDNA sequencing categorised these isolates into ten separate genera. Three strains isolated from contaminated in vitro cultures, Pantoea agglomerans, Staphylococcus succinus and Aerococcus viridans, were used for comparative analysis with isolates from seeds. Antibiotic sensitivity testing of the isolated contaminants, including phytotoxicity of antibiotics on in vitro cultures of ash, was also investigated. Phytotoxic effects on explants immersed in ampicillin or cultured on medium containing ampicillin were negligible, however tetracycline, either alone or in combination with other antibiotics, had phytotoxic effects. We conclude that ampicillin is a suitable antibiotic to limit the growth of contaminating bacteria during the in vitro culture of ash.

Necrotizing fasciitis successfully treated with extracorporeal blood oxygenation and ozonization (EBOO)

A case of necrotizing fasciitis in a dialysis patient is described. Since traditional therapies were unsuccessful, extracorporeal blood oxygenation and ozonation (EBOO) was tried. This technique is no longer in the experimental stage and is used routinely in our hospital. Patient condition improved radically after EBOO.

A new self-locating peritoneal catheter

OBJECTIVE

Peritoneal catheters often become dislocated, and this may lead to malfunction. Since it is not usually possible to bring them back into their correct position, they must be replaced. With the aim of preventing this complication, we designed a new catheter.

DESIGN

The new catheter has the same form as the Tenckhoff catheter except for a small increase in external diameter of the last 2 cm, made possible by the high specific weight of a small 12-g tungsten cylinder incorporated in the Silastic at the abdominal end. The new catheter may be inserted by a percutaneous technique.

SETTING

University hospitals of Siena and Perugia, Italy.

PATIENTS

In the last three years, 32 of these catheters have been implanted for a total experience of 468 patient-months. Their position was checked on insertion and every two months thereafter by radiography; 26 Tenckhoff catheters (415 patient-months) were studied at the same time. Insertion was performed surgically and by a percutaneous method. The frequency of cuff extrusion, exit-site infections, leakage, and peritoneal infection were noted, together with peritoneal function, which was evaluated by KT/V and weekly creatinine clearance one month after catheter insertion; the tests were repeated when dislocation occurred and at the end of the trial.

RESULTS

No dislocations occurred with the self-locating catheters, whereas nine dislocations occurred in control patients (p = 0.0003). There were no significant differences with respect to controls for cuff extrusion, exit-site infections, leakage, peritoneal infection, and peritoneal function.

CONCLUSIONS

The presence of a small weight at the catheter up prevents displacement completely, keeping the intraperitoneal part of the catheter in place.

Morphological and morphometric changes in mesothelial cells during peritoneal dialysis in the rabbit

The morphometric and morphological changes in the mesothelial cell population were studied in rabbits in peritoneal dialysis with lactate and bicarbonate buffer solution. During dialysis the mesothelial population underwent radical changes in morphology and morphometric analysis showed a significant increase in cell size. Light microscope examination showed two types of changes: hyperplasia of the mesothelial cell with diameters of up to 80 microns, nucleus proportional to the cytoplasm, a large nucleole giving an owl's eye appearance and cytoplasm rich in granular material. The second change was multiple nuclei and arrest of cell division. Nuclear division occurred, but no separation of the cytoplasm. The cells became larger than 200 microns, packed with nuclei and relatively little cytoplasm. Electron microscopy confirmed that the hyperplastic cells had perfect structure whereas the polynucleate cells contained vacuoles and little cytoplasmic reticulum. Immunohistochemistry using monoclonal antibodies SK2-27 and SK 60-61 specific to cytokeratins 14, 16, 17 and 8, 18, respectively, identified the cells as mesothelial. The changes were related to the glucose content of the peritoneal dialysis solution. Glucose is therefore the bioincompatible agent that modifies the mesothelium during peritoneal dialysis, causing it to become hyperplastic or blocking replication.

Pulmonary toxicity following exposure to an aerosolized leather protector

BACKGROUND

An aerosol spray for leather protection was reformulated to remove trichloroethane. The new formulation contained isobutane, n-heptane, ethyl acetate and fluoroaliphatics.

RETROSPECTIVE REVIEW

Thirty-nine patients reported symptoms to the regional poison center. Respiratory symptoms developed within hours of exposure. Most symptoms resolved within two days. Abnormal pulmonary function tests, including obstructive disease or diminished diffusing capacity, were demonstrated in three of the four tested patients.

CONCLUSIONS

The mechanism for the pulmonary toxicity has not been determined.

Behavior of prealbumin in the acute phase of polymyalgia rheumatica treated with 6-methylprednisolone

Serum levels of prealbumin, fibronectin, fibrinogen, alpha 1-acid glycoprotein, C-reactive protein, immunoglobulins, and white blood cell count were prospectively studied in 33 patients affected by polymyalgia rheumatica during the first 45 days of treatment with 6-methylprednisolone. Almost all parameters considered, except for fibronectin and IgM, settled within the normal range fairly quickly, while prealbumin showed a specular course compared with the other reactants. This behavior reflected the improvement of clinical symptoms registered in all patients after steroid treatment. Finally, the genesis of the low baseline prealbumin levels found in polymyalgia rheumatica/giant cell arteritis and their behavior during treatment are discussed.

Plasma levels of fibronectin in polymyalgia rheumatica giant cell arteritis

In order to verify whether measurement of plasma fibronectin (Fn) could represent a useful tool in acute-phase-response assessment, Fn was measured in 16 previously untreated patients (group A) affected by polymyalgia rheumatica giant cell arteritis (PMR-GCA), both before, during, and after 45 days of steroid therapy, and its course was compared with the behavior of some acute-phase reactants such as erythrocyte sedimentation rate (ESR), fibrinogen (Fng), and prealbumin (Preal). No difference was detected between the baseline Fn levels found in patients and those registered in a control group composed of 15 sex- and age-matched healthy subjects; no correlation was found with the other acute-phase parameters considered, and no significant variation of plasma Fn levels was registered as a result of the steroid therapy administered. On the contrary, all the other parameters revealed a good degree of correlation and tended progressively and homogeneously towards normalization as a result of the therapy administered. Plasma Fn was also measured in another group of 16 PMR-GCA patients (group B), all of whom had pathological retinal fluoroangiographic findings, and its levels were compared with those of the von Willebrand factor antigen (vWfAg), a biochemical index of vascular damage. While the levels of Fn continued to be the same as those detected in the control group, the values of vWfAg registered in group B proved to be significantly different from those found in another homogeneous control group of 25 healthy subjects. Finally, no correlation could be detected between Fn and vWfAg, and neither of them showed any significant correlation with the ESR.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gamma-glutamyltransferase and alcohol consumption in primary gout]

The behaviour of gamma-GT, an enzyme whose activity is related with alcohol intake, was studied in three groups of patients with primary gout, divided on the basis of alcohol intake. Poor drinkers (A) and good drinkers (B) do not show significant differences in the serum levels of gamma-GT, uric acid and triglycerides. The above parameters are highest in the group of strong drinkers (C), in which the increase in serum gamma-GT activity is statistically significant and reaches values above the normal range.

Autologous blood predeposit for elective surgery: a program for better use and conservation of blood

We report the results of a pilot study on predeposit autotransfusion for elective surgery. In 2 years 319 U, each consisting of 350 ml of blood, were donated by 206 patients. Each patient gave 1, 2, or 3 U according to hematocrit levels within 10 days of undergoing surgery on the gastrointestinal tract, lung, liver, kidney, brain, thyroid, arteries, or breast. A hemoglobin drop of about 0.8 gm/dl occurred after each blood donation. A total of 259 autologous and 128 homologous U were transfused to 166 patients during surgery or within postoperative day 4; 40 patients required no blood transfusion. About 70% of patients did not need homologous blood products in addition to autologous units. The most active team of surgeons and anesthesiologists covered about 40% of the patients' blood needs during the study period with autologous units. No patient experienced untoward reactions before, during, or after surgery. Surgeons' and anesthesiologists' responses to the program improved during the study as soon as the advantages of the procedure became clearer. However, gentle pressure from the Transfusion Center was essential for the program's expansion. The patients' acceptance was excellent. We conclude that predeposit autotransfusion is a safe and feasible procedure for transfusion treatment in elective surgery.