Nutritional status in post SARS-Cov2 rehabilitation patients

BACKGROUND & AIMS

After prolonged hospitalization, the assessment of nutritional status and the identification of adequate nutritional support is of paramount importance. In this observational study, we aimed at assessing the presence of a malnutrition condition in SARS-Cov2 patients after the acute phase and the effects of a multidisciplinary rehabilitation program on nutritional and functional status.

METHODS

We recruited 48 patients (26 males/22 females) admitted to our Rehabilitation Unit after discharge from acute Covid Hospitals in northern Italy with negative swab for SARS-Cov2. We used the Global Leadership Initiative on Malnutrition (GLIM) criteria to identify patients with different degrees of malnutrition. Patients underwent a 3 to 4-week individual multidisciplinary rehabilitation program consisting of nutritional intervention (energy intake 27to30 kcal/die/kg and protein intake 1-1.3 g/die/kg), exercise for total body conditioning and progressive aerobic exercise with cycle- and arm-ergometer (45 min, 5 days/week). At admission and discharge from our Rehabilitation Unit, body composition and phase angle (PhA) (BIA101 Akern), muscle strength (handgrip, HG) and physical performance (Timed-Up-and-Go, TUG) were assessed.

RESULTS

At admission in all patients the mean weight loss, as compared to the habitual weight, was -12.1 (7.6)%, mean BMI was 25.9 (7.9) kg/m², mean Appendicular Skeletal Muscle Index (ASMI) was 6.6 (1.7) kg/m² for males and 5.4 (1.4) kg/m² for females, mean phase angle was 2.9 (0.9)°, mean muscle strength (HG) was 21.1 (7.8) kg for males and 16.4 (5.9) kg for females, mean TUG value was 23.7 (19.2) s. Based on GLIM criteria 29 patients (60% of the total) showed a malnutrition condition. 7 out of those 29 patients (24%) presented a mild/moderate grade and 22 patients (76%) a severe grade. After a rehabilitation program of an average duration of 25 days (range 13-46) ASMI increased, with statistically significant differences only in females (p = 0.001) and HG improved only in males (p = 0.0014). In all of the patients, body weight did not change, CRP/albumin (p < 0.05) and TUG (p < 0.001) were reduced and PhA increased (p < 0.01).

CONCLUSIONS

We diagnosed a malnutrition condition in 60% of our post SARS-Cov2 patients. An individualized nutritional intervention with adequate energy and protein intake combined with tailored aerobic and strengthening exercise improved nutritional and functional status.

Small plasma focus as neutron pulsed source for nuclides identification

In this paper, we present preliminary results on the feasibility of employing a low energy (2 kJ, 31 kV) plasma focus device as a portable source of pulsed neutron beams (2.45 MeV) generated by nuclear fusion reactions D-D, for the "in situ" analysis of substances by nuclear activation. This source has the relevant advantage of being pulsed at requirement, transportable, not permanently radioactive, without radioactive waste, cheap, among others. We prove the feasibility of using this source showing several spectra of the characteristic emission line for manganese, gold, lead, and silver.

[To reduce the pain of heel prick in the newborn: comparison of six types of lancets]

Heel prick is an usual method performed to get a blood sample for newborn screening. Its wide use justifies the effort in reducing the pain as much as possible and some simple steps, including the use of spring heelsticks, are recommended by national and international guide-lines. But not all the heelsticks cause the same pain and allow to get enough blood for the screening. The aim of this work was to test six automatic heelstick devices with regard to the pain in heel prick measured with NIPS scale and, at the same time, to value their effectiveness in getting a blood sample suitable for filter paper for newborn screening. The following devices were assessed: Amnes Minilet Lancets, Wuxi Xinda Ltd, Exxe Safe Blade, Lifescan Stik Johnson & Johnson, One Touch Ultra Soft, Accu-Chek Safe T Pro Plus. The device Exxe Safe Blade statistically differs from all others: it is the least painful and it doesn't need any prick repetition.

Vitamin D at term of pregnancy and during lactation in white and black women living in Northern Italy

AIM

Evaluate the vitamin D serum status in a population of white and black mothers who live in the same geographic area of northern Italy (45 degrees 8' N of latitude) and its correlation with vitamin D serum concentrations of the respective newborns at birth, at 2 and 12 months.

METHODS

Twelve white woman-infant pairs and 12 black woman-infant pairs were recruited from January through March 2006. The study population had no pre-existing disease and delivered at term of pregnancy (37-41 weeks of gestational age). Only black infants were given vitamin D supplementation from birth to 1 year of age.

RESULTS

Eleven black and 12 white women had low vitamin D serum levels at term of pregnancy. Similarly, black and white newborns were both vitamin D deficient at birth. After 12 months white women re-gained physiological vitamin D serum levels, whereas black women maintained a status of vitamin D deficiency. Black newborns who were given supplementation showed lower vitamin D serum concentrations as compared with white newborns at 1 year of age.

CONCLUSION

These data showed that all the women living in the same region of northern Italy without any supplementation are equally vitamin D deficient at term of pregnancy regardless of their skin pigmentation. Consequently, every woman should be supplied with additional vitamin D during pregnancy and lactation, though such supplementation seems to exert the most beneficial effects in black women.

Lack of improvement in the modality of beta2 administration in pediatric departments: survey in Piedmont and Aosta Valley

AIM

In recent years many consensus conferences of scientific societies have reaffirmed the advantages of metered dose inhalator (MDI) and spacer administration compared to classic aerosol in acute asthma and maintenance therapy. Faced with a more than convincing documentation, the practitioners have shown a controversial attitude concerning this type of administration. At the same time, as a general acceptance of its superiority there is an inexplicable lack of use.

METHODS

This survey was carried out in 2006 and it involved pediatric hospital wards in Piedmont and Aosta Valley to evaluate the use of spacers in acute asthma in hospitalised children undergoing treatment. These results were compared to those obtained from another survey carried out in 2008 using identical questionnaires in the same departments in order to evaluate the implementation of such a practice.

RESULTS

In the two years between one survey and the other no increase in the use of MDI and spacer has been detected, but, on the contrary, a consistent decrease.

CONCLUSION

Notwithstanding the amount of evidence concerning its superiority compared to nebulisers MDI and spacer is not commonly used for asthma therapy yet. A "promotional" multidisciplinary intervention could play a determining role in the implementation of such a practice.

[Growth in stature in infantile-juvenile obesity]

The study aimed to assess the effect of juvenile simple adiposity on growth. The height (measured using a Hapenden stadiometer) of 1443 subjects (799 boys and 644 girls) aged from 6 to 16 was measured. The Quetelet index (QI) of adiposity was used; all subjects examined exceeded the 95th centile of the standard Cronk and Roche scale. Heights are expressed as standard deviation scores (SDS) and are compared to the British Standard. Adipose boys are taller than British boys up to the age of 12, then the difference lessens and the average heights of 15-year-old adipose boys are below the 50th centile of British growth charts. Female subjects showed a higher SDS from 6 to 8 years, after which the difference lessens gradually, and after 13 years the average height is below the 50th centile of British standards. Adipose boys are taller than normal boys during childhood; in prepuberty and puberty this difference lessens and during puberty they are shorter than British boys. This growth model is probably due to advanced skeletal maturity in adipose subjects with the result that at puberty growth lessens because it is exhausted. The wide epidemiological cross-sectional study confirms that growth is favourable in juvenile adiposity but does not alter adult height.

[Assessment of final body height of a group of persons with juvenile obesity]

Essential adiposity positively influences growth during childhood, but little is known about its effects on final height. A study was performed in 39 subjects (20 males and 19 females, mean age 10.7 for males, and 8.2 years for females) affected by essential adiposity to assess height during and at the end of the developmental age. During childhood the height of adipose subjects included in the study exceeded the mean values for matched chronological ages from the British reference sample (0.716 SDS for males, 0.587 for females). In adulthood, this advantage was completely reversed: the height of males in the study was in line with mean values (0.069 SDS), whereas the females were slightly under the mean height of the reference group (0.165 SDS). Since height is known to be heavily influenced by genetic factors, the results have been corrected for genetic bias. Improved results are obtained following correction for genetic influence: males (0.890 SDS), females (0.584 SDS). In conclusion, childhood adiposity has a positive influence on growth during the developmental age, and also appears to have a positive influence on genetic potential, as may be deduced from the height of the parents, thus improving final height.