Moderate Restriction Research Articles

SPIROMETRY EVALUATION OF PULMONARY FUNCTIONS IN TYPE 2 DIABETES MELLITUS PATIENTS: A CROSS-SECTIONAL STUDY

Background and Aims: Type 2 diabetes mellitus (T2DM) during the chronic stage elicits significant micro and macrovascular complication and imposes mortality and morbidity among the individuals. However, the effect of T2DM on the lung as a target end organ damage was not widely studied. Hence, the present study was done for the spirometry analysis of pulmonary functions in T2DM patients. Methods: This was a cross-sectional study conducted on 50 T2DM patients and they were subjected to spirometry evaluation. The restrictive pattern of lung functions was analyzed by evaluating the following parameters forced vital capacity (FVC) in liters, forced expiratory volume in 1 second (FEV1), and FEV1/FVC were evaluated. The association between lung function parameters and duration of diabetes, glycated hemoglobin (HbA1c) were also analyzed. Results: In this study among the diabetic patients, the mean FVC was 2.45±0.36 L, the mean FEVI was 1.82±0.12 (L/s) and the mean FEV1/FVC was 87.42±7.54, respectively. Regarding lung complication, out of 50 diabetic patients, 25 (50%) had normal lung functions, 16 (32%) had mild restriction and 9 (18%) had moderate restriction. The FVC, FEVI, and FEV1/FVC were significantly reduced in diabetic patients with moderate lung restriction as compared to normal and mild restriction patterns. Diabetes duration displayed no significant association with a decline in pulmonary function and FEV1/FVC showed weak significant negative correlation (r=−0.412; p=0.02) with HbA1c levels. Conclusion: The study shows that in diabetics patients there was a marked decline in pulmonary function and it might be due to uncontrolled diabetes-related complications.

Dietary Interventions in Heart Failure with Preserved Ejection Fraction (HFpEF): a systematic scoping review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Evelyn Trust. Background Pharmacotherapies have improved outcomes for patients with Heart Failure with reduced Ejection Fraction (HFrEF), but less so for patients with HFpEF. Limited treatments results in substantial burden at personal, clinical and economic levels. Diet has been implicated in the pathogenesis and prognosis of HFpEF, as such, dietary manipulation has the potential to be a useful management strategy. Purpose The aim of the scoping review was to establish which nutritional interventions have so far been tested in patients with HFpEF and establish how the dietary manipulation was achieved. The aim of the meta-analysis was to quantify the effects of interventions tested to determine whether there is evidence to support specific dietary recommendations in patients with HFpEF. Methods Key word searches were performed in five bibliographic databases to identify randomised or controlled studies of dietary interventions conducted in HFpEF or mixed heart failure (HF) samples. Study characteristics were summarised according to PICO (population, intervention, comparator, outcome) categories and intervention complexity was assessed. Studies included in the meta-analysis were appraised for bias and the quality of the body of evidence was assessed via the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. Results Twenty-five different interventions reported across 31 papers were identified. Only ten (40%) were conducted exclusively in HFpEF subjects. Studies employing highly tailored prescribed methods were most common (n=12, 48%). Dietary supplementation (n=10, 40%) and dietary pattern manipulations (n=3, 12%) were less represented. Seventeen studies were considered for meta-analysis; all but one were judged to be at high risk of bias. There was moderate quality evidence that caloric restriction led to clinically meaningful improvements in blood pressure and body weight. There was moderate quality evidence carbohydrate restriction resulted in meaningful reductions in blood pressure. There was very low quality evidence protein supplementation improved blood pressure and body weight and moderate quality evidence for clinically meaningful improvements in function. Conclusions Very few dietary interventions have been tested in HFpEF specifically. Most interventions tested were complex at the patient level, which may not be suitable for the older, multi-morbid patients who typify HFpEF. Results of meta-analyses performed were not of sufficient quality to make generalised conclusions. Some interventions delivered clinically meaningful changes that may be important to patients, therefore, clinicians could draw on these findings to inform personalised care plans and treatment goals.

Short-term effect of plant-based Nordic diet versus carbohydrate-restricted diet on glucose levels in gestational diabetes – the eMOM pilot study

BackgroundThe optimal nutritional treatment for gestational diabetes (GDM) is still a matter of debate. With increasing rates of GDM and potential negative consequences for the health of mother and child, the best treatment should be established. The Nordic diet with emphasis on plant-based protein show promising health outcomes in other populations but has yet to be investigated in GDM population. The aim of this study, which is part of the “Effect of plant-based Nordic diet versus carbohydrate-restricted diet on glucose levels in gestational diabetes” (eMOM) pilot study was to compare the short-term effects of healthy Nordic diet (HND) and the currently recommended moderate restriction of carbohydrates diet (MCRD) on glucose and lipid metabolism in women with GDM.MethodsThis was a randomized crossover where each of the diet interventions (HND and MCRD) were consumed for 3 days with a 3-day wash-out period in between. In total, 42 pregnant women diagnosed with GDM (< 29 + 0 gestational week) were randomized. Glucose data was collected by continuous glucose monitors (CGM, Freestyle Libre®, Abbott, USA) worn for 14 days, and participants gave blood samples before and after diet interventions. The primary outcome was time spent in glucose target range (TIR, < 7.8 mmol/L). TIR, 3-day mean tissue glucose as well as changes in fasting glucose, homeostatic model of insulin resistance (HOMA-IR) and blood lipids were analyzed with paired samples statistical analyses.ResultsThirty-six women with complete 14 days CGM data were analyzed. Both diet interventions produced a high degree of TIR (99% SD 1.8), without a difference between the diets (p = 0.727). The 3-day mean glucose was significantly lower in HND than in MCRD (p = 0,049). Fasting insulin (p = 0,034), insulin resistance (p = 0,030), total and LDL cholesterol (p = 0,023 and 0,008) reduced more in the MCRD diet than the HND. NS differences in any other measure of CGM or blood tests.ConclusionsHND and MCRD did not differ in terms of their short-term effect on TIR. A larger study with sufficient power is needed to confirm the differences in short-term mean glucose, insulin resistance and lipid metabolism.Trial registrationRegistered in clinicaltrials.gov (21/09/2018, NCT03681054).

Prolonged-release pirfenidone in patients with pulmonary fibrosis as a phenotype of post-acute sequelae of COVID-19 pneumonia. Safety and efficacy

IntroductionOne of the major concerns with post-acute sequelae of COVID-19 (PASC) is the development of pulmonary fibrosis, for which no approved pharmacological treatment exists. Therefore, the primary aim of this open-label study was to evaluate the safety and the potential clinical efficacy of a prolonged-release pirfenidone formulation (PR-PFD) in patients having PASC-pulmonary fibrosis. MethodsPatients with PASC-pulmonary fibrosis received PR-PFD 1800 mg/day (1200 mg in the morning after breakfast and 600 mg in the evening after dinner) for three months. Blood samples were taken to confirm the pharmacokinetics of PR-PFD, and adverse events (AEs) were evaluated monthly using a short questionnaire. Symptoms, dyspnea, and pulmonary function tests (spirometry, diffusing capacity for carbon monoxide, plethysmography, and 6-min walk test [6MWT]) were evaluated at baseline, and one and three months after having started the PR-PFD treatment. ResultsSeventy subjects with mild to moderate lung restriction were included. The most common AEs were diarrhea (23%), heartburn (23%), and headache (16%), for which no modifications in the drug study were needed. Two patients died within the first 30 days of enrolment, and three opted not to continue the study, events which were not associate with PR-PFD. Pulmonary function testing, 6MWT, dyspnea, symptoms, and CT scan significantly improved after three months of treatment with PR-PFD. ConclusionIn patients with PASC pulmonary fibrosis, three months' treatment with PR-PFD was safe and showed therapeutic efficacy. Still, it remains to be seen whether the pulmonary fibrotic process remains stable, becomes progressive or will improve.

Coping Mechanisms for Lymphedema: An Analysis of Patient Experiences.

Background and objective Lymphedema is a condition caused by impaired lymphatic function. Acquired lymphedema is often due to neoplasia, infection, trauma, or radiation damage. Most patients rely on advice from fellow patients and personal research to manage their symptoms. We believe coping mechanisms for lymphedema can be more streamlined and made easily accessible if the most common effective strategies are determined and collected in a single repository for reference. To that end, we aimed to assess the experiences of lymphedema patients and the coping mechanisms they employed. Methods Feedback from lymphedema patients was obtained using a 19-item questionnaire-based survey distributed to multiple online lymphedema support groups. It focused on the type of lymphedema and its effect on the respondents and sought data to characterize coping mechanisms that individuals with lymphedema use and their effectiveness. Results The respondents (n=400) had a median age of 55 years (range: 18-83 years). The overall mean BMI was 35.8 kg/m2, with respondents with lower extremity (LE) lymphedema having a greater mean BMI (38.4 vs. 31.0, p<0.05). Most of the respondents were female (n=382, 95.5%). LElymphedema was more common (n=280, 70%) than the upper extremity (UE) variant (n=120, 30%). Within the LE group, 99 were unilateral (35.4%) and 181 were bilateral (64.6%). Moderate restriction was the most reported level with 44% in the unilateral group and 64% in the bilateral group. Stretching, low-impact exercise, manual lymphatic drainage (MLD), and compression bandages were the most commonly used coping methods and most of the respondentsrated them as somewhat effective. Of note, 30% of respondents in either group rated increased water intake as either slightly, moderately, or very helpful; 25% of respondents also rated decreased alcohol intake as very helpful. The use of a therapist and familyand doctor support was rated as extremely helpful. Within the UE group, 105 were unilateral (87.5%) and 15 were bilateral (12.5%). The most common cause of UE lymphedema was breast cancer-related (98/120, 81.7%) followed by melanoma treatment. Mild restriction was the most reported level (n=48, 45.7%). The UE group had similar results as the LE group in terms of coping mechanisms, dietary changes, and psychosocial support. Conclusion Based on the experiences of the lymphedema patients surveyed, the management of the condition is multifactorial and hence not compatible with a one-size-fits-all strategy. LE lymphedema was more common than the UE variant; but both groups reported engaging in stretching, low-impact exercise, manual lymphatic drainage, and compression bandages with similar rates of satisfaction reported in both groups. Dietary changes were not commonly employed. Therapy, doctor, and family support were the most commonly used support mechanisms, with high satisfaction among both groups. The overall coping mechanisms and their ratings in terms of efficacy between UE and LE groups were similar although the impact of quality of life was greater for bilateral conditions. We believe our findings represent the first steps to providing information potentially useful to aid future and current lymphedema patients in finding the coping methods that work best for them.

Recovery Sleep After Sleep Restriction Is Insufficient to Return Elevated Daytime Heart Rate and Systolic Blood Pressure to Baseline Levels.

Sleep restriction alters daytime cardiac activity, including elevating heart rate (HR) and blood pressure (BP). There is minimal research on the cumulative effects of sleep loss and the response after subsequent recovery sleep on HR and BP. This study examined patterns of HR and BP across baseline, sleep restriction, and recovery conditions using multiple daytime cardiac measurements. Participants (15 healthy men, mean [standard deviation] = 22.3 [2.8] years) completed an 11-day inpatient protocol with three nights of 10 hours/night baseline sleep opportunity, five sleep restriction nights (5-hour/night sleep opportunity), and two recovery nights (10-hour/night sleep opportunity). Resting HR and BP were measured every 2 hours during wake. Multilevel models with random effects for individuals examined daytime HR and BP across study conditions and days into the study. Mean daytime HR was 1.2 (0.5) beats/min lower during sleep restriction compared with baseline ( p < .001). During recovery, HR was 5.5 (1.0) beats/min higher ( p < .001), and systolic BP (SBP) was 2.9 (1.1) mm Hg higher ( p = .009). When accounting for days into the study (irrespective of condition) and measurement timing across the day, HR increased by 7.6 beats/min and SBP increased by 3.4 mm Hg across the study period ( p < .001). Our findings suggest that daytime HR and SBP increase after successive nights of sleep restriction, even after accounting for measurement time of day. HR and SBP did not recover to baseline levels after two recovery nights of sleep, suggesting that longer recovery sleep may be necessary to recover from multiple, consecutive nights of moderate sleep restriction.

Exercise training modifies the bone and endocrine response to graded reductions in energy availability in skeletally mature female rodents.

Reductions in energy availability leading to weight loss can induce loss of bone and impact important endocrine regulators of bone integrity. We sought to elucidate whether endurance exercise (EX) can mitigate bone loss observed in sedentary (SED) skeletally mature rodents subjected to graded energy deficits. Female virgin rats (n=84, 5-mo-old; 12/group) were randomized to baseline controls and either sedentary (SED) or exercise (EX) conditions, and within each exercise status to adlib-fed (ADLIB), or moderate (MOD) or severe (SEV) energy restriction diets for 12 weeks. Rats assigned to EX groups performed treadmill running to increase weekly energy expenditure by 10%. MOD-ER-SED, SEV-ER-SED, MOD-ER-EX and SEV-ER-EX were fed modified AIN93M diets with 20%, 40% 10%, and 30% less energy content, respectively, with 100% of all other nutrients provided. Energy availability (EA) was effectively reduced by ~14% and ~30% in the MOD-ER and SEV-ER groups, respectively. MOD-ER for 12 weeks resulted in few negative impacts on bone and, except for serum leptin in MOD-ER-SED rats, no significant changes in endocrine factors. By contrast, SEV-ER in SED rats resulted in significantly lower total body and femoral neck bone mass, and reduced serum estradiol, IGF-1 and leptin. EX rats experiencing the same reduction in energy availability as SEV-ER-SED exhibited higher total body mass, lean mass, total BMC, and higher serum IGF-1 at the end of 12 weeks. Bone mechanical properties at 3 bone sites (mid-femur, distal femur, femoral neck) were minimally impacted by ER but positively affected by EX. These findings indicate that combining increased EX energy expenditure with smaller reductions in energy intake to achieve a targeted reduction in EA provides some protection against loss of bone mass and lean mass in skeletally mature female rats, likely due to better preservation of circulating IGF-1, and that bone mechanical integrity is not significantly degraded with either moderate or severe reduced EA.

Echocardiographic classification of anatomical diversity of the tricuspid valve: insights from the bright trial

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Trial funded by Abbott Background As the treatment of tricuspid regurgitation with tricuspid transcatheter edge-to-edge repair (TEER) becomes more widespread, a better understanding of tricuspid anatomy is increasingly important to properly select patients for this therapy. The diversity of tricuspid anatomies in the real-world population is not well known, and strategies for characterization of some anatomic features are not well defined. Purpose To propose a method to accurately and consistently characterize the tricuspid valve anatomy with transthoracic and transesophageal echo in patients receiving tricuspid TEER and investigate the diversity of tricuspid valve anatomies reflected in a real-world population. Methods The bRIGHT trial is a prospective, single-arm, multi-center registry initiated to evaluate the safety and effectiveness of the TriClip transcatheter edge-to-edge repair (TEER) System in patients with severe tricuspid regurgitation (TR) in a real-world post-market setting. Detailed echocardiographic analysis was performed on subjects from 25 sites with available baseline echo. Subjects were evaluated for three key anatomical factors that are anticipated to be critical in determining the feasibility of TEER: number of tricuspid valve leaflets, degree of leaflet restriction, and coaptation gap size. Herein, we present a proposed method for characterizing these factors through echo analysis. Results Between August 2020 and July 2022, 312 patients subjects (age, 78.4±7.6 years, 54% women) at 25 sites were enrolled into the bRIGHT trial and 283 subjects had available baseline echo. Coaptation gap size was measured at the largest clippable location (Figure 1) and was found to range from 2.3 mm to 20.8mm (avg. 8.6 ± 3.3 mm). According to the analysis method proposed by Hahn et. Al, the majority of subjects were found to have 3 leaflets (80%), however 4 and 5 leaflet anatomies were also present (20% and 1% respectively). Severity of leaflet restriction was categorized according to a 4-grade scale. In the subjects studied, restriction severity ranged from none to severe, with 21% of subjects having no restriction, 65% displaying mild restriction, 12% displaying moderate restriction, and 2% severe restriction. Conclusions In this analysis of 283 subjects treated as part of the bRIGHT trial, a proposed method to accurately and consistently characterize the tricuspid valve anatomy from baseline echo was developed. The method reaved the broad range of tricuspid valve anatomies realized in this real-world population. ___________________________________

Groundwater quality appraisal using IWQI and PCA for irrigation uses

ABSTRACT This study used data collected over 19 sites to assess groundwater quality status of Kurukshetra (Haryana state, India) for irrigation purposes. Irrigation Water Quality Index (IWQI), Wilcox diagram, and principal component analysis were considered to determine current water quality. ArcGIS was used for spatial distribution of irrigation parameters. Results suggest that out of total samples, 5.3% of groundwater samples fall under ‘High Restriction,’ 68.42% of groundwater samples under ‘Moderate Restriction,’ and 26.28% of groundwater samples under ‘Low Restriction.’ Results of Wilcox and USSL diagrams suggested the suitability of groundwater for irrigation. Wilcox diagram indicated that 78.9% of groundwater samples fall in the Excellent-to-Good region, whereas USSL diagram classified all groundwater samples in low-to-medium or from medium-to-high class range. The results of PCA approach demonstrated that first five principal components (PCs) consisting of nine input variable represent 79.23% of total variance in groundwater quality.

SALT RESTRICTION COMBINED WITH RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKADE IS A POTENT ANTIHYPERTENSIVE STRATEGY IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: The relationship between high dietary salt intake and high blood pressure is well established. Recommendations for salt restriction have found their way into major guidelines for essential hypertension. Patients with primary aldosteronism (PA), the most common endocrine cause of arterial hypertension, are believed to be exquisitely salt sensitive, i.e., respond particularly well to salt restriction. However, surprisingly little efforts have been made to determine the precise impact of salt restriction in patients with PA. We, therefore, set out to implement a moderate salt restriction in patients with PA to assess its impact on blood pressure and secondary health outcomes. Design and method: We used nutritional education and continuous self-monitoring via a smartphone app to reduce salt intake in 41 patients with PA for a time span of 12 weeks. All patients were on mineralocorticoid receptor antagonist therapy and had stable blood pressure. Patients were monitored every 4 weeks with blood pressure and urine sampling and detailed blood work at weeks 0 and 12. Mental well-being was addressed by validated scoring systems. Results: Patients achieved a significant reduction of dietary salt intake (from 9.1 to 5.2 g/d) and of blood pressure (from 130/84 to 121/81 mmHg). We also registered a significant loss of body weight (-1.4 kg). While subjects initially featured PHQD scores compatible with depression, scores normalized at the end of the study. Multivariate regression analysis revealed that cumulative intake of drugs targeting the renin-angiotensin-aldosterone system was an independent predictor of blood pressure reduction. Conclusions: Salt restriction is an effective treatment in patients with PA. Patient empowerment by education and self-monitoring promotes salt restriction. Effects are facilitated by concomitant RAAS blockade. Salt restriction, despite being moderate, also improves mental well-being.

Comparative analysis of whole blood transcriptomics between European and local Caribbean pigs in response to feed restriction in a tropical climate

BackgroundFeed restriction occurs frequently during pig growth, either due to economic reasons or stressful environmental conditions. Local breeds are suggested to have better tolerance to periods of feed restriction. However, the mechanisms underlying the response to feed restriction in different breeds is largely unknown. The aims of the present study were (1) to compare the blood transcriptome profile in response to feed restriction and refeeding of two contrasted breeds, Large White (LW), which has been selected for high performance, and Creole (CR), which is adapted to tropical conditions, and (2) to investigate the effect of a moderate feed restriction and refeeding on whole blood transcriptome. Analysis of blood transcriptome allows to study the response to feed restriction and refeeding in a dynamic way. RNAseq was performed on blood samples of growing LW and CR pigs at two time points: after 3 weeks of feed restriction and after 3 weeks of refeeding. The data was compared with samples from control animals offered the same diet on an ad libitum basis throughout the whole experiment.ResultsIn terms of performance (body weight and feed efficiency), CR pigs were less impacted by feed restriction than LW. The transcriptional response to feed restriction and refeeding between CR and LW was contrasted both in terms of number of DEGs and enriched pathways. CR demonstrated a stronger transcriptional response to feed restriction whereas LW had a stronger response to refeeding. Differences in the transcriptional response to feed restriction between CR and LW were related to cell stress response (Aldosterone Signalling, Protein ubiquitination, Unfolded Protein Signalling) whereas after refeeding, differences were linked to thermogenesis, metabolic pathways and cell proliferation (p38 MAPK, ERK/MAPK pathway). In both breeds, transcriptional changes related to the immune response were found after restriction and refeeding.ConclusionsAltogether, the present study indicates that blood transcriptomics can be a useful tool to study differential genetic response to feed restriction in a dynamic way. The results indicate a differential response of blood gene expression to feed restriction and refeeding between breeds, affecting biological pathways that are in accordance with performance and thermoregulatory results.

The Replacement of Only One Portion of Starchy Carbohydrates with Green Leafy Vegetables Regresses Mid and Advanced Stages of NAFLD: Results from a Prospective Pilot Study.

The gold standard treatment for NAFLD is weight loss and lifestyle interventions, which require a diet enriched in fiber and reduced in sugars and saturated fats. Fibres may be advantageous for NAFLD patients since they reduce and slow the absorption of carbohydrates, lipids, and proteins, lowering the energy density of the meal and increasing their sense of satiety. Furthermore, the polyphenol content and other bioactive compounds of vegetables have antioxidant and anti-inflammatory properties preventing disease progression. The aim of this study is to ascertain the effects of a diet enriched by green leafy vegetables and with a moderate restriction of carbohydrate intake in patients with NAFLD over a three month period. Among the forty patients screened, twenty four patients completed the clinical trial consisting of swapping one portion of carbohydrate-rich food for one portion of green leafy vegetables, and liver and metabolic markers of NAFLD were evaluated. All patients underwent routine blood tests, anthropometric measurements, bioelectrical impedance analysis, fibroscan, and fatty liver index (FLI) evaluation before and at the end of the study. The population under study (n = 24) had a median age of 47.5 (41.5-52.5) years and included mainly women (70.8%). We found that FLI, which is used to predict fatty liver (73 (33-89) vs. 85 (54-95), p < 0.0001) and the FAST score, which is a fibroscan-derived parameter identifying patients at risk of progressive NASH (0.03 (0.02-0.09) vs. 0.05 (0.02-0.15), p = 0.007), were both improved after changes in diet. The BMI (33.3 (28.6-37.3) vs. 35.3 (31.2-39.0), p < 0.0001), WC (106.5 (95.0-112.5) vs. 110.0 (103.0-124.0), p < 0.0001), neck circumference (38.0 (35.0-41.5) vs. 39.5 (38.0-42.5), p < 0.0001), fat mass (32.3 (23.4-40.7) vs. 37.9 (27.7-43.5), p < 0.0001), and extracellular water (17.3 (15.2-20.8) vs. 18.3 (15.9-22.7), p = 0.03) were also all significantly lower after three months of diet. Metabolic parameters linked to NAFLD decreased: HbA1c (36.0 (33.5-39.0) vs. 38.0 (34.0-40.5), p = 0.01), triglycerides (72 (62-90) vs. 90 (64-132), p = 0.03), and the liver markers AST (17 (14-19) vs. 18 (15-27), p = 0.01) and γGT (16 (13-20) vs. 16 (14-27), p = 0.02). In conclusion, replacing only one portion of starchy carbohydrates with one portion of vegetables for a three month period is sufficient to regress, at least in part, both mid and advanced stages of NAFLD. This moderate adjustment of lifestyle habits is easily achievable.

Ocular geometry in adults born small, appropriate or large for gestational age at term.

Intrauterine growth restriction leading to a birth weight (BW) which is too low for gestational age (GA) is a known risk factor for various altered organ morphologies and dysfunction in later life. This study aimed to determine for the first time the effects of being small (SGA) or large for gestational age (LGA) on the ocular geometry of adults born at term. All participants were examined with optical biometry (LenStar 900, Haag Streit) to compare the corneal curvature, white-to-white distance, anterior chamber depth, lens thickness and axial length between former moderate (BW percentile 3rd to <10th) and severe (BW <3rd percentile) SGA, controls (BW 10th-90th percentile) and former moderate (BW >90th to 97th percentile) and severe (BW >97th percentile) LGA. Multivariable linear regression was used to analyse associations with GA, BW percentile categories, placental insufficiency, preeclampsia and breastfeeding after adjustment for age and sex. In total, 589 eyes of 296 individuals born at term (aged 30.0 ± 9.4 years, 156 females) were examined, including 40 severe SGA, 38 moderate SGA, 140 with normal BW, 38 moderate LGA and 40 severe LGA. There was an association between a steeper corneal curvature with moderate (B = -0.201; p < 0.001) and severe SGA (B = -0.199; p < 0.001), with extreme SGA associated with smaller white-to-white (B = -0.263; p = 0.001) and a shorter axial length (B = -0.524; p = 0.031). Severe and moderate prenatal growth restriction in adults born at term leads to an altered ocular geometry, namely a steepening of the cornea and a smaller corneal diameter.

Effect of a moderately carbohydrate-restricted diet on liver enzymes, steatosis and fibrosis in normal-weight individuals with non-alcoholic fatty liver disease: study protocol for a parallel randomised controlled clinical trial

IntroductionNon-alcoholic fatty liver disease (NAFLD) is a hepatic condition that is considerably prevalent across the world. Dietary intakes, in which macronutrient composition is precisely planned, might be able to reduce...

Does Physical Frailty and Pulmonary Function Affect the Number of Hospital Stay Among Liver Cirrhosis Patients? - A Retrospective Study

Background and need of research: Cirrhosis is permanent scarring(fibrosis) of liver and its major complication is frailty, defined as deterioration in physical and physiological function. Other complications such as Ascites, Hepatopulmonary syndrome, Respiratory muscles and generalized muscle weakness cause alteration in pulmonary function which is associated with frequent hospitalization and delisting from transplantation. The main aim of this study is to evaluate physical frailty and degree of pulmonary function abnormalities among cirrhotic patient using Short physical performance battery (SPPB) and pulmonary function using forced based spirometry pulmonary test (PFT) and to determine its relation with hospitalizations in cirrhotics. Methods: After approval from the institutional ethical committee, data of one hundred and thirty-three liver cirrhotic patients were retrieved from Physiotherapy department and Abdominal Organ Transplant between January’22-November’22. Data available like demographic and clinical parameters, severity of frailty assessed by Short Physical Performance Battery (SPPB) and Pulmonary Function Test (PFT) were evaluated. Statistical analysis was done using SPSS V.25(IBM). Result: Out of 133 subjects, 18(8%), 8(21%), 52(39%) were severely, moderate, and mildly frail respectively. In PFT findings, 15(11%), 43(32%), 16 (12%) had mild, moderate, and severe restriction. 4-meter gait speed test was weakly correlated with number of hospital admissions (r=0.199, p&lt;0.05). Sit to Stand test (STS) was moderately correlated with number of hospital admissions (r=0.24, p&lt;0.05). Comparison with categories of PFT and hospital admissions was not significant (Kruskal-Walli’s test, p&lt;0.53). Conclusion and Clinical Implications: SPPB (4m gait speed and Chair STS test) showed weak correlation with number of hospitalizations. However, PFT showed no correlation with number of hospitalizations. Findings of this study imply that assessment of frailty can be used to guide future rehabilitation for such patients. Keywords: Short Physical Performance Battery, Liver cirrhosis, Pulmonary function Test, Frailty, Retrospective study.

Moderate dietary salt restriction improves blood pressure and mental well-being in patients with primary aldosteronism: The salt CONNtrol trial.

Primary aldosteronism (PA) is a frequent cause of hypertension. Aldosterone excess together with high dietary salt intake aggravates cardiovascular damage, despite guideline-recommended mineralocorticoid receptor antagonist (MRA) treatment. To investigate the antihypertensive impact of a moderate dietary salt restriction and associated physiological changes, including mental well-being. A total of 41 patients with PA on a stable antihypertensive regimen-including MRA-followed a dietary salt restriction for 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24-h urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well-being by validated questionnaires. Dietary salt intake significantly decreased from 9.1 to 5.2g/d at the end of the study. In parallel, systolic (130 vs. 121mmHg) and diastolic blood pressure (BP) (84 vs. 81mmHg) improved significantly. Patients' aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4g/d). Salt restriction entailed a significant weight loss of 1.4kg, improvement in pulse pressure (46 vs. 40mmHg) and normalization of depressive symptoms (PHQD scale, p<0.05). Salt restriction, cortisol after dexamethasone suppression test and dosage of renin-angiotensin-aldosterone-system (RAAS) blockers were independently associated with BP reduction. A moderate restriction of dietary salt intake in patients with PA substantially reduces BP and depressive symptoms. Moreover, the findings underline that a sufficient RAAS blockade seems to augment the effects of salt restriction on BP and cardiovascular risk.

Current parenteral nutrition practice and clinical outcomes of term and late preterm infants: A retrospective study

Limited studies have described parenteral nutrition (PN) practices and clinical outcomes in term and late preterm infants. The aim of this study was to describe the current practice of PN in term and late preterm infants and their short-term clinical outcomes. We conducted a retrospective study in a tertiary NICU between October 2018 and September 2019. Infants (gestation ≥34 weeks) admitted on the day of birth or the following day and received PN were included. We collected data on patient characteristics, daily nutrition, clinical and biochemical outcomes until discharge. A total of 124 infants [mean (SD) gestation: 38 (1.92) weeks] were included; 115 (93%) and 77 (77%) commenced on parenteral amino acids and lipids, respectively, by day 2 of admission. The mean parenteral amino acid and lipid intake on day 1 of admission was 1.0 (0.7) g/kg/day and 0.8 (0.6) g/kg/day respectively and increased to 1.5 (1.0) g/kg/day and 2.1 (0.7) g/kg/day by day 5, respectively. Eight (6.5%) infants accounted for 9 episodes of hospital-acquired infections. The mean z-scores for anthropometrics at discharge were significantly lower than at birth (Weight:-0.72 (1.13) vs - 0.04 (1.11); p<0.001; Head circumference:-0.14 (1.17) vs 0.34 (1.05); p<0.001; Length:-0.17 (1.69) vs 0.22 (1.34); p<0.001). A total of 28 (22.6%) and 16 (12.9%) infants had mild and moderate postnatal growth restriction (PNGR), respectively. None had severe PNGR. Thirteen infants (11%) experienced hypoglycaemia, whereas 53 (43%) experienced hyperglycaemia. The intakes of parenteral amino acids and lipids in term and late preterm infants were at the lower end of the currently recommended doses, especially in the first five days of admission. One third of the study population had mild to moderate PNGR. Randomised trials investigating the impact of initial PN intakes on clinical, growth and developmental outcomes are recommended.

Short-Term Moderate Energy Restriction Does Not Affect Indicators of Oxidative Stress and Genotoxicity in Humans

Restriction of energy intake (ER), without malnutrition of essential nutrients, has repeatedly been demonstrated to increase longevity in rodents. In the antioxidant theory of aging the lack of balance between the generation of free radicals and free radical scavenging was thought to be a main causal agent in the aging process. From this point of view the antiaging effect induced by ER might be due to the lower rate of free-radical production and related damage induced by a lower metabolic rate. The antiaging effects of ER might also occur in humans. This study explored the effects of a 10-week moderately energy-restricted diet (80% of habitual) in 24 non-obese middle-aged men (16 ER subjects, 8 controls) on resting metabolic rate (RMR) and indicators of the primary antioxidant defense system, oxidative stress and genotoxicity. RMR decreased significantly in both groups, even when adjustments were made for the change in body composition. The increase in blood vitamin C concentrations correlated with the increase in urinary 8-hydroxy-deoxyguanosine (80HdG) excretion. The change in urinary 80HdG excretion also correlated with the change in RMR per kg fat-free mass. No differences between groups were found for changes in indicators of genotoxicity, erythrocyte catalase, glutathione peroxidase and superoxide dismutase activity and in plasma vitamin E, A or β-carotene concentrations. We conclude that 10 weeks of moderate ER did not affect indicators of antioxidative capacity, oxidative stress and genotoxicity of humans. Since subjects were not in energy balance at the end of the study, no conclusions can be made with respect to long-term effects.

“ SPIROMETRIC EVALUATION IN PATIENTS WITH CHRONIC TYPE 2 DIABETES MELLITUS ”

Background: Chronic hyperglycaemia causes many changes in the lungs such as thickened pulmonary capillary basal lamina and alveolar epithelium causing decreased pulmonary elastic recoil and lung volumes. Aim: of the current study is to know the evidence based signicance of spirometry on type 2 diabetes mellitus. Methods: This was a cross sectional observational study with 90 Type 2DM patients were selected of age more than 35 years and with duration of diabetes &gt; 5 years. spirometry was done for: FVC, FEV1, FEV1/ FVC. Results: Recorded FVC in Type 2 DM is decreased when compared to the predicted values.Recorded FVC of diabetic patients have a mean of 2.14 ± 0.67 with a range of 1.13 – 4.17 compared to predicted values with mean of 2.54 ± 0.63 with a range of 1.72 – 4.03. Recorded FEV1 in Type 2 DM is decreased when compared to the predicted values. Recorded FEV1 of diabetic patients have a mean of 1.93± 0.63 with a range of 0.95 – 3.33 compared to predicted values with mean of 2.10 ± 0.49 with a range of 1.42 – 3.36. 53.3% of the diabetics had mild restriction of pulmonary functions 14.4% of the diabetics had moderate restriction of pulmonary functions. Conclusion: DIABETES MELLITUS causes decrement in the lung functions in the form of Restriction which is more seen in patients with longer duration of DM &amp; patients with uncontrolled glycemic status.

Evaluation and prediction of irrigation water quality of an agricultural district, SE Nigeria: an integrated heuristic GIS-based and machine learning approach.

Poor irrigation water quality can mar agricultural productivity. Traditional assessment of irrigation water quality usually requires the computation of various conventional quality parameters, which is often time-consuming and associated with errors during sub-index computation. To overcome this limitation, it becomes critical, therefore, to have a visual assessment of the irrigation water quality and identify the most influential water quality parameters for accurate prediction, management, and sustainability of irrigation water quality. Therefore, in this study, the overlay weighted sum technique was used to generate the irrigation water quality (IWQ) map of the area. The map revealed that 29.2% of the area is suitable for irrigation (low restriction), 41.7% is moderately suitable (moderate restriction); and 29.1% is unsuitable (high restriction), with the irrigation water quality declining towards the central-southeastern direction. Multilayer perceptron artificial neural networks (MLP-ANNs) and multiple linear regression models (MLR) were integrated and validated to predict the IWQ parameters using Cl-, HCO3- SO42-, NO3-, Ca2+, Mg2+, Na+, K+, pH, EC, TH, and TDS as input variables, and MAR, SAR, PI, KR, SSP, and PS as output variables. The two models showed high-performance accuracy based on the results of the coefficient of determination (R2 = 0.513-0.983). Low modeling errors were observed from the results of the sum of square errors (SOSE), relative errors (RE), adjusted R-square (R2adj), and residual plots, further confirming the efficacy of the two models; although the MLP-ANNs showed higher prediction accuracy for R2. Based on the sensitivity analysis of the MLP-ANN model, HCO3, pH, SO4, EC, and Cl were identified to have the greatest influence on the irrigation water quality of the area. This study has shown that the integration of GIS and machine learning can serve as rapid decision-making tools for proper planning and enhanced agricultural productivity.