Selenium intake and metabolic syndrome: A systematic review.
Clinical nutrition (Edinburgh, Scotland). 2019;38(2):603-614
BACKGROUND & AIMS Metabolic syndrome is a multi-causal disease. Its treatment includes lifestyle changes with a focus on weight loss. This systematic review assessed the association between Selenium intake and metabolic syndrome. METHODS Data were collected mainly from four databases: PubMed, CENTRAL (Cochrane), Scopus and Web of Knowledge. Keywords related to metabolic syndrome, selenium, as well as metabolic syndrome features were searched. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. A systematic review protocol was registered at PROSPERO (n. 42016046321). Two reviewers independently screened 2957 abstracts. Six studies were included to perform data extraction with standardized spreadsheets. The risk of bias was assessed by using specific tools according to the design of the relevant studies. An assessment was carried out based on the appropriateness of the study reports accordingly to STROBE and the CONSORT-based checklist for each study design. RESULTS Three studies found no association between Selenium intake and metabolic syndrome; two of them found an inverse association; and one study found a direct association between Selenium intake and metabolic syndrome. One study also showed an inverse association between Selenium intake and the prevalence of high waist circumference, high diastolic blood pressure, and hyperglycaemia in women. CONCLUSIONS Overall, based on the argumentation and results of this study, it is possible to conclude that Selenium intake and metabolic syndrome are not clearly associated in adults and elderly.
Nutrition Risk Screening in Patients Admitted to an Adult Emergency Department of a Brazilian University Hospital.
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2017;(1):84-91
BACKGROUND The prevalence of malnutrition in emergency units is high, and data on the nutrition risk of patients admitted in these units are scarce. The aims of this study are to determine the nutrition risk profile of individuals admitted in an emergency unit and to identify clinical, anthropometric, and laboratory attributes according to nutrition risk classification. MATERIALS AND METHODS A total of 234 individuals in an emergency unit from 1 university hospital in Brazil were enrolled in this cross-sectional study. The nutrition risk profile was determined using the Nutrition Risk Screening 2002. Sociodemographic, clinical, anthropometric, and laboratory data were collected. Comparisons between individuals "at risk" and "not at risk" and logistic regression analyzes were performed. RESULTS The prevalence of nutrition risk at admission was 48.7%. Patients at risk were older ( P = .031), were less educated ( P = .022), had a lower body mass index ( P < .001), had higher concentrations of C-reactive protein (CRP; P = .007), had a higher CRP/serum albumin ratio ( P = .004), had lower concentrations of serum albumin ( P = .002), and had severe weight loss ( P < .001). Altogether, this profile resulted in a longer hospital stay ( P = .004), more complications ( P = .005), and greater use of antibiotics ( P = .024). In regression analyses, low serum albumin (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.23-6.13) and, higher serum CRP (OR, 1.13; 95% CI, 1.00-3.72), use of antibiotics (OR, 13.3; 95% CI, 1.59-111.16) were predictors of long hospital stay. CONCLUSION The prevalence of nutrition risk in emergency patients was high and its profile associated with worse clinical, laboratory, and anthropometric outcomes. The use of other laboratory and clinical variables may also be a good strategy for predicting adverse outcomes in emergency units.
Effects of Prebiotic and Synbiotic Supplementation on Inflammatory Markers and Anthropometric Indices After Roux-en-Y Gastric Bypass: A Randomized, Triple-blind, Placebo-controlled Pilot Study.
Journal of clinical gastroenterology. 2016;(3):208-17
BACKGROUND Studies have shown that prebiotics and synbiotics modulate the intestinal microbiota and may have beneficial effects on the immune response and anthropometric indices; however, the impact of the use of these supplements after bariatric surgery is not yet known. GOALS This study investigated the effects of prebiotic and synbiotic supplementation on inflammatory markers and anthropometric indices in individuals undergoing open Roux-en-Y gastric bypass (RYGB). STUDY In this randomized, controlled, and triple-blind trial conducted as a pilot study, individuals undergoing RYGB (n=9) and healthy individuals (n=9) were supplemented with 6 g/d of placebo (maltodextrin), prebiotic (fructo-oligosaccharide, FOS), or synbiotic (FOS+Lactobacillus and Bifidobacteria strains) for 15 days. RESULTS Interleukin-1β, interleukin-6, tumor necrosis factor-α, C-reactive protein, albumin, and the C-reactive protein/albumin ratio showed no significant changes on comparison between groups after supplementation. The reduction in the body weight of patients undergoing RYGB was 53.8% higher in the prebiotic group compared with the placebo group (-0.7 kg, P=0.001), whereas the reduction in the BMI and the increase in the percentage of excess weight loss were higher in the placebo and the prebiotic groups compared with the synbiotic group (P<0.05). CONCLUSIONS Supplementation of FOS increased weight loss, whereas both prebiotics and synbiotics were not able to promote significant changes in inflammatory markers, although in most analyses, there was a reduction in their absolute values. The use of FOS may represent a potential adjunct in the treatment of obesity.
Goodpasture's syndrome with absence of circulating anti-glomerular basement membrane antibodies: a case report.
Journal of medical case reports. 2016;:205
BACKGROUND Goodpasture's syndrome, a rare disease, is an organ-specific autoimmune disease mediated by anti-glomerular basement membrane antibodies. Its pathology is characterized by crescentic glomerulonephritis with linear immunofluorescent staining for immunoglobulin G on the glomerular basement membrane. Although rare, a few cases with absence of circulating anti-glomerular membrane antibodies have been described. CASE PRESENTATION The objective of this clinical case report is to describe and discuss a case of a 27-year-old white man who was hospitalized with a 1-year history of weight loss and a 1-month history of hemoptysis, with aggravation the day before, having developed dyspnea and cough in the previous 24 hours. An analytical study showed normocytic normochromic anemia with a hemoglobin level of 7.2 g/dL and leukocytosis with normal renal function and coagulation times. A blood transfusion was performed without complications. Chest computed tomography revealed a reticulonodular infiltrate of both lungs. Bronchoscopy showed no apparent lesions. Sputum cultures, rapid urine antigens for Legionella pneumophila and Streptococcus pneumoniae, studies for Influenza, virologic markers and serologic studies for autoimmunity were all negative. At the end of the tenth day his general state deteriorated with fatigue, hematuria, and in 3 days he developed aggravation of renal function with recurrent hemoptysis and anemia. Immunosuppression with daily prednisolone 1 g administered intravenously was initiated. An urgent bronchoscopy showed no lesions. A kidney biopsy showed fibrinoid necrosis and cellular crescents. Immunofluorescence revealed a linear immunoglobulin G deposition compatible with Goodpasture's syndrome. Immunosuppressive therapy with daily cyclophosphamide 120 mg orally was added. Subsequently he was transferred to a referral center at which 21 sessions of plasmapheresis and four sessions of hemodialysis were performed with good response; he currently has no need of hemodialysis. CONCLUSIONS The absence of circulating anti-glomerular basement membrane antibodies in Goodpasture's syndrome adds complexity to the diagnosis creating an unusual setting in a rare disease. In our case a kidney biopsy was essential for diagnosis and clinical approach. Studies have shown that early aggressive therapy leads to an improved prognosis. Physicians should consider tissue diagnoses such as bronchoscopy and kidney biopsy in pulmonary renal syndrome.
Polysaccharide K and Coriolus versicolor extracts for lung cancer: a systematic review.
Integrative cancer therapies. 2015;14(3):201-11
Plain language summary
Lung cancer is the second most commonly diagnosed cancer, generally has a poor prognosis and is the leading cause of cancer mortality. PSK is an immune modulating polysaccharide from the mushroom Coriolus versicolor which has been used in Japan in combination with standard cancer therapy for over 30 years. This systematic review looked at the evidence for the use of PSK in lung cancer and included 11 controlled human trials and 17 preclinical studies. 15 of the 17 preclinical studies supported the anticancer effects of PSK, whilst two studies showed no significant effects. No harmful or negative effects were seen in any of the studies. The review explores the mechanisms by which PSK exerts its anticancer effects. 5 of the human trials were non-randomised and suggest an increased survival of lung cancer patients who received PSK alongside chemo- or radiotherapy, although these studies have methodological weaknesses. All 6 randomised human trials showed benefits on at least one of the following study endpoints: parameters of immune function, body weight, performance score, tumour-related symptoms, or survival. No major adverse effects were reported in the studies reviewed above. There are no known contraindications for use during chemotherapy or radiation therapy. The authors conclude that PSK may significantly improve immune function, tumour-related symptoms, and survival in patients with lung cancer, when used as adjunctive therapy alongside or following standard chemotherapy or radiation therapy, or surgery. PSK appears to increase the tolerability of chemotherapy and reduce limiting factors such as bone marrow suppression.
BACKGROUND Polysaccharide K, also known as PSK or Krestin, is derived from the Coriolus versicolor mushroom and is widely used in Japan as an adjuvant immunotherapy for a variety of cancer including lung cancer. Despite reported benefits, there has been no English language synthesis of PSK for lung cancer. To address this knowledge gap, we conducted a systematic review of PSK for the treatment of lung cancer. METHODS We searched PubMed, EMBASE, CINAHL, the Cochrane Library, AltHealth Watch, and the Library of Science and Technology from inception to August 2014 for clinical and preclinical evidence pertaining to the safety and efficacy of PSK or other Coriolus versicolor extracts for lung cancer. RESULTS Thirty-one reports of 28 studies were included for full review and analysis. Six studies were randomized controlled trials, 5 were nonrandomized controlled trials, and 17 were preclinical studies. Nine of the reports were Japanese language publications. Fifteen of 17 preclinical studies supported anticancer effects for PSK through immunomodulation and potentiation of immune surveillance, as well as through direct tumor inhibiting actions in vivo that resulted in reduced tumor growth and antimetastatic effects. Nonrandomized controlled trials showed improvement of various survival measures including median survival and 1-, 2-, and 5-year survival. Randomized controlled trials showed benefits on a range of endpoints, including immune parameters and hematological function, performance status and body weight, tumor-related symptoms such as fatigue and anorexia, as well as survival. Although there were conflicting results for impact on some of the tumor-related symptoms and median survival, overall most randomized controlled trials supported a positive impact for PSK on these endpoints. PSK was safely administered following and in conjunction with standard radiation and chemotherapy. CONCLUSIONS PSK may improve immune function, reduce tumor-associated symptoms, and extend survival in lung cancer patients. Larger, more rigorous randomized controlled trials for PSK in lung cancer patients are warranted.
Diaphragmatic hernia: an unusual presentation.
BMJ case reports. 2013
A 53-year-old lady presented to A&E with a 3-day history of severe epigastric pain and vomiting. This was preceded by a 3-month history of generalised abdominal discomfort, early satiety and increasing shortness of breath. A CT scan showed a left-sided posterior diaphragmatic defect. Urgent repair of the hernia showed herniation of three-quarter of the stomach, half of the transverse colon, the 13 cm spleen and the pancreas in the chest. There were no postoperative complications. Traumatic diaphragmatic hernias are known to be a complication of major trauma. However, the patient in this case report presented acutely, after mild physical trauma related to using a rowing machine. This exercise, when not performed correctly can raise intra-abdominal pressure. It is plausible that this trauma, although mild, was sufficient in causing the lady's diaphragmatic hernia. This case would suggest that the trauma required to cause a diaphragmatic hernia need not be as severe as originally thought.
Stomach in a parastomal hernia: uncommon presentation.
BMJ case reports. 2012
Parastomal herniae are among the most common complications of stoma formation. The authors present an unusual case of a 41-year-old lady who presented with frequent early postprandial vomiting devoid of bile, upper abdominal distension and weight loss in the preceding 4 weeks losing weight for the last 4 weeks. Barium meal revealed herniation of the stomach through the gastric wall causing gastric outlet obstruction. Intraoperatively she was found to have a subcutaneous incarcerated parastomal hernia containing viable stomach and small bowel loops. The hernial contents were reduced back into the peritoneum and the abdominal wall defect repaired using the open sombrero repair technique.
Right ventricular dilatation during exercise. A new sign?
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 2007;(9):939-40
Comparison between fatigue, sleep disturbance, and circadian rhythm in cancer inpatients and healthy volunteers: evaluation of diagnostic criteria for cancer-related fatigue.
Journal of pain and symptom management. 2006;(3):245-54
The aim of this study was to evaluate whether diagnostic criteria for cancer-related fatigue syndrome (CRFS) could be rigorously applied to cancer inpatients, and to explore the relationship between subjective fatigue and objective measures of physical activity, sleep, and circadian rhythm. Female cancer patients (n=25) and a comparison group of subjects without cancer (n=25) were studied. Study participants completed a structured interview for CRFS and questionnaires relating to fatigue, psychological symptoms, and quality of life (QoL). Wrist actigraphs worn for 72 hours were used as an objective measure of activity, sleep, and circadian rhythm. Compared to controls, cancer patients were more fatigued, had worse sleep quality, more disrupted circadian rhythms, lower daytime activity levels, and worse QoL. After exclusion of subjects with "probable" mood disorders, the prevalence of CRFS was 56%. Fatigue severity among the cancer patients was significantly correlated with low QoL, depression, constipation, and decreased self-reported physical functioning. It can be concluded that the diagnostic criteria for CRFS can be applied to cancer inpatients but strict application requires a rigorous assessment of psychiatric comorbidity. Despite cancer inpatients having greater impairments of sleep and circadian rhythm, it was found that fatigue severity did not appear to be related to these impairments.