Ophthalmic Complications of Bariatric Surgery

Obesity is increasing vastly in the world, and the number of bariatric surgeries being performed is also increasing. Patients being submitted to bariatric surgeries, especially malabsorptive procedures, have an increased risk of developing nutrient deficiencies, which can culminate in symptomatic hypovitaminosis, if supplementation is not done correctly. The eye and the optic system need an adequate level of several vitamins and minerals to perform properly, especially vitamin A, and this article wants to cover the main nutrients involved, the possible ophthalmic complications that can arise by their deficiency, and the management of those complications.

Vitaminas, Minerais e Oligoelementos por Via Entérica no Recém-Nascido. Revisão do Consenso Nacional

Na presente atualização da recomendação sobre vitaminas, minerais e oligoelementos por via entérica no recém-nascido, é dada especial relevância às necessidades destes micronutrientes do recém-nascido de termo e pré-termo, suprimentos fornecidos pelo leite materno, leite humano fortificado, fórmulas lácteas para recém-nascido de termo e pré-termo comercializadas em Portugal e suplementos recomendados por rotina no recém-nascido de termo e pré-termo.

Effects of severe protein restriction in levels of parasitemia and in mortality of mice accutely infected with Trypanosoma cruzi

Adult mice were submitted to different degrees of protein restriction for five weeks (4.75, 9.5,14.25 and 19% of protein in isocaloric diets with normal content of mineral and vitamins), being subsequently infected with two strains of Trypanosoma cruzi: 10(5) trypomastigotes of Y strain or 14(5) trypomastigotes of CL strain. The same diet was maintained for all animals and the infection wasfollowed up by evaluation of blood parasites, mortality and intensity of lesions in the heart and skeleton muscle. Only severe protein restriction (4.75%) induced decrease in resistance to the infection with both the Y and CL strains of T. cruzi, which resulted in higher parasitemia and mortality. The inflammatory lesions in heart and skeleton muscle were less extensive in groups with severe protein restriction despite the increased number of parasite in muscle cells. Depression of immune mechanisms could be responsiblefor the reduced resistance and reduced inflammatory reaction after T. cruzi infection in severely protein restricted animals.

Sudden sensorineural hearing loss : evaluation of co-morbidities and potential clinical associations

RESUMO: A surdez súbita (SS) caracteriza-se por uma perda abrupta de audição, mais frequentemente unilateral e associada a sensação de preenchimento aural, acufenos e vertigem. Afecta 5-20/100.000pessoas/ano (sobretudo adultos em fase activa na década de 40), com grande impacto na qualidade de vida. Possíveis causas incluem doenças infecciosas, circulatórias, traumáticas, imunológicas, neoplásicas, neurológicas, tóxicas e cocleares. No entanto, a causa da SS permanece desconhecida na maioria dos casos (80%), o que origina tratamentos controversos e frequentemente ineficientes. Os tratamentos disponíveis variam desde corticosteróides a antivirais, vasodilatadores, anti-agregantes, anticoagulantes, vitaminas e oxigénio hiperbárico (OHB). Atendendo a falta de informação relativa à etiologia e fisiopatologia da SS, pretendemos avaliar a evolução clínica dos doentes com SS tratados com OHB no Centro de Medicina Subaquática e Hiperbárica (CMSH) de Lisboa entre 2000 e 2005, durante um período mínimo de 5 anos, na tentativa de identificar eventuais factores de risco ou noxas clínicas com a SS. O estudo retrospectivo proposto baseia-se na revisão de processos clínicos do CMSH e na aplicação telefónica de questionários médicos de “follow-up” confidenciais – tanto a doentes (grupo de estudo), como aos respectivos esposos/companheiros/membros próximos da família (grupo de controlo) –, com particular ênfase nos antecedentes médicos e história clínica actual. Um estudo preliminar de 20 pessoas (10 doentes e 10 controlos) foi efectuado para antecipar dificuldades e estimar as necessidades logísticas. As dificuldades identificadas foram: 1) selecção dos doentes com números de telefone válidos e processos clínicos completos (com audiograma inicial e final); 2) contacto telefónico com os participantes de ambos os grupos (de estudo e controlo); 3) recursos humanos requeridos. Dado que a SS não é uma doença em si, mas um sintoma de uma doença subjacente, acreditamos que este estudo epidemiológico seja importante e útil, capaz de gerar novas luzes sobre a fisiopatologia e mecanismos desta entidade clínica.-------------ABSTRACT:Sudden sensorineural hearing loss (SSHL) is characterized by abrupt, mostly unilateral loss of hearing, frequently associated to aural fullness, tinnitus and vertigo. It affects 5-20/100.000 people/year (particularly working adults in the 40ths), with huge impact on quality of life. Possible causes include infectious, circulatory, traumatic, immunologic, metabolic, neoplastic, neurologic, toxic and unidentified cochlear diseases. Nevertheless, SSHL’s etiology remains unknown in most cases (80%), giving rise to controversial (and frequently ineffective) treatments. Available therapies range from corticosteroids to antivirals, vasodilators, antiaggregants, anticoagulants, vitamins and hyperbaric oxygen (HBO). Given the lack of data concerning SSHL’s etiology and physiopathology, we intend to evaluate clinical evolution of such patients treated with HBO in the Underwater and Hyperbaric Medical Center (UHMC) at Lisbon from 2000 to 2005 during a minimum period of 5 years, in an attempt to identify eventual risk factors or clinical associations to SSHL. The intended retrospective study is based on the review of patients’ medical charts from UHMC and confidential follow-up questionnaires applied telephonically both to patients (study group) and patients’ spouse/partner/close family member (control group), focusing past and present medical history. A preliminary study of 20 subjects (10 of each group) was performed to anticipate difficulties and to estimate the required logistics. The identified difficulties were: 1) selection of subjects with valid phone numbers and complete medical charts (with initial and final audiograms); 2) telephonic contact with subjects from the study and control group; 3) human logistics required. As it is believed that SSHL is not a disease by itself but rather a symptom of an underlying disease, we believe that this epidemiologic study is important and will hopefully generate sound scientific knowledge concerning physiopathology and mechanism of disease of SSHL.

Changes in body fluid and energy compartments during prolonged hunger strike

Prolonged total food deprivation in non-obese adults is rare, and few studies have documented body composition changes in this setting. In a group of eight hunger strikers who refused alimentation for 43 days, water and energy compartments were estimated, aiming to assess the impact of progressive starvation. Measurements included body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC), and bioimpedance (BIA) determinations of water, fat, lean body mass (LBM), and total resistance. Indirect calorimetry was also performed in one occasion. The age of the group was 43.3±6.2 years (seven males, one female). Only water, intermittent vitamins and electrolytes were ingested, and average weight loss reached 17.9%. On the last two days of the fast (43rd-44th day) rapid intravenous fluid, electrolyte, and vitamin replenishment were provided before proceeding with realimentation. Body fat decreased approximately 60% (BIA and TSF), whereas BMI reduced only 18%. Initial fat was estimated by BIA as 52.2±5.4% of body weight, and even on the 43rd day it was still measured as 19.7±3.8% of weight. TSF findings were much lower and commensurate with other anthropometric results. Water was comparatively low with high total resistance, and these findings rapidly reversed upon the intravenous rapid hydration. At the end of the starvation period, BMI (21.5±2.6 kg/m²) and most anthropometric determinations were still acceptable, suggesting efficient energy and muscle conservation. Conclusions: 1) All compartments diminished during fasting, but body fat was by far the most affected; 2) Total water was low and total body resistance comparatively elevated, but these findings rapidly reversed upon rehydration; 3) Exaggerated fat percentage estimates from BIA tests and simultaneous increase in lean body mass estimates suggested that this method was inappropriate for assessing energy compartments in the studied population; 4) Patients were not morphologically malnourished after 43 days of fasting; however, the prognostic impact of other impairments was not considered in this analysis.

Alimentação e miopia

Dissertação de mestrado em Optometria Avançada

Detection of Altered Risk Factors in Hospitalized Patients with Coronary Artery Disease

OBJECTIVE: To assess biochemical, anthropometric, and dietary variables considered risk factors for coronary artery disease. METHODS: Using anthropometrics, dietary allowance, and blood biochemistry, we assessed 84 patients [54 males (mean age of 55± 8 years) and 30 females (mean age of 57±7 years)], who had severe ( > or = 70% coronary artery obstruction) and nonsevere forms of coronary artery disease determined by cardiac catheterization. The severe form of the disease prevailed in 70% of the males and 64% of the females, and a high frequency of familial antecedents (92% ' 88%) and history of acute myocardial infarction (80% ' 70%) were observed. Smoking predominated among males (65%) and diabetes mellitus among females (43%). RESULTS: Males and females had body mass index and body fat above the normal values. Females with nonsevere lesions had HDL > 35 mg/dL, and this constituted a discriminating intergroup indicator. Regardless of the severity of the disease, hyperglycemia and hypertriglyceridemia were found among females, and cholesterolemia > 200 mg/dL in both sexes, but only males had LDL fraction > 160 mg/dL and homocysteine > 11.7 mmol/L. The male dietary allowance was inadequate in nutrients for homocysteine metabolism and in nutrients with an antioxidant action, such as the vitamins B6, C, and folate. Individuals of both sexes had a higher lipid and cholesterol intake and an inadequate consumption of fiber. The diet was classified as high-protein, high-fat, and low-carbohydrate. CONCLUSION: The alterations found had no association with the severity of lesions, indicating the need for more effective nutritional intervention.

Caracterización, procesamiento e industrialización del grano de quinoa, cultivado en la provincia de Córdoba - Argentina. Characterization, processing and industrialization of quinoa seed harvested in the province of Córdoba - Argentina

La quinoa (Chenopodium quinoa Willd), es un pseudocereal originario de la región Andina. Fue utilizada como alimento básico por los pueblos nativos. La quinoa, la papa y el maíz constituyeron el trinomio base de la alimentación indígena de este continente. La colonización española fue desplazando su cultivo a favor del trigo europeo y otros cereales, quedando reducida a las zonas altas de la región andina. La Quínoa ha adquirido una considerable atención en los últimos tiempos, principalmente por la calidad de sus proteínas y la ausencia de gluten en ella. Su empleo está ampliamente difundido en los países andinos, especialmente Bolivia y Perú, con un notable crecimiento de la superficie sembrada. En nuestro país la explotación de este cultivo se ubica principalmente en las provincias norteñas de Salta y Jujuy. En estos últimos años se ha reivindicado su cultivo y los granos privados de saponinas son considerados como un excelente alimento, reconocido por la OMS, la FAO y la NASA. Además de la calidad de sus lípidos y vitaminas, y al elevado contenido en almidón, la quinoa posee una proteína de excelente calidad nutricional y libre de gluten, lo que hace a este grano especialmente indicado para la alimentación de personas que sufren de la enfermedad celíaca o del síndrome de intestino irritado. El presente proyecto está orientado al aprovechamiento integral del grano de quinoa. Es nuestra intensión aquí, demostrar que dicho grano, cultivado en la provincia de Córdoba, permitirá elaborar productos alimenticios asi como también derivados de su industrialización. Para este objetivo se cuenta con las instalaciones de la Planta Piloto del Instituto de Ciencia y Tecnología de los Alimentos (ICTA), de la UNC, así como de intrumental moderno y acorde, como HPLC, GC, Espectrofotómetro UV-Vis, rotavapores de laboratorio e industrial, cámara fría, balanzas analíticas y de precisión, muflas, estufas, molinos y tamices, así como también, contamos con profesionales, algunos de ellos realizando su tesis doctoral en este tema. En cuanto a los objetivos que se persiguen, se espera obtener productos tales como sopas, papillas, productos para panadería y galletería y salsas. En el plano industrial, se pretende elaborar concentrados proteicos, almidón y saponinas. Como se dijo más arriba, a nivel internacional la quinoa ha comenzado a extender sus fronteras, y es así que hoy el principal productor mundial de este grano, Bolivia, destina un porcentaje importante de su producción a la exportación. La creciente demanda mundial de quinoa a hecho que se constituya en un cultivo estratégico y de alto valor, con precios internacionales que rondan los U$S 1200 la tonelada. Si a esto unimos que la planta presenta una gran resistencia a la sequía, que se adapta bien a terrenos salitrosos, arenosos y pobres, podemos comprender la importancia que adquiere para nuestra provincia, toda vez que en la misma existen zonas geográficas potencialmente aptas para su cultivo. Quinoa (Chenopodium quinoa Willd) is a pseudocereal originating in the Andean region. It was used as a staple food by native peoples. Quinoa, potatoes and corn were the tree most important indigenous staple food to this part of South America. Spanish colonization was marginalized cultivation in favor of European wheat and other grains, displacing it to the highlands of the Andean region. Quinoa has recently gained considerable attention, mainly by its protein quality and lack of gluten. Its use is widespread in the Andean countries, especially Bolivia and Peru, with a notable increase in plantings. In our country, the exploitation of this crop is located mainly in the northern provinces of Salta and Jujuy. In recent years its cultivation has been promoted, and the grains once free of saponins are considered an excellent food, recognized by WHO, FAO and NASA. In addition to its lipid and vitamins, and high starch contain, quinoa protein has an excellent nutritional value and it is free of gluten, making it particularly suitable for this grain to feed people with celiac disease or irritable bowel syndrome. This project aims at an integral development of quinoa grain. It is our intention here to demonstrate that this grain grown in the province of Córdoba, can produce food products resulting from local industrialization. This team has access to the facilities of the Pilot Plant of the Institute of Science and Food Technology (ICTA) of the UNC, and the modern equipments in it, as HPLC, GC, UV-Vis spectrophotometer, laboratory and industrial rotary evaporators, cold storage, analytical and precision balances, flasks, ovens, grinders and screens. Also, we have an important professional staff, some of them doing their thesis on this subject. With regard to the objectives pursued, we expect to obtain products such as soups, baby food, bakery products and biscuits and sauces. At the industrial level, it aims at producing protein concentrates, starch and saponins.

Evolució i estabilitat d’àcids grassos i vitamines antioxidants a la llet materna

Recerca realitzada durant el periode Gener 2006-Abril 2007, a la Facultat de Farmàcia de la Universitat de Barcelona sota la direcció de la Dra. M. Carmen López Sabater. La nutrició durant els primers anys de vida té una enorme importància, amb repercussions en el creixement i desenvolupament del nen i en les possibles malalties futures. Tenint en compte que la llet materna és l’aliment ideal per al nadó durant els primers sis mesos de vida, és important conéixer la composició nutricional de la mateixa i la seva evolució al llarg de la lactància (calostre, llet de transició i madura). La llet conté nutrients majoritaris (proteïnes, carbohidrats i lípids) i nutrients minoritaris, com vitamines i minerals. S'ha desenvolupat i validat un mètode per a la determinació d'àcids grassos (AG) i Àcid Linoleic Conjugat (CLA) en llet materna per Cromatografia de Gasos "fast" (fast-GC), permetent reduir el temps d'anàlisi considerablement en comparació amb els mètodes utilitzats fins el moment. La repetibilitat i reproducibilitat trobades han estat bones, amb coeficients de variació inferiors al 10% en tots els casos. L'aplicació a 6 mostres de llet materna ha demostrat que es tracta d'un mètode senzill, ràpid, eficient i pràctic per a l'anàlisi rutinari d'un elevat nombre de mostres. També s'ha començat a desenvolupar un mètode per a l'anàlisi dels anàlegs de tocoferol de la llet materna, degut a l'interès de la vitamina E com a antioxidant natural. És un mètode per Cromatografia Líquida d'Ultra Resolució (UPLC) amb detecció per Fluorescència (FD) i per Photodiode Array (PDA) que permet treballar amb quantitats de mostra petites mantenint o inclús millorant la sensibilitat i reduint el temps d’anàlisi.

Dietary supplements utilization: an explanatory survey among Swiss consumers

Dietary supplement (DS) use increased rapidly over the last years. However evidence of benefits of many DS for healthy users are scarce and may not equate known risks of overdose, drug interaction and recently discovered negative long-term effects. Therefore this study aimed to investigate perceptions and motivations of DS users in Lausanne, Switzerland. Method A convenience sample was recruited at the entrance of local sales points. Data were collected in on-site semi-structured interviews to assess dietary supplementation habits. Results The 119 participants provided information on 147 users. Among 273 declared products, the majority were mixed products, containing minerals and vitamins (78), mineral products (69), and herbal products (28). 55% of DS users took more than one product simultaneously. Seventy five percent of participants indicated that DS use presents no risk or nearly no risk and about half (49%) of participants did not inform their physician about their consumption. Male participants reported to share this information with their physicians significantly less frequently than female participants (p = 0.008). About half of participants looked for information on potential risks of DS, men significantly more often than women (p=0.001). Discussion According to other studies in the US, our study shows that, in Lausanne (Switzerland), DS are commonly used as mixed products. Risk perception seems generally low among DS users. Implications Physicians should be trained to evaluate patientsʼ health behaviour and needs in order to provide good evidence based information or propose alternatives to DS use.

Annual variation in the biochemical composition of newly hatched larvae of Maja brachydactyla in captivity

Quality of newly hatched larvae (NHL) of Maja brachydactyla in captivity has been characterized throughout the year to evaluate their availability for mass production. Spawning took place every month and NHL were collected and analyzed to estimate individual dry weight (DW) and proximate biochemical composition (protein, carbohydrate and lipids). Lipid class, fatty acid composition, amino acid profile, mineral and vitamins A, E and C contents were analyzed seasonally. NHL obtained throughout the year are a potential source for aquaculture purposes, since the increment in the relative protein and lipid (especially phospholipids and n-3 PUFA) content might compensate the decrease in DW of larvae hatched from broodstock kept during one year in captivity. However, the decrease in vitamins A and E as well as in certain essential amino acids (Lys, Val, and His) and trace elements (Cu and Fe) of NHL at the end of the year might be indicative of a nutritional deficiency in broodstock diets.

Developmental and pathological lymphangiogenesis: from models to human disease.

The lymphatic vascular system, the body's second vascular system present in vertebrates, has emerged in recent years as a crucial player in normal and pathological processes. It participates in the maintenance of normal tissue fluid balance, the immune functions of cellular and antigen trafficking and absorption of fatty acids and lipid-soluble vitamins in the gut. Recent scientific discoveries have highlighted the role of lymphatic system in a number of pathologic conditions, including lymphedema, inflammatory diseases, and tumor metastasis. Development of genetically modified animal models, identification of lymphatic endothelial specific markers and regulators coupled with technological advances such as high-resolution imaging and genome-wide approaches have been instrumental in understanding the major steps controlling growth and remodeling of lymphatic vessels. This review highlights the recent insights and developments in the field of lymphatic vascular biology.

Compliance with dietary recommendations in the population of Geneva, Switzerland: a ten-year trend study (1999-2009)

Introduction: There is little information regarding compliance with dietary recommendations in Switzerland. Objectives: To assess the trends in compliance with dietary recommendations in the Geneva population for period 1999 - 2009. Methods: Ten cross-sectional, population-based surveys (Bus Santé study). Dietary intake was assessed using a self-administered, validated semi quantitative Food Frequency Questionnaire. Compliance with the Swiss Society for Nutrition recommendations for nutrient intake was assessed. In all 9320 participants aged 35 to 75 years (50% women) were included. Trends were assessed by logistic regression adjusting for age, smoking stats, education and nationality, using survey year as the independent variable. Results: After excluding participants with extreme intakes, the percentage of participants with a cholesterol consumption< 300 mg/day increased from 40.8% in 1999 to 43.6% in 2009 for men (multivariate-adjusted p for trend = 0.04) and from 57.8% to 61.4% in women (multivariate-adjusted p for trend = 0.06). Calcium intake > 1 g/day decreased from 53.3% to 46.0% in men and from 47.6% to 40.7% in women (multivariate-adjusted p for trend< 0.001). Adequate iron intake decreased from 68.3%to 65.3% in men and from 13.3% to 8.4% in women (multivariate-adjusted p for trend< 0.001). Conversely, no significant changes were observed for carbohydrates, protein, total fat (including saturated, monounsaturated and polyunsaturated fatty acids), fibre, vitamins D and A. Conclusion: Fewimprovements were noted in adherence to dietary recommendations in the Geneva population between 1999 and 2009. The low and decreasing prevalence of adequate calcium and iron intake are of concern.

Risk of hepatitis C among brazilian ex-soccer players

In order to evaluate the significance of injecting vitamins complexes and stimulants minutes before soccer games and its role in spread of hepatitis C virus (HCV) we interviewed and tested 40 ex-soccer players, who played professionally in Mato Grosso, Brazil, between 1970 and 1989. Five players were found anti-HCV positive with enzyme-immunoassay. When re-tested by imunoblot (RIBA), three of these five were confirmed to be positive reacting. The anti-HCV positivity (7.5%) was higher than usually found among blood donors (0.9%) in this region (p < 0.01). None of the players had had prior history of any risk factor that might indicate HCV exposure. We suggest that the common practice of soccer players in the inner part of Brazil in the 70's and 80's, to receive fortifying injections, often with shared syringes, may place ex-soccer players in a potencial risk group for HCV infection and warrants further investigation and attention by public health workers.