CRP AND ATHEROSCLEROSIS IN HEMODIALYSIS PATIENTS, A NESTED CROSS-SECTIONAL STUDY

CRP is a recognized marker of systemic inflammation. The degree to which CRP is associated with carotid and/or femoral intima media thickness (IMT), markers of atherosclerosis, may quantify the degree to which inflammation explains cardiovascular disease in patients with end stage renal disease. The purpose of this study was to estimate the association between CRP and both carotid and femoral IMT in hemodialysis (HD) patients. The present cross-sectional study is nested in the Sevelamer hydrochloride and ultrasound-measured femoral and carotid intima media thickness progression in end stage renal disease (SUMMER) clinical trial. Carotid (common, internal and bifurcation) and femoral arteries were visualized in B-mode ultrasonography. CRP was measured in serum. The study cohort included 177 HD patients (39.5% female, mean age 67.8±11.5 years). All measures of both carotid and femoral IMT were significantly, positively associated with CRP. Compared to subjects without, subjects with PVD, coronary revascularization and hypertension had significantly higher CRP levels. Conversely, subjects treated with sevelamer hydrochloride had significantly lower CRP levels than those not exposed to this medication. CRP was significantly, positively associated with serum phosphorus, calcium and PTH, and significantly inversely associated with HDL. In conclusion, CRP is significantly, positively associated with both femoral and carotid IMT and suggests an association between inflammation and atherosclerosis in HD patients

Auditory Hallucinations in Acute Stroke

Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months

Gender aspects suggestive of gastroparesis in patients with diabetes mellitus: a cross-sectional survey

BACKGROUND: It is suggested that symptoms related to gastroparesis are more common in female than in male patients with type 2 diabetes mellitus (T2DM). The association between sex and prevalence of symptoms suggestive of gastroparesis among patients with T2DM in Israel has not been reported. The aim of this study was to describe the associations between sex, clinical characteristics, type, severity and prevalence of dyspeptic symptoms in a large population of patients with T2DM in Israel. METHODS: All patients completed a demographic questionnaire and the Gastroparesis Cardinal Symptom Index (GCSI). Data regarding disease duration, medications, complications, recent blood glucose and HbA1c levels were also collected. In this nested case–control study, 173 female and 209 male patients were identified from within a cross-sectional survey of 382 patients with T2DM. Logistic and general linear modeling was used to assess associations between sex, clinical data, and the presence (type and number) of symptoms. RESULTS: Compared to males, female patients with T2DM had a higher body mass index (BMI) (31.9 vs. 29.2; P = 0.001) and HbA1c levels (7.9 vs. 7.5; P = 0.04). A larger proportion of males suffered from peripheral vascular disease (P = 0.02) and ischemic heart disease (P = 0.001). Other disease characteristics did not differ between the sexes. The prevalence of nausea (P = 0.001), early satiety (P = 0.005), loss of appetite (P = 0.002), or presence of any cardinal symptom (P = 0.001) was significantly higher among females. Severity of most cardinal symptoms was also higher in females. The presence of at least one cardinal symptom was more likely among obese females with longer disease duration and poor glycemic control. CONCLUSIONS: Prevalence and severity of symptoms suggestive of gastroparesis is particularly high among obese females with long standing and poorly controlled T2DM

Nutrition Knowledge Translation Performance in Health Professionals: Findings from the 2017 Unified Forces Preventive Nutrition Conference (UFPN)

Background: Dietitians and other health care professionals must be able to translate findings from clinical trials into best treatment practices, a skill termed “knowledge translation„. This skill requires knowledge of treatment guidelines as well as the science underpinning treatment recommendations. Unsatisfactory knowledge translation of medical nutrition therapy (MNT) has been documented. Methods: Individuals registered to attend a leading national nutrition conference were asked to participate in an online cross-sectional survey. Participants were asked to provide demographic and professional information, answer questions on nutrition knowledge and to choose a clinical action plan in response to dietitian-designed case vignettes describing research outcomes. Responses were compared by profession and participation in research activities. Results: Of 3000 registered conference attendees, 299 individuals replied: 79.0% dietitians, 93.3% female, with a mean household income matching the 5th decile of income, 60.7% indicated a single employment setting, 20.7% reported participating in research. Almost 74% of respondents indicated that they would make clinical recommendations based on findings of an in vitro study. In one vignette, a patient with a disease previously not encountered by the respondent required a clinical treatment plan. Only 53% of participants chose to seek formal nutrition guidelines. Fewer than 15% of participants could identify the pathway for fat during weight loss. Differences in knowledge translation skills by research participation were not detected. Conclusions: Our findings reveal a deficit in knowledge translation proficiency in a convenience sample of dietitians and other health professionals, highlighting the need to develop these skills

Knowledge and Attitudes Towards Nutrigenetics: Findings from the 2019 Unified Forces Preventive Nutrition Conference (UFPN)

Background: Nutrigenetics indicates that individual genetic variability results in altered health outcomes necessitating personalized nutrition adaptation. Registered dietitians are recognized as the clinical nutrition experts, but their knowledge and attitudes regarding nutrigenetics has not been delineated. Methods: This cross sectional online survey was conducted in a convenience sample of 169 national nutrition conference attendees. The survey queried demographics, knowledge, and attitudes towards nutrigenetics and information on training in nutrigenetics. Results: The majority of participants were registered dietitians and female, 45% of whom held advanced degrees. Personalized nutrition was perceived by 93.5% of participants as highly important or important; however, 94% of respondents indicated they are not sufficiently knowledgeable in personalized nutrition and only 9.5% had received training in nutrigenetics. The mean nutrigenetics knowledge score was 6.89 ± 1.67 (out of a possible 12). A multivariate regression model of knowledge score identified education as the only independent predictor of this outcome. Conclusion: Personalized nutrition is a rapidly developing field that incorporates genetic data into clinical practice. Dietitians recognize the importance of advanced studies to acquire knowledge in nutrigenetics. Only by acquiring the necessary knowledge can dietitians accurately translate this nutrigenetics into clinical practice

Status of Nutrition in Hemodialysis Patients Survey (SNIPS): Nutrition Intake in Obese and Overweight vs. Healthy Weight Patients

Elevated body mass index (BMI) has been associated with improved survival and fewer hospitalizations in hemodialysis patients; however, it is not clear that dietary intake is associated with increased BMI in hemodialysis patients. The present analysis was designed to compare energy and macronutrient intake and distribution, as well as compliance with the International Society of Renal Nutrition and Metabolism (ISRNM) dietary guidelines, by body weight status (overweight/obese vs. normal weight) in hemodialysis patients. The status of nutrition in hemodialysis patients survey (SNIPS) cohort is a cross-sectional study including a representative sample of individuals on hemodialysis treated in hospital dialysis centers throughout Israel. Of the 375 patients eligible for the current analysis, 60.1% had BMI ≥ 25 kg/m2 (overweight/obese). For each participant, the following measures were recorded: dietary intake, blood biochemistry, anthropometric and hemodynamic measures. These were compared by body weight status. Compared to their normal-weight counterparts, overweight/obese hemodialysis patients did not differ by energy and macronutrient intake, distribution of these nutrients in the diet. Regardless of body weight status, hemodialysis patients have poor compliance with ISRNM dietary guidelines