Search

Upper limb musculoskeletal complaints are common among certain health professionals. We report two cases, both involving technicians working in a diagnostic tuberculosis laboratory in Hong Kong. A work process evaluation suggest that the need to repeatedly open and close small bottles, as well as to work for prolonged periods of time in confined areas, could be related to the workers' clinical presentation. The cases are also compatible with the diagnosis of repetitive strain injury (RSI) of the upper limb, but this term is not commonly used nowadays because of various definitional issues. A review of the various diagnostic issues in RSI is presented.

We evaluated retrospectively 34 patients with post-kidney transplant diabetes (PTDM) (group 1) and 68 submitted to renal transplant without PTDM (group 0) to determine the prevalence and risk factors for developing PTDM in patients followed at the Hospital Universitário Pedro Ernesto. The prevalence of PTDM was 7.4%. Group 1 patients were older at data collection (p<0.005) and at transplantation (p<0.005). Among them there was a higher frequency of cadaver donors (p= 0.023) and hypercholesterolemia (p= 0.006), and a lower frequency of arterial hypertension (p<0.0001). We observed a trend to higher frequency of positive sorology for C hepatitis (p= 0.057) and use of tacrolimus (p= 0.069) in group 1 as compared to group 0. The most important risk factors for developing PTDM (by logistic regression) were the age at renal transplant [OR= 1.099, IC 95% (1.045-1.156), p= 0.0001] and positive sorology for C hepatitis [OR= 3.338, IC 95% (1.205-9.248), p= 0.020]. We conclude that the prevalence of PTDM in our hospital was similar to that found in the literature and that the patients who developed PTDM presented a higher prevalence of traditional risk factors for PTDM, like older age and positive C virus hepatitis sorology, comparing to controls.

Objective: To assess the tolerance and acceptability of a nutrition supplement in patients with cystic fibrosis (CF), to monitor changes in dietary intake, and to evaluate nutritional status., Design: Subjects were their own controls for this 3-month, prospective, open study. Acceptability and tolerance questionnaires and 3-day food records were completed at baseline and monthly intervals. Compliance and nutritional status were also assessed., Setting: This study was conducted at the University of Wisconsin Hospital and Clinics Cystic Fibrosis Center, Madison., Subjects: Patients with CF older than 4 years of age were recruited during clinic or hospital visits if they met specific weight or growth criteria (n = 19)., Intervention: Subjects were asked to consume the supplement at a maximum of 30% their estimated daily energy requirements., Main Outcome Measures: Responses to acceptability ratings of and tolerance questions about the supplement were obtained along with anthropometric data and biochemical measurements of serum albumin, plasma retinol, alpha-tocopherol, and fatty acid levels., Statistical Analyses Performed: Data were analyzed using Minitab and Statistical Analysis Software. Paired and unpaired t tests and nonparametric sign tests were used, as well as regression and Pearson correlations. A significance level of .05 was used for all tests., Results: All subjects tolerated the supplement, although 12 reported mild symptoms of fullness, nausea, and/or bloating, which were resolved when intake was distributed throughout the day. Mean compliance was 69% of recommended intake. Weight gain in children was strongly correlated with compliance (r = .98). Linoleic acid intake increased significantly (P = .0003) as did plasma linoleic acid in the phospholipid fraction (P = .03)., Conclusion: The supplement studied would be a beneficial addition to the supplementation choices available to patients with CF.

The purpose of this study was to characterize the nutritional status of infants diagnosed with cystic fibrosis (CF) through neonatal screening and to determine if they would achieve normal nutrition when managed with early intervention. In addition, nutrient intake was assessed to determine energy and macronutrient-consumption patterns. Evaluation of growth revealed that normal patterns could be achieved with mean energy intake values at ages 6 and 12 mo of 481 and 426 kJ/kg body wt (115 and 102 kcal/kg body wt), respectively. Biochemical assessment demonstrated low alpha-tocopherol and linoleic acid values at diagnosis in the majority of infants whereas one-third had abnormal indices of protein nutriture. Essential fatty acid deficiency was also demonstrated at diagnosis by abnormal triene-tetraene ratio values in 27% of screened infants. With predigested formula and dietary supplementation, there was improvement in all indices of nutritional status and only a low percentage of patients showed mild biochemical abnormalities at age 12 mo.

The effects of various levels and types of dietary chloride salts on blood pressure were examined in three studies. Weanling Sprague-Dawley rats were fed semipurified diets that contained moderate (1.9 mg Cl/g diet) and supplemental (15.6 mg Cl/g diet) chloride as NaCl, KCl, lysine monohydrochloride with or without CaCO3, or MgCl2 for 56 or 119 d. Rats fed excess chloride excreted more than 84% of the chloride in urine, excreted increased urine volumes (from 3 to 7 wk), tended to consume more fluids (especially if NaCl was fed), had significantly increased blood pressure (7 and 13 wk), had hypertrophied kidneys (8 and 17 wk) and had altered levels of sodium and potassium in their kidneys (17 wk), but experienced no changes in the size of fluid compartments, such as plasma volume or bromine space. Altogether, 56% of the variance in blood pressure measurements at wk 7 could be predicted on the basis of urinary chloride excretion during wk 7 and kidney weight as a percentage of body weight and kidney sodium concentration, but only 30% of the variance in blood pressure measurements at wk 16 could be predicted on the basis of urinary chloride excretion during wk 16 and kidney sodium concentrations.

Presymptomatic infants diagnosed through neonatal screening for cystic fibrosis can have biochemical evidence of malnutrition. With aggressive dietary management and treatment with pancreatic enzymes, normal biochemical indices of nutrition can be achieved at 12 months of life in most cases. Males with cystic fibrosis appear to be more at risk than females for abnormal growth and biochemical indices of nutrition in the first year of life. This may be related to the observed decrease in fat intake when compared to females. Males, especially, should be carefully observed for development of nutritional abnormalities based on this data. Careful attention should be paid to vitamin E and essential fatty acid status in all CF infants. The numbers in this study are small and the long-term consequences of early nutritional intervention await the conclusion of the randomized, controlled study on-going in Wisconsin.

The effect of supplementing a basal diet containing 697 mg calcium daily (17.4 mmol/d) with an additional 900 mg Ca daily from milk, Ca chloride, or a Ca carbonate preparation was examined in eight adult males during a 56-d metabolic balance study. The ingestion of the milk or Ca supplements had no overall effect on Ca retention by these subjects because the milk and supplements depressed apparent absorption of Ca in the gut and fractional tubular reabsorption of Ca in the kidneys. Supplementation of the diet with CaCl and to a lesser extent with milk significantly increased renal acid excretion whereas supplementation with CaCO3 depressed renal acid excretion. The three Ca supplements significantly altered magnesium and phosphorus absorption and urinary excretion in different manners but had no overall effect on retention of P or Mg. The responses of our subjects to these treatments may be different than those of subjects who are chronically in negative balance in regard to Ca.

Five lactating Holstein cows averaging 13 wk postpartum were used in a Latin square design to examine the effect of daily abomasal infusion of choline (22 g), myo-inositol (37 g), soy oil (325 ml), or crude soy lecithin (900 ml) on lactation performance. Dry matter intake was reduced by infusion of soy lecithin as compared with infusion of water (18.1 and 21.1 kg/d, respectively). Plasma beta-hydroxybutyrate concentration was increased when cows received the myo-inositol or soy lecithin infusion, and plasma glucose was lower when cows received the choline or soy lecithin treatment. Infusion of soy lecithin caused approximately a twofold increase in plasma triglyceride-rich lipoprotein concentration. Milk fat percentage and milk fat yield were greater during soy lecithin infusion (3.54%, 1.11 kg/d) than during water (3.09%, .98 kg/d) or soy oil (3.06%, .98 kg/d) infusion. This resulted in greater 3.5% FCM yield during soy lecithin infusion (31.6 kg/d) than during water (29.5 kg/d) or soy oil (29.6 kg/d) infusion. Infusion of phospholipid with triglyceride allowed more fatty acid to be infused without causing diarrhea. Infusion of triglyceride in the presence of phospholipid increased milk fat synthesis whereas infusion of triglyceride alone did not.