The a Body Shape Index Might Be a Stronger Predictor of Chronic Kidney Disease Than BMI in a Senior Population

The A Body Shape Index (ABSI) was recently introduced to quantify abdominal adiposity relative to the body mass index (BMI) and height. This cross-sectional study was performed to explore whether the ABSI is linked to chronic kidney disease (CKD) in older adults and compare the predictive capacity of the ABSI versus BMI for CKD. In total, 7053 people aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups based on their estimated glomerular filtration rate (eGFR). The correlation of the ABSI with the eGFR and the differences and trends in the ABSI and BMI among the groups were analyzed, and the cutoff points for moderate-to-severe CKD were calculated. The association between the ABSI and CKD was stronger than that between the BMI and CKD. The ABSI had a better capacity to discriminate the CKD stage than did the BMI. The capacity of the ABSI to predict moderate-to-severe CKD was higher than that of the BMI and was more substantial in women than men. The ABSI cutoff points for CKD were ≥0.0822 and 0.0795 in men and women, respectively. In conclusion, the ABSI serves as a better index than the BMI for screening and detecting high-risk individuals with CKD.

“You Say Severe, I Say Mild”: Toward an Empirical Classification of Dysarthria Severity

Purpose: The main purpose of this study was to create an empirical classification system for speech severity in patients with dysarthria secondary to amyotrophic lateral sclerosis (ALS) by exploring the reliability and validity of speech-language pathologists' (SLPs') ratings of dysarthric speech. Method: Ten SLPs listened to speech samples from 52 speakers with ALS and 20 healthy control speakers. SLPs were asked to rate the speech severity of the speakers using five response options: normal, mild, moderate, severe, and profound. Four severity-surrogate measures were also calculated: SLPs transcribed the speech samples for the calculation of speech intelligibility and rated the effort it took to understand the speakers on a visual analog scale. In addition, speaking rate and intelligible speaking rate were calculated for each speaker. Intrarater and interrater reliability were calculated for each measure. We explored the validity of clinician-based severity ratings by comparing them to the severity-surrogate measures. Receiver operating characteristic (ROC) curves were conducted to create optimal cutoff points for defining dysarthria severity categories. Results: Intrarater and interrater reliability for the clinician-based severity ratings were excellent and were comparable to reliability for the severity-surrogate measures explored. Clinician severity ratings were strongly associated with all severity-surrogate measures, suggesting strong construct validity. We also provided a range of values for each severity-surrogate measure within each severity category based on the cutoff points obtained from the ROC analyses. Conclusions: Clinician severity ratings of dysarthric speech are reliable and valid. We discuss the underlying challenges that arise when selecting a stratification measure and offer recommendations for a classification scheme when stratifying patients and research participants into speech severity categories.

Prognostic Accuracy of a Novel Prognostic Score Using a Combination of PCT, DDi, and Lactate Biomarkers in Patients With Sepsis: A Retrospective Cohort Study

Background A combination of multiple biomarkers will be more accurate in predicting the mortality of sepsis patients. Herein, we aimed to assess the ability to predict adverse outcomes of a novel scoring system using the combination of PCT, DDi, and lactate (PDLS) in patients with sepsis from the emergency department (ED) of a hospital. Methods The patients’ baseline characteristics, main laboratory data and outcome were collected from the patient's electronic medical record. A receiver operating characteristic curve (ROC) analysis determine the optimal cutoff points for biomarkers PCT, DDi and lactate and establish a PDLS system based on their cutoff points. ROC was used to compare the accuracy of PDLS to Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores in predicting short-term mortality in patients with sepsis. Results The analysis cohort included 1001 patients. 117 sepsis patients died in 28 days. An increase in PDLS was associated with higher mortality and adverse events including MV, VD, AICU, and CRRT. PDLS was an independent predictor of 28-day mortality, MV, VD, AICU, and CRRT. The Area Under the Receiver Operating Characteristic curve (AUROC) of PDLS (0.96; Cl=0.94-0.98) was significantly higher than that of SOFA (0.84; Cl=0.80-0.89) and APACHE II (0.84; Cl=0.79-0.88). Conclusion PDLS is an independent prognostic predictor of adverse clinical outcomes for sepsis patients and was superior to other prognostic scores, including SOFA and APACHE II.

Investigation of Predictors to Achieve Acceptable Lung Dose in T-Shaped Upper and Middle Esophageal Cancer With IMRT and VMAT

PurposeThe purpose of this study is to investigate whether there are predictors and cutoff points that can predict the acceptable lung dose using intensity-modulated radiation therapy (IMRT) and volume-modulated arc therapy (VMAT) in radiotherapy for upper ang middle esophageal cancer.Material and MethodsEighty-two patients with T-shaped upper-middle esophageal cancer (UMEC) were enrolled in this retrospective study. Jaw-tracking IMRT plan (JT-IMRT), full-arc VMAT plan (F-VMAT), and pactial-arc VMAT plan (P-VMAT) were generated for each patient. Dosimetric parameters such as MLD and V20 of total lung were compared among the three plannings. Ten factors such as PCTVinferior length and PCTVinferior length/total lung length were calculated to find the predictors and cutoff points of the predictors. All patients were divided into two groups according to the cutoff points, and the dosimetric differences between the two groups of the three plans were compared. ANOVA, receiver operating characteristic (ROC) analysis, and Mann–Whitney U-test were performed for comparisons between datasets. A p <0.05 was considered statistically significant.ResultThe quality of the targets of the three plannings was comparable. The total lung dose in P-VMAT was significantly lower than that in JT IMRT and F-VMAT. Monitor unit (MU) of F-VMAT and P-VMAT was significantly lower than that of JT IMRT. ROC analysis showed that among JT IMRT, F-VMAT, and P-VMAT, PCTVi-L, and PCTVi-L/TLL had diagnostic power to predict the suitability of RT plans according to lung dose constraints of our department. For JT IMRT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 16.6 and 0.59. For F-VMAT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 16.75 and 0.62. For P-VMAT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 15.15 and 0.59. After Mann–Whitney U-test analysis, it was found that among the three plannings, the group with lower PCTVi-L and PCTVi-L/TLL could significantly reduce the dose of total lung and heart (p <0.05).ConclusionPCTVi-L <16.6 and PCTVi-L/TLL <0.59 for JT IMRT, PCTVi-L <16.75 and PCTVi-L/TLL <0.62 for F-VMAT and PCTVi-L <15.15, and PCTVi-L/TLL <0.59 for P-VMAT can predict whether patients with T-shaped UMEC can meet the lung dose limits of our department.

Outcomes of Peripheral Blood Eosinophilia in Hospitalized Exacerbations of COPD

Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible, is usually progressive, and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases. Objective To identify outcomes of patients with eosinophilic COPD exacerbations requiring hospital admission. Patients and Methods This study is a prospective cohort study that was conducted on two groups of total 60 patients recruited from Ain Shams University hospitals between October 2019 and July 2020. Group 1: Eosinophilic COPD exacerbation if the peripheral blood eosinophil on admission is ≥ 200 cells/µL and/or ≥2% of the total leukocyte count Group 2: Non-eosinophilic COPD exacerbation if the peripheral blood eosinophil on admission is < 200 cells/µL and/or < 2% of the total leukocyte count. Results There was significant high diagnostic performance in predicting readmission at 6-month among eosinophilic group. Eosinophils count, percent (%) and NLR cutoff points had high characteristics (highest in NLR ≥3.1 at discharge) in predicting readmission at 6-month among eosinophilic group. Diagnostic performance of Eosinophils count, percent (%) and NLR were assessed. Eosinophils count, percent (%) and NLR had significant high diagnostic performance in predicting readmission at 6-month among eosinophilic group. Eosinophils count, % and NLR cutoff points had high characteristics (highest in NLR ≥2.1 at discharge) in predicting readmission at 6month among non-eosinophilic group. Conclusion Eosinophils can be used as a prognostic marker in non-infective COPD exacerbations. Validity of eosinophil count and percent as a prognostic parameter in COPD exacerbation can be increased by combining with other parameters for example NLR.

Green Restaurants ASSessment (GRASS): A Tool for Evaluation and Classification of Restaurants Considering Sustainability Indicators

Green restaurants are based on the implementation of environmental management and are closely related to quality management through a set of instruments and programs. This study aimed to build an instrument classification adopting cutoff points and classify restaurants using traffic light scores from the sustainability assessment checklist validated in Brazilian Portuguese for restaurants. The questionnaire classification validation was performed using a cross-sectional study conducted in a convenience sample of 97 restaurants. The instrument has 76 items, and all items were based on yes/no/not applicable answers, comparing sustainability activities. The instrument score was obtained by assigning one point to each “yes” item. Each section received a score, and a total score was provided to the restaurant from the three sections’ sum. International instruments used in the checklist development stage were checked to assist in the cutoff points determination. Therefore, the score for restaurants with low adherence to sustainable practices or red seal ranges from 0 to 40%, restaurants with medium adherence to sustainable practices or yellow seal from 40% > to <75%, and restaurants with good adherence to sustainable practices or green seal ≥75%. The instrument is divided into three sections (1. water, energy, and gas supply; 2. menu and food waste; 3. waste reduction, construction materials, chemicals, employees, and social sustainability). Percentages must be reached in all sections. Researchers did not find any green or sustainable restaurants through the checklist application in the tested sample, and 47.4% of the restaurants had the yellow seal (presenting sustainable activities) with higher scores for Section 2 regarding menu and food waste. The items less scored were the company has goals for the rational use of water, the company achieves zero greenhouse gas emissions with proven partnerships, the company has a documented program to reduce carbon emissions, and towels or uniforms are made of organic or sustainable material. Thus, it demonstrates the attention points and improvements in the analyzed restaurants. We hope that the construction and validation of the checklist and its score’s determination have contributed to broadening the discussions on sustainability in food services and serve as a starting point for future research. Strategies like these are fundamental to improve the understanding of the subject and to expand the knowledge of nutritionists who deal directly with this economic sector.

Cut-off points to screening for sarcopenia in community-dwelling older people residents in Brazil

Background At a time when the world’s population is aging, one of the most important challenges for the healthcare field is to control the decline of the musculoskeletal system. This decline consists of a reduction in muscle mass and function, which is called sarcopenia and is associated with adverse health outcomes. Although there has been an increase in the number of publications on sarcopenia and its consequences, the reported prevalence varies widely, since these depend on the characteristics of the population studied, the definitions found in the literature and the cut-off points adopted. In this perspective, the heterogeneity in the classification and the different reference values has a critical impact on the epidemiology of sarcopenia, since neither the procedures, the components and the cut-off points are consistent. Objectives To develop cut-off points for the screening of sarcopenia in community-dwelling older people residents in the northeast of Brazil and compare the prevalences between the values defined by the consensus and the values of the population studied. Methods Community-dwelling older men and women living in three cities in the countryside of Rio Grande do Norte were evaluated. Cutoff points were defined for the variables used to screen for sarcopenia (handgrip strength, SMI, gait speed and SPPB) using the 20th percentile of their population distributions. Results The sample was composed of 1,290 older people (62.5% female and 37.5% male), with an average of 69.5 (± 6.05) years of age. Regarding the cutoff points, the handgrip values were defined as 25.3 kg and 16 kg for men and women, respectively. Considering the SMM adjusted according to their height, the values of 7.88 kg/m2 were adopted for men and 5.52 kg/m2 for women. When adjusting by BMI we obtained 0.73 kg/BMI for men and 0.41 kg/BMI for women. For gait speed it was defined 0.71 m/s for men and 0.63 m/s for women. In the case of SPPB, the result was the same for both genders (≤8). When applying the values found in the studied population, a variation in prevalence was observed for both men and women, depending on the cut-off points and consensus used. Conclusion The cutoff values found in our population were lower than those adopted by international consensus (EWGSOP2, IWGS and FNIH), except for HGS in woman and SMI/m2 for men. Therefore, using specific cutoff points for different populations can provide an accurate assessment of the presence of sarcopenia and better target health prevention strategies for the older people living in the community.