The Association between Zinc and Copper and Cardiometabolic Risk Factors in Adults

Cardiometabolic risk (CMR) factors increase the likelihood of developing cardiovascular diseases (CVD). In Qatar, 24% of the total deaths are attributed to CVDs. Several nutritional disturbances have been linked to high risk of CVD. Many studies have discussed the effects of zinc (Zn) and copper (Cu) on CMR factors; however, evidence has been controversial. This investigated the association between CMR factors and the status of Zn, Cu, and Zn/Cu ratio. A total of 575 Qatari adults (≥18 years) were obtained from Qatar Biobank. Plasma levels of Zn and Cu were determined using inductively coupled plasma mass spectrometry (ICP-MS). Anthropometric data and CMR factors were determined using standard methods. Adjusted associations between minerals and CMR were estimated by logistic regression. The associations’ strength was tested using partial correlation. Zn was not strongly correlated (p-value˃0.01) or significantly associated with CMR factors and metabolic syndrome (MetS). Cu levels correlated positively with body mass index (BMI) (0.23; p˂0.001), pulse rate (PR) (0.18; p˂0.001), total cholesterol (0.13; p=0.01), and high-density lipoproteins (HDL) (0.27; p˂0.001); and negatively with diastolic blood pressure (DBP) (−0.13; p=0.01). High Cu significantly decreased the risk of MetS (0.121; p˂0.001). Furthermore, Zn/Cu ratio positively correlated with waist circumference (0.13; p=0.01), systolic blood pressure (0.13; p˂0.01), and DBP (0.14; p˂0.01); and negatively with BMI (−0.19; p˂0.001), PR (−0.17; p˂0.001), and HDL (−0.27; p˂0.001). High Zn/Cu ratio increased the prevalence of low HDL (4.508; p˂0.001) and MetS (5.570; p˂0.01). These findings suggest that high Cu levels are associated with a protective effect on DBP, HDL, and MetS and that high plasma Zn/Cu ratio is associated with the risk of low HDL and MetS. We recommend future studies to focus on minerals status among abdominally obese and prediabetic subjects because of the probable link between low serum Zn and Cu and insulin resistance and CVD.

Nutritional Support in Patients with Severe Acute Pancreatitis-Current Standards

Severe acute pancreatitis (SAP) leads to numerous inflammatory and nutritional disturbances. All SAP patients are at a high nutritional risk. It has been proven that proper nutrition significantly reduces mortality rate and the incidence of the infectious complications in SAP patients. According to the literature, early (started within 24–48 h) enteral nutrition (EN) is optimal in most patients. EN protects gut barrier function because it decreases gastrointestinal dysmotility secondary to pancreatic inflammation. Currently, the role of parenteral nutrition (PN) in SAP patients is limited to patients in whom EN is not possible or contraindicated. Early versus delayed EN, nasogastric versus nasojejunal tube for EN, EN versus PN in SAP patients and the role of immunonutrition (IN) in SAP patients are discussed in this review.

OVERWEIGHT AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH PHENYLKETONURIA: A SYSTEMATIC REVIEW

ABSTRACT Objective: To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors. Data sources: A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors “Phenylketonurias”, “Overweight”, “Child” and “Adolescent”. Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included. Data synthesis: A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest. Conclusions: Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

Rapunzel Syndrome and Small Bowel Intussusceptions Due to a Cotton Thread Bezoar: A Case Report

Rapunzel syndrome is a rare disease in which a trichobezoar extends into the duodenum or distal small intestine. It is associated with compulsive eating of indigestible substances or pica and is more common in cases of underlying psychiatric disturbances. If left untreated, gastrointestinal bezoars with or without the Rapunzel syndrome may lead to several complications such as ulceration, perforation, peritonitis, pancreatitis, biliary obstruction, severe nutritional disturbances, and rarely intestinal obstruction. We present an exceptionally rare case of Rapunzel syndrome caused by a large cotton thread bezoar in an adolescent girl, associated with multiple jejunal intussusceptions. Further, we present a literature review of this entity. An interesting association of bezoar with intussusception is explained. Since a history of pica may not be forthcoming in all cases, it is important to be familiar with the imaging characteristics, complications, and management of bezoars.

Foliar indices for carrot crop using the compositional nutrient diagnosis method1

ABSTRACT Carrot has a high yield potential, which requires an adequate and adaptable nutritional management, according to the needs and demands of each crop. Foliar diagnosis is a tool for adjustment and constant improvement of crop fertilization programs. This study aimed to determine leaf indices and reference values using the compositional nutrient diagnosis (CND) method, at three phenological stages of carrot crops [40 and 70 days after sowing (DAS) and at harvest]. In order to calculate the CND method, a database was created with leaf contents of the nutrients N, P, K, Ca, Mg, S, B, Cu, Mn and Zn and root yields, in commercial carrot crops. The nutrient limitation order was generated according to the fertilization response potential. At 70 DAS and at harvest, Mg and Mn were the most limiting nutrients by deficiency, while Zn was the most limiting by excess at 70 DAS, and P and Ca were the most limiting by excess at harvest. The results indicate that the foliar diagnosis performed with the CND method is only effective for the correction of nutritional disturbances in subsequent crops.

Nutritional screening and nutritional management in dialysis patients

Patients on dialysis are prone to nutritional disturbances, that is, protein-energy wasting, obesity, and imbalance in body fluids and in serum phosphorus and potassium equilibrium. Hence, specialized nutritional care is highly important and include (a) a carefully assessment of the nutritional status, (b) prescription of diet with adequate energy and nutrients to treat and prevent the development of nutritional disturbances often observed in these patients, and (c) periodic follow-up to check adherence of the prescribed diet as well as to evaluate the nutritional status and efficacy of the dietary intervention. This chapter discusses these three aspects in detail and will guide nephrologists and dieticians when treating dialysed patients.

Vallecular Cyst in Neonates: Case Series—A Clinicosurgical Insight

The objective of the case series is to understand the clinical and surgical aspects of new minimally invasive technique of coblation in cases of vallecular cysts in neonates.Method of Study. Four neonates underwent surgery for vallecular cyst by using Arthrocare ENT coblator system.Results Obtained. All the four cases presented in stridor and difficult intubation was also a concern which necessitated a swift, high precision instrument with almost immediate results. Coblation excision includes direct contact with vallecular cyst, improved targeting of the cyst, and preservation of normal tissue. All the four cases had an uneventful postoperative period and smooth recovery and had an early discharge from the hospital.Conclusions. Early diagnosis and intervention hold the key for an early recovery and for minimizing nutritional disturbances secondary to poor feeding in cases of neonatal vallecular cysts.