No abstract

Several approaches have been used to assess protein-energy wasting syndrome, such as clinical evaluation, biochemical nutritional markers, anthropometric measurements, but Bioelectrical Impedance Analysis (BIA) techniques hold a central place in clinical settings. The aim of this study is to report our clinical experience with BIA and the correlations between biochemical nutritional markers and BIA nutritional parameters in hemodialysis (HD) patients associating or free of chronic liver disease. This cross-sectional observational study included 69 HD patients divided into two groups: 33 with chronic liver disease (CLD+) versus 36 chronic liver disease-free (CLD-) from one HD unit in Romania. Serum albumin (SA), serum creatinine (SCr) and C-reactive protein (CRP) were obtained from the HD arterial line immediately before the HD session and by BIA the body composition including total body water (TBW), total body fat (TBF), lean fat free mass(LFFM), body muscular mass (BMM), malnutrition index and body protein reserve (PR) were assessed. No significant differences between groups were found in BCM, BMM, PR and TBF (p = 0.92, p = 0.60, p = 0.907, and p = 0.634, respectively). Malnutrition index had a significantly higher mean value in HD-CLD(+) patients (p = 0.00). HD-CLD(-) group showed a strong correlation between SA and SCr and BCM, BMM (kg), LFFM (kg) and body PR (kg) (r=.48, r=.50, r=.44, r=.50; resp. r=.42, r=.40, r=.36, r=.42). In HD-CLD(+) patients, a significant positive correlation was found between SA and SCr and LFFM and body PR (r=.37, r=.35; resp. r=.44, r=.35). Discussion: BIA is one of the most accurate techniques for assessing nutritional status and should be regularly used in clinical practice along with biochemical nutritional markers in HD patients. Although the protein metabolism depends to a large extent on liver function, CLD cannot be considered as having a significant impact on nutritional status in HD patients.

People on maintenance haemodialysis (MHD) are at risk of developing malnutrition, which is defined as the consequence of insufficient food intake or a suboptimal quality diet. The kidney and the liver play a central role in protein metabolism. The major aim of the study was to evaluate, for the first time in Romania, the impact of intensive dietary counseling and personalised diets on serum albumin (SA) and others nutritional parameters, but also the relationship between albumin level, inflammation and nutritional status in a cohort of haemodialysis patients which associate or not chronic liver disease (CLD). We prospectively analysed the inflammatory status and malnutrition in 162 HD patients, mean age 56�13 years, from a single dialysis centre. At baseline we evaluated: a. calorie-protein intake using patient�s diet history with the help of 72 hrs recall method;b. nutritional status by anthropometric measures- post dialysis body weight (BW), body mass index (BMI), TSF (tricipital skinfold), MAC (mid-arm circumference), MAMC (mid-arm muscle circumference);c. modified subjective global assessment score (mSGA);d. biochemical tests: pre-dialysis serum albumin, serum creatinine, alkaline reserve, Kt/V and Protein C Reactive (CRP). The patients were followed-up for 6 months.

Cardiac arrhythmias in children and young are presented in a broad spectrum, given the large and varied number of known arrhythmias. The incidence of pre-excitation syndromes in children ranges from 1:250 to 1:1000 [11].Our understanding of ventricular preexcitation began in 1921 when Wedd described an “intraventricular block and a PR interval of 0.08 ms.” [1] Wolff-Parkinson-White (WPW) was first described in 1930 as a bundle-Branch Block with Short P-R Interval. Moreover, the delta wave Wolff et al. described the presence of the delta wave on the EKG for the first time [2].Clinical manifestations in WPW are broad, ranging from recurring PSVT to SCD. The risk of developing the last condition in people with WPW syndrome is still unknown. However, multiple studies reveal that asymptomatic WPW has a low chance of SCD and a favorable prognosis [3-6]. Moreover, multiple studies present reasonable life expectancy in patients with WPW syndrome, even if they may present multiple episodes of PSVT [7-10].

Cardiovascular diseases are part of a group of conditions starting from the heart structures and blood vessels. Since the symptomatology of these conditions is complex, which affects the whole body, special attention is required from the medical personnel. The management of these pathologies is a complex one, which obligatorily implies the existence of good communication between the primary healthcare as well as the treating specialists.According to the latest statistical studies, cardiovascular diseases are currently the main cause of death worldwide. According to statistics from 2015, 17.9 million deaths were due to cardiovascular pathologies, which is 6.3% more than the death rate in the 90s. From the point of view of the distribution of these conditions depending on sex, the predominance is noted among men of acute coronary diseases and vascular accidents, the same conditions being found also in the case of the opposite sex [McGill, H. 2008].Arterial hypertension is defined by specialized literature as a chronic cardiovascular disease. It is characterized by the constant presence of elevated blood pressure values. Over time, this conjuncture creates an environment in which it is stimulated in the development of coronary diseases, aneurysms, but also peripheral vascular disease, as well as purely cardiac pathologies such as heart failure (which has systemic symptoms), or atrial fibrillation [Lawes, C, 2001].