C. Maiolo

Home telemonitoring for patients with severe respiratory illness: the Italian experience

We investigated the feasibility of telemonitoring services for patients with severe respiratory illness. In the first phase of the study, patients were observed and treated using face-to-face medical visits for 12 months. In the second phase of the study, the patients were monitored at home for 12 months, during which time determinations of arterial oxygen saturation and heart rate were performed twice a week, and the data were automatically transmitted to the hospitals processing centre via a normal telephone line. Thirty patients on long-term oxygen therapy were enrolled in the study; 23 completed the 12 months of home telemonitoring. The numbers of hospital admissions and of acute home exacerbations during the telemonitoring phase of the study decreased by 50% and 55%, respectively, in comparison with the first phase. Estimates of hospitalization costs for the patients during the second phase were approximately 17% lower than those for the first phase. Patients were satisfied with the quality of the personal telemonitoring process in 96% of cases. We believe that telemedicine can enable the provision of high-quality home care for patients with severe respiratory illness.

Total body water estimation using bioelectrical impedance: a meta-analysis of the data available in the literature.

Abstract.Bioelectric impedance analysis (BIA) is commonly used in clinical settings and field studies for estimating total, extracellular, and intracellular water compartments. The objective of the present study was to carry out a meta-analysis of published reports in which total body water (TBW) was estimated using BIA techniques and comparisons were made with reference values. We identified 16 reports conducted among healthy and obese adults and individuals with chronic renal failure. Based on the weighted mean difference, we found that those studies using only multi-frequency BIA did not significantly overestimate the TBW compared with the reference values. Thus, among BIA techniques, multi-frequency BIA seems to be a more accurate method for estimating the TBW compartment for healthy and obese adults and for those with chronic renal failure.

Physical activity energy expenditure measured using a portable telemetric device in comparison with a mass spectrometer

Background: Several studies have evaluated the accuracy of portable metabolic gas analysis systems, which measure physical activity energy expenditure. Since the Cosmed K2 telemetric system, two K4 devices (RQ and b2) have been developed. Objective: To compare measurements using the Cosmed K4 RQ with measurements by a traditional method (mass spectrometer) for a sample of healthy subjects performing physical exercise of various intensities. Methods: Nine healthy male footballers (mean (SD) age 18.3 (2.2) years) performed an incremental exercise running test from 8 km/h to exhaustion, with an increase of 2 km/h for each level of the test protocol. The expired air was collected simultaneously using the Cosmed K4 RQ and Airspec QP9000 mass spectrometer. Oxygen consumption (Vo2) and carbon dioxide production (Vco2) were measured at rest and at each exercise intensity. Results: No significant differences were found between Vo2 and Vco2 measured by the two instruments, at rest or during exercise. Conclusions: The application of the Cosmed K4 RQ system for Vo2 and Vco2 measurements at rest and during both submaximal and maximal exercise may be of interest to sport physiologists, nutritionists, and doctors.

The application of body cell mass index for studying muscle mass changes in health and disease conditions

Abstract.Body mass index (BMI) fails to detect altered nutritional state in the presence of overweight or obesity, since malnutrition can be present and masked by the abnormal amount of fat mass. Measuring body cell mass (BCM) contents for the evaluation of muscle mass and protein tissue states is well accepted. The aim of the present study was to apply body cell mass index (BCMI) to monitor the muscular mass changes of male and female Olympic athletes, renal dialysis patients, and anorexia nervosa patients in comparison with healthy subjects. The BCMI values of male subjects from the healthy group and Olympic athletes groups, but not the renal dialysis group, were significantly higher (p<0.0001) than those of female subjects from the same groups. In addition, subjects with normal or high BMI values may be malnourished as highlighted by a low BCMI. We believe the BCMI is more sensitive than the BMI for studying the nutritional status of the individual.

Evaluating body composition of Italian prostate cancer patients without metastases

Abstract.Prostate cancer (PCa) is becoming an increasingly important public health problem worldwide, and anthropometric studies have revealed that body composition is a potential risk factor for this type of cancer. The objective of the present study was to compare Italians with PCa and no history of androgen deprivation therapy or bone metastases with healthy controls in terms of body composition. We recruited 11 PCa patients [mean age (±SD), 68.67±4.93 years; body mass index (BMI), 28.42±2.96 kg/m2] and 11 healthy controls matched for age and BMI. Anthropometric and body composition parameters were measured for all participants using dual X-ray absorptiometry and bioelectric impedance analysis techniques. We found that lean body mass, but not fat mass, was significantly lower for PCa patients in comparison with healthy controls (50.24±5.03 vs. 53.63±5.61 kg, p<0.05). Thus, PCa patients with no history of androgen deprivation therapy and no bone metastasis suffer muscle mass depletion.

Body composition analysis for healthy Italian vegetarians

Abstract.The elementary nutritional needs of vegetarians are totally, or in great part, supplied by vegetarian food; thus the body composition of vegetarians could differ from that of omnivorous persons. The objective of the present study was to compare healthy Italian vegetarians to healthy omnivorous individuals in terms of body composition, determined using dual X-ray absorptiometry. The study population consisted of 20 vegetarians [mean age (±SD), 34.78±15.07 years; mean BMI, 22.41±2.15 kg/m2] and 10 omnivorous persons matched for age and BMI. We found no significant differences between the two groups in terms of fat mass, lean body mass, soft tissue, bone mineral content, or bone mineral density. These findings suggest that the vegetarian diet does not induce negative alterations in body composition.

Lower intestinal bleeding due to aorto-enteric fistula

The case is described of a man who complained of intermittent fever and fatigue. After three digestive endoscopies and computed tomography, a 99m technetium-HM-PAO-labelled white cell scan was usefully employed to establish diagnosis. Anaerobic aortic Graft infection and anaemia due to lower intermittent occult intestinal bleeding were found. The intestinal bleeding was caused by secondary aorto-jejunal fistula. This condition is rare, but should be suspected whenever a patient with aortic prosthesis presents with occult digestive bleeding and unexplained fever.

Artificial neural network analysis: a novel application for predicting site-specific bone mineral density

Abstract.Dual X-ray absorptiometry (DXA), which is the most commonly used method for the diagnosis and followup of human bone health, is known to produce accurate estimates of bone mineral density (BMD). However, high costs and problems with availability may prevent its use for mass screening. The objective of the present study was to estimate BMD values for healthy persons and those with conditions known to be associated with BMD, using artificial neural networks (ANN). An ANN was used to quantitatively estimate site-specific BMD values in comparison with reference values obtained by DXA (i. e. BMDspine, BMDpelvis, and BMDtotal). Anthropometric measurements (i. e. sex, age, weight, height, body mass index, waist-to-hip ratio, and the sum of four skinfold thicknesses) were fed to the ANN as independent input variables. The estimates based on four input variables were generated as output and were generally identical to the reference values for all studied groups. We believe the ANN is a promising approach for estimating and predicting site-specific BMD values using simple anthropometric measurements.

Analysis of body water compartments after a short sauna bath using bioelectric impedance analysis

Abstract.Studies have suggested that long-term sauna bathing may lower blood pressure in persons with hypertension by causing a direct loss of extracellular water and plasma minerals. The objective of the present study was to evaluate the effect of short-term sauna bathing on body water compartments as estimated by bioelectric impedance analysis (BIA). We recruited 15 men [mean age (±SD) of 23.93±5.12 years and mean body mass index (BMI) of 23.25±2.84 kg/m2] and 10 women matched for age and BMI. Total body resistance, reactance, and impedance were measured for all participants using BIA, at baseline, after a short sauna bath, and after a rest period. Total, extracellular, and intracellular water compartments were calculated using BIA formulae. There were no significant differences for any of the body water compartments when comparing the measurements taken before and after the sauna bath and after the rest period. However, it remains to be determined whether or not BIA is sensitive to rapid changes in water volume.

The effect of physical activities of various intensities on the energy expenditure of type 2 diabetic men.

Abstract.Interventions that focus on changing lifestyles through the combined use of dietary management, weight reduction, and increased physical activity are essential for managing type 2 diabetes mellitus (T2DM). The objective of the present study was to examine mildly obese T2DM patients [n=10; mean age (±SD), 51.29±6.80 years; body mass index (BMI), 30.26±6.19 kg/m2; and glycosylated haemoglobin (HbA1c), 8.16±1.16%)] and to compare them with normoglycaemic persons (n=10; age, 53.00±9.48 years; BMI, 27.63±3.33 kg/m2, and HbA1c, 5.85±0.56%) in terms of energy expenditure while performing physical activities of various intensities (i. e. light, moderate, and heavy). The resting metabolic rate for T2DM patients was significantly higher than that for healthy controls (2,200±354 kcal/day vs. 1,628±176 kcal/day, respectively; p<0.0001). The values of energy expenditure at all three levels of physical activity were comparable between the two groups. Physical activity seems to have various beneficial effects on mildly obese T2DM patients because it increases the plasma glucose consumption, resulting in similar energy expenditure in comparison with normoglycaemic individuals.