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Aims: To estimate the prevalence of malnutrition in chronic obstructive pulmonary disease (COPD) patients hospitalized for exacerbation and to evaluate its clinical and prognostic influence on the exacerbation. Subjects/Methods: The subjects were 78 consecutive patients with moderate-to-severe COPD who were admitted to hospital with a diagnosis of exacerbation. Nutritional status was assessed by means of body mass index (BMI), bioelectric impedance analysis and levels of plasmatic albumin. Previous spirometry, 6-min walk test, severity of the exacerbation, days of hospitalization and readmission in the following 3 months were also evaluated. Results: Malnutrition [BMI <20 or fat-free mass (FFM) index ≤16] occurred in 38% of patients, while in 40% the involuntary weight loss revealed a malnutrition risk and in 18% patients the plasmatic albumin levels were <3 g/dl. FFM was correlated with forced expiratory volume in 1 s, forced vital capacity and distance walked in 6 min. Number of days of hospitalization were related to FFM, muscle mass, BMI and albumin. The patients readmitted in the following 3 months had less FFM than the patients who were not readmitted. Conclusions: The high prevalence of malnutrition among hospitalized COPD patients is related to their lung function and exercise tolerance. Moreover, nutritional parameters during exacerbation are related to length of hospitalization and readmission.

A series of 1936 patients were studied between November 1968 and October 1975. The requirements for the inclusion in this study were the radiographic finding of stone (s) in the urinary tract (excluding primitive bladder stones) and/or the spontaneous passing or surgical removal of urinary calcul i.In all the cases the protocol included a clinical history with emphasis on dietary habits; a general biochemical study and the appropiate X-rays; assessment in blood and in 24-hour urine of creatinine, uric acid, phosphorus, calcium, magnesium and, in urine, pH, oxal ic acid and cystine; and the analysis of the stone by chemical and infrared spectrophotometry methods (1), and also the study of a 30 mm-thick section of the stone by polarization microscopy (2).In certain cases the diagnosis was confirmed by purine or amino acids paper chromatography in the urine; a functional study of the acid/base balance, and renal or bone biopsies. When possible, a familial study was carried out. The methods used and the selection criteria of each etiological type have already been reported (3-5). Table I shows the etiological classification of the 1936 patients with renal I ithiasis. Almost one third of the cases were of metabol ic origin and in nearly one half the cause of the disease was demonstrated. RESULTS AND DISCUSSIONThe higher incidence within the metabolic group corresponds to uric acid I ithiasis, a common finding in other Mediterranean countries (6, 7). It also was related to the large number of gouty patients

Abdominal aortic calcification (AAC), cardiac valvular calcification (CVC), and atherosclerotic carotid plaque (CP) are known cardiovascular risk factors. The accuracy of the AAC score in predicting CP and CVC in patients with end-stage renal disease (ESRD) is assessed in this study. Twenty-two consecutive prevalent dialysis patients (group 1) and 26 consecutive nondialysis stage V chronic kidney disease patients (group 2) were assessed for their demographic and laboratory variables. Lateral radiograph of the lumbosacral spine was used to assess the AAC score. CP and CVC were assessed using carotid sonography and echocardiogram, respectively. Prevalence of AAC, CP, and CVC in groups 1 and 2 was, respectively, 72.7%, 81.8%, and 72.7% and 76.9%, 80.8%, and 57.7%. AAC was strongly associated with CP and CVC in both groups (P < 0.001). Tests of accuracy for the AAC score as a predictor of CP and CVC showed sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio of a positive test, and likelihood ratio of a negative test, respectively, in group 1: 83%, 75%, 93%, 50%, 3.32, and 0.23 and 85%, 77%, 87%, 70%, 4.5, and 0.29, and in group 2: 90%, 95%, 83%, 69%, 3.9, 0.41, and 82%, 91%, 77%, 71%, 4.1, and 0.21. Reproducibility of the AAC score among observers was acceptable. The AAC score can predict CP and CVC with moderate accuracy in ESRD patients. However, as our study was underpowered, the findings need validation in larger, adequately powered studies.

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