Clinical Phenotypes of Sepsis in a Cohort of Hospitalized Patients According to Infection Site.

OBJECTIVES: Clinical sepsis phenotypes may be defined by a wide range of characteristics such as site of infection, organ dysfunction patterns, laboratory values, and demographics. There is a paucity of literature regarding the impact of site of infection on the timing and pattern of clinical sepsis markers. This study hypothesizes that important phenotypic variation in clinical markers and outcomes of sepsis exists when stratified by infection site. DESIGN: Retrospective cohort study. SETTING: Five hospitals within the Wake Forest Health System from June 2019 to December 2019. PATIENTS: Six thousand seven hundred fifty-three hospitalized adults with a discharge International Classification of Diseases, 10th Revision code for acute infection who met systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA), or Sequential Organ Failure Assessment (SOFA) criteria during the index hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome of interest was a composite of 30-day mortality or shock. Infection site was determined by a two-reviewer process. Significant demographic, vital sign, and laboratory result differences were seen across all infection sites. For the composite outcome of shock or 30-day mortality, unknown or unspecified infections had the highest proportion (21.34%) and CNS infections had the lowest proportion (8.11%). Respiratory, vascular, and unknown or unspecified infection sites showed a significantly increased adjusted and unadjusted odds of the composite outcome as compared with the other infection sites except CNS. Hospital time prior to SIRS positivity was shortest in unknown or unspecified infections at a median of 0.88 hours (interquartile range [IQR], 0.22-5.05 hr), and hospital time prior to qSOFA and SOFA positivity was shortest in respiratory infections at a median of 54.83 hours (IQR, 9.55-104.67 hr) and 1.88 hours (IQR, 0.47-17.40 hr), respectively. CONCLUSIONS: Phenotypic variation in illness severity and mortality exists when stratified by infection site. There is a significantly higher adjusted and unadjusted odds of the composite outcome of 30-day mortality or shock in respiratory, vascular, and unknown or unspecified infections as compared with other sites.

Effects of 12 Months Consumption of 100 g Dried Plum (Prunes) on Bone Biomarkers, Density, and Strength in Men.

Several male animal studies have demonstrated bone-protective effects of dried plum; however, no human male study has evaluated the effect of dried plum on bone health. We conducted a randomized controlled clinical study to test if daily inclusion of 100 g of dried plum in the diet positively influenced bone mineral density (BMD), bone strength, and bone biomarkers in men. Sixty-six men were randomly assigned to one of two daily treatment groups: (1) control (0 g dried plum) or (2) 100 g dried plum. Blood samples were collected at baseline and after 3, 6, and 12 months to assess bone biomarkers. Bone was measured at baseline and after 6 and 12 months via dual-energy X-ray absorptiometry and peripheral quantitative computed tomography. Tartrate-resistant acid phosphatase-5b (TRAP5b) and C-terminal collagen cross-link (CTX) levels decreased significantly in the dried plum group at 3-, 6-, and 12-month intervals compared with baseline. No changes were observed in the control group for TRAP5b and CTX levels. Bone-specific alkaline phosphatase levels decreased significantly after 6 and 12 months in the control and dried plum groups. BMD for total body, spine (L1-L4), hip, and ulna did not change in the control and dried plum groups from baseline to 6 or 12 months. In the proximal tibia, endosteal circumferences increased significantly within the dried plum group during the course of treatment. The results suggest that daily consumption of 100 g dried plum for 12 months has modest bone-protective effects in men. ClinicalTrials.gov identifier: NCT04720833.

Effects of Dried Apple Consumption on Body Composition, Serum Lipid Profile, Glucose Regulation, and Inflammatory Markers in Overweight and Obese Children.

Consumption of fruits reduces the risk of chronic diseases such as cardiovascular disease; however, very few studies have investigated the effect of fruit consumption in overweight and obese children. We examined whether consuming dried apple as a snack is a practical solution for weight loss and improves body composition and metabolic markers. Thirty-eight overweight or obese children aged 10 to 16 years were randomly assigned to one of two groups consuming twice daily 120 kcal serving per day of either dried apple or a control snack (muffin) for 8 weeks. Body weight, height, waist circumference, and body composition were determined during an initial visit and after 8 weeks of intervention. Blood samples were collected to measure serum concentrations of blood lipids, glucose, insulin, proinsulin, total adiponectin, and C-reactive protein, as well as total antioxidant capacity and activity of glutathione peroxidase. Body weight increased in the muffin group (P = .01). BodPod and dual-energy X-ray absorptiometry showed that fat-free mass increased (P < .05) only in the muffin group. High-density lipoprotein cholesterol concentration increased (P = .04) after the 8-week treatment within the apple group. Overall, minor differences were detected in growing children who consumed snacks of either dried apples or muffins with similar macronutrient profiles for 8 weeks. Future research should evaluate the effects of consuming fresh apples that include the peel.