Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre.

Objectives: To compare complications associated with percutaneous gastrostomies performed using PUSH and PULL techniques, whether endoscopic (PEG) or radiological (PRG), in a tertiary-level hospital. Methods: This was a prospective observational study. Adult patients who underwent percutaneous PULL or PUSH gastrostomy using PEG or PRG techniques at the Virgen del Rocio University Hospital and subsequently followed up in the Nutrition Unit between 2009-2020 were included. X2 tests or Fisher's test were used for the comparison of proportions when necessary. Univariate analysis was conducted to study risk factors for PRG-associated complications. Results: n = 423 (PULL = 181; PUSH = 242). The PULL technique was associated with a higher percentage of total complications (37.6% vs. 23.8%; p = 0.005), exudate (18.2% vs. 11.2%; p = 0.039), and irritation (3.3% vs. 0%; p = 0.006). In the total sample, there were 5 (1.1%) cases of peritonitis, 3 (0.7%) gastrocolic fistulas, and 1 (0.2%) death due to complications associated with gastrostomy. Gender, age, and different indications were not risk factors for a higher number of complications. The most common indications were neurological diseases (35.9%), head and neck cancer (29%), and amyotrophic lateral sclerosis (17.2%). Conclusions: The PULL technique was associated with more total complications than the PUSH technique, but both were shown to be safe techniques, as the majority of complications were minor.

[Consensus on criteria and minimum data set for the referral of candidate patients for home enteral nutrition teleconsultation: TELENUT project]. / Consenso sobre criterios y conjunto mínimo de datos para la derivación de pacientes candidatos a teleconsulta de nutrición enteral domiciliaria: proyecto TELENUT.

Introduction: Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.

Introducción: Introducción: la teleconsulta es una herramienta asistencial útil en el manejo multidisciplinar de pacientes con indicación de nutrición enteral domiciliaria (NED). El empleo de diferentes herramientas de teleconsulta de NED, como ocurre en el Sistema Andaluz de Salud (SAS), conlleva heterogeneidad en los procesos de derivación entre los servicios de Atención Primaria (AP) y hospitalaria en una misma región. Objetivos: consensuar perfiles de pacientes y conjunto de datos mínimos necesarios para garantizar una derivación adecuada a la teleconsulta de NED, independientemente de la herramienta existente. Estos aspectos consensuados en Andalucía pueden servir de referencia en otras regiones. Métodos: se siguieron tres pasos consecutivos: a) revisión no sistemática de la literatura indexada sobre la teleconsulta en nutrición clínica en España; b) encuesta para conocer la implementación y las necesidades no satisfechas de las herramientas de teleconsulta en los hospitales públicos andaluces; y c) reuniones de trabajo y consenso de 14 profesionales sanitarios de AP (n = 4) y endocrinología y nutrición clínica hospitalaria (n = 10). Resultados: se consensuaron tres formularios de derivación en los que se definieron tres perfiles de pacientes, con el correspondiente conjunto mínimo de datos necesario para solicitar la teleconsulta de NED. El equipo de AP debe proporcionar este conjunto mínimo de datos al especialista en nutrición clínica a través de una herramienta de teleconsulta, implementada en el SAS. Conclusiones: tres formularios consensuados entre profesionales sanitarios involucrados en el proceso de derivación sirven para estandarizar la solicitud de teleconsulta de NED entre equipos asistenciales en función de perfiles de pacientes.

Gastrostomies: experience and complications with three modalities in a tertiary centre over a 26-year period.

Objectives: To describe the complications associated with the different gastrostomy techniques [endoscopic (PEG), radiologic (PRG), and surgical (SG)] performed in the last 26 years in a terciary hospital. Methods: Retrospective observational study. Patients who underwent gastrostomy at the Virgen del Rocío University Hospital between 1995 and 2021 were included. For PEG, the PULL technique was performed until 2018 and subsequently the PUSH technique predominantly. For PRG, a pigtail catheter was used until 2003, a balloon catheter between 2003 and 2009, and a balloon catheter with gastropexy between 2015 and 2021. For SG, the conventional technique (CSG) was performed until 2009 and since then the laparoscopic assisted percutaneous gastrostomy (PLAG) technique. Descriptive analysis was performed obtaining the median and quartiles of the quantitative variables [P50 (P25-P75)] and the frequency for the qualitative variables [n (%)].The comparison of complications between patients who underwent different techniques was performed with Fisher's test. Results: n = 1,070 (PEG = 608, PRG = 344, SG = 118). The three most frequent indications were head and neck tumors, neurological diseases and gastroesophageal tumors. The percentage of patients who had any complication was 48.9% (PEG-PULL), 23.7% (PEG-PUSH), 38.5% (pigtail PRG), 39.2% (balloon PRG), 29.7% (balloon with gastropexy PRG), 87.3% (CSG), and 41.26% (PLAG). 2 (0.18%) patients died from gastrostomy-related complications. 18(1.68%) presented with peritonitis and 5 (0.4%) presented with gastrocolic fistula. The rest of the complications were minor. Conclusion: Gastrostomy in any of its modalities is currently a safe procedure with a low rate of complications, most of which are minor.

Biliary obstruction secondary to duodenal follicular lymphoma with papillary involvement.

Duodenal-type follicular lymphoma is a clinical variant of follicular lymphoma located in the intestine, presenting as multiple small polyps. The estimated frequency is 1/7000 people and extraduodenal involvement is rare. It predominantly affects middle-aged women, although some cases of young patients have been published in the literature. They are usually located in the second periampullary portion of the duodenum. It is diagnosed incidentally or after performing an imaging test due to non-specific digestive symptoms (abdominalgia, diarrhea or hyporexia). The prognosis is usually favorable without specific treatment5.

Bioavailability and systemic transport of oleanolic acid in humans, formulated as a functional olive oil.

Evidence of the pharmacological activity of oleanolic acid (OA) suggests its potential therapeutic application. However, its use in functional foods, dietary supplements, or nutraceuticals is hindered by limited human bioavailability studies. The BIO-OLTRAD trial is a double-blind, randomized controlled study with 22 participants that received a single dose of 30 mg OA formulated as a functional olive oil. The study revealed that the maximum serum concentration of OA ranged from 500 to 600 ng mL-1, with an AUC0-∞ value of 2862.50 ± 174.50 ng h mL-1. Furthermore, we discovered a physiological association of OA with serum albumin and triglyceride-rich lipoproteins (TRL). UV absorption spectra showed conformational changes in serum albumin due to the formation of an adduct with OA. Additionally, we demonstrated that TRL incorporate OA, reaching a maximum concentration of 140 ng mL-1 after 2-4 hours. We conjecture that both are efficient carriers to reach target tissues and to yield high bioavailability.

Outcomes of a multidisciplinary Diabetic Foot Day Unit.

OBJECTIVE: To analyse the main characteristics of patients and the health outcomes obtained and to evaluate the impact of peripheral artery disease (PAD) in patients treated in our multidisciplinary Diabetic Foot Unit. RESEARCH DESIGN AND METHODS: Observational prospective study. 273 patients from two different populations (with and without PAD - classified according to the presence of distal pulses) treated over a 14-month period in the multidisciplinary Diabetic Foot Unit were included. The data on patient characteristics and outcomes were analysed for the purpose of comparison. For the inference study, a comparison of medians with the non-parametric test for independent samples for the quantitative variables and a χ2 test for the comparison of proportions in qualitative variables were performed. RESULTS: Patients with PAD ulcers were older (60 (54-67) vs. 64 (75-81), p=0.000) and had a higher macrovascular burden (8.1% vs. 29% for ischaemic heart disease history, p=0.000; 6.7% vs. 18.1% for cerebrovascular disease history, p=0.004). Their Texas Score was higher (p=0.000) and their major amputation rate was higher (1.4% vs. 12.3%, p=0.001). They had less background of previous ulcers (52.6% vs. 26.8%, p=0.000), their episode duration was shorter (4 (0-10) vs. 0 (0-3) weeks, p=0.000), and their proportional need for antibiotic therapy was lower (64.4% vs. 51.4%, p=0.03). CONCLUSIONS: The differences found between ulcers with and without vascular involvement support the need for a different approach and for the inclusion of vascular surgeons on the team. The multidisciplinary care model for diabetic foot patients could be effective and improve health outcomes.

Endoscopic ultrasound guided diagnosis of a retroperitoneal extra-gastrointestinal stromal tumor.

GIST tumors are mesenchymal tumors that are usually positive for the CD-117 marker. They present mostly at middle ages of life and although the most frequent locations are the stomach, small intestine and rectum/colon, they can appear in unusual places such as the retroperitoneum. The case that we present reflects the diagnostic process with imaging tests such as echo-endoscopy with puncture, of a retroperitoneal GIST tumor.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia un the perioperative setting]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia en el contexto perioperatorio.

Introduction: People with diabetes are at high risk of requiring surgical intervention throughout their lives, and of perioperative complications in case of poor metabolic control. Hospitalization represents a stressful event that, together with other factors associated with diagnostic and therapeutic procedures, leads to a deterioration in the nutritional status of the patients. An association between poor nutritional status and adverse outcomes in surgical patients has been observed. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) in the perioperative setting.

Introducción: Las personas con diabetes tienen un riesgo elevado de requerir una intervención quirúrgica a lo largo de su vida y de tener complicaciones perioperatorias en caso de un control metabólico deficiente. La hospitalización representa un evento estresante que, unido a otros factores asociados a procedimientos diagnósticos y terapéuticos, conlleva un deterioro del estado nutricional de los pacientes. Se ha observado una asociación entre un estado nutricional deficiente y resultados adversos en pacientes quirúrgicos. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) en el periodo perioperatorio.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and heart failure]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia e insuficiencia cardíaca.

Introduction: Heart failure (HF) is one of the leading causes of morbidity and mortality among older people, making it a major public health problem. Cardiovascular diseases in general, and HF in particular, are common comorbidities in people with type 2 diabetes (DM2). The concurrence of DM2 and HF is associated with more severe clinical symptoms and signs, and poorer quality of life and prognosis. Furthermore, due to the hypercatabolic state and nutrient absorption disorders, malnutrition is present in many HF cases. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with HF.

Introducción: La insuficiencia cardíaca (IC) es una de las principales causas de morbilidad y mortalidad entre las personas mayores, lo que la convierte en un importante problema de salud pública. Las enfermedades cardiovasculares en general, y la IC en particular, son comorbilidades frecuentes en personas con diabetes tipo 2 (DM2). La presencia de DM2 e IC se asocia con síntomas y signos clínicos más graves, y peor calidad de vida y pronóstico. Además, debido al estado hipercatabólico y los trastornos de la absorción de nutrientes, la desnutrición está presente en muchos casos de IC. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con IC.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y caquexia tumoral.

Introduction: Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.

Introducción: La diabetes es una comorbilidad frecuente en pacientes con cáncer, ya que comparten factores de riesgo comunes. En la enfermedad oncológica, la presencia de caquexia tumoral representa un factor de mal pronóstico, que se ve agravado por un estado nutricional deficiente. Clínicamente, la caquexia se manifiesta como una reducción significativa del peso corporal, acompañado de cambios en la composición corporal y alteraciones en el equilibrio del sistema biológico, y causa una disfunción progresiva. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con caquexia tumoral concurrente.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and liver cirrhosis]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y cirrosis hepática.

Introduction: Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis.

Introducción: La cirrosis hepática es una enfermedad progresiva y crónica del hígado, de etiología diversa, que se asocia frecuentemente con intolerancia a la glucosa y en algunos casos concurre con diabetes tipo 2 (DM2). La DM2 se asocia con resultados adversos en pacientes con cirrosis, incluyendo una mayor tasa de ingresos hospitalarios, una mayor prevalencia de carcinoma hepatocelular y un mayor riesgo de mortalidad. La desnutrición es otra complicación frecuente en la cirrosis, cuya prevalencia aumenta con el grado de disfunción hepática, empeorando el pronóstico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con cirrosis hepática.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and concurrent pathologies]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y otras patologías.

Introduction: Type 2 diabetes mellitus is a highly prevalent disease worldwide, generating an increasing clinical and economic burden due to its micro- and macrovascular complications. Frequently, people with diabetes are hospitalized for various pathologies. These patients generally have higher risk of complications, prolonged hospitalizations and mortality. An additional factor that worsens the prognosis in these patients is the concurrence of malnutrition, especially in elderly people. All this makes the management of these patients challenging and requires a specific nutritional approach, whose purpose is to cover the nutritional requirements while always maintaining glycemic control. The purpose of this work is to provide, based on the evidence available in the literature and clinical experience, consensus recommendations by eighteen experts in Endocrinology and Nutrition on the nutritional approach of hospitalized patients with diabetes/ hyperglycemia and compare the optimal management, based on these recommendations with bedside usual care according to a panel of Spanish doctors surveyed about their daily clinical practice. This first article of this extraordinary issue of the journal Nutrición Hospitalaria describes the methodology of the study and the results obtained regarding common issues for all pathologies.

Introducción: La diabetes mellitus tipo 2 es una enfermedad muy prevalente en todo el mundo y genera una carga clínica y económica creciente debido a sus complicaciones micro- y macrovasculares. Con frecuencia, las personas con diabetes son hospitalizadas por diversas patologías. Estos pacientes tienen, por lo general, un mayor riesgo de complicaciones, de estancias prolongadas y de mortalidad. Un factor adicional que empeora el pronóstico en estos pacientes es la presencia de desnutrición, sobre todo en personas de edad avanzada. Todo ello hace que el manejo de estos pacientes sea complejo y requiera un abordaje nutricional específico, cuya finalidad sea cubrir los requerimientos nutricionales manteniendo siempre el control glucémico. La finalidad de este trabajo es generar, en base a los datos disponibles en la bibliografía y la experiencia clínica, recomendaciones consensuadas por parte de dieciocho expertos en Endocrinología y Nutrición sobre el abordaje nutricional de pacientes hospitalizados con diabetes/hiperglucemia y comparar el manejo óptimo basado en estas recomendaciones con la atención habitual a pie de cama, según un panel de médicos españoles encuestados sobre su práctica clínica diaria. En este primer artículo de este número extraordinario de la revista Nutrición Hospitalaria, se describe la metodología seguida y los resultados obtenidos sobre las cuestiones comunes para todas las patologías.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and sarcopenia]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y sarcopenia.

Introduction: Sarcopenia is a multidimensional condition that negatively affects muscle mass, muscle strength, and physical performance. The prevalence of sarcopenia in people with diabetes is much higher than that of the general population, especially in individuals with poor nutritional status. Both sarcopenia and malnutrition are conditions amenable to intervention to improve clinical prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with sarcopenia.

Introducción: La sarcopenia se describe como una afección multidimensional que afecta negativamente a la masa muscular, la fuerza muscular y el rendimiento físico. La prevalencia de sarcopenia en personas con diabetes es muy superior a la de la población general, especialmente en individuos que presentan un estado nutricional deficiente. Tanto la sarcopenia como la desnutrición son condiciones susceptibles de intervención para mejorar el pronóstico clínico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con sarcopenia concurrente.

[GLUCECONTROL 2.0. Annex 1]. / GLUCECONTROL 2.0. Anexo 1.

Introduction: Exhaustive bibliographc research in PubMed/Medline.

Introducción: Búsqueda bibliográfica exhaustiva en PubMed/Medline.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and hip fracture]. / Abordaje de la desnutrición en pacientes hospitalizados con diabetes/hiperglucemia y fractura de cadera.

Introduction: The yearly incidence of hip fracture is very high, which generates significant healthcare and socioeconomic burden. These fractures can occur at any age, but the vast majority occur in people over 65 years of age and predominantly in women, due to the increased risk of menopause-associated osteoporosis. Type 2 diabetes mellitus (DM2), apart from altering glucose, lipid and protein metabolisms, also causes a deregulation of calcium, phosphorus and magnesium and dysfunction in bone metabolism. The prevalence of malnutrition in patients with hip fracture is also high, due to their advanced age, and the acute injury itself provokes catabolic and inflammatory responses that result in disease-related malnutrition and sarcopenia, which aggravates the patient's clinical condition. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with hip fracture.

Introducción: La incidencia de fractura de cadera cada año es muy alta, lo que genera una importante carga asistencial y socioeconómica. Estas fracturas pueden producirse a cualquier edad, pero la gran mayoría ocurren en personas mayores de 65 años y con predominancia del sexo femenino, debido al mayor riesgo de osteoporosis tras la menopausia. La diabetes mellitus tipo 2 (DM2), aparte de alterar el metabolismo glucídico, lipídico y proteico, también causa una desregulación del calcio, fósforo y magnesio, y alteraciones del metabolismo óseo. La prevalencia de desnutrición en pacientes con fractura de cadera es también elevada, por la edad avanzada, y la misma lesión aguda generar respuestas catabólicas e inflamatorias que resultan en desnutrición relacionada con la enfermedad y sarcopenia, lo que agrava el estado clínico del paciente. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con fractura de cadera.

Percutaneous Radiology Gastrostomy (PRG)-Associated Complications at a Tertiary Hospital over the Last 25 Years.

OBJECTIVES: We aimed to describe and compare the complications associated with different percutaneous radiologic gastrostomy (PRG) techniques. METHODS: A retrospective and prospective observational study was conducted. Patients who underwent a PRG between 1995-2020 were included. TECHNIQUES: A pigtail catheter was used until 2003, a balloon catheter without pexy was used between 2003-2009 and a balloon catheter with gastropexy was used between 2015-2021. For the comparison of proportions, X2 tests or Fisher's test were used when necessary. Univariate analysis was performed to study the risk factors for PRG-associated complications. RESULTS: n = 330 (pigtail = 114, balloon-type without pexy = 28, balloon-type with pexy = 188). The most frequent indication was head and neck cancer. The number of patients with complications was 44 (38.5%), 11 (39.2%) and 54 (28,7%), respectively. There were seven (25%) cases of peritonitis in the balloon-type without-pexy group and 1 (0.5%) in the balloon-type with-pexy group, the latter being the only patient who died in the total number of patients (0.3%). Two (1%) patients of the balloon-type with-pexy group presented with gastrocolic fistula. The rest of the complications were minor. CONCLUSIONS: The most frequent complications associated with the administration of enteral nutrition through PRG were minor and the implementation of the balloon-type technique with pexy has led to a decrease in them.

Prevalence of non-alcoholic fatty liver disease (NAFLD) in a cohort of patients with type 2 diabetes: the PHIGNA-DM2 study.

Introduction: Background: type 2 diabetes (T2D) is a risk factor for nonalcoholic fatty liver disease (NAFLD). Objective: to evaluate the prevalence of NAFLD in a cohort of patients with T2D. Methods: an observational, descriptive study performed between May 2018 and December 2019 at the Endocrinology and Nutrition Unit. The χ² test was performed for qualitative variables and a non-parametric test for the comparison of medians of quantitative variables. Steatosis degree was defined by the coefficient attenuated parameter (CAP): (S0: < 248 dB/m; S1: 248-268 dB/m; S2: 268-288 dB/m; S3: > 288 dB/m) or stiffness: F0-F1: < 8 kPa; F2: 8-10 kPa; F3: 10-15 kPa; F4: > 15 kPa, using transient elastography (TE) (FibroScan®). A univariate analysis was performed and subsequently a multivariate analysis with statistically significant variables used to study the predictive factors of intense steatosis and advanced fibrosis. Results: n = 104 patients with T2D; 84 (80.7 %) were obese. TE demonstrated advanced fibrosis in 20 % and intense steatosis (S3) in more than 50 %. Lower total bilirubin (OR: 0.028; 95 % CI: (0.002-0.337); p = 0.005) was found to be an independent factor for S3 steatosis in the multivariate analysis. BMI ((OR: 1.497; 95 % CI: (1.102-2.034); p = 0.01)) was a predictive factor for advanced fibrosis in a multivariate analysis. Conclusions: NAFLD-associated intense steatosis and NAFLD-associated fibrosis were commonly found in patients with T2DM and obesity. Diabetic patients should be screened for liver disease as one more target organ.

Introducción: Antecedentes: la diabetes de tipo 2 (DM2) es un factor de riesgo para la enfermedad del hígado graso no alcohólico (EHGNA). Objetivo: evaluar la prevalencia de la EHGNA en una cohorte de pacientes con DM2. Métodos: estudio descriptivo observacional realizado entre mayo de 2018 y diciembre de 2019 en la Unidad de Endocrinología y Nutrición. Se realizó una prueba de χ² para las variables cualitativas y una prueba no paramétrica para la comparación de medianas de variables cuantitativas. El grado de esteatosis se definió mediante el parámetro coeficiente atenuado (CAP): (S0: < 248 dB/m; S1: 248-288 dB/m; S2: 268-288 dB/m; S3: > 288 dB/m) o rigidez: F0-F1: < 8 kPa; F2: 8-10 kPa; F3: 10-15 kPa; F4: > 15 kPa, usando la elastografía transitoria (TE) (FibroScan®). Se realizó un análisis univariante y posteriormente un análisis multivariante con las variables estadísticamente significativas para estudiar los factores predictivos de esteatosis intensa y fibrosis avanzada. Resultados: n = 104 pacientes con DM2; 84 (80,7 %) eran obesos. La TE demostró fibrosis avanzada en el 20 % y esteatosis intensa (S3) en más del 50 %. Los niveles disminuidos de bilirrubina total (OR: 0.028; 95 % CI: (0.002-0.337); p = 0.005) se encontraron como factores independientes para la esteatosis S3 en el analisis multivariable. El IMC (OR: 1.497; 95 % CI: (1.102-2.034); p = 0.01) fue un factor predictivo de fibrosis avanzada. Conclusiones: la esteatosis intensa asociada a EHGNA y la fibrosis asociada a EHGNA se encontraron comúnmente en pacientes con DM2 y obesidad. Los pacientes diabéticos deben someterse a pruebas de detección de enfermedad hepática como un órgano diana más.

Relationship between nutritional treatment compliance and nutritional status improvements in patients with gastrointestinal impairment taking an oral peptide-based supplement.

OBJECTIVES: Compliance in outpatients with gastrointestinal (GI) malabsorption is key in nutritional treatment. The objective of this study was to assess compliance in patients with GI impairment and malnutrition taking a high-calorie, high-protein, peptide-based oral nutritional supplement (ONS-PBD). METHODS: A prospective, multicenter, observational study was conducted in 19 medical sites in Spain where ONS-PBD were prescribed as standard of care. Patients consumed ONS-PBD daily for 12 wk. Compliance was calculated as the percentage consumed of the prescribed amount of ONS per day. RESULTS: A total of 90 adult patients were included in the study, of whom 64 completed the 12-wk regimine. Mean compliance was 78.8% ± 24.5%. Risk of malnutrition decreased in 56.3% of patients at 12 wk, as measured with the malnutrition universal screening tool. A reduction in abdominal pain was observed and stool consistency improved, with a mean of 54.7% and 27.5%, respectively. Improvements in quality of life and a decrease in percentage of patients with severe functional impairment were observed. CONCLUSIONS: These data show that ONS-PBD compliance in malnourished patients with GI symptoms is high, reducing GI symptoms and improving patients' nutritional status.

Degradation and in-use stability study of five marketed therapeutic monoclonal antibodies by generic weak cation exchange liquid chromatographic method ((WCX)HPLC/DAD).

Therapeutic monoclonal antibodies (mAbs) represent a very important class of the current biopharmaceutics. The great complexity of their structure made necessary the use of different analytical approaches for assessing different physico-chemical properties. In this work, weak cation exchange (WCX) high performance liquid chromatography with diode array detection ((WCX)HPLC/DAD) is used to assess the charge variant profile. The method here developed combined the effect of ionic strength and controlled pH gradient and allows for the charge variants analysis of the five mAbs studied, namely bevacizumab (BVZ), cetuximab (CTX) infliximab (INF), rituximab (RTX) and trastuzumab (TTZ), which are among the most used mAbs worldwide. The differences in the charge variants in the natural isoforms of the mAbs promoted characteristic WCX chromatograms for each of mAbs that can be also useful for identification purposes. These chromatograms have provided to be suitable for tracking changes in the charge variants of each mAb analyzed both in controlled degraded and in stabilities study along time of in-use samples solutions at 2 mg/mL in 0.9% NaCl stored refrigerated (at 4 °C) and frozen (-20 °C) for two months. The results obtained indicated different stabilities of these mAbs, all IgG1, against degradation by different stressed environmental conditions and in-use stability along two months.

Perioperative Nutritional Support: A Review of Current Literature.

Since the beginning of the practice of surgery, the reduction of postoperative complications and early recovery have been two of the fundamental pillars that have driven the improvement of surgical techniques and perioperative management. Despite great advances in these fields, the rationalization of antibiotic prophylaxis, and other important innovations, postoperative recovery (especially in elderly patients, oncological pathology or digestive or head and neck surgery) is tortuous. This can be explained by several reasons, among which, malnutrition has a major role. Perioperative nutritional support, included within the ERAS (Enhanced Recovery After Surgery) protocol, has proven to be a main element and a critical step to achieve better surgical results. Starting with the preoperative nutritional assessment and treatment in elective surgery, we can improve nutritional status using oral supplements and immunomodulatory formulas. If we add early nutritional support in the postoperative scenario, we are able to significantly reduce infectious complications, need for intensive care unit (ICU) and hospital stay, costs, and mortality. Throughout this review, we will review the latest developments and the available literature.