Malnutrition and sarcopenia worsen short- and long-term outcomes in internal medicine inpatients.

PURPOSE: This work aims to describe patients hospitalized in internal medicine wards in terms of nutrition and sarcopenia. It also seeks to evaluate short- and long-term mortality related to malnutrition and sarcopenia. METHODS: This cross-sectional study collected data on consecutive patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini-Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F scale) and handgrip strength test. Patients who were hospitalized for >48 hours were excluded. RESULTS: The sample included 619 patients with a mean ± SD age of 76.0 ± 14.8 years of which 50.6% were women. Patients were classified into three groups based on malnutrition: group 1 (MNA-SF 12-14 points) (no risk) included 158 patients, group 2 (MNA-SF 8-12 points) (high risk) included 233 patients, and group 3 (MNA-SF 0-7 points) (malnourished) included 228 patients. Malnourished patients had more dysphagia, significantly lower protein and albumin levels, and significantly higher inflammatory marker levels and pressure ulcers. In-hospital mortality was significantly higher in groups 2 and 3 (p < .00001). The worst outcome (mortality and readmissions or mortality) was more common among malnourished patients (p = .0001). Inflammation, comorbidity, and sarcopenia were most closely associated with negative outcomes. CONCLUSION: Malnutrition upon admission is associated with worse short- and long-term outcomes in internal medicine inpatients. Sarcopenia, multimorbidity, and inflammation-measured by albumin, C-reactive protein, or their ratios-are key risk factors. Early identification of malnutrition and sarcopenia through active screening is important in caring for internal medicine patients.

[Acanthosis nigricans as the initial paraneoplastic manifestation of gastric adenocarcinoma]. / Acantosis nigricans como manifestación inicial paraneoplásica de adenocarcinoma gástrico.

We report the case of a 29-year-old man with cutaneous hyperpigmentation located especially in intertriginous areas. The lesions were velvety, rugose and highly pruriginous. The patient was diagnosed with acanthosis nigricans. Initial treatment with topical corticosteroids and oral antihistamines was unsuccessful and, due to suspicion of a paraneoplastic cutaneous syndrome, gastroscopy with sampling for biopsy and abdominal CT were carried out, revealing the existence of an infiltrating gastric adenocarcinoma and underlying adenopathies. The patient underwent total gastrectomy extended to spleen and pancreatic tail and D2 lymph node dissection. Treatment was completed by radiotherapy and chemotherapy to treat lymph node involvement.

Acantosis nigricans como manifestación inicial paraneoplásica de adenocarcinoma gástrico / Acanthosis nigricans as the initial paraneoplastic manifestation of gastric adenocarcinoma

Presentamos el caso clínico de un varón de 29 años de edad con hiperpigmentación cutánea localizada especialmente en las zonas de las flexuras. Eran lesiones aterciopeladas, rugosas y muy pruriginosas. Se diagnosticó de acantosis nigricans. Tras la ineficacia del tratamiento inicial con corticoides tópicos y antihistamínicos orales, y ante la sospecha de afección cutánea paraneoplásica, se realizó una endoscopia oral con toma de muestras para biopsia y tomografía computarizada abdominal, que revelaron la presencia de un adenocarcinoma gástrico infiltrante y adenopatías subyacentes, motivo por el que se sometió al paciente a una gastrectomía total ampliada al bazo y la cola pancreática, y una resección D2 ganglionar. Se completó el tratamiento con radioterapia y quimioterapia por positividad ganglionar

We report the case of a 29-year-old man with cutaneous hyperpigmentation located especially in intertriginous areas. The lesions were velvety, rugose and highly pruriginous. The patient was diagnosed with acanthosis nigricans. Initial treatment with topical corticosteroids and oral antihistamines was unsuccessful and, due to suspicion of a paraneoplastic cutaneous syndrome, gastroscopy with sampling for biopsy and abdominal CT were carried out, revealing the existence of an infiltrating gastric adenocarcinoma and underlying adenopathies. The patient underwent total gastrectomy extended to spleen and pancreatic tail and D2 lymph node dissection. Treatment was completed by radiotherapy and chemotherapy to treat lymph node involvement