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BACKGROUND: Pancreatic enzyme replacement therapy (PERT) is indicated in case of clinically relevant exocrine pancreatic insufficiency (EPI). Clinical trials addressing PERT have used the coefficient of fat absorption (CFA) to define EPI but this test is cumbersome to perform. Our aim was to compare two easier-to-perform tests to detect clinically relevant EPI: Fecal Elastase-1 (FE-1) and 13C-Mixed Triglyceride Breath Test (TGBT). METHODS: We prospectively included 54 patients with chronic pancreatitis (CP), 24.1% operated, 29.6% had EPI. EPI was defined as a CFA <93%. The sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values for different cut-offs of FE-1 and TGBT were calculated. RESULTS: The area under the ROC curve for FE-1/TGBT was 0.861/0.876 for the global sample, 0.842/0.794 for non-operated patients and 0.917/1 for operated patients respectively. Se, Sp, PPV and NPV for a cut-off of FE-1 <200 µg/g were 93.8%, 63.2%, 51.7% and 96% respectively. The best cut-off point for FE-1 was 84 µg/g, which yielded an 87.5% Se, 81.6% Sp, 66.7% PPV and 93.9% NPV. The same parameters for a TGBT <29% were 81.3%, 84.2%, 68.4% and 91.4% respectively. The best cut-off point for TGBT was <23%, which yielded an 81.3% Se, 94.7% Sp, 86.7% PPV and 92.3% NPV. Diabetes was associated to decreased FE-1 levels, even in multivariate analysis. CONCLUSIONS: FE-1 and TGBT showed similar results for the diagnosis of EPI in CP. In non-operated CP patients, TGBT does not offer any advantage to FE-1 but in operated CP patients TGBT seems a more accurate test.
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OBJECTIVE: To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. BACKGROUND: EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. METHODS: Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. RESULTS: These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement. CONCLUSIONS: EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.
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Medicina Basada en la Evidencia , Insuficiencia Pancreática Exocrina/terapia , Enfermedades Pancreáticas/cirugía , Complicaciones Posoperatorias/terapia , Guías de Práctica Clínica como Asunto , Humanos , EspañaRESUMEN
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.
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Diabetes Mellitus , Hiperglucemia , Desnutrición , Humanos , Hiperglucemia/tratamiento farmacológico , Desnutrición/complicaciones , Hospitalización , Diabetes Mellitus/terapia , Estado NutricionalRESUMEN
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.
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Diabetes Mellitus Tipo 2 , Insuficiencia Cardíaca , Hiperglucemia , Desnutrición , Humanos , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Calidad de Vida , Desnutrición/complicaciones , Desnutrición/terapia , Hiperglucemia/etiología , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/terapia , PronósticoRESUMEN
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.
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Diabetes Mellitus , Hiperglucemia , Desnutrición , Neoplasias , Humanos , Caquexia/etiología , Caquexia/terapia , Desnutrición/complicaciones , Desnutrición/terapia , Neoplasias/complicaciones , Neoplasias/terapia , Diabetes Mellitus/terapia , Hiperglucemia/complicaciones , Hiperglucemia/terapia , Estado NutricionalRESUMEN
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.
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Carcinoma Hepatocelular , Diabetes Mellitus Tipo 2 , Intolerancia a la Glucosa , Neoplasias Hepáticas , Desnutrición , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Desnutrición/terapia , Desnutrición/complicaciones , Cirrosis Hepática/complicaciones , Cirrosis Hepática/terapia , Carcinoma Hepatocelular/complicaciones , Neoplasias Hepáticas/complicacionesRESUMEN
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.
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Diabetes Mellitus Tipo 2 , Hiperglucemia , Desnutrición , Humanos , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Hospitalización , Hiperglucemia/complicaciones , Hiperglucemia/terapia , Desnutrición/terapia , Desnutrición/complicaciones , Estado NutricionalRESUMEN
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.
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Diabetes Mellitus , Hiperglucemia , Desnutrición , Sarcopenia , Humanos , Sarcopenia/etiología , Sarcopenia/terapia , Sarcopenia/epidemiología , Desnutrición/etiología , Desnutrición/terapia , Fuerza Muscular , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Estado NutricionalRESUMEN
Introduction: Exhaustive bibliographc research in PubMed/Medline.
Introducción: Búsqueda bibliográfica exhaustiva en PubMed/Medline.
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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.
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Diabetes Mellitus Tipo 2 , Fracturas de Cadera , Hiperglucemia , Desnutrición , Sarcopenia , Humanos , Femenino , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Desnutrición/terapia , Desnutrición/complicaciones , Fracturas de Cadera/etiología , Fracturas de Cadera/terapia , Fracturas de Cadera/epidemiología , Sarcopenia/epidemiologíaRESUMEN
BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.
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COVID-19 , Desnutrición , Sarcopenia , Adulto , Humanos , Masculino , Femenino , Calidad de Vida , COVID-19/epidemiología , Sarcopenia/epidemiología , Estado Funcional , Estudios Retrospectivos , Unidades de Cuidados Intensivos , Hospitalización , Sobrevivientes , Desnutrición/epidemiología , Brotes de Enfermedades , Estado NutricionalRESUMEN
Among the principal causes producing detrimental effects on global biodiversity are introductions of alien species. Very few attempts to control introduced amphibians and reptiles in Middle America (Mexico and Central America) can be identified, so listings are provided for 24 exotic species, 16 translocated species, and 11 species that were removed from the introduced species listing because of lack of substantiating evidence that they are from established populations. Biosecurity methods are also identified that can be applied for preventing, controlling, and managing introduced and especially invasive species.
ResumenEntre las principales causas que producen efectos perjudiciales sobre la biodiversidad mundial se encuentran la introducción de especies exóticas. Se pueden identificar muy pocos intentos de controlar anfibios y reptiles introducidos en América Central (México y América Central), por lo que proporcionamos listas de 24 especies exóticas, 16 especies translocadas y 11 especies que eliminamos de la lista de especies introducidas debido a la falta de evidencia que corrobore que provienen de poblaciones establecidas. También identificamos métodos de bioseguridad que se pueden aplicar para prevenir, controlar y gestionar especies introducidas y especialmente invasoras.
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INTRODUCTION: Hypogonadism is common in human immunodeficiency virus (HIV)-infected men; the high concentration of sex hormone binding globulin (SHBG) in this population, induces a "false increase" in total testosterone (TT) values. AIMS: To validate the determination of TT and measured free testosterone (FT [radioimmunoassay {RIA}]) for hypogonadism diagnosis in an HIV-infected population using calculated free testosterone (CFT) as reference method; and also to determine the prevalence and identify the risks factors of hypogonadism. METHODS: Cross-sectional, observational study. Ninety HIV-infected males (42 ± 8.2 years), not HCV coinfected, antiretroviral therapy (ART)-naive (14 patients), on current ART with enhanced protease inhibitor (PI) (39 patients), or patients on PI-naive ART (NN) (37 patients). MAIN OUTCOME MEASURES: CFT was calculated by determining TT, SHBG, and albumin (Vermeulen's formula); hypogonadism was defined as CFT <0.22 nmol/L (reference range for young healthy males in our laboratory); sensitivity of TT and FT (RIA) for hypogonadism diagnosis was calculated. RESULTS: Twelve patients (13.3%, 95% confidence interval [CI] 7.8-21.9) by CFT presented hypogonadism. TT and FT (RIA) presented a sensitivity of less than 30% in the diagnosis of hypogonadism. Logistic regression multivariate analysis confirmed an independent association between hypogonadism, the patient's age per decade, odds ratio (OR) 6.9 (CI 1.9-24.8; P = 0.003), and longer duration of HIV infection per decade, OR 13.1 (CI 1.3-130.6; P = 0.02). Hypogonadism was associated with erectile dysfunction. CONCLUSIONS: TT and FT (RIA) are not useful in the differential diagnosis of hypogonadism in HIV-infected males. There is a significant prevalence of hypogonadism in HIV-infected males, with the patient's age and duration of the disease being the only identifiable risk factors.
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Infecciones por VIH/sangre , Hipogonadismo/sangre , Radioinmunoensayo , Testosterona/sangre , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/efectos adversos , Estudios Transversales , Hormona Folículo Estimulante/sangre , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/epidemiología , Hormona Luteinizante/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prolactina/sangre , Valores de Referencia , Factores de Riesgo , Globulina de Unión a Hormona Sexual/metabolismoRESUMEN
Previous studies have shown that music may lead to spontaneous body movement, even when people try to stand still. But are spontaneous movement responses to music similar if the stimuli are presented using headphones or speakers? This article presents results from an exploratory study in which 35 participants listened to rhythmic stimuli while standing in a neutral position. The six different stimuli were 45 s each and ranged from a simple pulse to excerpts from electronic dance music (EDM). Each participant listened to all the stimuli using both headphones and speakers. An optical motion capture system was used to calculate their quantity of motion, and a set of questionnaires collected data about music preferences, listening habits, and the experimental sessions. The results show that the participants on average moved more when listening through headphones. The headphones condition was also reported as being more tiresome by the participants. Correlations between participants' demographics, listening habits, and self-reported body motion were observed in both listening conditions. We conclude that the playback method impacts the level of body motion observed when people are listening to music. This should be taken into account when designing embodied music cognition studies.
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The links between music and human movement have been shown to provide insight into crucial aspects of human's perception, cognition, and sensorimotor systems. In this study, we examined the influence of music on movement during standstill, aiming at further characterizing the correspondences between movement, music, and perception, by analyzing head sway fractality. Eighty seven participants were asked to stand as still as possible for 500 seconds while being presented with alternating silence and audio stimuli. The audio stimuli were all rhythmic in nature, ranging from a metronome track to complex electronic dance music. The head position of each participant was captured with an optical motion capture system. Long-range correlations of head movement were estimated by detrended fluctuation analysis (DFA). Results agree with previous work on the movement-inducing effect of music, showing significantly greater head sway and lower head sway fractality during the music stimuli. In addition, patterns across stimuli suggest a two-way adaptation process to the effects of music, with musical stimuli influencing head sway while at the same time fractality modulated movement responses. Results indicate that fluctuations in head movement in both conditions exhibit long-range correlations, suggesting that the effects of music on head movement depended not only on the value of the most recent measured intervals, but also on the values of those intervals at distant times.
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Percepción Auditiva/fisiología , Movimientos de la Cabeza/fisiología , Música , Adolescente , Adulto , Cognición/fisiología , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
RATIONALE AND OBJECTIVE: The treatment of active moderate-severe Graves' ophthalmopathy (GO) is based on the administration of highdose intravenous glucocorticoids. The present study compares the efficacy and safety of 2 different intravenous methylprednisolone (MTPiv) dosing regimens. MATERIAL AND METHODS: We carry a retrospective descriptive study with sequential sampling of 24 patients (83% females) presenting moderatesevere GO (EUGOGO criteria) and receiving treatment in our center between January 2006 and June 2008. We use 2 dosing regimens: regimen A (12 weeks): 6 doses of 0.5g/week followed by 6 doses of 0.25 g/week, for a cumulative dose of 4.5 g of MTPiv (n=13); and regimen B (16 weeks): 4 cycles of 15 mg/kg, followed by 4 cycles of 7.5mg/kg, for a cumulative dose of 90 mg/kg (range, 4.9-7.4 g) (n=11). Comparisons were made for safety (fasting glucose, cytolysis-cholestasis enzymes, lipid profile) and efficacy data (clinical improvement and recurrence). RESULTS: Mild-moderate liver cytolysis was recorded in four patients, one with associated moderate cholestasis and another with hyperglycemia, leading to treatment suspension - with no differences between the 2 treatment regimens. Percentage clinical improvement with regimen A was 92% (CI, 65-94%) versus 100% with regimen B (CI, 74-100%). The recurrence rate was 43% with regimen A and 63% with regimen B (p>0.05). None of the variables examined in the univariate logistic regression study were associated to a lesser treatment response or increased risk of recurrence of GO. CONCLUSIONS: The treatment of GO with MTPiv is safe and effective, with a lower recurrence rate when using dosing regimen A.
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Oftalmopatía de Graves/tratamiento farmacológico , Metilprednisolona/administración & dosificación , Adulto , Anciano , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Esquema de Medicación , Femenino , Enfermedad de Hashimoto/tratamiento farmacológico , Humanos , Hiperglucemia/inducido químicamente , Hiperglucemia/epidemiología , Infusiones Intravenosas , Masculino , Metilprednisolona/efectos adversos , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Quimioterapia por Pulso , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Virtuosity in music performance is often associated with fast, precise, and efficient sound-producing movements. The generation of such highly skilled movements involves complex joint and muscle control by the central nervous system, and depends on the ability to anticipate, segment, and coarticulate motor elements, all within the biomechanical constraints of the human body. When successful, such motor skill should lead to what we characterize as fluency in musical performance. Detecting typical features of fluency could be very useful for technology-enhanced learning systems, assisting and supporting students during their individual practice sessions by giving feedback and helping them to adopt sustainable movement patterns. In this study, we propose to assess fluency in musical performance as the ability to smoothly and efficiently coordinate while accurately performing slow, transitionary, and rapid movements. To this end, the movements of three cello players and three drummers at different levels of skill were recorded with an optical motion capture system, while a wireless electromyography (EMG) system recorded the corresponding muscle activity from relevant landmarks. We analyzed the kinematic and coarticulation characteristics of these recordings separately and then propose a combined model of fluency in musical performance predicting music sophistication. Results suggest that expert performers' movements are characterized by consistently smooth strokes and scaling of muscle phasic coactivation. The explored model of fluency as a function of movement smoothness and coarticulation patterns was shown to be limited by the sample size, but it serves as a proof of concept. Results from this study show the potential of a technology-enhanced objective measure of fluency in musical performance, which could lead to improved practices for aspiring musicians, instructors, and researchers.
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The relationships between human body motion and music have been the focus of several studies characterizing the correspondence between voluntary motion and various sound features. The study of involuntary movement to music, however, is still scarce. Insight into crucial aspects of music cognition, as well as characterization of the vestibular and sensorimotor systems could be largely improved through a description of the underlying links between music and involuntary movement. This study presents an analysis aimed at quantifying involuntary body motion of a small magnitude (micromotion) during standstill, as well as assessing the correspondences between such micromotion and different sound features of the musical stimuli: pulse clarity, amplitude, and spectral centroid. A total of 71 participants were asked to stand as still as possible for 6 min while being presented with alternating silence and music stimuli: Electronic Dance Music (EDM), Classical Indian music, and Norwegian fiddle music (Telespringar). The motion of each participant's head was captured with a marker-based, infrared optical system. Differences in instantaneous position data were computed for each participant and the resulting time series were analyzed through cross-correlation to evaluate the delay between motion and musical features. The mean quantity of motion (QoM) was found to be highest across participants during the EDM condition. This musical genre is based on a clear pulse and rhythmic pattern, and it was also shown that pulse clarity was the metric that had the most significant effect in induced vertical motion across conditions. Correspondences were also found between motion and both brightness and loudness, providing some evidence of anticipation and reaction to the music. Overall, the proposed analysis techniques provide quantitative data and metrics on the correspondences between micromotion and music, with the EDM stimulus producing the clearest music-induced motion patterns. The analysis and results from this study are compatible with embodied music cognition and sensorimotor synchronization theories, and provide further evidence of the movement inducing effects of groove-related music features and human response to sound stimuli. Further work with larger data sets, and a wider range of stimuli, is necessary to produce conclusive findings on the subject.
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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. (AU)
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. (AU)