Prevalence and Biological Correlates of Oropharyngeal Dysphagia in Outpatients of a Geriatric Evaluation Clinic: A Brief Report.

BACKGROUND: Oropharyngeal dysphagia (OD) is a relevant disease among older adults and is associated with serious adverse health-related outcomes, such as malnutrition, sarcopenia, or frailty. Increasing its recognition and the related mechanisms will allow us to its prevention and treatment at different levels of care. OBJECTIVES: This study aimed to determine the prevalence and biological correlates of OD in outpatient older adults. METHOD: This is a cross-sectional study including 100 adults aged 60 or older from a geriatric clinic of a tertiary hospital in Mexico City. Health variables and geriatric syndromes were recorded. The Eating Assessment Tool-10 detection test and the volume-viscosity swallowing test were used to diagnose OD. Logistic regression models were performed to identify the factors associated with OD. RESULTS: Mean age was 81.2 (±7.5) years and 21% had OD. The presence of xerostomia (p = 0.05) and a worst nutritional status (p = 0.035) were obtained. CONCLUSIONS: The prevalence of OD among older adults was high. Inadequate nutrition status and the presence of xerostomia are more likely to be present with this swallowing disorder.

Characteristics of patients receiving nutrition care and its associations with prognosis in a tertiary hospital.

OBJECTIVE: The aim of this study was to describe the medical nutritional therapy (MNT) of adult non-critically ill hospitalization patients. METHODS: In a retrospective study, adults hospitalized for more than 48 h in non-intensive care unit medical and surgical areas that were classified as being at nutritional risk were included. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: A total of 255 patients, aged 54.13±18.4 years, who were at risk of malnutrition were included in this study. Of these, 50% were males. Notably, 52.5% received oral nutrition supplementation (ONS), 23.5% enteral nutrition (EN), 15% parenteral nutrition (PN), and 9% received enteral and parenteral nutrition (EPN). Patients with EPN presented the highest frequency of malnutrition (52%), and therefore they received more than 100% of energy and protein requirements. The median length of stay was 25 days. Among patients with nutritional risk receiving EPN, no deaths occurred. Patients, identified at nutritional risk, but without malnutrition according to GLIM, and receiving ONS had significantly lower mortality than patients receiving other MNT. CONCLUSIONS: Oral nutrition supplementation was the more frequent MNT prescribed. The frequency of malnutrition and percentage of prescribed energy and protein were higher in patients receiving PN and EPN compared with those receiving ONS.

[Critical deficiencies of energy and protein with a high provision of non-nutritional calories after one week in an intensive care unit]. / Déficit energético y proteico crítico con gran aporte de calorías provenientes de fármacos tras una semana en una unidad de cuidados intensivos.

INTRODUCTION: Introduction: nutritional therapy is essential for the treatment of critically ill patients, although its right application fails frequently, which increases the risk for undernutrition and complications. Objective: to evaluate the nutritional adequacy of patients with enteral nutritional support in an intensive care unit (ICU). Methods: a cohort study was conducted including adults admitted to the ICU with enteral support and stay ≥ 7 days. Demographic data, severity of the disease, and clinical and nutritional scores, including IL-6 levels and body composition, were evaluated at admission. Nutritional intake was recorded daily in relation to the target intake according to international guidelines, for calculation of caloric and protein deficiencies. Results: in all, 26 from 132 admitted patients were included. Their probability of mortality was 20-25 % due to disease severity by APACHE (16.6 ± 6.02) and SOFA (8 ± 4.4). Undernutrition risk was 5.6 ± 1.09 by NRS-2002 and 4.3 ± 1.2 by angle phase. Caloric deficiency was -674 kcal/day, with 13 % proteins (28 ± 11.5 g/d) and 42 % lipids, including 17.5 % of non-nutrient calories from propofol. NUTRIC was significantly associated with percentages of the caloric prescription at days 3 and 7 (R2 = 0.21, p = 0.01). Conclusion: patients had a caloric/protein deficit with critical protein deficit of -85.2 g/day, and an inadequate proportion between protein calories and non-protein calories, increasing their risk of complications.

INTRODUCCIÓN: Introducción: la terapia nutricional es esencial para tratar a pacientes críticos pero, si no es la adecuada, aumenta el riesgo de desnutrición y complica la evolución. Objetivo: evaluar la adecuación de la terapia nutricional enteral en una unidad de cuidados intensivos (UCI). Métodos: se evaluó una cohorte adulta ingresada a una UCI con nutrición enteral y estancia ≥ 7 días. Al ingreso se registraron la severidad de la enfermedad y los datos socio-demográficos, clínicos y nutricionales, con cribados que incluyeron la IL-6 y la composición corporal. Diariamente se evaluó el aporte de nutrientes con respecto al 70 % óptimo de lo prescrito por las guías internacionales, para estimar el déficit energético-proteico. Resultados: se incluyeron 26 de 132 pacientes ingresados. Su probabilidad de mortalidad era del 20-25 % debido a la severidad de su enfermedad por los sistemas APACHE (16,6 ± 6,0) y SOFA (8 ± 4,4); su riesgo de desnutrición era de 5,6 ± 1,09 puntos por el NRS-2002, con 4,3 ± 1,2 de ángulo de fase. El déficit energético promedio era de -674 kcal/día, con un 13 % en aporte proteico (28 ± 11,5 g/d) y un 42 % en lípidos, y con el 17,5 % proveniente del propofol. El NUTRIC se asoció significativamente con los porcentajes de prescripción calórica alcanzados los días 3 y 7 (R2 = 0,21, p = 0,01). Conclusión: los pacientes sufrieron déficit calórico/proteico, con déficit proteico crítico de > 85,2 g/día e inadecuada relación entre calorías proteicas y no proteicas, aumentando su riesgo de complicaciones.

Critical analysis of studies evaluating the efficacy of infusion of L-ornithine L-aspartate in clinical hepatic encephalopathy in patients with liver failure.

Introduction. Hepatic encephalopathy (HE) refers to a complex neuropsychiatric syndrome that is progressive but potentially reversible and may have a significant impact on quality of life, as it is characterized by alterations in cognitive function, behavior and personality as well as transient neurological symptoms and electroencephalographic abnormalities. Objective. The aim of this study was to evaluate scientific evidence for the effectiveness and safety of LOLA infusions for treatment of clinical hepatic encephalopathy in patients with chronic liver disease. Material and methods. We included all randomized, controlled, double-blind, and humans' studies that were published in indexed journals. Results. Were identified 48 references (17 using PubMed, 12 using Medline and 19 using the Cochrane database). Of these, six were selected as having met the inclusion criteria. A total of 623 patients were randomized in these publications. Conclusion. The available scientific evidence supports the adoption of LOLA infusion as a treatment for clinical encephalopathy in patients with liver failure, because it has been shown to improve neuropsychiatric status and decrease serum levels of ammonia with a low incidence of adverse effects (less than 5%).

A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults.

OBJECTIVE: The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. METHODS: A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. RESULTS: Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41-2.90, p=0.01). CONCLUSIONS: A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

[Nutritional management of the critically ill inpatient with COVID-19. A narrative review]. / Manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19. Una revisión narrativa.

INTRODUCTION: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.

INTRODUCCIÓN: La pandemia actual por COVID-19 afecta principalmente a personas mayores, con obesidad o con otras enfermedades crónicas coexistentes como diabetes de tipo 2 e hipertensión arterial. Se ha observado que alrededor del 20 % de los pacientes requerirán hospitalización y algunos de ellos necesitarán soporte de ventilación mecánica invasiva en unidades de cuidados intensivos. El estado nutricional parece ser un factor relevante que influye en el resultado clínico de los pacientes con COVID-19 críticamente enfermos. Diversas guías internacionales han publicado recomendaciones para asegurar la ingesta energética y proteica de las personas con COVID-19, junto con medidas de seguridad para disminuir el riesgo de infección por parte del personal de salud. El propósito de esta revisión es analizar las principales recomendaciones relacionadas con el adecuado manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19 con la finalidad de mejorar el pronóstico y los resultados clínicos.

Increased Efficacy and Safety of Enteral Nutrition Support with a Protocol (ASNET) in Noncritical Patients: A Randomized Controlled Trial.

BACKGROUND: Unintentional underfeeding is common in patients receiving enteral nutrition (EN), and is associated with increased risk of malnutrition complications. Protocols for EN in critically ill patients have been shown to enhance adequacy, resulting in better clinical outcomes; however, outside of intensive care unit (ICU) settings, the influence of a protocol for EN is unknown. OBJECTIVE: To evaluate the efficacy and safety of implementing an EN protocol in a noncritical setting. DESIGN: Randomized controlled clinical trial. PARTICIPANTS AND SETTINGS: This trial was conducted from 2014 to 2016 in 90 adult hospitalized patients (non-ICU) receiving exclusively EN. Patients with carcinomatosis, ICU admission, or <72 hours of EN were excluded. INTERVENTION: The intervention group received EN according to a protocol, whereas the control group was fed according to standard practice. MAIN OUTCOME MEASURES: The proportion of patients receiving ≥80% of their caloric target at Day 4 after EN initiation. STATISTICAL ANALYSES PERFORMED: Student t test or Wilcoxon rank-sum test were used for continuous variables and the difference between the groups in the time to receipt of the optimal amount of nutrition was analyzed using Kaplan-Meier curves. RESULTS: Forty-five patients were randomized to each group. At Day 4 after EN initiation, 61% of patients in the intervention arm had achieved the primary end point compared with 23% in the control group (P=0.001). In malnourished patients, 63% achieved the primary end point in the intervention group compared with 16% in the control group (P=0.003). The cumulative deficit on Day 4 was lower in the intervention arm compared with the control arm: 2,507 kcal (interquartile range [IQR]=1,262 to 2,908 kcal) vs 3,844 kcal (IQR=2,620 to 4,808 kcal) (P<0.001) and 116 g (IQR=69 to 151 g) vs 191 g (IQR=147 to 244 g) protein (P<0.001), respectively. The rates of gastrointestinal complications were not significantly different between groups. CONCLUSIONS: Implementation of an EN protocol outside the ICU significantly improved the delivery of calories and protein when compared with current standard practice without increasing gastrointestinal complications.

Characteristics of patients receiving nutrition care and its associations with prognosis in a tertiary hospital

SUMMARY OBJECTIVE: The aim of this study was to describe the medical nutritional therapy (MNT) of adult non-critically ill hospitalization patients. METHODS: In a retrospective study, adults hospitalized for more than 48 h in non-intensive care unit medical and surgical areas that were classified as being at nutritional risk were included. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS: A total of 255 patients, aged 54.13±18.4 years, who were at risk of malnutrition were included in this study. Of these, 50% were males. Notably, 52.5% received oral nutrition supplementation (ONS), 23.5% enteral nutrition (EN), 15% parenteral nutrition (PN), and 9% received enteral and parenteral nutrition (EPN). Patients with EPN presented the highest frequency of malnutrition (52%), and therefore they received more than 100% of energy and protein requirements. The median length of stay was 25 days. Among patients with nutritional risk receiving EPN, no deaths occurred. Patients, identified at nutritional risk, but without malnutrition according to GLIM, and receiving ONS had significantly lower mortality than patients receiving other MNT. CONCLUSIONS: Oral nutrition supplementation was the more frequent MNT prescribed. The frequency of malnutrition and percentage of prescribed energy and protein were higher in patients receiving PN and EPN compared with those receiving ONS.

The two sides of superior mesenteric artery syndrome treatment: conservative or surgical management?

INTRODUCTION: Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by vascular compression of the duodenum. There is controversy regarding the optimal treatment. CASE REPORT: In case 1, we describe the case of a 21-year-old woman (body mass index -BMI- 16.9 kg/m2) with high-level obstructive symptoms three months prior, with computed tomography scan (TC) showing a superior mesenteric artery aorta angle (SMAA) of 13º and compression of the third portion of the duodenum (D3), for this reason a nasojejunal tube was placed for enteral feeding. In case 2, enteral nutrition was initiated for feeding a 17-year-old female with anorexia nervosa (BMI 8.3 kg/m2). She presented macrohematuria, vomiting, epigastralgia, abdominal distension and acute abdomen when oral feeding was reinitiated. TC reported a SMAA of 15º, in addition to compression of the left renal vein (Nutcracker syndrome) and gastro duodenal expansion, surgical management was necessary. DISCUSSION: Both cases had favorable evolution, being the nutritional support fundamental. SMAS should be suspected in all people with high-level obstructive symptoms and recent weight loss.

A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults

SUMMARY OBJECTIVE The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. METHODS A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. RESULTS Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41-2.90, p=0.01). CONCLUSIONS A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

Validation of a new formula for predicting body weight in a Mexican population with overweight and obesity.

INTRODUCTION: Body weight measurement is of critical importance when evaluating the nutritional status of patients entering a hospital. In some situations, such as the case of patients who are bedridden or in wheelchairs, these measurements cannot be obtained using standardized methods. We have designed and validated a formula for predicting body weight. OBJECTIVES: To design and validate a formula for predicting body weight using circumference-based equations. METHODS: The following anthropometric measurements were taken for a sample of 76 patients: weight (kg), calf circumference, average arm circumference, waist circumference, hip circumference, wrist circumference and demispan. All circumferences were taken in centimetres (cm), and gender and age were taken into account. This equation was validated in 85 individuals from a different population. The correlation with the new equation was analyzed and compared to a previously validated method. RESULTS: The equation for weight prediction was the following: Weight = 0.524 (WC) - 0.176 (age) + 0.484 (HC) + 0.613 (DS) + 0.704 (CC) + 2.75 (WrC) - 3.330 (if female) - 140.87. The correlation coefficient was 0.96 for the total group of patients, 0.971 for men and 0.961 for women (p < 0.0001 for all measurements). CONCLUSION: The equation we developed is accurate and can be used to estimate body weight in overweight and/or obese patients with mobility problems, such as bedridden patients or patients in wheelchairs.

Introducción: La medición del peso corporal resulta de suma importancia en la evaluación del estado nutricional de los pacientes que ingresan a una institución hospitalaria. En algunas situaciones, estas mediciones no pueden obtenerse por los métodos estandarizados, como es el caso de los pacientes encamados o en silla de ruedas. Nosotros diseñamos y validamos una fórmula de predicción del peso corporal. Objetivos: Diseñar y validar una fórmula de predicción del peso corporal utilizando circunferencias. Métodos: Se realizaron las siguientes medidas antropométricas en una muestra de 76 pacientes: peso en kg (P), circunferencia de pantorrilla (CP), circunferencia media de brazo (CMB), cintura (CC), cadera (CCad), circunferencia de muñeca (CM) y media envergadura (ME) todas las circunferencias fueron tomadas en cm y así mismo se tomó en cuenta el género y la edad. De estas mediciones obtuvimos una ecuación de predicción del peso corporal. Esta ecuación se validó en 85 individuos de una población diferente. Se realizó un análisis de la correlación de la nueva ecuación contra un método previamente validado. Resultados: La ecuación de predicción de peso fue la siguiente: Peso = 0,524 (CC) - 0,176 (edad) + 0,484 (CCad) + 0,613 (ME) + 0,704 (CP) + 2,75 (CM) - 3,330 (si es mujer) -140,87. El coeficiente de correlación fue de 0,96 para el grupo de pacientes totales y de 0,971 para hombres y 0,961 para mujeres (todos p < 0,0001). Conclusión: La ecuación desarrollada en nuestro trabajo, es precisa, y puede emplearse para estimar el peso corporal en pacientes con sobrepeso y/o obesidad que tengan problemas de movilidad como pacientes encamados, o en sillas de ruedas.

The two sides of superior mesenteric artery syndrome treatment: conservative or surgical management? / Las dos caras del tratamiento del síndrome de la arteria mesentérica superior: ¿manejo conservador o quirúrgico?

Introduction: Superior mesenteric artery syndrome (SMAS) is a rare condition characterized by vascular compression of the duodenum. There is controversy regarding the optimal treatment. Case report: In case 1, we describe the case of a 21-year-old woman (body mass index [BMI] 16.9 kg/m2) with high-level obstructive symptoms three months prior, with computed tomography scan (TC) showing a superior mesenteric artery aorta angle (SMAA) of 13° and compression of the third portion of the duodenum (D3), for this reason a nasojejunal tube was placed for enteral feeding. In case 2, enteral nutrition was initiated for feeding a 17-year-old female with anorexia nervosa (BMI 8.3 kg/m2). She presented macrohematuria, vomiting, epigastralgia, abdominal distension and acute abdomen when oral feeding was reinitiated. TC reported a SMAA of 15°, in addition to compression of the left renal vein (Nutcracker syndrome) and gastro duodenal expansion, surgical management was necessary. Discussion: Both cases had favorable evolution, being the nutritional support fundamental. SMAS should be suspected in all people with high-level obstructive symptoms and recent weight loss (AU)

Introducción: el síndrome de la arteria mesentérica superior (SAMS) es una condición rara caracterizada por la compresión vascular del duodeno, y existe controversia acerca de su tratamiento. Caso clínico: en el caso 1, presentamos a una mujer de 21 años (índice de masa corporal [IMC] 16,9 kg/m2) con datos de obstrucción alta y epigastralgia durante los tres meses previos, con tomografía computarizada (TC) que reporta ángulo de la arteria mesentérica superior (AAMS) de 13° y compresión de D3. Se colocó sonda nasoyeyunal para alimentarla. En el caso 2, se inició alimentación enteral por sonda nasogástrica en una mujer de 17 años con anorexia nerviosa (IMC 8,3 kg/m2). Al reiniciar la vía oral presentó hematuria, vómito, epigastralgia, distensión abdominal y abdomen agudo. La TC reportó AAMS 15°, compresión de la vena renal izquierda (síndrome de Nutcracker) y distensión gastroduodenal. Requirió tratamiento quirúrgico. Discusión: ambas pacientes tuvieron evolución favorable, siendo fundamental el soporte nutricional. Se debe sospechar el SAMS en los pacientes con datos de obstrucción intestinal alta y pérdida de peso reciente (AU)

Validation of a new formula for predicting body weight in a Mexican population with overweight and obesity / Validación de una nueva fórmula de predicción de peso en población mexicana con sobrepeso y obesidad

INTRODUCTION: Body weight measurement is of critical importance when evaluating the nutritional status of patients entering a hospital. In some situations, such as the case of patients who are bedridden or in wheelchairs, these measurements cannot be obtained using standardized methods. We have designed and validated a formula for predicting body weight. OBJECTIVES: To design and validate a formula for predicting body weight using circumference-based equations. METHODS: The following anthropometric measurements were taken for a sample of 76 patients: weight (kg), calf circumference, average arm circumference, waist circumference, hip circumference, wrist circumference and demispan. All circumferences were taken in centimetres (cm), and gender and age were taken into account. This equation was validated in 85 individuals from a different population. The correlation with the new equation was analyzed and compared to a previously validated method. RESULTS: The equation for weight prediction was the following: Weight = 0.524 (WC) - 0.176 (age) + 0.484 (HC) + 0.613 (DS) + 0.704 (CC) + 2.75 (WrC) - 3.330 (if female) - 140.87. The correlation coefficient was 0.96 for the total group of patients, 0.971 for men and 0.961 for women (p < 0.0001 for all measurements).CONCLUSION: The equation we developed is accurate and can be used to estimate body weight in overweight and/or obese patients with mobility problems, such as bedridden patients or patients in wheelchairs (AU)

Introducción: La medición del peso corporal resulta de suma importancia en la evaluación del estado nutricional de los pacientes que ingresan a una institución hospitalaria. En algunas situaciones, estas mediciones no pueden obtenerse por los métodos estandarizados, como es el caso de los pacientes encamados o en silla de ruedas. Nosotros diseñamos y validamos una fórmula de predicción del peso corporal. Objetivos: Diseñar y validar una fórmula de predicción del peso corporal utilizando circunferencias. Métodos: Se realizaron las siguientes medidas antropométricas en una muestra de 76 pacientes: peso en kg (P), circunferencia de pantorrilla (CP), circunferencia media de brazo (CMB), cintura (CC), cadera (CCad), circunferencia de muñeca (CM) y media envergadura (ME) todas las circunferencias fueron tomadas en cm y así mismo se tomó en cuenta el género y la edad. De estas mediciones obtuvimos una ecuación de predicción del peso corporal. Esta ecuación se validó en 85 individuos de una población diferente. Se realizó un análisis de la correlación de la nueva ecuación contra un método previamente validado. Resultados: La ecuación de predicción de peso fue la siguiente: Peso = 0,524 (CC) - 0,176 (edad) + 0,484 (CCad) + 0,613 (ME) + 0,704 (CP) + 2,75 (CM) - 3,330 (si es mujer) -140,87. El coeficiente de correlación fue de 0,96 para el grupo de pacientes totales y de 0,971 para hombres y 0,961 para mujeres (todos p < 0,0001). Conclusión: La ecuación desarrollada en nuestro trabajo, es precisa, y puede emplearse para estimar el peso corporal en pacientes con sobrepeso y/o obesidad que tengan problemas de movilidad como pacientes encamados, o en sillas de ruedas (AU)

Desnutrición en pacientes adultos con leucemia aguda / Malnutrition in adults patients with acute leukemia

El estado nutricio de los pacientes se deteriora principalmente durante el tratamiento intensivo de la enfermedad. Estudios previos sugieren que la desnutrición puede tener efectos negativos en el pronóstico de los enfermos. El objetivo de este estudio fue determinar la frecuencia de desnutrición durante el tratamiento de inducción a la remisión y su impacto en algunas variables clínicas. Se estudiaron durante 18 meses a los pacientes con diagnóstico de leucemia aguda de novo. Se evaluó el estado nutricio a través de la valoración global subjetiva, mediciones antropométricas, albúmina sérica e índice de riesgo nutricio en el diagnóstico y un mes después. Se dio seguimiento a los pacientes durante 2 meses para registrar la estancia intrahospitalaria, remisión completa, mortalidad temprana y toxicidad. Fueron incluidos 32 pacientes. La prevalencia de desnutrición de acuerdo a la valoración global subjetiva fue de 0.61 al diagnóstico e incremento a 0.93 un mes después (p<0.05). Al comparar los indicadores antropométricos se encontraron diferencias significativas en el peso, índice de masa corporal, panículos adiposos, área muscular braquial y porcentaje de masa grasa (p<0.005). 22 pacientes (0.71) alcanzaron la remisión completa y la tasa de mortalidad temprana fue de 0.10. No se demostró asociación entre el estado nutricion y las variables estudiadas. La frecuencia de desnutrición es alta en pacientes con leucemia aguda al diagnóstico y se incrementa significativamente después de la quimioterapia para inducir la remisión. Las tasas de desnutrición registradas en el presente estudio justifican una intervención terapéutica desde el punto de vista nutricional (AU)

The nutritional status of patients is frequently impaired during intensive induction chemotherapy. Previous studies have suggested that malnutrition may have an adverse effect on prognosis. The aim of the study was to determine the prevalence of malnutrition during induction chemotherapy treatment and its impact on the outcome. Acute leukemia patients were prospectively studied during first remission induction chemotherapy. The study was performed over a period of 18 consecutive months. The subjective global assessment, nutrition risk index, anthropometric and laboratory data were determined at diagnosis and on day 30 of the treatment in order to evaluate nutritional status. Patients were prospectively followed until 60 days after diagnosis. An analysis was made including demographic data, nutritional assessment, albumin, complications, rate of complete remission, rate of early mortality and length of hospital stay. 32 patients were included. At diagnosis, the prevalence of malnutrition was 61% according to the subjective global assessment and increased to 93% on day 30(p<0.05). Patients have deterioration of the nutritional status the weight, body mass index, skin folds, arm muscle area and percent body fat were stadistically significant(p<0.005). We obtained initial complete remission in 22 patients (71%), the mortality rate due to post-chemotherapy aplasia (early mortality) in the prospective cohort was 10%. Nutritional status was not associated with complete remission or early mortality rate. The high incidence of malnutrition at the time of diagnosis and during chemotherapy indicate the importance of nutritional status evaluation, during this period intensive supportive care, including nutritional therapy is required (AU)

Comparación del índice de gravedad del síndrome de Cushing entre pacientes con origen endógeno y yatrogénico de la enfermedad / Comparison of the severity index in Cushing's syndrome between patients with endogenous and iatrogenic disease

Resumen El síndrome de Cushing (SC) es una patología rara que puede verse más frecuentemente secundaria a la ingesta de glucocorticoides (GC). Los datos más distintivos entre SC endógeno (SCE) y yatrógeno (SCI) no han sido publicados. Objetivo Comparar la puntuación obtenida del índice de gravedad en síndrome de Cushing (IGSC) en ambas etiologías: endógeno y yatrógeno; y documentar qué parámetros clínicos del IGSC son los más frecuentes y representativos del SC. Material y métodos Estudio observacional, descriptivo y transversal. En el grupo SCE se incluyeron pacientes de ambos géneros con diagnóstico de hipercortisolismo endógeno, que dispusieran de una medición de corticotropina (ACTH) y ausencia de causas de pseudocushing. En el grupo con SCI se incluyeron aquellos pacientes con antecedentes de uso de GC sistémicos a dosis altas, facies cushingoide, ausencia de causas de pseudocushing y sin diagnóstico de hipertensión arterial y diabetes mellitus previo al inicio de la ingesta de GC. Se indagó el diagnóstico de la entidad nosológica causante de SCE. A los pacientes con SCI se les documentó las características de los GC empleados y la forma de uso. Se calcularon las dosis diarias y acumuladas en miligramos de prednisona. Se aplicó el IGSC a los pacientes con SCI y SCE, y se comparó la puntuación y características clínicas entre ambos. Resultados Se incluyeron 20 pacientes, 10 con SCI y 10 con SCE. El 80% (8) de los pacientes con SCE y la mitad (5) de los pacientes con SCI fueron mujeres. Los diagnósticos en los pacientes con SCE fueron 9 SC dependientes de ACTH y 1 independiente de ACTH. El promedio de la dosis diaria en equivalencia de prednisona utilizada por los pacientes de SCI fue de 13,5mg, y la media de dosis total acumulada para todos los pacientes con SCI fue de 9.962,5mg. El promedio de la puntuación total del IGSC para el grupo de SCE fue de 8,6 vs 3,8 (..) (AU)

Abstract Cushing's syndrome (CS) is a rare condition that is most often secondary to glucocorticoid (GC) intake. Definitive data on the distinction between endogenous CS (ECS) and yatrogenic (YCS) have not been published. Objective To compare the severity index in Cushing's syndrome (SICS) score in the two etiologies, endogenous and yatrogenic, and identify which clinical parameters of the SICS are the most frequent and representative of CS. Material and methods We performed an observational, descriptive and cross-sectional study. The ECS group included men and women with a diagnosis of endogenous hypercortisolism, with measurement of adrenocorticotropin hormone (ACTH) and absence of causes of pseudo-Cushing's syndrome. The YCS group included patients with a history of use of high-dose systemic GC, cushingoid facies, absence of causes of pseudo-Cushing's syndrome and no diagnosis of hypertension or diabetes mellitus before the start of GC intake. We investigated the diagnosis of the disease entity causing ECS. In patients with ICS, the characteristics of the GC employed and how these drugs were used were recorded. We calculated daily and cumulative doses in milligrams of prednisone. In all patients, the SICS was applied and the clinical characteristics of the two groups were compared. Results We included 20 patients, 10 with YCS and 10 with ECS. There were eight women in the ECS group (80%) and five in the YCS group (50%). The diagnoses in patients with ECS were ACTH-dependent CS in nine and ACTH-independent CS in one. The mean daily dose of prednisone equivalent used by patients with YCS was 13.5mg, and the mean total cumulative dose for all patients with ICS was 9962.5mg. The mean total SICS score for the ECS group was 8.6 (..) (AU)