[Oral nutritional supplementation in hematologic patients]. / Suplementación oral nutricional en pacientes hematológicos.

RATIONALE: Hematological patients often present anorexia which along with other secondary effects from the chemotherapy and/or radiotherapy treatments compromise their nutritional status. Oral supplementation can aid to fulfill the energy and protein requirements of these patients. Nevertheless, the use of commercial nutritional supplements normally available, is limited by its poor intake. OBJECTIVE: To evaluate the degree of fulfillment of the prescribed supplements and fulfillment of energy requirements, as well as the development of nutritional status in hematological patients hospitalized for treatment with chemotherapy and/or radiotherapy. METHODS: Prospective, randomized and open study of inpatients at the hematological ward. Patients were randomized sequentially and they were assigned into 3 different nutritional interventions providing: Group 1 (G1), a flavored supplement; Group 2 (G2): a non flavored (neutral) supplement and Group 3 (G3): "kitchen" foods as supplements. Need and amount of nutritional supplements were provided according to the oral intake previously analyzed. Nutritional assessment (at admission and discharge) was based in the Subjective Global Assessment test (SGA), Risk Nutritional Index (RNI) and percentage of lost weight. Both fulfillment of supplement intake and achievement of energetic requirements were analyzed. RESULTS: 125 patients of 51.3 +/- 16.8 years; 45% men and 55% women. DIAGNOSIS: 54% lymphoma, 33% leukemia, 8% myeloma and others 4%. Length of stay (LOS): 7.0 +/- 3.6 d. The nutritional assessment done by SGA showed significant negative changes in G2 and G3 (G1: 30% developed malnutrition and 28% improved their nutritional status, p = NS; G2: 50% developed malnutrition against 7% whom improved their nutritional status, p = 0.002; y G3: 37% developed malnutrition against 21% whom improved their nutritional status, p = 0.02). According to RNI, patients evolved negatively from their nutritional state but no significant differences were found within groups (G1, from 81% of malnutrition to 90%; G2, from 77% to 91%, and G3 from 71% to 85%). Globally, during hospitalization patients lost weight significantly (2.3 +/- 2.2 kg, p < 0.001), but within groups weight loss differences were not significant (G1, 1.16 kg; G2, 1.75 kg, y G3, 1.17 kg). All three groups required intake of supplements (G1, 47%; G2, 30%, and G3, 47%). The percentage of fulfillment of oral intake was similar in both commercial supplemented groups (G1, 47% and G2, 58%) although it was significantly greater in those receiving kitchen supplements (G3, 100%, p < 0.001). The fulfillment of energy requirements at admission and discharge did not showed significant changes (G1, from 53% to 46%; G2, from 67% to 52% and G3 from 49% to 55%). CONCLUSION: Our results suggest that hematological patients admitted to hospital for treatment with chemotherapy and/or radiotherapy loose weight during their hospitalization and present intakes below their energy requirements so they need supplementation. Kitchen supplements are better accepted than commercial ones although that does not result in an increased total energy intake. The group which received commercial flavored supplements was the only one which did not showed negative significant changes in the nutritional status evaluated by SGA.

Suplementación oral nutricional en pacientes hemotológicos / Oral Nutritional supplementation in hematologic patients

Introducción: Los pacientes afectos de neoplasias hematológicas presentan con frecuencia anorexia que sumada a los efectos secundarios del tratamiento con quimioterapia y/o radioterapia comprometen su estado nutricional. La suplementación oral puede ayudar a cumplir los requerimientos energético-proteicos de estos pacientes. No obstante, el uso de los suplementos nutritivos comerciales habitualmente disponibles está limitado por su pobre aceptación. Objetivo: Evaluar el grado de cumplimiento de la prescripción de suplementos y de los requerimientos energéticos así como de la evolución del estado nutricional en pacientes hematológicos hospitalizados para tratamiento con quimioterapia y/o radioterapia. Metodología: Estudio prospectivo, aleatorio y abierto de pacientes ingresados en la planta de hematología. De forma secuencial los pacientes se asignaron a 3 tipos de intervención nutricional: Grupo 1 (G1), suplemento comercial oral con sabores; Grupo 2 (G2), suplemento comercial oral de sabor neutro, y Grupo 3 (G3), suplemento de cocina. Necesidad y cantidad de suplementos nutricionales pautados en función de la ingesta calórica calculada. Valoración nutricional (al ingreso y al alta) mediante Valoración Global Subjetiva (VGS), Índice de Riesgo Nutricional (IRN) y % de pérdida de peso (%PP). Se analizaron tanto el cumplimiento de la ingesta de suplementos como el cumplimiento de los requerimientos energéticos. Resultados: Se analizaron 125 pacientes de 51,3 ± 16,8 años (45% hombres y 55% mujeres). Diagnósticos: 54% linfoma; 33% leucemia; 8% mieloma y 4% otros. Estancia hospitalaria: 7,0 ± 3,6 días. La valoración nutricional mostró cambios significativos negativos en los pacientes de los grupos G2 y G3 con respecto a la VGS (G1: 30% desarrollaron malnutrición y 28% mejoraron su estado nutricional, p = NS; G2: 50% desarrollaron malnutrición frente al 7% que mejoraron su estado de nutrición, p = 0,002; y G3: 37% desarrollaron malnutrición versus el 21% que mejoró su estado de nutrición, p = 0,02). Según el IRN, los pacientes evolucionaron negativamente de su estado de nutrición, sin que las diferencias fueran significativas (G1, del 81% de malnutrición al 90%; G2, del 77% al 91%, y G3 del 71% al 85%). Globalmente, durante la hospitalización los pacientes perdieron peso de manera significativa (2,3 ± 2,2 kg, p < 0,001), sin que fueran significativas las pérdidas de cada grupo (G1, 1,16 kg; G2, 1,75 kg, y G3, 1,17 kg). Todos los grupos presentaron necesidad de suplementos (G1, 47%; G2, 30%, y G3, 47%). El porcentaje de cumplimiento de la ingesta de suplemento fue similar en los grupos con suplementos comerciales (G1, 47% y G2, 58%) siendo significativamente mayor en los que recibieron suplementos de cocina (G3, 100%, p < 0,001). El cumplimiento de los requerimientos energéticos al ingreso y alta del paciente no mostró cambios significativos (G1, del 53% al 46%; G2, del 67% al 52% y G3 del 49% al 55%). Conclusión: Nuestros resultados sugieren que los pacientes hematológicos ingresados en el hospital por tratamiento con quimioterapia y/o radioterapia pierden peso durante su hospitalización y presentan ingestas inferiores a sus requerimientos energéticos por lo que requieren suplementos. Los suplementos de cocina son mejor aceptados que los suplementos comerciales pero ello no comporta que incrementen las ingestas energéticas totales. El grupo que recibió suplementos comerciales con sabores fue el único que no presentó cambios negativos significativos en el estado de nutrición evaluada por la VGS (AU)

Rationale: Hematological patients often present anorexia which along with other secondary effects from the chemotherapy and/or radiotherapy treatments compromise their nutritional status. Oral supplementation can aid to fulfill the energy and protein requirements of these patients. Nevertheless, the use of commercial nutritional supplements normally available, is limited by its poor intake. Objective: To evaluate the degree of fulfillment of the prescribed supplements and fulfillment of energy requirements, as well as the development of nutritional status in hematological patients hospitalized for treatment with chemotherapy and/or radiotherapy. Methods: Prospective, randomized and open study of inpatients at the hematological ward. Patients were randomized sequentially and they were assigned into 3 different nutritional interventions providing: Group 1 (G1), a flavored supplement; Group 2 (G2): a non flavored (neutral) supplement and Group 3 (G3): "kitchen" foods as supplements. Need and amount of nutritional supplements were provided according to the oral intake previously analyzed. Nutritional assessment (at admission and discharge) was based in the Subjective Global Assessment test (SGA), Risk Nutritional Index (RNI) and percentage of lost weight. Both fulfillment of supplement intake and achievement of energetic requirements were analyzed. Results: 125 patients of 51.3 ± 16.8 years; 45% men and 55% women. Diagnosis: 54% lymphoma, 33% leukemia, 8% myeloma and others 4%. Length of stay (LOS): 7.0 ± 3.6 d. The nutritional assessment done by SGA showed significant negative changes in G2 and G3 (G1: 30% developed malnutrition and 28% improved their nutritional status, p = NS; G2: 50% developed malnutrition against 7% whom improved their nutritional status, p = 0.002; y G3: 37% developed malnutrition against 21% whom improved their nutritional status, p = 0.02). According to RNI, patients evolved negatively from their nutritional state but no significant differences were found within groups (G1, from 81% of malnutrition to 90%; G2, from 77% to 91%, and G3 from 71% to 85%). Globally, during hospitalization patients lost weight significantly (2.3 ± 2.2 kg, p < 0.001), but within groups weight loss differences were not significant (G1, 1.16 kg; G2, 1.75 kg, y G3, 1.17 kg). All three groups required intake of supplements (G1, 47%; G2, 30%, and G3, 47%). The percentage of fulfillment of oral intake was similar in both commercial supplemented groups (G1, 47% and G2, 58%) although it was significantly greater in those receiving kitchen supplements (G3, 100%, p < 0.001). The fulfillment of energy requirements at admission and discharge did not showed significant changes (G1, from 53% to 46%; G2, from 67% to 52% and G3 from 49% to 55%). Conclusion: Our results suggest that hematological patients admitted to hospital for treatment with chemotherapy and/or radiotherapy loose weight during their hospitalization and present intakes below their energy requirements so they need supplementation. Kitchen supplements are better accepted than commercial ones although that does not result in an increased total energy intake. The group which received commercial flavored supplements was the only one which did not showed negative significant changes in the nutritional status evaluated by SGA (AU)

Poliartritis secundaria a instilaciones intravesicales de BCG, a propósito de un caso / Polyarthritis secondary to intravesical BCG instillation, a case report

La inmunoterapia endovesical con BCG es el mejor tratamiento complementario para tumores T1 G2-G3 y TiS. Sin embargo, esta terapia se ha asociado con diversos efectos secundarios, incluidos síntomas articulares. En este artículo, describimos un caso de poliartritis secundaria a instilaciones vesicales, una rara complicación. Realizamos una revisión de las manifestaciones clínicas, mecanismos de producción y tratamientos descritos con anterioridad en la literatura médica. Por último, exponemos nuestra breve experiencia y nuestro resultado final

Immunotherapy with intravesical instillation of Bacillus Calmette is the best complementary after TUR treatment against T1 grade 2- 3 and CIS bladder cancer. However, this therapy is associated with several side- effects, incluiding joint symptoms. In this article we describe a case of polyarthritis associated with intravesical instillation, a rare complication. We review the clinical features, the pathogenic mechanisms and treatments described previously in the medical literature. Finally, we expose our brief experience and our final result

Micronutrient supplementation in mild Alzheimer disease patients.

OBJECTIVE: To evaluate if nutritional supplementation with or without micronutrient enhancement prevent weight loss and the progression of the disease in mild Alzheimer's Disease (AD) patients. DESIGN: Mild AD patients were recruited from an Alzheimer Day Centre. Subjects received oral liquid supplements with (Study-group: S) or without (Control-group: C) micronutrient enhancement. Intake assessment, nutritional status, biochemical parameters, cognitive function, and eating behaviour disorders were determined at baseline and at 6 months of treatment. RESULTS: At baseline both groups were not different in any variable measured. They were norm nourished, with normal biochemical parameters. Blandford scale demonstrated a mild alteration of feeding behaviour, the cognitive scale classified the patients as impaired and there was presence of memory complaints. After 6 months of nutritional supplements, a similar increase in energy consumption was observed in both groups of patients (P<0.05). In the within-group analysis, we found a trend (P=0.05) to increase body mass index; a significant increase in triceps skin fold thickness, mid-upper-arm circumference and serum magnesium, zinc and selenium, and a significant reduction in serum vitamin E (P<0.001, each). Serum cholesterol decreased substantially only in the S-group (P=0.025). No significant differences at baseline, within-group, neither between-group analysis in feeding behaviour nor in cognitive function were observed. CONCLUSIONS: According to our results no benefits in the progression of the disease was observed with micronutrient enhancement supplements. Effectiveness of nutritional supplements in preventing weight loss in mild AD patients showed a similar behaviour as observed in other populations. Due to the beneficial evolution of serum cholesterol in the S-group, this intervention deserves further investigation.

Effects of taurine on polymorphonuclear phagocytosis activity in burned patients.

This study determines the effects of taurine (Tau) on phagocytosis of polymorphonuclear neutrophils (PMN) isolated from normal subjects (n = 41) and severely burned patients (n = 20). Phagocytosis was measured by nitroblue of tetrazolium (NBT) reduction in samples with and without latex bead stimulation. Taurine was added at doses of 0.2, 0.4, 0.8 and 1.6 mM to stimulated samples. In control cells there were statistically significant increases in phagocytosis after addition of Tau 0.8 mM and 1.6 mM to as compared to samples without Tau addition (295 +/- 23% and 330 +/- 35% vs. 248 +/- 18%; mean +/- S.E.; p < 0.05). A statistically significant increase in phagocytosis was observed in cells from the burned population after addition of Tau 1.6 mM (288 +/- 38% vs. 198 +/- 13%; mean +/- S.E.; p < 0.05). No changes in phagocytosis were found in cells from a subgroup of burn patients (n = 13) followed over 7, 15 and 21 days. These results indicate that taurine supplementation in vitro at doses of 0.8 to 1.6 mM improves the phagocytic capacity of neutrophils in healthy subjects and in patients with severe burn injury, mainly when neutrophil function is unaltered.