Antibacterial properties of phenothiazine derivatives against multidrug-resistant Acinetobacter baumannii strains.

AIM: As options to treat recalcitrant bacterial infections which are increasingly limited due to multidrug-resistant strains, searching for new, effective antibacterial compounds is necessary. One strategy is to generate treatment alternatives by drug repurposing. METHODS AND RESULTS: In this work, phenotypic microarrays were used for the screening of miscellaneous compounds against the growth and biofilm formation of Acinetobacter baumannii, an important emergent multidrug-resistant opportunistic pathogen. The results showed that the phenothiazine derivatives, such as promethazine, trifluoperazine, thioridazine, and chlorpromazine, inhibited the growth of antibiotic-sensitive and multidrug-resistant strains (showing minimal inhibitory concentrations ranging from 0·05 to 0·6 g l-1 and minimal bactericidal concentrations ranging from 0·1 to 2·5 g l-1 ). All phenothiazine derivatives were active against biofilm cells (with minimal biofilm eradication concentrations ranging from 0·5 to >3 g l-1 ). Chlorpromazine promoted reactive oxigen species (ROS) production, and cell membrane and DNA damage. Chlorpromazine showed synergy with antibiotics such as ceftazidime, meropenem, and colistin and was an effective treatment for experimentally infected Galleria mellonella when combined with ceftazidime. CONCLUSIONS: It was demonstrated that phenothiazine derivatives, especially chlorpromazine, are drugs with attractive antibacterial properties against nosocomial MDR strains of A. baumannii, by generating ROS and cell membrane and DNA damage. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study indicates that repurposing phenothiazine derivatives for treating recalcitrant infections by A. baumannii could be promising.

Anti-inflammatory and antiproliferative evaluation of 4ß-cinnamoyloxy,1ß,3α-dihydroxyeudesm-7,8-ene from Verbesina persicifolia and derivatives.

The anti-inflammatory and antiproliferative activities of 4ß-cinnamoyloxy,1ß,3α-dihydroxyeudesm-7,8-ene (1) and of three derivatives, namely diacetate (2), hydrogenate (3) and diacetate hydrogenate (4) were evaluated. All derivatives exert an anti-inflammatory effect significantly lower than that exerted by 1. Otherwise, both the lead compound and 2-4 showed a comparable antiproliferative activity on human tumor cell lines. The investigation of the mechanism of action accountable for cytotoxicity highlighted the capacity to impair mitochondrial functions through two different pathways, depending on chemical structure. In particular, the lead compound 1 and derivative 3 are able to induce mitochondrial permeability transition, while derivatives 2 and 4 inhibit Complex II in the respiratory chain.

First Mexican Consensus on Crohn's disease.

INTRODUCTION: Crohn's disease (CD) is a subtype of chronic and incurable inflammatory bowel disease. It can affect the entire gastrointestinal tract and its etiology is unknown. OBJECTIVE: The aim of this consensus was to establish the most relevant aspects related to definitions, diagnosis, follow-up, medical treatment, and surgical treatment of Crohn's disease in Mexico. MATERIAL AND METHODS: Mexican specialists in the areas of gastroenterology and inflammatory bowel disease were summoned. The consensus was divided into five modules, with 69 statements. Applying the Delphi panel method, the pre-meeting questions were sent to the participants, to be edited and weighted. At the face-to-face meeting, all the selected articles were shown, underlining their level of clinical evidence; all the statements were discussed, and a final vote was carried out, determining the percentage of agreement for each statement. RESULTS: The first Mexican consensus on Crohn's disease was produced, in which recommendations for definitions, classifications, diagnostic aspects, follow-up, medical treatment, and surgical treatment were established. CONCLUSIONS: Updated recommendations are provided that focus on definitions, classifications, diagnostic criteria, follow-up, and guidelines for conventional medical treatment, biologic therapy, and small molecule treatment, as well as surgical management.

Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: systematic review and meta-analysis.

INTRODUCTION: Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit. AIMS: To determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS. METHODS: We carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI. RESULTS: Twenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics. CONCLUSIONS: Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations.

[Clinical characteristics of acute pancreatitis in Mexico]. / Características clínicas de la pancreatitis aguda en México.

BACKGROUND: Acute pancreatitis (AP) etiology and frequency vary in relation to geographic region. AIMS: To determine the etiology, frequency, and mortality of AP in a Mexican population. PATIENTS AND METHODS: We carried out a prospective study of first episode AP patients over a period of 6 years. RESULTS: A total of 605 patients with a mean age of 40 years were included in the study. Sixty-four percent of them presented with overweight and/or obesity determined through BMI. Etiology was biliary in 66.60%, it was due to alcohol consumption in 15.90%, hypertriglyceridemia in 7.80%, it was post-endoscopic retrograde cholangiopancreatography (ERCP) in 2.10%, and was undetermined in 7.20%. Pancreatic infection was suspected in 70 patients and they underwent CT-guided fine needle aspiration. Thirty-two of those patients were diagnosed with pancreatic infection in which Staphylococcus spp was the most common microorganism. Overall mortality was 5.00% (2.60% < 30 years and 10.00% > 70 years). Necrosis, pancreatic infection, and mortality were more frequent in the cases in which etiology was due to alcohol ingestion. CONCLUSIONS: The most frequent AP etiology was biliary, but that caused by alcohol presented with more complications. Overall mortality was 5.00% and was higher in the elderly patients.

[Epidemiology and clinical characteristics of ulcerative colitis in north-eastern Mexico]. / Epidemiología y características clínicas de la colitis ulcerosa crónica idiopática en el noreste de México.

BACKGROUND: Inflammatory Bowel Disease (IBD) compromises two entities: Ulcerative Colitis (UC) and Crohn Disease (CD). The incidence and prevalence vary widely in relation to ethnicity and demographic localization. Historically it has been considered a rare disease in Mexico. OBJECTIVE: To determine the frequency of new UC cases and their clinical characteristics in a referral hospital of North-Eastern Mexico. METHODS: An epidemiological, descriptive and retrospective study was made which included newly diagnosed patients with UC in a five years period. RESULTS: The adjusted rate of patients diagnosed with UC to the number of admissions for year was 2.3, 2.6, 3.0, 3.6 and 4.1/1000 admissions between 2004 and 2008. The rate of newly diagnosed patients with UC has doubled in the year 2008 compared with the year 2004 (p < 0.05). Fifty five percent of the patients showed mild disease, 30% showed moderate disease and 15% showed severe disease. Fifty percent of the patients had pancolitis, left sided colitis was present in 21% and 29% of the patients just had proctitis. Other clinical aspects of UC corresponded to those previously described. CONCLUSION: The frequency of new patients diagnosed with UC has significantly increased in this tertiary-care referral hospital for the last five years.

Second Mexican consensus on biologic therapy and small-molecule inhibitors in inflammatory bowel disease. / Segundo Consenso Mexicano de terapia biológica y moléculas pequeñas en enfermedad inflamatoria intestinal.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. Therapy with anti-TNF-α agents was the first biologic therapy approved in Mexico for IBD. New biologic agents, such as vedolizumab and ustekinumab, have recently been added, as have small-molecule inhibitors. AIM: To update the biologic therapeutic approach to IBD in Mexico with new anti-TNF-α agents and novel biologics whose mechanisms of action induce and maintain remission of Crohn's disease and ulcerative colitis (UC). MATERIALS AND METHODS: Mexican specialists in the areas of gastroenterology and inflammatory bowel disease were summoned to participate. The consensus was divided into 3 modules, with 49 statements. The Delphi method was applied, sending the statements to all participants to be analyzed and edited, before the face-to-face meeting. During said meeting, the clinical studies were shown, emphasizing the level of clinical evidence, and the final discussion and voting round on the level of agreement of all the statements was conducted. RESULTS: In this second Mexican consensus, recommendations are made for new anti-TNF-α agents, such as golimumab, new biologics with other mechanisms of action, such as vedolizumab and ustekinumab, as well as for the small-molecule inhibitor, tofacitinib. CONCLUSIONS: The updated recommendations focus on patient-reported outcomes, biologic therapy, small-molecule inhibitors, and the safety aspects of each of the drugs.

[Hepatic actinomycosis ; presentation a case in a diabetic patient]. / Actinomicosis hepática; presentación de un caso en un paciente diabético.

We report the case of an Hispanic female diabetic patient admitted to our hospital complaining of progressive abdominal pain, weight loss, nausea and vomiting. Work-up included an abdominal computed tomography (CT) scan which reported a large liver mass consistent with atypical abscess. Serum alpha-fetoprotein value was normal, so a fine needle aspiration biopsy of the liver was performed and the report was consistent with an actinomycosis-induced abscess. Patient was treated with intravenous and oral amoxicillin with satisfactory clinical response.

[Considerations in evaluating the quality of life of patients with digestive, liver and bile disorders in Mexico]. / Consideraciones en la evaluación de la calidad de vida de enfermos con afecciones digestivas, hepáticas y biliares en México.

BACKGROUND: In Mexico, there are few reviews of life quality related to health. These reviews do not substitute symptom, analytic and morphologic evaluations by physicians. They only complement them, by introducing the patient;s vision about his perception of his own health. They also intent to reflect the impact of disease on the patient and on his general health. Besides, they also recognize the influence of health on a daily living basis. Objetive: To analyze the nowadays literature existing in Mexico, with regard to the instruments to evaluate the quality of life within patients with gastrointestinal diseases. METHODS: Search of instruments for measuring the status of life related to health in the mexican population in the MEDLINE database, with emphasis on gastrointestinal and hepatobiliar diseases. RESULTS: One hundred references had been found, but only 10 correspond to studies that use different instruments of evaluation of life status related to gastrointestinal diseases in Mexico. Five of these studies are specific questionnaires and five are generic. CONCLUSION: Actually there are few investigations about evaluation of quality of life in Mexican patients, because of the cultural differences within the Hispano-American countries. All of the questionnaires must be evaluated before using them in our population.

[Helicobacter pylori erradication and its relation to antibiotic resistance and CYP2C19 status]. / Erradicación de H. pylori y su relación con la resistencia a los antibióticos y el estatus de CYP2C19.

OBJECTIVE: to assess the efficacy of rabeprazole (RPZ), amoxicillin (Am), and clarithromycin (Cla) (7 vs. 14 days) in the eradication of H. pylori, and to determine the effect of strain-specific antibiotic resistance and host CYP2C19 status. MATERIAL AND METHODS: first, we determined the CYP2C19 status of 100 healthy subjects to establish a sample size for the clinical trial. Then, 59 H. pylori-infected patients were randomized to receive RPZ (20 mg daily) plus Cla (500 mg b.d.) and Am (1,000 mg b.d.) for 7 vs. 14 days. The MIC for Am and Cla were determined using the agar dilution method. The CYP2C19 genotype was determined by the PCR-RFLP method. RESULTS: In the per-protocol analysis (PP) eradication rates were 89.7 and 72% for the 7- and 14-day groups (p = 0.159). In the intention to-treat analysis (ITT) eradication rates were 86.7 and 62.1% in the 7- and 14-day groups, respectively (p = 0.06). None of the strains was resistant to Am, and 4 strains were resistant to Cla: 3 (11.1%) in the 14-day group and 1 (4%) in the 7-day group. Neither strain-specific antibiotic resistance nor host CYP2C19 status influenced eradication rates. CONCLUSIONS: both 7- and 14-day therapies were effective for H. pylori eradication. Strain resistance and CYP2C19 status do not seem to influence eradication rates in the studied population.

Anxiolytic-like actions of the hexane extract from leaves of Annona cherimolia in two anxiety paradigms: possible involvement of the GABA/benzodiazepine receptor complex.

A hexane extract of leaves of Annona cherimolia produced anxiolytic-like actions when administered to mice and tested in two animal models of anxiety: the mouse avoidance exploratory behavior and the burying behavior tests. In order to discard unspecific drug-actions on general activity, all treatments studied in the anxiety paradigms were also analyzed in the open field test. Results showed that A. cherimolia induced anxiolytic-like actions at the doses of 6.25, 12.5, 25.0 and 50.0 mg/kg. Picrotoxin (0.25 mg/kg), a GABA-gated chloride ion channel blocker, antagonized the anxiolytic-like actions of A. cherimolia, while a sub-effective dose of muscimol (0.5 mg/kg), a selective GABA(A) receptor agonist, facilitated the effects of a sub-optimal dose of A. cherimolia (3.12 mg/kg). Thus, the involvement of the GABA(A) receptor complex in the anxiolytic-like actions of A. cherimolia hexane extract is suggested. In addition the extract was also able to enhance the duration of sodium pentobarbital induced sleeping time. Taken together, results indicate that the hexane extract of A. cherimolia has depressant activity on the Central Nervous System and could interact with the GABA(A) receptor complex. On the other hand, the chromatographic separation of this extract led to the isolation of palmitone, and beta-sitosterol as major constituents. In addition a GC-MS study of some fractions revealed the presence of several compounds such beta-cariophyllene, beta-selinene, alpha-cubebene, and linalool that have been reported to show effects on behavior that could explain some of the extract effects.

[Assessment of activity of care of a nutritional support multidisciplinary team in the follow-up of total parenteral nutrition]. / Evaluación de la actividad asistencial de un equipo multidisciplinario de soporte nutricional en el seguimiento de la nutrición parenteral total.

INTRODUCTION: In total parenteral nutrition (TPN) nutritional support multidisciplinary teams (NSMT) must provide a high quality nutritional assistance based on evidence and daily follow-up of patients with TPN. OBJECTIVES: To assess the degree of adherence to quality standards of care provided to patients on TPN by the NSMT in two consecutive annual periods, according to structure, procedure, and outcomes indicators, previously defined in the team working protocol. PATIENTS AND METHODS: Prospective study of all patients that received TPN at our Center (421-bed general teaching hospital) during the years 2002 and 2003, using the data introduced in NUTRIDATA by daily follow-up of clinical and analytical conditions, and nutritional and non-nutritional complications, comparing both periods and considering an statistical significance level of p < 0.05. RESULTS: One hundred and sixty-three patients and 145 patients received TPN during 2002 and 2003(65.9% male), respectively, with similar parameters of gender, age, indications for TPN, baseline nutritional status, mean nutritional supply, and non-nutritional complications. As to the different quality indicators established in the comparative study, we found a significant improvement in 2003 vs. 2002 in relation to initial anthropometrical assessment (71.03% vs 51.53%; p < 0.001), initial biochemical assessment (97.93% vs. 92.63%; p < 0.04), performance of systematic monitoring analysis (84.83% vs. 71.78%; p < 0.01), hypernatremia incidence (8.27% vs. 15.34%; p = 0.05) and moderate hyperphosphatemia (26.89% vs. 40.49%; p < 0.02), TPN ending for clinical improve- ment (76.60% vs. 64.40%; p = 0.04), and reduction of days on TPN (15.74 +/- 20.43 vs. 11.88 +/- 8.34; p < 0.02), the impaired electrolyte levels significantly improving as a whole. We also observed a non-significant trend towards an improvement of adequacy of TPN indications, hyperphosphatemia, severe hypophosphatemia, total stay, and post-surgical stay, in 2003 vs. 2002. CONCLUSIONS: The NSMT experience shows that analysis of indicators based on quality standards, in two successive annual periods allows assessing the improvement of efficiency of nutritional intervention in hospital-admitted patients with TPN with regards to indication, assessment, follow-up, and course.

[Economic assessment of the implementation of a parenteral nutrition protocol for patients undergoing intestinal resection by a multidisciplinary team]. / Evaluación económica de la implantación por un equipo multidisciplinar de un protocolo de nutrición parenteral en pacientes tras resección intestinal.

OBJECTIVE: An economic assessment on the impact of total parenteral nutrition guidelines developed by the Hospital Nutrition Committee for patients undergoing intestinal resection and implemented by a nutritional support multidisciplinary team, was conducted. METHOD: A comparative retrospective study of two consecutive annual periods before and after the implementation of total parenteral nutrition guidelines for patients undergoing intestinal resection developed by the Nutrition Committee was carried out. Cost-effectiveness analysis from the hospital perspective was performed with the pharmacoeconomic program Pharma-Decision Hospital. Effectiveness was assessed as nutritional gain and safety profile; as well as determination of the costs of acquisition, preparation, administration, monitoring and nutritional complications. Sensitivity analysis (+/-20%) of effectiveness and hospital stay. RESULTS: Among 326 patients hospitalized for intestinal resection, 69 out of 172 (40%) received parenteral nutrition during the early period, versus 40 out of 154 (26%) after the surgery procedure (p < 0.01). In 79% of the patients with parenteral nutrition, the adequacy of the indication was assessed, being adequate in 51.7% and 56.7%, respectively (p = 0.66). Nutritional gain before and after surgery was similar (78.3 vs. 82.5%, p > 0.05), with patients having less episodes of hypophosphatemia postoperatively (60 vs. 38%). Mean total cost per patient before and after surgery was 9,180.81 and 7,871.96, respectively. The sensitivity analysis confirmed the above results. CONCLUSIONS: The development of total parenteral nutrition guidelines by the Nutrition Committee for surgical patients undergoing intestinal resection and their implementation by a multidisciplinary team improved the use of parenteral nutrition and reduced associated costs, with the same nutritional evolution.

Nutritional status study of inpatients in hospitals of Galicia.

OBJECTIVE: To know the prevalence of malnutrition and to validate a nutritional screening protocol (SP) in patients hospitalised in Hospitals representative of inpatients admitted for acute illnesses in Galicia. DESIGN: Cross-sectional study of 376 randomised patients (189 female, 210 > or =65 y old) from 12 public hospitals admitted to hospital for acute medical, surgical or trauma illnesses. The patients elicited were evaluated by a simple SP, including variables relative to recent weight changes, serum albumin, lymphocytes, food ingestion and diagnosis at admission (Cardona's Protocol), and with a diagnostic protocol (DP, Subjective Global Assessment). Both SP and DP were performed by personnel trained in nutritional evaluation. Results of SP and DP were compared; principal factors related to malnutrition were also analysed; statistical significance was considered at P<0.05. RESULTS: From patients studied, according to DP 169/360 (46.94%), patients presented malnutrition (134 B category and 35C category). SP rate was significantly related to severity of malnutrition detected by DP (P<0.001). The principal factors related to the presence of malnutrition were older age and degree of metabolic stress. CONCLUSIONS: In adult patients admitted for acute illnesses, the prevalence of protein-energy malnutrition is high. The risk was related to age and to metabolic stress. The risk of malnutrition in a hospital setting is evaluated appropriately by a simple screening procedure that may contribute to detecting and correcting malnutrition risk.

Oxidative transformations of guaia-1(10)-en-12,8-olides into xanthanolides

Dihydropsuedoivalin (1) was isolated from Stevia tomentosa, which, when treated with base, afforded epidihydropseudoivalin (2). The stereochemistry of 1 and 2 was established by crystallographic X-ray studies of the two derivatives of epidihydropseudoivalin. Treatment of 1 and 2 with Jones's reagent afforded the xanthanolides 3 and 4, respectively.

Antimicrobial activity of Byrsonima crassifolia (L.) H.B.K.

From Byrsonima crassifolia (L.) H.B.K. a tropical tree widely distributed in Mexico, Central and South America, which has been used medicinally since prehispanic times, we report here the antibacterial activities of organic extracts of roots and stems. The ethyl acetate of roots was the most active against Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, Shigella flexneri, Staphylococcus aureus, Staphylococcus epididermis, Streptococcus pneumoniae and Micrococcus luteus.

Phytochemical study of cuachalalate (Amphiptherygium adstringens, Schiede ex Schlecht).

Cuachalalate is an endemic plant of Mexico and belongs to the Julianiaceae family. It is a resinous and dioecious plant and is a medicinal plant commonly used in Mexico. Its curative properties are: cholesterol lowering, anti-inflammatory, antiulcerous agent. The collection site is in Barranca Honda, Morelos, Mexico. Three samplings were made during the research period. A decortication of four trees per sex was carried out. An additional collection of resin was made during the last sampling, in order to verify the presence of the compounds of interest. Masticadienonic, alpha-hydroxymasticadienonic and masticadienonic/isomasticadienonic acid mixtures were isolated and identified. Major accumulations of masticadienonic, alpha-hydroxymasticadienonic acids and masticadienonic/isomasticadienonic acid mixtures were related to female plants and a mixture of alpha-hydroxymasticadienonic acid and an unknown compound with male plants. Major accumulation of masticadienonic acid occurred in February, and alpha-hydroxymasticadienonic was mainly found in November. An anti-inflammatory test with the alpha-hydroxymasticadienonic acid was made and strong inhibition of the inflammation was observed in a preliminary test.

Insect growth regulatory activity of some extracts and compounds from Parthenium argentatum on fall armyworm Spodoptera frugiperda.

The methanolic extract from aerial parts of Parthenium argentatum, afforded argentatin A and B. These compounds were evaluated for their effect on the fall armyworm (Spodoptera frugiperda). Toosendanin, a commercial insecticide derived from Melia azedarach was used as positive control. When tested for activity, using neonate larvae into the no-choice artificial diet bioassays, argentatin A, argentatin B and methanol extract caused significant growth inhibitory activity with GC50 of 17.8, 36.1 and 6.4 ppm at 7 days, respectively, and increased the development time of surviving larvae in a concentration-dependent manner with RGI values of 0.40, 0.60 and 0.26, at 25.0, 25.0 and 5.0 ppm, respectively. In addition, it was possible to observe in most of the treated groups a significant delay in the time of pupation, adult emergence and deformities. Acute toxicity against adults of S. frugiperda was also found, MeOH extract had the most potent activity with LD50 value of 3.10 ppm. In addition, MeOH extract and argentatin A caused acetylcholinesterase inhibition of 93.7% and 90.0%, at 5.0 and 50.0 ppm, respectively; whereas argentatin B had only slight inhibitory activity. Therefore, the MeOH extract was identified as insecticidal extract from P. argentatum with activity at concentrations above 15.0 ppm.

[Nutritional study in geriatric patients (older than 65 years of age) with ambulatory enteral nutrition: correlation between underlying disease, nutritional support, and drug treatment]. / Estudio nutricional en pacientes geriátricos (mayores de 65 años) con nutrición enteral ambulatoria, correlación entre patología de base, aporte nutricional y tratamiento farmacológico.

GOAL: To identify the current status of out-patient enteral nutrition among elderly patients in Galicia: indications, access routes, forms of administration, types of diet, complications, disability status. Assessment of nutritional status and concomitant pharmacological treatment. METHODS: Prospective, observational, multi-centric study lasting for one month. Data capture by means of a questionnaire regarding: age, sex, diagnosed pathology leading to nutritional analysis, disability status, current nutritional status, type of diet, months under treatment with NEA (out-patient enteral nutrition in its Spanish acronym), form of administration, complications, concomitant medication. The statistical methodology included a descriptive analysis and a study of the correlations between the different variables. For the comparison of both groups, Student's t test or Mann-Whitney's U test was used for quantitative variables and chi-squared, Yate's correction or Fisher's exact test was used for qualitative variables. RESULTS: 469 patients were studied, corresponding to 13 publicly-funded centres. Age: 81.15 years (95% CI 80.8-82.3), women (70.6%). DIAGNOSIS: neurological disorders (46.1%), cerebrovascular accidents (27.5%), neoplasia (12.4%) and others (14.1%). 45.2% presented a bedbound disability status and 53.5% presented communication difficulties. Standard diet was the most common (39.4%). DURATION OF THE NUTRITION: > 1 year in 36.7% of cases, between 6 months and 1 year for 21.3%, between 3 and 6 months for 10.9% and < 3 months in 13.7% of cases. Nasogastric tube was the route for administration in 55.2%. Patients with nutrition treatment lasting over 1 year presented a significantly lower rate of malnutrition (p < 0.0001). Neurological patients and those with communication difficulties had a lower prevalence of malnutrition (p < 0.0001), as did those with a greater degree of disability (p < 0.01). Undernourished patients presented a greater prevalence of bedsores (49.1% versus 25.8%, p < 0.0001). The mean number of prescribed medicines was 3.27 +/- 2.41, with 64% of them being administered through the nasogastric tube. The most frequent interaction was digoxin-fibre (29.6%) and incorrect administration was observed with omeprazol and medication to combat Parkinson's disease.