RESUMEN
BACKGROUND: Allogeneic hematopoietic stem cell transplantation (alloHSCT) is frequently associated with impaired oral intake and malnutrition, which potentially increases morbidity and mortality. Therefore, nutrition is one of the major challenges in the post-transplant period. METHODS: To document the current clinical approach in nutritional treatment, we designed a questionnaire concerning the current practice in nutrition after alloHSCT and distributed it to German speaking centers performing alloHSCT in Germany, Austria and Switzerland between November 2018 and March 2020. Twenty-eight (39%) of 72 contacted centers completed the survey, 23 from Germany, two from Austria and three from Switzerland, representing 50% of alloHSCT activity within the participating countries in 2018. RESULTS: All centers reported having nutritional guidelines for patients undergoing alloHSCT, whereby 86% (n = 24) provided a low-microbial diet during the neutropenic phase. The criteria to start parenteral nutrition (PN) directly after alloHSCT seemed to be consistent, 75% (n = 21) of the corresponding centers started PN if the oral nutritional intake or the bodyweight dropped below a certain limit. In the setting of intestinal graft-versus-host disease (GvHD) the current practice appeared to be more heterogenous. About 64% (n = 18) of the centers followed a special diet, added food stepwise modulated by GvHD symptoms, while only four centers regularly stopped oral intake completely (intestinal GvHD grade >1). Half of the centers (54%, n = 15) applied a lactose-free diet, followed by 43% (n = 12) which provided fat- and 18% (n = 5) gluten-free food in patients with intestinal GvHD. Supplementation of micronutrients in acute intestinal GvHD patients was performed by 54% (n = 15) of the centers, whereas vitamin D (89%, n = 25) and vitamin B12 (68%, n = 19) was added regularly independently of the presence of GvHD. Only 5 (18%) participating centers ever observed a food-associated infection during hospitalization, whereas food-associated infections were reported to occur more often in the outpatient setting (64%, n = 18). CONCLUSION: The survey documented a general consensus about the need for nutritional guidelines for patients undergoing alloHSCT. However, the nutritional treatment in clinical practice (i.e. lactose-, gluten- or fat-free in intestinal GvHD) as well as the use of food supplements was very heterogeneous. In line with current general recommendations the centers seemed to focus on safe food handling practice rather than providing a strict neutropenic diet. More high-quality data are required to provide evidence-based nutrition to patients during and after alloHSCT.
Asunto(s)
Dieta/métodos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Desnutrición/prevención & control , Neutropenia/dietoterapia , Política Nutricional , Austria , Peso Corporal , Consenso , Dieta/normas , Suplementos Dietéticos , Ingestión de Alimentos , Alemania , Encuestas de Atención de la Salud , Humanos , Desnutrición/etiología , Neutropenia/etiología , Nutrición Parenteral/normas , Pautas de la Práctica en Medicina , SuizaRESUMEN
The Spanish Hygia study has led to considerable irritation due to the general recommendation to prescribe antihypertensives preferably to be taken in the evening, especially since the lay press as well as medical media made enthusiastic comments. The discussion about the optimal time to take antihypertensive drugs shows once again how dangerous the uncritical handling of study data can be. No possible risks were pointed out. The Hygia study compared 19,084 patients with morning and evening intake of antihypertensive drugs under the control of a 48h blood pressure measurement (!). There was a significantly better reduction in blood pressure and the rate of cardiovascular and cerebrovascular events with evening intake. The data are scientifically valuable; however, the conclusions are incomprehensible based on the data, contradict many other studies and are dangerous for certain patient groups. There are also methodological shortcomings. Therefore, a general evening intake is not justified and nonsensical due to the diverse, individually very different pathophysiological findings of the nocturnal blood pressure behavior. Basically, the outpatient 24h blood pressure measurement (ABPM) enables a better assessment of the individual cardiovascular and cerebrovascular risks and prevents an incorrect assessment of the blood pressure and thus unnecessary or sufficient treatment. Instead of a general recommendation, the ABPM offers the option of an individually tailored treatment. Taking antihypertensive drugs in the evening should always be preceded by an ABDM in the case of prognostically unfavorable nocturnal hypertension in order to avoid the risk of nocturnal ischemic risks due to excessive drops in blood pressure.
Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Humanos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Antihypertensive drug therapy is one of the most successful medical measures ever, at all levels. The treatment situation in Germany has clearly improved in recent years. Nowadays, a wide range of very effective and well-tolerated hypertensive substances is available. Combination therapy has a long and successful tradition in hypertensive treatment, especially with suitable fixed combinations. Furthermore, the administration of fixed combinations is very beneficial to therapy adherence because it is essentially dependent on the number of drugs to be taken. The value of beta blockers and the double blockade of the renin-angiotensin-aldosterone system are under discussion and the interpretation of corresponding studies must be conducted very carefully. The hypertensive effect of a substance cannot be comprehensively assessed without taking the time of day, the time point of measurement and the time point of intake into consideration. This is particularly important with respect to the effect over 24 h. Optimal antihypertensive therapy must also take into consideration the individual blood pressure rhythm with respect to the dose and dosing intervals. The importance of the central (aortic) blood pressure as target blood pressure will increase.
Asunto(s)
Antihipertensivos/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Humanos , Hipertensión/diagnósticoAsunto(s)
Drama/historia , Fantasía , Música/historia , Médicos/historia , Alemania , Historia del Siglo XIX , Historia del Siglo XX , HumanosAsunto(s)
Drama/historia , Cirugía General/historia , Medicina en las Artes , Música/historia , Alemania , Historia del Siglo XIX , ItaliaAsunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Antihipertensivos/uso terapéutico , Vasoespasmo Coronario/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , Amidas/efectos adversos , Amidas/uso terapéutico , Bencimidazoles/efectos adversos , Bencimidazoles/uso terapéutico , Benzoatos/efectos adversos , Benzoatos/uso terapéutico , Vasoespasmo Coronario/fisiopatología , Quimioterapia Combinada , Terminación Anticipada de los Ensayos Clínicos , Fumaratos/efectos adversos , Fumaratos/uso terapéutico , Humanos , Hipertensión/fisiopatología , Ramipril/efectos adversos , Ramipril/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Renina/antagonistas & inhibidores , Sistema Renina-Angiotensina/fisiología , TelmisartánAsunto(s)
Presión Sanguínea , Enfermedades Cardiovasculares/diagnóstico , Hipertensión/diagnóstico , Pulso Arterial , Rigidez Vascular , Factores de Edad , Anciano , Antihipertensivos/uso terapéutico , Aorta , Determinación de la Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Factores de Riesgo , Procesamiento de Señales Asistido por Computador , Rigidez Vascular/efectos de los fármacosRESUMEN
The two biggest studies worldwide on telemedicine in chronic heart failure were conducted in Germany. The study design, patient selection and equipment as well as the mode of therapeutic intervention varied between the two studies as much as their outcomes. A comparison of the two studies allows conclusions to be drawn as regards achieving effective telemedical intervention in chronic heart failure. Patient age, medication and degree of heart failure and the telemedical program itself are decisive factors in attaining a successful approach. It is best to induct patients into the program after hospitalisation for decompensated heart failure, especially in cases where the maximum drug therapy could not be administered.
Asunto(s)
Insuficiencia Cardíaca/rehabilitación , Selección de Paciente , Telemedicina , Cuidados Posteriores , Anciano , Femenino , Alemania , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Consulta Remota , Proyectos de Investigación , Tasa de Supervivencia , Telemetría , Resultado del TratamientoRESUMEN
High salt intake over long term is associated with increased incidence of arterial, predominantly systolic, hypertension and increased risk of cardiovascular diseases, e.g., stroke, heart failure, and renal insufficiency. High salt consumption is a vascular risk factor generating aortic stiffness and decreased vascular compliance leading to central blood pressure augmentation, higher cardiac load, and diminished diastolic perfusion. The development of heart failure can be a consequence of this sequelae. Randomized trials show a reduction in blood pressure with lower sodium intake. In long-term clinical trials, a reduction in cardiovascular morbidity and mortality has been demonstrated. Recommendations should emphasize the simultaneous reduction in sodium intake and increase in potassium intake.
Asunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/prevención & control , Conducta de Reducción del Riesgo , Cloruro de Sodio Dietético/efectos adversos , Enfermedades Cardiovasculares/dietoterapia , HumanosAsunto(s)
Presión Sanguínea/fisiología , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Monitores de Presión Sanguínea/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Cumplimiento de la MedicaciónAsunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Angiotensina II/inmunología , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Antihipertensivos/efectos adversos , Presión Sanguínea/efectos de los fármacos , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Demencia/tratamiento farmacológico , Resistencia a Medicamentos , Humanos , Hipertensión/mortalidad , Hipertensión Renal/diagnóstico , Hipertensión Renal/tratamiento farmacológico , Hipertensión Renal/mortalidad , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Valores de Referencia , Vacunas/uso terapéuticoAsunto(s)
Arteriosclerosis/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Determinación de la Presión Sanguínea/métodos , Presión Sanguínea/fisiología , Hipertensión/fisiopatología , Músculo Liso Vascular/fisiopatología , Flujo Pulsátil/fisiología , Adulto , Factores de Edad , Anciano , Aorta/fisiopatología , Arteriosclerosis/diagnóstico , Niño , Humanos , Hipertensión/diagnóstico , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Túnica Íntima/fisiopatología , Túnica Media/fisiopatologíaAsunto(s)
Determinación de la Presión Sanguínea/métodos , Hipertensión/diagnóstico , Hipertensión/terapia , Angiotensina II/inmunología , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Presión Sanguínea/inmunología , Determinación de la Presión Sanguínea/instrumentación , Quimioterapia Combinada , Estimulación Eléctrica/instrumentación , Inglaterra , Alemania , Promoción de la Salud , Humanos , Riñón/inervación , Médicos de Familia/economía , Médicos de Familia/normas , Presorreceptores/fisiología , Salarios y Beneficios/tendencias , Cloruro de Sodio Dietético/administración & dosificación , Cloruro de Sodio Dietético/efectos adversos , Simpatectomía , Telemetría , VacunasRESUMEN
Restricting salt intake not only leads to a decrease of blood pressure and a reduction in the incidence of arterial hypertension but also to a fall in cardiovascular morbidity and mortality. But high sodium intake is not only a risk factor for hypertension but also for cardiovascular diseases. Moderate reduction of daily salt intake in the entire population of Germany from the present level of 8-10 mg to 5-6 mg is of great benefit for disease load and to the economy. Any possible risk for a few groups of persons is predictable and can be coped with. General sodium reduction cannot be achieved only by individual advice, instruction or information campaigns but requires a reduction in the sodium content of industrially processed foods, in fast-food chains, restaurants and canteens because they supply 80% of total daily sodium intake. To achieve the target of restricting the sodium intake of the whole population it is recommended that an interdisciplinary and interprofessional task force, "Less salt for all" be established. This is to bring together the expertise of scientific societies and institutions that see their main task in the reduction of cardiovascular mortality and morbidity by primary prevention. Individual prevention in patients at risk can be very significantly improved by population-related preventive measures. These include, in addition to general limitation of sodium intake, continuing change in lifestyle.