Home enteral nutrition in Spain; NADYA registry 2011-2012.

OBJECTIVE: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2011 and 2012. MATERIAL AND METHODS: We retrieved the data of the patients recorded from January 1st 2011 to December 31st 2012. RESULTS: There were 3021 patients in the registry during the period from 29 hospitals, which gives 65.39 per million inhabitants. 97.95% were adults, 51.4% male. Mean age was 67.64 ± 19.1, median age was 72 years for adults and 7 months for children. Median duration with HEN was 351 days and for 97.5% was their first event with HEN. Most patients had HEN because of neurological disease (57.8%). Access route was nasogastric tube for 43.5% and gastrostomy for 33.5%. Most patients had limited activity level and, concerning autonomy, 54.8% needed total help. Nutritional formula was supplied from chemist's office to 73.8% of patients and disposables, when necessary, was supplied from hospitals to 53.8% of patients. HEN was finished for 1,031 patients (34.1%) during the period of study, 56.6% due to decease and 22.2% due to recovery of oral intake. CONCLUSIONS: Data from NADYA-SENPE registry must be explained cautiously because it is a non-compulsory registry. In spite of the change in the methodology of the registry in 2010, tendencies regarding HEN have been maintained, other than oral route.

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE de los años 2011 y 12. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero de 2011 al 31 de diciembre de 2012. Resultados: Hubo 3021 pacientes en el registro durante el periodo, procedentes de 29 hospitales, lo que da una prevalencia de 65,39 casos por millón de habitantes. 97.95% fueron adultos, 51,4% varones. La edad media fue 67,64 ± 19,1 años y la mediana 72 años para los adultos y 7 meses para los niños. La duración media de la NED fue 351 días y para el 97,5% fue el primer episodio con NED. La mayoría de pacientes tenían NED por una enfermedad neurológica (57,8%). La vía de acceso fue sonda nasogástrica para el 43,5% y gastrostomía para el 33,5%. La mayoría de pacientes tuvieron un nivel de actividad física limitado y, respecto a la autonomía, 54,8% necesitaba ayuda total. La fórmula de nutrición se suministró desde las oficinas de farmacia para el 73,8% y los fungibles, cuando fueron necesarios, desde los hospitales para el 53,8%. La NED se suspendió en 1.031 pacientes (34,1%) durante el periodo de estudio, 56,6% debido a fallecimiento y 22,2% debido a recuperación de la vía oral. Conclusiones: Los datos del registro NADYA-SENPE deben ser interpretados con precaución ya que se trata de un registro voluntario. A pesar del cambio de metodología del registro en 2010, las tendencias en NED se han mantenido, salvo la importancia cuantitativa de la vía oral.

[Home parenteral nutrition in Spain 2011 and 2012; a report of the home and ambulatory artificial nutrition group NADYA]. / Nutrición Parenteral Domiciliaria en España 2011 y 2012: informe del grupo de nutrición artificial domiciliaria y ambulatoria NADYA.

OBJECTIVE: To report the data of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group for the years 2011 and 2012. METHODOLOGY: We compiled the data from the on-line registry introduced by reviewers of NADYA group responsible for monitoring of NPD introduced by since January 1, 2011 to december 31, 2012. Included fields were: age, sex, diagnosis and reason for HPN, access path, complications, beginning and end dates, complementary oral or enteral nutrition, activity level, autonomy degree, product and fungible material supply, withdrawal reason and intestinal transplant indication. RESULTS: Year 2010: 184 patients from 29 hospitals , representing a rate of 3.98 patients/million inhabitants/ year 2011, with 186 episodes were recorded NPD . During 2012, 203 patients from 29 hospitals , representing a rate of 4.39 patients/million inhabitants/year 2012 , a total of 211 episodes were recorded NPD . CONCLUSIONS: We observe an increase in registered patients with respect to previous years.Neoplasia remains as the main pathology since 2003. Although NADYA is consolidated registry and has been indispensable source of information relevant to the understanding of the progress of Home Artificial Nutrition in our country, there is ample room for improvement. Especially that refers to the registration of pediatric patients and the registration of complications.

Objetivo: Comunicar los datos del registro de Nutrición Parenteral Domiciliaria (NPD) del grupo de trabajo NADYA-SENPE de los años 2011 y 2012. Material y métodos: Recopilación de los datos del registro "on-line" introducidos por los colaboradores del grupo NADYA responsables del seguimiento de la NPD desde el 1 de enero de 2011 al 31 de diciembre de 2012 dividido por años naturales. Resultados: Año 2010: Se registraron 184 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 3,98 pacientes/millón habitantes/año 2011, con 186 episodios de NPD. Durante el año 2012 se registraron 203 pacientes, procedentes de 29 hospitales, lo que representa una tasa de 4,39 pacientes/millón habitantes/año 2012, con un total de 211 episodios de NPD. Conclusiones: Se observa un aumento progresivo de los pacientes registrados respecto a años anteriores. El principal grupo patológico sigue siendo oncológico ocupando el primer lugar desde 2003. Aunque el registro NADYA es un registro consolidado y ha sido y es fuente imprescindible de información relevante para el conocimiento de los avances de la Nutrición Artificial Domiciliaria en nuestro país, queda un amplio margen para la mejora. En especial lo que hace referencia al registro de pacientes pediátricos y al registro de las complicaciones.

[Efficacy of parenteral glutamine in patients undergoing bone marrow transplantation]. / Eficacia de la glutamina parenteral en pacientes sometidos a trasplante autólogo de médula ósea.

INTRODUCTION: Autologous bone marrow transplant (ABMT) represents a high metabolic stress. Glutamine has proven to be effective in severe catabolic states, although there are controversial studies. OBJECTIVES: To assess the effect of parenteral nutrition (PN) therapy supplemented with glutamine on the occurrence of mucositis and mean hospital stay in patients submitted to ABMT. METHODS: Retrospective study of patients submitted to ABMT between 2006 and 2009. In 2008, one vial of L-alanyl-L-glutamine (20 g) was added by protocol to the PN formulations of these patients. Thirteen clinical charts since that date (glutamine group) and 13 previous charts (control group) were randomly selected (n = 26). We compared the degree of mucositis and hospital stay in both groups. In the subgroup of glutamine-treated patients, we compare the glutamine dose in the patients developing some degree of mucositis with that of those not having this complication. RESULTS: Mean hospital stay: 27.8 ± 7.4 days (control group) vs. 20.3 ± 5.3 days (glutamine group) (p = 0.01). The severity of mucositis was lower in the glutaminetreated group (p = 0.02). The weight-adjusted dose of L-alanyl-L-glutamine in the patients not developing mucositis was higher than in the other ones (0.32 vs. 0.24 g/kg/day; p = 0.02). CONCLUSIONS: Glutamine supplementation reduces the degree of mucositis and hospital stay in patients submitted to autologous bone marrow transplantation. The degree of mucositis is lower in the subgroup of patients receiving higher doses of glutamine.

[Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year]. / Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal.

BACKGROUND: In recent years, there has been an increase of drugs poisoning cases seen in the Emergency Department. This study has aimed to evaluate the characteristics of these cases in the Ramón and Cajal Hospital in Madrid. MATERIALS AND METHODS: A descriptive analysis about the drug poisonings diagnosed in 2004 was performed, using a retrospective search in the database of the electronic clinical records. The studied variables were gender, age, intention, drugs, admission into the hospital and relapse. RESULTS: There were 566 drug poisoning (47%) with a cumulative incidence of 0.1%, in which women (62.3%) were found to predominate, and the average patient age was 42.46+/-19.97 years (range 14-100 years). In 64.31% of the cases (566), only one kind of drug was used, benzodiazepine being the most common. This appeared at least once in 62% of the cases. Furthermore, 83% were cases of voluntary poisoning. Of the involuntary poisonings, digoxin was the most common drug with a frequency of 58.4%. A total of 28.6% of the cases were admitted into hospital, while the total number of patients who suffered a relapse in this period was 10%. DISCUSSION: Voluntary drug intoxications are caused mostly by psychoactive drugs, likely due to a high prevalence of underlying psychiatric disease in these patients. However, unintentional intoxications are mainly found in patients under chronic treatment with drugs such as digoxin and antiepileptics. More studies should be carried out to analyze which kind of preventive actions could reduce or avoid the high number of relapses.

Epidemiología de las intoxicaciones medicamentosas durante un año en el Hospital Universitario Ramón y Cajal / Epidemiology of drug poisoning in the Ramón y Cajal University Hospital during a year

un aumento de las intoxicaciones medicamentosasatendidas en los servicios de Urgencias. El objetivode este trabajo fue evaluar las características deéstas en el Hospital Ramón y Cajal de Madrid.Material y métodos. Se realizó un análisisdescriptivo de las intoxicaciones medicamentosasdiagnosticadas en el año 2004, a través de unabúsqueda retrospectiva, en la base de datos de lahistoria clínica electrónica. Las variables estudiadasfueron sexo, edad, intencionalidad, tipo de fármaco,ingreso hospitalario y reincidencia.Resultados. Se recogieron 566 intoxicacionesmedicamentosas con una incidencia acumulada del0,1%, en las cuales existía un predominio de mujeres(62,3%), y la media de edad de los pacientes fue de42,46±19,97 años (rango 14-100 años). En un64,31% de los casos se utilizó un solo tipo defármaco. Las benzodiacepinas, presentes en el 62%de los casos, fueron las de mayor frecuencia. Además,un 83% fueron voluntarias. En las intoxicaciones novoluntarias la digoxina fue el fármaco que apareciócon más frecuencia (58,4%). Un 28,6% del totalrequirieron ingreso hospitalario, mientras que lareincidencia en este periodo fue del 10%.Discusión. Los intentos autolíticos medicamentososson producidos en su mayoría por fármacospsicoactivos, debido probablemente a una altaprevalencia de patología psiquiátrica subyacente enestos pacientes. Las intoxicaciones no voluntarias,sin embargo, se presentan fundamentalmente enpacientes con tratamiento crónico, mediantefármacos como la digoxina o los antiepilépticos. Sedeberán realizar estudios para analizar qué tipo demedidas de prevención pueden disminuir o evitar elgran número de reincidencias

Background. In recent years, there has been anincrease of drugs poisoning cases seen in theEmergency Department. This study has aimed toevaluate the characteristics of these cases in theRamón and Cajal Hospital in Madrid.Materials and methods. A descriptive analysisabout the drug poisonings diagnosed in 2004 wasperformed, using a retrospective search in thedatabase of the electronic clinical records. Thestudied variables were gender, age, intention, drugs,admission into the hospital and relapse.Results. There were 566 drug poisoning (47%) witha cumulative incidence of 0.1%, in which women(62.3%) were found to predominate, and theaverage patient age was 42.46±19.97 years (range14-100 years). In 64.31% of the cases (566), onlyone kind of drug was used, benzodiazepine being themost common. This appeared at least once in 62%of the cases. Furthermore, 83% were cases ofvoluntary poisoning. Of the involuntary poisonings,digoxin was the most common drug with a frequencyof 58.4%. A total of 28.6% of the cases wereadmitted into hospital, while the total number ofpatients who suffered a relapse in this period was10%.Discussion. Voluntary drug intoxications are causedmostly by psychoactive drugs, likely due to a highprevalence of underlying psychiatric disease in thesepatients. However, unintentional intoxications aremainly found in patients under chronic treatmentwith drugs such as digoxin and antiepileptics. Morestudies should be carried out to analyze which kindof preventive actions could reduce or avoid the highnumber of relapses

[Inhaled insulin. General characteristics. Repercussion on lung function]. / Insulina inhalada. Características generales. Repercusión sobre la función pulmonar.

Inhaled insulin satisfies the unsuccessful search for non-injectable insulin pathways for the chronic treatment of diabetes. Its use will allow insulin-dependent patients to even receive a single daily injection of basal insulin or early insulinization in patients with type 2 diabetes and poor glycemic control, many of whom maintain the treatment with oral antidiabetics due to aversion to the subcutaneous route (sc). Current data indicate that this insulin is at least as effective as the sc in regards to glucose control. However, clinical experience will clarify its true efficacy and the presence of possible side effects in the long term, especially on the lung function. In this sense, it has been observed that inhaled insulin leads a non-significant small decrease in forced expiratory volume in one second (FEV1). This appears early and does not progress during the first 2 years of treatment, being reversible after its withdrawal.

Tratamiento ambulatorio con insulina intravenosa a través de un catéter central en una paciente con síndrome de resistencia a la insulina subcutánea / Ambulatory intravenous insulin therapy by a venous central catheter access in a patient with subcutaneous insulin resistance syndrome

El síndrome de resistencia a la insulina subcutánea es una causa poco frecuente de diabetes inestable, caracterizada por un mal control glucémico pese al empleo de altas dosis de insulina subcutánea y que mejora, junto con la disminución de los requerimientos de insulina, cuando ésta se administra por vía intravenosa. Su etiología es desconocida y su manejo clínico resulta muy difícil, dada la necesidad de emplear una vía alternativa a la subcutánea para el tratamiento ambulatorio. Presentamos el caso de una paciente con este síndrome en la que se decidió colocar un acceso venoso central con bomba de infusión adaptada como solución provisional hasta contar con un dispositivo de administración de insulina intraperitoneal, que es el tratamiento más comúnmente aceptado en la actualidad (AU)

The subcutaneous insulin resistance syndrome is a rare cause of brittle diabetes, defined as diabetes mellitus poorly controlled with high doses of subcutaneous insulin, which ameliorates, together with a reduction of insulin requirements, when insulin is intravenously infused. Its cause is unknown and its clinical management very difficult, because of the need to use an alternative to the subcutaneous route for ambulatory therapy. We report the case of a patient with this syndrome, in which a venous central access connected to anadapted insulin pump was placed as a temporary solution until having an intraperitoneal insulin infusion device, the currently most accepted treatment for this condition (AU)

Insulina inhalada. Características generales. Repercusión sobre la función pulmonar / Inhaled insulin. General characteristics. Repercussion on lung function

La insulina inhalada satisface la búsqueda infructuosa de vías no inyectables de insulina para el tratamiento crónico de la diabetes. Su uso permitirá a pacientes insulinodependientes recibir incluso un solo pinchazo diario de insulina basal, o una insulinización precoz en enfermos con diabetes tipo 2 y mal control glucémico, a muchos de los cuales se les mantiene el tratamiento con antidiabéticos orales por aversión a la vía subcutánea (sc). Los datos actuales indican que dicha insulina es, al menos, igual de eficaz que la sc en cuanto al control glucémico, aunque la experiencia clínica nos esclarecerá su verdadera eficacia y la presencia de posibles efectos secundarios a largo plazo, especialmente sobre la función pulmonar. En este sentido, se ha observado que la insulina inhalada provoca un pequeño descenso del volumen espiratorio forzado en el primer segundo (FEV1) no clínicamente significativo, que aparece de forma temprana y no progresa durante los 2 primeros años de tratamiento, siendo reversible tras la retirada del mismo

Inhaled insulin satisfies the unsuccessful search for non-injectable insulin pathways for the chronic treatment of diabetes. Its use will allow insulin-dependent patients to even receive a single daily injection of basal insulin or early insulinization in patients with type 2 diabetes and poor glycemic control, many of whom maintain the treatment with oral antidiabetics due to aversion to the subcutaneous route (sc). Current data indicate that this insulin is at least as effective as the sc in regards to glucose control. However, clinical experience will clarify its true efficacy and the presence of possible side effects in the long term, especially on the lung function. In this sense, it has been observed that inhaled insulin leads a non-significant small decrease in forced expiratory volume in one second (FEV1). This appears early and does not progress during the first 2 years of treatment, being reversible after its withdrawal

Insulina inhalada y función pulmonar / Inhaled insulin and pulmonary function

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