Effect on Body Composition of a Meal-Replacement Progression Diet in Patients 1 Month after Bariatric Surgery.

BACKGROUND: Progression diets after bariatric surgery (BS) are restricted in calories and protein, and they may induce a worsening of body composition. The aim of this study was to evaluate the effect of a modified diet with an oral nutritional supplement that is hyperproteic and normocaloric over the body composition. METHODS: A two-arm ambispective observational cohort study was designed. Forty-four patients who underwent sleeve gastrectomy were included in the study. Thirty patients received a progression diet with a normocaloric, hyperproteic oral nutritional supplement during the first two weeks after surgery (820 kcal, 65.5 g protein). They were compared with a historical cohort of 14 patients treated with a standard progression diet (220 kcal, 11.5 g protein). Anthropometric and body composition (using electrical bioimpedanciometry) data were analyzed before BS and 1 month after the surgery. RESULTS: The mean age was 47.35(10.22) years; 75% were women, and the average presurgical body mass index (BMI) was 45.98(6.13) kg/m2, with no differences between both arms of intervention. One month after surgery, no differences in the percentage of excess weight loss (%PEWL) were observed between patients in the high-protein-diet group (HP) and low-protein-diet group (LP) (HP: 21.86 (12.60)%; LP: 18.10 (13.49)%; p = 0.38). A lower loss of appendicular skeletal muscle mass index was observed in the HP (HP: -5.70 (8.79)%; LP: -10.54 (6.29)%; p < 0.05) and fat-free mass index (HP: 3.86 (8.50)%; LP:-9.44 (5.75)%; p = 0.03), while a higher loss of fat mass was observed in the HP (HP: -14.22 (10.09)%; LP: -5.26 (11.08)%; p < 0.01). CONCLUSIONS: In patients undergoing gastric sleeve surgery, the addition of a normocaloric, hyperproteic formula managed to slow down the loss of muscle mass and increase the loss of fat mass with no differences on total weight loss.

Pressure injuries during the SARS-CoV-2 pandemic: A retrospective, case-control study.

AIM OF STUDY: The main objective of this study was to ascertain whether severe alterations in hypoxemic, inflammatory, and nutritional parameters in patients diagnosed with SARS-CoV-2 infection were associated with the occurrence and severity of developed dependency-related injuries. The secondary objective was to determine whether there were prognostic factors associated with the occurrence and severity of developed dependency-related injuries during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: A retrospective, single-centre, case-control study was conducted to compare SARS-CoV-2 patients who developed dependency-related injuries after the first 48 h after admission with a control group made up of SARS-CoV-2 patients without dependency-related injuries. The cases of the 1987 patients diagnosed with SARS-CoV-2 infection during the study period were reviewed. Data from 94 patients who developed dependency-related injuries and from 190 patients who did not develop them during hospital admission were analysed. RESULTS: High baseline dependency levels, prolonged hospital stays, and low oxygen saturation levels on arrival in emergency department triage were associated with the occurrence of dependency-related injuries among patients diagnosed with SARS-CoV-2 infection. CONCLUSIONS: SARS-CoV-2 infection can lead to complications such as dependency-related injuries. Although there are several non-modifiable variables associated with the occurrence of dependency-related injuries in these patients, it is essential to conduct further research and introduce consensus guidelines to reduce their incidence and prevalence.

Quiste biliar tipo V con cistolitiasis / Type V biliary cyst with cystolithiasis

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Type V biliary cyst with cystolithiasis.

We present the case of a 40-year-old female who presented to the General Surgery clinic due to a single episode of abdominal pain which required a visit to the Emergency Department. The patient had undergone surgery during childhood due to the suspicion of a hepatic hydatid cyst. However, an intraoperative cholangiography identified a small, non-complicated biliary cyst. Therefore, a hepatic resection was not performed. The patient did not undergo follow-up of the lesion.

Guía rápida para el tratamiento tópico de lesiones vasculares en extremidades inferiores / Quick guide for the topical treatment of vascular lesions in the lower limbs

Las lesiones vasculares de las extremidades inferiores constituyen un problema de salud con importantes consecuencias socioeconómicas y sanitarias. Su prevalencia se sitúa en el 3% de la población adulta. Es fundamental establecer un diagnóstico diferencial entre los distintos tipos de lesiones, ya que el tratamiento difiere en función de su etiología. No existe un tratamiento único y efectivo para las úlceras de extremidad inferior,por lo que el equipo clínico ha de llegar a un acuerdo sobre el tratamiento a utilizar.La necesidad de tener un criterio común de actuación surgió en nuestro hospital a causa de la manifiesta diversidad en el tratamiento de las lesiones vasculares dependiendo del lugar donde estaba ubicado el paciente y la escasez de registro de las mismas, incluso en la unidad especializada. Además, las curas eran modificadas con demasiada frecuencia, no dejando tiempo a que se pudiera comprobar su eficacia. Esta situación de variablidad en el abordaje de las curas se agudizaba en los períodos de mayor concentración de personal suplente.El propósito de este artículo es presentar una experiencia de consenso sobre una guía para el tratamiento de lesiones vasculares, útil en diferentes niveles asistenciales y algunos documentos que forman parte de la guía,como son la guía rápida, el algoritmo de decisión de tratamiento y la hoja de registros de las curas, que pueden servir para agilizar el trabajo enfermero (AU)

Vascular lesions of the lower limbs represent a health problem with significant socioeconomic and healthcare consequences. The prevalence of this condition is around 3% in the adult population. It is of outmost importance to establish a differential diagnosis between the different types of lesions as the treatment varies depending on their aetiology.There is no single and effective treatment for ulcers of the lower limb and therefore the clinical team must be in agreement regarding the most appropriate treatment to follow.The need to have a common criteria for the course of action emerged in our hospital as a result of the various different treatments for vascular lesions depending there the patient was and a lack of a registry of the lesions, including at the specialist unit. In addition, wound care wasmodified way too frequently, leaving no time to verify their efficacy, This situation of variability in wound care approach exacerbated during the periods in which there were more nursing substitutes in attendance.The aim of this article is to present a consensus experience on a clinical practice guide for the treatment of vascular lesions that is useful at the different levels of health care and some documents that are part of such guide, such as the quick reference guide, the decision-making algorithm for treatment and the wound care log, which might help to expedite nursing work (AU)

Multiorgan histiocytosis after B-cell acute lymphoblastic leukemia.

The association of multiorgan histiocytosis after acute lymphoblastic leukemias is very rare as most cases are localized forms of Langerhans cell histiocytosis (LCH). We report on an 18-year-old man diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) with p16 deletion (9p21). He was treated with induction chemotherapy using the Spanish PETHEMA group protocol and achieved complete remission. Three months after the diagnosis of B-ALL, he developed a severe multiorgan histiocytosis that is clinically suggestive of LCH but lacked typical immunohistochemical features of LCH and indeterminate cell histiocytosis: CD1a was strongly positive, CD68 and S-100 protein were moderately positive, and langerin was negative. The drugs of the first-line treatment recommended for LCH had been part of the chemotherapy of B-ALL that the patient had received. Therefore, we prescribed the second-line treatment for LCH (cytarabine and 2'-chlorodeoxyadenosine), and he achieved partial remission. The patient died during the aplasia induced by the third cycle of chemotherapy from pneumonia. We could not demonstrate the transdifferentiation of tumoral lymphocytes into histiocytes, using p16 deletion (9p21) as a marker, because these cells did not share the mutation. Neither could we study immunoglobulin-H rearrangement as we had exhausted all the tissue samples. In the medical literature, there are a few reported cases of T-cell acute lymphoblastic leukemia followed by disseminated LCH and just 1 case of B-ALL followed by localized LCH affecting the bones. Therefore, our patient may be the first published case of B-ALL followed by histiocytosis, which had 2 singularities: it was multiorgan and the immunohistochemistry was not typical of LCH.