Undernutrition measured by the Mini Nutritional Assessment (MNA) test and related risk factors in older adults under hospital emergency care.

OBJECTIVES: In developed countries, undernutrition affects mostly older adults, worsens with hospitalization, and affects immune response, with higher rates of infection and delayed wound healing-which leads to an increase in hospital stay and health costs. The aim of this study was to assess the prevalence of undernutrition and related risk factors in a sample of older adults who presented at the emergency room (ER) of a university hospital in Spain. METHODS: This was a cross-sectional study of 288 patients ≥70 y of age who were seen at the emergency department at the University Hospital of Valladolid. Variables of nutritional evaluation, including a Mini Nutritional Assessment Test, sociodemographic factors, comorbidities, chronic treatments, frequency of visits to the ER, and destination after hospital discharge were collected. RESULTS: The percentage of undernutrition was 14.9% and the risk for undernutrition was 54.5%. Most patients were able to independently conduct basic activities of daily living (BADLs), lived at home, resided in an urban environment, and had autonomous mobility. The mean body mass index (BMI) was 26.14 ± 4.52 kg/m2. Patients who were dependent on others for BADLs; institutionalized or bedridden; and with hematologic disease, chronic depressive syndrome, polymedication, low hemoglobin or low hematocrit, and hypochromia were associated with a higher prevalence of undernutrition. In the multivariate analysis, for each unit of increase in BMI, patients had 12% lower risk for developing undernutrition, and for each unit of increase in the frequency of ER visits, patients had a 41% higher risk for developing undernutrition. CONCLUSIONS: Older adults who presented to the ER had a high percentage of undernutrition, which is related to sociodemographic factors, comorbidities, polymedication, and biochemical factors. We also found a direct association between the frequency of ER visits and undernutrition, in addition to an inverse relationship with BMI. Detecting undernutrition in an ER may improve health and reduce related complications in older adults.

Magnesium, zinc, arsenic, selenium and platinum urinary excretion from cancer patients of Antofagasta region, Chile: multi-metal approach.

OBJECTIVES: To evaluate the short-term 24 h urinary excretion of platinum, arsenic, selenium, magnesium and zinc in patients with lung cancer and with cancer other than lungs treated with cisplatin or/and carboplatin from Antofagasta, Chile. DESIGN: Urine measurements of Pt and Se were made by inductively coupled plasma optical emission spectrometry, As by hydride-generation atomic absorption spectrometry and Mg and Zn by means of flame furnace atomic absorption spectrometry. SETTING: All samples were provided by the Oncological Centre of Antofagasta Regional Hospital (Region of Antofagasta, Chile). PARTICIPANTS: Ninety 24-h urine samples from cancer patients after the infusion of Pt-base drugs and 10 24-h urine samples from cancer patients not treated with metal-base drugs. MAIN OUTCOME MEASURES: Concentrations of Pt, Se, As, Zn and Mg coming from 24-h urine samples. RESULTS: Pt excreted was not significantly different between patients with lung and other cancers treated with cisplatin. The excretion of Mg, Zn and Se was greater than As. Then, Pt favours the excretion of essential elements. For lung and other types of cancers treated with drugs without Pt, excretion of Mg, Zn and Se was also greater than that of As, suggesting antagonism Mg-Zn-Se-anti-cancer drug relationship. CONCLUSIONS: The amounts of Mg, Zn and Se excreted were greater than for As either with or without Pt-containing drugs, suggesting antagonist Mg-Zn-Se-anti-cancer drug relationships. The excretion of As, Mg, Zn and Se is induced by Pt. Knowledge obtained can contribute to understanding the arsenic cancer mechanism and the As-Mg-Zn-Se-Pt inter-element association for lung cancer and other types of cancer.

[Nutritional characteristics and lifestyle in university students]. / Características nutricionales y estilo de vida en universitarios.

Obesity and the lifestyle characteristic of our society lead young people to conditions of potential cardiovascular risk. The aim of this study was to assess the anthropometrical situation and the lifestyle in a sample of university students. A full anthropometrical evaluation was undertaken, including bioelectric impedance analysis (BIA), in 111 students in the last year of Human Nutrition and Dietetics, as well as a lifestyle questionnaire (physical activity, alcohol and cigarette consumption). A sexual dimorphism was found in weight distribution according to the classification proposed by SEEDO: 6.4% of women presented a weight lower than the health recommendations (there no men in this group) whereas 27.8% of men and 6.5% of women were in the overweight range. 15.3% of the cases had excessive waist circumference. Fat mass by BIA was higher among women. On the other hand, 67% of university students stated to perform regular physical activity, 16.7% stated being cigarette smokers, and 55.6% stated to consume high-grade alcohol. To conclude, we studied a sample population of young and healthy subjects with, however, a significant percentage of women with body weight lower than the healthy standards, overweighed people, and smokers usually taking high-grade alcohol. These data should elicit an alert of the potential cardiovascular risk in the university population if action is not taken. This population should be included in the health promotion plans.

An approach to the arsenic status in cardiovascular tissues of patients with coronary heart disease.

Among non-cancer effects of arsenic, cardiovascular diseases have been well documented; however, few are known about the arsenic fate in cardiovascular tissues. We studied the analytic bioinorganic arsenic behaviour in cardiovascular tissues from an arsenic exposure coronary heart disease patient group from Antofagasta-Chile against a small unexposed arsenic coronary heart patient group. Total arsenic concentrations were measured in pieces of cardiovascular tissues of the arsenic-exposed and unexposed coronary heart patient groups by hydride generation atomic absorption spectrometry (HG-AAS); speciation analysis was made by high performance liquid chromatography-inductively coupled plasma-mass spectrometry (HPLC-ICP-MS). Pieces of auricle (AU), mammary artery (MAM), saphenous vein (SAP) and fat residuals (FAT) were considered in this study. The arsenic concentrations in AU and MAM tissues were significantly different between both groups of patients. Also, it was demonstrated that the AU is an 'As(3+) target tissue.' Otherwise, linking of the total concentrations of arsenic with conditional variables and variables related to medical geology factors allowed us to infer that the latter are more important for the cardiovascular risk of arsenic exposure in the Antofagasta region. Knowledge of total arsenic and the prevalence of the trivalent ion (As(3+)) in the AU of patients could contribute to understanding the effect of arsenic on cardiovascular diseases.

[Evaluation of two methods for correcting the impact factor using the investigation done at the "Del Río Hortega" University Hospital (1999-2004) as the data source]. / Evaluación de dos métodos de corrección del Factor de Impacto utilizando la investigación del H.U. "Del rio Hortega" (1999-2007) como fuentes de datos.

BACKGROUND AND OBJECTIVE: To adjust the Impact Factor (IF) provided by the Institute for Scientific Information (ISI) is necessary for improving bibliometric analysis among the various areas of knowledge. Our objective was to evaluate two parameters (the maximum and the median value of each subject area) for IF adjustment using the original (not corrected) IF as the reference method in a tertiary hospital biomedical investigation model. MATERIAL AND METHOD: We retrieved articles from Hospital Universitario "Del Río Hortega" from Valladolid (Spain) for the period 1999-2004 as data source. We have describe the characteristics of the followed IF distributions: IF Corrected by the Maximum value (IFCORMAX), IF Corrected by the Median value (IFCORMED) and IF without adjustments (IF). Besides, we have analyzed both the inter-annual and the inter-subject differences obtained by the three methods. RESULTS: The three analyzed IF series shown not normal distributions that are positively skewed. The IF adjusted by the median showed the highest coefficient of variation (CV = 357.3%). The IF adjusted by the Maximum value increased the "weight" of journals with the highest not corrected IF for each subject category. Inter-annual differences were similarly estimated by the three methods. The IF adjusted by the median increased the inter-subject difference from 7.3% to 12.4%. CONCLUSIONS: Our results suggests that IF adjusted by the maximum value of each discipline is the best method to correct the ISI-IF values, because journals with the high IF are always rewarded, while IF adjusted by the median infra-estimated most of them.

Soporte nutricional en los pacientes con trastornos del comportamiento alimentario / Nutritional support in patients with eating disorders

Los TCS (trastornos del comportamiento alimentario) son un grupo de enfermedades psiquiátricas que se caracterizan por tener una alteración definida del patrón de ingesta o de la conducta sobre el control de peso. En este grupo de enfermedades se incluyen fundamentalmente la anorexia nerviosa (AN) y la bulimia nerviosa (BN). Las manifestaciones clínicas de estas patologías son muy variadas debido a que puede afectar a todo el organismo como consecuencia de la malnutrición. El diagnóstico de los TCA es clínico, utilizándose esencialmente los criterios diagnósticos propuestos por la Asociación Americana de Psiquiatría (DSM-IV). La mejoría del estado nutricional es un objetivo primordial en estos pacientes malnutridos. Generalmente se establece una ganancia de peso de 250-500 g/sem en pacientes ambulatorios y 1.000-1.500 g/sem en pacientes ingresados. Según las recomendaciones de la Asociación Americana de Psquiatría, el tratamiento nutricional debería aportar inicialmente 30-40 kcal/kg/día (1.000-1.500 kcal/día) e irse incrementando durante la hospitalización. En la mayoría de las pacientes este aporte energético se realizará mediante soporte nutricional con dieta oral a la que añadiremos suplementos vía oral a medida que la paciente lo requiera. Suelen utilizarse dietas completas poliméricas, generalmente con una densidad calórica de 1,5 kcal/ml. No obstante, en algunos pacientes es necesario utilizar soporte nutricional artificial al no alcanzarse los objetivos necesarios. La nutrición enteral es la forma de nutrición artificial de elección en este tipo de pacientes

[Maple syrup disease: a rare entity that we must know. Review of its dietetic management]. / Enfermedad de jarabe de arce: una entidad rara que debemos recordar. A propósito de su manejo dietético.

Maple syrup disease is secondary to a deficiency of deshydrogenase complex of a cetoacid of branched-chain. This disease has a recessive autosomic inheritance, with an incidence of 1/200,000 newborns, without differences between male and female. Due to clinical presentation and biochemical response to tiamin, these patients can be classified in five clinical entities: classic, intermediate, intermittent, positive response to tiamin and deficiency of dihydrolipoyl deshydrogenase (E3). In these patients, an increase of seric branched-chain aminoacids is detected, it could be detected by (chromatography) during neonatal period. Valine, isoleucine, and aloisoleucine are increased in serum, orine, and cephaloraquideum liquid by ionic changed chromatography, chromatography of high resolution or high voltage electrophoresis. Patients have two phases in this disease (acute phase and maintaining phase). Objectives in acute phase are based in three topics: to eliminate toxic metabolites, nutritional support and to get anabolism. Utilization of hemodialysis/peritoneal dialysis/blood exchange is one of the first treatments. Dietetic support is the second treatment, with a minimum energy intake and controlling blood levels of aminoacids. Modified dietetic formulas is a main device to treat these patients.

Recomendaciones dietéticas tras la menopausia / Diet recommendations after the menopause

La población española está aumentando su esperanza de vida convirtiéndose las mujeres con menopausia en un grupo importante de pacientes a tratar en nuestras consultas. Las recomendaciones de macronutrientes y micronutrientes no distan mucho de las realizadas para la población general. Es importante señalar la ingesta de calcio y vitamina D como condicionantes muy importantes-en el mantenimiento de una correcta masa ósea y prevención de la osteoporosis. El perfil de ingesta de grasas, vitaminas antioxidantes, soja, vitamina B12 y fólico en el riesgo cardiovascular, así como la ingesta calórica en el sobrepeso juegan un papel fundamental y potencialmente modificable en esta población. En resumen, la dieta es un elemento de prevención primaria ew las mujeres, no obstante en la menopausia cobra un valor especial por los requerimientos especiales y por la clara relación entre determinados hábitos alimentarios y patologías de alta prevalencia como la osteoporosis y el aumento del riesgo cardiovascular y obesidad

Spanish population has increased the average of age. Menopausal women are an important group in our clinical practice. Recommendations of macro and micronutrients are similar to general population. It is important intakes of calcium and vitamin D, to prevent osteoporosis and a good bone mineral density. Level of dietary intakes of fats, antioxidants, soy, B12 vitamin, folic acid in cardiovascular risk and caloric intake in overweigth playa main role in general population. In summary, diet is a piece of primary prevention in women, however in elderly womens playa main role the requirements, due to a direct association between diet habits and high prevalent diseases such as osteoporosis, cardiovascular risk and obesity

[Mini Nutritional Assessment (MNA) test as a tool of nutritional evaluation in hospitalized patients]. / Mini Nutritional Assessment (MNA) como método de evaluación nutricional en pacientes hospitalizados.

OBJECTIVE: The objective of the study was to identified the prevalence of malnutrition in come patients with MNA (Mini Nutritional Assessment) test as a clinical tool. METHODS: A total of 145 patients were studied in Hospital del Río Hortega (Valladolid), from mars of 2000 till may of 2002. In all patients a MNA test, an anthropometric and biochemical evaluation were performed. RESULTS: Mean age was 57.44 +/- 18.06 years, weight 63.5 +/- 13.7 kg and body mass index 23.4 +/- 4.9 kg/m2. The studied population were 48.6% haematological tumours and other tumours, opposite to the rest of the patients who were presenting cerebro-vascular accidents 2.1%, respiratory problems or infections 16.8%, renal failure 3.5% and neurological diseases or processes of dementia in minor proportion 2.9%. Patients were divided in two groups, malnutrition MNA < 17 (n = 99) (group I) and risk of malnutrition MNA = 17 (n = 43) (group II). The malnutrition prevalence was 68.2% (group I) and risk of malnutrition 29.6% (group II) with test MNA. In biochemical evaluation the malnutrition group I had low levels of albumin (2.9 +/- 0.7 g/dl vs 3.41 +/- 2.71 g/dl; p < 0.05), prealbumin (14.9 +/- 6.2 g/dl vs 17.6 +/- 8.1 g/dl; p < 0.05) and transferrin (152.2 +/- 54.9 g/dl vs 189.9 +/- 32.6 g/dl; p < 0.05. Arm muscular circumference and arm circumference had values under average in patients with malnutrition. On having analyzed the different paragraphs of the test MNA between both groups, it was observed since in the group of undernourished patients the punctuation he was below the average in all the paragraphs. CONCLUSIONS: The risk of malnutrition in hospital was frequent, detected by MNA test.

Enfermedad de jarabe de arce: una entidad rara que debemos recordar. A propósito de su manejo dietético / Mapple syrup disease: a rare entity that we must know. Review of its dietetic management

La enfermedad de jarabe de arce o cetoaciduria de cadena ramificada es causada por una deficiencia en la actividad del complejo de la deshidrogenasa de los á cetoácidos de cadena ramificada. Esta enfermedad se hereda con carácter autósomico recesivo, afecta por igual a ambos sexos, siendo su incidencia de 1/200.000 recién nacidos. Basado en la presentación clínica y respuesta bioquímica a la administración de tiamina, estos pacientes se dividen en cinco fenotipos clínicos y bioquímicos diferentes: clásica, intermedia, intermitente, sensible atiamina y deficiencia de dihidrolipoil deshidrogenasa (E3). En los pacientes con esta enfermedad se detecta un aumento cualitativo de aminoácidos ramificados en plasma, se puede apreciar por métodos utilizados en screening (cromatografía en capa fina) durante el periodo neonatal. Los aminoácidos valina, isoleucina, y aloisoleucina se encuentran aumentados en plasma, orina, y líquido cefalorraquídeo determinados por cromatografía de intercambio iónico, cromatografía de alta resolucióno electroforesis alto voltaje. Es necesario diferenciar la fase en la que se encuentra el paciente (fase aguda o fase de mantenimiento). Los objetivos en la fase de descompensación metabólica aguda se basan en tres puntos: eliminar los metabolitos tóxicos, soporte nutricional y conseguir anabolismo. La utilización de exaguino transfusión/hemodiálisis/diálisis peritoneales una de las primeras medidas, junto con las modificaciones dietéticas que aportan un minimo energético y que intentan controlar los niveles de aminoácidos en sangre. La utilización de fórmulas dietéticas modificadas artificialmente constituye uno de los pilares del tratamiento en estos pacientes

Mapple syrup disease is secondary to a deficiency of deshidrogenase complex of á cetoacid of branched-chain. This disease has a recesive autosomic inheritance, with an incidence of 1/200.000 newborns, without differences between male and female. Due to clinical presentation and biochemical response to tiamin, these patients can be classified in five clinical entities: classic, intermediate,intermittent, positive response to tiamin and defficience of dihidrolipoil deshidrogenase (E3). In these patients, an increase of seric branched-chain aminoacids is detected, it could be detected by (cromathography) during neonatal period. Valine, isoleucine, andaloisoleucine are incresaed in serum, orine, and cephaloraquideum liquid by ionic changed cromathography, cromathography of high resolution or high voltage electrophoresis. Patients have two phases in this disease (acute phase and mantaining phase). Objectives in acute phase are based in three topics: to eliminate toxic metabolites, nutritional support and to get anabolism. Utilization of hemodyalisis/peritoneal dyalisis/blood exchange is one of the first treatments. Dietetic support is the second treatment, with aminimun energy intake and controlling blood levels of aminoacids. Modified dietetic formulas is a main device to treat these patients

Mini Nutritional Assessment (MNA) como método de evaluación nutricional en pacientes hospitalizados / Mini nutritional assessment (MNA) test as a tool of nutritional evaluation in hospitalized patients

Objetivo: El objetivo del trabajo fue identificar la prevalencia de la desnutrición en los pacientes hospitalizados atendidos por nuestra Unidad utilizando el test MNA (Mini Nutritional Assessment) como herramienta de estudio.Métodos: Estudiamos un total de 145 pacientes ingresados en el Hospital del Río Hortega, desde marzo de 2000 a mayo de 2002. A todos ellos se les realizó el test MNA, valoración antropométrica y bioquímica.Resultados: La edad media de los pacientes fue de 57,44 +/- 18,06 años, el peso 63,5 +/- 13,7 kg Y el índice de masa corporal 23,4 +/- 4,9 kglm2. La población estudiada presentaban tumores hematológicos o en otras localizaciones en un 48,6%, frente al resto de los pacientes que presentaban accidentes cerebrovasculares 21 %, problemas respiratorios o infecciones 16,8%, insuficiencia renal 3,5% y enfermedades neurológieas o procesos de demencia en menor proporción 2,9%.Se dividió a los pacientes en dos grupos, los que presentaban desnutrición MNA = 17 (n = 43) (grupo 11). La frecuencia de desnutrición fue del 68,2% (grupo 1) y de riesgo de desnutrición del 29,6% (grupo 11) con el test MNA; siendo la puntuación media de 14,55 +/- 4,4 puntos.En la valoración bioquímica el grupo de pacientes con desnutrición (grupo 1) tuvo menores valores de albúmina (2,9 +/- 0,7 g/di vs 3,41 +/- 2,71 g/di; p 0,05).Conclusiones: Los pacientes hospitalizados presentaron un riesgo de desnutrición elevado, detectado por el test MNA

Objetive: The objetive ofthe study was to identified the prevalence of malnutrition in come patients with MNA (Mini Nutritional Assessment) test as a clinical tool. Methods: A total of 145 patients were studied in Hospital del Río Hortega (Valladolid), from mars of 2000 till may of 2002. In all patients a MNA test, an anthropometric and biochemical evaluation were performed. Results: Mean age was 57.44 +/- 18,06 years, weight 63.5 +/- 13.7 kg and body mass index 23.4 +/- 4.9 kg/m2. The studied population were 48.6% haematological tumours and other tumours, opposite to the rest of the patients who were presenting cerebro-vascular accidents 2.1%, respiratory problems or infections 16.8%, renalfailure 3.5% and neurological diseases or processes of dementia in minor proportion 2.9%. Patients were divided in two groups, malnutrition MNA = 17 (n = 43) (group Il). The malnutrition prevalence was 68.2% (group 1) and risk of malnutrition 29.6% (group Il) with test MNA. In biochemical evaluation the malnutrition group 1 had low levels of albumin (2.9 +/-0.7 g/dl vs 3.41 +/-2.71 g/dl; p < 0.05), prealbumin (14.9+/- 6.2 g/dl vs 17.6 +/- 8.1 g/dl; p < 0.05) and transferrin (152.2 +/- 54.9 g/dl vs 189.9 +/- 32.6 g/dl; p<0.05. Arm muscular circumference and arm circumferce had values under average in patients with malnutrition. On having analyzed the different paragraphs of the test MNA between both groups, it was observed since in the group of undernourished patients the punctuation he was below the average in all the paragraphs. Conclusions: The risk of malnutrition in hospital was frequent, detected by MNA test

Effects of dietary intake and life style on bone density in patients with diabetes mellitus type 2.

OBJECTIVE: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. DESIGN: Cross-sectional study. SETTING: Tertiary care hospital. PARTICIPANTS: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. RESULTS: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 +/- 6.9 vs. 62.1 +/- 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 +/- 387 vs. 839 +/- 251 mg/day; p < 0.05) and zinc intake (9.23 +/- 3.5 vs. 13.3 +/- 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = -0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. CONCLUSIONS: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.

[Colonic polyps: dysplasia predictive factors]. / Pólipos de colon: factores predictivos de displasia.

OBJECTIVE: Analyze the presence of dysplasia in colonoscopy visualized colonic polyps, and the predictive factors for high grade dysplasia. MATERIAL AND METHODS: We studied the polyps observed in the colonoscopies carried out during the year 2001. Colonoscopies carried out in 2,144 patients were analyzed, with demonstration of polyps in 326 patients (average age: 67 12,6 years, 63,5% males). 732 polyps were analyzed, with average of 2.27 2 polyps by patient. RESULTS: 72% polyps were located distally to splenic flexure, and sigmoid colon was the most frequent location (34.7%). Most of the polyps (86%) were sessile. Only 3% were > 2 cm, and the majority (88%) was < 1 cm. The most prevalent histological type was tubular adenoma (36%). Dysplasia was observed in 42.2% (low grade in 40% and high grade in 2.2%) Size > 1 cm and location proximal to splenic flexure were the only variables with indendent significant association to high grade dysplasia. CONCLUSIONS: The presence of high grade dysplasia in the colonic polyps was related in our cohort both to the location of the polyps in the colon and to its size, so that greater risk was for proximal polyps and for polyps > 1 cm.

[Usefulness of miglitol in patients with diabetes mellitus type 2 and insufficient control of the blood glucose]. / Utilidad del miglitol en pacientes con diabetes mellitus tipo 2 y mal control glucémico.

OBJECTIVE: Miglitol belongs to the group of the inhibitors of the alpha-glucosidases and in several studies has demonstrated its usefulness in the improvement of the glycemic control in the different types of diabetic patients. The goal of our study was to analyze the usefulness of miglitol in the blood glucose and lipid control in a group of patients with diabetes type 2 treated with sulfonylureas and insulin, with insufficient glycemic control. PATIENTS AND METHODS: A group of 33 patients with diabetes mellitus type 2 treated with sulfonylureas and insulin and with insufficient glycemic control (HbA1c>7.5%) was studied. All patients were treated with miglitol during 3 months with progressive doses: the first week 50 mg twice a day, subsequently and during one month 50 mg three times a day. At the beginning of the study and up to three months the following variables were measured; weight, height, BMI (body mass index), systolic and diastolic blood pressure, HbA1c, number of episodes of peripheral hypoglycemia, basal glucose, albuminuria, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, as well as transaminases (GOT, GPT, gamma GT and bilirubin). RESULTS: The median age was 64.1 +/- 12.5 years, and the median length of diabetes mellitus was 9.1 +/- 7 years. The median value of BMI was 27.7 +/- 6.9 kg/cm2. The blood glucose and HbA1c values decreased 4.8% and 5.8%, respectively. A decrease in the number of hypoglycemia episodes (39.4% previous quarter versus 3% quarter wih miglitol) was observed. Also decreased the dose of sulfonylureas needed by the patients (86.2 +/- 24.3 mg/day versus 64.6 +/- 21.9 mg/day; p<0.05) (25%). Total cholesterol, HDL-cholesterol, and LDL-cholesterol levels were not modified, but indeed a reduction of the levels of triglycerides (145.2 +/- 111 mg/dl versus 133.1 +/- 79 mg/dl; p<0.05) (8.3%) was detected. Fifteen percent of patients showed side effects (digestive discomfort) that disappeared two or three weeks after beginning the treatment. CONCLUSIONS: Miglitol is a useful drug in order to improve the glycemic control in diabetic type 2 patients treated previously with other drugs and with insufficient control of the blood glucose. Its side effects are limited and transitory.

[Observational study on the efficacy of the application of two classical regimens of triple antiretroviral therapy]. / Estudio de campo sobre la eficacia de la aplicación de dos modalidades clásicas de triple terapia antirretroviral.

BACKGROUND: To compare the temporal evolution of viral load and CD4 parameters in two cohorts of HIV infected patients enrolled in classical triple antiretroviral regimens. METHODS: Retrospective, observational, descriptive study of the proportions of patients reaching undetectable levels of viral load (VL) as well as the time necessary to get it. The two cohorts were as follows: 91 HIV patients on triple therapy with zidovudine plus lamivudine and indinavir (cohort A) versus 80 HIV patients with Stavudine plus Didanosine and Indinavir (cohort B). RESULTS: The evolution of the patients in terms of percentages who reach undetectable VL was similar in the two therapeutic cohorts (75.8%for cohort A vs 73.8% for cohort B) along the duration of the study (four years). However, the mean time period needed to reach undetectable VL was different, 209 days (IC 95% 175-243 days) for patients in zidovudine plus lamivudine and indinavir and 330 days (IC 95% 263-396 days) for stavudine plus didanosine and indinavir regimen. The immunological status observed in the patients when reaching his first undetectable VL was significantly different. The proportion of patients with CD4 cells counts >200/mm3 in cohort A was 83.1% while for patients from cohort B was 65.4% (p=0.032). CONCLUSIONS: This observational study from clinical settings seems demonstrate similar efficacy to reach undetectable VL with both classical triple antiretroviral therapies evaluated but a shorter delay of time to reach that virological situation for zidovudine plus lamivudine and indinavir regimen is reported.

Estudio de campo sobre la eficacia de la aplicación de dos modalidades clásicas de triple terapia antirretroviral / Observational study over the efficacy of the application of two classical regimens of triple antiretroviral therapy

Fundamento: Comparar la evolución temporal de los parámetros de carga viral (CV) y CD4 en dos cohortes de pacientes VIH tratados con dos regímenes clásicos de terapia antirretroviral. Métodos: Estudio retrospectivo, observacional, y descriptivo del porcentaje de pacientes que alcanzaron cargas virales no detectables y el tiempo que tardaron en lograrlo. Las cohortes fueron: 91 pacientes tratados con zidovudina, lamivudina e indinavir (cohorte A) versus 80 pacientes tratados con estavudina, didanosina e indinavir (cohorte B).Resultados: La evolución de los pacientes fue similar en cuanto al porcentaje de los mismos que alcanzaron CV "no detectables" (75,8 por ciento en la cohorte A y 73,8 por ciento en la cohorte B) a lo largo del tiempo de seguimiento (cuatro años). El tiempo medio transcurrido hasta alcanzar el referido "éxito" fue diferente, 209 días (IC 95 por ciento: 175-243 días) en el caso del régimen A y 330 días (IC 95 por ciento: 263-396 días) para el régimen B. El estado inmunológico en el momento de su primera CV "no detectable" de los pacientes que recibían Zidovudina, Lamivudina e Indinavir se encontraba significativamente más conservado que en el otro grupo (83,1 frente a 65,4 por ciento para cifras de linfocitos CD4/mm3 superiores a 200, respectivamente; p=0,032).Conclusiones: En nuestro estudio si bien la eficiencia de ambas combinaciones terapéuticas resultó equiparable en cuanto a la similitud del porcentaje de individuos que alcanzaron viremias "no detectables" a lo largo del tiempo de seguimiento, aquéllos tratados con Zidovudina, Lamivudina e Indinavir lo lograron antes (AU)

Background: To compare the temporal evolution of viral load and CD4 parameters in two cohorts of HIV infected patients enrolled in classical triple antiretroviral regimens. Methods: Retrospective, observational, descriptive study of the proportions of patients reaching undetectable levels of viral load (VL) as well as the time necessary to get it. The two cohorts were as follows: 91 HIV patients on triple therapy with zidovudine plus lamivudine and indinavir (cohort A) versus 80 HIV patients with Stavudine plus Didanosine and Indinavir (cohort B). Results: The evolution of the patients in terms of percentages who reach undetectable VL was similar in the two therapeutic cohorts (75.8% for cohort A vs 73.8% for cohort B) along the duration of the study (four years). However, the mean time period needed to reach undetectable VL was different, 209 days (IC 95% 175-243 days) for patients in zidovudine plus lamivudine and indinavir and 330 days (IC 95% 263-396 days) for stavudine plus didanosine and indinavir regimen. The immunological status observed in the patients when reaching his first undetectable VL was significantly different. The proportion of patients with CD4 cells counts >200/mm3 in cohort A was 83.1% while for patients from cohort B was 65.4% (p=0.032). Conclusions: This observational study from clinical settings seems demonstrate similar efficacy to reach undetectable VL with both classical triple antiretroviral therapies evaluated but a shorter delay of time to reach that virological situation for zidovudine plus lamivudine and indinavir regimen is reported (AU)

Hipercalcemia secundaria a hiperparatiroidismo primario ectópico

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Comparación de características organolépticas de una dieta triturada convencional versus dieta liofilizada / Comparison of organoleptic characteristics of conventional triturated diet versus dehydrated diet

Fundamentos: Las dificultades para deglutir alimentos y bebidas son un problema en la vida de muchas personas, constituyendo un claro detrimento en su calidad de vida. El objetivo de nuestro trabajo es comparar la aceptación de una dieta liofilizada completa frente a la dieta convencional triturada de nuestro Hospital en grupo de pacientes con alteraciones en la deglución.Métodos: Estudiamos un total de 22 pacientes ingresados en el Hospital Universitario del Río Hortega (Valladolid) en Octubre del 2000. El motivo de ingreso de estos pacientes fueron los siguientes; (n=5) 22,7 por ciento accidentes cerebrovasculares agudos, (n=9) 40,9 por ciento tumores del tracto aéreo-digestivo superior y un 36,4 por ciento(n=8) patología neurológica degenerativa (demencia de Alzheimer, demencia multinfarto y parkinson avanzado). A todos los pacientes se les administró en la misma bandeja durante 5 días consecutivos dos recipientes por cada plato (primer plato, segundo plato y postre) un recipiente con alimento convencional y otro recipiente con alimento liofilizado reconstituido (Vegenat®), las características de las dietas completas convencionales (250 ml de la dieta) y liofilizadas (50 g de producto disueltos en agua), posteriormente se realizó una encuesta de satisfacción valorando los ítems; textura, sabor, olor y color.Resultados: La edad media de los pacientes estudiados fue 76.7ñ10.8 años. Al analizar la aceptación del producto en sus diferentes apartados organolópticos los preparados liofilizados se mostraron superiores, de este modo un 84,2 por ciento de las respuestas de los pacientes en los 5 días que recibieron la dieta fue con respecto a la textura muy buena frente a un 0 por ciento de las respuestas con respecto a la dieta convencional (p<0,05). Un 40,4 por ciento de las respuestas de los pacientes fueron muy buenas en lo que respecta al sabor frente a un 13,1 por ciento en la dieta convencional (p<0.05). La aceptación del olor también fue superior en la dieta liofilizada analizando la respuesta muy buena (28,9 por ciento vs 10,5 por ciento; p<0,05), también el color se mostró superior (18,1 por ciento vs 2,22 por ciento).Conclusión: En conclusión, la aceptación por parte de los pacientes con disfagia de una dieta liofilizada ha sido elevada, mostrándose útil en este grupo de pacientes donde las alteraciones nutricionales son frecuentes (AU)

Nutritional treatment for acquired immunodeficiency virus infection using an enterotropic peptide-based formula enriched with n-3 fatty acids: a randomized prospective trial.

OBJECTIVE: Dietary counseling and intervention based on application of conventional criteria have been ineffective in preventing the progressive weight loss associated with HIV infection. The aim of the study was to compare the progression of clinical and nutritional indicators during nutritional supplementation with or without an enterotropic peptide-based formula enriched with n-3 fatty acids. DESIGN: Randomized trial. SETTING: Tertiary care. SUBJECTS: Ninety-one patients were screened for the study. Twenty-three did not meet the inclusion criteria, therefore 74 patients were randomized. Of these, 38 were randomized to group I (standard formula) and 36 were randomized to group II supplementation (enterotropic peptide-based formula enriched with n-3 fatty acids). INTERVENTIONS: Group I received standard enteral formula and group II received a enterotropic peptide-based enteral formula. The volume was the same (3 cans/day, 236 ml per can). In both groups enteral supplementation were recommended in conjunction with a registered dietitian under a dietary counseling program based on standard nutrition principles. Patients received a prospective serial assessment of nutrition status, nutritional intake with 24 h written food records, GI symptoms, immune function, anthropometric status and intercurrent health events including infections and hospitalization. These determinations were performed at baseline and at 3 months. RESULTS: Treatment with both supplements resulted in a significant and sustained increase in weight (3.2% in group I and 3.1% in group II); this increase was mostly due to fat mass (12.8% in group I) and (7.5% in group II). Total body water and fat free-mass remained unchanged. CD4 counts remained stable in group I, while a significant increase was detected in group II (576+/-403 vs 642+/-394 cells/mm(3); P<0.05). After the 3 month period CD4 counts remained higher in group II. Hospitalization events (infections) were also followed during the 3 month period. Group II had fewer hospitalizations than group I, but no statistical differences were found. CONCLUSIONS: Oral nutritional supplements for a 3 month period were well tolerated and resulted in body weight gain in HIV-infected patients. Supplement-enriched formula, with peptides and n-3 fatty acids, increased CD4 count.