[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.

[Eating behavior, body attitudes and psychopathology in morbid obesity]. / Conductas alimentarias, actitudes hacia el cuerpo y psicopatología en obesidad mórbida.

INTRODUCTION: Obesity is an ever more frequent health problem. An assessment of eating habits, attitudes towards the body and presence and degree of psychopathology in morbid obese subjects is presented. METHOD: Eighty subjects with morbid obesity (BMI > 40), candidates for bariatric surgery, were systematically studied. A semistructured interview was carried out, including demographic and anthropometric data, eating habits, family history of obesity and family and personal background of psychiatric illness. The following tests were also administered: BITE, EDI and GHQ-28. RESULTS: Most of the subjects were women (90%), married (67.5%), with medium educational and professional levels. Mean age was 38 years, weight 131.3 kg, and BMI 50.17 kg/m2. A high frequency of familial history of obesity (82.5%) was observed, with fewer familial antecedents of depression (37.5%) and personal history of psychiatric illness (36.3%). A total of 27.5% admitted binge eating, 60% were nibblers and 46.3% sweet eaters. BITE results shows a medium level of bulimia (12.25), with 22.5% high scorers. A high level of body dissatisfaction (mean score of 21.5), with a significant drive for thinness stood out in the EDI. GHQ detects the existence of psychopathology in low degree (mean total score of 8.64), especially anxiety-insomnia, with a high proportion of possible psychopathologic disorders (46.2%). CONCLUSIONS: Morbid obese subjects have a significant frequency of binge eating, and show a high level of body dissatisfaction, an important drive for thinness and medium frequency of low degree psychopathology, mainly anxiety.

Conductas alimentarias, actitudes hacia el cuerpo y psicopatología en obesidad mórbida / Alimentary conducts, body attitudes and psychopathology in morbid obesity

Introducción. La obesidad constituye un problema de salud cada vez más frecuente. Se presenta una valoración de los hábitos alimentarios, actitudes hacia el cuerpo y presencia y grado de psicopatología en obesos mórbidos.Metodología. Se estudiaron 80 sujetos con obesidad mórbida (índice de masa corporal [IMC] > 40), candidatos a cirugía bariátrica. Se mantuvo entrevista con recogida de datos demográficos y antropométricos, hábitos alimentarios, antecedentes familiares de obesidad, y personales y familiares de enfermedad psiquiátrica. Se administraron los siguientes tests: BITE, EDI y GHQ-28.Resultados. Se recoge un predominio de mujeres (90 per cent) casadas (67,5 per cent), con niveles educativo y profesional medios, con una media de edad de 38 años, peso de 131 kg y un IMC de 50,17 kg/m2. Se registró una elevada frecuencia de antecedentes familiares de obesidad (82,5 per cent), y menor de antecedentes familiares de depresión (37,5 per cent) y personales de enfermedad psiquiátrica (36,3 per cent). Un 27,5 per cent admitía atracones, un 60 per cent picaba y un 46,3 per cent era comedor de dulces. En el BITE se registra un nivel medio de bulimia (12,25) con un 22,5 per cent de sujetos con puntuaciones altas. En el EDI destaca una elevada insatisfacción corporal (puntuación media de 21,5) con una significativa búsqueda de la delgadez. En el GHQ se refleja la existencia de psicopatología en grado leve (puntuación media total de 8,64), especialmente ansiosa, con una elevada proporción de sujetos con psicopatología probable (46,2 per cent).Conclusiones. Los obesos mórbidos presentan una frecuencia significativa de conductas bulímicas, una elevada insatisfacción corporal, una importante tendencia a la delgadez y una frecuencia intermedia de psicopatología en grado leve, especialmente ansiosa. (AU)

[Detection of malnutrition risk in hospitalized elderly patients]. / Detección del riesgo de malnutrición en ancianos hospitalizados.

UNLABELLED: OBJECTIVE AND SCOPE: To validate a protocol for the detection of malnutrition risk in a population of elderly patients admitted to a general hospital for non-surgical reasons. MATERIALS AND METHOD: The study involved 95 patients (34 of them male) over the age of 65 who were assessed on the third and fifth day after admission by means of a simple screening protocol (PC in its Spanish acronym) that considered recent changes in weight, serum albumin, lymphocyte concentration, food intake and diagnosis on admission, together with a more complex diagnostic protocol (PD in its Spanish acronym) including anthropometric, biochemical and immunological parameters. The PC was applied by personnel not expert in nutrition, while the PD was carried out by persons trained in nutritional assessment. The results of the PC and PD were compared, with statistical significance being considered at levels of p < 0.05. RESULTS: According to the PD, 75 patients (78.9%) suffered protein-energy malnutrition (39 slight, 31 moderate, 5 severe). The score obtained in the PC had a significant relationship with the severity of the malnutrition diagnosed using PD (p < 0.001). Furthermore, the absence or presence of nutritional risk assessed using the PC had a significant correlation with the diagnosis of malnutrition and its degree according to the PD (p < 0.01), thus indicating the validity of the PC as a method for screening of malnutrition. CONCLUSIONS: 1. In our population of geriatric patients admitted for reasons other than surgery, there was a high prevalence of protein-energy malnutrition. 2. The risk of malnutrition in an elderly population in hospital settings is appropriately assessed by means of a simple screening test effected by non-specialized personnel. 3. The score obtained in the PC is linked with the presence of malnutrition and with its severity. 4. The use of simple screening techniques in populations with a high prevalence of malnutrition may contribute to the detection and correction of this problem.

Pasteurella spp: un nuevo germen causante de tiroiditis aguda supurada / Pasteurella spp: a new microorganism adding to acute suppurative thyroiditis etiology

La tiroiditis aguda supurada es una entidad poco frecuente debido a la resistencia natural de la glándula a la infección. Patología preexistente sobre el tiroides así como defectos anatómicos locales predisponen a padecer la enfermedad. Presentamos el primer caso descrito en la literatura por Pasteurella spp tras infección de vías respiratorias superiores, con clínica poco florida mimetizando tiroiditis subaguda. La evolución fue satisfactoria tras drenaje quirúrgico (AU)

[Pasteurella spp: a new microorganism to the cause of acute suppurative thyroiditis]. / Pasteurella spp: un nuevo germen causante de tiroiditis aguda supurada.

Acute suppurative thyroiditis is an uncommon disease due to local resistance of the gland to infection. Preexisting gland pathology and local anatomic abnormalities are predisposing factors. We present the first case described in the medical literature caused by Pasteurella spp after upper respiratory infection with insidious manifestations resembling subacute thyroiditis. The course was benign after surgical drainage.