Alicia Calleja Fernández

Inclusion and Release of Fenbufen in Mesoporous Silica

This work reports the immobilization of Fenbufen, a nonsteroidal anti-inflammatory drug, into two different hexagonal mesoporous silicas (MCM-41) which exhibit some differences in terms of morphology and pore size, and their behavior as systems for sustained release at pH 7.5. The drug/mesoporous silica systems have been characterized by powder X-ray diffractometry (PXRD), Fourier transform infrared spectroscopy (FT-IR), N(2) adsorption-desorption, and transmission electron microscopy (TEM). The results show that the drug is mainly incorporated inside the pores, and its loading is dependent on both the pore size and the impregnation temperature. The Fenbufen/mesoporous-silica systems give a well-sustained release profile, releasing 100% of the initially loaded drug at the end of the in vitro assays.

Solubility and release of fenamates intercalated in layered double hydroxides

Abstract The effect of a Mg- and Al-containing layered double hydroxide (LDH), used as an additive or as a matrix, on the dissolution and solubility of two non-steroidal anti-inflammatory drugs (NSAIDs), namely, mefenamic and meclofenamic acids, is reported. The use of MgAl-LDH enhances the solubility of mefenamic acid at the three pH values tested, and the value is larger when the acid is intercalated as opposed to simply being mixed with the layered material. For pure mefenamic acid, the most unfavourable pH is 1.2, while for the physical mixture and the sample with the intercalated drug, the most unfavourable pH is 4.5, for which the minimum increase in the amount of dissolved acid is recorded. The (dissolution) release-rate for both drugs when they are intercalated between the layers is much slower than for the physical mixture or for the dissolution of the pure drug.

Food intake and nutritional status influence outcomes in hospitalized hematology-oncology patients

BACKGROUND Malnutrition in oncology and hematology-oncology patients is important due to its prevalence and associated mortality and morbidity. The aims of the study were to assess the prevalence of malnutrition in oncology and hematology patients and determine if intake or malnutrition influences hospitalization outcomes. METHODOLOGY A cohort study was performed in all patients admitted to the oncology and hematology wards in a 30-day period. Nutritional assessment was performed within 24-hours of admission and repeated after 7 days of hospitalization, including Subjective Global Assessment, anthropometry, dietary assessment (24-hour recall) and estimation of caloric and protein needs. Medical records were reviewed 30 days after discharge. RESULTS Seventy-three patients were evaluated on admission and 29 on day 7 of hospitalization. The prevalence of malnutrition was 47.7%. On admission, patients consumed 71.6 (SD 22.0)% of the prescribed dietary calories and 68.2 (SD 23.5)% of prescribed proteins. The death rate was 2.8% among patients who ate ≥75% and 17.9% among those who ate <75% (p = 0.040). No significant differences were observed between the intake of calories (p = 0.124) and protein (p = 0.126) on admission and on day 7 of hospitalization. Nutritional status was related to readmission rate, being 35.1% for malnourished vs. 8% for well-nourished (p = 0.014). Nutritional status and food intake were not related to the rest of the studied outcomes (length of stay and mechanical, metabolic or infectious complications). CONCLUSIONS Intake did not decrease during hospitalization. There was an upward trend between reduced intake and mortality. Malnutrition was related to hospital readmission.

CHRONIC ENTERITIS IN PATIENTS UNDERGOING PELVIC RADIOTHERAPY: PREVALENCE, RISK FACTORS AND ASSOCIATED COMPLICATIONS.

INTRODUCTION the radiation of tumours located in pelvic organs can cause mucositis in the bowel. The aim of this study was to determine the prevalence, risk factors, and complications of chronic radiation enteritis in patients who had received pelvic radiotherapy. PATIENTS AND METHODS cross-sectional study recruiting 150 patients that had been treated with radiation therapy during the year 2008 because of a prostate, cervical, endometrial or rectal cancer. The patients were asked about symptoms related to enteritis, and about changes in body weight and in dietary patterns. Sex, age, treatment modalities, acute enteritis, and type of cancer were considered possible risk factors, and were analysed with univariate and multivariate methods. RESULTS the study included 100 patients, 84% males, median age 72.3 years. Chronic radiation enteritis was found in 20% of the patients, most of them grade 1 (45%). Furthermore, 10% had lost ≥ 5 kg of weight, 3% had been hospitalized due to diarrhoea or bowel obstruction, and 11% had changed their diet, mainly by removing vegetables, legumes and pastry. Male gender, age, previous acute radiation enteritis, and chemotherapy were associated with chronic enteritis, but only chemotherapy remained independently related to bowel toxicity after multivariate analysis (OR = 3.59 [95% CI 1.20-10.73]). CONCLUSION chronic enteritis is common among patients treated with pelvic radiotherapy, especially if chemotherapy is associated. The complication rate is low, but a significant number of patients change their usual diet in order to prevent symptoms.

A home enteral nutrition (HEN); Spanish registry of NADYA-SENPE group; for the year 2013

AIM To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the year 2013. MATERIAL AND METHODS From January 1st to December 31st 2013 data was recorded for the HEN registry and further descriptive and analytical analysis was done. RESULTS In this period 3 223 patients (50.6% men) and a total of 3 272 episodes of HEN were registered in 33 Spanish hospitals. The rate of prevalence was of 67,11 patients/million habitants/ year 2013. A high percentage of patients (98,24%) were older than 14 years. Adults mean age was 69,14 years (sd 17,64) and men were younger than women p-value <0,001. Children mean age was 2,38 years (sd 4,35). The most frequent indication for HEN was neurological disease for children (49,1%). and for adults (60,6%). Gastrostomy was the most used administration route for children (51%) while younger ones were fed with NGT (p-value 0,003) also older adults (48%) were fed with this type of tube (p-value <0,001). The most frequent reasons for cessation of treatment was death, 44,4% were children and 54,7% were adults. CONCLUSIONS The number of patients and hospitals registered increased in the last years while the other variables maintain steady. The registry developed allowing contrasted analysis of data in order to get more information.

Adecuación del código de dietas a las necesidades nutricionales del paciente hospitalizado

Introduccion: la dieta hospitalaria debera aportar la suficiente cantidad de energia a partir de una adecuada distribucion de macronutrientes. Objetivo: determinar la calidad nutricional de las dietas hospitalarias. Metodologia: estudio transversal realizado en condiciones de practica clinica habitual. Se realizo una valoracion nutricional de todas las dietas hospitalarias y una estimacion de las necesidades energeticas y proteicas del paciente hospitalizado. Finalmente, se valoro la adecuacion del diseno nutricional y dietetico de las dietas actuales teniendo en cuenta las necesidades nutricionales del paciente. Se considero: “Dieta energetica y proteicamente completa” si el aporte de energia y proteinas estaba por encima del percentil 95 de las necesidades nutricionales detectadas en los pacientes del centro; “Dieta energetica y proteicamente potencialmente completa” si el aporte de energia y proteinas estaba comprendido entre el percentil 75 y 95 de las necesidades nutricionales detectadas en el centro; “Dieta energetica y proteicamente incompleta” si el aporte de energia y proteinas estaba por debajo del percentil 75 de las necesidades nutricionales detectadas en el centro. Resultados: fueron evaluadas nutricionalmente 54 dietas destinadas a pacientes adultos. Fueron valorados un total de 201 pacientes con una mediana de edad de 71,60 (RIC 21,40) anos y el 51,25% fueron mujeres. Sus necesidades energeticas fueron 25,84 (DE 2,55) kcal/kg peso/ dia o 1.753,54 (DE 232,51) kcal/dia, el percentil 95 fue de 2.153,9 kcal/dia y el percentil 75 fue 1.772,5 kcal/dia. Las necesidades proteicas fueron 1,2 (DE 0,10) g/kg peso/dia o 82,30 (DE 16,76) g/dia, el percentil 95 fue 112,3 g/dia y el 75 fue 91,8 g/dia. El 25% de las dietas cubrian las necesidades energeticas de la poblacion hospitalaria; una dieta cubria las necesidades proteicas. Conclusion: las dietas evaluadas no cubrian las necesidades nutricionales del paciente hospitalizado. La reestructuracion actual lograra satisfacer sus necesidades nutricionales asi como sus expectativas gastronomicas.

Cuestionario semicuantitativo para la valoración de la ingesta dietética del paciente hospitalizado: una herramienta sencilla para la práctica clínica

Introduccion: la cuantificacion y registro de la ingesta alimentaria del paciente hospitalizado es clave dentro del plan de cuidado nutricional. Objetivo: evaluar la validez de un cuestionario semicuantitativo de valoracion del consumo comparado con una tecnica de registro de alimentos por observacion y pesada de los platos incluidos en la dieta hospitalaria. Metodos: estudio transversal realizado en condiciones de practica clinica habitual. Las tecnicas de valoracion del consumo que se compararon fueron un registro por doble pesada y un cuestionario semicuantitativo por observacion de la ingesta de cinco categorias (todo [> 80%], casi todo [80-60%], la mitad [60-40%], casi nada [40-20%] o nada [< 20%]), ambas realizadas por un dietista-nutricionista. La comparacion entre ambas herramientas fue realizada con el indice kappa con ponderacion cuadratica e intervalo de confianza del 95%. Resultados: fueron realizadas un total de 1.980 valoraciones. Se observo con el cuestionario semicuantitativo que en el 50% de los casos se ingirio todo, en el 19% casi todo, en el 13% la mitad, en el 9% menos de la mitad y en el 9% nada. La mediana de la ingesta por doble pesada de alimentos fue de 76,8 (RIC 45,8)%. Se observo que existio un acuerdo satisfactorio entre la tecnica de doble pesada y la valoracion visual del consumo con un valor κ = 0,907 (IC 95% 0,894-0,925). Conclusion: la escala visual empleada en este estudio permite cuantificar la ingesta real del paciente de forma precisa y adecuada por personal cualificado.

CARACTERÍSTICAS TÉCNICAS DE LOS PRODUCTOS ALIMENTARIOS ESPECÍFICOS PARA EL PACIENTE CON DISFAGIA

Dysphagia is a common problem among elderly and also in some pathological conditions such as neurodegenerative diseases or tumors. Making an adequate diet for this disease may present some difficulties. The aim of this document is to make a detailed technical report about the characteristics of the products that are available in Spain to hydrate and to feed patients with dysphagia. Food and pharmaceutical industries have developed a range of products designed to ensure homogeneous texture and a suitable viscosity to guaranty an adequate hydration. An adequate nutritional status is also achieved with these products for patients with dysphagia, without compromising their safety. The ingredients used to achieve a suitable viscosity are different types of starches, gums and other substances. It has been developed thickeners and gellified water for hydratation, and in case of food there are purees (dehydrated, lyophilized, pasteurized and sterilized), fruit purees, fruit pudding, and dehydrated cereal. Patients who do not meet their nutritional needs have also oral supplements with different viscosities. The industry offers extensive information about the technical characteristics of the products, except for viscosity. It would be recommended for the manufacturers to include in detail the technical specifications of the used methodology and the measurement and the results obtained in the analysis of viscosity that can be consulted by professionals of the Clinical Nutrition and Dietetics Units who treat these patients.