Jaime Pereira

Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia

BACKGROUNDnSeveral cardiovascular risk factors are present in patients with chronic renal failure (CRF), among which are systemic inflammation and hyperhomocysteinemia. Increased oxidative stress, endothelial activation/dysfunction, and coagulation activation are considered integral components of the inflammatory response, but have also been proposed as mediators of plasma homocysteine (tHcy)-induced cell damage. Using correlation analysis, we assessed the relative contributions of inflammation and hyperhomocysteinemia in the abnormal oxidative stress, endothelial activation/dysfunction, and hemostasis activation in patients with CRF.nnnMETHODSnThe relationships of inflammatory proteins and tHcy with plasma markers of these processes were studied in 64 patients with CRF (serum creatinine 526 +/- 319 micromol/L) on conservative treatment, comparing the results with healthy controls (N = 15 to 40, depending on the measured variable) of similar sex and age.nnnRESULTSnPatients had significant increases in inflammatory cytokines (TNF-alpha and IL-8) and acute-phase proteins (C-reactive protein, fibrinogen and alpha1-antitrypsin). tHcy was increased in 87.5% of patients (mean = 27.1 micromol/L, range 6.5 to 118). Patients had significant increases in (1) indices of oxidative stress: TBARS (thiobarbituric acid-reactive species), a marker of lipid peroxidation and AOPP (advanced oxidation protein products), a marker of protein oxidation; (2) endothelial cell markers such as von Willebrand factor (vWF:Ag), soluble ICAM-1 and soluble thrombomodulin (sTM); (3) markers of intravascular thrombin generation: thrombin-antithrombin complexes (TAT) and prothrombin fragment F(1+2) (PF(1+2)); and (4) indices of activation of fibrinolysis: plasmin-antiplasmin complexes (PAP), fibrin degradation products (FnDP) and fibrinogen degradation products (FgDP). tHcy was significantly correlated with plasma creatinine (r = 0.29, P < 0.018) and with serum folate (r = -0.38, P < 0.002). However, no significant correlations were observed between tHcy and TBARS, AOPP, vWF:Ag, sICAM-1, sTM, TAT, F(1+2), sTF, PAP, FnDP, and FgDP. Conversely, acute-phase proteins showed significant, positive correlations with most markers of oxidative stress, endothelial dysfunction and hemostatic activation.nnnCONCLUSIONSnSystemic inflammation, which is closely associated with augmented oxidative stress, endothelial cell dysfunction and hemostatic activation, emerges as a major cardiovascular risk factor in CRF. tHcy is unrelated to these events. Thus, alternative mechanisms through which hyperhomocysteinemia could predispose to vascular lesion and thrombotic events in CRF needs to be investigated.

Template bleeding time and PFA-100 have low sensitivity to screen patients with hereditary mucocutaneous hemorrhages: comparative study in 148 patients.

Summary.u2002 Objectives and patients:u2003We compared the template bleeding time (BT) and closure time (CT) in the PFA‐100® as screening tests in 148 consecutive patients with unequivocal mucocutaneous bleeding and positive family history. Exclusion criteria: drug intake, concomitant diseases including minor infections, low platelet count, diseases of secondary hemostasis.Results:u2003Type 1 von Willebrand disease (VWD‐1) was diagnosed in 26 patients, primary platelet secretion defect (PSD) in 33, VWD‐1 +u200aPSD in nine, whereas 80 patients did not comply with the criteria for known hemostatic disorders (UD, unknown diagnosis). BT and CT were prolonged in 35.8% and 29.7% of all the patients, respectively (Pu2003=u20030.23). Sensitivity increased to 48% if an abnormality of BT and/or CT was considered. Same comparisons for BT and CT in each diagnostic category were, respectively: 42 vs. 61.5% in VWD‐1 (Pu2003=u20030.18), 42 vs. 24% in platelet secretion defects (Pu2003=u20030.11), 67 vs. 89% in VWD‐1 +u200aPSD (Pu2003=u20030.50), and 27.5 vs. 15% in UD (Pu2003=u20030.06). Conclusion:u2003Both tests were relatively insensitive and not significantly different in detecting incoming patients with mucocutaneous hemorrhages. In patients with VWD‐1, the PFA‐100® performed slightly better, whereas the opposite occurred in those patients with platelet secretion defects. In the UD group, both tests lost sensitivity, but the BT detected 1.8 times more patients than the PFA‐100®. Given the large proportion of undiagnosed bleeders and the overall low sensitivity of these tests, clinical decisions still rely on the medical history and etiological diagnosis of the bleeding disorder.

Endothelial cell markers in chronic uremia: relationship with hemostatic defects and severity of renal failure.

Plasma von Willebrand factor antigen, soluble thrombomodulin, and tissue factor were increased in 31 patients with severe chronic renal failure (creatinine clearance <20 ml/min) under conservative treatment, whereas plasminogen activator inhibitor antigen did not differ significantly from healthy controls. No correlation among plasma levels of these proteins was found. Three patterns of relationship between endothelial cell markers and hemostatic defects were identified: 1) Plasma thrombomodulin, a marker of endothelium damage, was found an independent predictor of bleeding time and platelet aggregation, and secretion defects, and was also related to the severity of renal failure; 2) von Willebrand factor antigen, an index of endothelial cell activation and secretion, was significantly correlated with intravascular markers of thrombin and plasmin generation and with platelet adenosine triphosphate content, but not with plasma creatinine levels; and 3) tissue factor and plasminogen activator inhibitor antigen levels were not statistically correlated with the diverse hemostatic defects. Activation of coagulation and fibrinolysis, secondary to endothelial cell activation, appearing early during the evolution of chronic renal failure, is pathogenically related to the platelet dysfunction, and probably to development of atherosclerosis and thrombotic events in this disease. The progression of chronic renal failure, through endothelial cell damage, would lead to aggravation of the platelet functional defect potentiating the hemorrhagic risk.

Cardiovascular Risk Factors in Vegetarians: Normalization of Hyperhomocysteinemia with Vitamin B12 and Reduction of Platelet Aggregation with n-3 Fatty Acids

Hyperhomocysteinemia in association with vitamin B12 deficiency, and increased platelet aggregation, probably due to dietary lack of n-3 fatty acids, constitute cardiovascular risk factors frequently observed in vegetarians. We tested if administration of vitamin B12 normalizes the concentration of total plasma homocysteine, and if intake of eicosapentaenoic (20:5n-3) and docosahexaenoic (22:6n-3) fatty acids modulates platelet function in a population of lactoovovegetarians. One week after a single intramuscular injection of cyanocobalamin (10000 μg) in 18 individuals, serum vitamin B12 increased from 149±63 pg/mL to 532±204 pg/mL (p<0.0001) and total tHcy dropped from 12.4±4.7 to 7.9±3.1 μmol/L (p<0.0001). Ten of fourteen of these vegetarians completed an 8-week supplementation with 700 mg/day of each eicosapentaenoic and docosahexaenoic acids. Increased incorporation of these fatty acids into plasma lipids was observed in all of them, together with a significant reduction in maximum percentage or slope of platelet aggregation with all the agonists tested (ADP, epinephrin, collagen, arachidonic acid). No significant change in bleeding time was observed after n-3 fatty acid trial. Supplementation with vitamin B12 and n-3 fatty acids corrects hyperhomocysteinemia and reduces platelet reactivity to agonists in vegetarians. Whether this supplementation improves the already reduced cardiovascular morbidity and mortality associated with vegetarian diet has yet to be demonstrated.

Glycoprotein Ib/IX complex is the target in rifampicin-induced immune thrombocytopenia.

Thrombocytopenia is a major adverse effect of several drug treatments. Rifampicin has been recognized as a cause of immune thrombocytopenia during intermittent high‐dose therapy. We characterized the antibody of a patient who presented with purpura and thrombocytopenia during treatment of tuberculosis with rifampicin. Drug‐dependent binding of the antibody to platelets was demonstrated by flow cytometry. In a glycoprotein‐specific immunoassay, the binding epitope of the IgG antibody was found in the glycoprotein Ib/IX complex, using four different monoclonal antibodies (mAbs) against various epitopes on the GPIb/IX complex, as well as mAbs against GPIIb/IIIa, GPIa/IIa and GPIV. By immunoprecipitation of biotin‐labelled platelets, reactivity of the antibody with GPIb/IX was found only in the presence of the drug. These findings clearly demonstrate that rifampicin induces the formation of drug‐dependent antibodies capable of causing thrombocytopenia. The binding site of the rifampicin‐dependent antibody, located in the GPIb/IX complex, seems to be a favoured target for antibodies induced by different drugs.

Complicaciones de la nutrición enteral domiciliaria: Resultados de un estudio multicéntrico

Objective: To investigate the prevalence of trematode Aspidogastrea in the freshwater mussels in the Yangtze River basin within Anhui province, China. Methods: We initially harvested the freshwater mussels living in the Yangtze River running through Anhui area, and labeled them with corresponding number. Then the samples were dissected for isolating the flukes, which were identified by conventional staining. Results: Infection rate of trematode Aspidogastrea in freshwater mussels in the Yangtze River basin within the territory of Anhui province was 30.38℅(103/339)in general, and a total of 912 flukes of Aspidogastrea were detected in the 103 mussels, with average infection rate of 8.85 for each mussel. Conclusion: Trematode Aspdogastrea is prevalent in the freshwater bivalves living in the Yangtze River basin running through Anhui area, and the treamatode was identified as Aspidogaster sp. belong to Aspidogaste under Aspidogastridae of Aspidogastrea.Objective: to assess the use of oral nutritional supplements analyzing the reason for prescription and its implication in caloric-protein intake. Setting: study performed at a university hospital of 350 beds with medical and surgical specialties. Subjects, patients: Patients inclusion was done by selecting all starting oral nutritional supplement prescription. Exclusion criteria were being younger than 18 years, being admitted to the Intensive Care Unit, having cognition or communication impairments, being on concomitant parenteral nutrition or requiring complete enteral diet, and/or using nasogastric tube for feeding. We also excluded special enteral diets, specifically designed for certain conditions. Interventions: One-year long prospective study on prescription of oral nutritional supplements. Through clinical chart review and personal interview, we recorded demographic data, nutritional parameters, characteristics of the diet and supplement, and caloricprotein intake prescribed and ingested. The data were introduced in an Access97 database and processed by means of SPSS software for Windows®. We performed a descriptive study of quantitative and qualitative variables, a χ2 analysis between qualitative variables, and a comparative analysis between means of all paired data by means of the student’s t test, and variance analysis between quantitative variables. The significance level was set at p < 0.05. Results: we were only able to analyze 77 out of 130 prescriptions for nutritional supplements since we could not adequately interview the remaining patients, mainly due to neurological impairments. Mean age was 74.8 years (SD = 12) and 50.6% were women. The departments prescribing the highest number of supplements were hematology (22.1%) and internal medicine (20.8%). GI neoplasm was the most frequent diagnosis at admission (27.3%). The most frequent indication was kwashiorkor (45.5%), with 15.6% of patients being well nourished. Mean therapy duration was 11 days (SD = 11.1), and the main reason for termination was hospital discharge (70.1%). The supplement was concomitantly prescribed with the meals in 70.6% of the cases, and more than halfMaterial y metodos: Estudio retrospectivo de 55 pacientes de 65,4 ± 14,7 anos, 35,7% mujeres y 64,3% varones con un IMC 27,87 ± 5,56 kg/m (0% con IMC 30 kg/m ) en tratamiento con NPT con una duracion de 28 ± 5 dias (mas de 20 dias en el 75% de los casos). El 16,1% presentaba Diabetes Mellitus previa al inicio de NPT. En el 64,3% de los pacientes, la fistula ocurria tras cirugia reciente: en un 38.8% tras reseccion de colon, 16,6% de intestino delgado y 13,9% de estomago. La NPT se planificaba para aportar diariamente 1,5 × Gasto Energetico Basal, 1,5 g/kg/dia de proteinas, 6 mg de vitamina B 12 y 414 μg de acido folico. Ninguna solucion contenia hierro.Objective. To assess the impact of weight loss in clinical nprogression of the comorbidities in a group of morbid nobese patients submitted to surgical treatment with the nduodenal switch technique. nStudy setting. Between 2001-2006, we have operated by nthe duodenal crossing technique a total of 118 morbid nobese patients (97 women and 21 men), mean age 42.6 nyears. Average pre-surgical BMI was 49.7, with average noverweight of 69.1 kg. nAfter surgical intervention, we have prospectively nassessed the progression of the main comorbidities (arterial nhypertension, diabetes, OSAS, osteoarticular pathology, ndyslipidemia), according to the subscale of the nBAROS scoring system. Postsurgical controls are done at nmonths 3, 6, 12, 18, and 24 and annually thereafter. We nhave followed-up 110 patients, of whom 90 presented ncomorbidities, being the ones studied. nResults. At 3 months post-surgery, we observed a decrease nin the mean value of %WL to 31%, and a mean BMI nvalue of 41.3, the percentage of lost BMI being 40.3%. nMost of the weight loss occurred within 2 years, with %WL nof 74.8% and a percentage of lost BMI of 97.7%. nIn 68 patients (75.5%) there was resolution of their ncomorbidities, 14.4% having improvement, and 10% nwith no improvement in spite of the surgery. Of patients nachieving complete resolution, almost all of them achieved nit within two years after surgery. nCure rates correlate with weight loss, so that at 3 nmonths, with a mean weight loss of 25 kg (BMI decrease nof 8.4 points) the comorbidity resolution rate is 45.5%. At n12 months, with a mean decrease in BMI of 16.4 points, n%WL of 61.6% and % of lost BMI of 70.4%, the comorbidity nresolution rate is 89.7%. nAt two years, by the time most of the main comorbidities nresolved (68 patients), the BMI decreased by 22.4 npoints, the %WL 74.8% and the % of lost BMI 97.9%. nConclusion. The aim of bariatric surgery is weight loss nand overweight-associated comorbidities improvement. nIn our study, most of the comorbidities improvement nstarted at the third month, with the highest improvement nrate occurring within two years, verifying that there is a ndirect relationship between post-surgical weight loss ncomorbidities improvement and resolution in most of the ncases.Objective: To investigate the breeding rate and breeding density of Carpoglyphus lactis in stored Fructus Jujubae in Anhui, China in order to provide a scientific basis for prevention of Carpoglyphus lactis(C. lactis) from spoiling the dried fruit of such category. Methods： By the breeding nature of C. lactis, we collected samples of Fructus Jujubae, which were kept over 6 months in general, from the dried fruit shop and (or) Chinese herbal medicine warehouse, and isolated C. lactis from those samples. The mite specimens were prepared, and microscopically and morphologically identified. Species classification was done in accordance with Hughes (1976). Result:C. lactis was identified in 19 of the 300 samples, with breeding density and breeding rate of 6.52 heads/g and 6.33%. Constitute ratio at distinct developmental phase was associated with adult (including nymph, 85.71%), larva(12.27%), hypopus (0.56%) and egg(1.45%), respectively. The richness index, diversity index and evenness index was1.644, 1.644 and 0.923, respectively. Conclusion： Carpoglyphus lactis appears infesting in large quantity in the Fructus Jujubae stored in the above places in Anhui province, and the density is higher. Therefore, it is urgent to take effective measures to prevent C. lactis from spreading over other dried products stored in the same room and potential human intestinal acariasis as a result of the biological contamination.Objective: To determine possible associations between nthe risk of breast cancer in Brazilian women and demographic, nsocial and economical variables, and past dietary nintake. nMethods: A case-control study was conducted in Joinville, nSanta Catarina, Brazil, between june and november n2003 involving a group of 33 women recently diagnosed nwith breast cancer and a control group of 33 healthy nwomen volunteers. Personal details, health history and npast dietary intake were obtained via questionnaires and ninterviews. Data between groups were compared using χ2, nFisher, and Student’s t test, whilst associations were evaluated nusing a non-conditional logistic regression method nand odds ratio (OR). nResults: Statistically significant differences between the ntwo groups were revealed with respect to age distribution n(P = 0.007), family income level (P = 0.02), educational level n(P 45 years), low family income n(<

Increased activation of protein C, but lower plasma levels of free, activated protein C in uraemic patients: relationship with systemic inflammation and haemostatic activation

520/month), poor educational level (primary school nlevel or lower) and past regular consumption of pork fat nand fatty meat may be factors associated with an increased nrisk of breast cancer.A case of peritoneal mucinous carcinomatosis in a patient nwho suffered a Hirschsprung disease 30 year before nis presented. TH present condition caused an irreversible nintestinal obstruction and the patients received home nparenteral nutrition without unremarkable complications nlonger than two years.Introduction: Clinical nutrition is an activity realized in most of Health Centres of France, Canada, Great Britain and USA. The aim of our work was to determine activity and resources of Nutrition Units of Hospitals in the Community of Castilla y Leon. Material and methods: A questionnaire was send to all Hospitals of Castilla y Leon (SACYL); Hospital UniMaterial y método: Se estudió una población de pacientes postquirúrgicos (n = 22; 12 hombres y 10 mujeres) de 72,9 años de promedio (DE = 13,5) que fueron apareados en razón de edad y además un 40% de ellos por sexo, en dos grupos: A) con gastrectomía total (73%) o parcial (23%) por neoplasia y B) control, presencia de íleo paralítico postquirúrgico de causa no neoplásica. La duración media de la NPT fue de 14 días (DE = 2) y 13 días (DE = 2) respectivamente siendo la composición estándar de 12 g/N2, 100 kcal no proteicas/g N2, carbohidratos/lípidos: 63/38; volumen: 1.550-2.250 mL. Se realizaron controles basales habituales antes de la cirugía y al final de la NPT. Se analizaron los niveles de: Hb, Hto, contaje de linfocitos, contaje de neutrófilos y bioquímicos: glucosa, urea, creatinina, proteínas y albúmina. Análisis estadístico: test no paramétrico U de Mann Whitney y correlación de Pearson.El Órgano Oficial de SENPE, Nutrición Hospitalaria, no ha parado de crecer y prosperar a lo largo de sus 26 años de existencia. La revista se ha ido haciendo un hueco merecido en las bases de datos electrónicas y repositorios, alcanzando a los lectores interesados en su temática, no solo en España e Iberoamérica, sino también en países de ámbito sajón y en otros muy lejanos. El éxito ha traído parejo un incremento de originales, que en 2006 permitió alcanzar la cifra de 1.000 páginas publicadas. La creciente exigencia de los revisores, rechazando un treinta por ciento de los artículos recibidos, no ha sido impedimento para esta progresión, de lo que nos congratulamos. Otro de los éxitos positivos de este éxito editorial ha sido el aumento de números suplementarios de NUTR HOSP, documentos monográficos relativos a congresos, cursos, eventos o conclusiones de grupos de trabajo. La proliferación de los suplementos, muy halagüeña al comienzo, empezó a preocuparnos por las posibles desviaciones de la esencia de la revista. Vaya por delante que todos los suplementos han cumplido siempre las pautas éticas exigibles por la revista y por la SENPE, pero lo que escapaba al ámbito del comité editorial era la garantía de originalidad de todas las contribuciones, la homogeneidad en su estructura de acuerdo con las normas de publicación de la revista y, lo que es más importante, la falta de revisión por pares de sus contenidos. Esto último contradice formalmente la esencia de una revista científica. Por ello, Nutrición Hospitalaria y su comité editorial se encontraron ante un dilema: si se renuncia a la edición de suplementos que apoyan acciones especiales de la SENPE, se deja de prestar un servicio muy importante a la sociedad. Si se continua, incumplimos la normativa de revisión por pares. Hemos consultado los entornos científicos internacionales y rápidamente encontramos la solución, que colegas como Clin Nutr vienen aplicando desde hace uno o dos años: los suplementos deben aparecer bajo la cobertura de un ISSN diferente, llevando su propia paginación correlativa, en volúmenes independientes. Esta solución, que nos ha parecido la idónea, ha sido refrendada por el Comité Científico y la Junta Directiva de la Sociedad, y empezará a implementarse a partir de mayo de 2008. Así, el lector recibirá, a lo largo de los próximos meses, suplementos de Nutr Hosp ligeramente distintos. Los contenidos científicos de esta nueva línea editorial vendrán avalados por el Comité Científico Educacional y la Junta Directiva de SENPE. Creemos que con esta nueva fórmula que, como decimos, está ampliamente implantada en otras revistas científicas, se propiciará la multiplicación de los suplementos científicos de diversa índole que, en definitiva, redundará en beneficio de los miembros de SENPE y de nuestros lectores en general, sin menoscabo de las características referentes a originalidad y control que se exigen a los artículos que se publiquen en Nutrición Hospitalaria.OBJECTIVES: To analyze the complications related to enteral nutritional support in patients with lateral amyotrophic sclerosis included in our home-based mechanical ventilation program (HMVP), with a special emphasis on gastrointestinal complications. METHOD: Retrospective, descriptive study of the patients included in our HMVP directed by intensive care physicians, by means of systematic review of the medical records (included in a Microsoft Access database) during the period 2004-2011. RESULTS: In the period 2004-2011, 73 patients with a diagnosis of lateral amyotrophic sclerosis were followed: 34 (46.6%) refused nutritional support through gastrostomy or nasogastric tube, whereas 39 (53.4%) accepted. Twenty (51.3%) of the 39 patients with (home-based nutritional support) were females. The mean age of the patients was 60.6 + 13.4 years (95% CI 56.4-64.8). Diagnoses at the time of inclusion in the HMVP were: LAS, 21 cases (53.8%), and LAS with bulbar impairment 18 (43.1%). 34 patients (87.2%) were fed through percutaneous endoscopic gastrostomy (PEG), 3 (7.7%) through surgical gastrostomy, and 3 (7.7%). PEG was performed at the time of inclusion of the patients in the program, with a mean duration of 222.7 + 356.6 days (95% CI: 110.8-334.7). In patients with LAS, the mean duration was 271.4 + 449.5 days (95% CI: 130.3-412.1), and with LAS and bulbar impairment of 126.4 + 131.3 days (95% CI: 90-172.6). The mean duration of the nasogastric tube was 7.3 + 4.8 months (95% CI: 4-10.6). The mean duration of enteral nutrition was 578.6 + 872.9 days (95% CI: 304.7-852.6). There were complications in 35 patients (89.7%), and no complications occurred in only 4 patients (10.3%) (See table 2). Constipation occurred after initiating EN in 30 patients (76.9%); however, it was already present in 18 of them (60%). The remaining gastrointestinal complications observed were: abdominal bloating (9 patients; 23.1%); abdominal pain (6; 15,.4%); nausea and vomiting (5; 12.8%); diarrhea (3; 7.7%). CONCLUSIONS: Gastrointestinal complications are the most common ones; constipation stands out as the main problem in patients with LAS and HEN. However it may not be considered as a complication exclusively due to nutritional support since it is also a manifestation in the disease course. The occurrence of granulomas is also common.Obesity combined with breast cancer is a public health problem, given the high incidence and prevalence of both diseases. The aim of this review is to determine the current status of research on the relationship between the body weight of breast cancer patients and their prognosis. Overweight and obesity at the time of diagnosis are associated with a worse prognosis in breast cancer survivors. Observational studies show that breast cancer mortality is 33% higher in obese than in non-obese survivors. Furthermore, weight gain after diagnosis is common in these patients and is even greater in those receiving chemotherapy. Weight gains of 2-8 kg are observed in 68% of patients 3 years after diagnosis. Each 5 kg increase in body weight is associated with a 13% increase in breast cancer specific mortality. The mechanisms that cause this weight gain are not totally known. A higher weight gain is also associated with higher the risk of co-morbid cardiometabolic diseases, which worsen the quality of life and shorten overall survival. On the other hand, excess adipose tissue is an indirect promoter of tumor cell proliferation and releases circulating estrogens. Hence, preventing excess weight is important in these patients. An important limitation is the small number of randomised controlled trials investigating the type of diet that could be recommended specifically to breast cancer survivors. The evidence from current studies suggests that a healthy diet, low in fat and simple sugars and with a high proportion of fruit, vegetables and wholegrain products, has the potential to reduce morbidity and the risk of recurrence significantly, thus improving prognosis and quality of life in the long term.OBJECTIVEnTo compare measured resting energy expenditure (REE) with that predicted by formulas derived from populations with normal weight or obesity and from women with severe and morbid obesity.nnnMATERIAL AND METHODSn66 women (aged 35.6 +/- 10.3 y and BMI of 44.7 +/- 4.9 kg/m2) were evaluated by indirect calorimetry with a metabolic monitor Deltatrac (Datex Inst., Finland), before undergoing gastric bypass. REE was calculated with the following equations: Harris-Benedicts with both actual and adjusted weight, Ireton-Jones, Mifflins, and Carrascos Fast Estimation, which corresponds to 16.2 kcal x kg actual weight.nnnRESULTSn(mean +/- sd). Measured REE was 1797 +/- 239 kcal/day. All formulas, except Harris-Benedicts with adjusted weight, overestimated REE. The Ireton-Jones equation presented the greater overestimation (689 +/- 329 kcal/day), whereas Mifflins equation overestimated REE only by 6 +/- 202 kcal/day. No significant differences were detected between measured and calculated REE by Mifflins and Carrascos Fast Estimation. Accuracy (defined as difference between calculated and measured REE within +/- 10%) was greater with Mifflins equation (68%), followed by Harris-Benedicts with actual weight (64%) and Carrascos Fast Estimation (61%). By using the Bland-Altman analysis, significant correlations were observed between calculated-measured REE and mean REE (calculated + measured/2) with all equations except Carrascos Fast Estimation. This means that all but one formula underestimate or overestimate REE depending on the level of measured REE.nnnCONCLUSIONnIn severe and morbid obese women, Mifflins and Carrascos Fast Estimation equations provided the best performance to estimate REE. Before recommending an equation in an a subset of individuals it is necessary to make previous validation studies to determine that equation with the best predictive power for this particular group of patients.Objective To investigate the species and breeding density of acaroid mites in the stored rhizomatic traditional Chinese medicinal materials in Anhui province, China, in order to supply evidences for control and prevention of such species. Methods The stored traditional Chinese medicinal materials of root-stock origins were collected in 30 herb stores and warehouses in 17 cities across Anhui province. Mites were collected by using Tullgren funnel and directicopy, and identified under microscopy. Results 22 species of acaroid mites, belonging to 15 genera under 5 families, were identified from the total 47 stored samples, in which Tyrophagus putrescentiae，Acarus farinae, Carpoglyphus lactis, and Cologlyplus berlesei were predominant. Conclusion Breeding density of acaroid mites was high in the stored rhizomatic traditional Chinese medicinal materials in Anhui province. This indicates that the traditional Chinese medicinal herbs of root-stock origins in storage are seriously contaminated by the acaroid mites, and such infestation should be positively controlled to reduce the potential harm to public health.INTRODUCTIONnFor critically patients, enteral immunonutrition results in notable reductions in infections and in length of stay in hospital, but not on mortality, raising the question as to whether this relate to the heterogeneous nature of critically ill patients or to the absence of the altered absorption of specific nutrients within the immunonutrient mix (e.g. iron). Immune-associated functional iron deficiency (FID) is not only one of the many causes or anaemia in the critically ill, but also a cause of inappropriate immune response, leading to a longer duration of episodes of systemic inflammatory response syndrome and poor outcome.nnnOBJECTIVEnThis prospective cross-sectional study was undertaken to assess the prevalence of FID in critically ill patients during their stay in intensive care (ICU) in order to find the more appropriate population of patients that can benefit from iron therapy.nnnMETHODnFull blood cell counts, including reticulocytes (RETIC), serum iron (SI), transferring levels (TRF) and saturation (satTRF), serum TFR receptor (sTfR), ferritin (FRT) and C-reactive protein (CRP) were measured in venous blood samples from 131 random patients admitted to the ICU for at least 24 h (Length of ICU stay, LIS; min: 1 day; max: 38 days).nnnRESULTSnAnaemia (Hb < 12 g/dL) was present in 76% of the patients (Hb < 10 g/dL in 33%), hypoferremia (SI < 45 microg/dl) in 69%; satTRF < 20% in 53%; FRT < 100 ng/mL in 23%; sTfR > 2.3 mg/dL in 13%; and CRP > 0.5 mg/dL in 88%. Statistically significant correlations (r of Pearson; *p < 0.05, **p < 0.01) were obtained for serum CRP levels and WBC**, Hb*, TRF**, satTRF*, and FRT**. There was also a strong correlation between TRF and FRT (-0.650**), but not between FRT and satTRF or SI. LIS correlated with Hb*, CRP**, TRF*, satTRF* and FRT**.nnnCONCLUSIONSnA large proportion of critically ill patients admitted to the ICU presented the typical functional iron deficiency (FID) of acute inflammation-related anaemia (AIRA). This FID correlates with the inflammatory status and the length of stay at the ICU. However, 21% of the ICU patients with AIRA had an associated real iron deficiency (satTRF < 20; FRT < 100 and sTfR > 2.3). Since oral supplementation of iron seems to be ineffective, all these patients might benefit of iv iron therapy for correction of real or functional iron deficiency, which in turn might help to ameliorate their inflammatory status.In August 1976, a young man named LeRoy fell from a ledge, fracturing his femur. Major internal bleeding was nsuspected. During a laparotomy, the trauma team ensured that all internal organs were intact and the orthopedic nteam set his fracture. Thirty days later, LeRoy died. He had eaten little; each day he only received three liters of nglucose, the equivalent of 510 calories, intravenously. The glucose was insufficient to meet his nutritional needs, nand he lost over 20% of his body weight during his hospital stay. The cause of death was due to “physicianinduced” nmalnutrition. Meanwhile, a paper around the same time documented that the prevalence of malnutrition nin Boston hospitals was 44% and that malnutrition itself was a predictor of higher complication and death rates. nAs a result, like-minded physicians formed a society that created training programs and encouraged formation of nhospital nutrition teams. Industry produced nutrition formulas and catheters. Complications in sick hospitalized npatients plummeted while survival rates rose, and California passed legislation to mandate nutritional support. nThough the health care industry recognized the importance of nutrition in patient care, Congress failed to pass nfiscal support for nutrition teams. As a result, hospitals disbanded their newly created nutrition teams, nutrition neducation and skills declined, and hospital complications and death rates have risen again.Some bioethicists consider older age as a limiting factor nfor receiving special medical care. Older adults comprise nthe majority of home enteral nutrition patients n(neoplams of the head, neck, and upper gastrointestinal ntract neuromuscular swallowing disorders, dementia, netc) On the contrary, there are very few data on Home nParenteral Nutrition (HPN) in the elderly. We report nthese of a 75 years old man affected from a severe short nbowel syndrome due to mesenteric thrombosis. After a nhospital stay of two months he was sent home on HPN. nHis current caregiver was her wife, a 72 year old woman nsuffering from incipient Parkinson’s disease. nHPN lasted for 11 years and was stopped because of clinical ndeterioration. During this time he presented 5 catheter- nrelated infections (1.3 episodes/1,000 days). 5 catheters nwere used (average length 788 days). He was nhospitalized four times because of HPN complications. nFunctional status was maintained along almost all the nlength of HPN. nConclusions: The rate of complications in this patient nwas similar to other groups of age receiving HPN. The ntechnique was not burdensome for the family. Older age ncannot be consider, by itself a limiting factor when receiving nlong term nutritional support.Patients submitted to hematopoietic stem cells transplantation (HSCT) have an increased risk for having hyponutrition, both in the phase prior to transplantation and after this one. The indication of specialized nutritional support is common in allogenic HSCT, whereas patients submitted to auto-HSCT need it in the presence of complications that compromise an adequate nutrients intake. Enteral nutrition through a nasogastric tube has difficulties in these patients; the presence of mucositis delays the indication for enteral nutrition, which usually is poorly tolerated. Thus, frequently parenteral nutrition needs to be used as the route for nutritional support. The use of specific substrates, such as glutamine, is a controversial issue.La edad media fue 4,29 anos (0,1-14,4); el 48% de los ninos tenian menos de 3,5 anos. En el 70% de los casos, el motivo de la indicacion fue la disminucion de la ingesta. La duracion media fue 116,16 dias (4-1.165), manteniendose durante menos de 100 dias en el 79% de los pacientes. El porcentaje calorico medio administrado fue del 68%, precisando el 48% de la serie un aporte < 50%. El tipo de acceso inicial fue la sonda nasogastrica en el 92% de los ninos, la gastrostomia en el 5% y la sonda nasoyeyunal en el 3%. El modo de alimentacion mas frecuentemente utilizado fue la administracion exclusivamente nocturna en el 39% de los casos. El soporte de modo continuo se realizo en el 32%. La dieta polimerica pediatrica se empleo en el 70% de los pacientes. Los datos antropometricos, a excepcion de la talla, mejoraron de forma significativa tras la aplicacion del soporte. El 33% de los pacientes mostraban un indice de Waterlow inicial ≥ 90%.Metodo: Se realizo una busqueda de GPC disponibles en Internet en New Zeland Guidelines Group, Nacional Institute for Clinical Excellence, Scottish Intercollegiate Guidelines Network, Canadian Medical Association Infobase, Health Services/Technology Assesment, Fisterra y Medline. Se incluyeron ademas las direcciones de la ASPEN y la SENPE. Se recuperaron todas aquellas guias editadas o actualizadas en los ultimos cinco anos, en idioma ingles o castellano.Resumen es: Las enfermedades cardiovasculares representan la primera causa de muerte en Venezuela desde el ano 1967. Existen evidencias que demuestran que la lesion ...Material y metodo: Estudio retrospectivo. Cuando existe indicacion de administrar nutricion enteral en intestino, las enfermeras de nuestra Unidad colocan este tipo de sonda en la misma habitacion del enfermo, segun tecnica descrita por el fabricante. Despues de 24 horas de su colocacion, y sin fijarla en el ala de la nariz durante este tiempo, se realiza una radiografia de abdomen en decubito supino para valorar la situacion de la punta de la sonda (gastrica vs intestinal). Si no progresa a intestino, se reajusta la longitud introducida de la sonda y se repite la radiografia en las siguientes 24 horas. Ninguno de los pacientes tenian ventilacion asistida o sedo-relajacion. El exito en la colocacion se expresa como porcentaje de paso a traves del piloro.Introduction: Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. Objectives: Compare two immunoenhanced enteral nutritions with a control diet, and evaluate the effect in postoperative infections, length of stay and inflammatory markers. nPatients: A population of 44 patients with oral and laryngeal cancer was enrolled in a randomized trial. At surgery, patients were randomly allocated to three groups: (group I); patients receiving an arginine-enhanced formula (group II); patients receiving a standard polymeric formula, and (group III) patients receiving an arginine, RNA and omega-3 fatty acids enhanced formula, in an isonitrogenous way. nResults: The duration of enteral nutrition in the three groups was similar with an average duration of 14,5 ± 8 days. The length of postoperative stay was similar, with an average of 19,8 ± 8,5 days. Wound infections and general infections were more frequent in the control group. Fistula rates were not improved in the enhanced diet groups. No significant intergroup differences in the trend of the two plasma proteins (albumin, transferrin), lymphocytes, weight, IL-6, CPR and TNFα were detected. The control group showed the highest levels of TNFα at the fourteenth postoperative day. Gastrointestinal tolerance and diarrhoea rate were similar in all the patients. Conclusions: Immunoenhanced enteral nutrition formulas nimproved the infection rate in the postoperative of nhead and neck cancer patients. In the fistula rates, we nobserved that technical problems and nutritional status nmight have played an equally important role, and therefore nthe positive effect of immunonutrition in this parameter nmight have been overestimated.Introduction: Due to the high prevalence of overweight and obesity, new strategies are needed for its prevention and treatment. Nutritional Coaching (NC) has been shown to be effective in weight reduction, even though the innovation of this concept, it’s not always used properly. nObjective: To verify if NC, added to dietary assessment, is an effective approach for weight loss in overweight or obese population, compared with only technical dietary assessment. nMethodology: We performed a search for papers related to NC to establish quality parameters for this intervention. A systematic review was conducted, including randomized controlled trials that apply CN according to the selected parameters and comparing it with technical dietary assessment. nResults: Eight high quality studies were included in the analysis. Among these, six revealed statistical differences on behalf of the group that received NC. nConclusion: Nutritional Coaching is an effective approach for weight reduction. Future nutritional coaching intervention research would benefit from clear definitions of this new model.Introducción: El control de calidad es fundamental en cualquier intervención de enfermería clínico-asistencial y más aun en el paciente crítico. El protocolo de Enfermería de Nutrición Parenteral Total (NPT), que incluye el cambio de bolsa de nutrición, equipo de perfusión y cuidado del catéter venoso central (CVC) define unas actividades básicas. Fundamentamos el seguimiento en dos aspectos principales: 1. El paciente tiene un potencial de complicaciones relacionadas con la inserción del CVC y su manipulación, y 2. las repetidas manipulaciones de la conexión del CVC al equipo durante el tratamiento puede incidir en las infecciones del mismo.Material y metodo: Se estudiaron 27 pacientes (16 hombres y 11 mujeres) con carcinoma de colon y una edad media de 62,1 anos ? 11,2 (M?DE), de los cuales un 59% estaban en un estadio III de la enfermedad. De los pacientes incluidos, 11 habian recibido tratamiento quimioterapico previo y 16 no. El protocolo de Oncologia supuso la administracion aislada de 5fluoracilo en el 80% de los pacientes combinado con Oxaliplatino en un 17%. En todos los casos se registraron parametros antropometricos y analiticos (hemograma completo, glucosa, creatinina, bilirrubina, ALAT, ASAT, fosfatasa alcalina, albumina y marcadores tumorales) determinados antes de la cirugia y al final de la nutricion parenteral. Para evaluar la posible influencia del soporte nutricional los pacientes fueron divididos en dos grupos, en funcion de si habian o no recibido tratamiento citostatico previo a la intervencion. El analisis estadistico se realizo con el test ?2 y el de Wilcoxon (SPSS 10.0), aceptandose un nivel de significacion estadistica para p < 0,05.

Vascular access thrombosis is not related to presence of antiphospholipid antibodies in patients on chronic hemodialysis.

Chronic renal failure (CRF) courses with both systemic inflammatory reaction and haemostatic activation. We explored the relationship of these processes with plasma levels of free, activated protein C (APC) and complexes of APC with its inhibitors in patients with CRF under conservative treatment. Plasma concentrations of inflammatory cytokines [tumour necrosis factor alpha (TNFα) and interleukin 8], acute‐phase proteins (C‐reactive protein, fibrinogen, α1‐anti‐trypsin and von Willebrand factor), and markers of haemostatic activation (thrombin–anti‐thrombin complexes, plasmin–anti‐plasmin complexes, and fibrin and fibrinogen degradation products) were higher in patients than in controls. Inflammatory and haemostatic markers were significantly and positively correlated. Total plasma APC and APC:α1‐anti‐trypsin (α1AT) complexes were 44% and 75% higher in patients than in controls (Pu2003=u20030·0001), whereas free APC was 20% lower (Pu2003<u20030·015). No significant difference was observed in APC:protein C inhibitor (PCI) complexes between both groups. The free/total APC ratio was significantly lower in patients than in controls (Pu2003<u20030·0001). Total plasma APC and APC:α1AT were positively correlated with activation markers of haemostasis and acute‐phase proteins, whereas free APC was inversely correlated with plasma levels of creatinine, acute‐phase proteins and fibrin degradation products (FnDP). Systemic inflammation and activation of haemostasis are interrelated processes in CRF. APC generation was increased in response to elevated thrombin production, but the inflammatory reaction, associated with increased synthesis of α1AT, reduced its anticoagulant effect. Lower free plasma APC in CRF may be pathogenically associated with atherothrombosis, a major cause of death in this disease.

Thrombin Generation in Platelet-Poor Plasma Is Normal in Patients with Hereditary Mucocutaneous Haemorrhages

Accessible online at: www.karger.com/journals/nef Dear Sir, Patients with chronic renal failure (CRF) who require regular hemodialysis, may present vascular access thrombosis [1]. A broad spectrum of possible pathogenic mechanisms has been proposed: hemodynamic mechanisms [2], inherited thrombophilias [3] and immune etiologies. With respect to the latter, antiphospholipid antibodies (aPL) have been studied, but the role of these antibodies in the pathogenesis is controversial [4]. The aim of the present study was to analyze the prevalence of aPL antibodies and its correlation with vascular access thrombotic events. The studied population consisted of 208 consecutive CRF patients undergoing hemodialysis (112 females and 96 males; 53 B 18 years; time in hemodialysis was 35 B 29 months). In 77 patients was possible to collect a second a sample (6–18 months later). The most frequent etiologies were: diabetic nephropathy (20.2%), nephrosclerosis (15.9%) and chronic glomerulonephritis (14.4%). None of the patients had systemic lupus erythematosus (SLE) or other autoimmune disease known to be associated with aPL. All patients had arterious venous fistula (AVF) as the initial vascular access, use unfractionated heparin and cuprophane membrane filters. The thrombosis of vascular access was assessed by clinical patterns and flebography. The control group included 110 healthy blood donors and 28 CRF patients without hemodialysis. Antiphospholipid antibodies were determined by a home made solid-phase enzymelinked immunosorbent assays (anticardiolipin antibodies, aCL; antiphosphatidylserine antibodies, aPS and anti-beta-2-glycoprotein I antibodies, anti-s2GPI); a sample was considered positive when OD405 was greater than 3 SD above the average of the normal controls (cut off). The activity of the antibodies was expressed as the ratio: OD405 patient sample/ OD405 of cut off. Additionally, the aPL were determined as lupus anticoagulant activity by coagulation assays (dilute tissue thromboplastin inhibition, dTTI and kaolin clotting time, KCT). Fourteen of 208 patients (6.7%) presented aCL, 10 (4.8%) aPS and 9 (4.3%) antis2GPI. The prevalences between hemodialysis patients and normal controls were not statistically significant (table 1). In the secTable 1. Anticardiolipin, antiphosphatidylserine and anti-s2GPI antibodies in patients undergoing chronic hemodialysis and normal controls

Clot lysis time in platelet-rich plasma: method assessment, comparison with assays in platelet-free and platelet-poor plasmas, and response to tranexamic acid.

Mild hereditary bleeding disorders presenting with mucocutaneous haemorrhages are usually difficult to diagnose. We measured thrombin generation in platelet-poor plasma (TG-PPP) in 206 patients with a clinically unequivocal bleeding tendency: 45 with von Willebrand disease (vWD), 49 with platelet aggregation/secretion defects (PASD), 10 with a combination of both and 102 who did not fit the diagnostic criteria for any known haemostatic disorder. TG-PPP was not significantly different from controls in all patient groups, indicating that an abnormality in the plasmatic clotting system is unlikely to contribute to the bleeding in patients with type 1 vWD and PASD. In patients with undiagnosed mild hereditary bleeding disorders, there must be other mechanisms which explain the abnormal haemorrhagic tendency, most likely as yet unrecognized defects in platelet-vessel wall interaction. As a next step we plan to investigate thrombin generation in PRP.