Juan José López Gómez

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.

Impacto económico y satisfacción de la implantación de una consulta de alta resolución de patología nodular tiroidea en Endocrinología

BACKGROUND AND OBJECTIVE No conclusive data exist on the value of a high resolution thyroid nodule clinic for management of nodular thyroid disease. The aim of this study was to evaluate the economic impact of and user satisfaction with a high resolution thyroid nodule clinic (HRTNC) in coordination with primary care. PATIENTS AND METHOD A prospective, observational, descriptive study was conducted to analyze data from 3,726 patients (mean age 61±12 years; 85% women) evaluated at an HRTNC during 2014 and 2015. Demographic data (sex and age), number of ultrasound examinations and fine needle aspiration cytologies (FNAC), referral center and consultation type were assessed. RESULTS In 2014 and 2015, 3,726 neck ultrasound examinations and 926 FNACs (3.8% rated as non-diagnostic) were performed. Among the 1,227 patients evaluated for the first time, 21.5% did not require a second endocrine appointment, which resulted in mean estimated savings of 14,354.55 euros. Of all patients, 41.1% were referred from primary care, 33.4% from endocrinology, and 26.5% from other specialties. As compared to 2013, the number of thyroid ultrasound examinations requested decreased by 65.3% and 59.7% in 2014 and 2015 respectively, with mean estimated savings of 137,563.92 euros. Mean user satisfaction assessed was 4.0 points (95% confidence interval, 3.7-4.3) on a 5-point scale. CONCLUSIONS HRTNCs at endocrinology departments, coordinated with primary care, are a viable, cost-effective alternative with a positive user perception.

Selective pituitary resistance to thyroid hormone in a patient treated with amiodarone

La resistencia hipofisaria selectiva a las hormonas tiroideas es un sindrome que consiste en la respuesta inadecuada de la tirotropina a los cambios en las hormonas tiroideas y que, a diferencia de los sindromes de resistencia generalizada, cursa con hipertiroidismo central y clinica de tirotoxicosis. En ocasiones puede no ser diagnosticada adecuadamente y se la trata con farmacos con efectos deletereos en el tiroides, como la amiodarona, lo que dificulta el diagnostico y puede llegar a exacerbar la enfermedad. El tratamiento de esta enfermedad, por una parte, es sintomatico, basado en el control de la taquicardia y la ansiedad, y por otra, etiologico, dirigido a la hipofisis, con la regulacion de la secrecion de tirotropina o la glandula tiroides y el control de la produccion de hormonas tiroideas. Presentamos el caso de un paciente con resistencia hipofisaria a hormonas tiroideas tratado con amiodarona para el control de una fibrilacion auricular paroxistica.Selective pituitary resistance to thyroid hormones is a syndrome that involves inadequate response of thyroid-stimulating hormone to changes in thyroid hormones. Unlike generalized resistance syndromes, this entity produces central hyperthyroidism and clinical thyrotoxicosis. Sometimes the disease may not be properly diagnosed and is treated with drugs with harmful effects on the thyroid, such as amiodarone, hampering diagnosis and possibly exacerbating the disorder. The treatment of this condition can be symptomatic, based on control of tachycardia and anxiety, or etiological, acting on the pituitary to regulate thyrotropin secretion or on the thyroid gland to control thyroid hormone production. We report the case of a patient with pituitary resistance to thyroid hormone, who was treated with amiodarone to control paroxysmal atrial fibrillation.

The 10-item eating assessment tool is associated with nutritional status, mortality and hospital stay in elderly individuals requiring hospitalization with acute diseases

OBJECTIVE the purpose of this investigation was to investigate the associations between nutritional status by Mini Nutritional Assessment (MNA) test and dysphagia by EAT-10 in elderly individuals requiring nutritional oral care in an acute hospital. PATIENTS this was a cross-sectional survey covering a sample of 560 elderly individuals. As anthropometric parameters, weight and body mass index (BMI) have been included. Glucose, creatinine, sodium, potassium, albumin, prealbumin and transferrin serum levels were measured. The EAT-10 and MNA tests were carried out. The days of hospital stay and mortality were recorded. RESULTS the mean EAT-10 was 11.2 ± 0.89, the median was 10 and the interquartile range, 6-15. A total of 465 (83.1%) elderly patients had EAT-10 scores between 3 and 40, indicating the presence of dysphagia. The mean MNA test was 15.2 ± 1.1, median was 15 and interquartile rage, 11-18.5. According to their MNA score, a total of 340 (60.7%) elderly patients had MNA scores under 17 (malnutrition) and 177 subjects (31.6%) had a MNA score of 17-23.5 (risk of malnutrition). The MNA score and EAT-10 score were independently associated with hospital stance Beta -0.111 (CI 95%: -0.031- -0.78) and Beta 0.122 (CI 95%: 0.038-0.43), respectively. MNA score was associated with EAT-10 score Beta -0.236 (CI 95%: -0.213-0.09). The MNA score and EAT-10 score were independently associated with mortality odds ratio 0.91 (CI 95%: 0.84-0.96) and 1.040 (CI 95%: 1.008-1.074), respectively. CONCLUSION dysphagia assessed by the EAT-10 is associated with nutritional status in elderly subjects requiring acute hospitalization. Subsequently, malnutrition and dysphagia were associated with poor outcome such as hospital stay and mortality.

Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio quirúrgico

INTRODUCTION disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System. PATIENTS AND METHODS this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed. RESULTS MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST < 2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed. CONCLUSION patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM.

Omentin-1 Changes following Biliopancreatic Diversion and Relationship with Cardiovascular Risk Factors

Introduction: Omentin-1 might play a role in the pathogenesis of insulin resistance and obesity. The aim of the present study was to evaluate the influence of weight loss after biliopancreatic diversion on serum omentin-1 concentrations. Material and Methods A Caucasian population of 24 morbid obese patients was analyzed before and after 12 months of a biliopancreatic diversion surgery. Biochemical and anthropometric evaluation were realized at basal visit and at 12 months. Body weight, fat mass, waist circumferences, blood pressure, fasting blood glucose, fasting insulin, insulin resistance (HOMA-IR), lipid concentrations and omentin-1 were measured. Results: After bariatric surgery and in both gender groups (males vs. females); BMI, weight, fat mass, waist circumference, blood pressure, glucose , total cholesterol, LDL cholesterol, triglycerides, HOMA-IR and fasting insulin decreased in a statistical manner from basal values. Omentin-1 levels increased after bariatric surgery and in both gender the improvement was similar (males vs. females); (delta: –87.1 ± 19.0 ng/dL; p = 0.02 vs. –93.8 ± 28.1 ng/dL; p = 0.03). In the multiple regression analysis adjusted by age and sex; BMI kg/m2 (Beta –0.32: 95% CI –3.98 to –0.12) and insulin UI/L (Beta –0.41: 95% CI –8.38 to –0.16) remained in the model with basal omentin-1 levels as dependent variable. The regression model with post-surgery omentin-1 levels as dependent variable showed as independent variables BMI kg/m2 (Beta –0.13: 95% CI –7.69 to –0.09) and insulin UI/L (Beta –0.24: 95% CI –5.69 to –0.08), too. Conclusion: This study showed a significant increase in omentin-1 levels after weight loss secondary biliopancreatic diversion surgery. A weak negative correlation with BMI and basal insulin levels was detected.

Estudio de tolerancia y aceptación de una fórmula enteral con alta densidad energética en pacientes de una unidad de coronarias

Objective: The aim of our study was to evaluate the tolerance of enteral formula with high energetic density in patients hospitalized in a coronary care unit requering enteral support for at least five days. Methods: Opened, non-comparative, nonrandomized, descriptive study, evaluating the tolerance of enteral formula with high energy density in patients admitted to a coronary care unit. Results: 31 patients were included with a mean age of 67.32 ± 13.8 years, 66.7% were male. The average prescribed final volume Nutrison Energy® was 928.5 ± 278.5 mL/day (range: 800-1,500 mL/day). The average duration of enteral nutrition was 11.2 ± 3.2 days. The average calorie intake was 1,392 ± 417 cal/day, with 169.9 ± 50.9 g/day of carbohydrates, 53.8 ± 16.1 g/day of fat and 55.7 ± 16.9 g/day of protein. After administration there was a significant increased levels of transferrin. A total of 3 patients had an episode of diarrhea (9.7%). The number of patients experiencing at least one episode of gastric residue was 5 (16.1%) not forced in any way to withdra wing enteral nutrition, forcing in 2 patients to diminish the nutritional intake volume for 24 hours. During nutritional support, in only 3 patients it was required to decrease the volume made the previous day energy formula. With regard to vomiting, in 1 patient this situation (3.2%) was verified. No patient in the study presented any digestive complications associated with the administration of the enteral nutrition formula. Finally, no adverse events related to the administered formulation were recorded. Conclusions: The results show that enteral formula with high energy density is a well-tolerated formula with a very low frequency of gastrointestinal symptoms, which favors compliance.

Resistencia hipofisaria a las hormonas tiroideas en un paciente tratado con amiodarona

La resistencia hipofisaria selectiva a las hormonas tiroideas es un sindrome que consiste en la respuesta inadecuada de la tirotropina a los cambios en las hormonas tiroideas y que, a diferencia de los sindromes de resistencia generalizada, cursa con hipertiroidismo central y clinica de tirotoxicosis. En ocasiones puede no ser diagnosticada adecuadamente y se la trata con farmacos con efectos deletereos en el tiroides, como la amiodarona, lo que dificulta el diagnostico y puede llegar a exacerbar la enfermedad. El tratamiento de esta enfermedad, por una parte, es sintomatico, basado en el control de la taquicardia y la ansiedad, y por otra, etiologico, dirigido a la hipofisis, con la regulacion de la secrecion de tirotropina o la glandula tiroides y el control de la produccion de hormonas tiroideas. Presentamos el caso de un paciente con resistencia hipofisaria a hormonas tiroideas tratado con amiodarona para el control de una fibrilacion auricular paroxistica.Selective pituitary resistance to thyroid hormones is a syndrome that involves inadequate response of thyroid-stimulating hormone to changes in thyroid hormones. Unlike generalized resistance syndromes, this entity produces central hyperthyroidism and clinical thyrotoxicosis. Sometimes the disease may not be properly diagnosed and is treated with drugs with harmful effects on the thyroid, such as amiodarone, hampering diagnosis and possibly exacerbating the disorder. The treatment of this condition can be symptomatic, based on control of tachycardia and anxiety, or etiological, acting on the pituitary to regulate thyrotropin secretion or on the thyroid gland to control thyroid hormone production. We report the case of a patient with pituitary resistance to thyroid hormone, who was treated with amiodarone to control paroxysmal atrial fibrillation.