Biomedical subjects

M J Martínez Tutor

Publications and source records attributed to M J Martínez Tutor.

5 recordsLinked to original sources

PubMed1993

[Liver dysfunction associated with total parenteral nutrition].

An evaluation is made of liver malfunctions in patients receiving TPN over a period of > or = 15 days between 1989 and 1991. Use was made of the monitoring records on patients undergoing TPN and, subsequently, of clinical records, with analysis of diagnoses and type of intervention, the biochemical parameters (SGOT, SGPT, GGT, FA, LDH, and total and direct bilirubin), and the type and degree of malnutrition, nutritional backup, associated medication, etc. A group of patients was excluded from the study on the basis of the following criteria: liver-biliary disease, cardiac insufficiency, liver metastasis, sepsis, kidney insufficiency and hepatotoxic drugs. Of 237 patients, 75 (31.64%) had liver alterations: following application of the exclusion criteria, 24 patients (10.12%) were taken with liver alterations attributable to the TPN. Macro- and micronutrients were included in the TPN. We found no relation between the kcal/kg of weight, nor with the quantity of glucose and fats nor of nitrogen, calculated according to individual requirements: they remained within the limits established. No serious case of cholestatic jaundice was encountered. Moderate to severe malnutrition was found in 50% of patients, so that this must be treated as a risk factor. GGT is the first enzyme to alter; this occurred in the largest proportion of patients (91.66%), followed by SGPT. FA and GOT are altered in the same percentage of patients. Biochemical parameter monitoring is essential in patients undergoing TPN, not only for appraisal of the nutritional state but also to prevent or correct potential serious metabolic complications.

Adult↗

PubMedDate not supplied

[Current status of the degree of malnutrition in hospitalized patients of the Community of La Rioja].

UNLABELLED: Recent studies have reflected the prevalence of malnutrition within the hospital sphere. The high incidence of malnutrition in hospitals and the negative effect this has on the evolution of patients, since complications are significantly greater in undernourished patients, make it important to find out the nutritional status of patients when they are admitted to hospital and to follow their progress. In the La Rioja region, there have been no prior studies establishing the nutritional status of patients in hospital, so this study was undertaken. It is important to know whether malnutrition is present, the degree of any malnutrition found, and, where necessary, to make the medical and nursing staff aware of the importance of proper nutritional care during a hospital stay. MATERIALS AND METHODS: In a sample of 240 patients selected at random, a nutritional assessment was made on admission. If the patients were still hospitalized one week later, the nutritional assessment was repeated. RESULTS: After the initial assessment, only 12.5% of the 240 patients showed normal nutritional status; mild malnutrition was seen in 55% of cases while moderate and severe cases represented 28.3% and 0.8%, with the most prevalent types of malnutrition being kwasiorkor and mixed (31.6% and 29.6%, respectively). There was no statistical association between the sex of the patient and the degree of malnutrition (p > 0.05). On analysis of the cases by age group, those patients aged less than 65 years mainly presented a marasmus-like and mixed malnutrition, both to a slight degree, whereas the most prevalent malnutrition in patients over the age of 65 was the kwashiorkor type. Among patients with slight and moderate degrees of malnutrition, most of them were diagnosed as suffering from digestive-system related pathologies. After one week, 37.5% of them continued in hospital and approximately half of those presenting normal nutritional status on admission were found to have a status of slight malnutrition.

Female↗

PubMedDate not supplied

[Study of interactions between anti-retroviral agents and concomitant drugs].

UNLABELLED: Clinical efficacy of antiretroviral treatment requires drugs to maintain a plasma concentration over MIC90. One of the facts that can prevent drugs from reaching and maintaining required concentrations are pharmacological drug interactions. OBJECTIVE: The aim of this study is to identify the main interactions between antiretroviral medicines and concomitant treatment in a HIV positive group of patients in a general hospital. Clinical significance and the way to avoid or minimize these interactions is indicated. MATERIAL AND METHODS: from the computerized records of dispensation the Pharmacy Service and from the reports of the internal medicine deparment, demographic and epidemiological data were collected, as well as previous and current antirretroviral treatment and concomitant treatment. Interactions were identified after the Guide of Pharmacological Interactions for HIV. RESULTS AND DISCUSSION: the number of patients analysed was 189. Of these, in 153 (81%) 466 interactions were detected (2.46 interactions/patient). The classification according to its clinical significance was the following: no clinical relevancy (52.8%), potential interactions (45.5%) and co-administered drugs contraindicated or not recommended (1.7%, nA masculine = 8). This last one corresponded to the following medications: efavirenz/terfenadine, nelfinavir/terfenadine, ritonavir/diazepam and zidovudine/ribavirin (five cases). Zidovudine was the one with the highest number of interactions detected (129 patients) followed by indinavir while the co-administered drug was cotrimoxazole (93 cases). The remaining interactions detected for all the anti-retrovirals are shown. We conclude that thought the number of drug interactions is high, the number of contraindicated or not recommended ones is low. Finally the therapeutic alternatives for those interactions detected that show the highest clinical relevancy are described. General procedures to identify and prevent them are also described. CONCLUSION: We conclude that though the number of drug interactions is high, the number of contraindicated or not recommended ones is low. Finally the therapeutic alternatives for those interactions detected that show the highest clinical relevancy are described. General procedures to identify and prevent them are also described.

Adult↗

PubMedDate not supplied

[The protocolization and follow-up of enteral nutrition. 2 years of experience].

The Artificial Nutrition Unit was set up in 1980 in the Pharmacy Service, with the objective of preparing parenteral nutritional units. Different protocols were prepared, approved by the Commission of Pharmacy and Therapeutics. From 1986 onwards, follow-up was commenced and since March 1988, nutritional evaluation of the patients on enteral nutrition has been performed. Encouraged by the results obtained, a proposal for protocolizing enteral nutrition was put to the Commission of Pharmacy and Therapeutics, which was approved in December 1988. The main objective was to select the enteral diets which would be used as a formula for existing hospital diets and, after establishing this formula, protocolize the indications that would assists in selecting from among the diets available, the ones that would best adapt to the individual needs of each patient. As a secondary objective, the Artificial Nutrition Unit took on the responsibility of processing the medical instructions and dispensing enteral diets using the dosage/patient/day distribution system. It also provides information to medical and nursing staff on existing diets, as well as on rules for administration and storage in nursing units, providing when necessary the most suitable containers, equipment and pumps for administering the diets. It also carries out a nutritional evaluation of patients exclusively on enteral nutrition, as well as follow-up of these. Finally, it prepares the monthly actual cost figures generated by each nursing unit, since diets not administered after twenty-four hours are returned to the Nutrition Unit. One problem existing is the non-administration of products or patients who refuse to take their diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Protocols↗

PubMedDate not supplied

[Assessment of nutritional status. One year's experience].

UNLABELLED: The nutritional assessment of patients under parenteral nutrition is a highly important parameters. Since March 1988, our Pharmacy Service has been performing routine assessments on these patients starting on the day of admission and at weekly intervals thereafter, in order to correct any possible malnutrition states, and to start the most appropriate nutritional therapy. MATERIAL AND METHODS: A nurse from the Pharmacy Service is in charge of measuring all the anthropometric parameters. The pharmacist responsible for P.N. evaluates the nutritional condition and nutritional needs of parenteral nutrition patients. Each patient and his nutritional needs are evaluated on an individual basis. Patient follow-up is performed according to a well established protocol, and the preparation, dispensing and control of nutrient units are monitored. Nutritional state assessment includes the following points: Patient clinical history: weight loss over 10%, anorexia, current food intake, previous history, clinical condition, disease or surgery, losses, medication, etc. Physical exam: anthropometric measurements, patient general appearance, muscle mass, nervous system. Biochemical data: in order to determine the course of lean body mass, protein synthesis, immunocompetence and stress index. Malnutrition has been classified in two different ways: qualitative, etc.

Adult↗