Biomedical subjects

M Planas

Publications and source records attributed to M Planas.

68 records · Page 4Linked to original sources

PubMedDate not supplied

[National registry of Home Enteral Nutrition in 2003].

GOAL: To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003. MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3,858 patients that belong to twenty-one hospitals. Mean age from those adults 66.2 +/- 18.9 years, and from those younger than 14, 6.0 +/- 4.3 years. Neurological and neoplasic diseases were the diagnostics more frequents (38.9% and 37.4%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (54.7%) followed by naso-enteral tube (26.6%), and only in 17.6% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (80.1%). The mean time on HEN was 6.6 +/- 4.3 months; the 28.8% of patients stayed in the treatment for less than 3 months, 21.2 % between 3 and 6 months, and 50.0% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (73.1%). While the reference hospital supplies the material (62.4%), reference hospital pharmacy (46.8%) and public pharmacies (32.0%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (44.5%), gastrointestinal complications (30.5%), mechanical complications (21.7%), and the metabolic one (3.3%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 54.7% of patients were in the HEN programme, and in 35.2 % HEN was finish due to accept oral conventional alimentation (49.2%) or by deceased of patients (40.9%). While 26.6% of the patients were confined to bed or armchair, 19.7 % no or light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.

Adolescent↗

PubMedDate not supplied

[The year 2003 National Registry of Home-based Parenteral Nutrition].

OBJECTIVE: To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003. MATERIAL AND METHODS: Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003 RESULTS: Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability. CONCLUSIONS: We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.

Adolescent↗

PubMedDate not supplied

Trends in adult home parenteral nutrition in Spain. 1992-2003.

UNLABELLED: There are very few data on trends in prevalence in home parenteral nutrition (HPN) in different countries. NADYA is the committee of the Spanish Society for Parenteral and Enteral Nutrition that takes care of the Spanish registry since 1992. METHOD: A 12-year retrospective study of the activity of the registry was performed. The data were extracted from the NADYA's database as well as from the publications and abstracts reported on a yearly basis since 1992. Data on years 1993 and 1997-9 were not available. RESULTS: Yearly prevalence has more than doubled to 86 patients since 1992. The number of reporting centres went up to 17 in 2003 (10 centres in 1992) As an average, the number of patients per centre is 5. The prevalence in 2003 was 2.15 patients per million inhabitants. There are trends to increasing age at the time of the first indication (42 years in 1992; 51 in 2003). Ischemic and thrombotic vascular diseases were the most common underlying diagnosis in adults. Tunnelled central venous catheters were chosen in 2/3 of the patients. Only around 17% of the patients received support from home delivery companies (11% in 1992) There were more than 1 complication per patient and year, mostly HPN-related. CONCLUSIONS: We found a steadily increase in the number of reported patients and reporting centres over time. Prevalence went up to 2.15 patients per million inhabitants in 2003, still far behind the figures from other western countries. The NADYA registry allows a close follow-up of the evolution of HPN in Spain.

Humans↗

PubMedDate not supplied

[Nutritional support in liver transplantation].

Given the malnutrition present in patients suffering from advanced hepatic illness, as well as the implications of this in the post-hepatic transplant period, a study was made of various biochemical parameters (prealbumin, retinol-bound protein, zinc, magnesium, cholesterol and amino acid pattern) as indicators of the nutritional condition of a series of 15 patients who underwent hepatic transplants and required total parenteral nutrition (TPN) during the first 10 post-transplant days. Before the transplants were carried out, all the patients studied showed a decrease in all evaluated parameters. Ten days after the transplant, and having been fed parenterally during this time, the different parameters corrected themselves, with the exception of cholesterol. TPN, administered with enrichment of branched amino acids by 35%, practically normalized the plasma amino acid pattern.

Adult↗

PubMedDate not supplied

[The use of immunologic parameters to assess the effectiveness of parenteral nutrition. Preliminary study].

Malnutrition leads to cellular and humoral immunological response disorders. A study protocol on malnourished patients has been designed in order to assess immune response mechanisms that may be altered due to malnutrition and may or may not recover once normal metabolic conditions have been restored prior to starting the patient on parenteral feeding and control. The immune response was assessed especially regarding immunoglobulin, lymphocyte subsets and mitogen response levels. It is important to know the different malnutrition-related immunologic disorders, disorders secondary to diseases that hinder correct oral feeding, and immunologic tests may be used to assess nutritional parameters. The malnourished patients included in this trial has to be free of any other immunologic or neoplastic disease, and not receive immune response suppression therapy. The trial patients showed lower total and relative CD3 and CD4 lymphocyte values at the onset of the study, although the former lymphocyte subset recuperated sooner at the expense of increasing CD8 lymphocytes, while CD4 lymphocytes still remained low after 15 days of parenteral nutrition. Immunoglobulin levels remained within normal limits. The mitogen response capacity, which was sensibly low at the beginning, recuperated in 50% of the cases treated with parenteral nutrition. This parameters may be used as an index to assess the nutritional status of these patients. The cases studies allowed us to conclude that there was a decrease in CD4 cells and mitogen response in malnourished patients. After 15 days of parenteral nutrition, the cells did not recuperate but their function measured in terms of phytohemagglutinin, was normal in 50% of the cases.

Humans↗

PubMedDate not supplied

[The assessment of nutritional status in patients over 60 with arteriopathy].

The nutritional status of patients older than 60 years affected by arteriopathy, who were admitted in a scheduled manner to a Vascular Surgery Department, have been studied. The nutritional status was evaluated upon admittance to the hospital and again upon release from the same, to determine whether this changes during the hospital stay. A total of 93 patients (80 men males and 13 females), with a mean age of 71 years, who were admitted to the hospital during a one year period, were studied prospectively. Among the present risk factors, active smokers or ex-smokers (83.87%), diabetics (32.25%), and the consumption of more than 40 g of alcohol/day (21.5%), should be noted. Upon admittance to the hospital, 43.5% of the studied cases presented mild malnutrition. During the hospital stay, which lasted 26.4 +/- 13.8 days, the nutritional status of these patients was ot modified. It should be noted that the delayed type sensitivity skin tests showed anergy in all cases, which suggests that this parameter is not a good nutritional marker for individuals over 60. Finally, we observe that the lean body mass index did not correlate with the rest of the anthropometric parameters used, which could indicate that age affects the lean body mass more than it does the other body components.

Aged↗

PubMedDate not supplied

[Fat-rich diets in patients with mild chronic obstructive lung disease (COPD)].

A study was made in stable patients suffering from mild COLD of the maximum capacity for ergometric cycle exercise and gas exchange at rest and during maximum exercise, measured by indirect calorimetry. During the period of study (3 months) one group of patients receive the usual diet while the other received an oral nutritional supplement rich in fats an minimum of 75% of their energy expenditure measured at rest. The patients studied, with mild COLD, were hypermetabolic, and although at rest they presented indirect calorimetry data such as would correspond to similar subjects, during exercise not just the limit on exercise became clear but also the alteration to ventilatory capacity and gas exchange. The fat-rich nutritional supplement administered for three months did not succeed in enhancing exercise capacity or in altering gas exchange during maximum exercise is stable patients with mild COLD.

Aged↗

PubMedDate not supplied

[Nutrition in the first 100 liver transplants performed at the Hospital General Vall d'Hebrón].

The orthotopic liver transplant (OLT) is a therapeutic alternative in the terminal stages of liver pathology. It is a surgical procedure which is being used on a steadily increasing basis. In our Hospital, a OLT program was started in 1988. Coinciding with the one hundredth OLT, we have gathered, retrospectively the methods of nourishing these patients, as well as the possible connections existing between the nutritional support system and the time spent by these patients in the intensive care unit on one hand, and the mortality presented on the other hand. Parenteral nutrition (PN) was the initial nutritional support system most used by the patients in our unit. Those patients needing PN as the primary nutritional support system, presented significantly longer stays in the ICU and a tendency towards higher mortality than did those who required another type of nutrition as the primary nutritional support system. In 21% of the patients, the PN could, possibly, have been avoided. Oral nutrition (ON) was the next most frequent method of primary nutritional support, and the most frequent method as far as global nutrition, with enteral nutrition (EN) being used in very few cases.

Adolescent↗

PubMedDate not supplied

[The nutrition of liver transplant patients in an intensive medicine service comparing the years 1989 and 1992].

We examined the possible changes undergone in the form of feeding post liver-transplant patients admitted to our Intensive Care Unit (ICU), comparing 1989 and 1992. As biological nutritional parameters, we reviewed blood lymphocyte values and albumin prior to the transplant, immediately after, seven days following and on discharge from the ICU. In the two periods studied, we assessed the features of the nutritional support received by these patients (type and chronology). We found that, in 1992, parenteral nutrition (in significant form, p = 0.04) and oral diet (as trend, p = 0.06) was initiated earlier than in 1989. We noted a tendency to change the overall nutritional pattern, with an increase seen in 1992 in oral diet and a reduction in parenteral nutritional when compared to the 1989 period. In 1992, 24% of patients received oral diet as a first nutrition as against none in 1989. These data must be correlated with the time in the Intensive Medicine Service and the tendency to reduce mortality, even though transplant patients in 1992 were significantly older than in 1989, while their selection and the base pathology altered the pattern of these patients.

Adolescent↗

PubMedDate not supplied

[Carbohydrate and lipid metabolism in the cancer patient].

The role of nutrition in cancer patients is highly important, not just in preventing development of the cancer but also in avoiding greater weight loss accompanying the cancerous cachexia in the evolution of the cancer. The different ways of treating cancer also involve increased deterioration of the nutritional state. To design a correct nutritional strategy for these patients, it is fundamental to understand the anomalies present at the metabolic level, including those affecting the cancer carrying host and those observed in the tumor itself. The results of various studies carried out on animals and neoplastic subjects using predominantly glucose as the non-protein calorie source suggest a stimulating effect on tumor growth. On the other hand, it appears that there is, at the level of the tumor, an inability to correctly oxidize fatty acids. Enhanced knowledge of the different alterations to carbohydrate and fat metabolism found in cancer patients might aid in a better grasp and design of a nutritional strategy aimed at reducing morbidity and mortality in these patients and improving their quality of life.

Animals↗

PubMedDate not supplied

[Energy requirement in patients after liver transplantation].

We have made a study of the energy requirements of liver transplant patients in the immediate post-operative phase, by comparing different methods. A study of energy use was made with indirect Calorimetry (IC), of calculation of Resting Energy Expenditure (REE) according to Fick's formula modified by Liggett, and of the calculation of basal energy Expenditure (BEE) applying Harris-Benedict's equation (HB). The correlation between the REE calculation using indirect calorimetry and that of BEE using Harris-Benedict (r = 0.7567) did not give a correction factor, applied to the Harris-Benedict formula) (REE by IC/BEE), which was uniform for all patients, oscillating as it did between 1.0 and 1.8. We found no correlation between REE by IC and that calculated using the modified Fick method, nor between the modified Fick method and BEE as calculated by Harris-Benedict. Our conclusion is that, with the IC method as reference to evaluate energy use, the Harris-Benedict calculation appears to be more reliable than that using the modified Fick equation and that, in the group of patients studied, and given the individual variations in the REE ratio calculated by IC and the BEE calculated by HB, we were unable to find a suitable correction factor for them all. IC is therefore the ideal method for evaluating energy use in critical patients in the ICU.

Basal Metabolism↗

PubMedDate not supplied

[The effect of 2 lipid emulsions on platelet function].

We examined the effect on platelet aggregation and activation and the production of eicosanoids in nonseptic critical patients of two lipidic emulsions administered with total parenteral nutrition. The two lipidic emulsions, Intralipid (20% of long chain triglycerides) and Lipofundina (10% each of long and medium-chain triglycerides), of differing essential fat acid content, provided 43% of the non-protein calorific requirements calculated for each patient. There were no other variables in the parenteral nutrition administered: the patients were distributed in two groups on a randomized basis according to the type of lipids received. We assessed the parameters demonstrating platelet function before parenteral nutrition, and after 4 and 7 days of such nutrition. Throughout the study, platelet aggregability was seen not to differ significantly from normal, even though the activation parameters controlled, beta TG and PF4, were from the outset significantly higher than normal; the thromboxane B2 averages calculated remained high, with wide individual variability, while averages for 6-keto-PGF1 alpha [correction of 0], which were initially high, showed a tendency (not statistically significant) to drop after 4 and 7 days nutrition. We did not observe that the administration of LCT or MTC/LCT led to changes in platelet aggregation and/or activation in the patients studied.

Adolescent↗

PubMedDate not supplied

[Lipid emulsions and pulmonary function].

A review is made of possible adverse effects of lipid emulsions on the respiratory function, based on the use and acceptance thereof as part of the non-protein caloric supply of the total parenteral nutrition of critical patients from the first hypotheses of the role played by the subsequent lipemia, to the most recent which lend great importance to the eicosanoids generated by the fatty acids supplied by the lipid emulsions. It is also verified whether the observed effects are similar both in healthy as well as in damaged lungs. Another variable to keep in mind, is the rate of administration of the lipid emulsions, which, related to the clearance thereof, could have different actions. Finally, and due to the fatty acid pattern of the lipid emulsion being different than that of the chylomicron, it is evaluated whether the actions of these emulsions may vary as a function of the quantity and quality of the fatty acids supplied.

Animals↗

PubMedDate not supplied

[Lipid peroxidation in critical patients].

Lipid peroxidation is a part of normal metabolism. The degree of peroxidation of membrane depends on the quantity and the quality of his fatty acids, both as components of the membrane, as constituents of the cellular environment. The magnitude of the changes which result in response to an exogenous load of hydrogen peroxides, shall depend, in part, on the pre-existing tissue levels of endogenous hydrogen peroxide. The exposure of the membrane to oxygen free radicals produced in excess, stimulates the process of lipid peroxidation. An update is made on lipid peroxidation in different nosological entities, with special emphasis on the special context of critical patients, and within this group, on the concept of ischemia-reperfusion. On the other hand, a brief review is made of the possible antioxidant defenses which may be used in the clinical situation, and a more extensive review is made of the correct analytical methodology to be used for determining the peroxidation.

Antioxidants↗