Pressure ulcers and malnutrition: results from a snapshot sampling in a university hospital

We aimed to ascertain the factors potentially contributing to the manifestation of pressure ulcers [PU] due to poor nutritional status in a nonselected hospitalized population. This is a prospective cohort study of 471 adult inpatients treated at our university hospital. Study parameters included anthropometric data, demographics, medical history, mood status, diet-related factors and self-perception of health status. For each participant, the body mass index [BMI] was calculated, and a malnutrition universal screening tool [MUST] was used to screen for nutritional deficiencies, with the presence of PU constituting the outcome of interest. An independent-samples t test, chi[2] analysis and logistic regression analysis were performed. The overall prevalence of PU in our cohort was 14.2%. Advanced age, low BMI, poor health status by self-assessment, serious mood disorders, malnutrition, abnormal appetite status, a quantity of food intake half of normal, an artificial diet, limited or no autonomy in everyday activities [p < 0.01 for all] and recent weight loss [p < 0.05] were identified as important determinants for the manifestation of PU. Multivariate analysis highlighted limited autonomy in everyday activities [OR 6.456 and 95% CI 3.212-12.973; p = 0.000], MUST score [OR 3.825 and 95% CI 1.730-8.455; p = 0.001] and artificial diet [OR 1.869 and 95% CI 1.247-2.802; p = 0.018] as the most powerful predictors of PU development. Poor nutritional status, limited autonomy in everyday activities and artificial nutrition seemed to confer noteworthy prognostic value regarding PU development in the acute-care setting

Percutaneous Endoscopic Gastrostomy Through the Sinus Tract of a Surgical Gastrostomy

We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.