Evaluación de la técnica de conteo de grasas y ajuste de enzimas pancreáticas en un grupo de pacientes con insuficiencia pancreática secundaria a fibrosis quística con seguimiento en un hospital de alta complejidad / Evaluation of the fat counting technique and pancreatic enzyme adjustment in a group of patients with pancreatic insufficiency secondary to cystic fibrosis followed-up in a tertiary-level hospital

Objetivo: evaluar la efectividad de la técnica de conteo de grasas y ajuste de enzimas pancreáticas en un grupo de pacientes con insuficiencia pancreática secundaria a fibrosis quística (FQ). Materiales y métodos: En un grupo de pacientes con FQ, sin otra patología asociada, mayores de 1 año, con >10 000 UKD (unidades por kilo por día) de lipasa; se realizó educación y aplicación de técnica de conteo de grasas con ajuste enzimático, solicitando Van de Kamer y registro alimentario de 5 días durante la recolección de la muestra con un intervalo de 3 meses entre ambas determinaciones. Se evaluó la efectividad de la misma y las dosis de enzimas utilizadas mediante el porcentaje de excreción grasa (PEG), así como las variaciones en la cantidad de enzimas utilizadas y la ganancia de peso. Los datos se registraron en RED Cap (Research Electronic Data Capture) y se analizaron mediante Stata 12. Resultados: De un total de 21 pacientes, 16 completaron la intervención. El 50% presentó un índice de masa corporal (IMC) mayor del Plo 25 antes y después, un 87% alcanzó adecuación calórica mayor del 120% de la ingestas diarias recomendadas (RDA) al final, logrando un aumento promedio de z score de peso de 0,28 con una media inicial de 17 kg y final de 18,2 kg. En cuanto a la media del requerimiento enzimático fue de 14 800 UKD antes y 10 145 UKD después (z=0,002), asimismo el porcentaje de excreción grasa (PEG) tuvo una disminución del 38% (p=0,1705). Conclusiones: La implementación de la técnica de conteo de grasas y ajuste enzimático, podría ser una estrategia válida para aquellos pacientes con FQ que tienen dosis altas de enzimas e inadecuada ganancia de peso (AU)

Objective: To evaluate the effectiveness of the fat counting technique and pancreatic enzyme adjustment in a group of patients with pancreatic insufficiency secondary to cystic fibrosis (CF). Materials and methods: A group of patients with CF without other associated diseases, older than 1 year of age, lipase dose >10 000 UKD (units per kilo per day), received education on the fat counting technique with enzyme adjustment followed by its implementation of the intervention. Van de Kamer was requested and a 5-day food record was kept during the sample collection with an interval of 3 months between both measurements. The effectiveness of the technique and the enzyme doses used were evaluated based on the percentage of fat excretion (PFE), as well as the variations in the amount of enzymes used and weight gain. Data were recorded in RED Cap (Research Electronic Data Capture) and analyzed using Stata 12. Results: Of a total of 21 patients, 16 completed the intervention. Fifty percent had a body mass index (BMI) greater than Plo 25 before and after the intervention; 87% had achieved a caloric increase greater than 120% of the recommended daily intake (RDA) at the end of the study and an average increase in weight z score of 0.28 with an initial mean of 17 kg and a final mean of 18.2 kg. Mean enzyme requirement was 14 800 UKD before and 10 145 UKD after the intervention (z=0.002). PFE decreased by 38% (p=0.1705). Conclusions: The implementation of the technique of fat counting and enzyme adjustment may be a valid strategy for CF patients with high enzyme doses and inadequate weight gain. (AU)

Enzyme Therapy: Current Perspectives.

Enzymes control all metabolic processes in human system from simple digestion of food to highly complex immune response. Physiological reactions occuring in healthy individuals are disturbed when enzymes are deficient or absent. Enzymes are administered for normalizing biological function in certain pathologies. Initially, crude proteolytic enzymes were used for the treatment of gastrointestinal disorders. Recent advances have enabled enzyme therapy as a promising tool in the treatment of cardiovascular, oncological and hereditary diseases. Now, a spectrum of other diseases are also covered under enzyme therapy. But, the available information on the use of enzymes as therapeutic agents for different diseases is scanty. This review details the enzymes which have been used to treat various diseases/disorders.

Síndrome de DIOS en dos pacientes con fibrosis quística: revisión de la literatura / Case Studies of Two Cystic Fibrosis Patients with distal intestinal obstruction syndrome (DIOS) and a Literature review

En los pacientes con fibrosis quística (FQ) el íleo meconial, el síndrome de obstrucción distal y la constipación conforman un grupo de manifestaciones gastrointestinales con una gravedad variable como consecuencia del incremento en la viscosidad del moco y el tiempo prolongado del tránsito intestinal. El grupo de trabajo de fibrosis quística de la Sociedad Europea de Gastroenterología, Hepatología y Nutrición Pediátrica realizó un consenso en 2010 y definió el síndrome de obstrucción intestinal distal (DIOS) como un cuadro agudo de obstrucción intestinal que puede ser completo o incompleto. El DIOS completo se define como un cuadro de vómito bilioso y/o niveles hidroaéreos en el intestino delgado observados en la radiografía de abdomen, masa fecal a nivel ileocecal, y dolor y/o distensión abdominal; el incompleto se define como el cuadro de dolor abdominal y/o distensión y masa fecal a nivel ileocecal, pero sin los otros signos de obstrucción completa. La frecuencia de presentación de esta entidad en pacientes con FQ es variable y depende de las definiciones utilizadas; se ha considerado que la prevalencia va del 7% a 8% en niños y en adultos puede ser tan alta como de 23,3 episodios por 1000 pacientes/año, con una prevalencia que varía entre el 14% y el 16%. Dadas las dificultades que se presentan en estos pacientes para definir y establecer el diagnóstico, quisimos ilustrar este síndrome con 2 niños que consultaron a nuestra institución; además, se realizó una revisión del tema para generar sensibilización sobre el diagnóstico temprano y su manejo.

Patients with cystic fibrosis (CF) have greater than normal mucosal viscosity and prolonged intestinal transit times which can result in meconium ileus, distal intestinal obstruction syndrome (DIOS) and constipation of varying severity. The cystic fibrosis working group of the European Society of Gastroenterology, Hepatology and Pediatric Nutrition produced a consensus in 2010 that defined distal intestinal obstruction syndrome (DIOS) as acute intestinal obstruction which may be complete or incomplete. Fully developed DIOS is defined as bilious vomiting and/or sufficient amounts of fluid and air in the small intestine to be observed in an abdominal X-ray, a fecal mass in the ileocecal area, pain and/or bloating. Incomplete DIOS is defined as abdominal pain and/or bloating and fecal mass in the ileocecal area, but without the other signs of complete obstruction. The incidence of this condition in cystic fibrosis patients varies. Depending on the definition used, the prevalence of DIOS has been measured between 7% and 8% in children with cystic fibrosis, but has been reported to be as high as 23.3 episodes per 1,000 patients per year for adult cystic fibrosis patients with a prevalence ranging between 14% and 16%. Given the difficulties of establishing this diagnosis in these patients, we wanted to illustrate this syndrome with two children who were treated in our institution and to review this subject in order to generate awareness about early diagnosis and management.

Agentes tróficos na dieta de leitões desmamados sobre a atividade das enzimas digestivas e o desempenho / Trofic agents in the diet of weaned pigs on the activity of the digestive enzymes and the performance

Foi avaliado o efeito da adição de glutamina, ácidos graxos poliinsaturados ou parede celular de levedura à dieta de leitões desmamados sobre a atividade das enzimas pancreáticas (lipase, amilase e tripsina) e da mucosa intestinal (dipeptidase, sacarase e maltase) e sobre o desempenho. Foram utilizados 45 leitões desmamados e distribuídos em delineamento em blocos casualizados, em esquema fatorial, com quatro dietas (T1 - dieta basal (DB); T2 - DB + 1% de glutamina; T3 - DB + 0,2% de parede celular de levedura; T4 - DB + 5% de óleo de peixe) e duas idades de abate (sete e 14 dias pós-desmame). O desempenho foi medido nas duas primeiras semanas pós-desmame. A adição de 1% de glutamina na dieta dos leitões aumentou a atividade específica e total da amilase, e atividade total da tripsina na segunda semana pós-desmame. Os demais aditivos não alteraram a atividade das enzimas digestivas nos leitões. Também foi observado aumento na atividade total da lipase, e atividade específica da tripsina e maltase em função da idade pós desmame. De modo geral, as atividades das enzimas digestivas estiveram correlacionadas positivamente, com exceção da dipeptidase que não se correlacionou com nenhuma outra enzima. Foi observada correlação positiva entre ganho de peso e atividades da lipase e da amilase. Os aditivos incluídos na dieta não influenciam o desempenho dos leitões no pós-desmame.

It was evaluated the effect of the addition of glutamine, polyunsaturated fatty acids or cellular wall of yeast to the diet of weaned pigs on the activity of the pancreatic enzymes (lipase, amylase and trypsin) and the intestinal mucous membrane (dipeptidase, sucrase and maltase) and on the performance. Forty-five weaned pigs were used and distributed in a randomized block design, in factorial outline, with four diets (T1 - basal diet (BD); T2 - BR + 1% glutamine; T3 - BD + 0,2% cellular wall of yeast; T4 - BD + 5% fish oil) and two slaughter ages (seven and 14 days post weaning). The performance was measured in the first two weeks post-weaning. The addition of 1% glutamine in the diet of pigs increased the specific and total activity of the amylase, and total activity of the trypsin in the second week post weaning. The others supplements not change the activity of the digestive enzymes in the pigs. Also an increase was observed in the total activity of the lipase, and specific activity of the trypsin and maltase in function of the age post-weaning. In general, the activities of the digestive enzymes were correlated positively, except for the dipeptidase that was not correlated with any other enzyme. Positive correlation was observed between weight gain and activity of the lipase and of the amylase. The supplements included in the diet not influence the performance of weaned pigs.

EFFECTS OF SELENIUM IN DIET ON RAT PANCREAS PROTEIN SYNTHESIS AND ENZYMES ACTIVITY / 西安交通大学学报(医学版)

The study was to investigate comparatively the changes of protein synthesis and amylase, chymotrypsin, lipase activity in pancreas from two groups rats fed with selenium deficient diet from a Keshan disease (KD) endemic area (Se: 0.021ppm) and KD diet supplemented with sodium selenite(Se: 0.264ppm). The rats fed with Xian's cereals were taken as the control group. The results of our observations suggest that the dietary selenium of 0.241ppm level is sufficient to stimulate inocroporation of [~3H]-Leucine in protein by rat pancreas slices, to increase activity of amylase, chymotrypsin and lipase, toi ncrease activity of GSH-Px and to decrease TBA value in rat pancreas. In addition, it increases body weight and decreases mortality in rats too. It seems that selenium, by the ways of stimulating protein synthesis and increasing activity of pancreasec enzymes, can protect the pancreas and lead to gain weight in rats.