Evaluación del soporte nutricional intensivo en pacientes con neumonía grave por COVID-19

RESUMEN Introducción: En los pacientes críticos con COVID-19 ocurren una serie de alteraciones metabólicas, las cuales afectan directamente el estado nutricional del paciente. Para mejorar la sobrevida de los pacientes con COVID-19, se hace relevante el tratamiento nutricional oportuno, idealmente dentro de las primeras 24-48 horas de la admisión a la UCI. El objetivo de este estudio fue reportar la evolución, desde el ingreso hasta el egreso, del balance nitrogenado, diversos parámetros bioquímicos y el estado nutricional de los pacientes con neumonía por COVID-19. Método: Estudio observacional retrospectivo de temporalidad longitudinal, se realizó en la UCI del Hospital Las Higueras de Talcahuano, Chile. Se incluyeron a 33 pacientes al ingreso y al egreso de la UCI. Resultados: Se reportó un incremento significativo del balance nitrogenado al egreso de los pacientes de UCI, sin embargo, no se registraron cambios en la media de talla, peso, IMC, prevalencia de desnutrición durante la estancia en la UCI. La prevalencia de desnutrición moderada y severa fue de un 14,0%, valor inferior al 45,0% informado en pacientes con COVID-19. Conclusión: En este estudio se reportó que la implementación del protocolo y la terapia nutricionales durante la pandemia de COVID-19 se asoció a un aumento del balance nitrogenado y un mejor control glicémico en los pacientes que egresan de la UCI por neumonía de COVID-19.

ABSTRACT Introduction: In critically ill patients with COVID-19, a series of metabolic alterations occur, which directly affect the patient's nutritional status. To improve the survival of patients with COVID-19, timely nutritional treatment is relevant, ideally within the first 24-48 hours of admission to the ICU. The objective of this study was to report the evolution, from admission to discharge, of the nitrogen balance, various biochemical parameters and the nutritional status of patients with COVID-19 pneumonia. Method: We conducted a retrospective observational study in the ICU of Las Higueras Hospital in Talcahuano, Chile. Thirty-three patients were included at admission and discharge from the ICU. Results: A significant increase in nitrogen balance was reported at ICU patient discharge, however, no changes were recorded in mean height, weight, BMI, or prevalence of malnutrition during ICU stay. The prevalence of moderate and severe malnutrition was 14.0%, a value lower than the 45.0% reported in patients with COVID-19. Discussion: In this study we reported that the implementation of the nutritional protocol and therapy during the COVID-19 pandemic was associated with an increase in nitrogen balance and better glycemic control in patients discharged from the ICU due to COVID-19 pneumonia.

Nutritional treatment for elderly chronic kidney disease patients with diabetes / 中国实用内科杂志

Nutritional treatment is of great importance for chronic kidney disease(CKD), with its particularity for elderly patients with diabetes. Low-protein diet, as the core of the nutritional treatment, is expected to improve the prognosis of elderly CKD patients with diabetes. However, considering its higher risk of malnutrition, blood glucose elevation and depression in these patients, appropriate protein limitation and in-time nutritional status assessment should be emphasized.Meanwhile, the weak compliance of low-protein diet in elderly patients should be improved. Since elderly CKD patients with diabetes are likely to suffer from many other complications, individual ized nutritional therapy should be prescribed according to the nutritional status of the patient.

Pathophysiology of Cancer Cachexia and Significance of Nutritional Support during the Treatment in Palliative Care

<p>Cancer cachexia is a multifactorial syndrome defined by ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support. Nutritional treatment is a component of nutritional support, as well as symptom palliation and nutritional counseling. Nutritional treatment, exercise, and pharmacological agents are essential for treating cancer cachexia. In our studies at palliative care units, 76% and 73% of advanced cancer patients and bereaved families, respectively, required nutritional support, and nutritional support was also found to have beneficial effects on selected groups of advanced cancer patients. Our studies also indicated that as chronic inflammation is the underlying cause of cancer cachexia the plasma C-reactive protein (CRP) level might be useful as a prognostic marker/biomarker of advanced cancer. It was suggested that nutritional support based on the mechanism responsible for cancer cachexia is useful during the treatment of cancer cachexia although the evidence for this is not robust, and the CRP level is suggested to be a clinically significant index of the response to such treatment.</p>

Conventional Phenylketonuria Treatment

Abstract Phenylketonuria (PKU) is caused by a deficient activity of enzyme phenylalanine (Phe) hydroxylase, which results in high Phe blood concentration, which is toxic to the central nervous system. The fundamental purpose of nutritional treatment is to reduce and maintain blood Phe between 2 mg/dL (120 µmol/L) and 6 mg/dL (360 µmol/L) in order to prevent neuropathogenic complications. At the same time, nutrition support must provide enough energy and nutrients to promote normal growth and development and also to avoid vitamin and mineral deficiencies. Phenylketonuria treatment must be maintained long-life and its adherence must be frequently assessed. The amount of Phe required by patients with PKU varies throughout life and must be adjusted according to individual tolerance, residual phenylalanine hydroxylase enzymatic activity, age, sex, growth rate, protein intake, and nutritional and biochemical status among others. Treatment must be done by trained personnel. It is necessary to unify treatment criteria and further research must be done.

Determinantes de sucesso após a cirurgia bariátrica:fatores pré-operatórios que influenciam nos resultados pós-operatórios / Determinants of success after bariatric surgery: preoperative factorsinfluencing the postoperative results

Introdução: A obesidade, incluída no grupo de doenças crônicasnão-transmissíveis (DCNT), é definida pelo acúmulo excessivo degordura corporal no organismo. A intervenção cirúrgica é colocadacomo o único método de tratamento mais eficaz dessa patologiae leva em consideração os seguintes critérios para sua indicação:IMC, idade e tempo da doença.As práticas nutricionais no períodopré-operatório têm como foco promover modificações no hábito epadrão alimentar, potencializando as chances de obter resultadospositivos e satisfatórios após a cirurgia. Mais pesquisas ainda sãonecessárias para melhor definir os fatores que devem ser priorizadosno pré-operatório a fim de alcançar os resultados desejados.Objetivo: Determinar os fatores sugeridos na literatura como preditoresno pré-operatório que influenciam o resultado após a cirurgiabariátrica.Métodos: Foi realizada busca de artigos publicados no período de2003 a 2014, utilizando-se palavras-chaves em conformidade aosDescritores em Ciências da Saúde, nos idiomas inglês, português eespanhol. A seleção foi baseada nos títulos, resumos e descritores.Resultados: Foram incluídos 66 estudos sendo 12,1% (n=8) dos artigosforam de revisão, 21,2% (n=14) diretrizes e outros 66,6% (n=44)de artigos originais. Os principais fatores encontrados que podeminfluenciar na obtenção de resultados positivos no pós-operatórioforam a prática de atividades físicas, o comparecimento às consultasnutricionais, o Índice de Massa Corporal pré-operatório, a perdade peso pré-operatória e técnica cirúrgica utilizada e a presença decomorbidades.Considerações finais: apesar de identificados os principais fatorespreditores de sucesso pós-operatório, ainda há muita controvérsianos resultados dos estudos relacionados ao tema. Novos estudosdevem ser conduzidos para que os fatores sejam definitivamenteidentificados a fim de que sejam controlados antes da cirurgia contribuindo

Introduction: Obesity, included in the group of chronic non-communicablediseases (NCDs), is defined by excessive accumulation ofbody fat in the body. Surgical intervention is placed as the only methodto more effectively treat this condition and takes into accountthe following criteria for his nomination: BMI, age and disease duration.Nutritional practices in the preoperative period are focusedon promoting changes in habit and dietary patterns, increasing thechances of obtaining positive and satisfactory results after surgery.More research is needed to better define the factors that should beprioritized preoperatively in order to achieve the desired results.Objective: To determine the factors suggested in the literature aspredictors preoperative influencing the outcome after bariatricsurgery.Methods: A search was conducted for articles published in the period2003-2014, using keywords in accordance to Health SciencesDescriptors in English, Portuguese and Spanish languages . The selectionwas based on the titles, abstracts and keywords.Results: 66 studies were included and 12.1% (n = 8) of the articleswere reviews, 21.2% (n = 14) guidelines and other 66.6% (n = 44)were original articles. The main factors that can influence positivelythe postoperatively outcomes were preoperative physical activity,attendance at nutritional consultations, preoperative bodymass index, weight loss, surgical technique and the presence of comorbidities.Conclusion: Although we identified the main predictors for postoperativesuccess, there is still much controversy on the results ofstudies related to the topic. Further studies should be conductedto definitely identify these factores in order to control then beforesurgery and contribute to postoperative success in the short andlong term

Evaluación nutricional en diabéticos tipo 2 obesos mórbidos para la realización de la cirugía bariátrica / Nutritional assessment in type 2 diabetes patients with morbid obesity for carrying out of bariatics surgery

La diabetes mellitus representa un importante problema de salud en el mundo y en Cuba. El tratamiento de los diabéticos tipo 2 obesos mórbidos puede ser con cirugía bariátrica para lograr su control metabólico. Con el tratamiento convencional de la obesidad generalmente no mantienen la pérdida de peso a largo plazo. En el Hospital Universitario "General Calixto García" existe un grupo multidisciplinario con la atención nutricional de estos pacientes. En esta revisión se enfatizan la evaluación y el tratamiento nutricional antes y después de la intervención. Para muchos pacientes diabéticos tipo 2, los beneficios de la cirugía bariátrica, además de la pérdida de peso, son la disminución de la glucemia, de los lípidos, la presión sanguínea y puede ocurrir la remisión total de la enfermedad. En la atención primaria de salud los especialistas de medicina general integral realizarían la evaluación nutricional y seguimiento de los casos después de la operación para alcanzar y mantener un estado nutricional adecuado con menos complicaciones de la diabetes.

The diabetes mellitus is an important health problem at world scale and also in Cuba. Treatment of type 2 diabetes patients and morbid obesity may be using bariatics surgery to achieve its metabolic control. Using the conventional treatment of obesity generally there is not a weight loss at long term. At the "General Calixto García" University Hospital there is a multidisciplinary group in charge of the nutritional care of these patients. In present review the evaluation and nutritional treatment before and after intervention are emphasized. For many type diabetes patients the benefits of bariatics surgery as well as the weight loss there is the drop of glycemia, of lipids, blood pressure and may to occur the total remission of disease. In the primary health care the general integral medicine specialists made the nutritional evaluation and the follow-up of cases after achievement and maintenance of a suitable nutritional state with less diabetes complications.

Seguimiento nutricional de los pacientes fibroquísticos en el Hospital Universitario General Calixto García / The succession nutritional of patients with cystic fibrosis at General Calixto García University Hospital

Se realizó un estudio en los pacientes fibroquísticos del Hospital General Calixto García. Su valoración nutricional resulta indispensable. Fueron seguidos 21 pacientes durante los últimos seis meses del año 2009, para describir el estado nutricional según grupos de edades e indicadores de laboratorio, así como valorar los cambios en el peso de los pacientes en ese tiempo de tratamiento nutricional. Se realizaron evaluaciones antropométricas: peso, talla y se calculó el Índice de Masa Corporal, análisis de laboratorio y prueba cutánea de hipersensibilidad retardada. Predominó el estado nutricional normal para 71.4 por ciento, seguido de los desnutridos 19.1 por ciento. La edad media fue 30 años con un rango de 18 a 58. El grupo de edad que prevaleció fue de 21 a 30 años, principalmente los normopesos con 91.7 por ciento. Hubo mayor número de desnutridos en el grupo £ 20 años (66.7 por ciento). De los indicadores de laboratorio los más afectados: conteo total de linfocitos, colesterol y prueba cutánea de hipersensibilidad retardada (Inmunodeficiencia) en los pacientes desnutridos. La ganancia de peso fue evidente en los desnutridos y normopeso. Se realizó análisis descriptivo porcentual de los resultados y se utilizó x² con un nivel de significación de a = 0.05. Se concluye que la atención del paciente con Fibrosis Quística debe ser a través de un grupo multidisciplinario y que es muy importante realizar el seguimiento nutricional en estos pacientes para aumentar la supervivencia y mejorar la calidad de vida(AU)

In the study performed with patients with cystic fibrosis at Calixto Garcia Hospital nutritional evaluation was mandatory. During the last six months, 21 patients were observed to describe their nutritional status according to age groups and laboratory indicators so as to assess their weight changes during that observational period. Anthropometric evaluations based on weight, height, body mass index, lab tests and hypersensibility cutaneous retarded test were done. The highest figures (71.4 percent) were found on the group of patients with a normal nutritional stage, followed by the group of malnutrition status with a 19.1 percent of cases. The age mean was 30 years in a range group between 18 _ 58 years of age. The predominant age group was found between 21 and 30 years of age with a normal nutritional rank of 91.7 percent. From the laboratory indicators which were more affected were the total count of lymphocytes, cholesterol levels and the hyper sensibility cutaneous retarded test (immunodeficiency) test, and they were found in malnutrition cases. Weight gain was evident in those cases as well as and in the group of normal nutritional status. A perceptual and descriptive analysis was done with all results and the X2 with a significant level of á = 0.05 was estimated. It was concluded that attention of patients with cystic fibrosis must be done across a multidisciplinary approach of medicine professionals and that it was also important to have a follow-up nutritional status of those patients to increase the survival rate and quality of life(AU)

Cirugía bariátrica endoscópica para el tratamiento de la obesidad mórbida: presentación de 3 casos / Endoscopic bariatrics surgery for treatment of morbid obesity: presentation of three cases

La obesidad es un importante problema de salud por el riesgo aumentado de morbilidad y de mortalidad cardiovascular y global. Cuando han fracasado los tratamientos convencionales, la cirugía bariátrica es un tratamiento eficaz, pues consigue normalizar las comorbilidades en un elevado número de pacientes. Se presentan los casos de 3 pacientes con obesidad mórbida (IMC ≥ 40 kg/m2), operadas por vía endoscópica (derivación gástrica), para identificar las enfermedades asociadas antes y después del tratamiento, valorar los análisis de laboratorio antes y después de la cirugía, evaluar la pérdida de peso después de la operación e identificar las complicaciones perioperatorias(AU)

The obesity is an important health problem due to the increased risk of global and cardiovascular morbidity and mortality. When conventional treatments fail, the bariatrics surgery is an effective treatment since normalizes the comorbidities in a significant number of patients. This is the presentation of three female cases presenting with morbid obesity (CMI ≥ 40 kg/m²), operated on via endoscopy (gastric bypass) to identify the associated diseases before and after treatment, to assess the laboratory analyses before and after surgery, to assess the weight loss after surgery and to identify the perioperative complications(AU)

Early enteral feeding used in patients with gastreetomy / 国际外科学杂志

Objective To investigate the effect of early enteral nutrition(EN) support after gastreetomy and evaluate its feasibility. Methods Early enteral feeding was used in 129 eases with gastreetomy in 20 hours after operation. Result One hundred and twenty-nine eases accepted early enteral nutrition support, 5 ea-ses appeared diarrhea. After adjusting the infusion speed and the temperature of nutrient fluid, symptoms of 4 eases vanished, 1 ease could not complete the early enteral feeding plan. Conclusions The early nutri-tion after gastreetomy is safe, reliable, simple and economical. The early nutrition can improve the nutrition state of postoperative patient effectively.

La adherencia al tratamiento nutricional y composición corporal: un estudio transversal en pacientes con obesidad o sobrepeso / Adherence to the nutritional treatment and body composition: a crooss-sectional study in patients with obesity or overweight

To assess nutritional adherence to treatment among obese or overweight patients and to examine the relationship between anthropometrical variables, 94 subjects between 20-50 years old randomly selected were recruited at two nutritional health centers in Medellin-Colombia. Nutritional adherence to treatment was evaluated using a questionnaire, with a total score above 24 considered as adherent to the treatment. In addition, socio-demographic information was obtained and anthropometrical variables were measured. We used descriptive statistical, Kolmogorov-Smirnov test, Chi-square for proportions comparison, and Student T test or U Mann Whitney for means comparison. A 68% of the patients were classified as no adherent to the nutritional treatment, with significant differences found according to physical activity (p= 0,013). Mean weight (p= 0,014), BMI (p= 0,026), waist circumference (p= 0,005) and waist-hip ratio (p= 0,022) differed according to adherence, being significantly higher in non adherent patients. Percent body fat did not change by degree of adherence. However when controls were separated by gender the results were significant for both men and women. Nutritional adherence to treatment in patients on a diet for weight reduction produces significant changes in body composition.

Se determinó la adherencia al tratamiento nutricional en pacientes con obesidad o sobrepeso y se examinó la relación entre ésta y variables antropométricas, mediante un estudio transversal en 94 sujetos entre 20 y 50 años seleccionados de forma aleatoria en dos centros de atención nutricional de Medellín. La adherencia al tratamiento nutricional se evaluó aplicando un cuestionario, donde puntajes mayores o iguales a 24 se consideraron como adherentes. Además, se obtuvo información socio-demográfica y antropométrica, previa estandarización de los evaluadores. Se utilizaron medidas descriptivas, prueba de Kolmogorov-Smirnov, Chi-cuadrado para comparación de proporciones, T de Student o U Mann Whitney para comparación de promedios. El 68% de los pacientes fueron clasificados como no adherentes al tratamiento nutricional, encontrando diferencias según actividad física (p=0,013). El peso promedio (p=0,014), Indice de Masa Corporal (p=0,026), perímetro de cintura (p=0,005) y relación cintura cadera (p=0,022), difirieron de acuerdo a la clasificación de adherencia, siendo significativamente más altos en los no adherentes. No hubo diferencias en el porcentaje de masa grasa según adherencia (p=0,690), pero se hallaron al controlar por sexo, p=0,009 mujeres y p=0,026 hombres. La adherencia al tratamiento nutricional en pacientes en dieta para reducir de peso, produce cambios significativos en la composición corporal.