Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

INTRODUCTION: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. METHODS: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. INCLUSION CRITERIA: Adult ICU patients>18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48h. Statistical analysis was carried out using IBM-SPSS© 24 programme. RESULTS: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97g/kg/day (CI 0.95-0.99), P<0.001), and lower caloric intake than those who survived (12.94kcal/kg/day (CI 12.48-13.39) vs 16.47kcal/kg/day (CI 16.09-16.8), P<0.001). A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II>18. CONCLUSIONS: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

Introduction: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. Methods: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. Inclusion criteria: Adult ICU patients > 18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48 h. Statistical analysis was carried out using IBM-SPSS© 24 programme. Results: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73 g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97 g/kg/day (CI 0.95-0.99), P < 0.001), and lower caloric intake than those who survived (12.94 kcal/kg/day (CI 12.48-13.39) vs 16.47 kcal/kg/day (CI 16.09-16.8), P < 0.001).A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II > 18. Conclusions: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Introducción: En 2020, la pandemia provocada por el SARS-COV-2 demandó una enorme cantidad de recursos sanitarios para garantizar el tratamiento y apoyo adecuado a estos pacientes. Este estudio tiene como objetivo evaluar la ingesta de calorías/proteínas y evaluar sus asociaciones con resultados clínicos relevantes en pacientes críticamente enfermos con enfermedad por coronavirus (COVID-19). Métodos: Se realizó un estudio observacional prospectivo multicéntrico a nivel nacional que incluyó 12 unidades de cuidados intensivos (UCI) argentinas entre marzo y octubre de 2020. Criterios de inclusión: pacientes adultos de la UCI > 18 años ingresados en la UCI con diagnóstico de COVID-19 y ventilación mecánica durante al menos 48 h. El análisis estadístico se realizó mediante el programa IBM-SPSS© 24. Resultados: En el presente estudio se incluyeron 185 pacientes. Entre los que fallecieron se observó un aporte proteico más bajo (0,73 g/kg/día [intervalo de confianza {IC} del 95% 0,70-0,75] vs. 0,97 g/kg/día [IC 0,95-0,99], p < 0,001), y menor aporte calórico que los que sobrevivieron (12,94 kcal/kg/día [IC 12,48-13,39] vs. 16,47 kcal/kg/día [IC 16,09-16,8], p < 0,001).Se construyó un modelo de regresión logística para analizar qué factores estaban asociados con la probabilidad de lograr los objetivos calóricos/proteicos. Se observó una mayor probabilidad de lograr dichos objetivos cuando el inicio del soporte nutricional era precoz, el puntaje NUTRIC modificado era superior a 5 puntos y el paciente tenía diagnóstico de desnutrición mediante la Evaluación Global Subjetiva(B o C). Por otra parte, en los pacientes que necesitaron ventilación mecánica en decúbito prono se observó menor aporte calórico y proteico, situación similar en aquellos con APACHE II > 18. Conclusiones: Los pacientes críticos con insuficiencia respiratoria asociada a la enfermedad por COVID-19 que requerían ventilación mecánica y que fallecieron en la UCI tuvieron una ingesta calórica y proteica menor que los que sobrevivieron. El inicio temprano del soporte nutricional y la desnutrición aumentaron la posibilidad de alcanzar los objetivos calóricos y proteicos, mientras que la gravedad de la enfermedad y la ventilación mecánica en decúbito prono disminuyeron la posibilidad de alcanzar los objetivos calóricos y proteicos.

Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19 / Riesgo nutricional y resultados clínicos de pacientes adultos críticamente enfermos con COVID-19

Introduction: the COVID-19 pandemic put the world's population at risk. As the relationship between nutritional risk and clinical outcomes in critically ill patients with COVID-19 is still poorly understood, a multidisciplinary research team of the Argentine Society of Intensive Care (SATI) conducted a multicenter study aimed to define nutritional features, and to evaluate the relationship between nutritional risk and relevant clinical outcomes for COVID-19 patients in an intensive care unit (ICU). Methods: a multicenter, prospective, observational study including twelve Argentinian ICUs was conducted between March and October 2020. Inclusion criteria were: adult patients older than 18 years who were admitted to the ICU with a COVID-19 diagnosis were included. Clinical data included comorbidities scores, and nutritional screening tools such as the Subjective Global Assessment (SGA), the Nutritional Risk Screening (NRS) 2002, and the modified NUTRIC score (mNUTRIC SCORE) were used. In addition, clinical outcomes including overall mortality, mechanical ventilation (MV) days, and ICU and hospital length of stay (LOS) were recorded. Results: a total of 285 ICU patients met our inclusion criteria. Mean age was 61.24 (SD = 14.6) years; APACHE-II, 14.2 (SD = 6.6); Charlson Comorbidity Index (CCI), 2.3 (SD = 2.3). Most patients were admitted from the emergency room to the ICU. Hypertension, obesity, and diabetes were the most common comorbidities. Nutritional assessment showed that 36.9 % were SGA B+C, and 46 % were obese. Mean ICU LOS was 22.2 (SD = 19.5), and hospital LOS was 28.1 (SD = 21.9) days. Of all patients, 90.2 % underwent MV, and MV days were 20.6 (SD = 15.6). (AU)

Introducción: la pandemia de COVID-19 puso en riesgo a la población mundial. Dado que la relación entre el riesgo nutricional y los resultados clínicos en pacientes críticos con COVID-19 es aún poco conocida, un equipo de investigación multidisciplinario de la Sociedad Argentina de Cuidados Intensivos (SATI) realizó un estudio multicéntrico con el objetivo de definir las características nutricionales y evaluar la relación entre el riesgo nutricional y los resultados clínicos relevantes para los pacientes de la unidad de cuidados intensivos (UCI) de COVID-19. Métodos: entre marzo y octubre de 2020 se realizó un estudio observacional prospectivo y multicéntrico que incluyó 12 UCI argentinas. Criterios de inclusión: se incluyeron pacientes adultos mayores de 18 años que habían ingresado en la UCI con diagnóstico de COVID-19. Se utilizaron datos clínicos que incluían scores de comorbilidades, herramientas de cribado nutricional como la Evaluación Global Subjetiva (EGS) y el Cribado de Riesgo Nutricional (NRS) 2002, y la puntuación NUTRIC. Además. Se registraron los resultados clínicos, incluida la mortalidad, los días de ventilación mecánica (VM) y la duración de la estancia en la UCI y hospitalaria en general. Resultados: en total, 285 pacientes en UCI cumplieron nuestros criterios de inclusión. La edad media fue de 61,24 (DE = 14,6) años, la puntuación APACHE-II de 14,2 (DE = 6,6) y el índice de comorbilidad de Charlson (ICC) de 2,3 (DE = 2,3). La mayoría de los pacientes ingresaron desde la sala de emergencias a la UCI. La hipertensión, la obesidad y la diabetes fueron las comorbilidades más frecuentes. La evaluación nutricional mostró que el 36,9 % eran VGS B + C y el 46 % eran obesos. La estancia en la UCI fue de 22,2 (DE = 19,5) y la hospitalaria de 28,1 (DE = 21,9) días. El 90,2 % se sometieron a VM, siendo la media de días de VM de 20,6 (DE = 15,6). (AU)

Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19.

INTRODUCTION: Introduction: the COVID-19 pandemic put the world's population at risk. As the relationship between nutritional risk and clinical outcomes in critically ill patients with COVID-19 is still poorly understood, a multidisciplinary research team of the Argentine Society of Intensive Care (SATI) conducted a multicenter study aimed to define nutritional features, and to evaluate the relationship between nutritional risk and relevant clinical outcomes for COVID-19 patients in an intensive care unit (ICU). Methods: a multicenter, prospective, observational study including twelve Argentinian ICUs was conducted between March and October 2020. Inclusion criteria were: adult patients older than 18 years who were admitted to the ICU with a COVID-19 diagnosis were included. Clinical data included comorbidities scores, and nutritional screening tools such as the Subjective Global Assessment (SGA), the Nutritional Risk Screening (NRS) 2002, and the modified NUTRIC score (mNUTRIC SCORE) were used. In addition, clinical outcomes including overall mortality, mechanical ventilation (MV) days, and ICU and hospital length of stay (LOS) were recorded. Results: a total of 285 ICU patients met our inclusion criteria. Mean age was 61.24 (SD = 14.6) years; APACHE-II, 14.2 (SD = 6.6); Charlson Comorbidity Index (CCI), 2.3 (SD = 2.3). Most patients were admitted from the emergency room to the ICU. Hypertension, obesity, and diabetes were the most common comorbidities. Nutritional assessment showed that 36.9 % were SGA B+C, and 46 % were obese. Mean ICU LOS was 22.2 (SD = 19.5), and hospital LOS was 28.1 (SD = 21.9) days. Of all patients, 90.2 % underwent MV, and MV days were 20.6 (SD = 15.6). The univariate and multivariate analyses showed that risk factors for COVID-19 mortality were (odds ratio [95 % confidence interval]): SGA score of B or C: 2.13 [1.11-4.06], and NRS 2002 ≥ 3: 2.25 [1.01-5.01]. Conclusions: in the present study, nutritional status (SGA) and NRS 2002 were major mortality risk factors for CODIV-19 patients in the ICU.

INTRODUCCIÓN: Introducción: la pandemia de COVID-19 puso en riesgo a la población mundial. Dado que la relación entre el riesgo nutricional y los resultados clínicos en pacientes críticos con COVID-19 es aún poco conocida, un equipo de investigación multidisciplinario de la Sociedad Argentina de Cuidados Intensivos (SATI) realizó un estudio multicéntrico con el objetivo de definir las características nutricionales y evaluar la relación entre el riesgo nutricional y los resultados clínicos relevantes para los pacientes de la unidad de cuidados intensivos (UCI) de COVID-19. Métodos: entre marzo y octubre de 2020 se realizó un estudio observacional prospectivo y multicéntrico que incluyó 12 UCI argentinas. Criterios de inclusión: se incluyeron pacientes adultos mayores de 18 años que habían ingresado en la UCI con diagnóstico de COVID-19. Se utilizaron datos clínicos que incluían scores de comorbilidades, herramientas de cribado nutricional como la Evaluación Global Subjetiva (EGS) y el Cribado de Riesgo Nutricional (NRS) 2002, y la puntuación NUTRIC. Además. Se registraron los resultados clínicos, incluida la mortalidad, los días de ventilación mecánica (VM) y la duración de la estancia en la UCI y hospitalaria en general. Resultados: en total, 285 pacientes en UCI cumplieron nuestros criterios de inclusión. La edad media fue de 61,24 (DE = 14,6) años, la puntuación APACHE-II de 14,2 (DE = 6,6) y el índice de comorbilidad de Charlson (ICC) de 2,3 (DE = 2,3). La mayoría de los pacientes ingresaron desde la sala de emergencias a la UCI. La hipertensión, la obesidad y la diabetes fueron las comorbilidades más frecuentes. La evaluación nutricional mostró que el 36,9 % eran VGS B + C y el 46 % eran obesos. La estancia en la UCI fue de 22,2 (DE = 19,5) y la hospitalaria de 28,1 (DE = 21,9) días. El 90,2 % se sometieron a VM, siendo la media de días de VM de 20,6 (DE = 15,6). El análisis univariado y multivariado mostró que los factores de riesgo de mortalidad por COVID-19 eran (razón de posibilidades [intervalo de confianza del 95 %]): puntuación SGA de B o C: 2,13 [1,11-4,06], y NRS 2002 ≥ 3: 2,25 [1,01-5,01]. Conclusiones: en el presente estudio, el estado nutricional (EGS) y el NRS 2002 fueron los principales factores de riesgo de mortalidad para los pacientes con COVID-19 en la UCI.

Indomethacin for intracranial hypertension secondary to severe traumatic brain injury in adults.

BACKGROUND: Among people who have suffered a traumatic brain injury, increased intracranial pressure continues to be a major cause of early death; it is estimated that about 11 people per 100 with traumatic brain injury die. Indomethacin (also known as indometacin) is a powerful cerebral vasoconstrictor that can reduce intracranial pressure and, ultimately, restore cerebral perfusion and oxygenation. Thus, indomethacin may improve the recovery of a person with traumatic brain injury. OBJECTIVES: To assess the effects of indomethacin for adults with severe traumatic brain injury. SEARCH METHODS: We ran the searches from inception to 23 August 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8) in the Cochrane Library, Ovid MEDLINE, Ovid Embase, CINAHL Plus (EBSCO), four other databases, and clinical trials registries. We also screened reference lists and conference abstracts, and contacted experts in the field. SELECTION CRITERIA: Our search criteria included randomised controlled trials (RCTs) that compared indomethacin with any control in adults presenting with severe traumatic brain injury associated with elevated intracranial pressure, with no previous decompressive surgery. DATA COLLECTION AND ANALYSIS: Two review authors independently decided on the selection of the studies. We followed standard Cochrane methods. MAIN RESULTS: We identified no eligible studies for this review, either completed or ongoing. AUTHORS' CONCLUSIONS: We found no studies, either completed or ongoing, that assessed the effects of indomethacin in controlling intracranial hypertension secondary to severe traumatic brain injury. Thus, we cannot draw any conclusions about the effects of indomethacin on intracranial pressure, mortality rates, quality of life, disability or adverse effects. This absence of evidence should not be interpreted as evidence of no effect for indomethacin in controlling intracranial hypertension secondary to severe traumatic brain injury. It means that we have not identified eligible research for this review.

[Progression of renal function in patients with chronic kidney disease on a low-protein diet supplemented with aminoacids and ketoanalogues]. / Evolución de la función renal en pacientes con enfermedad renal crónica con dieta restringida en proteínas suplementada con una mezcla de aminoácidos y cetoanálogos.

INTRODUCTION: chronic kidney disease (CKD) is a public health problem. Low-protein diets supplemented with ketoacids and essential aminoacids have proved effective at different CKD stages. AIM: to assess the progression of renal failure in adult patients with CKD stages 3b and 4 receiving a protein-controlled diet supplemented with aminoacids and ketoanalogues. METHODS: retrospective, descriptive intervention study. The nutritional intervention consisted of a protein/calorie intake of 0.4-0.6 g/kg/day and 30-35 kcal/kg/day plus a tablet of ketoanalogues (Ketosteril®)/5 kg weight. We assessed nutritional condition, glomerular filtration (GF) and creatinine, urea and albumin levels at 0, 3, 6, 9 and 12 months. SPSS version 18 was used for data statistical analysis. RESULTS: thirty-three patients were studied (67% male; mean age 59.7 years, r: 24-87). Protein/calorie intake was 0.55 ± 0.20 g/kg/day and 34 ± 4.51 kcal/kg/day. Ketosteril® intake was 11.87 tablets/day (r: 9-14). Initial GF was 24.97 ± 6.64 ml/min/1.73 m2, showing a significant increase between three and 12 months (25.51 ± 8.57 and 29.26 ± 10.33 ml/min/1.73 m2; p = 0.006). Urea nitrogen decreased significantly at six months compared with the initial level (p < 0.005). Body mass index did not change significantly (initial, 26. 63 ± 4.08 kg/m2; after a year, 26.78 ± 3.98 kg/m2). Initial and final albumin levels were 3.53 ± 0.64 g/l and 4.00 ± 0.53 g/l, respectively (p = 0.79). CONCLUSION: a low-protein diet supplemented with ketoanalogues administered to patients with CKD stages 3b and 4 preserved nutritional condition and mineral balance, improved GF significantly and decreased urea levels.

Evolución de la función renal en pacientes con enfermedad renal crónica con dieta restringida en proteínas suplementada con una mezcla de aminoácidos y cetoanálogos / Progression of renal function in patients with chronic kidney disease on a low-protein diet supplemented with aminoacids and ketoanalogues

Introducción: la enfermedad renal crónica (ERC) es un problema de salud pública. Se ha evaluado el uso de dietas con bajo contenido proteico suplementadas con cetoácidos y aminoácidos esenciales en diferentes estadios de la ERC. Objetivo: observar la evolución de la función renal durante un año en pacientes adultos con ERC estadios 3b y 4 con dieta controlada en proteínas y suplementada con aminoácidos y cetoanálogos. Métodos: estudio retrospectivo, descriptivo de una intervención. Intervención nutricional: aporte proteico-calórico: 0,4-0,6 g/kg/día y 30-35 kcal/kg/día más un comprimido de alfacetoanálogos (Ketosteril(R))/5 kg de peso. Se evaluaron el estado nutricional, el filtrado glomerular (FG), la creatinemia, la uremia y la albuminemia a los 0, 3, 6, 9 y 12 meses. Se utilizó el programa SPSS versión 18 para el análisis estadístico. Resultados: fueron estudiados 33 pacientes, un 67% de ellos masculinos, con un promedio de edad de 59,7 años (r: 24-87). Aporte proteico-calórico: 0,55 ± 0,20 g/kg/día y 34 ± 4,51 kcal/kg/día. Consumo de Ketosteril(R): 11,87 comprimidos diarios (r: 9-14). FG inicial: 24,97 ± 6,64 ml/min/1,73 m2, con un aumento significativo entre los tres y los 12 meses (25,51 ± 8,57 y 29,26 ± 10,33 ml/min/1,73 m2; p = 0,006). Nitrógeno ureico: disminuyó significativamente a los seis meses respecto del valor inicial (p < 0,005). Índice de masa corporal: sin cambios significativos al inicio (26,63 ± 4,08 kg/m2) y al final (26,78 ± 3,98 kg/m2). Albuminemia: 3,53 ± 0,64 g/l y 4,00 ± 0,53 g/l al inicio y al final (p = 0,079).Conclusión: los pacientes con ERC estadios 3b y 4 tratados con una dieta baja en proteínas y cetoanálogos mantuvieron el estado nutricional y el equilibrio mineral, mejoraron significativamente el FG y disminuyeron la uremia

Introduction: chronic kidney disease (CKD) is a public health problem. Low-protein diets supplemented with ketoacids and essential aminoacids have proved effective at different CKD stages. Aim: to assess the progression of renal failure in adult patients with CKD stages 3b and 4 receiving a protein-controlled diet supplemented with aminoacids and ketoanalogues. Methods: retrospective, descriptive intervention study. The nutritional intervention consisted of a protein/calorie intake of 0.4-0.6 g/kg/day and 30-35 kcal/kg/day plus a tablet of ketoanalogues (KetosterilR)/5 kg weight. We assessed nutritional condition, glomerular filtration (GF) and creatinine, urea and albumin levels at 0, 3, 6, 9 and 12 months. SPSS version 18 was used for data statistical analysis. Results: thirty-three patients were studied (67% male; mean age 59.7 years, r: 24-87). Protein/calorie intake was 0.55 +/- 0.20 g/kg/day and 34 +/- 4.51 kcal/kg/day. KetosterilR intake was 11.87 tablets/day (r: 9-14). Initial GF was 24.97 +/- 6.64 ml/min/1.73 m2, showing a significant increase between three and 12 months (25.51 +/- 8.57 and 29.26 +/- 10.33 ml/min/1.73 m2; p = 0.006). Urea nitrogen decreased significantly at six months compared with the initial level (p < 0.005). Body mass index did not change significantly (initial, 26. 63 +/- 4.08 kg/m2; after a year, 26.78 +/- 3.98 kg/m2). Initial and final albumin levels were 3.53 +/- 0.64 g/l and 4.00 +/- 0.53 g/l, respectively (p = 0.79). Conclusion: a low-protein diet supplemented with ketoanalogues administered to patients with CKD stages 3b and 4 preserved nutritional condition and mineral balance, improved GF significantly and decreased urea levels

Dignificando el Final de la Vida en Cuidados Intensivos / Dignifying the End of Life in the Intensive Care Unit

Con frecuencia, cuando una persona se enferma, comienza un complicado proceso de consultas médicas, utilización de sofisticados medios auxiliares de diagnóstico, e instauración de tratamientos cada vez más complejos y costosos. Cuando, en vez de curar la enfermedad progresa; el enfermo se ve abrumado por la aplicación de nuevas exploraciones altamente tecnificadas que persiguen alcanzar un diagnóstico más preciso de la enfermedad a fin de instaurar medidas terapéuticas más agresivas. Como es de esperar, en muchos casos la enfermedad sigue su curso y llega un momento en el que tanto el paciente como sus allegados y el equipo médico se preguntan hasta qué punto es razonable continuar. Esta encrucijada es el punto de decisión de aceptar el final de la vida como evento natural. Pero en muchos casos se percibe como un fracaso, y no como la historia natural de los procesos graves.

Frequently, when a person falls ill, a complicated process of medical visits, use of sophisticated auxiliary means for diagnosis, and the establishment of treatments that are becoming more and more complex and expensive starts. When, instead of the patient's getting cured, the illness advances, the patient becomes overwhelmed due to the new and highly developed explorations that pursue a more precise diagnosis of the illness in order to establish more aggressive therapeutic measures. As it is expected, the illness, in many cases, continues advancing and reaches a moment in which both the patient and their close relatives, as well as the medical team, wonder until when it is still reasonable to continue with the treatments. This crossroads is the point of decision to accept death as a natural event. Most of the times, nevertheless, death is perceived as a failure, not as the natural story of serious processes.

Diabetes Treatment Satisfaction Questionnaire (DTSQ) of in non-ambulatory type 2 diabetic patients.

OBJECTIVES: The aim of this work is to determine the diabetes treatment satisfaction in a group of hospitalized patients with type 2 diabetes. METHODS: observational cross research. Patients over the age of 18 with diagnosed type 2 diabetes of at least one year until the present study were included. Those presenting pathologies attributed to diabetes were excluded. Patients should have responded to the DTSQ questionnaire upon admission. r Pearson regression, multivariate linear regression and U Mann-Whitney tests were analyzed. RESULTS: A total of 102 patients were included with an average age of 63.1 years. Average value of the DTSQs was 14.5. A significant statistic correlation was observed between the score of the questionnaires and good diabetes control showed by the levels of HbAc1 and fasting blood glucose, among other parameters. Indeed there was no correlation between satisfaction and age and BMI. Women had lower satisfaction score than men. CONCLUSIONS: levels of diabetes treatment satisfaction in the study population correlated well with diabetic status. That is, the lower diabetic compromise, the better satisfaction score. The degree of satisfaction in patients with type 2 diabetes was lower than the observed on patients with the same pathology but from primary levels of health care.

[Rapidly progressive compromise of cranial pairs as neurosyphilis manifestation]. / Compromiso rapidamente progresivo de pares craneales como manifestacion de neurosifilis.

Syphilis remains a common disease throughout the world, being neurosyphilis a relatively common manifestation. A case of a 34 years old male with HIV and neurosyphilis is presented, characterized by a clinical course evidenced by progressive palsy of cranial nerves. This case is unusual and a rare presentation of progressive cranial involvement with swallowing deficit, have found no similar data in the literature.

Hantavirus pulmonary syndrome in the Atlantic Argentinean Patagonia region.

The hantavirus causes a hemorrhagic disease and in 1993 was responsible for an outbreak of a pulmonary syndrome in the south of the United States of America. The disease is endemic in the north of Argentina where the Oran strain is prevalent. A fatal case of the Hanta Pulmonary Syndrome (HPS) occurring in a migrant agricultural worker is reported.

Subjective global assessment in the clinical setting.

BACKGROUND: Our goal was nutrition assessment in hospitalized patients of an internal medicine service. METHODS: Ours was a longitudinal, prospective, and observational study. Four hundred twelve patients participated in this study using the Subjective Global Assessment (SGA). We used chi(2) for univariate and logistic regression. RESULTS: Of 412 patients, 47.6% presented with malnutrition: 38.8% with moderate malnutrition (group B), and 8.58% with severe malnutrition (group C). Malnutrition was related to male patients older than 65 years, oncologic and infectious diseases, and length of hospitalization. CONCLUSIONS: Malnutrition incidence in an internal medical service is high. There is remarkable lack of interest in hospitalized patients' nutrition state. Results show similarities to other studies from Latin America.

Papel del tubo digestivo en la generación del síndrome de falla múltiple de órganos / Role of the digestive system in the generation of the multiple organ failure syndrome

El síndrome de falla múltiple de órganos (SFMO) es un problema común en las UTIs. En su generación intervienen múltiples agentes tóxicos. El intestino parece ser una fuente importante de los mismos ya que es particularmente sensible a la isquemia y reperfusión. De hecho el acoplamiento DO2-VO2 se observa antes que en el resto del organismo. Esto lo convierte en un gatillo de lesión a distancia, permitiendo el paso de mediadores a la circulación general con reinicio sistémico del ciclo liberación-lesión

Papel del tubo digestivo en la generación del síndrome de falla múltiple de órganos / Role of the digestive system in the generation of the multiple organ failure syndrome

El síndrome de falla múltiple de órganos (SFMO) es un problema común en las UTIs. En su generación intervienen múltiples agentes tóxicos. El intestino parece ser una fuente importante de los mismos ya que es particularmente sensible a la isquemia y reperfusión. De hecho el acoplamiento DO2-VO2 se observa antes que en el resto del organismo. Esto lo convierte en un gatillo de lesión a distancia, permitiendo el paso de mediadores a la circulación general con reinicio sistémico del ciclo liberación-lesión (AU)

Neumonía eosinófila crónica: a propósito de un caso / Chronic eosinophilic pneumonia: report of a case

Se acaba de describir un caso de neumonía eosinofílica crónica, entidad rara englobada dentro de los infiltrados pulmonares eosinofílicos (IPE) sin causa determinada y con excelente respuesta a los corticoides como sucede en todos los casos en que se presente dicha patología (AU)

Fibrinolisis primaria: ¿existe realmente? / Primary fibrinolysis: does it really exist?

Desde hace varios años se han descripto casos de pacientes con sangrado severo debido a estados fibrinolíticos. En éstas situaciones se ha usado el término de fibrinolisis primaria. Recientemente se ha hecho obvio que éste diagnóstico es insostenible. En tales casos se ha considerado que el acontecimiento primario es la CID con una fibrinolisis secundaria exagerada (AU)

Neumonía eosinófila crónica: a propósito de un caso / Chronic eosinophilic pneumonia: report of a case

Se acaba de describir un caso de neumonía eosinofílica crónica, entidad rara englobada dentro de los infiltrados pulmonares eosinofílicos (IPE) sin causa determinada y con excelente respuesta a los corticoides como sucede en todos los casos en que se presente dicha patología

Fibrinolisis primaria: ¿existe realmente? / Primary fibrinolysis: does it really exist?

Desde hace varios años se han descripto casos de pacientes con sangrado severo debido a estados fibrinolíticos. En éstas situaciones se ha usado el término de fibrinolisis primaria. Recientemente se ha hecho obvio que éste diagnóstico es insostenible. En tales casos se ha considerado que el acontecimiento primario es la CID con una fibrinolisis secundaria exagerada