[A protocol of assessment, follow-up and nutritional action at a nursing home]. / Protocolo de valoración, seguimiento y actuación nutricional en un centro residencial para personas mayores.

OBJECTIVE: 1) To assess the nutritional status of able elderly, institutionalized at a nursing home; 2) To propose the required nutritional interventions; 3) To establish a consensus protocol for nutritional assessment and follow-up at the Center. METHOD: Cross-sectional study on all able residents, carrying out: 1) Mini Nutritional Assessment Test; 2) Anthropometrical assessment; 3) Biochemical assessment; and 4) an additional questionnaire (gathering information on dental prostheses, swallowing difficulties, and special diets or oral supplements). Analysis of these data to implement appropriate recommendations and elaborating a nutritional protocol. RESULTS: The mean age of the 50 residents assessed was 84 years [66-97], mean weight 62 kg [35-87], mean height 154 cm [140-175], mean body mass index 26 [15.6-36], mean tricipital fold 18.1 mm [4-36], and mean muscle arm circumference 20.6 cm [14.7-27.1]. By using the Mini Nutritional Assessment Test we identified 3/50 (6% [95% CI: 1-16]) malnourished residents, and 6/50 (12% [95% CI: 4-24]) residents at risk for malnourishment. The body mass index allowed to identify 11/50 (22% [95% CI: 11-35]) overweighed residents-body mass index 27-29-, 10/50 (20% [95% CI: 10-33]) with grade I obesity -body mass index 30-35 and 1/50 (2% [95% CI: 0-10]) with grade II obesity-body mass index > 35-. None of them presented values below the 5th percentile for both the tricipital fold and the muscle arm circumference. Values above the 95th percentile were found in 10/50 (20% [95% CI: 10-33]) residents for the tricipital fold and in 7/50 (14% [95% CI: 5-26]) for the muscle arm circumference, both criteria being present in 3 residents. In all of them the body mass index mayor was > 27. When analyzing the biochemical parameters, the results were not concordant, since laboratory workups analyzed were not always done at the same time as the interview. After analyzing the data obtained, a nutritional assessment and follow-up protocol was elaborated in collaboration with the physicians in charge of the Center, in which five categories were defined according to the nutritional status. CONCLUSIONS: 1) 3/50 malnourished residents were identified, 6/50 at risk for malnourishment, and 22/50 with overweight. 2) We proposed the performance of a whole laboratory work-up in these residents, reviewed their dietary habits in order to correct them or prescribe oral supplements, and recommended adapted physical exercise. 3) A nutritional assessment and follow-up protocol was elaborated.

[The prophylaxis against post-liver-transplant hepatitis B re-infection]. / Profilaxis de reinfección por el virus de la hepatitis B postrasplante hepático.

OBJECTIVE: To review the prophylaxis against post-liver transplantation hepatitis B reinfection with anti-hepatitis B immunoglobulin and nucleoside analogues. METHOD: A bibliographic search was carried out using Pubmed, entering the following key words: hepatitis B and liver transplantation and (hepatitis B hyperimmune globulin and lamivudine and adefovir dipivoxil) up to June 2006. The initial search was filtered using the terms clinical trial, randomized clinical trial and review. The data contained in selected studies were reviewed. RESULTS: A total of 53 works were found. Prophylaxis with anti-HB immunoglobulin and lamivudine is the best strategy for avoiding recurrence of the hepatitis B virus in patients undergoing hepatic transplants; achieving very low reinfection rates (0-10%) with follow up periods of between 1-5 years. There is a great degree of variability (dose, duration and method of HBIg administration) in the prophylactic protocols reviewed. The use of low doses of anti-HB immunoglobulin (administered intravenously followed by intramuscular administration, or administered intramuscularly from the anhepatic stage), and lamivudine in patients who receive transplants with a low risk of recurrence, shows prophylactic efficacy comparable to the use of high doses of anti-HB immunoglobulin. Furthermore, it implies a considerable reduction in costs. CONCLUSIONS: The availability of suitably designed clinical trials is required to design a more cost-effective protocol and reduce variability.

Profilaxis de reinfección por el virus de la hepatitis Bpostrasplante hepático / No disponible

Objetivo: Revisar la profilaxis de la reinfección por el virus de la hepatitis B postrasplante hepático con inmunoglobulinas antihepatitis B y análogos de nucleósido.Método: Se realizó una búsqueda bibliográfica en Pubmedcon la siguiente estrategia: hepatitis B y liver transplantation y(hepatitis B hyperimmune globulin o lamivudine o adefovirdipivoxil) hasta junio de 2006. Se limitó la búsqueda inicial con los términos clinical trial, randomized clinical trial y review. Se revisaron diversas citas de los trabajos seleccionados.Resultados: Se identificaron 53 trabajos. La profilaxis con inmunoglobulinas anti-HBs y la mivudina es la mejor estrategia de evitar la recidiva por el virus de la hepatitis B en pacientes sometidos a trasplante hepático, consiguiéndose recurrencias muy bajas(0-10%) con periodos de seguimiento entre 1-5 años. Existe una gran variabilidad (dosis, duración y vía de administración de HBIg) en los protocolos de profilaxis revisados. La utilización de dosis bajas de inmuno globulinas anti-HBs (por vía intravenosa seguido de la vía intramuscular o por vía intramuscular desde la fase anhepática)y la mivudina en pacientes trasplantados con bajo riesgo derecidiva, permite una eficacia profiláctica comparable a las dosis altas de inmunoglobulinas anti-HBs con una considerable reducción de los costes. Conclusiones: Sería necesario disponer de ensayos clínicos con un diseño adecuado que permitieran establecer el protocolo más costo-efectivo y reducir la variabilidad (AU)

Objective: To review the prophylaxis against post-liver transplantation hepatitis B reinfection with anti-hepatitis B immunoglobulin and nucleoside analogues. Method: A bibliographic search was carried out using Pubmed,entering the following key words: hepatitis B and liver transplantation and (hepatitis B hyperimmune globulin and lamivudine and adefovir dipivoxil) up to June 2006. The initial search was filteredusing the terms clinical trial, randomized clinical trial and review.The data contained in selected studies were reviewed.Results: A total of 53 works were found. Prophylaxis with anti-HB immunoglobul in and la mivudine is the best strategy for avoiding recurrence of the hepatitis B virus in patients undergoinghepatic transplants; achieving very low reinfection rates (0-10%) with follow up periods of between 1-5 years. There is a greatdegree of variability (dose, duration and method of HBIg administration)in the prophylactic protocols reviewed. The use of lowdoses of anti-HB immunoglobulin (administered intravenously followed by intramuscular administration, or administered intramuscularly from the anhepatic stage), and la mivudine in patients who receive transplants with a low risk of recurrence, shows prophylactic efficacy comparable to the use of high doses of anti-HB immunoglobulin. Furthermore, it implies a considerablereduction in costs.Conclusions: The availability of suitably designed clinicaltrials is required to design a more cost-effective protocol and reducevariability (AU)