[Effect of antioxidant supplementation over oxidative stress and quality of life in cervical cancer]. / Efecto de la suplementación con antioxidantes sobre el estrés oxidativo y la calidad de vida durante el tratamiento oncológico en pacientes con cáncer cérvico uterino.

BACKGROUND: Mexico has a high rate of cervical cancer which represents an important public health issue. The treatment for this disease depends on the extension of the tumor; for the initial stages surgery is recommended, and for locally advanced tumors, a combination of chemotherapy and radiotherapy is used. All this process affects natural antioxidant consumption and Quality of Life (QoL). OBJECTIVE: To find out the effect that supplementation with antioxidants (ß-carotene, vitamin C y vitamin E) has on oxidative stress, and quality of life in patient diagnosed with cervical cancer during treatments with cisplatin and radiotherapy. MATERIALS AND METHODS: We conducted a randomized, blind clinical trial in women with cervical cancer whose antineoplasic treatment was radiotherapy in and radiotherapy with cisplatin. Patients were randomly assigned to receive antioxidant therapy or a placebo. Plasma concentrations of malondialdehyde (MDA), free carbonyls, dityrosines, and carbonyl/protein rate in two different moments, before oncologic therapy, and after finishing oncology treatment, we also evaluated food consumption by using a validated food frequency questionnaire and a QOL questionnaire before treatment and after it was over. The effect of the antioxidant treatment was assessed by the use t-student test for independent and paired samples, as well as frequencies and X² for categorical variables. RESULTS: We evaluated 103 patients who were randomly assigned to receive treatment with antioxidants 49 (47.60%) and placebo 54 (52.40%). We did not find statistically significant differences in food or antioxidant consumption according to the food frequency questionnaires. Most of the patients consumed more energy than needed to meet their requirement, but they did not consume enough of most of the antioxidants according to the Recommended Dailiy Allowance (RDA) recommendation. Serum levels of plasma free carbonyls and carbonil/mg of protein ratio were statistically significant (p < 0.009) which shows protein protection regarding oxidative stress in the supplemented group, this information was similar to the one found in the QOL questionnaire, which showed that Global QOL was better in the supplemented group (p < 0.025). Most of the patients had lower α-tocopherol and retinol plasma levels than the recommended values. CONCLUSIONS: Antioxidant supplementation showed to be effective in reducing oxidative stress in proteins, but it did not on food ingestion, patients did not meet their antioxidants requirement in their diets, in spite of an excess in energy consumption. Antioxidant plasma levels in most of the patients were lower than normal. QoL score was better in the supplemented group.

[Validation of a prognostic index through nutritional status indicators in patients with severe acute pancreatitis]. / Validación de un índice pronóstico de mortalidad a través de indicadores del estado nutricio en pacientes con pancreatitis aguda grave.

OBJECTIVE: To evaluate the accuracy of a previously proposed prognostic index of mortality determined by nutritional indicators in patients severe acute pancreatitis. Methods (study population, subjects, intervention): We evaluated used three nutritional status indicators (total lymphocyte count, creatinine/height index and subescapular skinfold) to determine an index associated to mortality prognosis in patients with severe acute pancreatitis. RESULTS: We assessed 34 patients, who were divided according to their outcome into: a) survivor, b) dead. The vast majority showed a litiasic origin of the disease, which was present among men, predominantly. The index' results were found to be directly (positively) related to mortality probability, i.e., the closer the score was to 2,the more probability the patient had to die. CONCLUSION: Even though we were able to prove association between the proposed index and the patient's prognosis, a larger sample is needed to validate this as a possible tool which could be used along other prognostic test such as APACHE II or Ranson scales.

Outcomes of temporary self-expanding plastic stents (SEPS) use for gastrointestinal leaks. A case series.

INTRODUCTION: Gastrointestinal fistulas can develop as a complication of any gastrointestinal surgery, trauma, malignant disease, radiotherapy or because of iatrogenic procedures. The use of self expandable metallic stents (SEMS) has been reported as a feasible and effective therapeutic method. Self expandable plastic stents (SEPS) have been successfully used to treat esophageal malignancies, perforations and leaks but information regarding outcomes of SEPS in gastrointestinal leaks is scarce. OBJECTIVE: To report the outcomes and complications of endotherapy using SEPS in upper gastrointestinal tract fistulas following gastrointestinal surgery. MATERIAL AND METHODS: Retrospective review of 5 cases of upper gastrointestinal leaks treated with SEPS. Medical records were reviewed to obtained patients demographics, procedure success, complications and follow up. RESULTS: We described 2 women and 3 men with an age ranged between 29 and 65 years old. SEPS were left in place for a median period of 90 days (range: 30-279 days). There were no complications related to SEPS placement, replacement or withdrawal. Fistulas closed in 60% of the cases where SEPS were the only therapeutic maneuver and in more than 80% when other therapy (cyanoacrilate, fibrin) was used. CONCLUSIONS: Endotherapy with SEPS appears as a feasible, safe and effective option for sealing gastrointestinal fistulas.

[Enteral feeding. Importance in clinical practice]. / Alimentación vía enteral. Importancia en la práctica clínica.

The gut is the most important organ for the final digestion, absorption and metabolizing of the nutrients ingested. When the gut is available, it must be used as the ideal way to provide nutrients to the body tissues, either orally or by using a feeding tube to help delivering the nutrients. This type of nutrition has important advantages: One of them is the stimulation of the intestinal cells to preserve its integrity and the guts barrier function; it is economic, safe, efficient and it has been associated to improve the patient's outcome. Nowadays, there are many industrialized formulas available for tube feeding use, as well as a great variety of tubes designed for administrating this formulas, depending on the age, size, and time in which the patient will be using them. The future directions for some cases like its use in critically ill patients or the molecular effects of providing nutrients enterally is still under investigation, and there are still questions to be answered in this broad field.