ABSTRACT
To our knowledge, this is the first reported case of clinical onset of celiac disease (CD) following duodenal switch surgery. A 61-year-old obese woman developed severe diarrhea soon after bariatric surgery (BS), which was unresponsive to standard medical treatment. After the most common diarrhea etiologies in the immediate postoperative period have been excluded, serological tests were performed. Final diagnosis was determined by anti-tissue transglutaminase antibody positivity. In light of this case report, we propose that CD should be ruled out in any patient presenting with typical or atypical symptoms after BS, regardless of the latency of onset.
Subject(s)
Bariatric Surgery/adverse effects , Celiac Disease/etiology , Duodenum/surgery , Postoperative Complications/diagnosis , Autoantibodies/blood , Bariatric Surgery/methods , Celiac Disease/diagnosis , Diarrhea/diagnosis , Diarrhea/etiology , Female , Humans , Middle Aged , TransglutaminasesABSTRACT
OBJECTIVES: To assess the dietary habits and food avoidance-behavior in patients with Chronic Fatigue Syndrome (CFS). METHODS: Cross-sectional pilot study with 28 patients diagnosed with severe CFS. Eating habits were assessed with a food frequency questionnaire and 3-day food records. We analyzed variables related to dietary restrictions induced by symptoms or external information. RESULTS: The most prevalent restrictions were for dairy products and gluten-containing grains, with 22 and 15 restricting patients, respectively. Patients reported different digestive symptoms, which did not improve with the use of exclusion diets. Thirteen patients had received information against the intake of certain foods through different sources. Six cases of grains restriction and 11 of dairy were compatible with a counseling-induced pattern of exclusion. CONCLUSIONS: There is not a homogeneous pattern of food avoidance. Dietary restrictions should be based on a proven food allergy or intolerance. Dietary counseling should be based on sound nutritional knowledge.
Subject(s)
Anorexia/psychology , Fatigue Syndrome, Chronic/psychology , Feeding Behavior , Adult , Aged , Anorexia/etiology , Cross-Sectional Studies , Dairy Products , Diet, Gluten-Free , Fatigue Syndrome, Chronic/complications , Fatigue Syndrome, Chronic/therapy , Female , Food Hypersensitivity/prevention & control , Humans , Middle Aged , Patient Education as Topic , Pilot Projects , Referral and Consultation , Surveys and Questionnaires , Young AdultABSTRACT
Objectives: To assess the dietary habits and food avoidance-behavior in patients with Chronic Fatigue Syndrome (CFS). Methods: Cross-sectional pilot study with 28 patients diagnosed with severe CFS. Eating habits were assessed with a food frequency questionnaire and 3-day food records. We analyzed variables related to dietary restrictions induced by symptoms or external information. Results: The most prevalent restrictions were for dairy products and gluten-containing grains, with 22 and 15 restricting patients, respectively. Patients reported different digestive symptoms, which did not improve with the use of exclusion diets. Thirteen patients had received information against the intake of certain foods through different sources. Six cases of grains restriction and 11 of dairy were compatible with a counseling-induced pattern of exclusion. Conclusions: There is not a homogeneous pattern of food avoidance. Dietary restrictions should be based on a proven food allergy or intolerance. Dietary counseling should be based on sound nutritional knowledge (AU)
Objetivos: Valorar los hábitos dietéticos y la conducta de evitación alimenticia en pacientes con Síndrome de Fatiga Crónica. Métodos: Estudio piloto transversal con 28 pacientes diagnosticados de Síndrome de Fatiga Crónica en grado severo. Los hábitos alimenticios se evaluaron mediante un cuestionario de frecuencia de consumo y registros dietéticos de 3 días. Se analizaron variables relacionadas con las restricciones dietéticas inducidas por síntomas o información externa. Resultados: Las restricciones más frecuentes fueron para los productos lácteos y cereales con gluten, con 22 y 15 pacientes que los restringían, respectivamente. Los pacientes informaron de diferentes síntomas digestivos, que no mejoraron con el uso de dietas de exclusión. Trece pacientes habían recibido información contraria al consumo de ciertos alimentos, a través de diferentes fuentes. Seis casos de restricción de cereales y 11 de lácteos fueron compatibles con un patrón de exclusión inducido por consejo. Conclusiones: No hay un patrón homogéneo de evitación alimenticia. Las restricciones dietéticas deberían basarse en una alergia o intolerancia alimentaria probada. El consejo dietético debería basarse en el conocimiento nutricional fundamentado (AU)
Subject(s)
Humans , Fatigue Syndrome, Chronic/psychology , Feeding Behavior/psychology , Nutritional Status , Food Preferences , Nutrition Surveys , Food Hypersensitivity/epidemiologyABSTRACT
Objectives: Diarrhea is a frequent complication associated to enteral tube feeding (ETF) and it is a frequent cause of reduction or suspension of this type of nutritional support. Our objective was to evaluate the factors associated with nosocomial diarrhea in patients receiving ETF. Results: The only significant factor associated with the appearance of diarrhea was antibiotic consumption, specially those patients receiving the combination of two or more antibiotics. We did not find any association between factors related to ETF, analytical parameters, nor other medications and diarrhea. Conclusions: Our observational data supports the idea that ETF should not be seen as a primary cause of diarrhea, other possible causes should be considered before reducing or discontinuing ETF administration (AU)
Objetivos: La diarrea es una complicación frecuente asociada a la nutrición enteral (NE) y es causa habitual de reducción o suspensión de este tipo de soporte nutricional. Nuestro objetivo fue evaluar los factores asociados a la diarrea nosocomial en pacientes que recibían NE. Resultados: El único factor significativo asociado con la aparición de diarrea fue el consumo de antibióticos, especialmente aquellos pacientes que recibían la combinación de dos o más antibióticos. No se encontró ninguna asociación entre factores relacionados a la NE, parámetros analíticos, ni otras medicaciones y la diarrea. Conclusión: Nuestros datos observacionales respaldan la idea que la NE no debería ser vista como causa principal de diarrea, debiéndose considerar otras causas posibles antes de reducir o suspender la administración de NE (AU)
Subject(s)
Humans , Diarrhea/epidemiology , Enteral Nutrition/adverse effects , Cross Infection/epidemiology , Risk Factors , Diarrhea/etiology , Anti-Bacterial Agents/adverse effects , Cross Infection/etiologyABSTRACT
OBJECTIVES: Diarrhea is a frequent complication associated to enteral tube feeding (ETF) and it is a frequent cause of reduction or suspension of this type of nutritional support. Our objective was to evaluate the factors associated with nosocomial diarrhea in patients receiving ETF. RESULTS: The only significant factor associated with the appearance of diarrhea was antibiotic consumption, specially those patients receiving the combination of two or more antibiotics. We did not find any association between factors related to ETF, analytical parameters, nor other medications and diarrhea. CONCLUSIONS: Our observational data supports the idea that ETF should not be seen as a primary cause of diarrhea, other possible causes should be considered before reducing or discontinuing ETF administration.
Subject(s)
Anti-Bacterial Agents/adverse effects , Cross Infection/etiology , Diarrhea/etiology , Enteral Nutrition/adverse effects , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Diarrhea/chemically induced , Drug Therapy, Combination , Humans , Middle Aged , Risk FactorsABSTRACT
OBJECTIVES: The objectives of this study were to assess the quality of life (QoL), nutritional status, and quantitative food intakes of non-terminal admitted cancer patients receiving oral feeding. As well as to evaluate what kind of relation exists between the quality of life, and the nutritional status and current intake. SCOPE: Medical Oncology and Radiotherapy Service ward at the Hospital Clinic de Barcelona. SUBJECTS: Fifty admitted patients in the Service ward. INTERVENTIONS: There was a follow-up of the dietary intake during 3 working days through direct observation, as well as an assessment of anthropometrical and biochemical parameters, a record of symptomatology related data, and a QoL assessment through the EORTC QLQ-C30 questionnaire. RESULTS: Our data show that 32.6% of the patients did not reach 25 kcal/kg/day, and 23.3% did not even fulfill 1 g protein/kg/day. Concerning QoL, mean score for global health status and overall QoL for all patients was 46.2. Compared to the general population, there were important deficits among cancer patients regarding physical, role and social functioning. The most pronounced differences in the symptom scales were for fatigue, and in single items for appetite loss and constipation. A low protein intake was associated to a poorer perception on physical functioning (p = 0.01), and fatigue was close to significance (p = 0.058). No significant differences were found regarding caloric intake and QoL. CONCLUSIONS: A significant percentage of patients who received exclusive oral feeding did not cover a minimum acceptable quantity of their protein-energy requirements. Our results point-out that poor food intakes can affect QoL by themselves.
Subject(s)
Diet , Neoplasms , Nutritional Status , Quality of Life , Aged , Cognition , Cross-Sectional Studies , Data Interpretation, Statistical , Energy Intake , Exercise , Fatigue , Female , Follow-Up Studies , Health Status , Hospitalization , Humans , Male , Middle Aged , Neoplasms/physiopathology , Neoplasms/psychology , Surveys and Questionnaires , Time FactorsABSTRACT
Objectives: The objectives of this study were to assess the quality of life (QoL), nutritional status, and quantitative food intakes of non-terminal admitted cancer patients receiving oral feeding. As well as to evaluate what kind of relation exists between the quality of life, and the nutritional status and current intake. Scope: Medical Oncology and Radiotherapy Service ward at the Hospital Clínic de Barcelona. Subjects: Fifty admitted patients in the Service ward. Interventions: There was a follow-up of the dietary intake during 3 working days through direct observation, as well as an assessment of anthropometrical and biochemical parameters, a record of symptomatology related data, and a QoL assessment through the EORTC QLQC30 questionnaire. Results: Our data show that 32.6% of the patients did not reach 25 kcal/kg/day, and 23.3% did not even fulfill 1 g protein/kg/day. Concerning QoL, mean score for global health status and overall QoL for all patients was 46.2. Compared to the general population, there were important deficits among cancer patients regarding physical, role and social functioning. The most pronounced differences in the symptom scales were for fatigue, and in single items for appetite loss and constipation. A low protein intake was associated to a poorer perception on physical functioning (p=0.01), and fatigue was close to significance (p=0.058). No significant differences were found regarding caloric intake and QoL. Conclusions: A significant percentage of patients who received exclusive oral feeding did not cover a minimum acceptable quantity of their protein-energy requirements. Our results point-out that poor food intakes can affect QoL by themselves
Objetivos: Los objetivos de este estudio fueron valorar la calidad de vida (QoL), el estado nutricional y la ingesta dietética cuantitativa realizada en pacientes oncológicos no terminales ingresados que recibieron alimentación oral. Así mismo evaluar qué tipo de relación existe entre la calidad de vida, y el estado nutricional y la ingesta actual. Ámbito: Servicio de Oncología Médica y Radioterapia del Hospital Clínic de Barcelona. Sujetos: Cincuenta pacientes ingresados en el Servicio. Intervenciones: Se realizó un seguimiento de la ingesta dietética durante 3 días hábiles mediante observación directa, así como una valoración de los parámetros antropométricos y bioquímicos, un registro de datos relativos a la sintomatología, y una valoración de la calidad de vida mediante el cuestionario EORTC QLQ-C30. Resultados: Nuestros datos muestran que un 32.6% de los pacientes no alcanzaron 25 kcal/kg/día, y un 23.3% no llegaron a cubrir 1 g proteína/kg/día. Respecto a la QoL, la puntuación media para el estado de salud global y la QoL global para todos los pacientes fue 46.2. Comparado con la población general, hubo déficits importantes entre los pacientes oncológicos respecto a la funcionalidad física, de rol y social. Las diferencias más pronunciadas en la escala de síntomas fueron para la fatiga y en los ítems simples, para la pérdida de apetito y el estreñimiento. La baja ingesta de proteínas se asoció con una percepción disminuida en la función física (p=0.01), la fatiga estuvo cerca de la significación estadística (p=0.058). No se encontraron diferencias significativas respecto a la ingesta calórica y la QoL. Conclusión: Un porcentaje significativo de pacientes que recibieron alimentación oral exclusiva no cubrieron una cantidad aceptable mínima de sus requerimientos energético- proteicos. Nuestros resultados apuntan que ingestas dietéticas escasas pueden afectar la QoL por sí mismas
Subject(s)
Aged , Middle Aged , Humans , Diet , Nutritional Status , Quality of Life , Neoplasms/physiopathology , Neoplasms/psychology , Cognition , Cross-Sectional Studies , Data Interpretation, Statistical , Energy Intake , Exercise , Fatigue , Follow-Up Studies , Health Status , HospitalizationABSTRACT
El presente trabajo informa la estadística presente obtenida para el Programa de Vigilancia Nutricional de la Sociedad Argentina de Nutrición (SAN) por le Grupo de Trabajo de Valoración Nutricional, a partir de un registro de Indice de Masa Corporal (IMC) en población de la República Argentina. Se encuestaron 10.338 personas a las que se les midió el peso y la talla entre otras variables, con los datos obtenidos se realizó la estadística, que concluye con que el 50 porciento de la muestra presentó un exceso de peso para la talla
Subject(s)
Nutrition Assessment , Food and Nutritional Surveillance , Body Mass Index , Body Weights and Measures/statistics & numerical data , StatisticsABSTRACT
El presente trabajo informa la estadística presente obtenida para el Programa de Vigilancia Nutricional de la Sociedad Argentina de Nutrición (SAN) por le Grupo de Trabajo de Valoración Nutricional, a partir de un registro de Indice de Masa Corporal (IMC) en población de la República Argentina. Se encuestaron 10.338 personas a las que se les midió el peso y la talla entre otras variables, con los datos obtenidos se realizó la estadística, que concluye con que el 50 porciento de la muestra presentó un exceso de peso para la talla
Subject(s)
Body Mass Index , Body Weights and Measures , Nutrition Assessment , Food and Nutritional Surveillance , StatisticsABSTRACT
Programa apoyado por la Sociedad Argentina de Nutrición cuyo propósito es asistir en la investigación de la realidad nutricinal argentina. En su estructura intervienen el diseño de encuestas y cuestionarios, y el procesamiento y análisis de datos mediante un conjunto de encuestadores en todo el país conectados a través de internet e integrados en el sistema ENAR(Encuestadores Argentinos)
Subject(s)
Nutrition Programs/organization & administration , Nutrition Surveys , Food and Nutritional Surveillance/methods , Data Collection , Information SystemsABSTRACT
En el contexto del programa, se intentó describir la distribución del índice de masa corporal y su asociación con diversas variables, como fecha de nacimiento, sexo, y peso al nacer, así como estatura y peso actual
Subject(s)
Food and Nutritional Surveillance , Body Mass Index , Obesity/diagnosis , Nutrition SurveysABSTRACT
Programa apoyado por la Sociedad Argentina de Nutrición cuyo propósito es asistir en la investigación de la realidad nutricinal argentina. En su estructura intervienen el diseño de encuestas y cuestionarios, y el procesamiento y análisis de datos mediante un conjunto de encuestadores en todo el país conectados a través de internet e integrados en el sistema ENAR(Encuestadores Argentinos)
Subject(s)
Data Collection , Information Systems , Nutrition Surveys , Food and Nutritional Surveillance , Nutrition Programs/organization & administrationABSTRACT
En el contexto del programa, se intentó describir la distribución del índice de masa corporal y su asociación con diversas variables, como fecha de nacimiento, sexo, y peso al nacer, así como estatura y peso actual
Subject(s)
Body Mass Index , Nutrition Surveys , Food and Nutritional Surveillance , ObesityABSTRACT
The use of Enteral Nutrition at Home (ENH) in the Hospital Clínico de Barcelona has grown greatly over the last decade, with a certain trend towards stabilization being observed in the last two years, but still growing at a rate of 9.2% per annum. A transverse analysis of the active patients on our ENH register at a given moment has revealed a total of 315 patients receiving treatment. The retrospective analysis of our series during 1998 gave a figure of 643 new cases. The most frequent indication for ENH was neoplasia (44%), followed by neurological pathology (28%). The administration route most frequently used was oral (66% of cases). In the oral route, oncological diagnoses were dominant (52%), whereas administration by means of a naso-gastric tube was mainly due to neurological disorders (72%). The use of PEG (12.5% of administrations via tube) was distributed between oncological and neurological patients, with a slight predominance of the first. Of those patients completing ENH in the same year, duration was in most cases (67%) less than one month. The decrease of the patient due to the underlying disorder was the main cause of termination, followed by the need for short-term nutritional support following discharge from hospital.
Subject(s)
Enteral Nutrition/statistics & numerical data , Home Care Services/statistics & numerical data , Hospitals , Humans , Retrospective Studies , SpainABSTRACT
El uso de la nutrición enteral a domicilio (NED) en el Hospital Clínico de Barcelona ha experimentado un gran crecimiento en la última década, observándose cierta tendencia a la estabilización en los últimos dos años, pero manteniendo un ritmo de crecimiento del 9,2 por ciento anual. Un análisis transversal de los pacientes activos en nuestro registro de NED en un momento dado reveló un total de 315 pacientes en tratamiento. El análisis retrospectivo de nuestra serie durante el año 1998 dio una cifra de 643 nuevos casos. La indicación más frecuente de NED fue la neoplasia (44 por ciento), seguida de la patología neurológica (28 por ciento). La vía de administración más frecuente fue la oral (66 por ciento de casos).En la vía oral predominaron los diagnósticos oncológicos (52 por ciento), mientras que la administración por sonda nasogástrica fue principalmente por trastornos neurológicos (72 por ciento). El uso de la PEG (un 12,5 por ciento de administraciones vía sonda) se repartió entre pacientes oncológicos y neurológicos, con cierta predominancia de los primeros. De los pacientes que finalizaron la NED durante el mismo año, en la mayoría de casos (67 por ciento) la duración fue inferior a un mes; siendo el éxitus por la enfermedad de base la principal causa de finalización, seguida por la necesidad de soporte nutricional de corta duración posterior al alta hospitalaria (AU)
The use of Enteral Nutrition at Home (ENH) in the Hospital Clínico de Barcelona has grown greatly over the last decade, with a certain trend towards stabilization being observed in the last two years, but still growing at a rate of 9.2% per annum. A transverse analysis G.f the active patients on our ENH register at a given moment has revealed a total of 315 patients receiving treatment. The retrospective analysis of our series during 1998 gave a figure of 643 new cases. The most frequent indication for ENH was neoplasia (44%), followed by neurological pathology (28%). The administration route most frequently used was oral (66% of cases). In the oral route, oncological diagnoses were dominant (52%), whereas administration by means of a nasogastric tube was mainly due to neurological disorders (72%). The use of PEG (12.5% of administrations via tube) was distributed between oncological and neurological patients, with a slight predominance of the first. Of those patients completing ENH in the same year, duration was in most cases (67%) less than one month. The decease of the patient due to the underlying disorder was the main cause of termination, followed by the need for short-term nutritional support following discharge from hospital (AU)
Subject(s)
Humans , Spain , Retrospective Studies , Home Care Services , Hospitals , Enteral NutritionABSTRACT
UNLABELLED: We studied 355 patients with Grave's disease to characterize transient hypothyroidism and its prognostic value following 131I therapy. METHODS: The patients received therapeutic 131I treatment as follows: 333 received a dose < 10 mCi (6.6 +/- 1.9 mCi) and 22 received a dose > 10 mCi (12.8 +/- 2.9 mCi). Diagnosis of transient hypothyroidism was based on low T4, regardless of TSH within the first year after 131I followed by recovery of T4 and normal TSH. RESULTS: After administration of < 10 mCi 131I, 40 patients developed transient hypothyroidism during the first year; transient hypothyroidism was symptomatic in 15. There was no transient hypothyroidism after high doses (> 10 mCi) of 131I. Iodine-131 uptake > 70% at 2 hr before treatment was a risk factor for developing transient hypothyroidism (Odds ratio 2.8, 95% confidence interval 0.9-9.4). At diagnosis of transient hypothyroidism, basal TSH levels were high (51%), normal (35%) or low (14%); therefore, the transient hypothyroidism was not centralized. If hypothyroidism developed during the first 6 mo after basal TSH > 45 mU/liter ruled out transient hypothyroidism. CONCLUSION: The development of transient hypothyroidism and its hormonal pattern did not influence long-term thyroid function. Since no prognostic factors reliably predicted transient hypothyroidism before 131I or at the time of diagnosis, if hypothyroidism appears within the first months after 131I, the reevaluation of thyroid function later is warranted to avoid unnecessary chronic replacement therapy.
Subject(s)
Graves Disease/radiotherapy , Hypothyroidism/etiology , Iodine Radioisotopes/therapeutic use , Female , Humans , Hypothyroidism/blood , Iodine Radioisotopes/adverse effects , Life Tables , Male , Middle Aged , Prognosis , Radiotherapy/adverse effects , Radiotherapy Dosage , Risk Factors , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/bloodABSTRACT
BACKGROUND: Evaluate the usefulness of basal cortisol and ACTH during the immediate postoperative period following hypophyseal surgery, as early indicators of remission in patients with Cushing's disease. METHODS: Nine patients with Cushing's disease and on whom selective transphenoidal adenomectomy was performed were included in the study. Basal cortisol and ACTH levels were compared the first week after surgery, with definitive results being obtained after a month's time during which basal cortisol levels below 165 nmol/l indicated patients cured of Cushing's disease. RESULTS: Cortisol levels determined post-op, in five patients in remission, were found to be lower than those in patients who were not cured (63 +/- 55.8 versus 606 +/- 267 nmol/l, p < 0.01). However, ACTH levels were not lower. All the patients in remission had initial cortisol levels lower than 182 nmol/l, whereas the uncured patients had levels higher than 404 nmol/l. There was a correlation between cortisol measured in the first week and the definitive value (r = 0.81, p < 0.01). CONCLUSION: Cortisol in the immediate postoperative period following hypophyseal surgery is a good indicator of definitive adrenocorticotropic function and permits the identification of those patients in remission.
