Integral nutritional approach to the care of cancer patients: results from a Delphi panel.

INTRODUCTION: Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. METHODS: A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. RESULTS: Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients. CONCLUSIONS: There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan.

Fabry disease in Argentina: an evaluation of patients enrolled in the Fabry Registry.

AIMS: Fabry disease (FD) is an X-linked inborn error of metabolism caused by alpha-galactosidase A deficiency. The Fabry Registry is an ongoing, global observational database that compiles clinical data from patients with FD. METHODS: Demographic and baseline clinical characteristics of Fabry Registry patients enrolled in Argentina were analysed and compared with patients enrolled in the rest of the world (ROW). Baseline clinical parameters included chronic kidney disease (CKD) stage, urine protein-to-creatinine ratio and left ventricular posterior wall thickness. Only data from untreated patients were included. RESULTS: As of 1 October 2010, 3752 patients were enrolled in the Registry, 70 patients from Argentina and 3682 from the ROW. Argentinean male subjects were younger than Fabry Registry male subjects enrolled in ROW: mean current age 32.5 years vs. 39.0 years for men (p = 0.0257 by t-test). The current age (mean ± standard deviation) of female subjects enrolled in Argentina was not significantly different from that of female subjects enrolled in the ROW: 40.1 ± 17.28 vs. 43.2 ±17.95 years respectively (p = 0.2967). Overall, a smaller percentage of patients from Argentina received ERT compared with patients in the ROW (54% vs. 58% respectively). When evaluated by gender, more men and fewer women in Argentina received ERT compared with ROW (85% vs. 79% for men and 27% vs. 38% for women). A larger proportion of patients in ROW had severe CKD (stage 4 or 5) compared with Argentina (9.8% vs. 0%), most likely because of the older age of the ROW population. CONCLUSIONS: The enrolment of Argentinean patients into the Fabry Registry has steadily increased, as has the inclusion of female and paediatric patients with FD. The medical community in Argentina should be aware of FD in these populations, as awareness will facilitate prompt diagnosis and initiation of treatment, thus leading to improved outcomes.

Beyond the reproductive effect of sex steroids: their role during immunity to helminth parasite infections.

During the helminth infections, the immune system tends to be modulated by host's sex hormones. Actually, many studies show the reciprocal relationship between sex steroids, the immune system and the elimination or establishment of helminth parasites. Is well known that innate immune response determines the type of adaptive immune response, so the effects in the innate immune response by hormones may affect subsequent adaptive immunity. The sex steroids as estrogens, progesterone and testosterone regulate growth, differentiation, survival and function of many cell types that could be involved in process like homeostasis and immunity, but also have a direct effect on the helminthes, that may probably be mediated by specific receptors on these parasites. Sex steroids, parasites and immunity are closely connected, and their interconnection is involved in the maintenance of elimination or establishment of helminthes in an immunocompetent host. For that reason, understanding the action's mechanisms of sex steroids on immune cells and its direct effect on helminth parasites is important for further progress in the development of novel therapies for chronic helminth diseases associated to immune dysregulation. In this review, we will describe the effects of sex steroids on the immune response during helminth infections as well as the direct effect in these parasites, and the possible implications of these effects on the incidence of several helminth infections.

El deporte y la ergogenia: una mirada desde la bioética / The sport and the ergogenic: a view from the bioethics

El deporte ha evolucionado a la par de la civilización y hoy es una actividad que involucra a muchos actores, genera pasiones y sustenta un vasto sector de la economía nacional e internacional. Se hace necesario mantener la visión enfocada en los valores que promueve esta actividad y, como sociedad, exigir en cada campeonato la divulgación de sus doctrinas. Diferentes formas de prácticas deportivas se han popularizado y con ello los atletas pueden ser agrupados en aficionados, o de elite. Es decir, los que obtienen resultados locales, nacionales o internacionales, deportistas de alto rendimiento, que están en su mejor forma física y psicológica para competir; y deportistas profesionales, aquellos que prestan sus servicios a cambio de una remuneración. Por último siendo esta una actividad humana debe ser motivo de permanente reflexión ética (1-3).

The sport activity has evolved with civilization and today is an activity that involves many actors, generates passion and supports a vast sector of the national and international economy. Is necessary to keep the focused vision on the values promoted by this activity and, as a society, require in each tournament a disclosure of his doctrines. Different forms of sport have become popular and thus the athletes can be grouped into amateur or elite; into the ones that plays locally, in a nation league or at international level; High performance athletes, who are in their best physical and psychological shape; and professional athletes who provide services in exchange for payment.

Nuevo método para detección de infección y erradicación del Helicobacter pylori (Hp) por determinaciòn de antígenos en meteria fecal / A new method for detection H. pylori infection and erradication by stool antigen test

Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests

Nuevo método para detección de infección y erradicación del Helicobacter pylori (Hp) por determinaciòn de antígenos en meteria fecal / A new method for detection H. pylori infection and erradication by stool antigen test

Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests (AU)

[A new method for detection and erradication of Helicobacter pylori infection by stool antigens test]. / Nuevo mètodo para detecciòn de infecciòn y erradicaciòn del Helicobacter pylori (Hp) por determinaciòn de antìgenos en materia fecal.

Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests.

Nuevo mÞtodo para detecciòn de infecciòn y erradicaciòn del Helicobacter pylori (Hp) por determinaciòn de antýgenos en materia fecal. / [A new method for detection and erradication of Helicobacter pylori infection by stool antigens test]

Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests.

Erradicación de la infección por helicobacter pylori en la práctica clínica / Helicobacter pylori eradication in clinical practice

El descubrimiento del helicobacter pylori...El objetivo de este estudio fue evaluar en la práctica clínica cotidiana la eficacia e incidencia de efectos adversos de un esquema cuádruple de tratamiento que combina Pantoprazol, Subcitrato de Bismuto Coloidal, Metronidazol y Tetraciclina para la erradicación de la infección por helicobacter pylori....La terapia cuádruple erradicó la infección en cerca del 90 por ciento de los pacientes. Los efectos adversos fueron leves, y no interfirieron con la eficacia del tratamiento ni motivaron abandonos de la medicación. Esta terapia puede ser recomendada, incluso como primera línea de tratamiento

Erradicación de la infección por helicobacter pylori en la práctica clínica / Helicobacter pylori eradication in clinical practice

El descubrimiento del helicobacter pylori...El objetivo de este estudio fue evaluar en la práctica clínica cotidiana la eficacia e incidencia de efectos adversos de un esquema cuádruple de tratamiento que combina Pantoprazol, Subcitrato de Bismuto Coloidal, Metronidazol y Tetraciclina para la erradicación de la infección por helicobacter pylori....La terapia cuádruple erradicó la infección en cerca del 90 por ciento de los pacientes. Los efectos adversos fueron leves, y no interfirieron con la eficacia del tratamiento ni motivaron abandonos de la medicación. Esta terapia puede ser recomendada, incluso como primera línea de tratamiento

[Absence of bleeding recurrence of peptic ulcer after long term follow-up of successful eradication of Helicobacter pylori]. / Ausencia de recidiva de sangrado por úlcera péptica en el largo plazo luego de una erradicación exitosa del Helicobacter pylori.

Helicobacter pylori (HP) eradication reduces dramatically the peptic ulcer relapse rate, but information regarding recurrence of peptic ulcer bleeding after eradication is still scanty. Available data show rebleeding rates of 0-3% per year in successfully eradication patients, compared with figures between 12 and 33% among the non eradicated ones. The aim of this study was to determine the rebleeding rate among successfully eradicated patients with a prior history of rebleeding peptic ulcer. 42 patients (34 male, mean age 49, range 18-74) hospitalised for Hp positive bleeding peptic ulcer undergoing conservative treatment, were given as soon as oral route was re-established, a one-week eradication treatment, followed by the same proton pump inhibitor for three or five weeks for duodenal and gastric ulcer healing respectively. No maintenance antiulcer therapy was indicated. Patients were advised not to take nonsteroideal anti-inflammatory drug. Ulcer healing and Hp eradication was confirmed in all 42 patients by means of endoscopy and biopsies for urease rapid test and histology four weeks after completion of the treatment. After this patients were invited to enter a long-term follow-up program with periodical visits. End point of the study was occurrence of rebleeding. Further endoscopies were planned when rebleeding or symptomatic relapse. Median follow-up time was 24.02 months, ranging from 3 up to 27 months. All patients were compliant with the follow-up visits. None of the patients presented with symptoms suggestive of ulcer relapse or upper gastrointestinal bleeding. Our data suggest, that Hp eradication can prevent bleeding relapses in patients with Hp positive bleeding peptic ulcers.

Ausencia de Recidiva de sangrado por úlcera péptica en el largo plazo luego de una erradicación exitosa del Helicobacter pylory / Absence of bleeding recurrence by peptic ulcer after long term follow-up of succesfully erradication of Helicobacter pylori

El objetivo de este trabajo fue determinar la tasa de resangrado en pacientes con historia previa de ulcera péptica sangrante H.P. positiva. 42 pacientes hospitalizados por úlceras pépticas sangrante fueron sujetos a tratamiento convencional para el cese de sangrado. Se les efectuó luego taramiento de erradicación del H.P. con triple terapia a 7 días sin mantenimiento posterior. A 4 semanas en el caso de ulcera duodenal y a 6 semanas en casos de ulcera gástrica se comprobó por vía endoscópica e histológica la curación de la úlcera y la erradicación de la bacteria. Los 42 pacientes fueron incluidos en un estudio de seguimiento y al cumplirse 24,02 meses (rango 3-27 meses) no hubo recidiva de la hemorragia en ninguno de ellos. Estos datos sugieren que la erradicación de H.P. puede prevenir la recidiva de sangrado ulceroso en pacientes H.P. positivos.

Ausencia de recidiva de sangrado por úlcera péptica en el largo plazo luego de una erradicación exitosa del Helicobacter pylori. / [Absence of bleeding recurrence of peptic ulcer after long term follow-up of successful eradication of Helicobacter pylori]

Helicobacter pylori (HP) eradication reduces dramatically the peptic ulcer relapse rate, but information regarding recurrence of peptic ulcer bleeding after eradication is still scanty. Available data show rebleeding rates of 0-3

per year in successfully eradication patients, compared with figures between 12 and 33

among the non eradicated ones. The aim of this study was to determine the rebleeding rate among successfully eradicated patients with a prior history of rebleeding peptic ulcer. 42 patients (34 male, mean age 49, range 18-74) hospitalised for Hp positive bleeding peptic ulcer undergoing conservative treatment, were given as soon as oral route was re-established, a one-week eradication treatment, followed by the same proton pump inhibitor for three or five weeks for duodenal and gastric ulcer healing respectively. No maintenance antiulcer therapy was indicated. Patients were advised not to take nonsteroideal anti-inflammatory drug. Ulcer healing and Hp eradication was confirmed in all 42 patients by means of endoscopy and biopsies for urease rapid test and histology four weeks after completion of the treatment. After this patients were invited to enter a long-term follow-up program with periodical visits. End point of the study was occurrence of rebleeding. Further endoscopies were planned when rebleeding or symptomatic relapse. Median follow-up time was 24.02 months, ranging from 3 up to 27 months. All patients were compliant with the follow-up visits. None of the patients presented with symptoms suggestive of ulcer relapse or upper gastrointestinal bleeding. Our data suggest, that Hp eradication can prevent bleeding relapses in patients with Hp positive bleeding peptic ulcers.

Ausencia de Recidiva de sangrado por úlcera péptica en el largo plazo luego de una erradicación exitosa del Helicobacter pylory / Absence of bleeding recurrence by peptic ulcer after long term follow-up of succesfully erradication of Helicobacter pylori

El objetivo de este trabajo fue determinar la tasa de resangrado en pacientes con historia previa de ulcera péptica sangrante H.P. positiva. 42 pacientes hospitalizados por úlceras pépticas sangrante fueron sujetos a tratamiento convencional para el cese de sangrado. Se les efectuó luego taramiento de erradicación del H.P. con triple terapia a 7 días sin mantenimiento posterior. A 4 semanas en el caso de ulcera duodenal y a 6 semanas en casos de ulcera gástrica se comprobó por vía endoscópica e histológica la curación de la úlcera y la erradicación de la bacteria. Los 42 pacientes fueron incluidos en un estudio de seguimiento y al cumplirse 24,02 meses (rango 3-27 meses) no hubo recidiva de la hemorragia en ninguno de ellos. Estos datos sugieren que la erradicación de H.P. puede prevenir la recidiva de sangrado ulceroso en pacientes H.P. positivos. (AU)

[Vaginal evisceration following radiotherapy and surgery for cervico-uterine cancer. Report of a case]. / Evisceración vaginal secundaria a tratamiento de carcinoma cervicouterino con radioterapia y cirugía. Informe de un caso.

A 60-year-old woman with past history of perineorrhaphy due to vaginal prolapse; squamous cell carcinoma of the uterine cervix stage IIB, treated with radiation theraphy at doses of 7500 rads administered as teletherapy and brachytherapy with Cesium 137. Ten weeks later a Piver II hysterectomy was performed, her posoperative morbidity was a vaginal abscess. Twelve years later, she developed a pulmonary metastasis. One year thereafter she had vaginal discharge of cetrinous fluid and prolapse of greater omentum through the vagina. She was treated by a midle exploratory celiotomy, primary closure of the vaginal defect and the pelvic floor was covered with an omental pedicle flap. The postoperative period was unremarkable.

Evisceración vaginal secundaria a tratamiento de carcinoma cervicouterino con radioterapia y cirugía. Informe de un caso / Vaginal evisceration following radiation therapy for cervical cancer. A case report

Mujer de 60 años de edad, con antecedentes de colpoperineorrafia por prolapso vaginal y de cáncer epidermoide cervicouterino EIIB diagnosticado en 1982. La pacientess recibió radioterapia, 7500 rads administrados como teleterapia (ciclo pélvico completo) y braquiterapia con Cesio 137. Diez semanas más tarde se le efectuó una histerectomía tipo Piver II, que se complicó con un absceso en la cúpula vaginal. Doce años después, la paciente presentó metástasis pulmonares y un año más tarde presento en forma súbita, descarga cetrina y salida del epiplón mayor a través de la vagina. A la paciente se le efectuó una plastía vaginal en un plano, por vía abdominal y también se le colocó un colgajo pediculado del epiplón mayor para cubrir la pelvis. La evolución posoperatoria fue satisfactoria

[Hematological differences between the effects of roller vs, centrifugal pump]. / Diferencias hematológicas entre los effectos de las bombas de rodillo y centrífuga.

A secondary complication in the utilization of the CPB (cardiopulmonary bypass) is post-op bleeding due to alterations in the red blood cells and the activation sequences between coagulation, fibrinolysis and complement. We did this study with the objective to evaluate the behavior of the blood cells and coagulation factors using centrifugal pump (n = 12) roller pump (n = 12); we evaluated the consumption of blood products as well as measuring the amount of blood products used. There were no demographic differences between the two groups, the time on CPB was less than 85 minutes, blood flow in the centrifugal pump was maintained at an average of 3.6 l Vs 3.37 l in the roller pump, this being statistically significant. The blood values were compared in each group there were no statistically significant differences, however factor VIII, fibrinogen and platelets presented a tendency (p < 0.05) to be higher in the centrifugal pump group than in the control group (roller pump). Thus 1. In patients in whom we used centrifugal pump there was a tendency for preservation of factor VIII, platelets and fibrinogen. 2. There was no significant difference in the number of blood units transfused between the centrifugal vs roller pump. 3. patients in the centrifugal group were better perfused during CPB.4. 24 hrs. post-op, both groups showed no difference in post-op bleeding.

Carbohydrate-lipid interactions during gestation and their control by insulin.

1. During the first two thirds of gestation, coinciding with a minimal accretion by the conceptus, the mother is in an anabolic state which is supported by her hyperphagia and the more efficient conservation of exogenous nutrients when she eats. During this phase maternal fat deposits are accumulated thanks to the enhancement in adipose tissue lipogenic and glycerologenic activity. In contrast, in the latter part of gestation, the rapid fetal growth is sustained by the intense transfer of nutrients from maternal circulation. 2. Glucose is quantitatively the most abundant of the several substrates that cross the placenta and despite increased maternal gluconeogenesis this transfer is responsible for the maternal tendency to hypoglycemia. This causes a switch to a net catabolic state which is especially evident in the net breakdown of fat depots. 3. Enhanced release of adipose tissue lipolytic products, free fatty acids (FFA) and glycerol, facilitates the liver synthesis of triglycerides and their later release into circulation associated to very low-density lipoprotein (VLDL). Glycerol is also used as an important gluconeogenic substrate and FFAs are broken down through beta-oxidation for ketone body synthesis. Flow through these pathways becomes increased when food is withheld and this actively contributes to the availability of fuels to the fetus which becomes partially preserved from maternal metabolic insult. Increased liver production of VLDL-triglycerides and decreased extrahepatic lipoprotein lipase contribute to exaggerated maternal hypertriglyceridemia which, besides being a floating metabolic reserve for emergency conditions such as starvation, constitutes an essential substrate for milk synthesis around parturition in preparation for lactation. 4. While the maternal anabolic tendencies found during the first two-thirds of gestation seem to be facilitated by hyperinsulinemia in the presence of a normal responsiveness to the hormone, it is proposed that most of the metabolic changes taking place during the last third of gestation seem to be caused by the insulin-resistant state which is consistently present at this stage, since its reversion caused by sustained exaggerated hyperinsulinemia also reverts several of these metabolic adaptations.