[Enteral nutrition; direct costs in a tertiary care hospital]. / Nutrición enteral; costes directos en un hospital terciario.

INTRODUCTION: The studies in which the direct costs generated by enteral nutrition have been analyzed in hospitals of our country are limited. The objective of our study has been the analysis of costs incurred by this treatment in our center. MATERIAL AND METHODS: A total of 449 consecutive patients who received nutritional support and that were hospitalized in the Hospital Río Ortega (Valladolid) since January 1999 to June 2001 has been studied. In this study only the direct costs were analyzed. RESULTS: The nutritional support was effective in the complete group with an improvement in the serum levels of albumin, prealbumin, and transferrin. In the analysis of direct costs generated by enteral nutrition the total median cost was of 598.4 +/- 761 euros/total treatment/patient, which represents a daily median cost of 36.3 +/- 8.8 euros/day/patient. In the analysis of costs by paragraphs, the expendable equipment constituted 36% of the total, representing the tubes 3%, the lines of nutrition 12%, the containers 21% and the nutritional preparations 64%. A cost analysis was also carried out in relation to the different groups of pathologies, and in this way the patients with hematological tumors and the patients with higher aereodigestive tract tumors showed some greater costs, due to their higher median hospital stay. The patients who received nutrition through a gastrostomy probe showed also higher costs, in addition due to a greater hospital stay. CONCLUSIONS: The costs of the nutritional support were superior in the group of patients with hematological tumors and with higher aereodigestive tract, due to their greatest hospital stay. A greater cost in the patients whose access route was the gastrostomy was also observed.

Nutrición enteral; costes directos en un hospital terciario / Enteral nutrition; direct costs in a tertiary care hospital

Introducción. Los estudios que han analizado los costes directos generados por la nutrición enteral en hospitales en nuestro país son escasos. El objetivo de nuestro estudio fue analizar el coste de este tratamiento en nuestro centro. Material y métodos. Estudiamos un total de 449 pacientes consecutivos con indicación de soporte nutricional que ingresaron en el Hospital del Río Hortega (Valladolid) desde enero de 1999 a junio de 2001.En este análisis sólo se analizaron los costes directos. Resultados. El soporte nutricional fue efectivo en el grupo global, mostrando una mejoría en los niveles de albúmina, prealbúmina y transferrina. En el análisis de costes económicos directos generados por la nutrición enteral el coste medio total fue de 99.348 ñ 126.462 pesetas por tratamiento completo por paciente (598,4 ñ 761 euros), representando un coste medio diario de 6.021 ñ 1.467 pesetas de tratamiento al día por paciente (36,3 ñ 8,8 euros). En el análisis de costes por apartados, el material fungible supuso un 36 por ciento del total, representando las sondas un 3 por ciento, las nutrilíneas un 12 por ciento, los contenedores un 21 por ciento y los preparados nutricionales un 64 por ciento. Se realizó también un análisis de costes en función del grupo de patologías; de este modo los pacientes con tumores hematológicos y los pacientes con tumores en vía aerodigestiva alta presentaron unos mayores costes en función de su mayor estancia media; del mismo modo que los pacientes nutridos a través de gastrostomía también influido el mayor coste por una estancia más larga. Conclusiones. El coste del soporte nutricional fue superior en el grupo de pacientes con tumores hematológicos y de vías aerodigestivas altas influido por la estancia. También existió un mayor coste en los pacientes cuya vía de acceso fue la gastrostomía (AU)

Histología y embriología oral clínicamente integradas como herramienta didactica en un curso de grado de la carrera de odontologia / Oral histology and embryology clinically integrated as a teaching tool in an undergraduated dentistry course of studies

The teaching of Oral Histology and Embryology clinically integrated was designed as a pilot experience to be developed during the 2005 academic year at the Division of Histology and Embryology (Chair [quot ]A[quot ]) of the National University of Cordoba School of Dentistry. This experience, in which the members of the faculty of the Department of Clinical and Basic Sciences have an active participation, is based on a systemic conception of the learning-teaching process and on the recommendations made by the OPS/OMS. This approach will allow us to optimize the quality of our undergraduate programs through better teacher training and the gradual integration of basic and clinical sciences. Our aim is to provide a better education with clinical relevance in basic sciences and scientific basis in clinical assistance.

La enseñanza integrada es un modelo pedagógico que se sustenta fundamentalmente en la concentración de los aspectos relevantes de un conjunto de disciplinas interrelacionadas, obteniéndose como producto una síntesis interdisciplinaria, lo que proporciona una visión más holística de la enseñanza y le permite al educando integrar conocimientos. A partir de esta concepción sistémica del proceso de enseñanza/aprendizaje y de las recomendaciones de OPS/OMS, se diseñó como experiencia piloto para el Ciclo Lectivo 2005 de la Cátedra "A" de Histología y Embriología de la Facultad de Odontología perteneciente a la Universidad Nacional de Córdoba, la enseñanza de la Histología y Embriología Oral clínicamente integradas, con activa participación de docentes de Ciencias Básicas y Clínicas. La estrategia para la sistematización de los contenidos de los módulos de aprendizaje se basó en una dinámica que se sustenta en el uso de facilitadores didácticos, que recrean instrumentos didácticos como son las ideas previas, los mapas conceptuales, la resolución de problemas y el estudio de casos clínicos. Esta experiencia nos va a permitir optimizar la calidad de la oferta educativa de grado a través de la mejora de la formación docente y la gradual integración de las ciencias básicas y clínicas, para el logro de una educación con relevancia clínica en las ciencias básicas y con base científica en la asistencia clínica.

Histología y embriología oral clínicamente integradas como herramienta didactica en un curso de grado de la carrera de odontologia / Oral histology and embryology clinically integrated as a teaching tool in an undergraduated dentistry course of studies

The teaching of Oral Histology and Embryology clinically integrated was designed as a pilot experience to be developed during the 2005 academic year at the Division of Histology and Embryology (Chair [quot ]A[quot ]) of the National University of Cordoba School of Dentistry. This experience, in which the members of the faculty of the Department of Clinical and Basic Sciences have an active participation, is based on a systemic conception of the learning-teaching process and on the recommendations made by the OPS/OMS. This approach will allow us to optimize the quality of our undergraduate programs through better teacher training and the gradual integration of basic and clinical sciences. Our aim is to provide a better education with clinical relevance in basic sciences and scientific basis in clinical assistance.(AU)

La enseñanza integrada es un modelo pedagógico que se sustenta fundamentalmente en la concentración de los aspectos relevantes de un conjunto de disciplinas interrelacionadas, obteniéndose como producto una síntesis interdisciplinaria, lo que proporciona una visión más holística de la enseñanza y le permite al educando integrar conocimientos. A partir de esta concepción sistémica del proceso de enseñanza/aprendizaje y de las recomendaciones de OPS/OMS, se diseñó como experiencia piloto para el Ciclo Lectivo 2005 de la Cátedra "A" de Histología y Embriología de la Facultad de Odontología perteneciente a la Universidad Nacional de Córdoba, la enseñanza de la Histología y Embriología Oral clínicamente integradas, con activa participación de docentes de Ciencias Básicas y Clínicas. La estrategia para la sistematización de los contenidos de los módulos de aprendizaje se basó en una dinámica que se sustenta en el uso de facilitadores didácticos, que recrean instrumentos didácticos como son las ideas previas, los mapas conceptuales, la resolución de problemas y el estudio de casos clínicos. Esta experiencia nos va a permitir optimizar la calidad de la oferta educativa de grado a través de la mejora de la formación docente y la gradual integración de las ciencias básicas y clínicas, para el logro de una educación con relevancia clínica en las ciencias básicas y con base científica en la asistencia clínica.(AU)

Nutrición enteral domiciliaria, análisis de eficiencia en un Área de Salud / Home enteral nutrition: analysis of efficiency in a Healt District

Introducción. Los estudios que han analizado los costes directos generados por la nutrición enteral domiciliaria (NED) han sido escasos. El objetivo de nuestro estudio fue realizar un análisis de costes directos de la nutrición enteral domiciliaria utilizando como referentes los valores de seguimiento nutricionales tanto bioquímicos como nutricionales. Material y métodos. Desde enero de 1999 hasta diciembre de 2001 estudiamos un total de 102 pacientes consecutivos con indicación de soporte nutricional domiciliario. A todos los pacientes se les registraron los siguientes datos epidemiológicos: edad, sexo y patología primaria que indicaba la nutrición enteral, realizándose una valoración antropométrica y una valoración bioquímica nutricional trimestralmente. Se registraron asimismo el número de episodios de diarrea, vómitos, neumonía por aspiración y fallecimientos durante el tratamiento. Resultados. La edad media de los pacientes fue 58,7 ñ 13,3 años. La distribución de pacientes por enfermedades fue: 71 (69,3 por ciento) tenían cáncer de cabeza y cuello; 14 (13,9 por ciento) tenían una alteración neurológica que afecta a la deglución (accidente cerebrovascular y/o demencia); 6 (5,9 por ciento) presentaban tumores en otras localizaciones, y 11 (10,9 por ciento) tenían un grupo de patologías que inducen disfagia o anorexia. La NED fue administrada vía oral a 81 pacientes (79,4 por ciento), por sonda nasogástrica (SNG) en 15 pacientes (14,7 por ciento), mediante gastrostomía endoscópica percutánea (GEP) en 5 pacientes (4,9 por ciento) y yeyunostomía en un paciente (1 por ciento). La duración media de la NED fue de 101ñ46,9 días. Existió una mejoría significativa en los parámetros bioquímicos y antropométricos de los pacientes con NED. En el análisis de costes económicos directos generados por la nutrición enteral; fórmulas nutricionales y material fungible utilizados (contenedores, sondas y nutrilíneas), el coste medio total fue de 300.033 ñ 599.203 ptas/tratamiento completo/paciente (1.803ñ3.601 euros), representando un coste medio diario de 2.970ñ5.932 ptas/día/paciente de tratamiento (17,8ñ35,6 euros). En el análisis de costes por apartados, el material fungible (nutrilínea, sonda nasogástrica y contenedor de fórmula nutricional) representó una media de 1.284ñ4.571 ptas/ tratamiento completo/paciente (7,7ñ27,4 euros) (5 por ciento en total) y los preparados nutricionales una media de 231.313ñ399.756 ptas/tratamiento completo/paciente (1.390,2 ñ 2.402 euros) (95 por ciento). Los pacientes con mayor consumo de recursos fueron los pacientes con tumores de cabeza y cuello. Para analizar la eficiencia de este tratamiento se realizó un análisis de coste por cada parámetro objetivo que indicaba mejoría en el estado nutricional, de este modo el aumento de 1 g/dl de albúmina supuso un gasto medio de 103.817ñ2.897 ptas (623,9ñ17,4 euros) y el aumento de 1 kg de peso supuso un gasto medio de 857.237ñ25.097 ptas (5.152,1ñ150,8 euros).Conclusiones. En resumen, la nutrición enteral domiciliaria se demostró efectiva en la mejora del estado nutricional en diferentes grupos de pacientes ambulantes. El coste del soporte nutricional fue superior en el grupo de pacientes con tumores de vías aerodigestivas altas, influido por la duración del tratamiento y la vía de acceso (AU)

[Home enteral nutrition: analysis of efficiency in a Health District]. / Nutrición enteral domiciliaria, análisis de eficiencia en un Area de Salud.

INTRODUCTION: Studies on the analysis of direct costs generated by household enteral nutrition (HEN) have been scant. The objective of our study was to carry out a direct costs analysis of household enteral nutrition using both the biochemical and nutritional monitoring values of the nutritional state as a point of reference. MATERIAL AND METHODS: Since January 1999 until December 2001, we studied a total sample of 102 consecutive patients with indication of household nutritional support. The following epidemiological data were obtained in all patients: age, sex, and primary condition for which enteral nutrition was prescribed; we carried out an anthropometric assessment and a biochemical nutritional assessment quarterly. We recorded also the number of episodes of diarrhea, vomiting, aspiration pneumonia, and death during the treatment. RESULTS: Average age of the patients was 58.7 13.3 years. The number and proportion of patients according to primary conditions were the following: 71 (69.3%) with head and neck cancer, 14 (13.9%) with a neurological condition with swallowing disturbance (stroke and/or dementia), 6 (5.9%) with tumors in other locations, and 11 (10.9%) with a group of diseases associated with dysphagia or anorexia. HEN was administered by oral route in 81 patients (79.4%), by nasogastric tube (NGT) in 15 patients (14.7%), by PEG in 5 patients (4.9%) and by yeyunostomy in 1 patient (1%). Average duration of HEN was 101 46.9 days. We showed a significant improvement of biochemical and anthropometric parameters in patients with HEN. The economic analysis of direct costs generated by enteral nutrition showed that the total average cost of nutritional formulas and expendable equipment utilized (holders, probes and nutritional tubes) was 300,033 599,203 pesetas/full treatment/patient (1,803 3,601 euros), or a daily average cost of 2,970 5,932 pesetas/day/patient (17.8 35.6 euros). In the analysis of costs acording to different items, the expendable equipment (nutritional tubes, nasogastric tubes and nutritional formula holders) were an average of 1,284 4,571 pesetas/full treatment/patient (7.7 27.4 euros) (5% in total), and the nutritional preparations were an average of 231,313 399,756 pesetas/full treatment/patient (1,390.2 2,402 euros) (95%). The patients with greater resources expenditure were those with tumors of head and neck. In order to analyze the efficiency of this treatment an analysis of costs was carried out for each objective parameter indicating nutritional status improvement; that way, the increase of 1 g/dl of albumin was an average cost of 103,817 2,897 pesetas (623.9 17.4 euros), while the increase of 1 kg of weight was an average cost of 857,237 25,097 pesetas (5,152.1 150.8 euros). CONCLUSIONS. In summary, nutrition enteral household was an effective therapy for nutritional status improvement in different groups of ambulatory patients. The cost of the nutritional support was superior in the group of patients with tumors of the upper aereodigestive system because of the greater duration of the treatment and the complex access route.

Palmoplantar pustulosis: a clinicoepidemiological study. The relationship between tobacco use and thyroid function.

BACKGROUND: Palmoplantar pustulosis (PPP) is a skin disease characterized by chronically recurring sterile pustules on the palms and the soles. Although the aetiology of PPP is unknown, it is interesting to note the high prevalence of tobacco use in these patients. It would seem that there may be a relationship between PPP, autoimmune diseases and alterations of thyroid function. METHODS: We studied a total of 17 patients with ages ranging from 28 to 67 years, diagnosed with PPP. Patients were interviewed about: autoimmune diseases, psoriasis and thyroid disease, tobacco use (classified as: A, non-smoker; B, ex smoker; C, smoker of less than 20 cigarettes/day; D, smoker of more than 20 cigarettes/day). The patients were interviewed regarding the possible existence of a personal or family history of thyroid disease, determined using thyroid-stimulating hormone, thyroxine, antithyroid antibodies (antimicrosomal and antithyroglobulin antibodies). RESULTS: The majority of the patients smoked cigarettes (according to classification). Of the 12 patients for whom a thyroid study was performed three had been diagnosed with thyroid diseases, an increase in thyroid-stimulating hormone in one case and two showed an increase in antimicrosomial antibodies. CONCLUSIONS: We have been able to demonstrate a high prevalence of thyroid dysfunction and tobacco use in patients with PPP.

Avian minor salivary glands: an ultrastructural study of the secretory granules in mucous and seromucous cells.

Ultrastructural descriptions in birds are scarce thus, in this study we have characterized the secretory granules of mucous and seromucous cells from the palatine and lingual salivary glands of birds with different diets. The samples were taken from the tongue and palatine mucosa of chicken (Gallus gallus), quail (Coturnix coturnix), chimango (Milvago chimango) and white heron (Egretta thula). The samples were processed for observation by transmission electron microscopy (TEM) employing 4% Karnovsky solution for fixation. The most noteworthy finding was the heterogeneous ultrastructural appearance of the secretory granules. Differences in substructure were found between the four species, between the palatine and lingual glands in the same species and even within the same acinus and the same cell. At variance with other authors, these differences cannot be attributed to the type of fixative solution used taking into account that all the samples were processed in the same way. Previous histochemical studies have shown the presence of sulfated and non sulfated glycoconjugates in these glands which can be associated to the maturation of the granules. These granules are probably representative of peculiar storage of the secretory products that would give rise to a heterogeneous and complex ultrastructural pattern of granules in the mucosa and seromucosa cells of these avian species.

Avian minor salivary glands: an ultrastructural study of the secretory granules in mucous and seromucous cells

Ultrastructural descriptions in birds are scarce thus, in this study we have characterized the secretory granules of mucous and seromucous cells from the palatine and lingual salivary glands of birds with different diets. The samples were taken from the tongue and palatine mucosa of chicken (Gallus gallus), quail (Coturnix coturnix), chimango (Milvago chimango) and white heron (Egretta thula). The samples were processed for observation by transmission electron microscopy (TEM) employing 4

Karnovsky solution for fixation. The most noteworthy finding was the heterogeneous ultrastructural appearance of the secretory granules. Differences in substructure were found between the four species, between the palatine and lingual glands in the same species and even within the same acinus and the same cell. At variance with other authors, these differences cannot be attributed to the type of fixative solution used taking into account that all the samples were processed in the same way. Previous histochemical studies have shown the presence of sulfated and non sulfated glycoconjugates in these glands which can be associated to the maturation of the granules. These granules are probably representative of peculiar storage of the secretory products that would give rise to a heterogeneous and complex ultrastructural pattern of granules in the mucosa and seromucosa cells of these avian species.

Avian minor salivary glands: an ultrastructural study of the secretory granules in mucous and seromucous cells.

Ultrastructural descriptions in birds are scarce thus, in this study we have characterized the secretory granules of mucous and seromucous cells from the palatine and lingual salivary glands of birds with different diets. The samples were taken from the tongue and palatine mucosa of chicken (Gallus gallus), quail (Coturnix coturnix), chimango (Milvago chimango) and white heron (Egretta thula). The samples were processed for observation by transmission electron microscopy (TEM) employing 4

Karnovsky solution for fixation. The most noteworthy finding was the heterogeneous ultrastructural appearance of the secretory granules. Differences in substructure were found between the four species, between the palatine and lingual glands in the same species and even within the same acinus and the same cell. At variance with other authors, these differences cannot be attributed to the type of fixative solution used taking into account that all the samples were processed in the same way. Previous histochemical studies have shown the presence of sulfated and non sulfated glycoconjugates in these glands which can be associated to the maturation of the granules. These granules are probably representative of peculiar storage of the secretory products that would give rise to a heterogeneous and complex ultrastructural pattern of granules in the mucosa and seromucosa cells of these avian species.