Effect of Breast Cancer Treatment on Dietary Vitamin Intake Levels.

Breast cancer is the most common tumor among women, representing the second cause of cancer deaths in women. Treatment with chemotherapy negatively interferes with nutritional status. The intake of vitamins before, during and after treatment in a pilot cohort of women with non-invasive breast cancer (type I, II) treated at the Valencian Institute of Oncology (IVO) is evaluated. A 3-day anthropometric and nutritional assessment was performed using the DIAL program. Nutritional intake is compared with the values of Estimated Average Requirements (EAR) and Dietary Reference Intake (DRI) provided by the United States Department of Agriculture (USDA) and the European Food Safety Authority (EFSA). There is an overall decrease in vitamin intake during treatment which worsens at the end of said treatment. The decrease is significant in the case of vitamins B2 (p = 0.006), B3 (p = 0.042), B5 (p = 0.001), and B8 (p = 0.021). The relative risk during and after treatment increases with respect to the reference timeframe, before treatment. Deficit risks are statistically significant in the case of vitamins B5 (p = 0.001), B8 (p = 0.001) and B12 (p = 0.001). Decreased vitamin intake during treatment suggests a negative change in the patients' dietary behaviors during this time. Nutritional intervention and support may be beneficial to optimize overall dietary intake and maintain compliance with EAR and DRI for patients during a time in which adequate nutrition is important.

El primer contacto hospitalario a través del Servicio de Urgencias es un predictor independiente de supervivencia global y de supervivencia libre de enfermedad en pacientes con cáncer colorrectal / First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer

Objeto: el objetivo del presente estudio es examinar la asociación entre el tipo de admisión hospitalaria, la supervivencia y las características patológicas de una amplia población de pacientes con cáncer colorrectal. Métodos: realizamos un estudio en 1.079 pacientes diagnosticados en el Hospital Costa del Sol de Marbella con cáncer colorrectal y evaluamos la relación entre su tasa de supervivencia y la vía por la que realizaron el primer contacto con el hospital (admisión programada o de urgencias). Las variables incluidas en nuestro estudio fueron las siguientes: edad, género, localización del tumor, estadio patológico, grado de diferenciación, quimioterapia previa a la cirugía y supervivencia. Resultados: los pacientes admitidos por primera vez al hospital a través del Servicio de Urgencias fueron diagnosticados con mayor frecuencia de cáncer de colon (63,7%) y con tumores pobremente diferenciados (64,2%) y metastásicos (70%). En el análisis de regresión de Cox la supervivencia libre de enfermedad produjo una razón de riesgo (RR) de 1,36 (intervalo de confianza [IC] 95%: 1,11-1,66) para los pacientes del Servicio de Urgencias y para la supervivencia global de 1,41 (IC 95%: 1,14-1-76). Conclusiones: La admisión hospitalaria a través del Servicio de Urgencias es un indicador de agresividad y de peor pronóstico frente a los pacientes que ingresan por vía programada

Aims: the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer. Methods: the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival. Results: colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival. Conclusions: hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes

First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer.

AIMS: the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer. METHODS: the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival. RESULTS: colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival. CONCLUSIONS: hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes.

Relationship Between Vitamin D Deficiency and the Components of Metabolic Syndrome in Patients with Morbid Obesity, Before and 1 Year After Laparoscopic Roux-en-Y Gastric Bypass or Sleeve Gastrectomy.

BACKGROUND: Vitamin D deficiency (VDD) is associated with obesity and metabolic syndrome (MS). After bariatric surgery (BS), high rates of VDD often persist and some patients are refractory to the resolution of comorbidities. The aim of the present study is to analyse the relationship between the levels of vitamin D and the persistence of MS components at 12 months after BS, according to the surgical technique used. METHODS: We performed a retrospective study of 46 patients undergoing BS: 23 underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) and 23 laparoscopic sleeve gastrectomy (LSG). These patients had an average BMI of 45 kg/m2 (34-63). Levels of vitamin D were classified as deficient (<20 ng/dl), insufficient (20-30 ng/dl) or normal (>30 ng/dl) and analysed in relation to the components of MS (high blood pressure (HBP), dyslipidaemia (DL) and type 2 diabetes mellitus (T2DM) preoperatively and 12 months after surgery. RESULTS: VDD was observed in 77% of the patients prior to surgery. There were no significant associations between predisposing factors and baseline vitamin D. After surgery, plasma levels of vitamin D increased in both groups, but only 18% of the patients achieved normal values. Both groups had achieved significant improvements in MS components. Thus, 63% of all the patients achieved complete resolution of HBP, 54% that of DL and 77% that of T2DM. Moreover, MS was present in 11% of the patients, compared to 63% at baseline, and the MS resolution rate was 83%, with no significant differences between LRYGBP and LSG. CONCLUSIONS: There is a relationship between VDD and persistence of MS, and particularly so with T2DM. VDD could represent a predictor of MS persistence at 12 months after surgery.

Protocolo de actuación ante valores críticos en pruebas de laboratorio en el lugar de asistencia al paciente en una unidad neonatal / Critical values protocol for point of care testing in a neonatal unit

Introducción. En las unidades asistenciales que realizan pruebas de laboratorio en el lugar de asistencia al paciente (POCT) sería recomendable establecer las mismas políticas de calidad que en el laboratorio central, entre ellas disponer de un protocolo de actuación ante valores críticos. El objetivo del estudio consistió en elaborar el listado de valores críticos para pruebas POCT realizadas en una unidad neonatal y establecer el protocolo de actuación. Material y métodos. Las magnitudes estudiadas fueron pH, pCO2, pO2, saturación de oxígeno, hemoglobina, sodio, potasio, calcio ionizado, glucosa, bilirrubina y lactato. Estas magnitudes fueron determinadas en un analizador ABL90 FLEX. El listado de valores críticos se elaboró mediante revisión de la bibliografía y consenso con los neonatólogos. El protocolo de actuación se adaptó a partir del protocolo del laboratorio de urgencias. La revisión del listado preliminar se basó en la práctica clínica y en los datos de frecuencia de aparición de valores críticos. Resultados. Se expone nuestra experiencia en la elaboración de un listado de valores críticos para POCT y en la implantación del protocolo de actuación. Conclusiones. Para establecer el listado de valores críticos y protocolo de actuación resultó fundamental la experiencia del laboratorio central. Para conseguir la implantación de un protocolo de actuación ante valores críticos en POCT es necesaria una estrecha colaboración entre la unidad asistencial y el personal del laboratorio. La frecuencia de aparición de valores críticos y la experiencia de los clínicos son herramientas que se complementan en la revisión del listado de valores críticos (AU)

Introduction. Care units performing point of care testing (POCT) should have the same quality policies as the central laboratory, including having a protocol for critical values. The aim of the study was to develop a list of critical values for POCT in a neonatal unit, and set the protocol performance. Material and methods. The tests included in the protocol were pH, pCO2, pO2, oxygen saturation, haemoglobin, sodium, potassium, ionized calcium, glucose, bilirubin, and lactate. These tests were determined using a POCT ABL90FLEX analyser. To prepare the list of critical values, a bibliography review was performed, as well as meetings with the neonatologists. The revision of the preliminary list was based on clinical practice and data frequency of critical values. To set the protocol, an adaptation of our emergency laboratory protocol was performed. Results. We show our experience in the preparation of a list of critical values for POCT and the implementation of a protocol. Conclusions. Central laboratory experience was a key element in establishing the list of critical values and action protocol. A close collaboration between health care unit and laboratory was required to achieve the implementation of a POCT critical values protocol. The frequency of critical values and clinician experience were complementary tools to revise the list of critical values (AU)