[Not Available]. / Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study.

BACKGROUND AND AIM: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. METHODS: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. RESULTS: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9-6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. CONCLUSIONS: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value.

Addressing Disease-Related Malnutrition in Healthcare: A Latin American Perspective.

Alarmingly high rates of disease-related malnutrition have persisted in hospitals of both emerging and industrialized nations over the past 2 decades, despite marked advances in medical care over this same interval. In Latin American hospitals, the numbers are particularly striking; disease-related malnutrition has been reported in nearly 50% of adult patients in Argentina, Brazil, Chile, Costa Rica, Cuba, Dominican Republic, Ecuador, Mexico, Panama, Paraguay, Peru, Puerto Rico, Venezuela, and Uruguay. The tolls of disease-related malnutrition are high in both human and financial terms-increased infectious complications, higher incidence of pressure ulcers, longer hospital stays, more frequent readmissions, greater costs of care, and increased risk of death. In an effort to draw attention to malnutrition in Latin American healthcare, a feedM.E. Latin American Study Group was formed to extend the reach and support the educational efforts of the feedM.E. Global Study Group. In this article, the feedM.E. Latin American Study Group shows that malnutrition incurs excessive costs to the healthcare systems, and the study group also presents evidence of how appropriate nutrition care can improve patients' clinical outcomes and lower healthcare costs. To achieve the benefits of nutrition for health throughout Latin America, the article presents feedM.E.'s simple and effective Nutrition Care Pathway in English and Spanish as a way to facilitate its use.

[Laparoscopic versus open surgery for colorectal cancer. A comparative study]. / Estudio comparativo entre cirugía laparoscópica y cirugía abierta en cáncer colorrectal.

BACKGROUND: Laparoscopic surgery for colorectal cancer is currently accepted and widespread worldwide. However, according tol the surgical experience on this approach, surgical and short-term oncologic results may vary. Studies comparing laparoscopic vs. open surgery in our population are scarce. OBJECTIVE: To determine the superiority of the laparoscopic vs. open technique for colorectal cancer surgery. METHODS: This retrospective and comparative study collected data from patients operated on for colorectal cancer between 1999 and 2011 at the Angeles Lomas Hospital, Mexico. RESULTS: A total of 82 patients were included in this study; 47 were operated through an open approach and 35 laparoscopically. Mean operative time was significantly lower in the open approach group (p= 0.008). There were no significant difference between both techniques for intraoperative bleeding (p= 0.3980), number of lymph nodes (p= 0.27), time to initiate oral feeding (p= 0.31), hospital stay (p= 0.12), and postoperative pain (p= 0.19). Procedure-related complications rate and type were not significantly different in both groups (p= 0.44). Patients operated laparoscopically required significantly less analgesic drugs (p= 0.04) and less need for epidural postoperative analgesia (p= 0.01). CONCLUSIONS: Laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Early oncological and surgical results confirm its suitability according to this indication.

Antecedentes: la cirugía laparoscópica para tratar pacientes con cáncer colorrectal ha sido ampliamente aceptada y difundida en todo el mundo. Sin embargo, dependiendo de la experiencia en este abordaje los resultados quirúrgicos y oncológicos a corto plazo pueden variar. En nuestra población existen pocos estudios que comparan los resultados de esta técnica con los de la cirugía abierta. Objetivos: determinar la superioridad de la técnica laparoscópica o abierta en cirugía de cáncer colorrectal. Material y métodos: estudio retrospectivo y comparativo de pacientes operados con técnica abierta o laparoscópica por cáncer de colon y recto entre 1999 y 2011 en nuestro centro. Resultados: se incluyeron 47 pacientes intervenidos de manera convencional y 35 por laparoscopia. El tiempo operatorio fue menor en el grupo de cirugía abierta (p= 0.008). No se encontraron diferencias en: sangrado intraoperatorio (p= 0.3980), número de ganglios resecados (p= 0.27), inicio de la vía oral (p= 0.31), tiempo de estancia hospitalaria (p= 0.12), y dolor referido por el paciente (p= 0.19). En el grupo de cirugía laparoscópica se requirieron menos dosis de analgésicos (p= 0.04) y menor necesidad de catéter epidural para analgesia postoperatoria (p= 0.01). Las tasas de morbilidad (p= 0.44) y mortalidad (p= 0.39) fueron similares en ambos grupos. Conclusiones: la cirugía laparoscópica es equiparable a la técnica abierta en cuanto a estándares oncológicos y resultados técnicos. Este trabajo demuestra que en nuestro hospital la cirugía laparoscópica en pacientes con cáncer de colon y recto es tan segura como la cirugía abierta.