Diagnosis of Sarcopenia in Long-Term Care Homes for the Elderly: the Sensitivity and Specificity of Two Simplified Algorithms with Respect to the EWGSOP Consensus.

OBJECTIVE: To analyze the prevalence of sarcopenia in elderly care homes using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP) and to evaluate the applicability, sensitivity, and specificity of two simplified algorithms that do not include gait speed measurement. DESIGN: Cross-sectional study. SETTING: Long-term care homes. PARTICIPANTS: 249 residents (187 females and 62 males) with a mean age of 84.9 ± 6.7 years (range, 70-106 yrs). MEASUREMENTS: Cognitive impairment was evaluated with the Pfeiffer test, functional capacity with the Barthel index, walking ability by the Functional Ambulation Classification, muscle mass by bioelectrical impedance analysis, muscle strength by handgrip dynamometry and, gait speed over a distance of 4 m. Sarcopenia was assessed using the EWGSOP-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the EWGSOP algorithm using the MacNemar test and obtaining the sensitivity and specificity, kappa coefficient, and area under the receiver operating characteristic curve (AUC). RESULTS: Total or severe dependence was recorded in 67% of the 249 residents, severe or moderate cognitive impairment in 64%, inability to walk in 49%, and capacity to walk only with the aid of an ambulator or two people in 21%. The prevalence of sarcopenia was 63.0% by the EWGSOP algorithm, 62.9% by algorithm A and 63.2% by algorithm B (P = 1.000); 143 participants were diagnosed with sarcopenia by all three methods (P =1.000, K = 1.000). CONCLUSION: Further studies that include residents with functional and/or cognitive impairment are required to validate these results, comparing the diagnostic performance of the EGWSOP algorithm with that of the simplified algorithms validated in the present report.

Ventilación no invasiva con presión de soporte con volumen asegurado en un paciente con enfermedad pulmonar obstructiva crónica (EPOC) agudizada / No disponible

El paciente con EPOC exacerbado y encefalopatía hipercápnica puede plantear serios problemas al tratarle con ventilación mecánica no invasiva (VMNI). Aun no siendo una contraindicación para la VMNI, la falta de colaboración puede ser motivo de fracaso de la técnica. En la actualidad disponemos de modos ventilatorios limitados por presión que aseguran el volumen corriente aportado al paciente. El modo presión de soporte con volumen asegurado (AVAPS) nos ofrece esta opción. Existen pocas publicaciones sobre el uso de esta modalidad ventilatoria en la situación de fallo respiratorio agudo hipercápnico. Presentamos el caso de un paciente con EPOC exacerbado en situación de encefalopatía hipercápnica, tratado con éxito con este modo ventilatorio

The patient with exacerbated COPD and hypercapnic encephalopathy may pose serious problems regarding treatment with non-invasive mechanical ventilation (NIMV). Although no contraindication has been found for NIMV, lack of collaboration may be a reason for failure of the technique. We currently have ventilatory methods limited by the pressure that ensures the tidal volume provided to the patient. The average volume assured pressure support (AVAPS) offers us this option. There are few publications on the use of this ventilatory modality when there is acute hypercapnic respiratory failure. We present the case of a male patient with exacerbated COPD with hypercapnic encephalopathy who was successfully treated with this ventilatory mode

Nutritional status in chronically-ill elderly patients. Is it related to quality of life?

OBJECTIVE: The aim of this study is to assess the quality of life in chronically-ill elderly patients and its relationship with parameters concerning the patients' nutritional status. DESIGN: A cross-sectional study. SETTING: Primary health-care centres in Jaen, Spain. PARTICIPANTS: A total of 168 chronically-ill elderly outpatients aged from 65 to 89 years. MEASUREMENTS: Quality of life was measured using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. A nutritional assessment was undertaken including socio-demographic variables, anthropometric measurements (body-mass index and calf circumference), functional evaluation (Barthel index and Folstein mini-mental status test) and a dietetic questionnaire. The mini-nutritional assessment test was used as an assessment tool to detect nutritional risk. RESULTS: Quality of life in chronically-ill elderly subjects, as determined by the WHOQOL-BREF questionnaire, which diminishes with age, is independent of anthropometric parameters and a statistically significant difference was found between gender, socio-demographic characteristics, functional capacity, nutritional status and the kind of chronic disease (p<0.05). CONCLUSION: The relationship between the quality of life with the patients' socio-demographic characteristics, functional capacity and nutritional status underlines the importance of taking these factors into account in the management of chronically ill patients, especially women.

Interacción paciente-ventilador / Patient-ventilator interaction

La ventilación mecánica es una terapia estándar en pacientes ingresados ​​en la UCI en una situación de insuficiencia respiratoria aguda grave. Además de los trastornos del intercambio gaseoso, la principal indicación para comenzar es la presencia de signos de la fatiga muscular respiratoria. Para la ventilación mecánica es esencial para tener éxito y ventilación del paciente están sincronizadas, es decir, el esfuerzo que hace el paciente de la fuente de inspiración para comenzar a ser reconocido por el ventilador y se entrega rápidamente un flujo de gas, el caudal aportado por el ventilador tendrá que adaptarse al flujo de pacientes durante la entrega de gas y que el ventilador reconocer el cese de la actividad inspiratorio del paciente, completar la entrega de gas y la válvula de espiración se abre para permitir la expiración del paciente. Esta secuencia de acontecimientos que parecen tan lógicas, casi nunca alcanzados en la práctica clínica, siendo comunes en los pacientes ventilados ver algún tipo de asincronía. La presencia de asincronía o desfase patientventilator conduce invariablemente a un aumento del trabajo respiratorio, lo que frustraría el objetivo fundamental de la asistencia respiratoria que no es otro que la disminución del trabajo paciente de la respiración (AU)

Mechanical ventilation is a standard therapy in patients admitted to the ICU in a situation of severe acute respiratory failure. Addition to the disruption of gas exchange, the main indication to start is the presence of signs of respiratory muscle fatigue. For mechanical ventilation is essential to succeed and patient ventilator are synchronized, ie the effort that the patient does the inspiration to start being recognized by the fan and it quickly delivers a gas flow, the flow contributed by the fan will need to adapt to patient flow during the delivery of gas and that the fan recognize the termination of inspiratory activity of the patient, complete the delivery of gas and expiratory valve opens to allow the expiration of the patient. This sequence of events that seem so logical, almost never achieved in clinical practice, still common in ventilated patients see some kind of asynchrony. The presence of mismatch or patient-ventilator asynchrony invariably leads to an increased work of breathing, which will defeat the fundamental objective of ventilatory support which is none other than the decrease of the patient work of breathing (AU)

[Patient-noninvasive mechanical ventilation interaction]. / Interacción paciente-ventilador en ventilación mecánica no invasiva.

Noninvasive mechanical ventilation is one more step in the treatment of patients with acute respiratory failure. In addition to gas exchange disorders, its primary indication to initiate it is the presence of signs of respiratory muscles fatigue. To assure successful mechanical ventilation, the ventilator and patient must be synchronized, that is, the effort the patient makes to start inspiration is recognized by the ventilator and it quickly delivers gas flow, that the flow provided by the ventilator adapts to the flow need of the patient during delivery of gas phase and that the ventilator recognizes the cessation of inspiratory activity by the patient, ends the delivery of gas and opens the expiratory valve to allow the patient expiration. This sequence of events, which seem so logical, is almost never achieved in the clinical practice, commonly observing some asynchrony in ventilated patients. The presence of patient-ventilator asynchrony leads to increased breathing work, which would lead to the failure of the main objective of ventilatory support, that is none other than decline in the patient's respiratory work.

Interacción paciente-ventilador en ventilación mecánica no invasiva / Patient-noninvasive mechanical ventilation interaction

La ventilación mecánica no invasiva constituye un escalón más del tratamiento del paciente en situación de fallo respiratorio agudo. Además de los trastornos del intercambio de gases, la indicación principal para iniciarla la constituye la presencia de signos de fatiga de los músculos respiratorios. Para que la ventilación mecánica tenga éxito es fundamental que ventilador y paciente estén sincronizados, es decir, que el esfuerzo que el enfermo hace para iniciar la inspiración sea reconocido por el ventilador y este entregue rápidamente un flujo de gas, que el flujo aportado por el ventilador se adapte a la necesidad de flujo del paciente durante la fase de entrega de gas, y que el ventilador reconozca el cese de la actividad inspiratoria del paciente, finalice la entrega de gas y abra la válvula espiratoria para permitir la espiración del paciente. Esta secuencia de hechos, que parecen tan lógicos, casi nunca se consigue en la práctica clínica, siendo habitual observar en los pacientes ventilados algún tipo de asincronía. La presencia de desadaptación o asincronía paciente-ventilador conduce invariablemente a un aumento del trabajo respiratorio, lo que hará fracasar el objetivo fundamental del soporte ventilatorio, que no es otro que la disminución del trabajo respiratorio del paciente(AU)

Noninvasive mechanical ventilation is one more step in the treatment of patients with acute respiratory failure. In addition to gas exchange disorders, its primary indication to initiate it is the presence of signs of respiratory muscles fatigue. To assure successful mechanical ventilation, the ventilator and patient must be synchronized, that is, the effort the patient makes to start inspiration is recognized by the ventilator and it quickly delivers gas flow, that the flow provided by the ventilator adapts to the flow need of the patient during delivery of gas phase and that the ventilator recognizes the cessation of inspiratory activity by the patient, ends the delivery of gas and opens the expiratory valve to allow the patient expiration. This sequence of events, which seem so logical, is almost never achieved in the clinical practice, commonly observing some asynchrony in ventilated patients. The presence of patient-ventilator asynchrony leads to increased breathing work, which would lead to the failure of the main objective of ventilatory support, that is none other than decline in the patient’s respiratory work(AU)

Tratamiento de la taquicardia supraventricular fetal precoz complicada con hidrops / Treatment of early fetal supraventricular tachycardia with hydrops

Describimos un caso de taquicardia supraventricular (TPSV) fetal asociado a hidrops grave y polihidramnios diagnosticado en la semana 23. Tras fracasar el tratamiento instaurado con digoxina v.o., se produjo la cardioversión con flecainida v.o. administrada a la madre y la progresiva resolución del hidrops y el polihidramnios. En la semana 34 nació un varón que, tras 6 meses de seguimiento, se encuentra sano sin tratamiento. Al no poder monitorizar en nuestro laboratorio los valores plasmáticos de flecainida se vigiló la posible aparición de toxicidad con electrocardiogramas seriados. Diversas publicaciones recomiendan la flecainida como fármaco de primera elección en caso de TPSV fetal asociada a hidrops. (AU)

Evolución de la capacidad funcional en ancianos institucionalizados tras una intervención nutricional / Evolution of functional capacity in elderly before nutritional intervention

Este trabajo forma parte de un amplio estudio, realizado con el propósito de conocer la influencia del enriquecimiento en calcio de la dieta, a partir de la utilización de leche semidesnatada enriquecida en calcio, sobre la calidad de vida y el estado óseo de una población mayor institucionalizada, que participa en un programa de intervención nutricional de 18 meses de duración. El objetivo de este trabajo es conocer la evolución de la capacidad funcional, física y mental, de dicha población. Se estableció un grupo control, cuya ingesta media de calcio fue de 921ñ128 mg/día y un grupo problema con una dieta similar pero con un aporte mayor de calcio, 1.056ñ 256 mg/día, por la incorporación de leche enriquecida en este mineral. La capacidad física se evaluó mediante el Indice de Katz, que mide el grado de independencia para la realización de las actividades básicas de la vida diaria (ABVD). Para la valoración de la capacidad mental se utilizó la Escala de Cruz Roja. Al inicio del estudio, los resultados de la valoración de capacidad funcional, tanto física como mental, fueron bastante similares en los dos grupos. Tras la intervención nutricional, se observó que la pérdida de capacidad física fue significativamente menor en el grupo problema que en el control (P<0,05), ya que el 91,8 por ciento de los individuos del grupo problema no desciende de categoría, frente al 74,6 por ciento del control. La pérdida de capacidad mental ha sido considerable en ambos grupos, aunque sin diferencias significativas entre ellos. (AU)

Dietary intake of calcium, magnesium and phosphorus in an elderly population using duplicate diet sampling vs food composition tables.

The aim of this study was to estimate the dietary intake of calcium, magnesium and phosphorus in the elderly institutionalised population using duplicate diet sampling and to establish any related difference with the results obtained using food composition tables. The study was carried out on a sample group of 112 subjects in Granada (Spain). 1-week food duplicate samples offered by the elderly were studied. Calcium and magnesium were determined by AAS and phosphorus was determined by spectrophotometry. Anova showed significant differences (p<0.05) in all the minerals analyzed. These results suggest that the use of food composition tables is not suitable to evaluate the calcium, magnesium and phosphorus in nutritional trials. Moreover, the results show clearly that it is essential to consider these differences to establish the adequate intakes of calcium, magnesium and phosphorus for the elderly population in relation to the mineral bone status.

Evolución de salud percibida durante una intervención nutricional en una población anciana institucionalizada / Health evolution perceived during a nutritional intervention in an elderly population institucionalized

El objetivo de este estudio es conocer la evolución de la autopercepción de salud de una población anciana institucionalizada, que participa en un programa de intervención nutricional de 18 meses de duración, cuya finalidad es estudiar la influencia del enriquecimiento en calcio de la dieta sobre el estado óseo de esta población. Se estableción un grupo control, cuya ingesta media de calcio fue de 921 +/- 128 mg/día, y un grupo problema con una dieta similar pero con un aporte mayor de calcio, 1056 +/- 256 mg/día, por la incorporación de leche enriquecida en este mineral. Las cuestines planteadas a los ancianos, al inicio y al final de la intervención, fueron: 1: ¿Se siente limitado en su movilidad? 2: ¿Considera su fuerza muscular normal para su edad?; 3: ¿Tiene dolores "de huesos"?. Los resultados obtenidos indican que la autopercepción de salud de la población anciana estudiada es independiente de la edad, y mejor en los hombres que en las mujeres. Tras la intervención mutricional, se observó que la salud percibida disminuyó menos en el grupo problema que en el control, por lo que al final del estudio, en el grupo problema la autopercepción de salud ósea era mejor que en el grupo control. No obstante, son necesarios estudios más amplios que permitan confirmar estos resultados (AU)

Ventilación mecánica no invasiva. Utilidad clínica enurgencias y emergencias / Non-invasive mechanical ventilation. Clinical utility in urgencias and emergencias

La ventilación mecánica no invasiva (VMNI) es una modalidad ventilatoria en la cual la interfase entre el ventilador y el paciente es una máscara nasal o facial. Esto evita muchas de las complicaciones de la ventilación mecánica convencional ligadas fundamentalmente a la intubación endotraqueal y la sedorrelajación del enfermo. Con VMNI el paciente mantiene intactos los mecanismos de defensa de la vía aérea, el habla y la deglución. La forma de administrar VMNI suele ser mediante presión de soporte durante la inspiración y presión positiva (PEEP) en la espiración (ésta es la modalidad conocida con las siglas BIPAP), o mediante presión positiva continua en la vía aérea (CPAP).Otras formas, como la ventilación con presión positiva intermitente con máscara facial o nasal se puede también emplear, aunque se utiliza menos. La principal indicación la constituye la insuficiencia respiratoria aguda con hipercapnia, aunque también puede ser utilizada en el fracaso respiratorio hipoxémico. En los pacientes con autoPEEP proporciona descanso a la musculatura respiratoria y mejora notablemente el intercambio de gases. Esta forma de ventilación mecánica se está empezando a utilizar en los servicios de urgencia y emergencia, evitando en muchos casos el ingreso del paciente en la unidad de cuidados intensivos y acortando la estancia en el hospital. El médico de urgencias debe conocer esta técnica de terapia respiratoria y administrarla precozmente al paciente en insuficiencia respiratoria, y no esperar a una situación de preintubación (AU)

Serum copper concentration in HIV-infection patients and relationships with other biochemical indices.

We have determined the degree of abnormalities in serum copper concentrations in HIV-seropositive individuals. The study was conducted at the Virgen de las Nieves Universitary Hospital in Granada (Spain). A total of 142 HIV-infected individuals and 84 control subjects were included in the study. The HIV-infected subjects were divided into three groups following the 1993 criteria of the Center for Disease Control and Prevention (Atlanta, USA). Serum copper levels in HIV-infected subjects were significantly higher than those found in control individuals (P < 0.001). Moreover, there were no statistically significant (P > 0.05) differences in serum Cu levels among the three groups considered although serum Cu enhancement occurred at the beginning of the infection process (group A). This increase then remains constant in advanced stages of HIV infection (groups B and C). The mean serum Cu concentration in women (1.41 mg/l) was not significantly higher than that found in men (1.39 mg/l) (P > 0.05). Linear regression analyses between serum copper concentrations and nutritional or biochemical indices (prealbumin, albumin, transferrin, lymphocytes CD4, body mass index, weight) were not statistically correlated (P > 0.05). These data suggest that copper which is an acute phase reactant, may be a useful marker of HIV activity and progression to AIDS as in other chronic infective diseases.

Body composition in institutionalized elderly people in Granada (Spain). Relation with other nutritional parameters.

Anthropometric characteristics and body composition were assessed in a group of 93 institutionalized elderly people, mean age 80.9 +/- 7.6 years, in Granada (Spain). The body composition was measured by the bioelectrical impedance technique. The influence of dietary energy intake, lifestyle, physical activity and health data were studied. Forty-five per cent of the women and 17% of the men were obese (BMI > 30 kg/m2) and 78% of the women and 54% of the men were overweight (BMI > 25 kg/m2). Only 12% of men and 4% of women suffered from undernutrition (BMI < 20 kg/m2). No significant correlations (P > 0.05) were found between BMI or body fat percentage and energy intake. Lifestyle and health data do not affect the BMI or body composition, but a significant negative correlation (P < 0.05) was found between the physical handicap level and the energy intake in all the sample (r = -0.26) and in the women (r = -0.16).

Serum concentration and dietary intake of Zn in healthy institutionalized elderly subjects.

We determined the serum concentrations and dietary intake of zinc, as indicators of Zn status, in 44 healthy institutionalized elderly subjects in Granada (Spain) (mean age 81.4 +/- 7.9 years). Determination of Zn in serum was carried out by electrothermal atomic absorption spectrophotometry. Serum samples had a mean Zn concentration of 10.49 +/- 3.5 mumol/1. No significant differences were found in the serum levels of Zn as regards the sex of the subjects. However, concerning Zn intake, determined by a 7-day weighted food record, a significant statistical difference (P < 0.001) was found between men and women, with mean values of 10.01 +/- 1.76 mg/day and 7.33 +/- 1.33 mg/day, respectively. Application of regression analysis to the serum concentration of Zn and other nutritional parameters shows a statistically significant correlation (P < 0.05) between serum levels of Zn and the body mass index. The lack of statistical correlation between the serum concentration of zinc and its intake indicates that this index cannot be used as an indicator of zinc status in the elderly.

Serum concentration and dietary intake of Mg and Ca in institutionalized elderly people.

We determined the serum levels and the dietary intake of Mg and Ca in 93 institutionalized elderly people (24 men and 69 women) in Granada (Spain). The serum samples had mean concentrations of 21.39 +/- 2.08 mg/l magnesium and 93.39 +/- 9.24 mg/l calcium. No significant differences were found in the serum levels of the two minerals as regards the sex of the subjects. Application of linear regression analysis to the serum Mg and Ca levels showed a statistically significant positive correlation (P < 0.05). A low vitamin D intake of these subjects (51.8% of the recommended dietary allowance) was observed. The intakes of Ca and Mg correlated positively together, as well as with the intakes of energy, protein, fibre (in the case of Mg only), iron and phosphorus (P < 0.05). The Ca and energy intake were adequate to their current recommendations, as too was the Ca:P ratio, whereas the diet had a poor supply of fibre, vitamin D and Mg.

Serum copper in institutionalized elderly subjects: relations with dietary intake of energy, specific nutrients and haematological parameters.

The concentrations of serum copper were determined as an indicator of corporal status of Cu and its relation to aging in 93 institutionalized elderly subjects (24 men and 69 women) in Granada (Spain). We found that aging does not affect serum Cu levels in the two age groups included in the study: Group I < 80 years and Group II > or = 80 years. Application of linear regression analysis to the serum Cu levels and the intake of energy, fibre, iron and magnesium showed a statistically significant negative correlation (P < 0.05) among them in all the subjects. However, no correlation was observed when the serum Cu levels were related to the intake of zinc or vitamin C. Therefore, at the daily intake levels of these two nutrients, they do not interfere in the absorption of copper and hence do not affect the corporal status of this element in the elderly. Blood erythrocyte and haemoglobin concentrations do not show any significant correlation with the serum Cu concentrations (P > 0.05).

Nutritional status of vitamin A and E in institutionalized elderly people in Granada (Spain).

A study has been carried out on the nutritional status of vitamin A and E in 93 institutionalized elderly people in Granada (Spain) by studying their vitamin intake and the serum values of retinol and alpha-tocopherol. The influence of lipid intake and lipids in plasma has been also discussed. The vitamin A intake is higher than the recommended amount and represent 209% DR in men and 217% DR in women. The vitamin E intake is deficient in 33% of the men and 27% of the women. The serum values of retinol indicate that 11% of the women have a deficiency (< 0.7 microM), and that 39% of the men and 32% of the women have low values (0.7-1.22 microM). As for the serum values of alpha-tocopherol, 6% of the women have deficient values, and 82% of the men and 37% of the women have low values (11.6-23.2 microM).