Respuesta metabólica en la malnutrición y enfermo crítico. Controles bioquímicos / Metabolic response in malnutrition and the critically ill patient. Biochemical controls

La pérdida de tejido durante el ayuno se ha demostrado que está involucrado en la oxidación de los depósitos de combustibles con el fin de generar energía para mantener las actividades metabólicas necesarias para la vida. Los niños sometidos a estrés aumentan los requerimientos de nutrientes a la vez que disminuye su capacidad para utilizar los nutrientes suministrados por la vía parenteral. Las hormonas aumentaran o disminuirán dependiendo del grado de malnutrición y de adaptación. El proceso adaptativo responde al grado existente de malnutrición y puede ser alterada por la infección. Los elementos trazas, realiza importantes funciones en la salud y resistencia a la enfermedad. El objetivo de los parámetros bioquímicos nutricionales son: 1. Identificar pacientes que se beneficiaran de la terapia nutricional. 2. Detectar y tratar deficiencia de micronutrientes. 3. Establecer valores basales los cuales medirán la efectividad de la intervención nutricional. Los test de laboratorio que pueden reflejar malnutrición proteica-energética son: proteínas sóricas, paramétros de función inmune. Los niveles de leptina reflejan los depósitos de grasa (AU)

[Pattern of blood levels of erythropoietin and proinflammatory cytokines in patients with anemia of chronic disorders secondary to infection]. / Perfil de los niveles séricos de eritropoyetina y citocinas proinflamatorias en pacientes con anemia de trastornos crónicos secundaria a infección.

OBJECTIVE: To evaluate the pattern of erythropoietin (EPO) and some proinflammatory cytokines in the anemia of chronic disorders (ACD) secondary to infection. METHODS: Sequential determination in serum of interleukin-1 beta (IL-1 beta), necrosis tumoral factor alpha (TNF-alpha), gamma interferon (IFN-gamma), interleukin-6 (IL-6), and erythropoietin (EPO) in 25 patients with chronic bacterial infectious diseases and ACD criteria. We evaluated the relationship of these mediators with the anemia and the iron metabolism. RESULTS: Serum EPO levels significatively decreased compared with initial values, and the last control was in normal rank (18.04 +/- 19.10 vs. 8.56 +/- 4.72 UI/mL; p < 0.001; normal rank: 4-15 mUI/mL). In the first control, there was a negative and non significative correlation between the EPO levels and the hemoglobin concentration (r = -0.115, NS), reaching significance in the last control (r = -0.446; p < 0.05). There was negative correlation between the hematocrit and TNF-alpha levels (r = 0.467; p < 0.05) and between the haemoglobin values and the log of serum TNF-alpha (r = 0.424; p < 0.001). An inverse correlation between the IL-6 levels and both, the hemoglobin concentration and the serum iron was found, and there was a direct correlation between this cytokine values and the EPO levels. CONCLUSIONS: Blunted response of erythropoietin and the action of TNF may contribute to the pathogenesis of ACD secondary to infection. Positive correlation between IL-6 and EPO suggest a proerythropoietic action of IL-6 in response to the anemia.

Study of gastrointestinal polypeptides controlling gastric acid secretion in patients with primary antibody deficiency.

BACKGROUND: gastric abnormalities are a common feature in patients with primary antibody deficiency. The most important problem is the high incidence of stomach cancer found in these patients. Chronic atrophic gastritis with pernicious anemia is also a common finding that predisposes to gastric adenocarcinoma. The aim of the present study was to identify factors predictive of high risk for developing gastric cancer in patients with primary antibody deficiency. PATIENTS AND METHODS: we studied gastric hormones (gastrin, somatostatin and gastrin-releasing peptide, GRP) in 47 patients (23 children and 24 adults) with primary antibody deficiency. In accordance with the World Health Organization (WHO) classification, patients were diagnosed as having X-linked agammaglobulinemia (Bruton disease) in 13 cases, common variable immunodeficiency in 28, and hypogammaglobulinemia with hyperIgM in 6. Gastric biopsy was performed in 22 patients (16 children and 6 adults). Hormone determinations were carried out by radioimmunoassay. RESULTS: baseline serum gastrin levels were normal or increased compared with controls, but the response to stimulation with a hyperproteic diet was delayed in 18 patients and lower than in controls in 7. In 4 adult patients, all with pernicious anemia, gastric biopsy revealed chronic atrophic gastritis involving the stomach corpus and antrum (type B gastritis). The absence of a normal response of gastrin secretion to stimulation with a hyperproteic diet may be explained by this finding. Serum somatostatin and GRP levels were higher than in controls. No correlations were found between these findings and patient age, type of immunodeficiency or duration of clinical manifestations.

Study of gastrointestinal polypeptides controlling gastric acid secretion in patients with primary antibody deficiency.

BACKGROUND: Gastric abnormalities are a common feature in patients with primary antibody deficiency. The most important problem is the high incidence of stomach cancer found in these patients. Chronic atrophic gastritis with pernicious anemia is also a common finding that predisposes to gastric adenocarcinoma. The aim of the present study was to identify factors predictive of high risk for developing gastric cancer in patients with primary antibody deficiency. PATIENTS AND METHODS: We studied gastric hormones (gastrin, somatostatin and gastrin-releasing peptide, GRP) in 47 patients (23 children and 24 adults) with primary antibody deficiency. In accordance with the World Health Organization (WHO) classification, patients were diagnosed as having X-linked agammaglobulinemia (Bruton disease) in 13 cases, common variable immunodeficiency in 28, and hypogammaglobulinemia with hyperIgM in 6. Gastric biopsy was performed in 22 patients (16 children and 6 adults). Hormone determinations were carried out by radioimmunoassay. RESULTS: Baseline serum gastrin levels were normal or increased compared with controls, but the response to stimulation with a hyperproteic diet was delayed in 18 patients and lower than in controls in 7. In 4 adult patients, all with pernicious anemia, gastric biopsy revealed chronic atrophic gastritis involving the stomach corpus and antrum (type B gastritis). The absence of a normal response of gastrin secretion to stimulation with a hyperproteic diet may be explained by this finding. Serum somatostatin and GRP levels were higher than in controls. No correlations were found between these findings and patient age, type of immunodeficiency or duration of clinical manifestations.

[Primary saccharose-isomaltose deficit: a 20-year case load]. / Déficit primitivo de sacarasa-isomaltasa: observaciones en veinte años.

In the last twenty years we have diagnosed 9 cases of congenital sucrase-isomaltase deficiency. In all the cases the diagnosis was made before 9 months of age and was confirmed by quantitative determination of sucrase-isomaltase activity in jejunal mucosal homogenates. Malnutrition and dehydration were frequent findings. In 3 cases there was clinical intolerance to dextrinomaltose and to glucose polymers. In the 6 cases in which were performed, abnormal breath H2 test after an oral sucrose load was found. Lactase activity was above the mean in all cases and an important decrease of maltase activity was demonstrated. The enzymatic deficiency persisted even though the clinical tolerance to sucrase improved with age.

[Experience with the impression cytology test for detecting vitamin A deficiency in children]. / Nuestra experiencia con el test de impresión citológica para detectar deficiencia de vitamina A en niños.

Impression cytology has been suggested as a relatively simple, cheap, practical and non invasive technique for documenting physiologically significant vitamin A deficiency. The vitamin A status of 41 patients was evaluated by serum retinol concentration by high power liquid chromatography (HPLC) and conjunctival impression cytology was performed on each child. All children with normal vitamin A status had normal conjunctival impression cytology. The sensibility of this method was 100%. However, in the 8 vitamin A deficient patients by impression cytology, only 6 of them showed low serum vitamin A levels. Impression cytology appears to detect preclinical vitamin A deficiency that this technique may by of potential usefulness as a screening tool for preclinical vitamin A deficiency populations.

[Disaccharidases: 25 years later]. / Disacaridasas: veinticinco años después.

This report shows, that the major factors involved were histological damage of the mucosa and the etiological diagnosis. Other factors (bacterial overgrowth, malnutrition, etc.), added to the previous referred, increase the oligosaccharidases alteration, yielding statistically significant values referring to healthy subjects. The oligosaccharidases activity were significantly decreased to referring to healthy subjects (p less than 0.001) in the IC1.o and 2.o that have not histological damage, in the DGR, IPLV and coeliac disease with AS of the mucosa and in the SPG that present APM. On the other hand, the analytical methodology with its different biochemical basis could evidence very various values and there is always important to remark the reference normal values in each laboratory.