Filnut-escala: justificacion y utilidad en el cribaje de riesgo por desnutricion dentro del proceso infornut / Filnut-escala: justificacion y utilidad en el cribaje de riesgo por desnutricion dentro del proceso infornut

Objetivos Justificar la asignacion de una puntuacion de riesgo de desnutricion para proteinas totales inferiores a 5g/dl y proponer una escala de puntuacion para nuestro filtro (FILNUT-Escala). Analizar el resultado del test de cribaje MUST (Malnutrition Universal Screening Tool) practicado en positivos al filtro nutricional Filtro de Nutricion y evaluar la utilidad de dicho test en esta poblacion. Metodos Busqueda en base de datos de laboratorio an ̃os 2004–2007) de peticiones analíticas en que había determinación de proteinas totales y albuimina, o colesterol total,y aquellas que tengan resultados para esos 3 parámetros más el recuento de linfocitos. Sobre ello se impuso la limitación a las proteínas totales de ser menores de 5 g/dl, dejando libre el resultado del resto de parámetros. Se analizaron las curvas de distribución correspondientes los valores de albumina y colesterol; igualmente procedio; tras establecerlas puntuaciones Control Nutricional (CONUT) correspondientes a las muestras con lospara ́metros necesarios. En el periodo septiembre 07-enero 08 se practica MUST a todos los positivos Filtro de Nutrición y se analiza la correspondencia de grados de riesgo. Resultados: Para proteinas totales inferiores a 5 g/dl, en el 95% de los de los casos (n=1.176) los valores de albúmina estarán entre 0,98-2,94 g/dl; por tanto se obtendrían puntuaciones CONUT por albuúmina de 4 o 6. En cuanto al colesterol total, (n=761) el 89,1% de las muestras queda por debajo de 180 mg/dl; correspondiéndose con 1 o 2 puntos. En el 98,79 % de los casos (n=490) que tenían los 4 parámetros la puntuación CONUT fue Z5, que se catalogaría de riesgo de medio o alto. Durante el periodo en estudio, el 100 % de los pacientes de riesgo medio o alto en FILNUT-Escala (n=568) dieron riesgo MUST: 421 (74,1%) alto y 147 (25,9%) medio (AU)

Objectives To offer a rationale for assigning a minimum score for risk of malnutrition for total proteins lower than 5g/dl and a scoring scale for our filter (FILNUT-Scale); and to analyse results of the MUST screening test performed on positive scores in the FILNUT nutritional filter and assess usefulness of said test in this population. Methods We searched the laboratory database for laboratory test orders (dated between 2004 and 2007) for which total proteins and albumin or cholesterol levels were determined, and we identified those with results for the above three parameters plus lymphocyte count. A limit (less than 5g/dl) was placed on the total protein level and the results for other parameters were not limited. Distribution curves for albumin and cholesterol were analysed. The same protocol was followed after establishing the CONUT score for each sample with the necessary parameters. From September 2007 to January 2008, the MUST test was performed on all FILNUT positives and we analysed how the degrees of risk corresponded. Results In 95% of the cases in which total proteins are lower than 5g/dl (n=1,176), albumin values are between 0.98 and 2.94g/dl, resulting in CONUT scores of 4 or 6 for albumin. Regarding total cholesterol, (n=761) 89.1% of the samples are lower than 180mg/dl, which accounts for one or two points in the score. In 98.79 % of the cases (n=490) that presented all four parameters, CONUT score was ¡Ý5, which could be classified as medium or high risk. During the study period, 100% of the patients identified as medium or high risk by the FILNUT-Scale (n=568) tested as at-risk by MUST: of these, 421 (74.1%) were (..) (AU)

[Filnut-scale: rationale and use in screening for malnutrition risk within the infornut process]. / Filnut-escala: justificación y utilidad en el cribaje de riesgo por desnutrición dentro del proceso infornut.

OBJECTIVES: To offer a rationale for assigning a minimum score for risk of malnutrition for total proteins lower than 5g/dl and a scoring scale for our filter (FILNUT-Scale); and to analyse results of the MUST screening test performed on positive scores in the FILNUT nutritional filter and assess usefulness of said test in this population. METHODS: We searched the laboratory database for laboratory test orders (dated between 2004 and 2007) for which total proteins and albumin or cholesterol levels were determined, and we identified those with results for the above three parameters plus lymphocyte count. A limit (less than 5g/dl) was placed on the total protein level and the results for other parameters were not limited. Distribution curves for albumin and cholesterol were analysed. The same protocol was followed after establishing the CONUT score for each sample with the necessary parameters. From September 2007 to January 2008, the MUST test was performed on all FILNUT positives and we analysed how the degrees of risk corresponded. RESULTS: In 95% of the cases in which total proteins are lower than 5g/dl (n=1,176), albumin values are between 0.98 and 2.94g/dl, resulting in CONUT scores of 4 or 6 for albumin. Regarding total cholesterol, (n=761) 89.1% of the samples are lower than 180mg/dl, which accounts for one or two points in the score. In 98.79 % of the cases (n=490) that presented all four parameters, CONUT score was >/=5, which could be classified as medium or high risk. During the study period, 100% of the patients identified as medium or high risk by the FILNUT-Scale (n=568) tested as at-risk by MUST: of these, 421 (74.1%) were at high risk and 147 (25.9%) were at medium risk. CONCLUSIONS: Total proteins lower than 5g/dl determine a medium or high risk of malnutrition where a complete nutritional screening profile is lacking. This is why it should be included in the FILNUT-Scale with a score of five points. Performing the MUST test on patients with five or more points is efficient and provides clinical data needed for a complete assessment.

Estudio de la evolución del síndrome de temor a caerse entre pacientes mayores con mareos, caídas y síncopes / Study of the fear of falling in elderly patients with dizziness, syncope and falls

Objetivos: estudiar la evolución al año del síndrome de temor a caerse (STAC) en población de mayores con mareos, caídas y síncopes. Analizar las variables recogidas al ingreso que se relacionan con el STAC en ese momento y al año. Métodos: estudio prospectivo de cohortes. 66 pacientes mayores estudiados en consulta específica de mareos, caídas y síncopes, clasificados en un grupo con STAC (n = 31) y sin STAC (n = 35) en 1 año, desde abril 2000 a diciembre de 2001. Criterio de exclusión: no realizar todas las pruebas y pérdidas durante el seguimiento. El protocolo incluye historia clínica, exploración física, mesa basculante y exploraciones complementarias rutinarias y/o específicas según el caso. El STAC se determinó mediante la pregunta: ¿tiene miedo a caerse? Resultados: de los pacientes con STAC al comienzo, éste desapareció en 14 (45,2%), mientras que de los que no lo tenían, apareció en 5 (14,3%), (p = 0,06). Las variables asociadas con STAC al ingreso tras análisis multivariante fueron tomar benzodiacepinas, mareos de repetición, cifras séricas de urea más elevadas y el descenso de la presión arterial sistólica (PAS) ortostática. Las asociadas con STAC al año fueron: tomar inhibidores de la enzima de conversión de la angiotensina (IECA), maniobra de Hallpike positiva y caída de presión arterial diastólica (PAD) con headup- tilt-test. El modelo incluye también tomar benzodiacepinas y reproducción de síntomas con el movimiento del cuello. Conclusiones: el STAC disminuyó a casi la mitad después de 1 año, pero aparece en pacientes que no lo tenían; no se asocia con las caídas al ingreso ni al final del estudio. Al año de seguimiento, se asocia con la ingesta de determinados fármacos así como con variaciones en la mesa basculante (AU)

Aims: to study fear of falling (FOF) syndrome at 1 year in a population of elderly individuals referred to a specific outpatient clinic for dizziness, falls and syncope. To analyse which variables gathered at the beginning of the study were related with FOF at that time and 1 year later. Methods: a prospective cohort study was performed from April 2000 to December 2001. Sixty six elderly individuals referred to a specific outpatient clinic for dizziness, falls and syncope were classified in a group with FOF (n = 31) or a group without FOF (n= 35). Patients without all the tests and those lost to follow-up were excluded. The protocol included medical history, physical examination, tilt test and routine or specific complementary tests, when deemed necessary. FOF was determined through the direct question: Are you afraid of falling? Results: FOF disappeared in 14 patients (45.2%) who had this syndrome at the beginning of the study and developed in five patients (14.3%) who did not (p = 0.06). After multivariate analyses, the variables associated with FOF at the beginning of the study were: taking benzodiazepines, recurrent dizziness, higher blood urea levels and a drop in systolic blood pressure with upright position. The variables significantly associated with fear of falling 1 year later were: angiotensin-converting enzyme inhibitors, positive Hallpike’s manoeuvre and a drop in diastolic blood pressure with the head-up-tilt test. The model also included taking benzodiazepines and symptom reproduction with movement of the neck. Conclusions: at 1 year, FOF syndrome decreased in nearly half the patients who had this syndrome at the beginning of the study but developed in other patients without this syndrome at that time. No association was found with falls at the beginning or end of the study. At 1 year of follow-up, FOF was associated with intake of certain medications and data from the tilt test (AU)

Motility abnormalities in esophageal body in GERD: are they truly related to reflux?

BACKGROUND: Esophageal motility abnormalities have been observed in patients with gastroesophageal reflux disease. GOALS: The aim of the present study was to determine if esophageal motor disorders in patients with a positive response to the omeprazole test are related to the existence of reflux or they are concomitant findings. STUDY: A 24-hour pH monitoring and a stationary manometry were performed on 128 patients: 49 of them had normal manometry, 31 hypotensive lower esophageal sphincter, 29 motor disorder in esophageal body, and 19 hypotensive lower esophageal sphincter and motor disorder in esophageal body. RESULTS: We found an association between the presence of abnormal reflux and motor disorder in esophageal body (chi test; P < 0.05). However, ineffective esophageal motility was the disorder most strongly related to reflux, whereas the hypercontractile disorders were not clearly attributed to it. CONCLUSIONS: Esophageal manometric abnormalities should be considered cautiously before considering a motor disorder as a consequence of abnormal reflux.

Situación funcional después de fractura de cadera en el anciano / Elderly persons´ functional situation after hip fracture

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Utilidad del cociente psa-l/psa-t y la dpsa para la discriminación entre hipertrofia benigna de próstata y cáncer de próstata / Usefulness of free/total prostate-specific antigen (PSA) ratio and PSA density to enhance differentiation of benign prostatic hyperplasia from prostate cancer

OBJETIVO: Investigar la rentabilidad diagnóstica del cociente PSA-L/PSA-T y densidad de PSA, en el diagnóstico del cáncer de próstata en pacientes con cifras de PSA-T en la zona gris de decisión diagnóstica entre 4-10 ng/ml. Establecer el punto de corte para hacer el diagnóstico diferencial entre enfermedad benigna de la próstata y cáncer, con el fin de evitar biopsias innecesarias. MÉTODO: Estudio prospectivo realizado a 136 varones de edades comprendidas entre 54 y 87 años (media 70,6). Los pacientes acuden a la consulta de urología por síntomas urinarios. Se les solicita una prueba de PSA-T, PSA-L, cociente de PSA-L/PSA-T, se realiza tacto rectal y ecografía transrectal con biopsia en octantes, se mide el volumen de la próstata y se calcula la densidad de PSA. A 113 pacientes se solicita estudio anatomopatológico, encontrándose 82 casos de HBP y 31 de carcinoma de próstata en diferentes estadios. RESULTADOS: No se encontraron diferencias significativas entre el grupo de pacientes con HBP y CAP para el PSA-T, PSA-L, cociente PSA-L/PSA-T ni tacto rectal. La DPSA y el volumen de la próstata son significativamente diferentes p < 0,05 en los pacientes con HPB y CAP. Para una sensibilidad del 94% (78,5-99), el punto de corte para el cociente de PSA sería de 0,28 y la especificidad del 11% (5,2-19,8). Con una sensibilidad del 96,2% (80,3-99,4) el punto de corte obtenido para DPSA es de 0,109 y la especificidad de 25% (15,5-36,6).CONCLUSIONES: En pacientes con cifras de PSA-T entre 4 y 10 ng/ml el cociente PSA-L/PSA-T no tiene ventajas sobre el PSA-T en el diagnóstico precoz del cáncer de próstata. La DPSA puede mejorar la especificidad, sin comprometer el diagnóstico de CAP (AU)

[Usefulness of free/total PSA ratio and PSA density in distinguishing benign prostatic hypertrophy from prostatic cancer]. / Utilidad del cociente PSA-L/PSA-T y la DPSA para la discriminacion entre hipertrofia benigna de próstata y cáncer de próstata.

OBJECTIVE: To investigate the clinical significance of the free-to-total prostate-specific antigen ratio (f/tPSA) and PSA density (PSAD) for prostate cancer detection in patients with intermediate tPSA levels (4-10 ng/ml). To establish a cutoff to discriminate between benign prostatic disease (BPH) and prostate cancer (CaP), avoiding unnecessary biopsies. METHODS: This prospective study included 136 men, aged between 54 and 85 (mean 70.6) years old. Urinary tract symptoms were present in these patients. Serum samples were obtained to measure tPSA, fPSA, and f/tPSA; digital rectal examination and transrectal ultrasound eight-sector biopsies were performed. Prostate volume was measured and PSAD calculated. The pathologic study, carried out in 113 patients, showed 82 with BPH and 31 with prostate cancer in various stages. RESULTS: There were no significant differences between patients with BPH and CaP when comparing tPSA, fPSA, f/tPSA or digital rectal examination. PSAD and prostate volume were significantly different in patients with BPH and CaP. With a sensitivity of 94% (78.5-99), the f/tPSA cutoff was 0.28 with a 11% (5.2-19.8) specificity. With a sensitivity of 96.2% (80.3-99.4) cutoff for PSAD was 0.109 and specificity 25% (15.5-36.6). CONCLUSIONS: In patients whose tPSA level is between 4 and 10 ng/ml, f/tPSA has no advantages over tPSA measurement for early detection of prostate cancer. DPSA can improve specificities, without compromising the detection of CaP.

[Thyroid nodule disease in a previously endemic goiter area]. / Estudio de la enfermedad nodular tiroidea en una zona previamente bociógena.

We conducted a 6-year study of 110 patients with thyroid nodular disease in a previously goitrogenic area. The aim of the present work was to establish its incidence, to determine if multinodular goiter and autonomous thyroid nodule have the same analytical and clinical behaviour and to verify if the iodation campaign had resulted in the development of thyrotoxicosis induced by iodine. The results demonstrated an incidence of 0.4 per 1,000 population and per year. The two modalities of thyroid nodular disease did not present any clinical and analytical differences. 58.2% of the patients had hyperthyroidism, 53.1% of which were T-4 thyrotoxicosis, 12.5% T-3 thyrotoxicosis and 34.4%, subclinical hyperthyroidism. 8.2% of the patients under study had hyperthyroidism induced by iodine (Jod Basedow), with iodide excretion values higher that 3 standard deviations with respect to the population average (> 220 micrograms/g creatinine).