[Artificial nutrition in hematopoietic stem cells transplantation]. / Nutrición artificial en el trasplante de células precursoras hematopoyéticas.

Patients submitted to hematopoietic stem cells transplantation (HSCT) have an increased risk for having hyponutrition, both in the phase prior to transplantation and after this one. The indication of specialized nutritional support is common in allogenic HSCT, whereas patients submitted to auto-HSCT need it in the presence of complications that compromise an adequate nutrients intake. Enteral nutrition through a nasogastric tube has difficulties in these patients; the presence of mucositis delays the indication for enteral nutrition, which usually is poorly tolerated. Thus, frequently parenteral nutrition needs to be used as the route for nutritional support. The use of specific substrates, such as glutamine, is a controversial issue.

[Cardiac Tamponade after on a guide changing of a central venous catheter for total parenteral nutrition. Could it be avoided?]. / Taponamiento cardíaco tras cambio de catéter venoso central, sobre guía, para nutrición parenteral total. Lo podemos evitar?

Catheterization of central veins is a routine process, especially in severely-ill patients. It is a technique associated with multiple potential complications, fortunately infrequent, depending on the skill with which it is performed. Cardiac blockade is one of these infrequent complications with a high mortality. We describe a case in which suspicion, early diagnosis, and immediate manipulative treatment allowed a successful recovery of the patient. In addition, the literature is reviewed and possible mechanisms involved in these episodes are discussed.

Taponamiento cardíaco tras cambio de catéter venoso central, sobre guía, para nutrición parenteral total. ¿Lo podemos evitar? / Cardiac blockade after changing central venous catheter, on a guide, for total parenteral nutrition. Can it be avoided?

La cateterización de venas centrales es un proceso rutinario, sobre todo en enfermos graves. Es una técnica en la que están descritas múltiples complicaciones, afortunadamente no muy frecuentes, y en relación con la pericia del que la realiza. El taponamiento cardíaco es una de estas infrecuentes complicaciones, con muy elevada mortalidad. Describimos un caso en el que por sospecha, diagnóstico precoz y tratamiento inmediato se siguió de éxito en las maniobras de recuperación del enfermo. Asimismo, se revisa la literatura y se analizan los posibles mecanismos de estos episodios (AU)

Catheterization of central veins is a routine process, especially in severely-ill patients. It is a technique associated with multiple potential complications, fortunately infrequent, depending on the skill with which it is performed. Cardiac blockade is one of these infrequent complications with a high mortality. We describe a case in which suspicion, early diagnosis, and immediate manipulative treatment allowed a successful recovery of the patient. In addition, the literature is reviewed and possible mechanisms involved in these episodes are discussed (AU)

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Nutrición enteral domiciliaria. informe anual 1999. Grupo NADYA-SENPE / Enteral nutrition at home. annual report 1999. NADYA-SENPE group

Objetivo: Durante 1999, como en años anteriores, el Grupo NADYA-SENPE ha realizado el registro anual de pacientes con Nutrición Artificial Domiciliaria, con el objetivo de mantener actualizados los conocimientos que sobre esta terapéutica tenemos. En el presente trabajo analizamos los resultados del sexto Registro Nacional de pacientes en tratamiento con Nutrición Enteral Domiciliaria correspondiente al año 1999, en el que han colaborado veintitrés centros de la red sanitaria nacional.Material y Métodos: La información se ha recogido en un cuestionario cerrado incluido en nuestra pagina web (www.nadya-senpe.com). El formulario incluye, además de los datos epidemiológicos, la indicación que motivó la nutrición, tratamiento nutricional, vía de acceso, complicaciones y hospitalizaciones, seguimiento del tratamiento, calidad de vida y evolución de los pacientes. La información total es procesada por el equipo coordinador. La Unidad de Nutrición del Hospital Universitario La Paz de Madrid, ha actuado como coordinador del grupo.Resultados: Durante el año 1999 han seguido tratamiento con Nutrición Enteral Domiciliaria (NED) 2262 pacientes en los veintitrés centros colaboradores. La edad media ha sido de 63,6 ñ 19,67 (H: 57,6 por ciento; M: 42,3 por ciento). El tiempo medio con tratamiento nutricional es de 5,89 ñ 4,25 meses. Las alteraciones neurológicas (37,5 por ciento) y las neoplasias (36,8 por ciento) han sido las indicaciones de NED más frecuentes. La mayoría de los pacientes utilizan la vía oral (50,7 por ciento), la utilización de vías artificiales es menos frecuente, la SNG es utilizada en el 27,9 por ciento y la PEG en un 12,7 por ciento. Las formulas polimericas son las mas empleadas (87,7 por ciento). Se contabilizaron 1403 episodios de complicaciones, lo que representa 0,62 complicac./paciente/año, el 40,8 por ciento gastrointestinales (0,26 complicaciones/paciente/año), el 18,7 por ciento complicaciones mecánicas, solo se contabilizaron 9 casos de broncoaspiración. En 836 ocasiones (0,38 hospitaliz./paciente) fue necesario hospitalizar al paciente, aunque debido generalmente a causas no asociadas con la nutrición (86,1 por ciento).Al finalizar el año el 51,4 por ciento de los pacientes continuaban con el soporte nutricional Conclusiones: La nutrición enteral domiciliaria es una técnica segura en pleno desarrollo en nuestro país.Requiere la existencia de equipos de nutrición adecuadamente dotados así como la colaboración de los servicios de atención primaria y la adecuada formación de familiares y pacientes. Es indispensable profundizar en el desarrollo y aplicación de vías clínicas que contemplen una metodología clara y concisa que abarque todos los aspectos relativos a la nutrición. La nutrición es, en si misma, una alternativa terapéutica independientemente de si el acceso se realiza por una vía natural o artificial. Es necesario que los responsables administrativos se den cuenta de que una nutrición adecuada de los pacientes redunda en una mejoría de su estado general, un tiempo de evolución mas corto y, por lo tanto, en una disminución de los costes (AU)

Goal: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. Material and Methods: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients’ quality of life and progress. All of the data are processed by the coordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. Results: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 ( 19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 ( 4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support Conclusions: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs (AU)

The use of sticky ovitraps to estimate dispersal of Aedes aegypti in northeastern Mexico.

A newly designed sticky ovitrap was used to determine the dispersal flight of the dengue vector Aedes aegypti in northeastern Mexico. Unfed marked females were released in the field where 100 sticky ovitraps had been positioned within a circular area 300 m in diameter. Success of this method was represented by a 7.7% (31 of 401) recapture rate during a 19-day sampling period. The maximum dispersal distance was 120 m with a mean of 30.5 m +/- 4.5 SD. Drastic hot and dry climatic conditions at the study site may have restricted mosquito dispersal. As expected, mostly gravid female mosquitoes were captured in the ovitraps. The method of sticky ovitraps proved to be useful and inexpensive for Ae. aegypti dispersal studies in Latin American countries. In addition to the marked mosquito populations, unmarked Ae. aegypti, Culex sp., roaches, and even small vertebrates such as lizards and sparrows were found glued to the sticky ovitraps. Based on these studies, the use of sticky ovitraps is recommended for Ae. aegypti dispersal studies, specially for dengue control programs in developing countries.

Bednet impregnation for Chagas disease control: a new perspective.

BACKGROUND: To determine the efficacy and acceptability of deltamethrin-impregnated bednets in controlling Chagas disease in South America. METHODS: In three endemic departments of Colombia, a qualitative study on people's knowledge about Chagas disease, vectors, preventive measures and their willingness for collaboration in control operations was undertaken. Additionally, in an entomological study with 100 laboratory-bred Chagas vectors (Rhodnius prolixus), vectors were released for 5 nights (20 each night) in an experimental room, with the human bait protected for one night by an unimpregnated and for four nights by a deltamethrin-impregnated bednet (13 mg/m2). Vectors were stained with fluorescent powder for observation, collected after 10 h exposure in the experimental room and observed for a further 72 h. RESULTS: The study population did not know anything about Chagas disease, but believed the vector to transmit cutaneous leishmaniasis. Therefore willingness to take part in control operations was high. The experimental hut study showed a vector mortality rate of 95% in a room with impregnated nets and of 10% in a room with unimpregnated nets. CONCLUSION: This study opens a new perspective for Chagas disease control in integrated vector borne disease prevention programmes.

Insecticide-treated materials for malaria control in Latin America: to use or not to use?

Studies on the protective efficacy of insecticide-treated materials (ITMs) in Plasmodium vivax endemic areas of Latin America have not yielded sufficient evidence for recommendation of their extensive use in the region. Therefore 2 randomized community trials have been conducted on the Pacific Coast of Nicaragua which analysed the minimum coverage of ITMs needed to be effective against malaria. For the characterization of the study area, epidemiological and entomological baseline surveys and household interview surveys were undertaken. Thereafter the communities were paired (6 pairs in the 1st year and 13 pairs in the 2nd year) according to 4-monthly reported malaria incidence rates, population size and bednet coverage, and then randomly allocated to intervention and control groups. In the intervention groups, bednets were impregnated with lambdacyhalothrin; in the control groups, people received general health education. Anopheles albimanus was found to be the main vector with marked indoor biting behaviour late in the evening. P. vivax (99%) clearly outweighed P. falciparum (1%) with low parasite prevalence rates in the asymptomatic general population (8%) and low parasite densities. The protective efficacy of ITMs varied according to the coverage achieved: protective efficacy was 68% in communities with an average ITM coverage of 50% (10 pairs); 31% in communities with an ITM coverage of 16-30% (4 pairs); and no protective efficacy in communities with ITM coverage below 16% (5 pairs). The comparison with other P. vivax endemic areas in Latin America showed that the vector's late biting behaviour and the indoor preference (where ITMs have a repellent effect) probably led to the favourable results in the study. In malaria endemic areas of Latin America, where P. vivax is predominant, studies on vector behaviour should be conducted in order to predict the impact of ITMs on malaria transmission.

[Hydropneumothorax secondary to enteral feeding tube]. / Hidroneumotórax secundario a sonda de nutrición enteral.

The placement of naso-gastric tubes is a routing procedure in Intensive Care Units. Their basic indications are the aspiration of gastric contents, as well as the enteral nutrition of the patients. Despite this being a simple technique, it is not exempt of complications, some of which are very serious, which should be kept in mind in order to prevent them and to diagnose them early. We describe a case of hydro-pneumothorax, secondary to the placement of a naso-gastric tube for enteral nutrition.

[Influence of the nutritional status on the characteristics of the ascitic fluid in alcoholic hepatic cirrhosis]. / Influencia del estado nutricional sobre las características del líquido ascítico en cirrosis hepática alcohólica.

A common characteristic of the patients with alcoholic liver cirrhosis is malnutrition, which in turn favors a large number of complications. The development of spontaneous bacterial peritonitis is partly related to the low concentrations of total proteins an C3 in the ascitic liquid. The objective of the present study has been to analyze the influence of the nutritional state on the characteristics of the ascitic liquid, before and after three weeks of an enteral nutritional support supplement, in a group of patients with alcoholic liver cirrhosis. On the whole, 38 patients were studied, who received a standard diet of 45 grams of protein and 2308 calories per day, additionally giving 27 of them an enteral diet of 1680 calories, composed of 294 grams of carbohydrates, 36.9 grams of fat, and 43.5 grams of protein in the form of branched chain amino acids. The group of patients supplemented in their diet presented a positive nitrogen balance which was significantly superior to the unsupplemented (p < 0.001). The nutritional state showed a significant improvement after three weeks with an additional enteral diet (p < 0.025). This improvement was translated into an also significant increase in the concentrations of total proteins and C3 of the ascitic liquid in the same group of patients (p < 0.001 for both parameters). These data appear to show that the nutritional support in patients with alcoholic cirrhosis may be a good strategy in the fight against some complications.