[Nutrition and cephalic pancreaticoduodenectomy]. / Nutrición y duodenopancreatectomía cefálica.

Cephalic pancreaticoduodenectomy (CPD) is the surgical procedure of choice for curative resection of pancreatic head and periampullary tumors. Preoperative nutritional intervention is crucial for reducing postoperative complications since malnutrition can be found in patients with these tumors. This malnutrition can get even worse during the postoperative period due to fasting and subsequent treatments. Besides, the surgical procedure entails surgical resections that alter the digestive process and can have long-term negative effects on the nutritional status. An aspect infrequently assessed is the alteration of exocrine and endocrine functions after surgery, that noticeably affects both the metabolic and general status of these patients. As regards long-term nutrition, there is no consensus on how to evaluate patients who have undergone a pancreatic resection. Consequently, early nutritional intervention since diagnosis may prevent or lessen the deterioration of nutritional status resulting from the disease itself as well as from the surgery and from the long term. The alimentary and nutritional education that would help the patient gain an adequate control of his metabolism and nutrition becomes vital.

Nutrición y duodenopancreatectomía cefálica. / [Nutrition and cephalic pancreaticoduodenectomy].

Cephalic pancreaticoduodenectomy (CPD) is the surgical procedure of choice for curative resection of pancreatic head and periampullary tumors. Preoperative nutritional intervention is crucial for reducing postoperative complications since malnutrition can be found in patients with these tumors. This malnutrition can get even worse during the postoperative period due to fasting and subsequent treatments. Besides, the surgical procedure entails surgical resections that alter the digestive process and can have long-term negative effects on the nutritional status. An aspect infrequently assessed is the alteration of exocrine and endocrine functions after surgery, that noticeably affects both the metabolic and general status of these patients. As regards long-term nutrition, there is no consensus on how to evaluate patients who have undergone a pancreatic resection. Consequently, early nutritional intervention since diagnosis may prevent or lessen the deterioration of nutritional status resulting from the disease itself as well as from the surgery and from the long term. The alimentary and nutritional education that would help the patient gain an adequate control of his metabolism and nutrition becomes vital.

Nutrición y duodenopancreatectomía cefálica / [Nutrition and cephalic pancreaticoduodenectomy].

Cephalic pancreaticoduodenectomy (CPD) is the surgical procedure of choice for curative resection of pancreatic head and periampullary tumors. Preoperative nutritional intervention is crucial for reducing postoperative complications since malnutrition can be found in patients with these tumors. This malnutrition can get even worse during the postoperative period due to fasting and subsequent treatments. Besides, the surgical procedure entails surgical resections that alter the digestive process and can have long-term negative effects on the nutritional status. An aspect infrequently assessed is the alteration of exocrine and endocrine functions after surgery, that noticeably affects both the metabolic and general status of these patients. As regards long-term nutrition, there is no consensus on how to evaluate patients who have undergone a pancreatic resection. Consequently, early nutritional intervention since diagnosis may prevent or lessen the deterioration of nutritional status resulting from the disease itself as well as from the surgery and from the long term. The alimentary and nutritional education that would help the patient gain an adequate control of his metabolism and nutrition becomes vital.

Sarcopenia: una entidad de relevancia clínica actual en adultos mayores / Sarcopenia: an entity of current clinical relevance in older adults

La sarcopenia se define como la pérdida progresiva y gradual de la masa, la función y la fuerza del músculo esquelético que se presenta durante elproceso del envejecimiento. Todavía está en discusión hasta qué punto se puede considerar como un efecto deletéreo propio de la edad o como unsíndrome geriátrico con repercusiones clínicas, daño funcional e incapacidad. Lo que es realmente fundamental es que la pérdida de la masa muscularesquelética contribuye a un mayor riesgo de discapacidad física, fragilidad, pérdida de la independencia, pobre calidad de vida, incremento en los costos para el cuidado de la salud y aumento en la tasa de mortalidad de las personas envejecidas. Su etiología es compleja y multifactorial.Recientemente diversos grupos de trabajo han centrado su interés en la investigación en el área de la sarcopenia, debido a las consecuencias que tiene en la salud y funcionalidad del adulto mayor. El objetivo de esta revisión es examinar la información disponible sobre la conceptualización, definición y métodos de diagnóstico de la sarcopenia. Se mencionan los métodos de determinación de la masa muscular esquelética por técnicas de imagen como la resonancia magnética y la absorciometría dual de energía de rayos X (DXA). Se considera su estimación a través de análisis de impedancia bioeléctrica y de ecuaciones de predicción. Se mencionan los puntos de corte que se han utilizado con mayor frecuencia para el diagnóstico de sarcopenia y, asimismo, se muestra su prevalencia en diversos estudios epidemiológicos y las propuestas de tratamientos actuales.(AU)

Sarcopenia: una entidad de relevancia clínica actual en adultos mayores / Sarcopenia: an entity of current clinical relevance in older adults

La sarcopenia se define como la pérdida progresiva y gradual de la masa, la función y la fuerza del músculo esquelético que se presenta durante elproceso del envejecimiento. Todavía está en discusión hasta qué punto se puede considerar como un efecto deletéreo propio de la edad o como unsíndrome geriátrico con repercusiones clínicas, daño funcional e incapacidad. Lo que es realmente fundamental es que la pérdida de la masa muscularesquelética contribuye a un mayor riesgo de discapacidad física, fragilidad, pérdida de la independencia, pobre calidad de vida, incremento en los costos para el cuidado de la salud y aumento en la tasa de mortalidad de las personas envejecidas. Su etiología es compleja y multifactorial.Recientemente diversos grupos de trabajo han centrado su interés en la investigación en el área de la sarcopenia, debido a las consecuencias que tiene en la salud y funcionalidad del adulto mayor. El objetivo de esta revisión es examinar la información disponible sobre la conceptualización, definición y métodos de diagnóstico de la sarcopenia. Se mencionan los métodos de determinación de la masa muscular esquelética por técnicas de imagen como la resonancia magnética y la absorciometría dual de energía de rayos X (DXA). Se considera su estimación a través de análisis de impedancia bioeléctrica y de ecuaciones de predicción. Se mencionan los puntos de corte que se han utilizado con mayor frecuencia para el diagnóstico de sarcopenia y, asimismo, se muestra su prevalencia en diversos estudios epidemiológicos y las propuestas de tratamientos actuales.

[Celiac disease: diagnosis prevalence in a community hospital]. / Enfermedad celíaca: prevalencia del diagnóstico en un hospital de comunidad.

INTRODUCTION: Celiac disease (CD) is a gluten-sensitive enteropathy characterized by a chronic injury of the small bowel, caused by gluten intolerance in genetically predisposed individuals. The different forms of presentation of CD resemble more a multisystem disorder than a primary gastrointestinal disease and it is frequently underdiagnosed. OBJECTIVE: To determine the prevalence of CD diagnosis in the population of affiliates to the HMO of the Hospital Italiano de Buenos Aires. METHODS: This is a cross sectional study, using secondary databases of diagnosis and laboratory from the electronic medical record (EMR) in a HMO population between 1998 and 2006. The criteria used to define a case was based on a diagnosis of CD in the EMR and/or a IgA antitransglutaminase antibodies value >15 AU/mL. RESULTS: According to these criteria, 283 patients with CD were identified in 128,748 individuals of the HMO. The prevalence of CD was 0.22%. The mean age of this group was of 42.3 years, and 80.2% of them were female. CONCLUSIONS: In a primary care HMO setting, using secondary databases from EMR we found 1 case of celiac disease every 470 affiliates, giving a prevalence of 0.22%. The rate between serological prevalence of CD and clinical diagnosis carried out in our center was near 3.3 to 1. Although this level of diagnosis could be considered relatively high, an important proportion of patients are left without diagnosis, considering the local estimated prevalence reported using serological tests. An increased level of awareness and clinical suspicion is needed at the primary care level.