Hemodinámica en el síndrome de Down / Haemodynamics in Down syndrome

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Análisis comparativo de los métodos de bioimpedancia en la evaluación nutricional de pacientes con enfermedades respiratorias / Comparative analysis of bioimpedance methods in the nutritional evaluation of patients with respiratory disease

ANTECEDENTES: las guías clínicas actuales consideran la monitorización nutricional una parte importante en la evaluación de pacientes respiratorios. Gracias a la bioimpedancia, es posible obtener una medida de la composición corporal. OBJETIVO: comparar los dos métodos más comunes de análisis de la composición corporal mediante bioimpedancia sobre una población de pacientes respiratorios: una única frecuencia (SFBIA) y espectroscopía de bioimpedancia (BIS). MÉTODO: grupo I (pacientes en Rehabilitación Respiratoria, 6 personas); Grupo II (pacientes hospitalizados, 10 personas); Grupo III (sujetos sanos, 5 personas). Medidas: dispositivo SFBIA y dispositivo BIS. Análisis comparativo con índices normalizados: porcentaje de grasa e índice de masa libre de grasa (FFMI). RESULTADOS: análisis Bland-Altman del porcentaje de grasa: valor medio de -3,5%, límites de concordancia del 95% desde -18,8% a 11,7%. Análisis Bland-Altman de FFMI: valor medio de 0,8 kg/m2, límites de concordancia del 95% desde -3,5 kg/m2 a 5,1 kg/m2. Correlación en el porcentaje de grasa: r = 0,73 (p = 0,0009). Correlación en FFMI: r = 0,86 (p = 0,00001). CONCLUSIONES: en la muestra analizada, los métodos SFBIA y BIS han mostrado una buena correlación y una concordancia moderada a la hora de estimar la composición corporal. En la mayoría de los casos, el método SFBIA subestimó el porcentaje de grasa y sobreestimó la masa magra comparado con el método BIS. Las mayores discrepancias entre ambos métodos fueron observadas en los casos extremos de composición corporal

BACKGROUND: Current clinical guides consider nutritional monitoring to be an important part of the evaluation of respiratory patients. Thanks to bioimpedance, it is possible to obtain a body composition measurement. OBJECTIVE: to compare the two most common methods for analyzing body composition using bioimpedance in a population of respiratory patients: single frequency (SFBIA) and bioimpedance spectroscopy (BIS). METHODS: group I (respiratory rehabilitation patients: 6 people); group II (hospitalized patients: 10 people); group III (healthy subjects: 5 people). Measurements: SFBIA device and BIS device. Analysis: comparison with normal indexes: percent fat and fat free mass index (FFMI). RESULTS: Bland-Altman analysis of percent fat: mean value of -3.5%, 95% limits of agreement from -18.8% to 11.7%. Bland-Altman FFMI analysis: mean value of 0.8 kg/m2, 95% limits of agreement from -3.5 kg/m2 to 5.1 kg/m2. Correlation in percent fat: r = 0.73 (p = 0.0009). Correlation in FFMI: r = 0.86 (p = 0.00001). CONCLUSIONS: in the sample analyzed, the SFBIA and BIS methods have shown good correlation and moderate agreement when estimating body composition. In most cases, SFBIA underestimated the percent fat and overestimated the lean mass compared to the BIS method. The largest discrepancies between the two methods were seen in the cases of extreme body composition

Perforación duodenal espontánea en paciente intervenido de prostatectomía radical / Spontaneous duodenal perforation in a radical prostatectomy patient

La prostatectomía radical es una cirugía para el cáncer localizado de próstata, muy conocida y con escaso número de complicaciones precoces postoperatorias. Presentamos el caso de un paciente de 54 años con PSA de 8 ng/ml y biopsia informada como adenocarcinoma de próstata Gleason 3+3=6 intervenido quirúrgicamente mediante prostatectomía radical retropúbica, que presentó una perforación espontánea de duodeno. Se manejó de forma conservadora ante el buen estado del paciente, resolviéndose a los 30 días. Ante un paciente intervenido es importante pensaren todas posibles complicaciones realizando las mínimas pruebas necesarias que permitan un diagnostico certero. El tratamiento habitualmente es quirúrgico, pudiéndose optar por el conservador en casos concretos(AU)

Radical prostatectomy is a well known treatment for prostate cancer, with a low incidence of early postoperative complications. Our case is a 54 year old patient diagnosed with prostate adenocarcinoma, Gleason score 3+3=6 with 8ng/ml of PSA, treated by retropubic prostatectomy, who suffered spontaneous perforation of the duodenum. We chose a conservative management, resolved in 30 days. When dealing with a surgical patient all kinds of complications must be taken into account by performing the minimum tests that will enable a sure diagnosis to be achieved. The usual treatment is surgery or conservative management, depending on the case and the patient(AU)

Tumor neuroectodérmico renal primitivo. A propósito de un caso / Primitive neuroectodermal tumour of the kidney. A case report

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Estado de la provisión de cuidados nutricionales al paciente quemado. Auditoría de procesos en un Servicio de Quemados de un hospital terciario / Current status of nutritional care provision to burnt patients. Processes audit of a burnt patients department from a tertiary hospital

Justificación: La respuesta al tratamiento médico-quirúrgico del paciente quemado pudiera depender tanto delos estragos provocados por la agresión térmica, a saberlas demandas metabólicas incrementadas, la aparición del Síndrome de Respuesta Inflamatoria Sistémica, y las infecciones microbianas; como de las prácticas culturales incluidas dentro de los procesos institucionales de cuidados nutricionales. Objetivo: Evaluar cómo la conducción de los procesos nutricionales de evaluación e intervención influye sóbre los indicadores de la efectividad terapéutica de los Servicios de Quemados. Serie de estudio: Cuarenta y dos pacientes atendidos con una superficie corporal quemada (SCQ) > 10%, entre enero del 2001-diciembre del 2003, en el Servicio de Quemados del Hospital Clínico Quirúrgico “Hermanos Ameijeiras” (Ciudad La Habana, Cuba).Métodos: Los procesos nutricionales de evaluación e intervención conducidos en el paciente quemado se auditaron mediante revisión de las historias clínicas. Los procesos auditados se declararon como Completados (o no). El grado de completamiento del proceso se relacionó con las tasas de complicaciones y mortalidad, y el índice de hospitalización predicho de la SCQ. Resultados: Los procesos nutricionales de evaluación e intervención se completaron en el 49,4% y 22,6% de las historias auditadas, respectivamente. El registro evolutivo del peso corporal se asoció con una menor mortalidad. La evaluación nutricional temprana y un aporte energético suficiente en lesionados con SCQ > 20% se asociaron con menores tasas de complicaciones y un mejor cumplimiento del índice de hospitalización Conclusiones: Este trabajo constituye la primera aproximación al comportamiento del Servicio de Quemados de la institución, como antesala del diseño e implementación de un programa de mejoría continua de la calidad en la atención médica. Se pudo comprobar que, a pesar del estado actual de completamiento de los procesos nutricionales, la observancia de los mismos puede influir favorablemente sobre los indicadores de efectividad del Servicio

Rationale: Response of the burned patient to surgical medical treatment might depend not only upon the damages brought about by thermal agression, namely, increased metabolic requirements, onset of the Systemic Inflamatory Response Syndrome, and microbial infections, but also the cultural practices embedded within nutritional care institutional processes. Goal: To assess how conduction of nutritional care processes of assessment and intervention may influence therapeutical effectiveness indicators of hospital Burn Services. Study serie: Forty-two patients with a Burn Body Surface Area (BBSA) > 10% assisted at the Burn Service of the “Hermanos Ameijeiras” Clinical Surgical Hospital(La Habana, Cuba), between January 2001-December2003.Methods: Nutritional care of assessment and intervention conducted upon the burn patient were audited after reviewing clinical charts. The audited processes were declared as Completed (or not). Completeness of the process was related to complications and mortality rates, and length of hospital stay predicted from BBSA. Results: Nutritional care processes of assessment and intervention were completed in 49.4% and 22.6% of the audited charts, respectively. Prospective recording of patient’s body weight was associated with lower mortality. Early nutritional assessment and sufficient energy supply to patients with BBSA > 20% were associated with lower complications rates and better compliance with BBSA-predicted length of stay. Conclusions: This work is the first enquiry into the behaviour of the institution’s Burn Service, in anticipation of the design and implementation of a medical care Continuous Quality Improvement Program. In spite of the current state of nutritional care processes completeness, their observance might favorably influence the Service’s effectiveness indicators

Concurrent Solution and Adsorption of Hydrocarbons in Gas Chromatographic Columns Packed with Different Loadings of 3-Methylsydnone on Chromosorb P

Thermodynamic properties of solution in 3-methylsydnone (3MS) and of adsorption at the nitrogen/3MS interface were gas chromatographically measured for a group of fifteen hydrocarbons at infinite dilution conditions. Retention volumes were measured at five temperatures within the range 37-52°C in six columns containing different loadings of 3MS on Chromosorb P AW. Partition and adsorption coefficients were calculated and from their temperature dependence the corresponding enthalpies were obtained, although with considerable error; infinite dilution activity coefficients of the hydrocarbons in the bulk and in the surface phases demonstrated a strong correlation. Bulk activity coefficients in 3MS were very much smaller than those previously measured for the same solutes in formamide (FA) and in ethyleneglycol (EG), and were also smaller than what could be predicted on account of 3MS cohesive energy density as estimated from the quotient sigma/v1/3 (sigma, surface tension; v, molar volume). There was not such a large difference between the surface activity coefficients in the three solvents; furthermore, the quotients (surface activity coefficient/bulk activity coefficient) for a given solute in 3MS were twice as large as in FA and about three times larger than in EG. These results make evident the difficulties inherent in the prediction of surface phase properties from those in the bulk and cast doubts on the pertinency of employing the surface tension to compare cohesive energy densities of polar solvents with important chemical differences.

Monoaminc and metabolite levels in the cerebrospinal fluid of hibernating and euthermic marmots.

Cerebrospinal fluid from yellow-bellied marmots, Marmota flaviventris, was analysed for monoamine and monoamine metabolite content during euthermia and deep hibernation. Dopamine (DA) levels were decreased, while DA metabolite levels, dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), were dramatically increased in hibernating marmots. Serotonin (5-HT) and 5-hydroxyindoleacetic acid (5HIAA) levels were also greatly enhanced during hibernation while norepinephrine (NE) levels were only moderately increased. These findings demonstrate that cerebrospinal monoamine levels are dynamically altered during hibernation, such that DA versus 5-HT and NE levels undergo opposite changes. Therefore, these data indicate that DA, 5-HT and NE neuronal systems are differentially altered during hibernation in mammals.