Document de consens per a l’abordatge comunitari de la desnutrició relacionada amb la malaltia crònica en persones amb complexitat clínica

Desnutrició; Malalties cròniques complexes; Atenció individualitzadaDesnutrición; Enfermedades crónicas complejas; Atención individualizadaMalnutrition; Complex chronic diseases; Individualized attentionAquest document, fruit del consens de múltiples professionals i societats científiques, vol promoure la detecció de situació de desnutrició en persones amb necessitats complexes d’atenció o pacients crònics complexos (PCC), i facilitar, des d’una perspectiva multidimensional i interdisciplinària, intervencions i respostes efectives i individualitzades als PCC en situació de desnutrició. Realitza una proposta basada en l’evidència i pragmàtica -tan a nivell individual com operatiu- a un problema prevalent i amb alt impacte en els resultats de salut i en la qualitat de vida de les persones, així com a nivell de costos econòmics

Management of acute mesenteric ischaemia: Results of a worldwide survey

Acute mesenteric ischaemia; Intestinal failure; SurveyIsquemia mesentérica aguda; Insuficiencia intestinal; EncuestaIsquèmia mesentèrica aguda; Insuficiència intestinal; EnquestaBackground Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide. Methods A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected. Results We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity. Conclusions Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes

Seeding approach to nucleation in the NVT ensemble: The case of bubble cavitation in overstretched Lennard Jones fluids

Simulations are widely used to study nucleation in first order phase transitions due to the fact that they have access to the relevant length and time scales. However, simulations face the problem that nucleation is an activated process. Therefore, rare event simulation techniques are needed to promote the formation of the critical nucleus. The Seeding method, where the simulations are started with the nucleus already formed, has proven quite useful in efficiently providing estimates of the nucleation rate for a wide range of orders of magnitude. So far, Seeding has been employed in the NPT ensemble, where the nucleus either grows or redissolves. Thus, several trajectories have to be run in order to find the thermodynamic conditions that make the seeded nucleus critical. Moreover, the nucleus lifetime is short and the statistics for obtaining its properties is consequently poor. To deal with these shortcomings we extend the Seeding method to the NVT ensemble. We focus on the problem of bubble nucleation in a metastable Lennard Jones fluid. We show that, in the NVT ensemble, it is possible to equilibrate and stabilise critical bubbles for a long time. The nucleation rate inferred from NVT-Seeding is fully consistent with that coming from NPT-Seeding. The former is quite suitable to obtain the nucleation rate along isotherms, whereas the latter is preferable if the dependence of the rate with temperature at constant pressure is required. Care should be taken with finite size effects when using NVT-Seeding. Further work is required to extend NVT seeding to other sorts of phase transitions

Malnutrition management of hospitalized patients with diabetes/hyperglycemia and COVID-19 infection

COVID-19; Diabetes; Medical nutritionCOVID-19; Diabetes; Nutrición médicaCOVID-19; Diabetis; Nutrició mèdicaDiabetes mellitus and/or hyperglycemia are highly prevalent medical conditions in patients hospitalized for coronavirus disease 2019 (COVID-19) and are associated with adverse outcomes. In addition, COVID-19 itself can provoke fluctuating and high glucose levels that can be difficult to manage upon hospitalization. Hospitalized patients with COVID-19 are at high risk of malnutrition due to an increase in nutritional requirements and a severe acute inflammatory response. The management of patients with diabetes/hyperglycemia and COVID-19 is challenging and requires a specific nutritional approach, the purpose of which is to fulfill the nutritional requirements while maintaining an optimal glycemic control. In this study, an expert group of nutritional endocrinologists carried out a qualitative literature review and provided recommendations based on evidence and guidelines, when available, or on their own experience. The optimal care based on these recommendations was compared with the routine bedside care as reported by a panel of physicians (mainly, endocrinologists, geriatricians, and internists) treating patients with diabetes/hyperglycemia and COVID-19 in their daily practice. Early screening and diagnosis, a diabetes-specific therapeutic approach, and a close malnutrition monitoring are essential to improve the clinical outcomes of these patients. In conclusion, the proposed recommendations are intended to provide a useful guide on the clinical management of malnutrition in patients with COVID-19 and diabetes/hyperglycemia, in order to improve their outcomes and accelerate their recovery. The comparison of the recommended optimal care with routine clinical practice could aid to identify gaps in knowledge, implementation difficulties, and areas for improvement in the management of malnutrition in this population.This study was funded by Abbott. Abbott Nutrition was the sponsor of the study, but it didn’t participate in the design, research, data collection and data review

Clinical nutrition issues in 2022: What is missing to trust supplemental parenteral nutrition (SPN) in ICU patients?

Clinical nutrition; Intensive care unit; Nutrition careNutrició clínica; Unitat de cures intensives; Cura de la nutricióNutrición Clínica; Unidad de cuidados intensivos; Cuidado de la nutriciónA multidisciplinary group of international physicians involved in the medical nutrition therapy (MNT) of adult critically ill patients met to discuss the value, role, and open questions regarding supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the intensive care unit (ICU) setting. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). The experts agreed on several key points: SPN has shown clinical benefits, resulting in this strategy being included in American and European guidelines. Nevertheless, its use is heterogeneous across European countries, due to the persistence of uncertainties, such as the optimal timing and the risk of overfeeding in absence of indirect calorimetry (IC), which results in divergent opinions and barriers to SPN implementation. Education is also insufficient. The experts agreed on actions needed to increase evidence quality on SPN use in specific patients at a given time point during acute critical illness or recovery.The organization of the Virtual Meeting that motivated this publication was funded by Baxter Healthcare SA. The authors received no financial support for the research, authorship, and/or publication of this article. MPC receives funding from the Research Foundation Flanders (FWO) (Grant No. 1832817N) and Onderzoeksraad, KU Leuven (Grant No. C24/17/070) and from the Private Charity Organization “Help Brandwonden Kids

Malnutrition management of hospitalized patients with diabetes/hyperglycemia and liver cirrhosis

Diabetes; Liver cirrhosis; Medical nutritionDiabetes; Cirrosis hepática; Tratamiento nutricionalDiabetis; Cirrosi hepàtica; Tractament nutricionalLa cirrosis hepática es una enfermedad progresiva y crónica del hígado, de etiología diversa, que se asocia frecuentemente con intolerancia a la glucosa y en algunos casos concurre con diabetes tipo 2 (DM2). La DM2 se asocia con resultados adversos en pacientes con cirrosis, incluyendo una mayor tasa de ingresos hospitalarios, una mayor prevalencia de carcinoma hepatocelular y un mayor riesgo de mortalidad. La desnutrición es otra complicación frecuente en la cirrosis, cuya prevalencia aumenta con el grado de disfunción hepática, empeorando el pronóstico. El presente artículo describe los resultados del consenso de expertos y las respuestas de los panelistas sobre el manejo nutricional en la práctica clínica habitual de los pacientes con diabetes/hiperglucemia hospitalizados en planta (no críticos) con cirrosis hepática.Liver cirrhosis is a progressive and chronic disease of the liver, of diverse etiology, which is frequently associated with glucose intolerance and in some cases concurs with type 2 diabetes (DM2). DM2 is associated with adverse outcomes in patients with cirrhosis, including a higher rate of hospitalizations, a higher prevalence of hepatocellular carcinoma, and an increased risk of mortality. Malnutrition is another frequent complication of cirrhosis, the prevalence of which increases with the degree of liver dysfunction, worsening the prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with liver cirrhosis

Comparison of computed tomography and dual-energy X-ray absorptiometry in the evaluation of body composition in patients with obesity

Body composition; Computed tomography; Morbid obesityComposición corporal; Tomografía computarizada; Obesidad mórbidaComposició corporal; Tomografia computaritzada; Obesitat mòrbidaObjective: a) To evaluate the accuracy of the pre-existing equations (based on cm2 provided by CT images), to estimate in kilograms (Kg) the body composition (BC) in patients with obesity (PwO), by comparison with Dual-energy X-ray absorptiometry (DXA). b) To evaluate the accuracy of a new approach (based on both cm2 and Hounsfield Unit parameters provided by CT images), using an automatic software and artificial intelligence to estimate the BC in PwO, by comparison with DXA. Methods: Single-centre cross-sectional study including consecutive PwO, matched by gender with subjects with normal BMI. All the subjects underwent BC assessment by Dual-energy X-ray absorptiometry (DXA) and skeletal-CT at L3 vertebrae. CT images were processed using FocusedON-BC software. Three different models were tested. Model 1 and 2, based on the already existing equations, estimate the BC in Kg based on the tissue area (cm2) in the CT images. Model 3, developed in this study, includes as additional variables, the tissue percentage and its average Hounsfield unit. Results: 70 subjects (46 PwO and 24 with normal BMI) were recruited. Significant correlations for BC were obtained between the three models and DXA. Model 3 showed the strongest correlation with DXA (r= 0.926, CI95% [0.835-0.968], p<0.001) as well as the best agreement based on Bland – Altman plots. Conclusion: This is the first study showing that the BC assessment based on skeletal CT images analyzed by automatic software coupled with artificial intelligence, is accurate in PwO, by comparison with DXA. Furthermore, we propose a new equation that estimates both the tissue quantity and quality, that showed higher accuracy compared with those currently used, both in PwO and subjects with normal BMI.This study was supported by grants from the Instituto de Salud Carlos III (Fondo de Investigación Sanitaria, PI20/01806). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study

Feasibility; Malnutrition; Morphofunctional assessmentFactibilitat; Desnutrició; Avaluació morfofuncionalFactibilidad; Desnutrición; Avaluació morfofuncionalDisease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.This study was supported by Persan Farma

Epidemiología de las enfermedades reumáticas en México. Un estudio de 5 regiones basado en la metodología COPCORD

To estimate the prevalence of musculoskeletal (MSK) disorders and to describe predicting variables associated with rheumatic diseases in 5 regions of México

Intervención nutricional en el paciente oncohematológico

Background: Oncohematological diseases such as lymphoma or leukaemia affect an increasing number of newly diagnosed patients in Spain and other countries. Both disease and treatment may have a negatively impact in the nutritional status of the patient. Malnutrition is not uncommon among oncohematological patients. This situation can compromised the course of the disease, the clinical response of the treatment and the patient’s quality of life. Method: The implementation of a multidisciplinary approach and a systematic and protocolled nutritional assessment would be useful when dealing with haematological malignancies. Results: We present a proposal of protocol for nutritional intervention in oncohematological patients. This proposal is been developed from the analysis of the published literature as well as clinical practice of a multidisciplinary team specialized in the management of patients with haematological malignanciesObjetivos: Las enfermedades oncohematológicas como el Linfoma o la Leucemia afectan a un número importante y creciente de personas en España. Tanto la enfermedad como las distintas modalidades de tratamiento que puede llegar a precisar el paciente a lo largo del curso de la misma impactan negativamente en el estado nutricional del paciente, no siendo infrecuente el desarrollo de desnutrición, situación que compromete la evolución, la respuesta al tratamiento y la calidad de vida del paciente. Método: La implementación de una estrategia multidisciplinar, sistematizada y protocolizada de valoración nutricional puede resultar de utilidad a la hora de abordar a los pacientes con enfermedades oncohematológicas. Resultados: Se presenta una propuesta de protocolo de evaluación y soporte nutricional en el paciente oncohematológico elaborada a partir del análisis de la literatura publicada al respecto, así como de la práctica clínica habitual de un equipo sanitario multidisciplinar especialmente implicado en el manejo de los pacientes con enfermedades oncohematológica