Relación entre la desnutrición y la calidad de la alimentación en el ámbito hospitalario

412 p.La prevalencia de malnutrición asociada a la enfermedad es alta en el medio hospitalario. Son muchos los factores causantes, pero uno de los más determinantes es la alimentación, debido a sus características nutricionales, sensoriales e higiénicas. Objetivo: determinar la relación entre la malnutrición y la calidad de la dieta hospitalaria. Material y métodos: se diseñó un estudio transversal en práctica clínica habitual que incluyó pacientes adultos ingresados más de 48 horas, a los que se había prescrito una dieta teóricamente completa. Se realizó el cribado nutricional con MNA, MUST y NRS-2002, que posteriormente fueron comparados con VSG. Se realizó una valoración nutricional que incluyó antropometría, composición corporal, bioquímica y funcionalidad. Se realizó un análisis de la ingesta con un recordatorio de 24 horas y fueron calculadas las necesidades energéticas y proteicas del individuo. El código de dietas fue evaluado cualitativa y cuantitativamente. El consumo real del paciente durante su período de hospitalización fue realizado con la técnica de la doble pesada y comparado con una escala visual. Se recogieron las causas de no consumo y la valoración sensorial del producto. La calidad microbiológica fue evaluada con registros de temperatura, tiempos de distribución y análisis microbiológicos. Finalmente, los resultados fueron comparados con una muestra de valoraciones realizada en un centro con cocina en línea fría. Resultados: Se reclutaron 201 pacientes con una mediana de edad de 72 años y el 51,20 % fueron mujeres. La prevalencia de malnutrición osciló entre el 36 y el 68 % (dependiendo del método empleado). El análisis de sensibilidad y especificidad evidenció buenos resultados en todos los cribados analizados, aunque el MUST ofreció resultados más sólidos. Las dietas analizadas no cubrieron las necesidades nutricionales del 20 % de los pacientes, y del 60 % tras realizarse la ingesta. El paciente malnutrido fue el individuo que realizó una mayor ingesta, aunque en total no se consumió el 50 % del alimento recibido y esto se debió principalmente a la presencia de anorexia (65 %) o por las características sensoriales (26,5 %). La valoración sensorial del producto evidenció que la temperatura percibida por el paciente fue fundamental para incrementar o disminuir la ingesta, especialmente en el paciente en riesgo nutricional. La calidad microbiológica mostró resultados insatisfactorios por temperaturas inadecuadas, tiempos muy prolongados en la distribución y presencia de Salmonella en 12 muestras. La comparativa con la cocina en línea fría demostró ventajas de ésta en el consumo y en la seguridad alimentaria respecto a la cocina tradicional. Conclusiones: Deberían establecerse protocolos para la detección y tratamiento de la malnutrición hospitalaria dada su alta prevalencia. El código de dietas debería ser reevaluado teniendo en cuenta las necesidades y expectativas del paciente. Sería necesario el desarrollo de un programa de seguridad alimentaria acorde a las características del centro y a los problemas detectado

External Load Monitoring in Female Basketball: A Systematic Review

The primary aim of this systematic review was to summarize the current state of research in relation to external load monitoring in female basketball. The review was conducted according to the PRISMA-P® statement. Publications included in the review: 1) were original research, 2) evaluated healthy female basketball players, and 3) monitored basketball practice and competition. The STROBE scale was used to assess quality. A total of 40 publications were included. The external load was assessed during practice (n = 9), competition (n = 11) or both events (n = 8). Also, time- motion analysis was implemented in practice (n = 2), competition (n = 9), or both events (n = 1). Accelerometry (n = 28) and time-motion (n = 12) analysis were the most frequently used methods. However, a wide range in methods and variables were used to quantify the external load. Placement of devices on the upper back and measuring with a sampling frequency of 100 Hz were most common. Player Load (PL) values increased with the competitive level of players and were higher in competition compared to training. Small-sided games can be used to gradually increase loads in female basketball (PL 5v5: 34.8 ± 8, PL 3v3: 47.6 ± 7.4, TD 5v5: 209.2 ± 35.8 m, and TD 3v3: 249.3 ± 2.8 m). Tasks without defense seemed to be less demanding. More research is needed to reach a consensus on load control in women's basketball, on what data are important to collect, and how to use and transfer knowledge to stakeholders

Effects of oral glutamine during abdominal radiotherapy on chronic radiation enteritis: a randomized controlled trial

[Abstract] Objective. Glutamine has been proposed as a preventive treatment for toxicity related to cancer therapies. The aim of this study was to test the efficacy of glutamine in the prevention of radiation enteritis. Methods. A randomized, double-blind, controlled trial was performed including 69 patients who were assigned to receive either glutamine (Gln, 30 g/d) or placebo while they were receiving abdominal radiotherapy. Patients were re-evaluated 1 y after completion of treatment. The presence of chronic enteritis was assessed using the Radiation Therapy Oncology Group scale. Nutritional status was evaluated using subjective global assessment, weight, and bioimpedance. Relative risk (RR) and its confidence interval (CI) were also calculated. Results. The trial initially included 69 patients (34 Gln, 35 placebo), but 11 patients were lost during follow-up (4 Gln, 7 placebo; P = 0.296). Chronic enteritis was developed by 14 % of patients: Gln 16.7 % versus placebo 11.1% (RR = 1.33; 95 % CI, 0.35–5.03; P = 0.540). Most cases of enteritis were grade I (75 %), with no differences between groups. The stool frequency increased after radiotherapy in patients who received Gln (from 1 ± 1 to 2 ± 2 stools per day, P = 0.012), but remained unchanged with placebo (1 ± 1 stools per day, P = 0.858; difference between groups P = 0.004). There were no differences between the two groups in terms of weight, fat mass, or fat-free mass index, or between patients with enteritis and those without intestinal toxicity. Conclusions. Chronic enteritis is a relatively infrequent phenomenon, and Gln administration during radiotherapy does not exert a protective effect.Castilla y León. Consejería de Sanidad; GRS 326/B/0

Efectos tisulares de la glutamina en pacientes con cáncer de recto tratados con quimorradioterapia preoperatoria

[Abstract] Background: The aim was to evaluate the effects of glutamine on tumor regression and histological damage in patients with rectal patients following chemoradiotherapy previous to surgery. Material and methods: Ten patients with rectal cancer surgically removed after chemoradiotherapy were included, a subgroup of a randomized trial that compared glutamine and placebo in the prevention of acute radiation enteritis. Samples of neoplasm and healthy tissue were evaluated by an expert pathologist searching for signs of tumor regression, muciphages, and signs of radiation-induced damage. Results: There were no differences in the grade of tumor regression with either glutamine or placebo. All patients who received glutamine presented muciphages, compared with 28.6% of the placebo group (p = 0.038). Histological damage was similar in patients receiving glutamine or placebo, and between those with radiation enteritis or without toxicity. Conclusion: Glutamine did not exert a protective effect over chemoradiotherapy in rectal cancer or healthy rectal tissue.[Resumen] Introducción: El objetivo fue evaluar los efectos de la administración de glutamina sobre la regresión tumoral y sobre el tejido sano en pacientes con cáncer rectal que recibieron quimiorradioterapia. Material y métodos: Se incluyó 10 pacientes con cáncer rectal operado después de quimiorradioterapia, un subgrupo de un ensayo clínico que comparó glutamina con placebo en la prevención de enteritis aguda. Un patólogo experto analizó las muestras de tumor y tejido sano, buscando datos de regresión tumoral, mucífagos y daño por radiación. Resultados: No hubo diferencias entre placebo y glutamina en el grado de regresión tumoral. Todos los pacientes con glutamina presentaron mucífagos, frente al 28,6% con placebo (p = 0,038). El daño sobre tejido sano fue similar en los pacientes con glutamina y placebo, y entre aquellos con y sin enteritis. Conclusión: La glutamina no ejerce un efecto protector frente a la quimiorradioterapia sobre el tumor o el tejido rectal sano

Monitoring Internal Load in Women’s Basketball via Subjective and Device-Based Methods: A Systematic Review

The monitoring of internal load in basketball can be used to understand the effects and potential physiological adaptations caused by external load. The main aim of this systematic review was to identify the methods and variables used to quantify internal load in female basketball. The studies included different populations and events: youth athletes, elite, and amateur players. Subjective methods included using the rating of perceived exertion (RPE) method, and sensor-based methods included monitoring the cardiac response to exercise, using heart rate (HR) as the primary metric. The results showed that the HRAvg exhibited a wider range of values during training than during competition, and different metrics were used to evaluate internal load, such as HRMax, HRmin, %HRMax, total time and % of time spent in different HR zones (2–8 zones), Banister’s TRIMP, and summated HR zones. RPE and HR metrics were the most commonly used methods. However, the use of multiple metrics with little standardization resulted in significant heterogeneity among studies, limiting meaningful comparisons. The review provides a reference for current research on female basketball. Future research could address this limitation by adopting more consistent measurement protocols standardizing the use of metrics.J.E-L. was a predoctoral researcher supported by a grant within the field of physical education, physical activity, and sports and its applied sciences given to the National Institute of Physical Education of Catalonia (INEFC), University of Barcelona (UB) (2020 PINEFC 00012). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Determination of the economically justifiable price of cenobamate in the treatment of focal-onset seizures in adult patients with drug-resistant epilepsy in Spain

Anti-seizure medications; Cenobamate; Economically justifiable priceMedicamentos anticonvulsivos; Cenobamato; Precio económicamente justificableMedicaments anticonvulsius; Cenobamat; Preu econòmicament justificableObjective To determine the economically justifiable price (EJP) of cenobamate to become a cost-effective alternative compared with third-generation anti-seizure medications in the treatment of focal-onset seizures (FOS) in adult patients with drug-resistant epilepsy (DRE) in Spain. Methods Cost-effectiveness analysis compared cenobamate with brivaracetam, perampanel, eslicarbazepine acetate, and lacosamide. Markov model simulation of treatment pathway over a 60-year time horizon is presented. We determined the effectiveness and quality-adjusted life-years (QALYs) of health status and disutilities associated with treatment-related adverse events. Acquisition costs and use of medical resources were obtained from published literature and expert opinion. Base-case of cenobamate’s EJP calculated applying a willingness-to-pay (WTP) threshold of €21,000/QALY. Analyses were performed at different thresholds, including dominant price scenario. Result robustness was assessed through sensitivity analyses. Results Base-case shows that cenobamate’s daily EJP of €7.30 is cost-effective for a threshold of €21,000/QALY. At a daily price of €5.45, cenobamate becomes dominant over all treatment alternatives producing cost-savings for the national health system (NHS). Sensitivity analyses supported the robustness of base-case findings. Conclusions Treatment with cenobamate produces incremental clinical benefit over third-generation ASMs, and at the base-case, EJP could represent a cost-effective option for the adjunctive treatment of FOS in adult patients with DRE in Spain

Efficacy of glutamine in the prevention of acute radiation enteritis: a randomized controlled trial

[Abstract] Background: Acute radiation enteritis is a common adverse effect related to radiotherapy (RT). Glutamine is an immune modulator and antioxidant amino acid that can exert a protective role in patients receiving abdominal or pelvic radiation. The aim of this study was to test if glutamine prevents radiation enteritis during RT. Materials and Methods: Double-blind, randomized, controlled trial including 69 patients who needed RT because of pelvic or abdominal malignancies and received glutamine (30 g/d) or placebo (casein, 30 g/d). Enteritis was evaluated according to the Radiation Therapy Oncology Group scale, intestinal inflammation using fecal calprotectin, and gut integrity with citrulline. The incidence of enteritis was analyzed by Kaplan-Meier curves, and the hazard ratio (HR) was calculated using Cox regression. Results: Patients were predominantly male (65.2%), with an average (SD) age of 66.6 (9.9) years, with urologic (44.9%), rectal (24.6%), or gynecological cancer (23.1%). More patients developed enteritis with glutamine than with the placebo (55.9% vs 22.0%; P =.002), with an HR of 1.59 (95% confidence interval, 0.62-4.05). There were no differences in final calprotectin levels (glutamine, 57.9 [85.8] mg/kg vs placebo, 54.0 [57.7] mg/kg; P =.182) or the number of patients with values >50 mg/kg (glutamine, 58.1% vs placebo, 54.6%; P =.777). Final citrulline levels were similar between groups (glutamine, 26.31 [10.29] mmol/L vs placebo, 27.69 [12.31] mmol/L; P =.639), without differences in the number of patients with <20 mmol/L (glutamine, 24.1% vs placebo, 25.0%; P =.938). Citrulline concentration was reduced during RT with placebo but remained unchanged with glutamine. Conclusion: Glutamine does not prevent the development of enteritis during RT. © 2013 American Society for Parenteral and Enteral Nutrition.Castilla y León. Consejería de Sanidad, SACYL GRS 326/B/0

Nanomechanical properties of composite protein networks of erythroid membranes at lipid surfaces

Erythrocyte membranes have been particularly useful as a model for studies of membrane structure and mechanics. Native erythroid membranes can be electroformed as giant unilamellar vesicles (eGUVs). In the presence of ATP, the erythroid membrane proteins of eGUVs rearrange into protein networks at the microscale. Here, we present a detailed nanomechanical study of individual protein microfilaments forming the protein networks of eGUVs when spread on supporting surfaces. Using Peak Force tapping Atomic Force Microscopy (PF-AFM) in liquid environment we have obtained the mechanical maps of the composite lipid-protein networks supported on solid surface. In the absence of ATP, the protein pool was characterized by a Young’s Modulus Epool ≈ 5–15 MPa whereas the complex filaments were found softer after protein supramolecular rearrangement; Efil ≈ 0.4 MPa. The observed protein softening and reassembling could be relevant for understanding the mechanisms of cytoskeleton reorganization found in pathological erythrocytes or erythrocytes that are affected by biological agents