Prevalencia de hiponatremia en pacientes con nutrición parenteral. Morbimortalidad asociada

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 30/11/2015Hyponatremia is the most common electrolyte disorder in clinical practice. Patients with hyponatremia present high morbimortality rates. The prevalence of hyponatremia among hospitalized patients has been found to vary from 30 to 42%, when defined as a serum sodium level (SNa) below 136 mmol/L, and to be 19.7% when defined as a SNa below 135 mmol/L. In these patients, hyponatremia is most often present at admittance, and is mild (SNa between 130 and 134 mmol/L). However, when hyponatremia is hospital-acquired, it is more often moderate or severe. Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting normal SNa. Such is the case in patients with severe hyponatremia (SNa < 120-125 mmol/L) as well as in mild forms. Minor descents in SNa of the order of 4 to 5 mmol/L are already accompanied by an increased mortality rate. In fact, some authors have detected a minimum mortality rate in patients with SNa between 138–142 mmol/L, postulating these levels as representing strict eunatremia. Hyponatremic patients also have longer hospital lengths-of-stay, as well as a higher readmissions rate. Hyponatremia is a consequence of an alteration in water metabolism, most often due to a reduced renal capacity to eliminate free water (antidiuresis), secondary to a non-osmotic increase in the secretion of Arginine Vasopressin (AVP), the Antidiuretic Hormone (ADH) of humans. This increase can be induced by physiologic stimuli (post-surgical stress, pain, nausea...) or by nonphysiologic, inappropriate AVP secretion (the Syndrome of Inappropriate Antidiuretic Hormone Secretion or SIADH). The combination of persistent AVP secretion together with increased oral or parenteral fluid intake results in plasmatic hypoosmolality, and induction or exacerbation of hyponatremia...La hiponatremia es el trastorno electrolítico más frecuente en la práctica clínica. A nivel hospitalario su importancia no sólo radica en su elevada prevalencia sino en la mayor morbimortalidad que asocia. La hiponatremia se produce por una alteración de los mecanismos que regulan el agua, habitualmente por una disminución de la capacidad renal de eliminar agua libre (antidiuresis), secundaria a un incremento no osmótico de la arginina vasopresina (AVP), la hormona antidiurética del humano (ADH). Este aumento puede estar causado por estímulos fisiológicos (estrés postquirúrgico, dolor, náuseas...) o por una secreción no fisiológica e inapropiada (SIADH). La elevación de ADH combinada con un aumento de agua tanto por vía oral o vÍa parenteral producen un descenso de la natremia, con la aparición o la exacerbación de hiponatremia. El cuadro anterior es frecuente en los pacientes hospitalizados y posiblemente más aún en los pacientes con nutrición artificial por vía parenteral. Estos últimos habitualmente precisan dicho soporte nutricional por una cirugía mayor digestiva (neoplasias, obstrucciones intestinales, isquemia intestinal...) o por otras alteraciones del aparato digestivo que requieren reposo intestinal (vómitos, diarreas...). En estas situaciones generalmente están presentes tanto estímulos fisiológicos de la ADH (dolor, náusea, estrés postquirúgicos...) como no fisiológicos (SIADH neoplásico, SIADH farmacológico...) que disminuyen la eliminación renal de agua libre. Lo anterior combinado con el incremento de aporte de líquidos por la NP produce un descenso de la natremia. En ocasiones se suman pérdidas corporales de sodio que pueden exacerban la hiponatremia. A pesar de esto no se conoce la frecuencia de hiponatremia en este grupo de pacientes ni tampoco su influencia en la morbimortalidad...Depto. de MedicinaFac. de MedicinaTRUEunpu

Prevalencia de hiponatremia en pacientes con nutrición parenteral. Morbimortalidad asociada

Hyponatremia is the most common electrolyte disorder in clinical practice. Patients with hyponatremia present high morbimortality rates. The prevalence of hyponatremia among hospitalized patients has been found to vary from 30 to 42%, when defined as a serum sodium level (SNa) below 136 mmol/L, and to be 19.7% when defined as a SNa below 135 mmol/L. In these patients, hyponatremia is most often present at admittance, and is mild (SNa between 130 and 134 mmol/L). However, when hyponatremia is hospital-acquired, it is more often moderate or severe. Several studies have found a high mortality rate in hospitalized hyponatremic patients as compared with those presenting normal SNa. Such is the case in patients with severe hyponatremia (SNa < 120-125 mmol/L) as well as in mild forms. Minor descents in SNa of the order of 4 to 5 mmol/L are already accompanied by an increased mortality rate. In fact, some authors have detected a minimum mortality rate in patients with SNa between 138–142 mmol/L, postulating these levels as representing strict eunatremia. Hyponatremic patients also have longer hospital lengths-of-stay, as well as a higher readmissions rate. Hyponatremia is a consequence of an alteration in water metabolism, most often due to a reduced renal capacity to eliminate free water (antidiuresis), secondary to a non-osmotic increase in the secretion of Arginine Vasopressin (AVP), the Antidiuretic Hormone (ADH) of humans. This increase can be induced by physiologic stimuli (post-surgical stress, pain, nausea...) or by nonphysiologic, inappropriate AVP secretion (the Syndrome of Inappropriate Antidiuretic Hormone Secretion or SIADH). The combination of persistent AVP secretion together with increased oral or parenteral fluid intake results in plasmatic hypoosmolality, and induction or exacerbation of hyponatremia..

Adiponectin gene variant rs3774261, effects on lipid profile and adiponectin levels after a high polyunsaturated fat hypocaloric diet with Mediterranean pattern

Producción CientíficaThe role of ADIPOQ gene variants on metabolic improvements after weight change secondary to different hypocaloric diets remained unclear. We evaluate the effect of rs3774261 of ADIPOQ gene polymorphism on biochemical improvements and weight change after high polyunsaturated fat hypocaloric diet with a Mediterranean dietary pattern for 12 weeks. A population of 361 obese subjects was enrolled in an intervention trial with a calorie restriction of 500 calories over the usual intake and 45.7% of carbohydrates, 34.4% of fats, and 19.9% of proteins. The percentages of different fats was; 21.8% of monounsaturated fats, 55.5% of saturated fats, and 22.7% of polyunsaturated fats. Before and after intervention, an anthropometric study, an evaluation of nutritional intake and a biochemical evaluation were realized. All patients lost weight regardless of genotype and diet used. After 12 weeks with a similar improvement in weight loss (AA vs. AG vs. GG); total cholesterol (delta: −28.1 ± 2.1 mg/dL vs. −14.2 ± 4.1 mg/dL vs. −11.0 ± 3.9 mg/dL; p = 0.02), LDL cholesterol (delta: −17.1 ± 2.1 mg/dL vs. −6.1 ± 1.9 mg/dL vs. −6.0 ± 2.3 mg/dL; p = 0.01), triglyceride levels (delta: −35.0 ± 3.6 mg/dL vs. 10.1 ± 3.2 mg/dL vs. −9.7 ± 3.1 mg/dL; p = 0.02), C reactive protein (CRP) (delta: −2.3 ± 0.1 mg/dL vs. −0.2 ± 0.1 mg/dL vs. −0.2 ± 0.1 mg/dL; p = 0.02), serum adiponectin (delta: 11.6 ± 2.9 ng/dL vs. 2.1 ± 1.3 ng/dL vs. 3.3 ± 1.1 ng/dL; p = 0.02) and adiponectin/leptin ratio (delta: 1.5 ± 0.1 ng/dL vs. 0.3 ± 0.2 ng/dL vs. 0.4 ± 0.3 ng/dL; p = 0.03), improved only in AA group. AA genotype of ADIPOQ variant (rs3774261) is related with a significant increase in serum levels of adiponectin and ratio adiponectin/leptin and decrease on lipid profile and C-reactive protein (CRP)

Effect of Two Meal Replacement strategies on Cardiovascular Risk Parameters in Advanced Age Patients with Obesity and Osteoarthritis

Producción CientíficaBackground and aims: Meal replacement diets consist of replacing one or more meals with an artificial nutritional supplement. The objective of this study was to compare the effect of one against two meal replacement strategies on body composition and cardiovascular risk parameters in patients with obesity. Methods: A randomized clinical trial was designed with a modified hypocaloric diet with an artificial nutritional preparation replacing one or two meals for three months in patients with obesity and osteoarthritis pending orthopedic surgery. An anthropometric evaluation and a measurement of the body composition were done with bioelectrical impedance measurement at the beginning and at three months. Results: A total of 112 patients were recruited. Fifty-two patients (46.4%) were randomized to one replacement and 60 patients (53.6%) to two meal replacements. Eighty-one patients (72.3%) were women, and the average age was 61 (11.03) years. The percentage of weight loss at three months was 8.27 (4.79)% (one meal replacement: 7.98 (5.97)%; two meal replacements: 8.50 (3.48)%; p = 0.56). A decrease in fat mass measured by the fat mass index (FMI) was detected (one meal replacement: −2.15 (1.45) kg/m2 vs. two meal replacements: −2.78 (2.55) kg/m2; p > 0.05), and a relative increase in fat-free mass was observed (one meal replacement: +3.57 (4.61)% vs. two meal replacements: +2.14 (4.45)%; p > 0.05). A decrease in HOMA-IR, systolic blood pressure (SBP), and total cholesterol was observed in both groups without differences between them. Conclusions: The substitution strategies of one or two meal replacements were effective in weight loss and fat mass decrease without differences between the two groups. An improvement in lipid parameters, glycemic control, and systolic blood pressure was observed without differences between strategies

Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes

Purpose: The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods: This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 μg/dL (confirmed ACS if >5 μg/dL and possible ACS if 1.8–5 μg/dL) in the absence of spe cific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results: The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS–PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS–PA and PA-only patients was simil ar, except for older age and larger tumor size of the adrenal lesion in the ACS–PA group. When comparing the ACS–PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64–22.32)) and cardiovascular events (OR 5.0 (2.29–11.07)) was higher in ACS–PA patients than in ACS patients. The coexistence of ACS in patien ts with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS–PA and PA-only groups. Conclusion: Co-secretion of cortisol and aldosterone affects almost one-thi rd of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS–PA and PA-only are similar

Capitulo 2. Ciencias Naturales y Ciencias Básicas, Ingeniería y Tecnología

La diseminación de la Levitación Magnética, a pesar de lo antiguo de su tecnología, ha sido limitada. Debido a sus inconvenientes prácticos de implementación, su uso es bastante restringido, comparado con otras tecnologías (SCMaglev japonés, Transrapid alemán, o productos comerciales para ocio y entretenimiento). Con el boom de las tecnologías limpias y amigables con el medio ambiente y en concordancia con los objetivos del milenio, es pertinente plantearse el objetivo de optimizar el proceso de Levitación Magnética para generar un aprovechamiento de las ventajas de esta tecnología a nivel mecánico, eléctrico, y ambiental.&nbsp; Actualmente la UNAD adelanta un proyecto de investigación cuyo objetivo es generar un modelo físico matemático de levitación magnética para aplicaciones en ingeniería. De este proyecto se ha derivado una primera revisión sistemática de los principios físicos y los modelos vigentes en Levitación Magnética

Role of rs1501299 variant in the adiponectin gene on total adiponectin levels, insulin resistance and weight loss after a Mediterranean hypocaloric diet

Background/Aim: Several adiponectin gene (ADIPOQ) single nucleotide polymorphisms (SNPS) have been related with adiponectin levels and risk for obesity. Our aim was to analyze the effects of rs1501299 ADIPOQ gene polymorphism on total adiponectin levels, insulin resistance and weight loss after a Mediterranean hypocaloric diet in obese subjects. Methods: A Caucasian population of 82 obese patients was analyzed, before and after 3 months on a Mediterranean hypocaloric diet. Before and after 3 months on a hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. Results: After dietary treatment and in wild type group, weight, BMI, fat mass, leptin levels, systolic blood pressure and waist circumference decreases were similar to the mutant type group. In wild type group, the decrease in total cholesterol was 28.1 ± 15.3 mg/dl (mutant group: 12.6 ± 16.7 mg/dl:p = 0.009), LDL- cholesterol was 31.8 ± 20.5 mg/dl ( 12.2 ± 11.5 mg/dl:p = 0.006), fasting glucose plasma 4.8 ± 2.5 mg/dL ( 0.5 ± 0.1 mg/dL:p = 0.02), insulin 3.6 ± 1.5 mUI/L (+0.6 ± 1.1 mUI/L:p = 0.02) and HOMA-IR 1.2 ± 0.9 ( 0.1 ± 1.1: p = 0.03). Conclusion: The present study suggests that T allele of ADIPO (rs1501299) could be a predictor of a lack of response of HOMA-IR, insulin, fasting glucose and LDL cholesterol secondary to a Mediterranean hypocaloric diet in obese subjects

Real World Practice Study of the Effect of a Specific Oral Nutritional Supplement for Diabetes Mellitus on the Morphofunctional Assessment and Protein Energy Requirements

Introduction: The prevalence of malnutrition in patients with diabetes mellitus is high. In these patients, monitoring nutritional intervention is complex. Aims: To evaluate the evolution in the nutritional status in patients with diabetes/prediabetes and malnutrition with a diabetes-specific enteral formula. Methods: Real-life study of one arm in 60 patients with diabetes and prediabetes, performing a dietary adaptation with diabetes-specific oral nutritional supplementation. A morphofunctional assessment was performed, consisting of intake assessment, anthropometry, body composition (bioimpedance and muscle ultrasound), handgrip strength and biochemical markers. The diagnosis of malnutrition was made using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The variables were measured at baseline and 3 months after starting the intervention. Results: The mean age was 67.13 (14.9) years. In total, 30 (50%) of the patients were women. Of the total, 60% of the patients had diabetes mellitus and 40% of the patients had prediabetes. The initial body mass index was 24.65 (5.35) kg/m2. It was observed that 80% of the patients had malnutrition, whereas after the intervention, the prevalence was 51.7% (p &lt; 0.01). At the beginning of the study, 20% of the patients suffered from sarcopenia and after the intervention it was 16.7% (p = 0.19). Conclusions: Medical Nutrition Therapy with an adapted oral diet associated with diabetes-specific oral nutritional supplementation reduces malnutrition in patients at nutritional risk and disturbances of carbohydrate metabolism

Diabetic foot

El «pie diabético» incluye una serie de síndromes en los que la interacción de la pérdida de la sensación protectora por la presencia de neuropatía sensitiva, el cambio en los puntos de presión a causa de la neuropatía motora, la disfunción autonómica y la disminución del flujo sanguíneo por enfermedad vascular periférica pueden dar lugar a la aparición de lesiones o úlceras inducidas por traumatismos menores que pasan «desapercibidos». Esta situación conlleva una importante morbilidad y un riesgo de amputación elevado. Se puede prevenir con la aplicación de programas de prevención, basados en la detección precoz de neuropatía, evaluación de factores de riesgo asociados, junto a aplicación de un programa estructurado de educación y tratamiento de los factores de riesgo. Incluyen el manejo óptimo de la lesión aguda, con antibioterapia específica y cuidados que favorecen un cicatrización correcta y temprana.Diabetic foot includes a group of syndromes in which the interaction among loss of protective sensation due to sensory peripheral neuropathy, a change in pressure spots due to motor neuropathy, autonomic dysfunction, and decreased blood supply due to peripheral vascular disease can lead to the occurrence of wounds or ulcers usually related to minimal injuries that are usually unnoticed. Diabetic foot is associated with higher morbidity and a high risk of amputation of the foot or limb. These situations can be avoided with an appropriate prevention program, based on the early detection of diabetic neuropathy and assessment of the associated risk factors in addition to structured patient education. Also important are optimal treatment of the acute injury, with specific antibiotics and foot care measures that encourage early and effective healing.Sin financiación0.104 SJR (2012) Q4, 53/57 RheumatologyUE

Papá y mamá vienen hoy al colegio

Se pretende llevar a cabo unos talleres en los que puedan participar los padres. El objetivo general de este proyecto es: 1) Ofrecer a los niños experiencias comunitarias (varios niños, varios animadores) en situaciones mas estimulantes y no reducidas al grupo de clase. De este modo se pretende posibilitar la comunicación, permitiendo que los niños satisfagan la necesidad de exponer sus experiencias a los demás.2) Potenciar las actividades grupales. 3) Facilitar la convivencia entre distintos niveles. 4) Utilizar mejor los espacios naturales. 5) Desmitificar al maestro como el único que puede enseñar, participarán padres, abuelos, hermanos etc. 6) Posibilitar la participación de otros miembros de la comunidad educativa interesados por la escuela. Las actividades que se realizan en los Talleres se centran en la manipulación, creación, experimentación y vivencia por parte de los niños de aquello que están aprendiendo. Se parte de la práctica para llegar a los conocimientos teóricos.Gobierno de Cantabria. Consejería de Educación y JuventudCantabriaES