The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: Part 2 (treatment)

Chronic pancreatitis (CP) is a complex disease with a wide range of clinical manifestations. This range comprises from asymptomatic patients to patients with disabling symptoms or complications. The management of CP is frequently different between geographic areas and even medical centers. This is due to the paucity of high quality studies and clinical practice guidelines regarding its diagnosis and treatment. The aim of the Spanish Pancreatic Club was to give current evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. These experts were selected according to clinical and research experience in CP. A list of questions was made and two experts reviewed each question. A draft was later produced and discussed with the entire panel of experts in a face-to-face meeting. The level of evidence was based on the ratings given by the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus, recommendations were given regarding the management of pain, pseudocysts, duodenal and biliary stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP

The Spanish Pancreatic Club recommendations for the diagnosis and treatment of chronic pancreatitis: Part 1 (diagnosis)

Chronic pancreatitis (CP) is a relatively uncommon, complex and heterogeneous disease. The absence of a gold standard applicable to the initial phases of CP makes its early diagnosis difficult. Some of its complications, particularly chronic pain, can be difficult to manage. There is much variability in the diagnosis and treatment of CP and its complications amongst centers and professionals. The Spanish Pancreatic Club has developed a consensus on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. A list of questions was drafted, and two experts reviewed each question. Then, a draft was produced and shared with the entire panel of experts and discussed in a face-to-fac

Propuesta de perfil de ácidos grasos omega 3 en nutrición enteral Proposed profile of omega 3 fatty acids in enteral nutrition

Revisamos las recomendaciones internacionales de ingesta oral de ácidos grasos n-3.y su contenido en las fórmulas de nutrición enteral. Sus acciones metabólicas dependen de su metabolización a EPA y DHA. La actividad de las 5D y 6D desaturasas, que catalizan este proceso, aumenta con el ejercicio, insulina, estrógenos de mujer fértil y proliferadores peroxisómicos, mientras que disminuye con el ayuno, déficit de proteínas y oligoelementos, edad > 30 años, sedentarismo, tabaco, alcohol, colesterol, ácidos grasos trans y saturados, insulinopenia y hormonas de estrés (adrenalina y glucocorticoides). La mayoría de las guías recomiendan 20-35% de la energía total en forma de grasas, repartidas en saturadas 7-10%, poliinsaturadas 6-10% y monoinsutaradas en España 20%. El de AG n-3 es de 0,5-2 g/día o bien 0,5-2% de la ingesta calórica total, con un límite superior de 3 g/día. El de AG n-6 es del 2,5-10% del aporte calórico total y el cociente recomendado n-6/n-3 no está bien definido pero la mayoría recomienan 5/1. El contenido en EPA y DHA, debe ser de al menos los 500 mg diarios. Por último, la ratio EPA/DHA en la mayoría es de 2/1. Las fórmulas de nutrición estándar presentan un contenido en grasas adecuado, pero la mayoría de los productos que contienen EPA y DHA exceden el límite de los 3 g/día. De los productos hiperproteicos y/o concentrados por vía oral sólo un producto de este grupo contiene EPA y DHA. Las del anciano frágil no todas aportan EPA y DHA y las que los contienen, su concentración puede ser incluso excesiva y en una relación poco parecida a la del aceite de pescado.We review the international recommendations on oral intake of n-3 fatty acids and their content in the enteral nutrition formulas. Their metabolic actions depend on their metabolization to EPA and DHA. The activity of desaturases catalyzing this process increases with exercise, insulin, estrogens in the fertile women, and peroxisomal proliferators, whereas it decreases with fasting, protein and oligoelements deficiencies, age < 30 years, sedentary lifestyle, cigarette smoking, alcohol, cholesterol, trans and saturated fatty acids, insulin deficiency, and stress hormones (adrenalin and glucocorticoids). Most of the guidelines recommend that 20-35% of the total energy comes from fat, being 7-10% saturated fats, 6-10% polyunsaturated, and 20% monounsaturated, in Spain. The recommendation for n-3 FA is 0.5-2 g/day or 0.5-2% of total caloric intake, with an upper limit of 3 g/day. For n-6 FA, 2.5-10% of total caloric intake, the n-6/n-3 ratio not being well established although most of the guidelines recommend 5:1. The EPA and DHA content should be at least 500 mg per day. Finally, the EPA/DHA ratio is 2:1 in most of them. Standard nutrition formulas present an appropriate fat content, although most of the products containing EPA and DHA exceed the limit of 3 g/day. Among the products with hyperprotein and/or concentrated, only of them contains EPA y DHA. Not all the formulas used for the frail elderly contain EPA or DHA, and in those containing them their concentration may be excessive and with a proportion very dissimilar to that of fish oil

Follow-Up of Patients After Male-to-Female (Mtf) Sex Reassignment Surgery (SRS)

Following surgery and legalization of the gender reassignment, long-term physical, sexual, hormonal, and psychological follow-up is necessary to establish and maintain the success of the procedure. Since persistent regret after sex reassignment surgery must be considered, along with suicide, as the worst conceivable outcome of SRS [1], it is crucial to know the opinion of patients when evaluating the cosmetic and functional results of the surgery [2]