Protocolo de manejo nutricional en pacientes con pancreatitis aguda

La pancreatitis aguda es una enfermedad de impacto en salud pública debido al aumento de los casos en los últimos años, sobre todo la alta incidencia en pancreatitis aguda grave. La pancreatitis aguda constituye una causa de morbilidad y mortalidad frecuente en centros hospitalarios, en donde la causa principal fue la de origen biliar. Un principio fundamental en el manejo nutricional de esta entidad es evitar el ayuno por más de 7 días sobre todo en la pancreatitis aguda grave, ya que esto favorece la desnutrición e incrementa la probabilidad del desarrollo de infecciones y complicaciones sistémicas. Todos los pacientes ingresados con diagnostico de pancreatitis aguda deben ser estratificados en su gravedad, y sometidos a una evaluación nutricional al ingreso hospitalario, a fin de diagnosticar en forma temprana la severidad de la enfermedad e iniciar de forma precoz el soporte nutricional. Existen consensos en privilegiar la nutrición enteral precoz por sobre la nutrición parenteral, salvo que exista contraindicaciones para la primera. Por lo general estos pacientes se encuentran normo nutridos al ingreso pero con riesgo de desnutrición por el híper catabolismo al que se encuentran sometidos, por lo que un soporte nutricional oportuno, constituye una parte fundamental en el tratamiento y evolución favorable de esta patología

Severe asthma: One disease and multiple definitions

Introduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Adherence issues related to sublingual immunotherapy as perceived by allergists

Objectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence. Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10. Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists. Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers. © 2010 Scurati et al, publisher and licensee Dove Medical Press Ltd

Diagnosis of congenital cytomegalovirus infection by detection of viral DNA in dried blood spots

Background: The reference method of cytomegalovirus (CMV) isolation from urine or saliva is not a feasible routine technique for all newborns,- and laboratory -diagnosis -of- this- infection-would be useful- -both for--epidemiological purposes and to enable prompt institution of adequate measures to identify and correct late sequelae. Extraction and amplification of viral DNA from dried blood spots (DBS) collected from babies in the first days of life during routine screening for genetic and metabolic disorders has been proposed for the early diagnosis of viral congenital infections. Objectives: To test the method for CMV DNA extraction from DBS and to evaluate the results obtained in newborns with and without a diagnosis of congenital infection based on viral isolation from urine and or saliva at birth. Study design: DBS from Guthrie cards collected in babies who underwent virological tests for CMV infection were tested for CMV DNA by observers blinded to the virological results. DNA was extracted from DBS both in water and in cell culture medium according to Shibata et al. with minor modifications. The products of nested polymerase chain reactions (PCR) amplifying two regions in the 1E1 and gp58 genes were detected by agarose gel electrophoresis. Strict control measures were adopted to avoid carryovers and contaminations. Results: DBS from the eight symptomatic and 11 asymptomatic congenitally infected babies were positive when extraction was performed in medium, whereas extraction in water failed to identify two of the asymptomatic cases. The results obtained with the two extraction methods agreed in the remaining cases; the 71 CMV negative control babies were negative and two out of 21 cases of supposed postnatal infection were diagnosed as congenital on the basis of a positive DBS. All positive cases were identified by gp58 PCR but only slightly over half of them by 1E1 PCR. Extraction in medium was more efficient than in water. Conclusions: The method of CMV DNA extraction in medium followed by amplification of the gp58 region showed 100% sensitivity and specificity compared with isolation in cell culture. Therefore, we propose this procedure to diagnose congenital CMV infection at birth and also later

IN VITRO EVALUATION OF THE ANTIVIRAL ACTIVITY OF THE ASPIRIN / DIETHYL ETHER (ADE) MIXTURE FOR HERPES ZOSTER AND POST-HERPETIC NEURALGIA

Aim of investigation. The efficacy of topical aspirin/diethyl ether mixture in the treatment of acute herpetic neuralgia and post-herpetic neuralgia had been established in two, previous open-label and placebo- controlled studies (De Benedittis et al., Pain 48: 383-390 , 1992; De Benedittis & Lorenzetti,Abstracts, 7th World Congress on Pain , Paris, p. 186 , IASP Publications, Seattle,1993). Moreover, a striking reduction of the percentage of acute herpetic neuralgia patients developing post-herpetic neuralgia had been observed in the treated groups as compared with the disease natural history reported in the literature. Since this action could be assumed as an indirect, objective indicator of treatment efficacy in controlling the severity of Herpes Zoster, the aim of the present study was to evaluate the in vitro activity of the ADE mixture on both viral particles and replicative cycle of varicella-zoster virus (VZV) and herpes simplex virus type l(HSV1) as the Herpesviridae prototype virus. Method. Suspensions of HSV1 were incubated alternatively with Aspirin 400 mM, diethyl ether and the mixture (1:1, v/v) of the two; the reduction of the viral titer was assessed by the plaque reduction assay. The activity on viral replication was checked on human fetal fibroblasts (MRCS) infected with VZV and on african green monkey kidney cells (VERO) infected with HSV1, and the 50% inhibiting dose (ID50) was calculated. Results. A 100% reduction of the suspensions titer was obtained both by the mixture and the ether; no effect was observed following the incubation with aspirin alone. An inhibition of the replicative cycle by aspirin was observed. The ID50 resulted in the range (1-3 mM) of the plasma concentrations attained in the clinical treatment of inflammation. Conclusions. Preliminary data indicate an antiviral activity of aspirin which is exerted at a replicative level but not on the viral particle. The antiviral effect might be due to inhibition by aspirin and Na salicylate of the transcription factor NF-kB (Kopp & Gosh, Science, 128: 432-435, 1994). Further studies aimed at assessing the aspirin concentrations attained by topical use and the viral replication stage of the inhibition are irrprugress-.-

CYTOMEGALOVIRUS E PAZIENTE HIV+: IMPEGNO DEL LABORATORIO DI DIAGNOSTICA VIROLOGICA

Obiettivo: valutare l'impatto delle infezioni da cytome galovirus in soggetti con infezioni da HIV sulla base del- le richieste di accertamento diagnostico di laboratorio. Materiali e Metodi: sono stati analizzati i dati relativi all'attivita diagnostica svolta nel 1994 per l'accertamen\uacto delle infezioni da CMV in circa 1000 pazienti HIV+ rico verati in 4 Ospedali lombardi. Si sono considerate esclusi vamente le indagini virologiche svolte su campioni di leu\uaccociti di sangue periferico (PBL). Tali prove sono consistite nella determinazione quantitativa di antigenemiapp65 e viremia p72 e nella ricerca di virus infettante tramite prove di isolamento in coltura cellulare. Risultati: complessivamente su 981 casi esaminati nel 1994 428 soggetti (43%) sono risultati positivi per CMV in alme no un'occasione (media: 2 campioni positivi/paziente). La febbre 6 stato it dato clinico segnalato piia frequentemen\uacte (1478 invii su 2076) da solo o in accompagnamento ad al tri problemi clinici. Un quarto circa dei campioni 6 stato inviato per it controllo della terapia. La determinazione della antigenemia 6 risultata positiva nel 40% dei campio\uacni esaminati e nella quasi totality (99%) dei positivi. Conclusioni: le indagini virologiche svolte hanno consenti to di fornire al clinico indicazioni di infezione in poco meno della meta dei casi esaminati e di effettuare it moni toraggio della terapia nella quota di pazienti trattati. Questi dati sono di particolare rilievo in termini di orga nizzazione e di impegno del personale quando si tenga pre\uacsente che i risultati sono stati disponibili entro 24 ore dall'invio dei campioni, per 5 giorni alla settimana. Solo a queste ultime condizioni si ritiene che it lavoro diagno stico possa avere un impatto significativo sulla gestione del paziente

CIRCULATING CMV-INFECTED ENDOTHELIAL CELLS (CCIC) IN AIDS PAITIENTS WITH CMV RELATED SYMPTOMS

OBJECTIVE: Tp assess the frequency of the presence and th with laboratory findings and clinical conditions of CCIC patients with CMV infection. METHODS: CMV infection routine diagnosis (viral isolation and determination of pp65 antigenemia and p72 viremia) was performed on 1737 blood samples (buffy-coat cells) from 450 HIV infected patients. Ficoll separation of mononuclear cells and PCR amplification of a IE1 gene region of CMV was performed on selected cases. RESULTS: CCIC were found in 30 samples from 21 patients: Eleven specimens were positive in the course of anti-CMV therapy. All positive samples were also pp65, p72 and isolation positive. Ficoll separation allowed a greater number of CCIC to be found. PCR was positive in all but one of the CCIC positive samples. DISCUSSION: CCIC were not frequently found; their systematic search in the mononuclear cell fraction could contribute to the understanding of their role

DIAGNOSIS OF CONGENITAL CMV INFECTION BY DETECTION OF VIRAL DNA BY PCR IN DRIED NEWBORN BLOOD SPOTS

Early laboratory diagnosis of congenital CMV infection is useful as it limits the applica\uaction of diagnostic procedures when neurologic or other types of sequelae will appear and allows adequate measures of identifying and correcting impairements to be adopt\uaced. The presence of the virus in the blood of infected babies can be demonstrated by PCR. In this study the CMV genome was sought in dried blood spots (Guthrie cards) collected in the first week of life from 15 babies, 7 symptomatic and 8 asymptomatic at birth, from which CMV was isolated in the first 2 weeks of life. A group of 30 uninfect\uaced babies (no virus isolated at birth) and a further 15 infants with a perinatal CMV in\uacfection were taken as controls. The DNA was extracted from the cards by incubation in sterile distilled water, heating at 55 \ub0C for 60 min. and at 100 \ub0C for 7 min. and centri\uacfugation at 10.000 rpm for 5 min. (Shibata et al, '94). The supernatant was subjected to nested PCR for the amplification of two regions in the 1E1 and gp58 genes, the amplifi\uaced products were electrophoresed in agarose gel (Barbi et al, 1994). Each sample was tested at least twice in different analytical sessions. Strict control measures were adopt\uaced to avoid carry-overs and contaminations. Thirteen of 15 congenitally infected babies turned positive while all the CMV negative control babies were negative. One of the 15 infants referred as perinatally infected was diagnosed as congenitally infected on the basis of a positive PCR. 100% of positive cases were identified by gp58 PCR and 61% by 1E1 PCR. These results are encouraging in view of the use of this technique in the rou\uactine screening of newborns for congenital CMV infection. Great care must be paid to the correct blood loading of the cards since the negative results obtained in two CMV infected babies might be due to a poor quality of the specimens