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Decrease in the capacity to deglution solids and liquids is a problem in many people, this problem decreases quality of life. The main objective of our work was to evaluate the influence in elderly ambulatory patients with dysphagia of a texture modified diet ready to use on nutritional parameters and quality of life.We enrolled 29 patients from Nutrition Department with dysphagia and an age over 70 years. Patients received a texture modified diet supplemented with dehydrated nutritional products (Resource Ready) (1,633 kcal, 59,9 g proteins (16%), 52,1 g lipids (29%), 231,7 g carbohydrates (57%), 11,1g de fiber, 82 mg cholesterol). Before and after 3 months of starting the treatment, we recorded a blood analysis, nutritional anthropometric evaluation (tricipital skinfold, midarm circumference, midarm muscle circumference, weight, height and body mass index), a bipolar bioimpedance and a dietary questionnaire of 3 days. SF36 as a questionnaire of quality of life was used before and after nutritional treatment.A total of 29 patients were recruited with a sex distribution of (18 females and 11 males), and an average age of 79,5+8,59 years. A 25,7% of patients had head and neck tumors, a 24% dementia and a 41,3% chronic neurological deterioration. After treatment, we detected an improvement in weight, fat mass, fat free mass, total proteins, albumin, transferrin and lymphocytes. Caloric, protein fat and carbohydrate intakes increased in a significative way. Caloric intake corrected by weight improved (26.1 +/- 5.7 cal/kg vs 28.9 +/- 4.5 cal/kg: p0.05). Quality of life improved significantly (SF 36 score 94.7 +/- 15 points vs 99.3 +/- 10 points; p0.05).A texture modified diet with dehydrated nutritional products improved dietary intake, nutritional status and quality of life of ambulatory elderly patients with dysphagia.

Few information about descriptive studies of autoimmunity in diabetes mellitus type 1 onset patients and family exist. The aim of our study was to analyze clinical and biochemical parameters of onset diabetes mellitus type 1 patients and first degree families.Forty seven onset diabetes mellitus type 1 patients and 148 first degree families were studied, between January 1999 and December 2002, in the west area of Valladolid. In all cases and families an anthropometric study and biochemical determination with autoimmunity levels were performed.Average age in onset diabetes mellitus type 1 patients was 16.09 (9.36) years, without differences between males (32 cases, 68%) and females (15 cases, 32%), with an incidence of 4.66 cases/100,000 habs./year. Average values of peroxidase antibodies (antiPTO) and glutamic descarboxilase antibodies (antiGAD) were higher in diabetic patients than in families. No differences were detected in insulin antibodies (IAA) and tiroglobuline antibodies (antiTG). No correlation was detected between anti TPO and anti pancreas. Autoantibodies did not influence in glycemic control. Average dose of NPH insulin and regular insulin were 27.58 (13.88) UI/d y 3.05 (4.90) UI/d, respectively.Average age of onset diabetes mellitus type 1 patients was similar than other studies, with a high frequency of males. Values of antiGAD y antiTPO were higher in diabetic patients than families. No correlation between autoimmunity and glycemic control was detected.

Nutritional education is an essential issue for the proper approach to patients. One of the first issues to have in mind is the appropriate nutritional guidelines in theses professionals in their routine life. The aim of out work was to determine the oral intake pattern in a group of health professionals.A 24-hours nutritional survey (encuesta) was performed in a group of 51 health professionals (including both medical and nurse personnel) who attended a course in specialized training in nutrition at Hospital Universitario Río Hortega. All participants had their weight, length, age, and profession recorded. Before complying with diet they received an identification session of alimentary rations.The mean age of participants was 25.9 (5.4) years and they were all women (52.9% nurses and 47.1% physicians). Body mass index (BMI) was 21.9 (2.6). The intake of vitamin D was lower than international recommendations (RDA): 2.25 (3.27) g/day. However, the intake of vitamin C, 183.8 (118) mg/day; vitamin B12, 4.73 (3.18) mg/day; folic acid, 262.4 (126) g/day, and iodine, 310.3 (185) g/day were higher than international recommendations. The caloric intake was appropriate for the age of participants and protein intake was 2-fold above normality 1.66 (0.9) g/ kg/day. Differences were observed only between the group of nurses and physicians regarding iodine intake, slightly higher in the former individuals.In summary, the caloric intake in these health professionals is appropriate, and there is an excess in the intake of proteins, vitamin C, vitamin B12, folic acid and iodine, with a low intake of vitamin D.

Decrease in the capacity to deglutition solids and liquids is a problem in many people, this problem decreases quality of life. The objective of our study is to compare the acceptance of texture modifies courses against conventional courses.A total of 70 patients were studied in our Hospital. First, 35 patients received a modified texture diet with conventional products and the next 35 patients received a modified texture diet with lyophilised products. All patients responded the next questions after to take the diets; texture, taste, smell and color.A total of 70 patients were studied (38 males and 32 females), the mean age was 74.9 +/- 16.8 years, no differences were detected between both groups (76.6 +/- 17.1 years vs 73.7 +/- 16.67 years). Lyophilised diets had better medians than conventional diets in all parameters; taste, smell, color and texture.Acceptance of lyophilised dishes were better than conventional dishes. These products could improve nutritional state in these patients.

Decrease in the capacity to deglutition solids and liquids is a problem in many people, this problem decreases quality of life. The objective of our work is to evaluate the acceptance degree of a dessert (stewed fruit) (including in the normal diet of the Hospital) in a group of patients with dysphagia.Forty seven patients were studied in Hospital Universitario del Río Hortega (Valladolid) in July of 2000. The main pathology of these patients was; (n = 12) 25.5% acute stroke, (n = 16) 34% aerodigestive tumors (Jarynx carcinoma (n = 5), cavum carcinoma (n = 9), oesophagus carcinoma (n = 2)) and 40.4% (n = 19) chronic neurologic disease (Alzheimer, vascular dementia, and parkinson). All patients took a oral triturated diet, a dessert with apple and pear (Resource fruits Instant). All patients took a portion of the dessert and after that a acceptance questionnaire was filled.Global acceptance of the product was 7.25 +/- 1.5, this punctuation was higher in the tumoral group 8 +/- 1.1 points, 6.86 +/- 1.4 in patients with acute stroke and 6.7 +/- 1.5 in patients with chronic neurologic disease (p0.05). Different organoleptic characteristics were analyzed, mean punctuation in texture was 1.79 +/- 0.6, color 2.2 +/- 0.5, smell 2.24 +/- 0.59 and taste 1.95 +/- 0.61, in a scale of 1 (very good) until 5 (very bad), a total of 57.9% patients responded very good (1) or good (2) in texture scale, 71.1% in color scale, 60.5% in smell scale and 63.2% in taste scale.Acceptance of this product in patients with dysphagia has been elevated, showing useful in these patients with nutrition alterations.

The valuation of nutritional state of an individual is necessary to performed a correct diagnostic approach and therapy in each case. This valuation can be performed by biochemical or anthropometric methods. In our country two tables of anthropometric values are used (Alastrue et al. and Frisancho et al.). The aim of our work was to compare the utility of both tables in the nutritional valuation of a urban and rural population of Valladolid.A total of 110 patients were valued biochemically and anthropometrically, presenting 65.5% pathology tumoral, with a 61.41 +/- 16.73 year old half age.Tricipital pleat classified the patients in a similar way (agreement 76.5%, kappa 0.68), however the muscular circumference of the arm didn't classify the patients in a same way (agreement 23%, kappa 0.02). in the correlation analysis among anthropometrics and biochemical parameters, positive correlations were detected between tricipital pleat and the index of corporal mass with the glucemia and cholesterol values. Positive correlations were also detected between the muscular circumference of the arm and urea and potassium levels.The anthropometric parameters are useful for the nutritional valuation of these patients but it is necessary to keep in mind the possible variations that can exist in function of the used tables. For it Would be useful that each geographical area and each group of pathologies even had its own table of percentiles in its normal population's function.

To analyze the clinical course and laboratory features, as well as the outcome of 6 adult patients with articular manifestations, and evidence of streptococcal infection.A retrospective review was performed of all patients seen in a rheumatology clinic at Louisiana State University Medical Center, with a diagnosis of poststreptococcal reactive arthritis (PSReA) to summarize the clinical features, laboratory findings, and clinical outcome between July 1991 and August 1994.Six patients were identified with PSReA. All had acute, severe inflammatory articular involvement that began shortly after a sore throat, with serological evidence of streptococcal infection, and accompanied by extraarticular clinical manifestations including glomerulonephritis and vasculitis, and poor response to aspirin and other nonsteroidal antiinflammatory drugs. In all cases the echocardiogram was negative, and on followup there was no evidence of cardiac involvement. In these patients antibiotic prophylaxis was not required.The clinical picture and serologic abnormalities exhibited by this group of patients suggest a diagnosis of PSReA rather than acute rheumatic fever. These cases also emphasize the resurgence of poststreptococcal infection related articular manifestations in our clinic population.

Recent evidence suggests that immunologic abnormalities are not uncommon in individuals with silicone breast implants. The purpose of our study was to evaluate in a consecutive manner, the prevalence of autoimmunity as assessed by the presence of antinuclear antibodies in a larger number of patients with silicone breast implants.Antinuclear antibody (ANA) testing using an indirect immunofluorescence technique was performed on 813 individuals with silicone breast implants. All subjects except for 3 transsexual males, were female. The overwhelming majority, over 99%, were white. The average age of the subjects was 46.2, with a range of 17 to 72 years.ANA positivity was found in 244 of 813 individuals (30%) using a mouse kidney substrate; and in 470 of 813 (57.8%) using a HEp-2 cell line. The most common immunofluorescent pattern found using HEp-2 was speckled, present in 341 (72.5%) individuals, followed by homogeneous pattern in 113 (24%), nucleolar in 63 (13.4%), and 5 (1.06%) were anticentromere. Anti-dsDNA antibodies measured by an ELISA assay were found in 6 of 71 patients (8%). Rheumatoid factor and C-reactive protein were found above healthy controls in less than 10% of cases studied. The high prevalence of ANA found in patients with silicone breast implants agrees with similar observations by others. The finding of anticentromere and nucleolar patterns has great interest and relevance. These fairly distinct ANA patterns are most commonly seen in the idiopathic form of scleroderma and related conditions.These findings suggest that ANA positivity is relatively common in individuals with silicone breast implants, and may support the existence of autoimmune mechanisms in the pathogenesis of the clinical manifestations seen in this population.

A variety of rheumatic disorders has been reported during the course of human immunodeficiency virus (HIV) infection; however, its association with systemic lupus erythematosus (SLE) is extremely rare. The effect of HIV infection on CD4 lymphocytes may ameliorate SLE activity and spur remission. We observed 2 patients with SLE who later developed HIV infection. Both patients' lupus went into remission, and their course was complicated by aseptic necrosis of the bone. These findings suggest that HIV infection may have an important effect on the natural course of SLE and may also have a pathogenic role in avascular necrosis.

The main objective was to investigate the expression of platelet derived growth factor (PDGF) receptors, and production of growth factors and cytokines from psoriatic skin and synovium derived fibroblasts.Fibroblast cultures were established from normal and psoriatic skin and synovium. Confluent cultures of fibroblasts were used for a receptor binding assay for PDGF, and then extracts were run on Western blot. The amount of immunoreactive A and B chain peptides present was determined with specific A or B chain antisera. Production of interleukin 1 beta and PDGF-beta was accomplished by neutralization with the use of commercially available antisera. A functional assay was used to measure transforming growth factor-beta (TGF-beta).There was an increased expression of the beta PDGF receptor in the psoriatic fibroblasts. Interleukin 1 beta and PDGF-beta production by psoriatic fibroblasts was also increased. However, TGF-beta production was similar in normal and psoriatic fibroblasts.Our data demonstrate an increased expression of beta PDGF receptor, and production of IL-1 beta and PDGF by psoriatic fibroblasts. The findings provide further support for an active role of this cell line in the pathogenesis of psoriasis and psoriatic arthritis.

To explore the potential role of fibroblasts in the pathogenesis of psoriasis and its related arthritis. Specifically, we analyzed the cell cycle of psoriatic fibroblasts obtained from skin and synovium by flow cytometry, and we also studied their response to several growth factors.Fibroblast cultures were established from normal and psoriatic skin, uninvolved and involved, and synovium. NIH-3T3 cells were also used as indicator cells in some of the experiments. Fibroblasts DNA cell cycle analysis was performed by flow cytometry, and the data was analyzed by using the "Cytologic DNA applications software version 2." In addition, fibroblasts were stimulated with growth factors including epidermal growth factor, transforming growth factor-beta, and platelet derived growth factor.A significant increase of S and G2-M phase values in confluent cultures of psoriatic fibroblasts in both skin and synovium compared to normal fibroblasts was found. Psoriatic fibroblasts also exhibited a greater proliferative response to growth factors compared to normal fibroblasts.Data obtained clearly showed a significant intrinsic in vitro alteration in skin and synovium fibroblasts from patients with psoriasis.

Accumulated evidence suggests that certain immunoregulatory hormones including prolactin (PRL) may play a role in the pathogenesis and disease expression of certain autoimmune diseases. Our objective was to investigate the possible role of PRL in the pathogenesis and disease expression of the spondyloarthropathies, including Reiter's syndrome (RS).Basal levels of PRL (serum) were determined by radioimmunoassay in patients with various types of spondyloarthropathies, patients with acute anterior uveitis (AAU), and healthy controls. Clinical manifestations at the time of serum collection were correlated with PRL levels.Hyperprolactinemia (PRL20 ng/ml) was found in 9 of 25 (36%) patients with RS. In contrast, only 1 of 34 (2.9%) (p0.001) patients with ankylosing spondylitis and none of the patients with psoriatic arthritis, AAU or healthy controls had hyperprolactinemia. The frequency of conjunctivitis, urethritis, dysentery, and uveitis was higher in hyper than in normoprolactinemic patients with RS.Our results suggest a possible role for this immunoregulatory hormone in the pathogenesis and disease expression of RS.

Chlamydia trachomatis infection is now recognized as the most prevalent veneral disease in the Western World. The majority of cases of Reiter's syndrome, one type of reactive arthritis, are secondary to sexually transmitted infections. Evidence of urogenital C. trachomatis infection is found in 36% to 61% of cases of Reiter's syndrome. We investigated the prevalence of infection by this organism in a group of patients with spondyloarthropathies. Positive cultures were obtained in 39.4% of patients with Reiter's syndrome, as well as in 22.2% of patients with psoriatic arthritis and in 20% of patients with ankylosing spondylitis. An important percentage of patients also had positive serum antibodies against C. trachomatis (62.1% of patients with Reiter's syndrome), suggesting presence of infection at some point during the course of the disease. Our findings and those from other authors support the use of long-term antibiotic therapy in patients with reactive arthritis, mainly in those in whom positive culture for C. trachomatis has been obtained as well as in their sex partners.

In the last decade, methotrexate (MTX) has emerged as a useful second line agent for a variety of arthritides. However, there still exists some reluctance for its wider use mainly because of concerns about its liver side effects. We describe our clinical experience with this drug in psoriatic arthritis (PsA). The study group included 24 men and 16 women, with a mean age of 47 years (16-75), with oligoarticular (13) or polyarticular (27) involvement, with a mean disease duration of 12 years (1-36). Patients received a mean dose of 11.2 mg of MTX orally/week during a mean period of 34 months (6-132). Seven had been previously treated with other second line agents. Thirty-eight patients had an excellent or good response. In them, the erythrocyte sedimentation rate dropped in a mean of 38 mm/h. Only 2 patients had a rather poor response. Two patients discontinued the medication because of side effects: leukopenia in one and stomatitis in the other. Eleven patients presented with liver test abnormalities: 3 mild, 6 moderate and 2 severe. Seven patients had 11 liver biopsies. Except for one, none had evidence of cirrhosis or inflammation. Indeed, no changes were observed in the histopathology in those with repeated biopsies. The case reported as cirrhosis occurred very early in the course of MTX therapy. He continued taking MTX treatment without further deterioration of liver chemistry and/or histology. It is concluded that MTX is an effective and safe agent in PsA. Results also indicate that it is not necessary to perform liver biopsies on a routine basis.

To evaluate the prevalence and characteristics of silent myocardial ischemia in asymptomatic patients with non insulin dependent diabetes mellitus, 50 diabetic patients (24 males, 26 females; mean age +/- SD = 58.3 +/- 6.4 years) with a normal resting electrocardiogram were prospectively studied. The total group underwent 48 hours electrocardiographic Holter monitoring, medical history, physical examination an a test for cardiac autonomic neuropathy. Serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and Hb A1c were determined. An ischemic episode was defined as asymptomatic ST-segment depression greater than or equal to 1 mm, greater than or equal to 1 min. Day-to-day variability was studied. Six hundred and forty one episodes with a total duration of 1,014 minutes of ischemia were recorded in 29 patients (58%). The mean number of episodes in 48 hours per patients was 19.2 +/- 21.9 and the mean time of ischemia over this period was 149 +/- 374 minutes. The average heart rate at the onset of the episodes was 95.2 +/- 8.4 beats per minute. Two hundred and ninety two (45.6%) episodes occurred without heart rate changes and in 349 (54.4%) episodes an increase in heart rate was detected at the onset of the episode. An important day-to-day variability in the number of episodes (73.8 +/- 29.5%) and ischemia duration (76.9 +/- 88.8%) was found. Fifteen patients had no ischemic episodes in either the first or second monitoring day. Silent ischemia was related to higher levels of total cholesterol (p less than 0.05), LDL-cholesterol (p less than 0.05) and Hb A1c (p less than 0.01) and was associated to diabetes complications: retinopathy (p less than 0.001), peripheral vascular disease (p less than 0.01), polyneuropathy (p less than 0.05), nephropathy (p less than 0.05), and impotence (p less than 0.01). Silent ischemia was not associated to abnormal test for cardiac autonomic neuropathy.prevalence of silent myocardial ischemia during daily activities in asymptomatic diabetic patients is very high (58%). Both an increase in oxygen demand and a decrease in oxygen supply may be involved in its pathophysiology. In diabetic patients silent ischemia is related to the presence of other risk factors for coronary artery disease and to diabetes complications and shows a marked day-to-day variability.