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Objectives In developed countries, undernutrition affects mostly older adults, worsens with hospitalization, and affects immune response, with higher rates of infection and delayed wound healing–which leads to an increase in hospital stay and health costs. The aim of this study was to assess the prevalence of undernutrition and related risk factors in a sample of older adults who presented at the emergency room (ER) of a university hospital in Spain. Methods This was a cross-sectional study of 288 patients ≥70 y of age who were seen at the emergency department at the University Hospital of Valladolid. Variables of nutritional evaluation, including a Mini Nutritional Assessment Test, sociodemographic factors, comorbidities, chronic treatments, frequency of visits to the ER, and destination after hospital discharge were collected. Results The percentage of undernutrition was 14.9% and the risk for undernutrition was 54.5%. Most patients were able to independently conduct basic activities of daily living (BADLs), lived at home, resided in an urban environment, and had autonomous mobility. The mean body mass index (BMI) was 26.14 ± 4.52 kg/m2. Patients who were dependent on others for BADLs; institutionalized or bedridden; and with hematologic disease, chronic depressive syndrome, polymedication, low hemoglobin or low hematocrit, and hypochromia were associated with a higher prevalence of undernutrition. In the multivariate analysis, for each unit of increase in BMI, patients had 12% lower risk for developing undernutrition, and for each unit of increase in the frequency of ER visits, patients had a 41% higher risk for developing undernutrition. Conclusions Older adults who presented to the ER had a high percentage of undernutrition, which is related to sociodemographic factors, comorbidities, polymedication, and biochemical factors. We also found a direct association between the frequency of ER visits and undernutrition, in addition to an inverse relationship with BMI. Detecting undernutrition in an ER may improve health and reduce related complications in older adults.

Normocalcemic and asymptomatic hyperparathyroidism diagnosis are becoming more common. However, their pathophysiology is incompletely known. The aim of the present study was to evaluate the clinical effect of calcium-sensing receptor polymorphism (A986S) in normocalcemic and asymtomatic HPT. Prospective study conducted with 61 consecutive normocalcemic and asymptomatic HPT patients was followed up during a minimum period of 1 year. Secondary causes of hyperparathyroidism were ruled out. Calcium and phosphorus metabolism parameters were evaluated in at least 2 determinations during follow-up to classify as normocalcemic or asymptomatic hyperparathyroidism. Bone mineral density and A986S polymorphism genotype were also analyzed. Thiry-eight patients (62.3%) had the genotype A986A, and 23 (36.7%) patients had A986S (20 patients, 32.8%) or S986S (3 patients, 4.9%). Age, sex, and genotype distributions were comparable in both normocalcemic and asymptomatic hyperparathyroidism. In normocalcemic patients, S allele genotype was associated to statistically significant higher level of intact PTH: 92.0 (SD 18.5) vs. 110.6 (SD 24.4) pg/ml, p0.05; and remained significant after adjustment by multiple linear regression. In asymptomatic hyperparathyroidism, A986A genotype resulted in a statistically significant higher level of intact PTH, alkaline phosphatase and procollagen amino-terminal propeptide; but only serum calcium remained as an independent predictor of serum intact PTH levels after a multiple linear regression. Bone mineral densitometry between genotypes did not show statistically significant differences. A986S polymorphism of CaSR is an independent predictor of PTH level in normocalcemic hyperparathyroidism patients, but not in asymptomatic hyperparathyroidism. More studies are needed to evaluate the effect of other polymorphisms in normocalcemic and asymptomatic hyperparathyroidism.

Objective: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. Design: Cross-sectional study. Setting: Tertiary care hospital. Participants: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. Results: A total of 21.7% of patients had osteoporosis (T score Conclusions: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.

Objetivo El miglitol pertenece al grupo de los inhibidores de las alfaglucosidasas, habiendo demostrado en diferentes estudios su utilidad en la mejoria del control glucemico en diferentes poblaciones de pacientes diabeticos. El objetivo de nuestro trabajo fue analizar la utilidad del miglitol en el control glucemico y lipemico en un grupo de pacientes con diabetes tipo 2 tratados con sulfonilurea e insulina, con mal control glucemico. Pacientes y metodos Se estudio una poblacion de 33 pacientes con diabetes mellitus tipo 2 tratados con sulfonilureas e insulina con mal control glucemico (HbA1c>7,5%). Todos los pacientes fueron tratados con miglitol durante tres meses con una pauta ascendente, la primera semana 50 mg dos veces al dia, posteriormente durante un mes 50 mg tres veces al dia. Al inicio del estudio y a los tres meses se midieron las siguientes variables; peso, talla, indice de masa corporal (IMC), presion arterial sistolica y diastolica, HbA1c, numero de hipoglucemias perifericas, glucosa basal, albuminuria, colesterol total, colesterol LDL, colesterol HDL y trigliceridos, asi como transaminasas (GOT, GPT, gama-GT y bilirrubina). Resultados La edad media fue de 64,1±12,5 anos, con una duracion de la diabetes mellitus de 9,1 ±7 anos. La media de IMC fue de 27,7 ±6,9 kg/cm2. Se detecto una disminucion de la glucosa de un 4,8% y de la HbA1c de un 5,8% (p Tambien disminuyo la dosis de sulfonilureas que precisaron los pacientes (86,2±24,3 mg/dia frente a 64,6±21,9 mg/dia; p Conclusiones El miglitol es un farmaco util en mejorar el control glucemico en pacientes diabeticos tipo 2 tratados previamente con otra terapia y con mal control. Los efectos secundarios son escasos y transitorios.

Although normocalcemic and asymptomatic hyperparathyroidism (HPT) are becoming more common, they remain only partially understood. Parathyroid hormone ( PTH ) polymorphisms have been associated with disease severity in classical HPT. The aim of the present study was to evaluate the clinical effect of PTH polymorphism (rs6254) in normocalcemic and asymptomatic HPT. A prospective study of 61 consecutive patients with normocalcemic or asymptomatic HPT was carried out. Secondary causes of HPT were ruled out. All patients were followed for≥1 year. Calcium and phosphorus metabolism parameters were assessed at least twice during the follow-up period to classify as normocalcemic or asymptomatic HPT. Bone mineral density (BMD) and the rs6254 polymorphism genotype were also assessed. Genotype rs6254GG was observed in 23 patients (37.7%) whereas GA and AA genotypes were presented in 29 (47.5%) and 9 (14.8%) patients, respectively. Age, sex and genotype distributions were comparable in both groups. In asymptomatic but not normocalcemic HPT patients, the GG genotype was associated with a significantly higher level of intact PTH [200.2 (SD 76.5) vs. 113.3 (SD 25.9) pg/ml; p

Obesity and the lifestyle characteristic of our society lead young people to conditions of potential cardiovascular risk. The aim of this study was to assess the anthropometrical situation and the lifestyle in a sample of university students. A full anthropometrical evaluation was undertaken, including bioelectric impedance analysis (BIA), in 111 students in the last year of Human Nutrition and Dietetics, as well as a lifestyle questionnaire (physical activity, alcohol and cigarette consumption). A sexual dimorphism was found in weight distribution according to the classification proposed by SEEDO: 6.4% of women presented a weight lower than the health recommendations (there no men in this group) whereas 27.8% of men and 6.5% of women were in the overweight range. 15.3% of the cases had excessive waist circumference. Fat mass by BIA was higher among women. On the other hand, 67% of university students stated to perform regular physical activity, 16.7% stated being cigarette smokers, and 55.6% stated to consume high-grade alcohol. To conclude, we studied a sample population of young and healthy subjects with, however, a significant percentage of women with body weight lower than the healthy standards, overweighed people, and smokers usually taking high-grade alcohol. These data should elicit an alert of the potential cardiovascular risk in the university population if action is not taken. This population should be included in the health promotion plans.

Maple syrup disease is secondary to a deficiency of deshydrogenase complex of a cetoacid of branched-chain. This disease has a recessive autosomic inheritance, with an incidence of 1/200,000 newborns, without differences between male and female. Due to clinical presentation and biochemical response to tiamin, these patients can be classified in five clinical entities: classic, intermediate, intermittent, positive response to tiamin and deficiency of dihydrolipoyl deshydrogenase (E3). In these patients, an increase of seric branched-chain aminoacids is detected, it could be detected by (chromatography) during neonatal period. Valine, isoleucine, and aloisoleucine are increased in serum, orine, and cephaloraquideum liquid by ionic changed chromatography, chromatography of high resolution or high voltage electrophoresis. Patients have two phases in this disease (acute phase and maintaining phase). Objectives in acute phase are based in three topics: to eliminate toxic metabolites, nutritional support and to get anabolism. Utilization of hemodialysis/peritoneal dialysis/blood exchange is one of the first treatments. Dietetic support is the second treatment, with a minimum energy intake and controlling blood levels of aminoacids. Modified dietetic formulas is a main device to treat these patients.

Objetivo: El objetivo del trabajo fue identificar la prevalencia de la desnutrición en los pacientes hospitalizados atendidos por nuestra Unidad utilizando el test MNA (Mini Nutritional Assessment) como herramienta de estudio. Métodos: Estudiamos un total de 145 pacientes ingresados en el Hospital del Río Hortega, desde marzo de 2000 a mayo de 2002. A todos ellos se les realizó el test MNA, valoración antropométrica y bioquímica. Resultados: La edad media de los pacientes fue de 57,44 ± 18,06 años, el peso 63,5 ± 13,7 kg y el índice de masa corporal 23,4 ± 4,9 kg/m². La población estudiada presentaban tumores hematológicos o en otras localizaciones en un 48,6%, frente al resto de los pacientes que presentaban accidentes cerebrovasculares 21%, problemas respiratorios o infecciones 16,8%, insuficiencia renal 3,5% y enfermedades neurológicas o procesos de demencia en menor proporción 2,9%. Se dividió a los pacientes en dos grupos, los que presentaban desnutrición MNA < 17 (n = 99) (grupo I) y los que presentaban riesgo nutricional MNA ≥ 17 (n = 43) (grupo II). La frecuencia de desnutrición fue del 68,2% (grupo I) y de riesgo de desnutrición del 29,6% (grupo II) con el test MNA; siendo la puntuación media de 14,55 ± 4,4 puntos. En la valoración bioquímica el grupo de pacientes con desnutrición (grupo I) tuvo menores valores de albúmina (2,9 ± 0,7 g/dl vs 3,41 ± 2,71 g/dl; p < 0,05), prealbumina (14,9 ± 6,2 g/dl vs 17,6 ± 8,1 g/dl; p < 0,05) y transferrina (152,2 ± 54,9 g/dl vs 189,9 ± 32,6 g/dl; p < 0,05), el resto de parámetros se mostraron dentro de la normalidad. En el análisis de los valores antropométricos la circunferencia muscular del brazo y la circunferencia del brazo se encontraron por debajo de la media en el grupo de pacientes con desnutrición (grupo I), no así el pliegue tricipital, el peso y el índice de masa corporal (IMC). Al analizar los distintos apartados del test MNA entre ambos grupos, se observó como en el grupo de pacientes desnutridos la puntuación se encontraba por debajo de la media en todos los aportados. La estancia media fue más elevada, aunque no se alcanzaron diferencias significativas en el grupo de pacientes desnutridos (29,5 ± 20 días frente a 23,7 ± 18 días; p > 0,05). Conclusiones: Los pacientes hospitalizados presentaron un riesgo de desnutrición elevado, detectado por el test MNA.

A 50-year-old female patient with a previous diagnosis of papillary thyroid carcinoma treated with thyroidectomy and radioiodine therapy was admitted to the hospital for her routine follow-up procedures. On her 131I whole-body scan, radioiodine accumulation in the lower mediastinum was detected. The planar images after drinking additional water showed a persistent abnormality in the lower mediastinum (Fig. 1). The patient’s detailed medical history did not reveal a previous diagnosis of hiatal hernia. However, the patient described faint gastrointestinal symptoms such as early satiety and postprandial abdominal discomfort during the last 8 months. SPECT/CT images helped to localize more precisely the uptake in the stomach, which was compressed and displaced anteriorly by a huge retroperitoneal mass located in the left hypocondrium ahead of the spleen and to the left of the stomach. The retroperitoneal mass did not display any 131I uptake (Fig. 2). An enhanced state-of-the-art CT of the chest, abdomen and pelvis confirmed the presence of a large heterogeneous contrast-enhanced retroperitoneal mass suggestive of a sarcoma without lymphatic or distant involvement (Fig. 3). Laparotomy revealed a mass of 19 cm in the omental transcavity. A complete surgical resection was performed and pathology showed a well-differentiated retroperitoneal leiomyosarcoma. Retroperitoneal sarcomas are relatively rare neoplasms that comprise approximately 10–15 percent of all soft tissue sarcomas. They occur predominantly in middle-aged individuals, although the presentation age range is broad. Leiomyosarcomas of the

Analyze the presence of dysplasia in colonoscopy visualized colonic polyps, and the predictive factors for high grade dysplasia.We studied the polyps observed in the colonoscopies carried out during the year 2001. Colonoscopies carried out in 2,144 patients were analyzed, with demonstration of polyps in 326 patients (average age: 67 12,6 years, 63,5% males). 732 polyps were analyzed, with average of 2.27 2 polyps by patient.72% polyps were located distally to splenic flexure, and sigmoid colon was the most frequent location (34.7%). Most of the polyps (86%) were sessile. Only 3% were2 cm, and the majority (88%) was1 cm. The most prevalent histological type was tubular adenoma (36%). Dysplasia was observed in 42.2% (low grade in 40% and high grade in 2.2%) Size1 cm and location proximal to splenic flexure were the only variables with indendent significant association to high grade dysplasia.The presence of high grade dysplasia in the colonic polyps was related in our cohort both to the location of the polyps in the colon and to its size, so that greater risk was for proximal polyps and for polyps1 cm.

Miglitol belongs to the group of the inhibitors of the alpha-glucosidases and in several studies has demonstrated its usefulness in the improvement of the glycemic control in the different types of diabetic patients. The goal of our study was to analyze the usefulness of miglitol in the blood glucose and lipid control in a group of patients with diabetes type 2 treated with sulfonylureas and insulin, with insufficient glycemic control.A group of 33 patients with diabetes mellitus type 2 treated with sulfonylureas and insulin and with insufficient glycemic control (HbA1c7.5%) was studied. All patients were treated with miglitol during 3 months with progressive doses: the first week 50 mg twice a day, subsequently and during one month 50 mg three times a day. At the beginning of the study and up to three months the following variables were measured; weight, height, BMI (body mass index), systolic and diastolic blood pressure, HbA1c, number of episodes of peripheral hypoglycemia, basal glucose, albuminuria, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, as well as transaminases (GOT, GPT, gamma GT and bilirubin).The median age was 64.1 +/- 12.5 years, and the median length of diabetes mellitus was 9.1 +/- 7 years. The median value of BMI was 27.7 +/- 6.9 kg/cm2. The blood glucose and HbA1c values decreased 4.8% and 5.8%, respectively. A decrease in the number of hypoglycemia episodes (39.4% previous quarter versus 3% quarter wih miglitol) was observed. Also decreased the dose of sulfonylureas needed by the patients (86.2 +/- 24.3 mg/day versus 64.6 +/- 21.9 mg/day; p0.05) (25%). Total cholesterol, HDL-cholesterol, and LDL-cholesterol levels were not modified, but indeed a reduction of the levels of triglycerides (145.2 +/- 111 mg/dl versus 133.1 +/- 79 mg/dl; p0.05) (8.3%) was detected. Fifteen percent of patients showed side effects (digestive discomfort) that disappeared two or three weeks after beginning the treatment.Miglitol is a useful drug in order to improve the glycemic control in diabetic type 2 patients treated previously with other drugs and with insufficient control of the blood glucose. Its side effects are limited and transitory.

To compare the temporal evolution of viral load and CD4 parameters in two cohorts of HIV infected patients enrolled in classical triple antiretroviral regimens.Retrospective, observational, descriptive study of the proportions of patients reaching undetectable levels of viral load (VL) as well as the time necessary to get it. The two cohorts were as follows: 91 HIV patients on triple therapy with zidovudine plus lamivudine and indinavir (cohort A) versus 80 HIV patients with Stavudine plus Didanosine and Indinavir (cohort B).The evolution of the patients in terms of percentages who reach undetectable VL was similar in the two therapeutic cohorts (75.8%for cohort A vs 73.8% for cohort B) along the duration of the study (four years). However, the mean time period needed to reach undetectable VL was different, 209 days (IC 95% 175-243 days) for patients in zidovudine plus lamivudine and indinavir and 330 days (IC 95% 263-396 days) for stavudine plus didanosine and indinavir regimen. The immunological status observed in the patients when reaching his first undetectable VL was significantly different. The proportion of patients with CD4 cells counts200/mm3 in cohort A was 83.1% while for patients from cohort B was 65.4% (p=0.032).This observational study from clinical settings seems demonstrate similar efficacy to reach undetectable VL with both classical triple antiretroviral therapies evaluated but a shorter delay of time to reach that virological situation for zidovudine plus lamivudine and indinavir regimen is reported.

Background To compare the temporal evolution of viral load and CD4 parameters in two cohorts of HIV infected patients enrolled in classical triple antiretroviral regimens. Methods Retrospective, observational, descriptive study of the proportions of patients reaching undetectable levels of viral load (VL) as well as the time necessary to get it. The two cohorts were as follows: 91 HIV patients on triple therapy with zidovudine plus lamivudine and indinavir (cohort A) versus 80 HIV patients with Stavudine plus Didanosine and Indinavir (cohort B). Results The evolution of the patients in terms of percentages who reach undetectable VL was similar in the two therapeutic cohorts (75.8%for cohort A vs 73.8% for cohort B) along the duration of the study (four years). However, the mean time period needed to reach undetectable VL was different, 209 days (IC 95% 175-243 days) for patients in zidovudine plus lamivudine and indinavir and 330 days (IC 95% 263-396 days) for stavudine plus didanosine and indinavir regimen. The immunological status observed in the patients when reaching his first undetectable VL was significantly different. The proportion of patients with CD4 cells counts >200/mm3 in cohort A was 83.1% while for patients from cohort B was 65.4% (p=0.032). Conclusions This observational study from clinical settings seems demonstrate similar efficacy to reach undetectable VL with both classical triple antiretroviral therapies evaluated but a shorter delay of time to reach that virological situation for zidovudine plus lamivudine and indinavir regimen is reported.

Objetivo: Analizar las características epidemiológicas, bioquímicas y clínicas al inicio del diagnóstico de hipotiroidismo, la dosis de hormona tiroidea necesaria para un correcto control, así como los costes directos generados anualmente, todo ello referido a pacientes con hipotiroidismo atendidos en un área de salud. Materiales y métodos: Se revisan las historias clínicas correspondientes a 75 pacientes diagnosticados de hipotiroidismo y atendidos en la consulta de Endocrinología de un área de salud, agrupando los datos recogidos en tres categorías: epidemiológicos, bioquímicos y clínicos, y económicos. Resultados: Del total de pacientes estudiados, el 94,7% eran mujeres y el 5,3% hombres, con una edad media de 52,07 ± 16,58 años. La patología responsable del hipotiroidismo más frecuente fue la autoinmune, incluyendo la tiroiditis de Hashimoto (48,0%) y la tiroiditis autoinmune atrófica (46,6%). El valor medio de la TSH (mUI/ml) fue de 17,57 ± 40,14, y el de los anticuerpos antitiroideos (UI/ml) fue de 629,30 ± 1.049,14 para los ACTPO y de 532,11 ± 1.028,34 para los ACTG. Un 58,7% de los pacientes presentaba bocio, pero sólo en el 2,6% era en un grado evidente. La dosis media de tratamiento sustitutivo con T4 fue de 81,00 ± 53,56 mg/día. La media de visitas anuales a la consulta de Endocrinología hasta el correcto control de la enfermedad fue de 2,67 ± 1,08. El mayor coste generado por estos pacientes fue el de la consulta especializada, con una media (e/año) de 160 ± 65 e y un coste total medio (consulta, analíticas y dosis sustitutiva T4) (e/año) de 12,9 ± 81,5 e. Comparando las dos patologías autoinmunes más prevalentes, observamos un mayor nivel de ACTPO en los pacientes con tiroiditis de Hashimoto, con un mayor número de visitas a la consulta y un mayor coste en tratamiento sustitutivo con T4, resultando en definitiva un mayor coste total en dichos pacientes. Conclusiones: La patología más prevalente es la autoinmune (incluyendo la T. de Hashimoto y la tiroiditis autoinmune atrófica), con mayores niveles de ACTPO en la tiroiditis de Hashimoto. El coste total es superior en los pacientes con tiroiditis de Hashimoto.

Producción Científica, Dietary counseling and intervention based on application of conventional criteria have been ineffectivein preventing the progressive weight loss associated with HIV infection. The aim of the study was to compare theprogression of clinical and nutritional indicators during nutritional supplementation with or without anenterotropic peptide-based formula enriched with n-3 fatty acids.