Search

BACKGROUND AND AIMS Monoclonal gammopathy of undetermined significance (MGUS) has a high prevalence in the elderly population, being as high as 9% in subjects over 85 years. Population aging leads to an increase in the number of patients with MGUS. In 2012, monoclonal gammopathy of renal significance (MGRS) was described to identify MGUS patients with renal alterations but without overt hematological disorders. Despite an increasing number of cases and case series being reported, the prevalence and natural history of MGRS are not known with precision, in part because a systematic search for kidney damage is not standardized in all patients in whom MGUS is diagnosed. Our objective was to analyze in how many MGUS patients urine has been systematically analyzed and in how many of them any alterations suggestive of MGRS were detected. METHOD A retrospective observational study was carried out in our center of all patients in whom a paraprotein had been detected in the blood during the first trimester of 2018 and who did not present a known underlying hematological disorder. Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. The percentage of patients with a urine test using dipstick and urine sediment was analyzed, as well as the presence or any alteration suggestive of MGRS in them. RESULTS Three hundred and sixty patients were recorded, 44% females and with a mean age of 74 ± 12 years. Mean GFR was 69 ± 22 mL/min/1.73 m2 being 32% below 60 mL/min/1.73 m2. Urine dipstick and urine sediment were performed in only 42% and 24% of patients, respectively. Urine dipstick was more frequently performed in patients with worse GFR (72 ± 20 versus 64 ± 24 mL/min/1.73 m2P = 0.001) and in older patients (73 ± 13 versus 76 ± 11, P = 0.027). Similarly, urine sediment was more frequently performed in patients with worse GFR (72 ± 20 versus 59 ± 25 mL/min/1.73 m2 P CONCLUSION Despite the risk of suffering some pathologic renal conditions included in the term MGRS, in most of our patients with MGUS, a urine dipstick or sediment analysis is not performed. MGUS patients with urine alterations show worse renal function. We advocate that all MGUS patients should have a dipstick and sediment urinalysis to rule out any possible associated kidney damage.

Resumen La relacion entre desnutricion prequirurgica y morbimortalidad esta documentada desde hace anos. A pesar de la existencia de herramientas que nos permiten detectar y tratar esta entidad, su aplicacion en la practica clinica es, a dia de hoy, lenta. Por otra parte, tanto la insulinorresistencia como la hiperglucemia perioperatoria se asocian a mayor morbimortalidad postoperatoria y estancia media mas prolongada. La ingesta de bebidas ricas en hidratos de carbono 2-4 h antes de la intervencion permite disminuir dicha insulinorresistencia. Otro factor que reduce la estancia y las complicaciones es el soporte nutricional enteral postoperatorio precoz en relacion con el soporte via parenteral tradicional. Tambien las formulas con inmunonutrientes han demostrado ser eficaces a la hora de disminuir complicaciones posquirurgicas y estancia media. A la vista de la evidencia cientifica y de las guias de practica clinica recomendamos la adopcion de estas medidas, sustituyendo a las tradicionales.

Intra-uterine growth restriction (IUGR) may induce significant metabolic and inflammatory anomalies, increasing the risk of obesity and CVD later in life. Similarly, alterations in the adipose tissue may lead to metabolic changes in children with a history of extra-uterine growth restriction (EUGR). These mechanisms may induce alterations in immune response during early life. The aim of the present study was to compare pro-inflammatory markers in prepubertal EUGR children with those in a reference population. A total of thirty-eight prepubertal children with a history of EUGR and a reference group including 123 healthy age- and sex-matched children were selected. Perinatal data were examined. In the prepubertal stage, the concentrations of inflammatory biomarkers were measured in both groups. The serum concentrations of C-reactive protein (CRP) and plasma concentrations of hepatocyte growth factor (HGF), IL-6, IL-8, monocyte chemotactic protein type 1 (MCP-1), neural growth factor, TNF-α and plasminogen activator inhibitor type 1 were determined. The plasma concentrations of inflammatory biomarkers CRP, HGF, IL-8, MCP-1 and TNF-α were higher in the EUGR group than in the reference group (P

Resumen Introduccion La derivacion biliopancreatica (DBP) es una intervencion malabsortiva por lo que es muy frecuente la aparicion de deficiencias nutricionales, ademas suele ser necesaria la suplementacion tras la cirugia. Material y Metodos Se compararon las concentraciones de marcadores bioquimicos que reflejan el estado nutricional de 53 controles y 28 pacientes sometidos a DBP en distintos tiempos tras la intervencion (seis meses, al ano, cinco y siete anos). Ademas, se evaluaron las principales comorbilidades asociadas a la obesidad. Resultados La distribucion por sexos del estudio fue del 86% y 72% de mujeres, para el grupo estudiado y controles, respectivamente. La edad media, para el grupo de sujetos intervenidos fue de 41 ± 10 anos, y de 57 ± 16 anos para el grupo control. Se observo el mayor porcentaje de perdida de peso a los 6 primeros meses, la perdida se estabilizo a los 5 anos de la intervencion. Las comorbilidades asociadas mas frecuentes fueron hipertension y diabetes. Se obtuvieron diferencias inter- e intragrupos para vitaminas A y E, acido folico, vitamina D y paratohotmona, zinc y calcio, prealbumina, hierro y hemoglobina, y para colesterol y fibrinogeno. Sin embargo, no se encontraron para vitamina B12, magnesio, proteinas totales y albumina, ferritina, transferrina y hematocrito, ni para homocisteina. Conclusion Los pacientes intervenidos de DBP presentan deficits notables de nutrientes y estas carencias suelen persistir a lo largo del tiempo por lo que la suplementacion y el seguimiento exhaustivo deberian realizarse a largo plazo.

Resumen Introduccion Las vitaminas liposolubles y el zinc son micronutrientes que deben ser aportados con la dieta. Los bypass gastricos y biliopancreaticos son considerados intervenciones malabsortivas, pudiendo provocar importantes deficits carenciales. Material y metodos Se compararon las concentraciones de vitaminas A y E, zinc y otros marcadores bioquimicos de 35 controles y 32 pacientes sometidos a cirugia bariatrica en distintos tiempos tras la intervencion (tras seis meses, al ano y transcurridos mas de cinco anos). Las determinaciones de las vitaminas y del zinc se realizaron mediante HPLC y por espectroscopia de absorcion atomica por llama de aire-acetileno, respectivamente. Resultados Para la vitamina A se obtuvieron medias de 2,15 μmol/L en los controles. Los pacientes en los distintos tiempos tras la intervencion mostraron valores decrecientes de vitamina A hasta alcanzar concentraciones de 0,63 μmol/L tras mas de cinco anos de la cirugia (p Conclusiones Los pacientes intervenidos de cirugia bariatrica presentan problemas absortivos con deficits notables de nutrientes por lo que este hecho deberia ser considerado a efectos de evitar posibles patologias derivadas de estas carencias.

Resumen Objetivo Evaluar la capacidad de procalcitonina (PCT), proteina C reactiva (PCR), interleucina-6 (IL-6) y proteina ligadora del lipopolisacarido (LBP), para discriminar entre sepsis y sindrome de respuesta inflamatoria sistemica (SIRS) de origen no infeccioso, y para predecir el riesgo de desarrollar shock septico o muerte. Material y metodos Estudio prospectivo de cohortes observacional. Poblacion de 191 pacientes con SIRS (115 varones y 76 mujeres; edad media: 62±19). En todos ellos se analizo la concentracion de PCR, PCT, IL-6 y LBP. Resultados Solo IL-6 y PCT son capaces de diferenciar entre SIRS y sepsis. El analisis de las curvas ROC (Receiver Operating Characteristic) nos muestra que las areas bajo la curva (AUC) mas significativas fueron las de la PCT, con valores de 0,703 para sepsis (p=0,0001), de 0,707 para shock septico (p=0,0001) y de 0,682 para muerte (p=0,0001), seguidas de las AUC de la IL-6 para sepsis, shock septico y muerte, con valores de 0,692 (p=0,0001), 0,617 (p=0,0155) y 0,613 (p=0,022), respectivamente. Las AUC de PCR fueron de 0,631 (p=0,014) para sepsis, de 0,574 (p=0,127) para shock septico y de 0,576 (p=0,123) en el caso de muerte. La LBP presenta una AUC de 0,612 (p=0,03) para sepsis. Los puntos de corte obtenidos para cada biomarcador a partir de las curvas ROC fueron de 109 pg/ml, 584 pg/ml y 1.769 pg/ml en el caso de IL-6; de 17 μg/ml, 56,8 μg/ml y 54,1 μg/ml para LBP; de 17,4 mg/dl, 11 mg/dl y 10,7 mg/dl para PCR, y de 0,55 ng/ml, 0,98 ng/ml y 2,36 ng/ml en el caso de la PCT para sepsis, shock septico y muerte, respectivamente. Conclusiones Tanto la PCT como la IL-6 fueron marcadores biologicos fiables en la deteccion de sepsis en nuestra poblacion de pacientes con SIRS. La PCT resulto ser el mejor marcador de mala evolucion ( shock septico o muerte).

The relationship between preoperative malnutrition and morbi-mortality has been documented for years. Despite the existence of tools that allow its detection, and therefore treat this entity, their introduction into clinical practice is not wide-spread. Both perioperative insulin resistance and hyperglycemia are associated with increased perioperative morbidity and length of hospital stay. The intake of carbohydrate-rich drinks 2-4h prior to surgery reduces insulin resistance. In the immediate postoperative period, the enteral route is safe and well tolerated and its early use reduces hospital stay and postoperative complications compared with parenteral nutritional support. Inmunonutrition has been proven effective to decrease postoperative complications and hospital stay. In view of these data we opted for the adoption of these measures replacing bowel rest and the indiscriminate use of postoperative parenteral nutrition.

Background Nutritional deficit during perinatal stage may induce significant alterations in adipose tissue and increase the risk of obesity, metabolic syndrome and cardiovascular disease in children with a history of extrauterine growth restriction (EUGR). Aims To describe the nutritional status in neonatal and prepubertal with a history of EUGR and establish an association between EUGR and later conditions. Study design Descriptive, analytical, observational case–control study. Subjects The study included a sample of 38 prepubertal children with a history of EUGR, and 123 gender-and-age matched controls. Outcome measures The EUGR group was asked to answer a food frequency questionnaire. Analysis of body composition in both groups included anthropometric measurements, assessment of blood pressure and biochemical markers. Results Newborns with EUGR received parenteral feeding with a standard nutritional regime and long-chain fatty acid support for 41 ± 23 days; enteral feeding with a special formula for premature infants was initiated at 7 ± 11 days of life. At the prepubertal stage, daily fiber and fatty acid intake in children who had experienced EUGR in the neonatal stage was below the recommended intake. In the EUGR group, the intake of vegetables, fruits and olive oil was below dietary recommendations, while the intake of butchery, fatty meats, pastries and snacks was above the recommendations for the Spanish population. Conclusions Appropriate nutrition education strategies should be developed for children with a history of EUGR to prevent later associated pathologies, as neonatal nutritional support and feeding during childhood are associated with an increase in diseases in this risk group.