OBJECTIVE: To study the current census rate of patients admitted to an internal medicine service. METHOD: We studied all patients admitted to the internal medicine service from January 1 to August 31, 2000 whose addresses were registered in four local authorities of our hospital district. We made exhaustive searches to ascertain whether these patients were included in the register in September 2000. RESULTS: We analyzed 1,095 admissions from a total of 1,759 up to August 31, 2000. Twenty-four percent corresponded to patients who were not registered. Fifty-eight percent of those not registered were aged more than 70 years. Twenty-seven percent of patients aged less than 40 years, most of whom were immigrants, were also unregistered. CONCLUSIONS: Twenty-four percent of the admissions to the internal medicine service that were studied corresponded to patients who were not registered with their respective local authorities. A possible explanation is the large immigrant population and the lack of registration among the elderly.

Aged↗

PubMedDate not supplied

A pharmacokinetic study of peritoneal absorption of glucose and alanine in rats: nutritional implications.

BACKGROUND: The aim of this work was to study the serum bioavailability of glucose and alanine after bolus injection into the peritoneal cavity in Wistar rats and to determine the influence of their metabolism on the rate of absorption of these nutrients. METHODS: A group of animals (n = 14) was infused intraperitioneally (i.p.) or i.v. with 2 microCi of nonmetabolizable L-[1-14C] glucose diluted in 5 mL of 5% D-glucose/250 g body wt, after which plasma radioactivity was determined. A second group of animals (n = 14) received, either i.p. or i.v., 3 microCi of nonmetabolizable D-[U-14C] alanine diluted in 2 mL of an iso-os-molar L-amino acid solution/250 g body wt, after which both plasma radioactivity and L-alanine concentration were determined. The constants of absorption from peritoneal cavity (Ka) and elimination from plasma (Ke) and the serum absolute bioavailability (BA(a)) after 8 h were calculated assuming a bicompartment pharmacokinetic model. RESULTS: L-glucose: Ka = 3.05 +/- 0.97 h-1; Ke = 0.40 +/- 0.12 h-1; BA(a) = 94% +/- 4%. D-alanine: Ka = 1.08 +/- 0.40 h-1; Ke = 0.11 +/- 0.06 h-1; BAa = 90% +/- 11%. L-alanine: Ka = 1.75 +/- 0.273 h-1; Ke = 0.02 +/- 0.01 h-1; BA(a) = 99% +/- 1%. No hyperglycemia, hypoglycemia, or glycosuria appeared in any case. CONCLUSIONS: The absorption rate from peritoneal cavity is nearly 10-fold higher than the elimination rate from plasma for the three substrates. Eight hours after i.p. injection an absolute bioavailability almost as high as after i.v. injection (i.e., close to 100%) was achieved. The metabolism of the nutrients seems to help the peritoneal absorption, as L-alanine is better absorbed then D-alanine. These results show that upon i.p. injection the studied nutrients are almost completely absorbed in a short period of time without hyperglycemia or neoglucogenesis and so suggest that their administration may be a feasible approach to feeding patients receiving peritoneal dialysis. This model could be applied to other compounds, such as peptides and disaccharides.

Absorption↗

PubMedDate not supplied

Inpatient intervention in an indigent, minority population with uncontrolled diabetes.

OBJECTIVE: To study whether a program of brief, intensive, inpatient intervention could improve glycemic control in an indigent, minority population with uncontrolled diabetes unresponsive to outpatient treatment. METHODS: Patients with uncontrolled diabetes unresponsive to treatment in our outpatient Diabetes Clinic were admitted to our inpatient Diabetes Unit, where their care was directed by the Diabetes Team (an attending diabetologist, an endocrinology fellow, two nurses, and two nutritionists). Of 108 patients admitted, data were available for 96. Patients from minority populations constituted 91.7% of the group. All patients were indigent. The mean duration of stay was 4.3 days. After dismissal, patients underwent follow-up again in our Diabetes Clinic. During the 540-day follow-up period, 25 patients were electively readmitted when satisfactory improvement in glycemic control was not achieved. Hemoglobin A1c levels were averaged and plotted for the group at defined time points up to 360 days before admission and up to 540 days after admission. RESULTS: During the year before admission, hemoglobin A1c increased slowly from 10.1 +/- 0.3% (mean +/- standard error) at day -360 to 10.3 +/- 0.2% at day -210 (F5 = 29; P<0.01) and then rapidly to 11.4 +/- 0.2% at admission (F7 = 1,541; P<0.001). After admission, hemoglobin A1c declined rapidly to 9.5 +/- 0.2% at day 90 (F4 = 121; P<0.005), plateaued at that level until day 240, and then declined again slowly to 9.0 +/- 0.3% at day 540, the end of the follow-up period (F10 = 70; P<0.01). All hemoglobin A1c levels 30 days or more after admission were significantly lower than the mean level at admission (P<0.05 at day 30 and P<0.001 from day 45 to day 540). CONCLUSION: Brief, intensive, inpatient intervention in an indigent, minority population with uncontrolled diabetes unresponsive to outpatient treatment produced and sustained a significant improvement in glycemic control. This mode of treatment is a practical approach to achieving the improvement in glycemic control that the Diabetes Control and Complications Trial demonstrated to be effective in delaying the onset and slowing the progression of diabetic retinopathy, nephropathy, and neuropathy.

Journal Article↗

PubMedDate not supplied

[Hiatal hernia in asthmatic patients: prevalence and its association with gastroesophageal reflux].

INTRODUCTION: Evidence of a high prevalence of hiatal hernia (HH) and gastroesophageal reflux (GER) in asthmatic patients has been found. However, the relationship between these entities has not been studied in our country. OBJECTIVES: 1) To inform the prevalence of hiatal hernia in asthmatic patients, 2) To compare the prevalence of hiatal hernia in asthmatic vs. non-asthmatic patients, 3) To establish a possible association between hiatal hernia and GER in asthmatic patients. MATERIALS AND METHODS: In order to detect and to compare the prevalence of hiatal hernia in asthmatic and non-asthmatic patients, upper gastrointestinal endoscopy was performed. To establish the association between asthma and GER, data obtained from a gastrointestinal symptoms questionnaire, an esophageal manometry and an ambulatory pH recording in asthmatics with or without hiatal hernia were compared. RESULTS: Hiatal hernia was more frequently observed in asthmatics than in non-asthmatics (62% vs. 34%, p = 0.02). The frequency of typical symptoms of GER was similar in both asthmatics with or without hiatal hernia (54 vs. 43%, p = 0.3). Lower esophageal sphincter incompetence was similar in asthmatics with hiatal hernia (35%) vs. asthmatics without hiatal hernia (22%), as detected by manometry. Pathological GER was diagnosed by pH recording in 81% of the asthmatics with hiatal hernia and in 65% of asthmatics without hiatal hernia (p = 0.1). CONCLUSIONS: There is a high prevalence of hiatal hernia in asthmatics, which in turn results to be greater than in non-asthmatic patients. The presence of hiatal hernia does not correlate with the detection of pathological GER as determined by pH recording in this group of patients.

Adult↗

PubMedDate not supplied

[Gastroesophageal reflux in asthmatic patients: an incidence study and clinical correlation].

The prevalence of gastroesophageal reflux (GER) in asthmatic patients is elevated, but the exact frequency remains unknown. The relationship between GER and asthma has not been investigated in Mexico. The objective of this study is to know the frequency of GER in Mexican asthmatic patients and the possible relationship with the severity of asthma. Fifty patients with adult-onset asthma were studied. AII of them fulfill the diagnostic criteria of the National Institutes of Health, U.S. The evaluation included a symptoms questionnaire, spirometry, esophageal manometry, 24-h esophageal pH-recording, and an upper gastrointestinal endoscopy. Twenty-three patients had mild asthma (46%), 16 moderate (32%) and 11 had severe asthma (22%). Twenty-seven (54%) reported heartburn and regurgitation at least twice a week. The esophageal pH-recording showed pathologic GER in 37 subjects (74%) and endoscopic esophagitis was found in 7 cases (14%). The pH-recording showed pathologic GER in 13 patients with mild asthma (57%), in 13 with moderate asthma (81%) and in all patients with severe asthma (100%). The frequency of GER in Mexican asthmatic patients is high and increases proportionately with the severity of asthma. This factor must be considered in the integral evaluation of these patients.

Adult↗

PubMedDate not supplied

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group].

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Enteral Nutrition↗

PubMedDate not supplied

[Parenteral nutrition at home: NADYA register for the year 2000].

AIM: We analyze the registered data of home parenteral nutrition (HPN) in our country during the year 2000. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Fourteen hospitals participated, and 67 patients were enrolled. Middle age was 5 +/- 4 years for patients < 14 years old, and 48 +/- 15 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.4%), neoplasm (16.4%), radiation enteritis (13.4%), motility disorders (7.5%), Crohn's disease (2.9%), and other. The mean time on HPN was 7.5 +/- 4.4 months. Tunelized catheter was the preferential route (77.6%), followed by the implantated one (20.9%). The intermittent method (nocturnal) was preferential (91.0%). Patients receive the formula from hospital pharmacy more frequently than from Nutriservice (71.5% versus 19.4%). The complications related to nutrition (0.32/100 days of HPN) included the infections (0.12 catheter sepsis/100 d of HPN), metabolic (0.06/100 d of HPN), mechanic (0.03/100 d of HPN) and electrolitic disorders (0.03/100 d of HPN). The readmission rate, for nutritional problems, was 0.3 hospitalizations/100 d of HPN. At the end of the year, 61.2% of the patients remained in the HPN program, 37.3% abandoned the treatment (due to death (40%), to progress to oral feeding (48%), and to progress to enteral nutrition (4%); and 1.5% of the patients were not follow up. CONCLUSIONS: This review illustrates that there is an increment in the registration of HPN patients in our country (1997: 0.7 patients/10(6) habitants, 2000: 1.9 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

Adolescent↗