RESUMEN
OBJECTIVES: High rates of malnutrition have been reported in the older hospitalized patient population. This is recognised to impact on patient outcomes and health costs. This study aimed to assess the impact of nutrition screening and intervention on these parameters. DESIGN: Randomised controlled prospective study. SETTING: The study was performed in the acute geriatric medicine wards of the Prince of Wales Hospital, Sydney Australia. PARTICIPANTS: All patients admitted to these wards under a geriatrician with an expected length of stay of at least 72 hours were considered for the study. INTERVENTION: Patients were screened on admission for malnutrition using the Mini Nutritional Assessment (MNA) tool and randomly assigned to control or intervention groups. Intervention patients were immediately commenced on a malnutrition care plan (MCP). Control patients were only commenced on a MCP if referred by clinical staff. MEASUREMENTS: Length of stay (LOS), weight change and frequency of readmission to hospital were compared between the groups. RESULTS: 143 patients were screened. 119 were identified as malnourished (MN) or at risk of malnutrition (AR). Overall LOS was not different between the two groups (control v. intervention: 13.4 ± 1.3 days v. 12.5 ± 1.2 days, p=0.64). However there was a significant decrease in LOS in the MN (control v. intervention: 19.5 ± 3 days v. 10.6 ± 1.6 days, p=0.013) and a trend to reduced readmissions. There was no difference in weight change over admission between the groups. Without screening, clinical staff identified only a small proportion of malnourished patients (35% of MN and 20% of AR). CONCLUSIONS: Malnutrition in the older hospital population is common. Malnutrition screening on hospital admission facilitated targeted nutrition intervention, however length of stay and re-presentations were only reduced in older malnourished patients with an MNA score less than 17.
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Envejecimiento , Evaluación Geriátrica , Desnutrición/dietoterapia , Desnutrición/epidemiología , Evaluación Nutricional , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Comorbilidad , Diagnóstico Precoz , Femenino , Costos de Hospital , Hospitales Públicos , Hospitales Urbanos , Humanos , Tiempo de Internación , Masculino , Desnutrición/economía , Desnutrición/fisiopatología , Nueva Gales del Sur/epidemiología , Readmisión del Paciente , Prevalencia , Aumento de PesoRESUMEN
A differential pump assembly is introduced which can provide a windowless transition between the full atmospheric pressure of an in-air sample environment and the high-vacuum region of a synchrotron radiation beamline, while providing a clear aperture of approximately 1 mm to pass through the X-ray beam from a modern third-generation synchrotron radiation source. This novel pump assembly is meant to be used as a substitute for an exit vacuum window on synchrotron beamlines, where the existence of such a window would negatively impact the coherent nature of the X-ray beam or would introduce parasitic scattering, distorting weak scattering signals from samples under study. It is found that the length of beam pipe necessary to reduce atmospheric pressure to below 10 mbar is only about 130 mm, making the expected photon transmission for hard X-rays through this pipe competitive with that of a regular Be beamline window. This result is due to turbulent flow dominating the first pumping stage, providing a mechanism of strong gas conductance limitation, which is further enhanced by introducing artificial surface roughness in the pipe. Successive reduction of pressure through the transitional flow regime into the high-vacuum region is accomplished over a length of several meters, using beam pipes of increasing diameter. While the pump assembly has not been tested with X-rays, possible applications are discussed in the context of coherent and small-angle scattering.
RESUMEN
PURPOSE: Acute rectal complications occur in the majority of patients receiving external-beam radiotherapy for carcinoma of the prostate. Sucralfate has been proposed to reduce radiation-induced mucosal injury by forming a protective barrier on ulcer bases, binding local growth factors, and stimulating angiogenesis. However, there is conflicting clinical evidence as to whether sucralfate, taken prophylactically during radiotherapy, can ameliorate the symptoms of acute radiation proctitis. METHODS AND MATERIALS: A double-blind randomized trial was conducted at four Radiation Oncology Departments in Sydney, Australia, between February 1995 and June 1997. A total of 338 patients with clinically localized prostate cancer receiving small volume radiotherapy, of whom 335 were evaluable, were randomized to receive either 3 g of oral sucralfate suspension or placebo twice a day during radiotherapy. Patients kept a daily record of their bowel symptoms and were graded according to the RTOG/EORTC acute toxicity criteria. RESULTS: One hundred sixty-four patients received sucralfate and 171 received placebo. Both groups were well balanced with regard to patient, tumor, treatment factors, and baseline symptoms, except that the placebo group had a significantly more liquid baseline stool consistency score (p = 0.004). Patients kept a daily diary of symptoms during radiotherapy. After adjusting for baseline values, there was no significant difference between the two groups with regard to stool frequency (p = 0.41), consistency (p = 0.20), flatus (p = 0.25), mucus (p = 0.54), and pain (p = 0.73). However, there was more bleeding in the sucralfate group, with 64% of patients noticing rectal bleeding, compared with 47% in the placebo group (p = 0.001). There was no significant difference between the two groups with respect to RTOG/EORTC acute toxicity (p = 0.88; sucralfate 13%, 44%, 43% and placebo 15%, 44%, 40% for grade 0, 1, and 2, respectively). CONCLUSION: This study suggests that oral sucralfate taken prophylactically during radiotherapy does not ameliorate the symptoms of acute radiation proctitis and may increase acute bleeding. The cause of the increased bleeding in the sucralfate group is unclear. As the pathogenesis of acute and late reactions are different, late follow-up, which includes sigmoidoscopic evaluation, is currently being performed on this cohort of patients.
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Antiulcerosos/uso terapéutico , Proctitis/tratamiento farmacológico , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/tratamiento farmacológico , Sucralfato/uso terapéutico , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Antiulcerosos/administración & dosificación , Método Doble Ciego , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Proctitis/etiología , Recto , Sucralfato/administración & dosificaciónRESUMEN
BACKGROUND: Little is known about the small intestinal mucosal pattern of Myanmar children. METHODS: Duodenal, jejunal and ileal mucosal specimens obtained from children within 6 h of death were examined under a dissecting microscope with the objective of determining villus pattern in relation to site within the small intestine and then correlated with age. RESULTS: Abnormalities in the small intestinal mucosa were detected at a very young age. In children under 1 year of age, the changes are more marked proximally and become less marked distally, perhaps reflecting exposure to the causative agent(s) in early life. Presumably these agents are ingested orally and inactivated progressively. The pattern in older children reflects more severe changes in the ileum. CONCLUSIONS: It is postulated that frequent intestinal infections or small bowel bacterial contamination could lead to damage of the intestinal mucosa.
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Mucosa Intestinal/anatomía & histología , Intestino Delgado/anatomía & histología , Envejecimiento/fisiología , Niño , Preescolar , Duodeno/anatomía & histología , Humanos , Íleon/anatomía & histología , Lactante , Yeyuno/anatomía & histología , MianmarRESUMEN
In Western countries, including Australia, colorectal cancer is the leading cause of cancer mortality in nonsmokers. Development of most colorectal cancers can be prevented by adenoma removal. The current screening strategies of faecal occult blood testing (FOBT), flexible sigmoidoscopy combined with FOBT and colonoscopy are all cost effective. In clinical practice, a range of options should be offered to allow for individual patients' preferences. A public education program is essential to the success of any screening strategy.
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Neoplasias Colorrectales/prevención & control , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Anciano , Australia , Colonoscopía/economía , Análisis Costo-Beneficio , Humanos , Persona de Mediana Edad , Sangre Oculta , Cooperación del Paciente , Sigmoidoscopía/economíaRESUMEN
OBJECTIVE: The aim of this study was to investigate the separate effects of indigenous oropharyngeal- and colonic-type flora on small intestinal mucosal immunity and morphometry in small intestinal bacterial overgrowth (SIBO). METHODS: A duodenal aspirate and random biopsies of underlying mucosa were obtained from 52 adult subjects (age range, 18-90 yr; median, 60 yr) without disorders that may otherwise disturb small intestinal histology or mucosal immunity. Villus height, crypt depth, villus/crypt ratios, counts of intraepithelial lymphocytes (IELs) and lamina propria total mononuclear cells, IgA, IgM, and IgG plasma cells, mast cells, and B and T lymphocytes were determined in relation to the presence or absence of SIBO and the nature of the overgrowth flora in all subjects. CD4+ve and CD8+ve T-cell counts were determined in 24 subjects. RESULTS: SIBO was present in 26 of 52 (50%) subjects. Overgrowth flora included colonic-type bacteria in 20 subjects and oropharyngeal-type flora alone in 6 subjects. Lamina propria IgA plasma cell counts were significantly increased in subjects with SIBO, irrespective of whether the overgrowth flora comprised oropharyngeal-type flora alone or included colonic-type bacteria. Neither villus height, crypt depth, villus/crypt ratios, nor total or other mononuclear cell counts in lamina propria differed significantly between subjects with and without SIBO, irrespective of the nature of the overgrowth flora. IEL counts were significantly higher than in culture-negative subjects only when the overgrowth flora included colonic-type bacteria. Even then, IEL counts were within a range currently considered normal. A significant, inverse correlation between advancing age and IEL counts became apparent after adjusting for the effect of SIBO of colonic-type flora. CONCLUSIONS: SIBO of oropharyngeal- and colonic-type flora are associated with differing disturbances of local duodenal mucosa. Nonetheless, these would not be readily apparent during routine histological assessment. Old age independently influences duodenal IEL counts.
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Infecciones Bacterianas/inmunología , Enfermedades Duodenales/microbiología , Duodeno/microbiología , Mucosa Intestinal/inmunología , Infecciones Bacterianas/patología , Biopsia , Colon/microbiología , Enfermedades Duodenales/inmunología , Enfermedades Duodenales/patología , Duodeno/patología , Humanos , Inmunidad Mucosa/inmunología , Mucosa Intestinal/patología , Recuento de Linfocitos , Persona de Mediana Edad , Orofaringe/microbiología , Células Plasmáticas/patologíaRESUMEN
OBJECTIVES: The aims of this study were 1) to document the sensitivity, specificity, and predictive values of the rice breath hydrogen test for small intestinal bacterial overgrowth; 2) to determine the possible influence of concurrent gastric bacterial overgrowth and gastroduodenal pH on the efficacy of this test; and 3) to investigate whether reliability is limited by an inability of small intestinal luminal flora to ferment rice or its product of hydrolysis, maltose. METHODS: Twenty adult subjects were investigated with microbiological culture of proximal small intestinal aspirate and a 3-g/kg rice breath hydrogen test. Gastroduodenal pH, the presence or absence of gastric bacterial overgrowth, and the in vitro capability of small intestinal luminal flora to ferment rice and maltose, its product of hydrolysis, were determined. RESULTS: Sensitivity of the rice breath hydrogen test for small intestinal bacterial overgrowth was 33% and remained low even when subjects with small intestinal overgrowth with oropharyngeal-type (38%) and colonic-type flora (20%) and those with concurrent small intestinal and gastric bacterial overgrowth (40%) were considered separately. Sensitivity remained suboptimal despite favorable gastroduodenal luminal pH and documented ability of bacterial isolates to ferment rice and maltose in vitro. Specificity of the rice breath hydrogen test for small intestinal bacterial overgrowth was 91%. Positive predictive value, negative predictive value, and predictive accuracy were 75%, 63%, and 65%, respectively. CONCLUSIONS: Clinical value of the rice breath hydrogen test for detecting small intestinal bacterial overgrowth is limited. The rice breath hydrogen test is not a suitable alternative to small intestinal intubation and culture of secretions for the detection of small intestinal bacterial overgrowth.
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Pruebas Respiratorias , Diarrea/microbiología , Enterobacteriaceae/patogenicidad , Hidrógeno/análisis , Intestino Delgado/microbiología , Síndromes de Malabsorción/microbiología , Oryza , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Recuento de Colonia Microbiana , Femenino , Fermentación , Mucosa Gástrica/microbiología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
BACKGROUND AND AIMS: To determine the prevalence of heartburn in the Australian community, and document factors precipitating it and medications used in treatment. METHODS: Telephone interviews with 1200 individuals aged 18 years or more were conducted one weekend in 1996. Each respondent was asked four questions about heartburn, its severity, factors causing it and current therapy. RESULTS: Fifty-six per cent of respondents reported that they had suffered from heartburn at some time in the past and 37% had symptoms at least once every 4-6 months. The frequency of heartburn increased with age and was more common in men (40.7%) than women (32.6%). There was no difference in frequency between city and rural dwellers, or between white- and blue-collar workers. Almost half the individuals experienced mild pain or discomfort, one-third had moderate discomfort and 15% reported severe pain or discomfort. Women were more likely to report greater problems than men. Aggravating factors included spicy foods, greasy/rich foods, stress, alcohol, overeating, pregnancy, smoking, food allergy and coffee. More than half the respondents relied on antacids to control symptoms, 20% used prescription medications and a similar number did not use any medication. CONCLUSION: Heartburn is common in the Australian community and sufferers attribute symptoms to various lifestyle events, including diet and stress. Antacid usage is the commonest mode of therapy.
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Pirosis/epidemiología , Adolescente , Adulto , Distribución por Edad , Antiácidos/uso terapéutico , Australia/epidemiología , Dispepsia/epidemiología , Femenino , Encuestas Epidemiológicas , Pirosis/tratamiento farmacológico , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Prevalencia , Distribución Aleatoria , Factores de Riesgo , Muestreo , Índice de Severidad de la Enfermedad , Distribución por SexoRESUMEN
We aimed to establish whether there was a variation in orocecal transit time (OCTT) in Myanmar children and whether shortened transit time correlated with malnutrition. OCTT was measured in 90 healthy Myanmar children aged 1-5 years, using the hydrogen breath test (10g in 10% aqueous solution). The relationships between OCTT, sex, age, and malnutrition status were assessed. OCTT for 1 to 5-year old children was 90.2 +/- 20min (mean +/- SD). There was no significant difference in mean OCTT between boys and girls, breast-fed and weaned children, malnourished and non-malnourished children. There was also no difference between age groups (1-2 years, 2-3 years, 3-4 years, and 4-5 years), and no correlation was found between age and orocecal transit time. The assessment of OCTT using the lactulose breath hydrogen test was found to be feasible and acceptable in the field setting. The OCTT of Myanmar children with rice as a staple food is similar to that of children from developed countries having a different diet, and no shortening of transit time was demonstrated in children with malnutrition.
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Tránsito Gastrointestinal/fisiología , Trastornos Nutricionales/fisiopatología , Pruebas Respiratorias , Estudios de Casos y Controles , Preescolar , Femenino , Humanos , Lactante , Masculino , Mianmar , OryzaRESUMEN
Murine studies have demonstrated that the presence of indigenous gut flora is crucial for the induction of systemic immune hyporesponsiveness to antigens initially encountered within the gastrointestinal lumen. This study investigated whether increased titers of such flora, as occur in human small intestinal bacterial overgrowth, may be associated with increased suppression of systemic immune responsiveness and the possible relation between systemic and mucosal immunity in this setting. Serum total immunoglobulin (Ig), immunoglobulin subclass, and soluble interleukin-2 receptor levels and lamina propria IgA plasma cell counts were determined in 50 consecutive subjects with (N = 30) and without (N = 20) small intestinal bacterial overgrowth. Luminal IgA levels were measured in 35 of these subjects. Serum concentrations of IgG3, but not of other immunoglobulin isotypes or soluble interleukin-2 receptors, were significantly reduced in subjects with bacterial overgrowth (P < 0.0005). Small intestinal lamina propria IgA plasma cell counts (P < 0.0005) and luminal IgA concentrations (P = 0.001) were significantly increased in this group. Serum IgG3 levels were significantly inversely correlated with luminal IgA levels (P < 0.01) and fell below the lower limit of normal (0.41 g/liter) in 17/30 (56.7%) subjects with bacterial overgrowth compared to 1/20 (5.0%) subjects without (P < 0.0005). These findings document an association between small intestinal bacterial overgrowth with indigenous gut flora and reduced serum IgG3 reactivity in humans, possibly via an interaction with mucosa-related immunoregulatory mechanisms. The possibility of underlying small intestinal bacterial overgrowth should be considered in patients with serum IgG3 deficiency, especially those with compatible symptoms and/or known predisposition.
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Inmunoglobulinas/sangre , Intestino Delgado/microbiología , Receptores de Interleucina-2/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Persona de Mediana EdadRESUMEN
BACKGROUND: In clinical and field conditions, breath gas analysis has been widely used in evaluating carbohydrate digestion. A field study was performed to determine the prevalence of lactose malabsorption in Myanmar children and to evaluate the possibility of using breath methane excretion to indicate lactose malabsorption in a field situation. METHODS: The study population consisted of 118 children aged 1 to 12 years. A hydrogen breath test after a lactose meal (2 g/kg, maximum 50 g) was used as a standard test. RESULTS: Lactose malabsorption was detected in 16.7% of children aged 1 to 2.9 years, with the prevalence increasing with age from 40.5% of those aged 3 to 5.9 years to 88.5% of those aged 6 to 8.9 years and reaching 91.7% in those aged 9 to 11.9 years. Lactose malabsorption was more prevalent when children were weaned before 4 months of age (87.2 vs. 41.1%; p < 0.01). Compared with lactose-tolerant children, those with lactose malabsorption had significantly higher concentrations of breath hydrogen excretion 60 minutes after the lactose test meal. Breath methane excretion was also significantly higher in samples at 120 minutes in children with lactose malabsorption. Breath methane excretion of greater than or equal to 2 parts per million at 180 minutes as a diagnostic test for lactose malabsorption had a sensitivity of 61.5% and a specificity of 84.6%. CONCLUSION: The breath methane test for lactose malabsorption has a lower sensitivity and specificity than the breath hydrogen test and therefore does not replace the lactose breath hydrogen test.
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Pruebas Respiratorias , Intolerancia a la Lactosa/diagnóstico , Metano/análisis , Niño , Preescolar , Femenino , Humanos , Hidrógeno/análisis , Lactante , Intolerancia a la Lactosa/epidemiología , Masculino , Mianmar/epidemiología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Quadruple therapy using omeprazole combined with classic bismuth triple therapy has been advocated as optimal therapy for the cure of Helicobacter pylori (H. pylori) infection. We investigated the efficacy of substituting lansoprazole for omeprazole in proton pump quadruple therapy. MATERIALS AND METHODS: In a prospective open study, 219 consecutive patients, with either peptic ulcer disease or biopsy-proven H. pylori-associated gastritis, received seven days of lansoprazole, bismuth, tetracycline and metronidazole after three days of lansoprazole pretreatment. Cure of infection was judged by 14C urea breath test at six weeks after completion of therapy. RESULTS: On an intention to treat basis, 198 of the 219 patients (90%) were confirmed to be cured of H. pylori infection. Compliance was excellent and minimal side effects reported. CONCLUSION: Lansoprazole-based quadruple therapy achieves a very high cure rate in an unselected population of either peptic ulcer patients or those with H. pylori-associated gastritis. Recommended regimens should achieve at least 90% cure of infection. Lansoprazole quadruple therapy is effective and compares favorably with other H. pylori treatment regimens.
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Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Bismuto/uso terapéutico , Gastritis/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Metronidazol/uso terapéutico , Omeprazol/análogos & derivados , Úlcera Péptica/tratamiento farmacológico , Tetraciclina/uso terapéutico , 2-Piridinilmetilsulfinilbencimidazoles , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antiulcerosos/administración & dosificación , Bismuto/administración & dosificación , Quimioterapia Combinada , Femenino , Gastritis/microbiología , Infecciones por Helicobacter/complicaciones , Humanos , Lansoprazol , Masculino , Metronidazol/administración & dosificación , Persona de Mediana Edad , Omeprazol/administración & dosificación , Omeprazol/uso terapéutico , Úlcera Péptica/microbiología , Estudios Prospectivos , Tetraciclina/administración & dosificación , Resultado del TratamientoRESUMEN
Paroxysmal dystonic choreoathetosis (PDC) is a rare neurological disorder characterized by episodes of involuntary movement, involving the extremities and face, which may occur spontaneously or be precipitated by caffeine, alcohol, anxiety, and fatigue. PDC is transmitted as an autosomal dominant trait with incomplete penetrance. A gene implicated in this paroxysmal disorder has been mapped to a 10-15 cM region on chromosome 2q31-36 in two families. We describe a third family with PDC. Two-point linkage analyses with markers linked to the candidate PDC locus were performed. A maximum two-point LOD score of 4.20 at a recombination fraction of zero was obtained for marker D2S120, confirming linkage to the distal portion of chromosome 2q. The anion exchanger gene, SLC2C, maps to this region, but the family was poorly informative for polymorphic markers within and flanking this candidate gene. Haplotype analysis revealed a critical recombination event that confines the PDC gene to a 5-cM region bounded by the markers D2S164 and D2S377. We compared the haplotype in our family with that in another chromosome 2-linked PDC family, but did not detect a region of shared genotypes. However, identifying a third family whose disease maps to the same region and narrowing the critical region will facilitate identification of the 2q-linked PDC gene.