RESUMO
INTRODUCTION: Heterogeneity of malnutrition rates associated with End-Stage Renal Disease (ESRD) under Haemodialysis (HD) points towards differing performances of the used indicators. OBJECTIVES: To identify those indicators that better describe the nutritional state of the patient with ESRD under HD. SETTING: Program of Haemodialysis, Service of Nephrology, "Hermanos Ameijeiras" Hospital (Havana City, Cuba). METHODS: Twenty-eight patients were recruited. Hospital admissions between december 2001-december 2002 were recorded. The condition of the patient (alive/deceased) after one year of observation was registered. The Subjective Global Assessment (SGA) form was administered to each patient. The nutritional profile included: height, weight, mid-arm circumference (MAC), triceps skinfold (TSF), albumin and total lymphocyte count (TLC). Nutritional status as described by means of albumin and MAC was correlated with SGA score, the ocurrence of hospital admissions and the final condition of the patient. RESULTS: Malnutrition rates were as follows (albumin < 35 g/L): 42.9%; (MAC < cut-off value): 60.7%; [(MAC < cut-off value) and/or (albumin < 35)]: 71.4%; (SGA score = At Risk/Malnourished): 42.9%. SGA score was an independent predictor of the ocurrence of admissions [OR = 14.14; CI 95%: 1.5-137.3] and mortality [OR = 21.0; CI 95%: 2.9-151.4]. Serum albumin was an independent predictor of the patient's mortality [OR = 21.0; CI 95%: 2.9-151.4]. The [(MAC < Cut-off value) and/or (albumin < 35)] rule failed to predict patient's morbimortality. Seventy-seven point eight percent of patients with +60 years-old died during the year of observation [OR = 13.2; IC 95%: 1.9-89.5]. CONCLUSIONS: Increased mortality associated with diminished values of albumin and MAC justifies the fostering of nutritional intervention aimed to preserve lean tissues.
Assuntos
Falência Renal Crônica/terapia , Estado Nutricional , Diálise Renal , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The results achieved by a Nutritional Support Group (NSG) operating within a tertiary-level hospital in the city of Havana (CUBA) for the last 8 years are presented in this work. Results relate to the performance of the Group in the three domains of medical care, on one hand, and the inception of a Metabolic, Nutritional and Feeding Intervention Program (PRINUMA) of institutional reach, on the other. Nutritional assistance has served the purpose of demonstrating the feasibility of intervention schemes conducted under the premise of the use of the enteral route as first choice, and the benefits observed in selected cases. Teaching has always been a priority of the Group, as a tool to expose the institution's medical care teams to new ideas and novel ways of acting, in order to eliminate those undesirable practices attempting against the patient's nutriture that have arisen most of the times from myths, fallacies and dogmas. Research has been a perfect complemment of the Group's performance in the two previous domains, making possible the incorporation of nutritional support and Artificial nutrition issues into the institution's R&D portfolio. GAN's medical workup has been accompannied by the deployment of the PRINUMA, in order to respond to the challenges brought about by the recognition of disease-associated-malnutrition as an institutional health problem. The guidelines followed in this article for reporting the Group's activities can become a methodological platform for the purpose of assessment by third parties.
Assuntos
Hospitais Públicos/organização & administração , Hospitais Urbanos/organização & administração , Apoio Nutricional , Educação de Pacientes como Assunto/métodos , Grupos de Autoajuda , Cuba , Educação Médica Continuada , Nutrição Enteral/estatística & dados numéricos , Humanos , Pacientes Internados , Desnutrição/etiologia , Desnutrição/prevenção & controle , Nutrição Parenteral/estatística & dados numéricos , Educação de Pacientes como Assunto/organização & administração , Avaliação de Programas e Projetos de Saúde , Grupos de Autoajuda/organização & administração , Medicina Estatal/organização & administraçãoRESUMO
Se estudia el metabolismo de estructuras encefalicas dopaminergicas, a traves de la dosificacion del acido homovanilico (HVA) en el liquido cefalo-raquideo (LCR) de 14 enfermos con Parkinson senil o arterioesclerotico. Se confirma que las concentraciones de HVA en tales muestras tienen un valor medio significativamente inferior al obtenido en 10 muestras de sujetos normales del mismo rango de edad. Algunos casos presentan valores que se encuentran en el rango normal. El tratamiento con L-Dopa durante 3 meses obtuvo mejorias clinicas en casi todos los casos que presentaban inicialmente niveles subnormales de HVA y que alcanzaron o sobrepasaron el nivel normal durante el tratamiento (8 9). Los casos con niveles inicialmente elevados o que mantuvieron concentraciones subnormales a pesar del tratamiento, fueron fracasos terapeuticos (05)