Nutrición basada en la evidencia en la pancreatitis aguda y la enfermedad hepática crónica estable

Acute pancreatitis is a disease that, by definition, generates an increase in metabolism. This metabolic reaction, together with the anorexia produced by the disease, clearly increases morbidity and mortality secondary to malnutrition.Malnutrition affects almost 70% of patients with cirrhosis, with a consequent increase in complications. The present review aims to evaluate the utility of the use of total parenteral nutrition (TPN) and/or enteral nutrition (EN) in patients with acute pancreatitis and in those with stable chronic liver disease.In patients with acute pancreatitis, the administration of enteral nutrition seems to confer advantages over parenteral nutrition in clinical variables (infections, surgical interventions, and mean length of hospital stay) (A-B); nevertheless, further studies stratifying patients according to the severity of pancreatitis and probably its etiology should be designed. Glutamine supplementation can be effective in reducing length of hospital stay and duration of nutritional support (B).In patients with stable chronic liver disease, there are no studies that demonstrate the superiority of EN over PN, or vice versa, in relevant clinical variables (mortality, length of hospital stay, etc.). There is only one study that has demonstrated that EN is superior to oral intake in reducing mortality (B).Improved study designs and the need to perform studies according to the type and severity of liver disease should be a research priority.     

Rol del enterocito en la dislipemia de la resistencia insulínica

The increase in cardiovascular morbidity and mortality associated to insulin resistance (IR) states (obesity, metabolic syndrome, type 2 diabetes) represents a major public health problem. In IR, dyslipidemia typically include hypertriglyceridemia, low high density lipoprotein cholesterol, increased small and dense low density lipoprotein particles, and post-prandial hyperlipidemia, which play a direct or indirect role in the mecanisms of atherosclerosis. Dyslipidemia is mainly due to accumulation of circulating triglyceride-rich lipoproteins from the liver and bowel. The bowel has traditionally been seen as a passive organ, but current evidence confirms that it is an active organ subject to regulation by free fatty acids, insulin, incretins, and inflammation. Two new concepts have emerged: intestinal IR and overproduction of chylomicrons in hyperinsulinemic/IR states. A better understanding of intestinal IR may make the enterocyte a therapeutic target.     

Utilización del POMA en nuestro medio para la valoración del equilibrio y la marcha en una población de personas mayors residentes en la comunidad

Objectivesto study the balance and the gait by the Performance Oriented Mobility Assessment (POMA) in the population of people ≥ 65 years in function of age, gender; relation with the capacity to develop the activities of daily living, physical exercise, perception of health and previous falls.Material and methodsWe study a cohort of 443 people, 262 women and 181 men, representative of the population ≥ 65 years, resident in the community and able to walk from the city of Mataró. The evaluation was made with the 22 items POMA. Basic and instrumental activities of the daily life (Katz Index and Lawton), physical activity, health perception (Iowa test) were also assessed.Results29.3% of subjects did not present abnormalities in any of the items, 22.6% presented one abnormality, 12.4% two, and 35.7% three or more. 35.9% and 50.2 of subjects did not present abnormalities in the static and dynamic components respectively. Women had greater number of abnormalities than men (42.0% vs 20.6%) for the global and also for each of the two components (static and dynamic) (p < 0.0001). The number of abnormalities increased significantly with age, specially on those 75 years and older (p < 0.0001). A greater number of errors was correlated with less independence on the basic and instrumental activities of daily living, with less physical activity, health perception and with antecedents of previous falls.     

Prevención de las caídas basada en la evidencia en Europa

ProFaNE (Prevention of Falls Network Europe) is a thematic network funded by the European Commission. This network brings together scientists, clinicians and other health professionals from across Europe to focus on four main topics (taxonomy and co-ordination of trials, clinical assessment and management of falls, assessment of balance function, and psychological aspects of falls). There are 24 members across Europe as well as Network Associates who contribute expertise at workshops and meetings. ProFa- NE, a 4-year project which started in January 2003, aims to improve and standardise healthcare processes by introducing and promoting good practice throughout Europe. ProFaNE has its own website (http://www.profane.eu.org) and undertakes workshops to bring together experts and observers involved in specific topics to exchange knowledge, expertise and resources on interventions to reduce falls. The present article discusses ProFaNE's achievements to date and the work in progress to achieve good clinical practice and research into the prevention of falls across Europe.     

Non-dits méthodologiques dans la recherche en psychiatrie

Modern psychiatric practice must ground itself in evidence-based medicine, but what is evidence in medicine? For certain philosophers, to have evidence, you must have beliefs: What are the consequences for medicine, and, in particular, psychiatric research? Why randomize the administration of treatments in clinical trials? Is it to make it possible to compare groups? But, if you’re unlucky, the lack of balance can be significant. This article addresses several concepts often used by methodologists: causality, evidence, belief, risk, randomness, models, observation, experimentation and measurement. The objective is to challenge the dominant discourse, often a little forced, in order to shed light on methodological omissions.     

Micafungina en el tratamiento de la infección fúngica en modelos animales

BackgroundMicafungin is an echinocandin antifungal drug recently approved for the treatment of candidiasis. The possibility of its clinical use against other invasive mycoses, has aroused the interest of numerous investigators in evaluating its efficacy in different animal models.ObjectivesTo critically review the current data on the use of micafungin in the treatment of invasive mycoses in animal models.MethodsWe searched the PubMed/Medline data base (National Library of Medicine) from 2005 to 2008, both inclusive, on the use of micafungin in the experimental treatment of the fungal infection.Results and conclusionsSeven, of a total of 18 articles reviewed, were done in animal models of candidiasis and six in animal models of pulmonary or SNC aspergillosis. Similarly to the other echinocandins, caspofungin and anidulafungin, micafungin seems to exert a fungicidal activity against Candida albicans and Candida glabrata and a fungistatic activity against Aspergillus fumigatus. The paradoxical effect observed in lung tissue the experimental caspofungin treatment of aspergillosis has not been seen in the case of micafungin. The available data demonstrate a higher efficacy of micafungin versus fluconazole in the experimental treatment of C. albicans infections caused by strains susceptible in vitro to both drugs. To improve the efficacy of micafungin in the treatment of C. glabrata and A. fumigatus infections, several authors have tested different combined therapies, the combination of micafungin with amphotericin B being that showed the best results.     

Etablissement de l’empreinte parentale dans la lignée germinale. Conséquences pour la prise en charge en AMP

Genomic imprinting is an epigenetic phenomenon in eutherian mammals that results in the differential expression of the paternally and maternally inherited alleles of a gene. Imprinted genes are necessary for normal mammalian development. Parental specific epigenetic modifications are imprinted on a subset of genes in the mammalian genome during germ cell maturation. Imprinting involves both cytosine methylation within CpG islands and changes in chromatin structure. All such epigenetic modifications are potentially reversible and can be erased. After the erasure step, new parental imprints are initiated, resulting in reintroduction of sex-specific imprints in the male and female germ line. Although the function of genomic imprinting is not clear, it has been proposed that it evolved in mammals to regulate intrauterine growth and mammalian development. If the epigenotype of individual gametes is directly correlated with their later developmental capacities, genomic imprinting would have important practical implications in reproductive medicine for the use of embryos derived from assisted reproduction.