La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.     

Farmacología de los antifúngicos en el tratamiento de la aspergilosis

The treatment of invasive aspergillosis requires the use of drugs that characteristically have complex pharmacokinetic properties, the knowledge of which is essential to achieve maximum efficacy with minimal risk to the patient. The lipid-based amphotericin B formulations vary significantly in their pharmacokinetic behaviour, with very high plasma concentrations of the liposomal form, probably related to the presence of cholesterol in their structure. Azoles have a variable absorption profile, particularly in the case of itraconazole and posaconazole, with the latter very dependent on multiple factors. This may also lead to variations in voriconazole, which requires considering the possibility of monitoring plasma concentrations.The aim of this article is to review some of the most relevant aspects of the pharmacology of the antifungals used in the prophylaxis and treatment of the Aspergillus infection. For this reason, it includes the most relevant features of some of the azoles normally prescribed in this infection (itraconazole, posaconazole and voriconazole) and the amphotericin B formulations.     

Fisionomía y sociología de los bosques de Nothofagus dombeyi en la región de Nahuel Huapi

Summary In the mountains around Lake Nahuel Huapi three belts of vegetation can be observed: the evergreen forests of Nothofagus dombeyi between surface level of the lake (ca. 770 m a.s.l.) and 1100–1200 m; the deciduous forests of Nothofagus pumilio; and the Andean-antarctic meadows and other communities above the timberline (±1600 m).A physiognomical study of the evergreen beech forests shows three main types of structure, one of which coincides with a quite different floristical composition.Detailed phytosociological work following the method of Braun-Blanquet is proving the floristical relationship between the deciduous forests of Nothofagus pumilio or N. antarctica and the main part of the evergreen patagonical forests of Nothofagus dombeyi, especially when austrocedrus chilensis is present. Besides other units, there has therefore been established a new alliance, Austrocedro-Nothofagion, belonging to the Nothofagetalia pumilionis-dombeyi as an order of the Nothofagetea pumilionis-antarcticae Oberd. 1960.Only a few stands in the extreme West of Argentine territory present the characteristics of the Nothofago-Winterion Oberd., which is an alliance of the Wintero-Nothofagetea Oberd., and corresponds to the forêt valdivienne of phytogeographical literature.Comment has been made on the theoretical bases of systematics, considering that in certain cases the forest communities studied demonstrate what some ecologists think to be a continuum of vegetation.     

Ingesta dietética de los estudiantes de secundaria de la ciudad de Badajoz

ObjectivesTo quantify dietary intake of secondary education students in Badajoz, Spain, evaluating food frequency use in teenagers of both sexes.Material and methodsThe study sample consisted of 1197 secondary education students (49.9% male and 50.1% female). After giving informed consent, they completed a self-administered food frequency questionnaire (FFQ) including 51 food items divided into five separate categories. This questionnaire was modified from the one used at the Valencian Community in 2003 and previously validated in a pilot study on 374 students.ResultsMale and females students reported higher intakes of 70.6% and 17.6% of foods analyzed respectively, while intake of 11.8% of food items was similar in both sexes. Sex differences were statistically significant for 35% of foods (of which 72% and 28% were taken more frequently by males and females respectively). Intake of milk and dairy products appeared to be adequate, while intake of fish and seafood was low consumption of meat products was high. Intake of vegetables, fruits, bread, and cereals was below the recommended levels. Intake of pasta, rice, and oils was adequate, and there was not a high consumptio of cookies or industrial pastries. There was an excess intake of sweets, but intake of soft drinks was not high.ConclusionsThese results show intermediate values as compared to other national surveys.     

Influencia de la enfermedad psiquiátrica previa en la evolución de los pacientes sometidos a cirugía bariátrica

IntroductionPresurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.Patients and methodsRetrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up > 6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).ResultsPatients in group 1 showed a greater tendency for weight gain. They regained a 9,4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p < 0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19,6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 ± 1.6 nutritional deficiencies per patient in group 1 and 2.5 ± 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).ConclusionsThe presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.     

Distribución de la circunferencia de la cintura y de la relación circunferencia de la cintura con respecto a la talla según la categoría del índice de masa corporal en los pacientes atendidos en consultas de endocrinología y nutrición

IntroductionWaist circumference (WC) and the waist-to-height ratio (WHtR) are anthropometric measures widely used in clinical practice to evaluate visceral fat and the consequent cardiovascular risk. However, risk thresholds should be standardized according to body mass index (BMI).ObjectiveTo determine the distribution of WC and WHtR according to the BMI cut-points currently used to describe overweight and obesity.Materials and methodsWC, WHtR and BMI were measured in 3521 adult patients (>18 years) attended in Endocrinology and Nutrition units.ResultsA total of 20.8% (734 patients) were diabetic. Obesity was found in 82.1% of diabetic patients and in 75% of non-diabetic patients. The WC thresholds proposed by the National Institute of Health (102 cm in men, 88 cm in women), Bray (100 cm in men, 90 cm in women) and the International Diabetes Federation (94 cm in men, 80 cm in women) were exceeded by 92.9%, 94.8% and 98.4% of obese men, 96.8%, 95.5% and 99.7% of obese women, 79.1%, 83.1% and 90% of diabetic men and 95.5%, 81.5% and 97.4% of diabetic women, respectively. Thresholds adapted to the degree of obesity (90, 100, 110 and 125 cm in men and 80, 90, 105 and 115 cm in women for normal BMI, overweight, obesity I and obesity greater than I) were exceeded by 58.4% of obese men, 54.2% of obese women, 57.5% of diabetic men and 60.7% of diabetic women. WC was higher in men, and BMI and the WHtR were higher in women. The WC of diabetic women equalled that of men, and WC, WHtR and BMI were higher in diabetic than in non-diabetic women (p<0.001). WC (p<0.005), WHtR (p<0.001) and BMI (p<0.5) were also higher in diabetic than in non-diabetic men.ConclusionWC and WHtR thresholds by BMI discriminated diabetic and obese patients better than single thresholds, and can be represented graphically by the distribution of percentile ranks of WC and WHtR by BMI.ik     

Influencia del grupo ecológico sobre la sensibilidad in vitro de los hongos dermatofitos a los antifúngicos

BackgroundDermatophytes can be divided into geophilic (soil), zoophilic (animals) and anthropophilic (humans) strains, depending on the source of the keratin that they use for nutritional purposes.AimsThe in vitro susceptibility of clinical isolates of dermatophyte fungi has been studied in the 3 ecological groups with several antifungal agents for the topical management of dermatophytoses in order to determine their relationship with the ecological group.MethodsA standardised dilution micromethod in a liquid medium was used for the determination of the in vitro antifungal activity of 9 topical antifungal drugs: amorolfine (AMR), bifonazole (BFZ), clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, terbinafine (TRB) and tioconazole. The in vitro activity was obtained against 124 clinical isolates of dermatophyte moulds from the anthropophilic, zoophilic and geophilic ecological groups.ResultsThe in vitro antifungal activity was different depending on the ecological group, although a species-dependent profile was also observed.ConclusionsAzole derivatives showed a similar antifungal profile, being more active against anthropophilic dermatophytes > zoophilic > geophilic. Activity of TRB and AMR was different from that of azole derivatives (zoophilic > anthropophilic > geophilic). A higher in vitro antifungal activity against the 3 ecological groups was observed with TRB and AMR, whilst BFZ was the less active drug.