[Relationship between dysphagia and malnutritition in patients over 65 years of age]

AIMS

The main objective of this study was to understand the relationship between oropharyngeal dysphagia, nutritional risk factors and functional impairment in the elderly (>65y) admitted to a medical-surgical hospital unit. Secondary objectives were to determine the prevalence of oropharyngeal dysphagia, the nutritional status and their functional capacity.

METHODS

A cross-sectional observational study was performed. It included patients over 65 years of age admitted to the Gastroenterology-Urology Department in La Princesa University Hospital (Madrid, Spain) during the months of February and March. The following variables were recorded: age, sex, body mass index, family support, diagnosis, comorbidity, oropharyngeal dysphagia (EAT-10 and volume-viscosity evaluation method), malnutrition (Mininutritional Assessment) and functional capacity (Barthel index).

RESULTS

A total of 167 patients were recruited, with 30.8% and 15.4% prevalence of dysphagia and malnutrition, respectively. Prevalence of malnutrition increased to 75% in patients with oropharyngeal dysphagia. The logistic regression analysis showed how conditions as low score on the Barthel index (OR 0.97 [95% CI, 0.95-0.99]), comorbidity (OR 7.98 [CI 95%, 3.09-20.61]) and dysphagia (OR 4.07 [CI 95%, 1.57-10.52]) were associated with a greater likelihood of suffering malnutrition.

DISCUSSION

Oropharyngeal dysphagia is one of the most underdiagnosed and underestimated conditions among elderly patients and one that has a greater effect on their nutritional status. Accordingly, we suggest using established diagnostic methods with a multidisciplinary team collaboration for its early detection.

[BK virus in kidney allografts: a search for histologic evidence of the infection]

BACKGROUND

BK virus (BKV) associated interstitial nephritis is a complication in renal transplantation recipients. Its incidence is controversial. The aim of the present study is to determine the incidence of histopathologic evidence of BKV-infection in a single centre.

MATERIALS AND METHODS

Renal allograft tissue samples (n = 838) from 526 patients undergoing renal transplant were evaluated by light microscopy. Polymerase chain reaction (PCR) assay for BKV DNA was performed in 41 microdissected cell populations from cases with viral inclusions, cases with other nuclear changes, and cases without nuclear changes.

RESULTS

Polyomavirus-inclusions were identified in six cases (five with interstitial nephritis and other one with only urothelial infection). In one case with interstitial nephritis the DNA was degraded. PCR confirmed BKV infection in the other five and was negative in cases without inclusions.

CONCLUSIONS

Five patterns of inclusions bodies are observed and they appear to be characteristic. PCR assay seemingly have a high specificity for BKV detection and it does not usually detect latent viral infection.

In-vitro study of the effect of adrenaline on the functional capacity of human neutrophils: role during exercise

We studied the effect of adrenaline on the capacity of human neutrophils to attach, ingest and destroy Candida albicans. The neutrophils were incubated in vitro in the presence of an adrenaline concentration taken as basal (10-10 m), and another that is referred to as being reached following physical exercise (10-9 m). Two higher concentrations (10-7 m and 10-5 m), which are seldom attained in blood but which can occur at specific locations in the organism, were tested as having a possible pharmacological application. At the two high concentrations (10-7 m and 10-5 m), the capacity to attach, ingest and destroy C. albicans was greater than at the physiological concentrations (10-10 m and 10-9 m). Indeed, the capacity to attach and ingest C. albicans was significantly less after incubation with these physiological concentrations than the control values (incubation in the absence of adrenaline). Hence, high concentrations of adrenaline seem to enhance neutrophils' phagocytic capacity compared to physiological plasma concentrations, whereas small variations such as those caused by physical exercise have no effect on this functional capacity.

Changes with aging in the modulation of macrophages by norepinephrine

The effect of aging on the norepinephrine (NE)-induced modulation of phagocytic and oxygen-dependent microbicidal processes of mouse peritoneal macrophages was studied. Phagocytosis of latex beads on culture plates and superoxide anion production was evaluated in young (12 weeks), adult (22 weeks), mature (48 weeks) and old (72 weeks) BALB/c mice after in vitro incubation with 10(-12), 10(-9), 10(-7), 10(-5) or 10(-3) M concentrations of NE. The results indicate that the phagocytic response to NE is quite similar in young and mature mice, with increased phagocytosis after incubation with 10(-7) and 10(-3) M, and decreased phagocytosis with 10(-5) M. Macrophages from adult mice increased their phagocytic capacity after incubation with the highest concentrations of NE (10(-5) and 10(-3) M) and macrophages from old animals only were stimulated with 10(-3) M. In addition, it was found that usually NE increased the extracellular superoxide anion production in the absence of phagocytosis in adult mice. No statistically significant changes were found in intracellular superoxide anion levels, but an increase was seen after phagocytosis in macrophages from adult, mature and old animals, especially after incubation with 10(-5) M. In conclusion, the results obtained indicate that the modulation of macrophages by NE does not only depend on the concentration of this neurotransmitter, but also on age.