Prevalence of malnutrition in various political, economic, and geographic settings

BACKGROUND

Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent.

METHODS

Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective.

RESULTS

At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist.

CONCLUSION

The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.

Two cases of takotsubo syndrome related to tracheal intubation/extubation

Takotsubo cardiomyopathy is an acute, reversible left ventricular dysfunction with characteristic contractility disorder and is usually preceded by emotional or physical stress. Two cases of Takotsubo cardiomyopathy related to tracheal manipulation are presented. Both the patients had all the typical symptoms and signs of Takotsubo cardiomyopathy, and both of them recovered completely within weeks. Tracheal manipulation is a well-known stress factor during the perioperative period, and experience from these two cases stresses the crucial role of measures aimed to stress reduction. Proper premedication and calm environment are recommended to produce anxiolysis before intubation. The administration of α- and β-blockers is also recommended to inhibit sympathetic stress caused by tracheal manipulation.

Pituitary-adrenal function in patients given long-term adrenal steroid therapy

Pituitary-adrenal function was investigated in 23 patients with rheumatoid arthritis and in 19 patients with bronchial asthma following prolonged glucocorticoid therapy. The duration of continuous treatment varied from 2 months to 15 years and the total dose of steroids from 400 mg to 54 g of prednisolone or its equivalent. After treatment had been discontinued, pituitary ACTH-reserve was estimated by means of an oral metyrapone test and adrenal response to ACTH by means of an intravenous or intramuscular ACTH-test. The pituitary ACTH-response was evaluated by determining the increment in the excretion of 11-deoxy-17-hydroxycorticosteroids during the administration of the metyrapone blocking agent and adrenal response to ACTH by the excretion of 11-oxygenated corticosteroids.

The reduction of the metyrapone and ACTH responses were found to be related to the duration of prednisolone treatment as well as to the daily and total administered dose, although a marked individual variation in several instances could be observed in the degree of suppression of endogenous ACTH or corticosteroid production. Deficient metyrapone and ACTH responses were more frequently encountered in bronchial asthma than in patients with rheumatoid arthritis who had received comparable doses of glucocorticoids during similar periods. No negative metyrapone tests, however, in either group of patients were obtained for 12 months or unless the total dose of steroids administered was at least 3.5 g of prednisolone or its equivalent. Most patients who showed reduced adrenocortical response to ACTH had received large total doses of corticosteroids and the lowest total dose on which a subnormal ACTH-response was observed was 6 g.

The results demonstrate that both pituitary ACTH-reserve and adrenocortical response to ACTH can be reduced by long-term adrenal steroid therapy, although the loss of pituitary ACTH-response occurs earlier during the course of treatment.