Implications of Salinity and Acidic Environments on Fitness and Oxidative Stress Parameters in Early Developing Seahorses Hippocampus reidi

Water acidification affects aquatic species, both in natural environmental conditions and in ex situ rearing production systems. The chronic effects of acidic conditions (pH 6.5 vs. pH 8.0) in seahorses (Hippocampus spp.) are not well known, especially when coupled with salinity interaction. This study investigated the implications of pH on the growth and oxidative stress in the seahorse Hippocampus reidi (Ginsburg, 1933), one of the most important seahorse species in the ornamental trade. Two trials were carried out in juveniles (0-21 and 21-50 DAR-days after the male's pouch release) reared under acid (6.5) and control (8.0) pH, both in brackish water (BW-salinity 11) and seawater (SW-salinity 33). In the first trial (0-21 DAR), there was no effect of pH on the growth of seahorses reared in SW, but the survival rate was higher for juveniles raised in SW at pH 6.5. However, the growth and survival of juveniles reared in BW were impaired at pH 6.5. Compared to SW conditions, the levels of superoxide dismutase and DT-diaphorase, as well as the oxidative stress index, increased for juveniles reared in BW. In the second trial, seahorse juveniles were reared in SW at pH 8.0, and subsequently kept for four weeks (from 21 to 50 DAR) at pH 6.5 and 8.0. The final survival rates and condition index were similar in both treatments. However, the growth under acidic conditions was higher than at pH 8.0. In conclusion, this study highlights that survival, growth, and oxidative status condition was enhanced in seahorse juveniles reared in SW under acidic conditions (pH = 6.5). The concurrent conditions of acidic pH (6.5) and BW should be avoided due to harmful effects on the fitness and development of seahorse juveniles.

Sustainable Aquaculture: Nutrition Studies in Early Developing Finfish, Ornamentals and Experimental Model Fish

Enhancing the knowledge of feeding/nutritional requirements is key in the growth of fish development and for the optimization of rearing techniques [...]

Turnover Rates and Diet–Tissue Discrimination Factors of Nitrogen and Carbon Stable Isotopes in Seahorse Hippocampus reidi Juveniles Following a Laboratory Diet Shift

Simple Summary

The main aim of the present study was to ascertain the effect of two feeding schedules (including copepods and Artemia nauplii) on the early development and physiology of seahorse Hippocampus reidi juveniles. For that, we analyzed seahorse performance (growth and survival) and trophic patterns by means of stable isotopes. Our results highlight that the welfare and condition of juveniles were enhanced by extending the period of feeding on copepods up to day 10 after the male’s pouch release. The analysis of turnover rates for δ¹³C and δ¹⁵N revealed that switching copepods to Artemia nauplii at earlier developmental stages would reduce prey assimilation resulting in lower growth rates and survivals. The present study also provides for the diet–tissue discrimination factors for δ¹³C and δ¹⁵N in seahorse juveniles for the first time.

Abstract

The initial development of seahorse juveniles is characterized by low digestion capabilities. Stable isotope analysis is an effective tool in studies of trophic food webs and animal feeding patterns. The present study provides new insights for the understanding of growth and food assimilation in early developing seahorses following a laboratory diet switch. The study was performed in the early life stages of the seahorse Hippocampus reidi by assessing the influence of diet shift on changes and turnovers in carbon (δ¹³C) and nitrogen (δ¹⁵N) stable isotope in juveniles. Newborn seahorses were fed for 60 days following two feeding schedules (A6 and A11) based initially on copepods Acartia tonsa and subsequently on Artemia nauplii (since days 6 and 11, respectively). After the prey shift, we determined δ¹³C and δ¹⁵N turnover rates as functions of change in either body mass (fitting model G) and days of development (fitting model D), contributions of metabolism and growth to those turnover rates, and diet–tissue discrimination factors. Survival, final dry weight, and final standard length for diet A11 were higher compared to diet A6. The shift from copepods to Artemia led to fast initial enrichments in δ¹³C and δ¹⁵N. Afterwards, the enrichment was gradually reduced until the isotopic equilibrium with the diet was reached. In most cases, both fitting models performed similarly. The isotopic analysis revealed that 100% of tissue turnover was attributed to growth in diet A11, whereas 19–25% was linked to metabolism in diet A6. Diet–tissue discrimination factors were estimated for the first time in seahorse juveniles, resulting in higher estimates for diet A11 (2.9 ± 0.7‰ for δ¹³C; 2.5 ± 0.2‰ for δ¹⁵N) than in diet A6 (1.8 ± 0.1‰ for δ¹³C; 1.9 ± 0.1‰ for δ¹⁵N). This study highlights the relevance of feeding on copepods and their effect on isotopic patterns and discrimination factors in seahorse juveniles after a dietary shift. Regarding the application of the results achieved in relation to the feeding schedules in the rearing of H. reidi, a long period of feeding on copepods during the first days of development is highly recommended.

First evidence of ingestion and retention of microplastics in seahorses (Hippocampus reidi) using copepods (Acartia tonsa) as transfer vectors

Microplastics (MPs) are a major concern for marine ecosystems since they can be ingested by a wide range of marine species and transmitted through the food web. However, the potential hazardous impact of MPs in fishes, especially in early developing stages, is relatively unknown. In the present study, we assessed for the first time the ingestion and retention of MPs in early developing seahorses Hippocampus reidi. Seahorses are vulnerable species that may also be affected by both the direct ingestion of MPs through their preys and the accidental ingestion of MPs particles present in the water (i.e., seahorses ingest the prey by suction). We used copepods as both preys for seahorse juveniles and transfer vectors of MPs. Fed or starved copepods previously exposed to polyethylene microspheres (1-5 μm in diameter; 10 and 100 μg L-1) for 60 min at 26 °C showed fast evacuation of microspheres. The presence of MPs in copepods was significantly higher in previously fasted copepods compared to fed copepods. Seahorse juveniles fed on copepods pre-exposed to MPs, accumulated MPs in the gut proportionally to the concentration of MPs in copepods. A lower concentration of MPs in seahorses was observed at the longer exposure time (60 min), especially in fish fed with fasted copepods. However, after longer exposure, MPs were mainly accumulated close to the anus both individually or forming aggregates. Further studies should be performed to assess secondary effects of MPs ingestion in seahorses since they are considered a flagship species for marine conservation.

Preferential habitats prediction in syngnathids using species distribution models

Syngnathids are considered as flagship species for marine conservation. Seahorses and pipefish are highly vulnerable to anthropogenic and environmental disturbances, but most species are currently considered Data Deficient by IUCN, requiring more biological and ecological research. Although syngnathids are well known for their unusual breeding biology, some aspects on the ecology of this family have rarely received attention. The knowledge on the factors governing syngnathids distribution is limited to some species and geographical regions. The present study is the first approach to predict syngnathid habitat preference in Spanish coasts, particularly in a marine National Park. In this study, Species Distribution Models (SDMs) were implemented to investigate the preferential habitat and distribution of the pipefish Syngnathus acus in Cíes Archipelago (Atlantic Islands of Galicia National Park, PNIA). Occurrence data of the species obtained from 2016 to 2018 surveys in PNIA were modeled as a function of bathymetric (depth, slope), substrate (sediment texture) and oceanographic (waves exposure) variables, using GAM, Random Forest and Maxent algorithms. From those SDMs, prediction models were built and the ensemble map of predictions was performed. The variables that most determined the distribution of the species were depth and wave exposure. The results of this study provide information on (1) habitat preference in the most dominant species in PNIA, the pipefish S. acus, towards sustainable management of this species in the National Park, and (2) predictive statistical tools for proper spatial conservation plans of this syngnathid species.

Dynamic changes in DNA methylation during seahorse (Hippocampus reidi) postnatal development and settlement

Introduction

Most living marine organisms have a biphasic life cycle dependent on metamorphosis and settlement. These critical life-history events mean that a developmentally competent larva undergoes a range of coordinated morphological and physiological changes that are in synchrony with the ecological transition from a pelagic to a benthonic lifestyle. Therefore, transition from a pelagic to a benthonic habitat requires multiple adaptations, however, the underlying mechanisms regulating this process still remains unclear. Epigenetic regulation and specifically DNA methylation, has been suggested to be particularly important for organisms to adapt to new environments. Seahorses (Family Syngnathidae, Genus Hippocampus) are a fascinating group of fish, distinguished by their unique anatomical features, reproductive strategy and behavior. They are unique among vertebrate species due to their “male pregnancy”, where males nourish developing embryos and larvae in a brood pouch until hatching and parturition occurs. After birth, free-swimming offspring are pelagic and subsequently they change into a demersal lifestyle. Therefore, to begin to address the question whether epigenetic processes could be involved in the transition from a planktonic to a benthonic lifestyle observed in seahorses, we studied global DNA methylation profiles in a tropical seahorse species (Hippocampus reidi) during postnatal development and settlement.

Results

We performed methylation-sensitive amplified polymorphism (MSAP) along with quantitative expression analysis for genes suggested to be involved in the methylation machinery at six age groups: 1, 5, 10, 20, 30 and 40 days after male’s pouch release (DAR). Results revealed that the H. reidi genome has a significantly different DNA methylation profile during postnatal development and settlement on demersal habitats. Moreover, gene expression analysis showed up- and down-regulation of specific DNA methyltransferases (DNMTs) encoding genes.

Conclusion

Our data show that the differences in the DNA methylation patterns seen among developmental stages and during the transition from a pelagic to a benthonic lifestyle suggest a potential for epigenetic regulation of gene expression (through DNA methylation) in this species. Therefore, epigenetic mechanisms could be necessary for seahorse settlement. Nevertheless, if these epigenetic mechanisms come from internal or if they are initiated via external environmental cues should be further investigated.

Does acidification lead to impairments on oxidative status and survival of orange clownfish Amphiprion percula juveniles?

The nitrification process in recirculating aquaculture systems can reduce water pH. Fish can also be exposed to water acidification during transport, an important feature in the aquarium industry, as live fish can be kept in a closed environment for more than 24 h during overseas aerial transportation. Therefore, it is important to study the responses of fish to acidic environments. We investigated the impacts of acute exposure to decreasing pH levels in orange clownfish Amphiprion percula juveniles on their survival and oxidative stress status. Fish were exposed to pH 5, 6, 7, and 8 for 96 h. We observed a significant reduction in survival (85%) and protein damage as measured by P-SH (protein thiol) for fish maintained at pH 5. Despite no effects on survival or oxidative damage, fish exposed to pH 6 showed an increase in their antioxidant defense systems, demonstrating this pH level could not be suitable for them as well. Furthermore, there were no negative effects for fish kept at pH 7, compared to those maintained at pH 8 during this short-term evaluation.

Administration of the probiotic Lactobacillus rhamnosus IMC 501 as a strategy for the control of Vibrio bacteria in the brine shrimp Artemia

The present study aimed to address the capability of the probiotic bacterium Lactobacillus rhamnosus IMC 501^® to survive in seawater and the ability of Artemia metanauplii to incorporate it, as well as to analyse the potential effect of the probiotic as a control agent for potentially pathogenic Vibrionaceae bacteria in Artemia. The results demonstrate the ability of L. rhamnosus IMC 501^® to survive in seawater for up to 30 h. They also advocate their capability to be efficiently incorporated into Artemia metanauplii at concentrations of 10⁴  CFU per Artemia after 30 min of suspension in probiotic solution, thereby promoting a 1-log reduction in Vibrionaceae levels after 3 h. These low levels of Vibrio bacteria were maintained for about 30 min after transfer into clear seawater, a sufficient time for Artemia to be ingested by aquatic organisms. These results contribute to broaden the knowledge on the suitability of probiotics as sustainable alternatives for the prevention/reduction of diseases in aquaculture facilities.

Successful Use of Geochemical Tools to Trace the Geographic Origin of Long-Snouted Seahorse Hippocampus guttulatus Raised in Captivity

Simple Summary

Seahorses (Hippocampus spp.) are currently exposed to a multitude of anthropogenic pressures worldwide. The illegal, unreported, and unregulated (IUU) fisheries and trade of these flagship species undermine the efforts to manage and protect their wild populations. Here we aim to validate a forensic tool to identify the geographic origin of seahorses and contribute to the ongoing fight against the illegal capture and trade of these organisms. The elemental fingerprints of long-snouted seahorse (Hippocampus guttulatus) bony structures, including the subdermal bony plates that cover their body, revealed that they can be successfully employed to confirm their geographic origin. The results of this first study using seahorses raised in captivity indicate that this tool may also allow to discriminate between different populations of wild specimens and enhance the traceability of traded specimens.

Abstract

The global market of dried seahorses mainly supplies Traditional Chinese Medicine and still relies on blurry trade chains that often cover less sustainable practices targeting these pricey and endangered fish. As such, reliable tools that allow the enforcement of traceability, namely to confirm the geographic origin of traded seahorses, are urgently needed. The present study evaluated the use of elemental fingerprints (EF) in the bony structures of long-snouted seahorses Hippocampus guttulatus raised in captivity in two different locations (southern Portugal and Northern Spain) to discriminate their geographic origin. The EF of different body parts of H. guttulatus were also evaluated as potential proxies for the EF of the whole body, in order to allow the analysis of damaged specimens and avoid the use of whole specimens for analysis. The contrasting EF of H. guttulatus raised in the two locations allowed their reliable discrimination. Although no single body part exactly mimicked the EF of the whole body, seahorse trunks, as well as damaged specimens, could still be correctly allocated to their geographic origin. This promising forensic approach to discriminate the geographic origin of seahorses raised in captivity should now be validated for wild conspecifics originating from different locations, as well as for other species within genus Hippocampus.

A multidisciplinary approach to identify priority areas for the monitoring of a vulnerable family of fishes in Spanish Marine National Parks

Background

Syngnathid fishes (Actinopterygii, Syngnathidae) are flagship species strongly associated with seaweed and seagrass habitats. Seahorses and pipefishes are highly vulnerable to anthropogenic and environmental disturbances, but most species are currently Data Deficient according to the IUCN (2019), requiring more biological and ecological research. This study provides the first insights into syngnathid populations in the two marine Spanish National Parks (PNIA—Atlantic- and PNAC—Mediterranean). Fishes were collected periodically, marked, morphologically identified, analysed for size, weight, sex and sexual maturity, and sampled for stable isotope and genetic identification. Due the scarcity of previous information, habitat characteristics were also assessed in PNIA.

Results

Syngnathid diversity and abundance were low, with two species identified in PNIA (Hippocampus guttulatus and Syngnathus acus) and four in PNAC (S. abaster, S. acus, S. typhle and Nerophis maculatus). Syngnathids from both National Parks (NP) differed isotopically, with much lower δ¹⁵N in PNAC than in PNIA. The dominant species were S. abaster in PNAC and S. acus in PNIA. Syngnathids preferred less exposed sites in macroalgal assemblages in PNIA and Cymodocea meadows in PNAC. The occurrence of very large specimens, the absence of small-medium sizes and the isotopic comparison with a nearby population suggest that the population of Syngnathus acus (the dominant syngnathid in PNIA) mainly comprised breeders that migrate seasonally. Mitochondrial cytochrome b sequence variants were detected for H. guttulatus, S. acus, and S. abaster, and a novel 16S rDNA haplotype was obtained in N. maculatus. Our data suggest the presence of a cryptic divergent mitochondrial lineage of Syngnathus abaster species in PNAC.

Conclusions

This is the first multidisciplinary approach to the study of syngnathids in Spanish marine NPs. Habitat preferences and population characteristics in both NPs differed. Further studies are needed to assess the occurrence of a species complex for S. abaster, discarding potential misidentifications of genus Syngnathus in PNAC, and evaluate migratory events in PNIA. We propose several preferential sites in both NPs for future monitoring of syngnathid populations and some recommendations for their conservation.

Application of Effective Day Degrees in the Assessment of Stable Isotope Patterns in Developing Seahorses under Different Temperatures

Relations between nutrient assimilation and growth rate in fishes may vary with abiotic factors such as temperature. The effects of feeding status, ontogeny and temperature regimes (15, 18 and 21 °C) on stable isotope (δ¹³C and δ¹⁵N) patterns were assessed in juveniles of the seahorse Hippocampus guttulatus. The use of effective day degrees (D°_eff), day degrees (D°) and chronological time (age) were compared as development progress indices. Newborn seahorses were maintained at three temperature levels both deprived of food (5 days) or fed (30 days) on copepods or/and Artemia. Isotopic signatures in fed seahorses clearly differed from those in unfed juveniles. Temperature had a significant effect on δ¹³C values in fed juveniles throughout the experimental period. δ¹⁵N values also varied significantly with age, but not with temperature level. Faster growth and food assimilation in seahorses held at 18 and 21 °C were supported by faster variations in isotopic values. Our findings demonstrate that effective day degrees should be preferred over chronological time as index of developmental progress in temperature fluctuating scenarios or for comparative studios.

Histological development of the long-snouted seahorse Hippocampus guttulatus during ontogeny

The objective of the present study was to describe histological development of the European long-snouted seahorse Hippocampus guttulatus, to increase understanding of the biology and physiology of the species. Most vital organs were present in juveniles by the time of their release from the male's pouch. Digestive tract specialization occurred at 89 effective day-degrees (D°_eff ), corresponding to 15 days post partum (dpp), with development of the first intestinal loop and mucosal folding. At 118 D°_eff (20 dpp), lipids were being mobilized from the liver and oocytes attained the perinuclear stage. The fovea emerged at 177 D°_eff (30 dpp), contemporaneous with the shift from pelagic to benthic behaviour in juveniles. At this stage, the most interesting feature was the formation of the second intestinal loop. Male gonads were never observed during the study (from 0 to 354 D°_eff ; 0-60 dpp), but the first oogonia were present at 30 D°_eff (5 dpp). In 354 D°_eff (60 dpp) juveniles, oocytes were observed in a cortical alveoli stage, indicating maturity. Low digestive efficiency was observed at early stages, which was due to a poorly developed gastrointestinal tract and an immature digestive tract prior to 89 D°_eff . The present study demonstrates that approximately 89 and 177 D°_eff represent two important transitional stages in the early development of H. guttulatus. At a temperature of approximately 19 ± 1°C and an age of 1 month (177 D°_eff ), main organs were fully functional, suggesting that the adult phenotype was largely established by that age, with females becoming mature at the age of 2 months (354 D°_eff ).

Delivering aminopyridine ligands into cancer cells through conjugation to the cell-penetrating peptide BP16

Peptide conjugates incorporating the N-based ligands (Me2)PyTACN or (S,S')-BPBP at the N- or the C-terminus of the cell-penetrating peptide were synthesized (PyTACN-BP16 (), BP16-PyTACN (), BPBP-BP16 (), and BP16-BPBP ()). Metal binding peptides bearing at the N-terminus the ligand, an additional Lys and a β-Ala were also prepared (PyTACN-βAK-BP16 () and BPBP-βAK-BP16 ()). Moreover, taking into account the clathrin-dependent endocytic mechanism of , the enzymatic cleavable tetrapeptide Gly-Phe-Leu-Gly was incorporated between the ligand and the N- or C-terminus of (BPBP-GFLG-BP16 () and BP16-GLFG-BPBP ()). Analysis of the cytotoxicity of all the peptide conjugates showed that: (i) the position of the ligand influenced the IC50 values, (ii) the incorporation of the βAla-Lys dipeptide rendered non active sequences, (iii) peptide conjugates derived from the (S,S')-BPBP ligand were more active than those bearing (Me2)PyTACN, and (iv) the introduction of the cleavable tetrapeptide significantly enhanced the activity of the BPBP conjugates (IC50 of 4.3 to 11.7 μM ( and ) compared to 26.0 to >50 μM (, and )). The most active peptide was BPBP-GFLG-BP16 () (IC50 of 4.3 to 5.0 μM). This high activity was attributed to its high internalization in MCF-7 cells, as shown by flow cytometry, and to the subsequent release of the ligand by the intracellular cleavage of the enzyme-labile spacer, as observed in cathepsin B enzymatic assays. Therefore, these results pave the way for the design of novel peptide conjugates to be used in pro-oxidant anticancer therapies.

Conservation genetics of threatened Hippocampus guttulatus in vulnerable habitats in NW Spain: temporal and spatial stability of wild populations with flexible polygamous mating system in captivity

This study was focused on conservation genetics of threatened Hippocampus guttulatus on the Atlantic coast of NW Iberian Peninsula. Information about spatial structure and temporal stability of wild populations was obtained based on microsatellite markers, and used for monitoring a captive breeding program firstly initiated in this zone at the facilities of the Institute of Marine Research (Vigo, Spain). No significant major genetic structure was observed regarding the biogeographical barrier of Cape Finisterre. However, two management units under continuous gene flow are proposed based on the allelic differentiation between South-Atlantic and Cantabrian subpopulations, with small to moderate contemporary effective size based on single-sample methods. Temporal stability was observed in South-Atlantic population samples of H. guttulatus for the six-year period studied, suggesting large enough effective population size to buffer the effects of genetic drift within the time frame of three generations. Genetic analysis of wild breeders and offspring in captivity since 2009 allowed us to monitor the breeding program founded in 2006 in NW Spain for this species. Similar genetic diversity in the renewed and founder broodstock, regarding the wild population of origin, supports suitable renewal and rearing processes to maintain genetic variation in captivity. Genetic parentage proved single-brood monogamy in the wild and in captivity, but flexible short- and long-term mating system under captive conditions, from strict monogamy to polygamy within and/or among breeding seasons. Family analysis showed high reproductive success in captivity under genetic management assisted by molecular relatedness estimates to avoid inbreeding. This study provides genetic information about H. guttulatus in the wild and captivity within an uncovered geographical range for this data deficient species, to be taken into account for management and conservation purposes.

Mycobacterium hippocampi sp. nov., a rapidly growing scotochromogenic species isolated from a seahorse with tail rot

A Gram-positive, aerobic, non-motile, non-sporulating, acid-fast, and rod-shaped bacterium (BFLP-6(T)), previously isolated from a seahorse (Hippocampus guttulatus) with tail rot, was studied using a polyphasic taxonomic approach. Growth occurred at 15-35 °C (optimum 25 °C), at pH 5.0-10.0 (optimum pH 7.0) and at NaCl concentrations between 0 and 6 % (w/v). The G+C content of DNA was 66.7 mol%. The predominant fatty acids were C(18:1) ω9c, C(16:0) and C(16:1) ω6c. A mycolic acid pattern of alpha-mycolates and keto-mycolates was detected. Analysis of concatenated sequences (16S rRNA, rpoB, ssrA and tuf genes), and chemotaxonomic and phenotypic features indicated that strain BFLP-6(T) represents a novel species within the genus Mycobacterium, for which the name Mycobacterium hippocampi sp. nov. is proposed. The type strain is BFLP-6(T) (=DSM 45391(T) =LMG 25372(T)).

Dynamics of PPARs, fatty acid metabolism genes and lipid classes in eggs and early larvae of a teleost

Dietary long chain polyunsaturated fatty acids (FA) have been recognized of crucial importance in early development of vertebrates, contributing to the impressive morphological and physiological changes both as building blocks and to energy production. The importance of lipids along development depends on ontogenetic, phylogenetic and environmental parameters. The expression patterns of FA metabolism genes have not been characterized in developing fish embryos nor compared to lipid class profiles. Full lipid metabolism only occurred after hatching, as revealed by alterations in lipid profiles and FA gene expression. Nonetheless, transcriptional changes of some FA genes were already present in embryos at notochord formation. Many genes displayed an expression profile opposed to the decrease of lipids along the development, while others responded solely to starvation. Transcription of most genes involved in FA metabolism had a strong correlation to PPARs' mRNA levels (α1, α2, β, γ). The comparison of mRNA expression of the genes with the lipid profiles produced new insights into the FA metabolism and regulation during the development of turbot larvae, providing the basis for future studies including comparative approaches with other vertebrate species.

Prevalence of malnutrition and its etiological factors in hospitals

BACKGROUND

Malnutrition among inpatients is highly prevalent, and has a negative impact on their clinical outcome. The Working Group for the Study of Malnutrition in Hospitals in Catalonia was created to generate consensus guidelines for the prevention and/or treatment of malnutrition in hospitals in Catalonia, Spain.

AIMS

The objectives of the study were to determine the prevalence of malnutrition on admission to hospital in Catalonia and to assess relationships between malnutrition, social and demographic data, overall costs, and mortality.

METHODS

Prospective and multicenter study conducted with 796 patients from 11 hospitals representative of the hospitalized population in Catalonia. Nutritional status was evaluated using the Nutritional Risk Screening 2002 method.

RESULTS

Overall, 28.9% of the patients are malnourished or at nutritional risk. Elderly patients, non-manual workers, those admitted to hospital as emergencies and with higher co-morbidities had higher risk of malnutrition. The type of hospital (second level vs. tertiary or University referral) to which they were admitted was also a factor predisposing to malnutrition. Length of hospital stay was longer in malnourished patients (10.5 vs. 7.7 days, p < 0.0001). The need for a convalescent home on leaving hospital was higher as well as the risk of mortality (8.6% malnourished vs. 1.3% nonmalnourished, p < 0.0001).

CONCLUSIONS

The prevalence of malnutrition is high in patients on admission to hospital in our community, resulting in elevated overall costs and higher risk of mortality. Age, social class and characteristics of the Unit and the Hospital are the main factors involved in hospital malnutrition.

Multidisciplinary consensus on the approach to hospital malnutrition in Spain

RATIONALE

Disease-related malnutrition constitutes a highly prevalent healthcare problem with high costs associated. In Spain, the prevalence of malnutrition in hospitalized patients has been reported from 30% to 50%.

OBJECTIVES

Main purposes of this consensus document were to establish recommendations that facilitate decision-making and action to prevent and early-diagnose disease-related hospital malnutrition, on the management of nutritional support methods and actions to evaluate nutritional treatment compliance and efficacy.

METHODS

A systematic bibliographical search of authors was performed, complemented by updated bibliography by author references up to 2010. From this review, some recommendations were defined, modified and critically evaluated by the representatives of scientific societies in a consensus conference (Dec 2010) following a structured brainstorming technique: the Metaplan(®) technique. A double validation process was undertaken until final recommendations were obtained.

RESULTS

30 consensus recommendations for the prevention and management of hospital malnutrition are presented in this document. Recommendations cover all clinical care settings as well as prevention, screening, diagnosis, treatment and follow-up of disease-related malnutrition.

CONCLUSIONS

Nutritional screening is strongly recommended at all clinical settings when nutritional risk factors are identified or there is clinical suspicion of malnutrition. Nutritional assessment should be designed and performed according to centers' resources, but clearly identified protocols should be available.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: oncohematological patient

Patients with cancer, irrespective of the stage of their disease, can require admission to the intensive care unit as a result of the complications of their underlying process or the surgical or pharmacological treatment provided. The cancer itself, as well as the critical status that can result from the complications of the disease, frequently lead to a high degree of hypermetabolism and inadequate energy intake, causing a high incidence of malnutrition in these patients. Moreover, cancer causes anomalous use of nutritional substrates and therefore the route of administration and proportion and intake of nutrients may differ in these patients from those in noncancer patients.

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): oncohematological patient]

Patients with cancer, irrespective of the stage of their disease, can require admission to the intensive care unit as a result of the complications of their underlying process or the surgical or pharmacological treatment provided. The cancer itself, as well as the critical status that can result from the complications of the disease, frequently lead to a high degree of hypermetabolism and inadequate energy intake, causing a high incidence of malnutrition in these patients. Moreover, cancer causes anomalous use of nutritional substrates and therefore the route of administration and proportion and intake of nutrients may differ in these patients from those in non-cancer patients.

Prevalence of malnutrition and its etiological factors in hospitals

BACKGROUND

Malnutrition among inpatients is highly prevalent, and has a negative impact on their clinical outcome. The Working Group for the Study of Malnutrition in Hospitals in Catalonia was created to generate consensus guidelines for the prevention and/or treatment of malnutrition in hospitals in Catalonia, Spain.

AIMS

The objectives of the study were to determine the prevalence of malnutrition on admission to hospital in Catalonia and to assess relationships between malnutrition, social and demographic data, overall costs, and mortality.

METHODS

Prospective and multicenter study conducted with 796 patients from 11 hospitals representative of the hospitalized population in Catalonia. Nutritional status was evaluated using the Nutritional Risk Screening 2002 method.

RESULTS

Overall, 28.9% of the patients are malnourished or at nutritional risk. Elderly patients, non-manual workers, those admitted to hospital as emergencies and with higher co-morbidities had higher risk of malnutrition. The type of hospital (second level vs. tertiary or University referral) to which they were admitted was also a factor predisposing to malnutrition. Length of hospital stay was longer in malnourished patients (10.5 vs. 7.7 days, p < 0.0001). The need for a convalescent home on leaving hospital was higher as well as the risk of mortality (8.6% malnourished vs. 1.3% nonmalnourished, p < 0.0001).

CONCLUSIONS

The prevalence of malnutrition is high in patients on admission to hospital in our community, resulting in elevated overall costs and higher risk of mortality. Age, social class and characteristics of the Unit and the Hospital are the main factors involved in hospital malnutrition.

[Importance of water in the hydration of the Spanish population: FESNAD 2010 document]

For any healthy individual, thirst is an appropriate sign to drink water, except for babies, sportsmen, and most of ill and elderly people. In these instances, it is convenient to schedule appropriate times to drink water since great demands and the physiological mechanisms that determine thirst in these situations may condition water unbalances with important consequences for health and the physical and intellectual performance. The human body has a number of mechanisms that allow keeping constant the water content by adjusting intakes and wastes. Water balance is determined by intake (consumed water, beverages, and water contained in foods) and wastes (urine, stools, the skin, and expired air from the lungs). Failure of these mechanisms and subsequent impairments in water balance may produce severe disarrangements that may threaten somebody's life. In the present document, we analyze the evidences regarding the factors conditioning water needs in the different life stages and physiological situations, as well as the consequences of water unbalance under different situations. A proper hydration may be achieved by feeding and the use of water and other liquids. Although water is the beverage by excellence and represents the ideal way of restoring the losses and get hydrated, we should be aware that, from the very beginning, we have sought other liquid sources with hydration properties. In the last decades we have increased the consumption of different beverages, with a proliferation of sugar-containing beverages. Since excessive sugar consumption has been related to obesity and other chronic conditions, it is evident that the use of these caloric beverages should be rationalized, especially in children. In this document all the considerations regarding hydration are presented and different recommendations are exposed.

The importance of the coding of hospital malnutrition in the health strategy of the European Union: a Spanish contribution

Malnutrition related to illness and inadequate nutrition remains a matter of relevant interest in the member countries of the European Union because of its elevated prevalence and high costs. It is estimated to affect 30 million patients and cost 170 billion euros annually. The 2008-2013 strategy "Together for Health" put forward in the European Parliament urges Member States to develop, together with local and regional authorities, initiatives in the field of education of the population, training, investigation and good clinical practices. SENPE (Spanish Society of Parenteral and Enteral Nutrition) collaborates in different areas in the development of this strategy which aim to put malnutrition related to illness in the focus of the health system. One of its contributions has been the preparation of the Document of Consensus on the Coding of Malnutrition SENPE-SEDOM (Spanish Society of Medical Documentation). The agreements adopted have helped normalize the process of coding this pathology with the assignment of specific codes for specifically defined terms. This document has allowed the optimization of information regarding the types and degrees of malnutrition and the procedures employed for its prevention or treatment in the hospital centres of the National Health System.

[Education on nutrition: from the university to specialized care]

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

Vibrio hippocampi sp. nov., a new species isolated from wild seahorses (Hippocampus guttulatus)

A Gram-negative, facultatively anaerobic, motile and slightly curved rod-shaped bacterium (BFLP-4(T)) was isolated from the faeces of wild seahorses (Hippocampus guttulatus) captured in northwest Spain (Toralla, Galicia). Strain BFLP-4(T) grew at 10-35 degrees C and pH 5-9 (optimally at 20 degrees C and pH 7.2) and at salt concentrations in the range 0-7% w/v NaCl. The G+C content of the DNA was 49.3 mol%. Phylogenetic analysis based on the 16S rRNA gene sequence showed that strain BFLP-4(T) was a member of the genus Vibrio, being most closely related to Vibrio ichthyoenteri (97.1%), Vibrio mediterranei (96.7%), Vibrio scophthalmi (96.7%) and Vibrio sinaloensis (96.6%). A phylogenetic analysis based on recA gene sequences also supported the affiliation of strain BFLP-4(T) to the genus Vibrio. Strain BFLP-4(T) could be readily differentiated from other closely related species by several phenotypic properties and fatty acid profiles. On the basis of phenotypic, chemotaxonomic and phylogenetic data, strain BFLP-4(T) represents a novel species within the genus Vibrio, for which the name Vibrio hippocampi sp. nov. is proposed. The type strain is BFLP-4(T) (=DSM 22717(T)=LMG 25354(T)).

Bacillus galliciensis sp. nov., isolated from faeces of wild seahorses (Hippocampus guttulatus)

A Gram-positive-staining, motile, rod-shaped, endospore-forming bacterium (BFLP-1( T)) was isolated from faeces of wild long-snouted seahorses ( Hippocampus guttulatus) captured in north-west Spain (Toralla, Galicia). Strain BFLP-1(T) grew at 10-30 degrees C and pH 5.5-9 (optimally at 20 degrees C and pH 7.2) and with 0-7 % (w/v) NaCl (optimally with 2 % NaCl). The G+C content of the DNA was 48.1 mol%. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain BFLP-1(T) was a member of the genus Bacillus and was most closely related to Bacillus herbersteinensis D-1,5a(T) (96.6 %), B. shackletonii LMG 18435(T) (96.0 %) and B. isabeliae CVS-8(T) (95.9 %). Chemotaxonomic data (peptidoglycan type, meso-diaminopimelic acid; major menaquinone, MK-7; predominant fatty acids, anteiso-C(15 : 0 ), anteiso-C(17 : 0) and C(16 : 1 )omega11c; major polar lipids, diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine and an unknown aminoglycophospholipid) supported the affiliation of strain BFLP-1(T) to the genus Bacillus . Comparative analysis of 16S rRNA gene sequences and chemotaxonomic and phenotypic features indicated that strain BFLP-1(T) represents a novel species within the genus Bacillus, for which the name Bacillus galliciensis sp. nov. is proposed. The type strain is BFLP-1( T) (=DSM 21539(T) =LMG 24668(T)).

[Recommendations for assessing the hyponutrition risk in hospitalised patients]

Given the frequency and clinical, social, and economic implications of hospital hyponutrition and the usual lack of sensibility before this problem from health care professionals, it seemed appropriate to create a working group within the Spanish Society of Parenteral and Enteral Nutrition (SENPE), which will lead to consensus recommendations on hyponutrition assessment among hospitalised patients. At a first stage, it seemed interesting to elaborate some recommendations on early and regular detection of hyponutrition among patients admitted to our hospitals. After carefully reviewing the screening methods published, the group considers that using screening methods should be recommended according to the possibilities at each centre in order to detect those patients that will further need a more complete evaluation of their nutritional status and, in case of necessary, to establish a nutritional action plan.

Trends in home enteral nutrition in Spain: analysis of the NADYA registry 1992-2007

BACKGROUND

There are few data on trends in home enteral nutrition (HEN) practice in different countries. NADYA is the Spanish home artificial nutrition (HAN) group, and is responsible for the Spanish HAN registry.

METHOD

We performed a 16-year retrospective study (1992-2007) of the Spanish HEN registry by retrieving data from the NADYA database and from publications of the working group. People receiving more than 1000 kcal/d with an enteral formula were included regardless of the access route (oral/tube feeding).

RESULTS

The number of patients registered increased more than 8 times during the study period: the current prevalence is 113 patients/10(6) inhabitants (oral and tube feeding), or 41 patients/10(6) inhabitants (tube feeding). The distribution of the patients was not uniform, and most came from six autonomous communities (Catalonia, Galicia, Castilla-León, Madrid, Andalusia and Extremadura). Gender distribution was nearly 1:1. The number of paediatric patients was very low, representing less than 10% of the total. Mean age in adults was above 65 years in most of the reports. We observed an increase in the age of the patients over the years. The most common underlying diseases were neurological disorders, followed by cancer. We observed an increase in the use of the oral route, from 5.8% in 1992 to 64% in 2007, with a parallel decrease in the use of nasogastric tubes. Gastrostomy tubes were used in 15-20% of the patients. The number of complications was low (less than one complication/patient/year), the most frequent being change of tube, followed by gastrointestinal complications. The principal reasons for discontinuing treatment were death related to the underlying disease (40-50%) and switch to oral diet (30-40%). Most of the patients (75%) were followed by the hospital nutrition unit. Provision of the enteral formula and disposables varied according to the autonomous community. Most of the patients had limited physical activity or were chair- or bed-bound, requiring partial or total help in their daily life.

CONCLUSIONS

The use of HEN has increased dramatically in the last 16 years in Spain. Most of the patients registered were elderly people with neurological disorders and limited physical activity. The oral route was the most frequently used. The number of complications was low. The mortality rate in these patients was highly related to the underlying disease.

[Management models in clinical nutrition: weaknesses and strengths]

At the 6th Abbott-SENPE Debate Forum a multidisciplinary and multiprofessional discussion was established in order to seek for the model or the models of clinical management most appropriate for Clinical Nutrition and Dietetics Units (CNAD) in Spain. The weaknesses and strengths as well as opportunities for the current systems were assessed concluding that a certain degree of disparity was observed not only due to regional differences but also to different hospital types. It was proposed, from SENPE, the creation of a working group helping to standardize the models and promote the culture of Integral Control and Change Management.

[Karnosfsky index as a mortality predicting factor in patients on home-based enteral nutrition]

Karnofsky Index (KI) is a widely used functional scale developed for oncology patients. It has proved useful as outcome predictor with cancer and geriatric patients. Theoretically, KI could be used to predict mortality in patients with home enteral nutrition (HEN).

STUDY OBJECTIVES

To determine baseline KI and its 6-month evolution in HEN patients, and to assess its relation with the mortality rate.

METHODOLOGY

Observational and prospective study carried out during 2002 and 2003 with tube feeding neurologic and cancer patients followed during 10 months since their HEN programme inclusion.

RESULTS

201 patients were included, 131 (65.2%) with neurological diseases and 70 (34.8%) with neoplasm. There were not significant differences between groups in age, days with HEN and mortality rate at the end of the study period (35.1% in neurologic patients and 40% in cancer ones). 27.1% of cancer patients had resumed full oral nutrition after ten months from the beginning of the study, whereas only 10.7% of neurologic patients did (p < 0.05). In the three measurement phases (initial, past-3 and past-6 months) KI values were higher for cancer patients than for neurologic ones (p < 0.001). In both groups we didn't found statistically significant differences in KI along the three measurements. A significant relation was observed overall between initial KI values and average survival after 10 months (p < 0.001), and an inverse relation was found between the former and mortality rate (p < 0.001).

CONCLUSION

KI is a useful tool to predict mortality rate in cancer and neurologic patients under HEN.

Non-anatomical intestinal transplantation

INTRODUCTION

Intestinal transplantation is the only long-range treatment option for patients with intestinal failure. We report an exceptional case of isolated intestinal transplantation with the implant in a non-anatomical position.

CLINICAL CASE

The patient was a thirty-eight-year-old man (60 kg weight, 180 cm height, 18.3 body mass index) with intestinal failure and home parenteral nutrition due to a short-bowel syndrome for which intestinal transplantation was indicated. The patient had a vascular malformation with the cava vein located left to the aorta, and the intestine was implanted with a 180 masculine rotation around the mesenteric axis, so that the implant s superior mesenteric artery and vein matched the recipient s cava and aorta. Postoperative follow-up was excellent and the patient was discharged after six weeks with a 10-kg gain in body weight.

DISCUSSION

This non-anatomical intestinal implantation of the small bowel, previously unreported, offers technical advantages over other options. Adequate intestinal function represents a unique model to prove the viability of intestinal implants in a non-anatomical position.

[Nutritional support in the home-based hospitalization setting]

The Hospital at Home (HAD) is a choice of care that enables own care in a hospital at home patient. Moreover, the nutritional support (NS) -enteral or parenteral nutrition- is usually indicated in patients with serious underlying disease, and/or frequently remain severely disabled.

AIMS

To analyze the characteristics of the patients, attended at home for specific questions of the NS that receive.

MATERIAL AND METHODS

descriptive and retrospective study of the patients attended by the Nutritional Support Unit (NSU), in the area of the HAD, from September 1, 2006 until August 31, 2007.

RESULTS

At home, the realized procedure was: refill of gastrostomia or jejunostomia feeding tube in 158 cases; modification of the guideline of enteral nutrition (EN) or parenteral nutrition (PN) in 53 cases; training of the skill of artificial nutrition in 14 cases. 39 visits were realized by complications -by infection or lead throught the estoma and by obstruction of the feeding tube-. Only in 3 patients (7.7%) the domiciliary assistance indicated the movement of the patient to the Emergency Unit.

CONCLUSION

In our center, the infrastructure of the HAD has allowed to give answer to the needs of the patients who receive NS at home in our area of influence.

[Immediate complications of feeding percutaneous gastrostomy: a 10-year experience]

Percutaneous gastrostomy feeding tube (PG) may be beneficial in some patients, in others such as advanced dementia or rapidly progressive diseases its value is being questioned. Patient selection is important to identify those who will benefit from PG. This study aims to identify patients factors that may help in patient selection for PG. To analyse the characteristics of this patient's cohort and to describe the immediate complications of the procedure that we have defined as the ones happened in the first 30 days. To compare the two patient's group -with and without- immediate complications, non-parametric tests were used.

[Oral nutritional supplementation in hematologic patients]

RATIONALE

Hematological patients often present anorexia which along with other secondary effects from the chemotherapy and/or radiotherapy treatments compromise their nutritional status. Oral supplementation can aid to fulfill the energy and protein requirements of these patients. Nevertheless, the use of commercial nutritional supplements normally available, is limited by its poor intake.

OBJECTIVE

To evaluate the degree of fulfillment of the prescribed supplements and fulfillment of energy requirements, as well as the development of nutritional status in hematological patients hospitalized for treatment with chemotherapy and/or radiotherapy.

METHODS

Prospective, randomized and open study of inpatients at the hematological ward. Patients were randomized sequentially and they were assigned into 3 different nutritional interventions providing: Group 1 (G1), a flavored supplement; Group 2 (G2): a non flavored (neutral) supplement and Group 3 (G3): "kitchen" foods as supplements. Need and amount of nutritional supplements were provided according to the oral intake previously analyzed. Nutritional assessment (at admission and discharge) was based in the Subjective Global Assessment test (SGA), Risk Nutritional Index (RNI) and percentage of lost weight. Both fulfillment of supplement intake and achievement of energetic requirements were analyzed.

RESULTS

125 patients of 51.3 +/- 16.8 years; 45% men and 55% women.

DIAGNOSIS

54% lymphoma, 33% leukemia, 8% myeloma and others 4%. Length of stay (LOS): 7.0 +/- 3.6 d. The nutritional assessment done by SGA showed significant negative changes in G2 and G3 (G1: 30% developed malnutrition and 28% improved their nutritional status, p = NS; G2: 50% developed malnutrition against 7% whom improved their nutritional status, p = 0.002; y G3: 37% developed malnutrition against 21% whom improved their nutritional status, p = 0.02). According to RNI, patients evolved negatively from their nutritional state but no significant differences were found within groups (G1, from 81% of malnutrition to 90%; G2, from 77% to 91%, and G3 from 71% to 85%). Globally, during hospitalization patients lost weight significantly (2.3 +/- 2.2 kg, p < 0.001), but within groups weight loss differences were not significant (G1, 1.16 kg; G2, 1.75 kg, y G3, 1.17 kg). All three groups required intake of supplements (G1, 47%; G2, 30%, and G3, 47%). The percentage of fulfillment of oral intake was similar in both commercial supplemented groups (G1, 47% and G2, 58%) although it was significantly greater in those receiving kitchen supplements (G3, 100%, p < 0.001). The fulfillment of energy requirements at admission and discharge did not showed significant changes (G1, from 53% to 46%; G2, from 67% to 52% and G3 from 49% to 55%).

CONCLUSION

Our results suggest that hematological patients admitted to hospital for treatment with chemotherapy and/or radiotherapy loose weight during their hospitalization and present intakes below their energy requirements so they need supplementation. Kitchen supplements are better accepted than commercial ones although that does not result in an increased total energy intake. The group which received commercial flavored supplements was the only one which did not showed negative significant changes in the nutritional status evaluated by SGA.

[V debate forum of the SENPE. Current issues on home-based and ambulatory artificial nutrition]

A multidisciplinary and multiprofessional debate is established trying to detect and find plausible solutions regarding Home-based and Ambulatory Enteral Nutrition (HBAEN) in Spain, due to the little attention paid by the Administration to the global problem of hyponutrition, the little interest showed by the collectivity of health care professionals, and the lack of a regulation differentiating the patient at his/her home and the patient at a nursing home. It was concluded that the current legislation on Home Based Enteral Nutrition (HBEN) has been variedly applied and does not contemplate the real clinical health care, with some pathologies subsidiary of this kind of therapy being excluded. Proposals to improve both financing and pathologies irrespective of the kind of nutritional therapy are made.

[Patient satisfaction in a home enteral nutrition program]

Home enteral nutrition is a treatment carried out frequently due to advantages for patients and caregivers (lower risk of nosocomial infections and better integration in socio-familiar media) but also for the health administration because of the lower economic cost and the release of hospital beds.

OBJECTIVE

To investigate patients' and caregivers' satisfaction related to tube enteral nutrition administered at home by a Service controlled and followed by the Nutritional Support Unit from the reference hospital.

METHODS

One questionnaire for the patients and another for the caregivers were delivered to the patients with home enteral nutrition asking for voluntary response. Similar questionnaires were sent to hospitalized patients and their relatives or possible caregivers.

RESULTS

According to the results of the questionnaires, the majority of patients and relatives were satisfied with the service received. In the cases in which the service was offered at home, the preference was to continue there and not to return to the hospital. Finally, the possibility of telephone contact and home visits were the most important factors that influenced patient satisfaction.

CONCLUSION

Our results let us conclude that home enteral nutrition controlled and followed up by the Nutritional Support Unit form the hospital is a treatment well accepted both by patients and relatives.

[Presentation of the new Spanish home artificial nutrition registry]

The registries are databases including information about a treatment or a disease in a definite population. Concerning home artificial nutrition there are registries of patients in different European countries, USA and Japan, collecting data such as the prevalence, indication, follow-up and complications of these treatments. The Spanish group of Home Artificial Nutrition (HAN), NADYA, was established in 1992 with professionals devoted to the practise of artificial nutrition. Since then, one of its wills was the development of the Spanish registry of HAN. This is a voluntary registry accessible through the web page www.nadya-senpe.com. In 2005, this group decided to update the registry according to the Data Protection Law and including other improvements. Thank to the work of all the members of this group we have many data on the practise of HAN in our country. Since 1994, except the years 97-98, the annual registries of patients on home parenteral nutrition and home enteral nutrition have been published periodically, observing an increase in both, the number of patients and collaborating centres, presenting to us the actual practise of HAN in our country.

[Spanish registry of Home-Based Parenteral Nutrition for the years 2004 and 2005 (NADYA-SENPE Group)]

OBJECTIVE

To report the results of the Home Parenteral Nutrition (HPN) registry of the NADYA-SENPE working group of the years 2004 and 2005.

MATERIAL AND METHODS

We summarized the data of the new on-line HPN registry of the NADYA-SENPE group for the period 2004-2005.

RESULTS

During the year 2004, 70 HPN-patients (23 males and 47 females) were registered from 14 hospitals. Mean age of adults was 53,7 +/- 14,87 years (m +/- SD) and 6 +/- 2,83 years for those younger than 14 years. The most frequent etiologies of the intestinal failure were neoplasia (24%) and mesenteric ischaemia (19%). Tunnelled catheters were used in 75% of the patients. The catheter-related infections were the most frequent complications, with a rate of 0,98 episodes/10(3) days. In 69% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 81% and 83%, respectively. Up to 54% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral intake (41%), or exitus (28%). During the year 2005, 79 patients (33 males and 46 females) were registered from 14 hospitals. Mean age of adults was 52,39 +/- 14,21 years and 6,5 +/- 5,21 years for those younger than 14 yrs. The most frequent etiologies of the intestinal failure were neoplasia (22%), and mesenteric ischaemia (15%). Tunnelled catheters were used in 63% of the patients. The catheter-related infections were the most frequent complications, with a rate of 1,14 episodes/10(3) days. In 51% of the cases the nutritional support was maintained for more than 2 years. HPN solutions and disposables were supplied by the hospital pharmacy in 76% and 81%, respectively. Up to 50% of the patients had a normal activity level. The most frequent reasons to end HPN treatment were the transition to oral/enteral feeding (41%) and exitus (31%).

CONCLUSIONS

We have observed a mild decrease in the number of HPN patients registered in the period 2004-2005, probably related to the change of the registry. The characteristics of the patients are similar to previous years. We have observed an increase in the septic catheter-related complications in the year 2005.

Evolución de la ansiedad y de la depresión detectada durante la hospitalización en un servicio de Medicina Interna

OBJECTIVE

To study the evolution of the symptoms of anxiety (Ax) and depression (Dp) two months after hospital release and factors associated with their persistence.

METHOD

An observational longitudinal study. Patients with Ax or Dp, evaluated by the Hospital Anxiety and Depression (HAD) scale on the fourth day of hospitalisation, were followed over two months without the use of psychopharmacological drugs. Sociodemographic factors, psychiatric history, functional state, comorbidity and the HAD stage three weeks before admission were evaluated.

RESULTS

Thirty-eight patients with Ax (22 males) with a mean age of 62.2 years and 35 patients with Dp (22 males) with a mean age of 68.1 years were studied. Symptoms of Ax persisted in 23 patients (60.5%; CI95%: 43.4-76) and symptoms of Dp persisted in 18 (51.4%; CI95%: 34-68.6). Ax before admission and a lower educational level were associated with the persistence of Ax. An age of 70 or more, female gender and primary studies, Barthel Index on admission of < 100 and depression in the three weeks before admission were associated with persistence of Dp.

CONCLUSIONS

Symptoms persisted in over half of the patients. The evaluation of HAD before admission may help in determining the treatment course to be followed.