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Biomedical subjects

A García de Lorenzo

Publications and source records attributed to A García de Lorenzo.

At least 19 recordsLinked to original sources
PubMed2006

[Pathophysiology of neuromuscular impairments in the critically ill patient].

OBJECTIVE: to analyze the causes and manifestations of muscle weakness that critically ill patients develop during their staying at the ICU, and literature review. DEVELOPMENT: in the early 1980s, a mixed axonal polyneuropathy was described in septic critically ill patients, which clinically manifested by muscle weakness of variable severity, leading to quadriplegia and/or ventilator dependency in its most severe presentation. Almost at the same time, an acute intensive care myopathy was described in asthmatic patients admitted to the ICU for asthma exacerbation. Later on, this myopathy was also observed in transplanted, septic, or burnt patients. Several authors consider acute intensive care myopathy as the main cause of muscle weakness in the ICU. CONCLUSIONS: in this article, we describe the clinical presentation, etiopathogenesis, diagnosis, and treatment of polyneuropathy of the critically ill patient and of acute intensive care myopathy. Both clinical pictures may be differentiated, with neurophysiological studies and eventually muscle biopsy being of great help. Although some authors rather include these conditions under the name of polyneuromyopathy, we propose the general denomination of Acute Neuromuscular Syndrome of the Critically Ill Patient, a more descriptive term no presupposing a single mechanism or etiology.

Critical Illness↗
PubMed2004

Fabry disease: overall effects of agalsidase alfa treatment.

BACKGROUND: Fabry disease is a rare X-linked disorder caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. Progressive accumulation of the substrate globotriaosylceramide in cells throughout the body leads to major organ failure and premature death. The Fabry Outcome Survey (FOS) is a European outcomes database which was established to collect data on the natural history of this little-known disease and to monitor the long-term efficacy and safety of enzyme replacement therapy (ERT) with agalsidase alfa. This paper presents the first analysis of the FOS database on the effects of ERT on renal function, heart size, pain and quality of life. DESIGN: The effects of 1 and 2 years of ERT with agalsidase alfa on renal function (assessed by estimated glomerular filtration rate), heart size (assessed by echocardiography), pain (assessed by the Brief Pain Inventory) and quality of life (assessed by the European Quality of Life Questionnaire EQ-5D) were analyzed in a cohort of 545 patients, 314 of whom were receiving treatment (188 for at least 12 months and 92 for at least 24 months; mean duration of treatment, 17 months; maximum duration, 56 months). RESULTS: Treatment with agalsidase alfa stabilized renal function in patients with a mild or moderate deterioration in renal function at baseline, reduced left ventricular size in patients who had an enlarged heart at baseline, and improved pain scores and quality of life. These improvements were similar in hemizygous men and heterozygous women with Fabry disease. CONCLUSIONS: Enzyme replacement therapy with agalsidase alfa leads to significant clinical benefits in patients with Fabry disease, and treatment is likely to alter the natural history of this disorder.

Adult↗
PubMed1999

Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis.

OBJECTIVE: To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy. DESIGN: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. SETTING: A medical-surgical intensive care unit (ICU) in a university hospital. PATIENTS: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. MEASUREMENTS AND MAIN RESULTS: Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost-utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12-36). Cumulative mortality was 35% in the ICU, 50% in hospital, 75% at 1 year, and 85% at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV1) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U.S. $26283 and U.S. $44602 in a "best" (cost/QALY calculated for the life expectancy in Spain) and a "worst case scenario" (cost/QALY calculated for a 68-year life expectancy), respectively. CONCLUSIONS: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV1 in hospital and in the first year after discharge.

Adult↗
PubMed1998

[Relationship between mixed venous saturation and cardiac index, hemoglobin and oxygen consumption in aortic surgery].

OBJECTIVE: Mixed venous oxygen saturation (SvO2) depends mainly on four variables: cardiac index (CI), hemoglobin concentration (Hb), arterial oxygen saturation (SpO2) and oxygen consumption (VO2). Our aim was to study the correlation between each of these variables and SvO2 during abdominal aortic surgery, a situation which is of special interest because of associated hemodynamic and metabolic variations and the high risk of cardiovascular events. PATIENTS AND METHODS: Twelve patients undergoing intrarenal aortic surgery were monitored by pulmonary artery catheter (Opticath), pulse oximetry and indirect calorimetry (Deltatrac Metabolic Monitor). SvO2, CI (measured by thermodilution), SpO2 and VO2 at six moments: post-induction (baseline), 1 min before and 1 min after clamping (pre-C, post-C), 1 min (post-D) and 10 min after declamping and at the end of the surgery. Hemoglobin concentration was measured at all moments except 10 min after declamping. RESULTS: All variables except SpO2 varied significantly (p < 0.001) during the study. SvO2 was associated with CI at all moments except post-D and at the end of surgery. Hemoglobin concentration was related to SvO2 at baseline and post-C. We found no correlation between SvO2 and VO2 or SpO2 at any moment. CONCLUSION: Monitoring SvO2 in patients undergoing aortic surgery is useful for detecting potentially prejudicial variations in cardiac output or hemoglobin concentration.

Aged↗
PubMed1993

[Peripheral parenteral nutrition: myth or reality?].

In the changing world of parenteral nutrition, daily doubts about methods arise which are not easily resolved. Controversy thus occurs on conceptual changes in energy requirements according to different levels of aggression, or as to the different utilisation of nutrients according to aggression, or referred to the most effective relations between energy and plastic substrates or the indication of and maintenance time for perioperative parenteral nutrition. While all these questions remain alive, recent years have seen the addition of a further polemical subject: is hypocalorific peripheral parenteral nutrition effective as nutritional backup for surgical patients? What are its indications and limitations? Answers to these questions require in the first place the establishment of criteria which clarify concepts that may not always be used precisely, perhaps due to their indiscriminate application (perioperative, peripheral, hypocalorific nutrition, etc.) After reviewing the physiological basis for this type of backup, we then make an evaluation of the effects of perioperative parenteral nutrition in terms of the evolution of the illness, before making a critical analysis of a variety of studies carried out by different writers, in an attempt to extract common conclusions from the diverse results on the efficacy of this type of nutritional backup.

Humans↗
PubMedDate not supplied

[Regulatory assessment of the "Nutrición Hospitalaria" journal].

A study is carried out to determine the degree of compliance by the journal entitled "Nutrición Hospitalaria" with the international standards issued by the ISO (International Standards Organization) by means of the application of a survey questionnaire drawn up in accordance with the guidelines published by national and international standards organizations. In total, 161 parameters are considered. Together with the general aspects of the publication, an analysis is made of its specific sections, decisive in the establishment of its level of compliance. After the analysis carried out, it was seen that the general standardization mean was 64% and the real average was 76.82%. At the same time, the necessary recommendations are given to improve these standardization levels and improve the editorial quality of "Nutrición Hospitalaria".

Periodicals as Topic↗
PubMedDate not supplied

[Metabolic response to stress, can we control it?].

When faced by an external aggression such as shock, sepsis, burns or surgery, the body develops a response, known as stress, comprising hypermetabolism and hypercatabolism related to an alteration in tissue sensitivity to insulin. This alteration seems to be rooted in the transmembrane protein GLUT-4 which takes care of the cell uptake of glucose in skeletal muscle. As a result, there are alterations in the metabolism of carbohydrates, fats and proteins (reduction of immunoglobulins). In the case of surgery, it has been shown that, on the one hand, factors such as rest, pre-operative fasting or the release of inflammatory response factors constrain an even greater alteration in the sensitivity to insulin; and on the other hand that the degree of resistance to insulin depends on the magnitude of the surgery, its duration, bleeding, or on hypothermia and extracorporeal circulation in the case of heart surgery. These metabolic alterations may lead to an increase in the number of infections, mean stay in hospital, and even lead to diabetes mellitus in the long term. Over the last few years, all of this has led several researchers to try to minimize the stress response associated with planned surgery through replacing pre-operative fasting by the administration of carbohydrates, whether or not in association with insulin in perfusion. Beneficial results have been described: control of hyperglycaemia, lower consumption of neoglycogenic amino acids and less alteration of plasma immunity (interleukins, TNF). Future studies will evaluate the influence of these measures on plasma immunity, mean hospital stay and morbidity/mortality.

Humans↗
PubMedDate not supplied

[Nutritional and metabolic status and dietetic evaluation in institutionalized elderly patients with non-insulin-dependent diabetes mellitus].

OBJECTIVE: To evaluate nutritional status and blood glucose level according to type of diet followed by elderly (> 65 years old) institutionalised patients with non insulin dependent diabetes mellitus (NIDDM). METHODS: A data collection questionnaire was administered to the staff of 80 Spanish geriatric facilities participating in this one-day cross-sectional study. Data collected included: age, gender, history of previous glucose control, type of antidiabetic treatment, body mass index (BMI), nutritional risk index (NRI), type of diet with patient's preference, nutritional status evaluation and biochemical parameters. RESULTS: Data from a total of 486 institutionalised elderly people (66.5% female) were collected with a mean +/- SD age of 80.8 +/- 7.5. Had a diabetic diet 93.3% of patients with no gender differences 55.7% were on oral antidiabetic treatment (53.9% females and 58.9% males, ns) and 24.7% on insulin therapy (24.5% females and 26.4% males, ns). Physical activity was presented in 86% of people with no gender differences. Exercise was practiced by people younger, 78.8 +/- 7.9 years, versus walking, 80.4 +/- 7.6 years or resting 82.1 +/- 7.3 years, p < 0.05. Both nutritional indexes, BMI and NRI, were equivalent in men and in women; 28.5 +/- 10.7 vs 28.1 +/- 7.6 and 103.5 +/- 12.9 vs 104.1 +/- 11.4, respectively. History glucose control was good in 68.8% of the sample with a trend towards significance between sexes (62.7% males, 71.7% females, p = 0.07) and significant differences according to type of diet; 70.7% diabetic versus 37.0% free diet, p = 0.0006). Eating behaviors (appetite and meal completeness) were similar in both males and females and in diabetic or free diet groups. Also, no differences were observed in patient preferences about diet according to type of diet (71% of diabetic patients always or almost always liked their food versus 82% of free diet patients) and either nutritional status (9.3% vs 15.6% in status I, 10.9% vs 12.5% in level II and 79.9% vs 71.9% in status III, respectively). The NRI, cholesterol, albumin and triglyceride levels were significantly higher in patients with high fat rate supplemented dietary intake than other supplemented diets. CONCLUSIONS: A high proportion of patients on a diabetic diet was observed in this study with no gender differences. Elderly NIDDM institutionalised patients on a diabetic diet showed a greater good history glucose control than patients on a free diet. Diabetic diet preference by these subjects is similar than free diet. A better nutritional risk control was shown in patients with high fat rate supplemented diet.

Aged↗
PubMedDate not supplied

[Nutrition in the surgical patient: immunonutrition].

Malnutrition plays an important role in the rate of postoperative complications that interfere with our surgical activity, impairing immune response mechanisms; synthesis and regeneration processes are damaged and the fight against infection is altered. Preoperative and postoperative administration of diets enriched with diverse substances included under the name of "immunonutrients" reduces the rate of complications. Our knowledge about the mechanisms of action of each immunonutrient is increasing as well as the fact that the combined action of these substances improves the immune system and protects the organism against the negative effect of the systemic inflammatory response syndrome.

Arginine↗
PubMedDate not supplied

[Evaluation of nutritional risk in ambulatory elderly patients].

OBJECTIVE: The purpose of this study was to evaluate the nutritional risk in ambulatory elderly people (> or = 65 years old) and determine influential factors. METHODS: A questionnaire was provided to 400 Spanish pharmacists to gather data from ambulatory elderly people in a one-visit prospective study. Data collected included: age, gender, body mass index, environment and nutritional assessment using the Nutrition Screening Initiative panel, a subjective nutritional evaluation and nutritional therapy. ANOVA and Mann-Whitney tests were used to evaluate differences and correlations. Logistic regression analysis was used to calculate association with risk factors. RESULTS: Data were collected from 1320 elderly subjects (60.0% female, mean +/- SD, age = 75.6 +/- 7.4). Moderate to high nutritional risk was present in 79.1%, without gender differences, and 18.6% were undergoing nutritional therapy of whom 93% consumed a complementary enteral diet. The following nutritional risk factors were identified (Odds ratio -95% confidence interval-): having three or more glasses of beer or wine in men (10.70, -6.11 to 18.70-), eating usually alone for women (1.96, -1.52 to 2.52-) and physical weakness for cooking, shopping or feeding in women (1.7, -1.34 to 2.16-). The assessment of nutritional status with the Nutrition Screening Initiative panel showed a linear significant correlation with age (p < 0.01). There was poor correlation between the objective (panel) and subjective evaluations (kappa index, 0.0822). The environment was not associated with nutritional status, but women showed a poorer subjective nutritional valuation than men (p < 0.001). Although chronic diseases and drug therapy are usually the most frequent risk factors, in our subjects, alcohol consumption was the most frequent risk factor. Poor fitness showed a very close association with a moderate to high nutritional risk. There is a high rate of elderly people at risk and a very low percentage of subjects undergoing nutritional therapy. CONCLUSIONS: The moderate to high nutritional risk rate in ambulatory Spanish elderly persons is higher than expected. Both physical and social issues influence nutritional status. Awareness of the high rate of nutritional risk, should prompt consideration of early, appropriate therapy to prevent malnutrition and deteriorating quality of life.

Activities of Daily Living↗
PubMedDate not supplied

[Assessment of the journal Nutrición Hospitalaria (part I): authors, institutions, articles].

An analysis is made into the productivity of the authors publishing in Hospital Nutrition and the Institutions to which they belong. Spanish authors are dominant, mainly ones from Madrid, and coming to a large extent from the health-care field (75.8%), basically in general hospitals. The types of article very over the period under study, with examples of purely technical articles alongside others such as bibliographical reviews, or Letters to the Editor.

Authorship↗
PubMedDate not supplied

Use of pro-, pre- and synbiotics in the ICU--future options.

Although the word synbiotics was coined to describe the combined action of pre- and probiotics, the ability to, like antibiotics, control infection, the term is now increasingly used in a wider sense, as a name for all the substances released by microbial fermentation in the lower gut. One obvious reason is that most of the substances released seem to influence the immune defense, increase resistance to disease, and, most important, prevent complications to surgery such as infections and thrombosis. Protection layer of lactobacillus does not exist only on the GI tract mucosa, it is important at all exterior body surfaces including those of the eye, the nose, the mouth, the respiratory tract, the vagina, not to forget the skin. It is clearly reduced at all sites when the patient is in the settings of ICU. Each human being has his/her own unique microbial collection, especially of strains of Bifidobacterium and Lactobacillus, and it should be possible to identify an individual on the basis of his/her personal intestinal microflora. The flora seems always to be significantly reduced in the sick, especially in connection with severe disease, care in ICU, and in patients with little food intake or on parenteral nutrition. Supply of both pre- and probiotics can modify functions such as appetite, sleep, mood and circadian rhythm, and this most likely through metabolites produced by microbial fermentation in the gut. Supply of lactic acid bacteria (LAB) can also significantly reduce serum levels of a variety of toxins such as endotoxin. An umbrella of supplemented probiotics could provide to the patients with liver cirrhosis a tool to reduce septic manifestations and the incidence of bleeding. LAB are effective in controlling diarrhea of both bacterial and viral origin. A series of experimental studies and several uncontrolled clinical studies support the idea of using probiotics in patients with IBD. Ecoimmunonutrition with pre- pro- and synbiotics offer to be suitable tools in the new millennium.

Adult↗