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Biomedical subjects

A Zarazaga

Publications and source records attributed to A Zarazaga.

13 recordsLinked to original sources
PubMed2001

Nutritional support in chronic renal failure: systematic review.

BACKGROUND AND AIMS: The purpose of this systematic review was to locate and assess in patients with chronic renal disease the quality of scientific evidence to establish graded recommendations based on the efficacy and effectiveness of nutritional support. METHODS: Computerized and online versions of MEDLINE (from 1989 through March 1999) and EMBASE (from 1988 through January 1999) were consulted. The Cochrane Library and the online Healthstar (from 1975) databases were also searched for clinical trials. A total of 593 studies were assessed. Following methodological review (primary reviewer), only 45 studies reviewed met criteria for selection and were analyzed by a group of experts (secondary reviewer). A final consensus was reached between the co-ordinators, experts and methodologists. RESULTS AND CONCLUSIONS: Low and very low-protein diets associated with specific enteral supplements are indicated in most patients with chronic renal disease and in patients with incipient diabetic nephropathy to slow progression of disease and to improve their overall status, contributing to improved survival (grade A recommendation). The use of protein-restricted diets in diabetic nephropathy is only indicated in type I diabetes mellitus (grade A recommendation). An improvement in nutritional parameters was found when specific diets were given in chronic renal disease (grade C recommendation).

Chronic Disease↗
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↗
PubMed1997

[Parenteral nutrition in the pre- and early postoperative periods. Unsolved problems and contradictions].

The analysis of early published and own clinical investigations dedicated study of parenteral nutrition in pre- and early postoperative periods was represented. Special attention was paid to contradictory conclusions being result of these investigations. The recommendations were given about cases when it is necessary to apply the parenteral nutrition in pre- and early postoperative periods, and when it is necessary to refuse it.

Humans↗
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

[Exocrine pancreatic insufficiency. Organic and functional deficiencies].

The exocrine pancreas is a gland which secretes water, enzymes and electrolytes into the intestinal lunar. These enzymes for the normal digestion of food and a deficit, whether due to a seduced secretion (chronic pancreatitis, cystic fibrosis), or dysfunction in the chronology of their secretion (following truncal vagotomy) will cause malabsorption which often develops, in clinical terms, into malnutrition sometimes this functional deficit is secondary to other pathologies or surgical operations which alter the digestive tract physiology, preventing the correct combination of nutrients and pancreatic enzymes together with the biliary salts. The outcome is malabsorption, mainly of fast and fat soluble vitamins. As the onset is slow and forms part of a chronic, pathology, diagnosis is difficult, for which reason it is included in the general group of malabsorption due to pancreatic insufficiency or surgical sequelae, finally resulting in pancreatic failure or problems following surgery. The purpose of this publication is to review one by one all the situations in which there is an alteration in the function of the pancreatic enzymes, with emphasis on cases in which a defined malabsorption syndrome will result, and in which the prescription of exogenous pancreatic enzymes will imposiue the picture.

Chronic Disease↗
PubMedDate not supplied

[Folates in human nutrition, Different clinical situations in which folate deficiencies exist].

The alimentary surveys carried out on various sectors of the population in industrialized countries have shown the existence of chronic clinically silent deficiency in micronutrients. In some cases, as in folates, their lability against conservation techniques, the change in alimentary habits, the abuse of alcohol and the great quantity of frequently used drugs which interfere in their absorption, diminish their content in the diet and their bio-availability. The appearance of macrocytic anemia is a late deficiency sign, and therefore in situations of an increase need and in patients included in the risk groups, a supplemental intake must be given in order to avoid irreversible lesions if it is not possible to monitor the folate levels. There are risk groups in which various etiological factors come into play, acting at a different metabolic level on the folates and making more difficult their dietetic or pharmacological compensation even if supply is considerably increased. We studied these factors independently and in each specific situation (old people, patients with liver disease, alcoholics, pregnant women and nursing mothers, neonates, children, malabsorption syndromes, gastrectomy, AIDS, anaesthesia and patients being treated with antifolic medication), evaluating their mechanisms of action and their potentiation in determined specific situations.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[National Task Force on Home and Ambulatory Artificial Nutrition. NADYA. The NADYA Group].

When a patient needs parenteral or enteral nutrition, be it in a transitory way or as a permanent form, and hospitalization is not strictly required, this treatment should take place in the home of the patient whenever possible. The support with artificial nutrition can be equally efficient, improving the life expectancy ad the quality of life of patients who would otherwise be faced with a much prolonged hospital stay. The Ambulatory and Home Artificial Nutrition group (NADYA) is a multidisciplinary team of health care professionals, from different areas of the national territory, who are dedicated to Clinical Nutrition. With the objective of promoting health and well-being of patients undergoing treatment, and to ease the therapeutic activity of the implicated professionals, this group has developed a series of suggestions for the practice of enteral or parenteral nutrition in the home of the patient. These suggestions include specifications about the technical team, criteria for selection and training of the patients, routes of access, formulas and material needed, follow up characteristics, and associated complications, and the represent a consensus of the regulations necessary for the guarantee of an adequate level of security and efficiency of the at home care of patients who require artificial nutrition support.

Ambulatory Care↗
PubMedDate not supplied

[The value of life. Development of an assessment system for therapeutic strategies].

The wide therapeutic supply which a present is available for diverse disorders, together with a excess of indiscriminate scientific information, occasionally complicates the possibility of acquiring a wide experience in the treatment of certain patients (limited experience). To acquire genuinely useful experience, it is necessary to accumulate simiular experiences from our environment, with it being necessary to precisely define, in an objective manner, concepts which until now are difficult to quantify (risk of mortality or morbidity, survival, quality of life, etc.). The definition of these parameters, shall favor the creation of homogenous groups (isoseverity indices), which is the first step in the evaluation of more complex conceps, such as; quality of life, increase of life expectancy, quality adjusted life years (QALY's), and beneficial application, all of which validated in diverse hospital media. Based on the previous, we would obtain other calculated parameters; the benefit (of the patient), the use (of the procedure), and the efficacy (of the physician or the unit). Once these parameters have been standarized, it shall be possible to compare them with the results published in other media, considered to be standards, with the aim of establishing the corresponding self-evaluation. The evaluation of the cost of each process, is a compulsory procedure, to produce, if possible, based on the previous results, a better distribution of the means without a decrease in the quality of assistance. With the aim of evaluating the results in an objective and quantifiable manner, we have worked these last years on developing assessment applied to the evaluation of predictive and isoseverity indices, such as the cost/benefit evaluation in critical, geriatric, and oncological patients, and in those with artificial nutrition in the home. The fruit of this labor has come together in the production of a computerized information system (SAETA), which builds de previously validated modules into is structure, thus permiting the storage and subsequent multifactoral analysis of the results.

Decision Theory↗
PubMedDate not supplied

[Carbohydrates--no glucose--in parenteral nutrition. A fading concept?].

An update is made on the binominal use/benefit of non-glucose carbohydrates (polyalcohols or polyols) in parenteral nutrition. The most recently published results, despite the controversy from different areas, have motivated the updating of the criteria metabolic aspects, indications and contraindications of the different carbohydrates alternatives of glucose (xylitol, sorbitol, glycerol, fructose), in the parenteral nutrition of patients with different degrees of aggression and situations of glucose intolerance or insulin resistance. It is known that, due to causes which are not entirely understood, non-glucose carbohydrates have not yet been considered as effective energy sources alternative to glucose in clinical situations described as unfavorable for their use. However, we may consider that in view of our own experience and that of previous publications, these carbohydrates have not only not decreased their use expectancy but, on the contrary, have increased as their advantages were clinically confirmed, without the appearance of major complications in this therapeutic modality. For this reason we consider that the understanding of the characteristics and the different metabolic aspects (pharmacological dose) of the polyols must make us review their clinical use, both alone as in different combinations.

Fructose↗
PubMedDate not supplied

[Never say never. Reflections on infohighways or highways of information].

The indiscriminate supply of unsolicited scientific information, means an overload for the professional in his assimilative intellectual process, which sometimes forces him to put aside his capacity for developing "scientific curiosity" (the basic principle of the university culture). This may cause an intimate discord between what I should do and what I can do, which may cause negative sensations in his self-esteem. With the incorporation of new means of communication, the velocity with which this information is supplied, is much higher than our capacity for assimilation, which often leads to reactions of rejection as a protective measure against such disproportionate aggression. This protective measure may be negative in our competitive society, possibly leading to the professional and even social disqualification. As we have to incorporate these new technologies into our activities, both at the professional as at the social level, getting to know them better, shall allow us to make a correct use thereof (with the latter being proportional to the depth of the former), avoiding, on the other hand, to be manipulated by its consumer offers. In this publication we give a summary of the current possibilities of using the Network, which are useful in our scientific and cultural environment (E-mail, access to scientific data bases, telematic protocols, electronic journals, etc.), with testing the possibilities of initiating our own first telematic projects, with a single finality: to potentiate the communication between all the scientific collaborators related to the discipline of nutrition, which is an aim that every scientific journal, and ours in particular, should have among its purposes.

Computer Communication Networks↗