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C Ortiz Leyba

Publications and source records attributed to C Ortiz Leyba.

17 recordsLinked to original sources
PubMed1992

[Fungemia caused by Rhodotorula mucilaginosa in relation to total parenteral nutrition].

BACKGROUND: Fungal infections are nowadays more common in clinical practice. The most frequently isolated fungi are Candida and Cryptococcus. Infection due to Rhodotorula mucilaginosa is very uncommon. We describe here our experience with R. mucilaginosa fungemia, with emphasis on total parenteral nutrition related episodes. METHOD: A retrospective review identified 3 patients with R. mucilaginosa, and predisposing conditions, clinical features, treatment used and outcome were analyzed. The case definition includes the repeated isolation of R. mucilaginosa in several blood-cultures and/or the isolation of R. mucilaginosa in one single blood culture together with its isolation in any other site. RESULTS: Three patients were identified. In all of them there are some defects in immune response (skin anergy in two, immunosuppressive therapy in the remaining patient), had an iv line placed, under antibiotic therapy and total parenteral nutrition. All factors could have been related to the development of R. mucilaginosa infection. CONCLUSION: Although its pathogenic role is controversial, in two or our patients R. mucilaginosa infections correlates well with clinical signs and symptoms of invasive infections (fever, hemodynamic changes). The treatment is still not clear.

Adult↗
PubMedDate not supplied

Prospective study on the efficacy of branched-chain amino acids in septic patients.

The metabolic response to sepsis is characterized by increased proteolysis and gluconeogenesis, reduced protein synthesis, and negative nitrogen balance. The effects of a solution with a high proportion of branched-chain amino acids (BCAA) on the nutritional state of septic patients were evaluated. Eighty patients with peritonitis were divided into two groups of 40 patients; group 1 was administered a solution with 22.5% BCAA and group 2 with 45% BCAA. The following parameters were evaluated: anthropometrics, creatinine/height index, urinary 3-methylhistidine, nitrogen balance, stress index, albumin, prealbumin, transferrin, retinol binding protein, lymphocytes, delayed cutaneous sensitivity tests, studies of hepatic function, and plasma aminogram. In group 2 a more positive nitrogen balance, a greater drop in the stress index, a rise in plasma prealbumin and retinol binding protein levels, an increase in the creatinine/height index, and a more marked fall in the urinary excretion of 3-methylhistidine were found. When solutions with a high BCAA content were administered, there was an increase in the plasma concentrations of these amino acids in the BCAA/aromatic amino acid quotient and a decrease in the aromatic amino acids. Plasma concentrations of leucine and valine achieved very high, potentially toxic, levels at 15 days when solutions with high BCAA content were used. It is concluded that solutions with BCAA are advisable for use in the septic patient in the increased protein catabolic phase, where positive nitrogen balance, a reduction in muscle protein catabolism, and faster recovery of muscle and visceral protein were obtained.

Aged↗
PubMedDate not supplied

[Prospective comparative study of different amino acid and lipid solutions in parenteral nutrition of patients undergoing bone marrow transplantation].

UNLABELLED: The patient who will undergo a bone marrow transplant (BMT) has a high protein catabolism in the time period after the infusion of the marrow, and therefore there is a need for an adequate nutritional support. The objective of our study is to analyze the behavior of nutritional assessment parameters, the lipid metabolism, the number of days of mucositis, the number of infections, the number of days to recovery, and the number of hospitalization days when using different parenteral nutrition solutions: 22.5% and 45% branched chain amino acid solutions, and lipid solutions with long chain triglycerides (LCT), vs. medium chain triglycerides (MCT). MATERIAL AND METHODS: We have carried out a prospective, randomized study in patients who underwent a BMT who received parenteral nutrition. The supply of nitrogen was 1.5 +/- 0.3 g of AA/kg/day (either in standard solution or in a 45% branched chain AA solution). The caloric supply was similar in all the groups, with a proportion of 60% coming from carbohydrates and 40% from lipids, either LCT or MCT/LCT. The nutritional assessment parameters were studied, as well as of the lipid metabolism, and also clinical evolutive data: number of days of mucositis, number of days of PN, number of days hospitalized, number of infections, rate of infection density. All the data were measured and/or quantified 4 times: pretransplant, on day--of the transplant, and after 7 and 14 days after the transplant. RESULTS: 62 patients were studied. Group A: 19 patients treated with 22.5% branched chain amino acids + 20% LCT. Group B: 26 patients (45% branched chain amino acids + 20% LCT). Group C: 17 patients, (45% branched chain amino acids + 20% MCT/LCT). There is a quicker recover of the marrow in groups B + C: 14.4 vs. 11.7 and 11.1, with a p < 0.05. The nitrogen balance improves significantly in groups B and C (p < 0.05). The retinol-binding protein increases significantly from day 0 to day 7 (p < 0.01) in the LCT group (Group B). The phospholipids decrease in group B after one day (p < 0.05), and after the 7th day (p < 0.05). The triglycerides increase in group C between 7 and 14 days. The LDL/HDL quotient increases in group B after 14 days (p < 0.05). The triglycerides increase in group C between 7 and 14 days. The LDL/HDL quotient will increase in the B group after 14 days (p < 0.05). There are no differences in the number of days of mucositis, the total number of infections, the number of infections per 100 days of hospitalization, or in the number of hospitalization days. CONCLUSIONS: In patients who are given parenteral nutrition in the period immediately after the BMT, we found an improvement in the catabolic metabolism parameters when using a solution with a high proportion of branched chain amino acids (45%) and a smaller alteration of the metabolism of the plasmatic lipoproteins when we use MCT/LCT enriched solutions.

Adolescent↗
PubMedDate not supplied

[Hypocaloric peripheral parenteral nutrition in postoperative patients (Proyecto Europan)].

Hypocaloric peripheral parenteral nutrition (HPPN) appears to be indicated in patients with moderate malnutrition subjected to a short period of fasting following surgery. Our objective is to determine whether or not the intake of hypocaloric parenteral solutions containing aminoacid is useful in postsurgical patients, by means of a study of different nutritional evaluation parameters. A study was performed on 35 postsurgical patients who fulfilled at least 2 of the following criteria indicating malnutrition: 1) albumin levels less than 3 g/dl; 2) prealbumin levels less than 21 mg/; 3) body weight less than 95% of ideal weight. The patients were divided into 3 groups: Group I consisted of 15 patients treated with conventional fluid therapy, Group II consisted of 10 patients treated with nutritional support based on glucose and aminoacid and Group III was comprised of 10 patients also treated with a nutritional therapy based on glycerol and aminoacid. The most significant data included a rapid recovery of short term proteins (prealbumin and retinol-binding protein) and a less negative nitrogen balance 5 days afterwards in both the glucose and glycerol groups, both of which were statistically significant. With regard to complications studied, there was a greater incidence of suture dehiscence in the control group than in the groups under treatment (13.3% compared to 50%). Our conclusion is that HPPN is a valid nutritional support measure in postsurgical patients in certain clinical situations and circumstances, although further controlled, randomized studies should be considered, during both the pre and post operative periods of these patients in order to clearly indicate how and when nutritional therapy should be applied.

Amino Acids↗
PubMedDate not supplied

Variations in plasma amino acids in septic patients subjected to parenteral nutrition with a high proportion of branched-chain amino acids.

Sepsis is characterized by an increase in the plasma concentration of aromatic amino acids (AAAs) and those containing sulfur and a decrease in the branched-chain amino acids (BCAAs). We studied changes in the plasma aminogram of septic patients given different types of total parenteral nutrition (TPN), analyzing variations in accordance with the type of TPN used and the importance that the use of BCAA may have in these patients. We studied 80 patients with peritonitis divided into two groups of 40 patients each: group 1 was given a solution with 22.5% BCAA and group 2 a solution with 45% BCAA. High BCAA content caused an increase in the plasma concentrations of these amino acids and in the BCAA/AAA quotient and a decrease in AAAs. Plasma concentrations of leucine and valine reached high, potentially toxic levels at 15 days when solutions with high BCAA content were used. Glycine increased in group 1, which may be important because of its tendency to produce hyperammonemia. BCAAs are of unquestioned nutritional importance in view of the evidence of changes that take place in muscle protein catabolism and in plasma amino acids. In the phase of increased protein catabolism, we saw a plasma amino acid pattern in keeping with the existing metabolic situation. The need for BCAA diminishes when the hypercatabolic state disappears.

Adult↗
PubMedDate not supplied

[Artificial enteral nutrition in sepsis patients].

The importance of avoiding bacterial translocation in critical patients in order to reduce the risk of multiorganic failure has led to an insistence on maintaining the enteral nutrition method in different clinical situations. The present study examines the possible alternative of enteral nutrition using an intact protein polymer and medium chain triglyceride diet in critical patients with sepsis. For this purpose, a prospective study was conducted on 20 patients who received this diet for a period of 20 days. In 16 cases, a jejunostomy catheter was used, and in the remaining 4, a nasogastric tube. 6 of the total patients died. The results obtained show a recovery of the visceral markers (prealbumin, transferrin and retinol-binding protein) of significant statistical importance. The improvement in albumin was discarded due to simultaneous intake of seroalbumin received by the patients. The nitrogenated balance and height creatinin index improved, whereas there was no increase in hepatic enzymes. In conclusion, this enteral diet is a perfectly valid alternative to parenteral nutrition in septic patients.

Aged↗
PubMedDate not supplied

[The behavior and utility of 3-methylhistidine, urinary urea excretion and the creatinine height index in the sepsis patient].

We have studied in a prospective manner the evolution of three urinary indices which measure protein catabolism: 3-methylhistidine, the creatinine level index, and the excretion of urinary nitrogen, the latter being calculated based on the excretion of urea in urine. These studies have been performed using healthy patients only being given parenteral nutrition. Our data shows a very significant decrease in 3-methylhistidine (p = 0.001) and in the excretion of nitrogen calculated (p = 0.026), there being a correlation among the differences between these two parameters.

Adolescent↗
PubMedDate not supplied

[Hypocaloric peripheral parenteral nutrition in postoperative patients (the Europan Project) (II)].

Hypocaloric peripheral parenteral nutrition (HPPN) appears to be indicated in patients in a situation of moderate malnutrition who are to undergo a short period of fasting following surgery. Our aim was to determine the utility of the contribution of parenteral solutions of amino acids (AA) with limited caloric supply in the post-surgical patient, using different nutritional evaluation parameters. We examined 75 post-surgical patients who met at least two of the three criteria established as malnutrition: 1) albumin < 3 g/dl; 2) pre-albumin < 21 mg/dl; 3) bodyweight of less than 95% of the ideal weight. They were divided into four groups: a control group, of 15 patients undergoing standard fluid therapy; Group I, 20 patients with nutritional support of glucose +AA; Group II, 20 patients with glycerol +AA; and Group III of 20 patients with sorbitol-xylitol +AA. The most significant data encountered were a rapid recovery of short half-life proteins (pre-albumin and retinol), a less negative nitrogen balance, and a greater decrease of urinary 3-methylhistidine, when HPPN was used. A notable increase was also obtained in the majority of AAs and of the G and M immunoglobulin plasmatic figures in the groups treated. In terms of complications, a greater percentage of wound dehiscences appeared in the control group than in those treated (13.3 vs 5%) while, on the other hand, there was a higher incidence of catheter-induced phlebitis in groups undergoing HPPN. We conclude that HPPN is a valid nutritional support in post-surgical patients with more or less significant malnutrition, and when the gastro-intestinal tract cannot be used, for whatever reason, during the first week following the operation.

Amino Acids↗
PubMedDate not supplied

[Comparative study of two lipid emulsions in the parenteral nutrition of the septic patient].

The nutritional support is essential in the treatment of the septic patient, but the optimal substrates, have not been well defined, although several studies advise the use of solutions with a high proportion of branched amino acids. The use of lipids in the Parenteral Nutrition (PN) of these patients is presently accepted by all authors, although there is no consensus of the composition of the mix to be used. We have done a prospective, randomized study in a group of critical septic patients who received PN. All cases were used a solution with a high proportion of branched amino acids and glucose. 40% of the non-protein calories were administered as lipids. Based on this, two groups were formed. Group 1 medium chain triglycerides and long chain triglycerides (MCT/LCT) in a ratio of 1:1, and Group II LCT. After ten days, both groups showed an increase in hepatic cholestasis enzymes and an improvement of the parameters of protein anabolism and catabolism. Group 1 showed a significantly higher increase in the retinol birdring protein and the improvement of the nitrogen balance. Besides this, the global analysis of all the parameters of protein anabolism and catabolism showed a more favorable evolution, with statistical significance, in those who received MCT/LCT. Therefore, the MCT/LCT in the PN of the septic patient who is given a solution rich in branched amino acids, achieves a greater protein saving and a faster recevesy of the markers of protein synthesis, than those with LCT. Both groups show an increase in cholestasis enzymes.

Adolescent↗
PubMedDate not supplied

Lipids and immune function.

Intravenous lipid emulsions as part of Total Parenteral Nutrition, are now standard in most centers. The most frequently used lipid formula contains predominantly long-chain triglycerides (LCT) of n-6 series . Controversy and concern exist about the immunosuppressive effects of this fuel source mainly based on experimental data because clinical studies are sparse. Some investigators have pointed out that this lipid emulsion impair monocyte, lymphocyte and neutrophil functions although these changes seem to be related to quantity and rate of lipid administration. A new lipid emulsion that contains 50% as medium chain triglycerides is available. The impact of this formula on immune function is unknown although some papers suggest that it produces less deleterious effects on immune response than the traditional lipid source. Prostaglandins and leukotrienes have numerous effects on immune functions and mediate many of the hemodynamic aspects of the metabolic response to injury. The use of n-3 fatty acids that produce less immunosuppressive eicosanoids have been studied in experimental model with hopeful results. Despite these conflicting data, almost all authors agree that there are no justification for withholding intravenous lipid therapy because they are safe and effective providing essential fatty acids with a high caloric content. Future studies are needed to define the precise composition of lipid emulsions that may vary in the different pathologic situations.

Fat Emulsions, Intravenous↗
PubMedDate not supplied

[Response to aggression: evaluation and therapeutic implications. Work Group on Metabolism and Nutrition of the SEMIUC].

The metabolic response to stress/aggression is a complex process which is mainly mediated by the interaction between the neuro-endocrine system and the circulating cytokines. This interaction brings about physiological and metabolic alterations--severe metabolic-nutritional deficits--of the hypermetabolic type, muscular proteolysis, lipolysis, glycogenolysis, and gluconeogenesis among others, which should be studied and understood prior to initiating or not a nutritional support. The parenteral or enteral nutritional support is usually indicated to prevent a worsening of these situations of altered metabolism frequently associated with inanition, although one should not attempt to revert to normal preexisting deficit situations. On the other hand, and is this special context, we should not forget the advances in nutrients with pharmacological effects, and in pharmacological nutrition. At this II Consensus Conference of the SEMIUC (Sociedad Española de Medicine Intensiva y Unidades Coronarias = Spanish Society of Intensive Medicine and Coronary Units), we have proposed four objectives: i) To make recommendation, based both on the scientific evidence, as on the experience of the components. ii) Define the scientific terminology to be used in this specific context. iii) Give an answer to the different and assorted clinical problems which are secondary to a situation of stress which has a multiple etiology. iv) Provide new ideas for the development of clinical trails and studies of this specific context.

Critical Care↗
PubMedDate not supplied

[L-carnitine levels in critical septic patients receiving parenteral nutrition].

Septicemia causes multiple and often not very well understood metabolic alterations. In this sense it is controversial whether or not carnitine is decreased, which may have several implications. Our objective is to measure the plasma carnitine levels in septicemic patients, and to find out whether this is modified if there is a multi-organ dysfunction syndrome (MODS), or if it is dependent on the lipid source. For this we carried out a prospective study in septicemic patients with MODS. These were given exclusively parenteral nutrition (PN) without any carnitine supplementation. The PN of 16 patients contained long chain triglycerides (LCT's), while that of another 12 contained a 1:1 mixture of long and medium chain triglycerides (LCT's and MCT's). We measured the plasma carnitine level at the baseline, after 5 days and after 10 days, using an enzymatic method that measures the total carnitine level (free and esterified). The normal values lie between 35 and 70 mumol/l. We included 28 septicemic patients whose ages were 53.41 +/- 16.51 years, and whose APACHE II on admission was 17 +/- 4. The carnitine levels were: baseline: 60.4 +/- 23.7; 5th day 57.7 +/- 22.9; 10th day 55.7 +/- 21.2 (p = n.s.). Of these patients, 10 had an MODS of septic origins with their baseline levels being: 65.3 +/- 30.9; 5th day 60.3 +/- 23.2; 10th day 61.5 +/- 15.5; while the levels of the 18 septicemic patients without MODS, the baseline levels were 61.9 +/- 13.8; 5th day 58.6 +/- 19.1; 10th day 56.6 +/- 19.3 (p = n.s.). In the patients who were given LCT's the baseline carnitine level was 60.7 +/- 23.1, 5th day 60.1 +/- 23.8; 10th day 58.6 +/- 12.8; while those patients who were given LCT/MCT showed baseline levels of 64.3 +/- 19.5; 5th day 58.6 +/- 19.1; 10th day 57.8 +/- 10.7 (p = n.s.). In our septicemic patients the serum carnitine levels we found were within the normal range, and these remained unchanged during the ten days in those patients with MODS or with the lipid mixture used.

Adult↗