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Biomedical subjects

J M Culebras

Publications and source records attributed to J M Culebras.

At least 55 records · Page 3Linked to original sources
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[Linoleic acid and the immune system. Controversies about lipid emulsions].

The selection of a given lipidic function for nutritional backup requires not only knowledge of the metabolism of the different existing lipidic emulsions and of their specific therapeutic indications, but also of their contraindications and controversies because, apart from their calorific value, the contribution of liposoluble vitamins and their function in preventing essential fatty acid deficiencies, we know that they are powerful metabolic modulators. This in associated with the fact that manipulation of dietary lipids (enteral or parenteral) can affect and modulate the response to the disease, attack or infection by improving or impairing the different immune functions. This review is focused on the scientific publications which have examined the varying effects of lipidic emulsions, in quantity and in quality (particularly linoleic acid) on the immune system, on the fatty acid composition of the cellular membranes and on the production of and prostaglandins and leukotrienes. An update is given of the known interrelation between lipids and immunity, with appraisal of triglycerides and long-medium -- and short-chain fatty acids, mixtures of medium -- and long-chain triglycerides, the proportions between infinity-3/infinity-6, and structured lipids.

Contraindications↗
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[A histopathological study of the hepatic changes induced by parenteral nutrition in the rat].

Total parenteral nutrition is associated with hepatic metabolic and morphologic changes. Histological alterations induced by administration of glucose plus amino acids (group A) or glucose plus amino acids and lipids (group B) have been investigated in the rat. Parenteral nutrition provided 187 kcal/kg/day in both groups of animals. Rats in group B received 30% of nonprotein calories as lipids (Intralipid). In group A the most frequent histopathological findings were inflammation, portal edema and microesteatosis. Those alterations did not disappear by lipid addition, being frequent the existence of congestive phenomenons and esteatosis together with occasional pigment deposits in Kupffer cells. Those data suggest that supplementation of solutions with LCT-base lipid emulsions does not compensate for the histopathological alterations induced by parenteral nutrition.

Animals↗
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[Functional food].

Explore the source record for details and available documents.

Food, Fortified↗
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[Obesity and the immune system].

With an increased prevalence of obesity in developed countries, associated chronic diseases rise in a parallel way. Morbidity secondary to overweight and obesity include type 2 diabetes, dislipemia, hypertension, heart disease, cerebrovascular disease, cholelithiasis, osteoarthritis, heart insufficiency, sleep apnoea, menstrual changes, sterility and psychological alterations. There is also a greater susceptibility to suffer some types of cancer, infections, greater risk of bacteremia and a prolonged time of wound healing after surgical operations. All these factors indicate that obesity exerts negative effects upon the immune system. Immune changes found in obesity and their possible interrelations are described in this article. Changes produced during obesity affect both humoral and cellular immunity. It is known that adipose tissue, together with its role as energy reserve in form of triglycerides, has important endocrine functions, producing several hormones and other signal molecules. Immune response can be deeply affected by obesity, playing leptin an important role. Properties of leptin, alterations of leptin levels in different situations and its changes with different medical and surgical therapies for obesity are described in this article.

Antibody Formation↗
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[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↗
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[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↗
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Nutritional and metabolic support: converging concepts.

The response to injury and infection can be viewed as a mobilization of body protein, fat, and carbohydrate stores to ensure normal or above-normal circulating levels of substrate in the absence of dietary intake. The situation does not readily yield to nutritional manipulation, and inappropriate nutritional support can cause additional stress. Artificial nutrition is mainly a form of nutrient administration and not nutrient utilization. Modulation of neurohumoral and wound responses to trauma due to starvation and refeeding has not been delineated. The provision of adequate substrates alone does not necessarily guarantee their efficient use in metabolism. With a clear knowledge of the role of cellular mediators in the pathophysiology of disease, it may be possible to develop more rational therapeutic approaches during critical illness. Determination of appropriate and optimal substrate support through parenteral and enteral nutrition remains of great clinical importance. The clinical application of branched-chain amino acids, dispensable amino acids, acetylated amino acids, dipeptides or tripeptides, cysteine, glutamine, and arginine has been explored in recent years. The idea that lipids are deleterious in sepsis and organ failure should be revised and documented, and recent studies suggest that fish oils as a lipid source may also favorably affect immune responses. Under stressful conditions, total parenteral nutrition can require large amounts of energy at a time when there are marked disturbances in glucose utilization. In this area, the use of nonglucose carbohydrates or oligosaccharides can be appropriate, despite the lack of broad acceptance. Existing conventional substrates should be studied beyond mere provision of energy and metabolic pathway support.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbohydrate Metabolism↗
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[Europan: the European project for the study of hypocaloric peripheral parenteral nutrition in surgical patients].

This is the first time that a concerted action in the field of biomedicine proposed by Spain has been accepted by the European Communities. The research project, presented by one of the authors under the name of EUROPAN, proposes the study of hypocaloric peripheral parenteral nutrition in surgical patients. At present the concerted actions committee in biology (COMAC-BIO) of the E.C. is financing an exploratory phase in order to elaborate a prospective protocol by means of a workshop that will take place in Madrid in march 13 and 14. Twenty four European experts and several Spanish observers will take part in the meeting. The exploratory phase will conclude in june 1989, date in which it will be submitted for approval to the Commission of the European Communities and their consultative committees. If the concerted action proposal is finally approved, it will have to be executed during the next three years, ending by january 1992. Legal aspects of the E.C. in which this project is considered, as well as scientific, social and organizational goals and actions to be executed are described in this article.

Congresses as Topic↗
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[The role of multiparameter indices in preoperative nutritional assessment].

The consequence of malnutrition in surgical patients is an increase in post-operative complications. Detection of alteration in the nutritional state is a target in surgery theatres, using a variety of methods, notably anthropometry, analytic protein calculation, and delayed hypersensitivity cutaneous trials, which provide and objective assessment of the different body behaviors. A drawback is the large number of calculations required per patient, so that there is a limited number of patients with all the normal tests. To improve results in predicting complications in surgical patients based on nutritional parameters, the use is proposed of Multiparametric Nutritional Indices, obtained from the joint valuation of those parameters, by using multivariable statistical calculation techniques. The main indices in the literature are described. Multiparametric Indices are useful and easily calculated for the nutritional screening of surgical populations.

Humans↗
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[Hormones, growth factors, and drugs in metabolism and nutrition].

The manipulation of the inflammatory and hormonal responses may produce, on one hand, positive effects, and, on the other hand, potentially negative effects. The modification of the neuro-endocrine-humoral pattern may become more important and effective than the supply of nutrients. In this article we bring an up date of the role of insulin, anabolic steroids, blocking the catabolic hormones, phenobarbital, somatostatin, clenbuterol and metaprorenol, growth factors: GH and IGF-1, cytokines, and anti-cytokines sera. The use of GH, IGF-1, and of the epidermal and or colonic growth factors, along with a blocking of the cytokines, the manipulation of the lipidic mediators, and the supply of classical nutrients, specific to the aggression situation, may improve the protein synthesis and tissue repair. It may at the same time both decrease the loss of body proteins as well as promoting and acceleration of the recovery, shortening the hospital stay and reducing the convalescence time. The future seems to point towards molecular and cellular biotechnology and towards "nutritional" pharmacology, which contemplates the effects of growth factors, the recent advances in the field of cytokine modulation, and the manipulation of the binomer nutrient-medication.

Adrenergic beta-Agonists↗