Phytosterolemia associated with parenteral nutrition administration in adult patients

Vegetable lipid emulsions (LE) contain non-declared phytosterols (PS). We aimed to determine PS content depending on the brand and LE batch; and in adult hospitalized patients treated with parenteral nutrition (PN), to establish the association between plasma and administered PS. I. LE study: Totals and fractions of PS in 3-4 non-consecutive batches from 6 LE were analysed. II. Patient study: randomized, double-blind study of patients with at least 7 previous days of PN with 0.8 g/kg/day of an olive/soybean LE, were randomized (Day 0) 1:1 to olive/soybean (O/S) or 100% fish oil (FO) at a dose of 0.4 g/kg/day for 7 days (Day 7). Plasma PS, its fractions, total cholesterol on Days 0 and 7, their clearance, and their association with PS administered by LE were studied. In part I. LE study: differences were found in the total PS, their fractions and cholesterol among different LE brands and batches. Exclusive soybean LE had the highest content of PS (422.36 ± 130.46 μg/mL). II. Patient study: 19 patients were included. In the O/S group, PS levels were maintained (1.11±6.98 μg/mL) from Day 0 to 7, while in the FO group, significant decreases were seen in total PS (-6.21±4.73 μg/mL) and their fractions, except for campesterol and stigmasterol. Plasma PS on Day 7 were significantly associated with PS administered (R2=0.443). PS content in different LE brands had great variability. PS administered during PN resulted in accumulation and could be prevented with the exclusive administration of FO LE

Matemática Financiera: Autoevaluación y rendimiento académico

Durante el curso 2006-2007, un equipo de profesores del Departamento de Matemática Económica, Financiera y Actuarial de la Universidad de Barcelona, relacionados con la asignatura de Matemática Financiera, vio la necesidad de adaptar materiales y crear nuevas formas para mejorar el aprendizaje, aprovechando el plan Bolonia. En nuestra facultad el número de alumnos siempre ha sido muy elevado y es una de las principales variables a tener en cuenta. En aquel curso, el volumen de alumnos que cursaban asignaturas relacionadas con la Matemática Financiera ascendió a 3.328. Utilizando Moodle hemos elaborado un material de aprendizaje y autoevaluación consistente en un banco de 218 preguntas. Con los datos completos de tres cursos académicos, desde 2008-2009 hasta el curso 2010-2011, los resultados de la experiencia se exponen en esta ponencia y se pueden calificar de esperanzadores

Effect of Fish Oil Parenteral Emulsion Supplementation on Inflammatory Parameters after Esophagectomy

(Background) Esophagectomy (EPG) presents high morbidity and mortality. Omega-3 fatty acids (omega-3FA) are a pharmaconutrient with benefits for postoperative morbidity. Studies of omega-3FA administered parenterally after esophagectomy are scarce. This study proposes to investigate the effect of combining fish oil lipid emulsions (LE) administered parenterally with enteral nutrition support. (Methods) Randomization was 1:1:1 in three groups: Group A received a LE mixture of 0.4 g/kg/day of fish oil and 0.4 g/kg/day of LCT/MCT 50:50, Group B received 0.8 g/kg/day of fish oil LE, and Group C received 0.8 g/kg/day of LCT/MCT 50:50. Variables were measured at recruitment time and day +1, +3, and +5. Inflammatory variables studied were Interlukin-6, C-reactive protein (CRP), tumoral necrosis factor-alpha (TNF-alpha), IL-10, IL-8 and CD25s. Safety, nutritional parameters and complications were analyzed. (Results) Administration of omega-3LE in the immediate postoperative period did not modulate the earlier inflammatory response. Statistically significant differences were found in IL-6 and CRP overall temporal evolution but were not found when studying the type of LE administered or in patients needing critical care. Administration of omega-3 resulted in safe and improved hypertriglyceridemia, depending on the dose. (Conclusions) omega-3FA has no impact on the early inflammatory postoperative response assessed for a short period but was safe. More studies for longer periods are needed

Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery

[ES] La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC) ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva.[EN] Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery

Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection

[ES] La infección de localización quirúrgica es la complicación más frecuente y más evitable de la cirugía, pero las guías clínicas para su prevención tienen un seguimiento insuficiente. Presentamos los resultados de un consenso Delphi realizado por un panel de expertos de 17 sociedades científicas con revisión crítica de la evidencia científica y guías internacionales, para seleccionar las medidas con mayor grado de evidencia y facilitar su implementación. Se revisaron 40 medidas y se emitieron 53 recomendaciones. Se priorizan 10 medidas principales para su inclusión en bundles de prevención: ducha preoperatoria; correcta higiene quirúrgica de manos; no eliminación del vello del campo quirúrgico o eliminación con maquinilla eléctrica; profilaxis antibiótica sistémica adecuada; uso de abordajes mínimamente invasivos; descontaminación de la piel con soluciones alcohólicas; mantenimiento de la normotermia; protectores-retractores plásticos de herida; cambio de guantes intraoperatorio, y cambio de material quirúrgico y auxiliar antes del cierre de las heridas.[EN] Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.Peer reviewe

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Recursive estimation of a partition. Learning examples in R-expN and I-expN

Nous allons présenter dans cet article un algorithme de classification du type auto-apprentissage qui peut traiter des données multidimensionnelles continues à l'intérieur du cube unitaire: CLRO. La première partie traite de divers concepts généraux régissant, à notre avis, les algorithmes d'auto-apprentissage. Dans une deuxième partie nous supposerons que les données ne peuvent prendre que les deux seules valeurs 0 ou 1; ceci nous permettra d'établir une estimation récursive d'une loi de probabilité répresentée de façon exponentielle ayant un forme particulièrment simple. Nous généraliserons ensuite au cas des données réelles comprises entre 0 et 1. On montre que, moyennant certaines hypothèses simplificatrices que l'on justifie, l'algorithme conserve sa forme simple. La troisième partie traite, sous le schéma général, le cas de la classification automatique de points dans l'espace RN, considérés munis de mesures gausiennes. L'algorithme est développé avec le souci de la simplicité des calculs en vue de son utilisation en ligne de façon récursive. Il procède a l'estimation de la moyenne et de la covariance des classes au fur et à la mesure qu'elles sont crées et modifiées selon les principes décrits pour l'auto-apprentissage. Nous donnons un example d'application à la reconaissance d'objects en Robotique.In this paper we present two algorithms, based on a self learning process, for the sequential classification of multidimensional data. In the first part we discuss the general aspects of sequential learning algorithms. In the second part we describe an algorithm for the sequential classification of data in the unit cube I^n, i.c. data whose values are between 0 and 1. In the third part we describe another algorithm to classify gaussian data in R^n. Finally, we discuss an application of these algorithms to the problem of object recognition in robotics, and we compare the results and the computation time obtained with both algorithms

Què s'ha fet en el pla d'igualtat de gènere?

Podeu consultar la Setena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/4335