Efecto de la inclusión en la dieta de hidrolizado proteico de pescado sobre el crecimiento corporal y composición proximal del músculo de doncella (Pseudoplatystoma punctifer)

The effect of including fish protein hydrolyzate in the diet on body growth and proximate composition of the muscle of juvenile spotted tiger shovelnose catfish (Pseudoplatystoma punctifer) was evaluated. A completely randomized experimental design with a 2x4 factorial arrangement (2 diets, 4 sampling times [days 15, 30, 45 and 60]) was used, resulting in 8 treatments with 3 replications each. The formulated diets were isocaloric (42.15% CP) and isoproteic (4 415.69 kcal EB kg-1): a control (DT; without supplementation) and another with the inclusion of 1.20% fish protein hydrolyzate (DHP) in substitution of fishmeal. A total of 114 juveniles (642.65 g; 47.93 cm) were distributed in excavated ponds of 200 m2 (19 fish/pond) for 60 days. Every 15 days, eight fish per experimental unit were captured to evaluate body growth (final weight FW, final length FL, weight gain WG, length gain LG, specific growth rate SGR, feed conversion FC, protein efficiency rate PER). survival S and condition factor CF). In addition, three fish per experimental unit on days 0 and 60 of the experiment were slaughtered for muscle chemical composition analysis. DHP did not affect FL, LG, PER, S, CF, or proximal muscle composition; however, the fish fed with the DHP diet presented better performance expressed in FW (1049.17 g vs. 919.56 g), WG (406.52 g vs. 276.91 g) and SGR (0.82 vs. 0.60) at 60 days of feeding, as well as better CF compared to the diet without supplementation.Se evaluó el efecto de la inclusión en la dieta de hidrolizado proteico de pescado sobre el crecimiento corporal y la composición química del músculo de juveniles de doncella.  El estudio siguió un diseño experimental completamente al azar con un arreglo factorial de 2 x 4 [2 dietas vs. 4 tiempos de muestreo (15°, 30°, 45° y 60° día)], resultando en 8 tratamiento con 3 repeticiones cada uno. Los tratamientos fueron: T1: DT15; T2: DHP15; T3: DT30;  T4: DHP30; T5: DT45; T6: DHP45; T7: DT60 y T8: DHP60. Las dietas formuladas fueron isocalóricas (42.15% PB) e isoproteicas (4,415.69 kcal EB kg-1): una testigo (DT; sin suplementación) y otra con inclusión de 1.20% de hidrolizado proteico de pescado (DHP) en substitución de la harina de pescado. Un total de 114 doncellas (642.65 g; 47.93 cm) fueron distribuidas en estanques excavados de 200 m2 (19 peces/estanque) y alimentadas con las dietas experimentales durante 60 días. Cada 15 días, ocho peces por unidad experimental fueron capturados para evaluar el crecimiento corporal de los animales (peso final PF, longitud final LF, ganancia de peso GP, ganancia de longitud GL, tasa de crecimiento específico TCE, conversión alimenticia CA, tasa de eficiencia proteica TEP, sobrevivencia S y factor de condición FC). Adicionalmente, al iniciar (día 0) y finalizar (día 60) el experimento tres peces por unidad experimental fueron sacrificados por punción cerebral para análisis de composición química del músculo. DHP no afectó la LT, GL, TEP, S, FC, ni la composición proximal del músculo de doncella; sin embargo, juveniles de esta especie alimentados con dieta suplementada presentaron mejor desempeño expresados en PF (1049.17 g vs. 919.56 g), GP (406.52 g vs. 276.91 g)y TCE (0.82 vs. 0.60) a los 60 días de alimentación, así como mejor CA en comparación con la dieta sin suplementación

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Compilación de Proyectos de Investigacion de 1984-2002

Instituto Politecnico Nacional. UPIICS

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research