Early Postoperative Monitoring of the Liver Graft

Liver transplantation (LT) is a common current technique for end-stage liver disease. Complications after the surgical procedure, though uncommon, can be of very different origin and can also be severe enough to lead to liver and multiorgan failure and finally graft loss and/or recipient’s death. Intensivists and the surgical team must be familiarized with these early complications to detect them as soon as possible in order to use the best diagnostic tools and take the best therapeutic measures to restore anatomical integrity and organ function to optimize the liver graft. In this chapter, we present an updated state of the art for efficiently tackling with all different, most usual complications that an LT patient can present during early postoperative period

Chemical factors controlling the steady-state distribution of mixed carbonate-siliciclastic sediments in Bayona Bay (northwest Spain)

The relative space distributions of single mineral constituents in mixed terrigenous-carbonated sediments of the Bayona Bay have been analysed. In order to determine the existence of different mixing mechanisms, a study comparing the general sedimentary trends resulting from the average patterns and the single mineral behaviour, reflected in the single-mineral mapping, was carried out. The relative abundance of all mineral phases in surface sediment samples was first determined by quantitative X-ray powder diffraction data, using the Rietveld method. This procedure enabled us to create specific maps for both the minerals forming the terrigenous fraction and the different calcium carbonate polymorphs involved in the carbonatic component. A cross-linked behaviour between the carbonate facies and the terrigenous minerals involved in the calcium carbonate generation was found, suggesting the existence of a chemical control mechanism which, through dissolution-crystallization processes, constrains the mixed environment's long-term evolution. In the general framework of the region studied, these relations operate for the relative amount of plagioclase to calcium carbonate. The existence of dissolution and growth between both minerals, favoured by the high rate of removal, is proposed, yielding a final crossed pattern, representative of the steady-state. Furthermore, a specific analysis, restricted to the region of low rate of material removal and maximum amount of intermixed sediments, clearly shows an anisotropic distribution for every calcium carbonate polymorph (calcite and aragonite). These correlate with the biotite distribution, and can be connected to local variations in seawater Mg/Ca ratio, induced by biotite weathering.En este trabajo se analiza de forma específica la distribución espacial de cada uno de los minerales involucrados en sedimentos mixtos terrígenos-carbonatados de la bahía de Bayona y se compara con la distribución global de sedimentos, tal como resulta de análisis granulométricos, con el fin de determinar la existencia de diferentes mecanismos de mezcla entre los minerales de ambas fracciones. El contenido porcentual en peso de cada fase mineral, en muestras superficiales de sedimento, se determinó a partir de datos cuantitativos de DRX, empleando el método de Rietveld. Este procedimiento nos ha permitido realizar mapas específicos de distribución, tanto para cada mineral de la fracción terrígena como para cada uno de los diferentes polimorfos de carbonato cálcico en la componente carbonatada. Como resultado de este estudio comparativo, se ha encontrado una correlación, en la distribución espacial y granulométrica, de las facies carbonatadas y los minerales terrígenos implicados en la generación de carbonato cálcico. Un posterior análisis de este resultado sugiere la presencia de mecanismos químicos de control que regulan la interacción entre siliciclastos y carbonatos mediante procesos de disolución-cristalización mediados por el agua del mar. El estudio se ha realizado a dos escalas. En el ámbito general de la bahía de Bayona, las relaciones de distribución observadas entre plagioclasas y carbonato cálcico pueden ser explicadas, dentro del balance global del Ca³⁺ disuelto en el agua del mar, mediante la meteorización química de las plagioclasas y la consiguiente generación de carbonatos. En este caso, los patrones de distribución reflejan la aproximación a un estado estacionario mediante sucesivos eventos de mezcla asociados a la alta removilización material en el medio, tanto para la distribución porcentual en peso como para la distribución granulométrica entre ambos minerales. Finalmente, se realiza un análisis particularizado en una región con baja tasa de removilización y donde la interacción entre sedimentos de ambas fracciones es máxima. El resultado muestra claramente una distribución espacial anisótropa para cada uno de las fases de carbonato cálcico (calcita y aragonito). La abundancia relativa de cada uno de los polimorfos, así como el contenido en Mg³⁺ de la calcita, ha sido correlacionado con la distribución de la biotita y explicado a partir de las diferencias de solubilidad en función de la alta relación Mg³⁺ /Ca³⁺ en el agua de mar que resulta, localmente, de la meteorización química de dicho mineral.Instituto Español de Oceanografí

Immigration, work and health in Spain: the influence of legal status and employment contract on reported health indicators

Objective To analyze the relationship of legal status and employment conditions with health indicators in foreign-born and Spanish-born workers in Spain. Methods Cross-sectional study of 1,849 foreign-born and 509 Spanish-born workers (2008–2009, ITSAL Project). Considered employment conditions: permanent, temporary and no contract (foreign-born and Spanish-born); considered legal statuses: documented and undocumented (foreign-born). Joint relationships with self-rated health (SRH) and mental health (MH) were analyzed via logistical regression. Results When compared with male permanently contracted Spanish-born workers, worse health is seen in undocumented foreign-born, time in Spain ≤3 years (SRH aOR 2.68, 95% CI 1.09–6.56; MH aOR 2.26, 95% CI 1.15–4.42); in Spanish-born, temporary contracts (SRH aOR 2.40, 95% CI 1.04–5.53); and in foreign-born, temporary contracts, time in Spain >3 years (MH: aOR 1.96, 95% CI 1.13–3.38). In females, highest self-rated health risks are in foreign-born, temporary contracts (aOR 2.36, 95% CI 1.13–4.91) and without contracts, time in Spain >3 years (aOR 4.63, 95% CI 1.95–10.97). Conclusions Contract type is a health determinant in both foreign-born and Spanish-born workers. This study offers an uncommon exploration of undocumented migration and raises methodological issues to consider in future research.The study was funded partially by Fondo de Investigaciones Sanitarias [Spanish Fund for Health Research] grant numbers FIS PI050497, PI052334, PI061701

Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units.

The COVID-19 pandemic created tremendous challenges for health-care systems. Intensive care units (ICU) were hit with a large volume of patients requiring ICU admission, mechanical ventilation, and other organ support with very high mortality. The Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), a network of Spanish researchers to investigate in respiratory disease, commissioned the current proposal in response to the Instituto de Salud Carlos III (ISCIII) call. CIBERESUCICOVID is a multicenter, observational, prospective/retrospective cohort study of patients with COVID-19 admitted to Spanish ICUs. Several work packages were created, including study population and ICU data collection, follow-up, biomarkers and miRNAs, data management and quality. This study included 6102 consecutive patients admitted to 55 ICUs homogeneously distributed throughout Spain and the collection of blood samples from more than 1000 patients. We enrolled a large population of COVID-19 ICU-admitted patients including baseline characteristics, ICU and MV data, treatments complications, and outcomes. The in-hospital mortality was 31%, and 76% of patients required invasive mechanical ventilation. A 3-6 month and 1 year follow-up was performed. Few deaths after 1 year discharge were registered. Low anti-SARS-CoV-2 S antibody levels predict mortality in critical COVID-19. These antibodies contribute to prevent systemic dissemination of SARS-CoV-2. The severity of COVID-19 impacts the circulating miRNA profile. Plasma miRNA profiling emerges as a useful tool for risk-based patient stratification in critically ill COVID-19 patients. We present the methodology used in a large multicenter study sponsored by ISCIII to determine the short- and long-term outcomes in patients with COVID-19 admitted to more than 50 Spanish ICUs

Major candidate variables to guide personalised treatment with steroids in critically ill patients with COVID-19: CIBERESUCICOVID study.

Although there is evidence supporting the benefits of corticosteroids in patients affected with severe coronavirus disease 2019 (COVID-19), there is little information related to their potential benefits or harm in some subgroups of patients admitted to the intensive care unit (ICU) with COVID-19. We aim to investigate to find candidate variables to guide personalized treatment with steroids in critically ill patients with COVID-19. Multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish ICUs. The primary outcome was 90-day mortality. Subsequent analyses in clinically relevant subgroups by age, ICU baseline illness severity, organ damage, laboratory findings and mechanical ventilation were performed. High doses of corticosteroids (≥ 12 mg/day equivalent dexamethasone dose), early administration of corticosteroid treatment ( Between February 2020 and October 2021, 4226 patients were included. Of these, 3592 (85%) patients had received systemic corticosteroids during hospitalisation. In the propensity-adjusted multivariable analysis, the use of corticosteroids was protective for 90-day mortality in the overall population (HR 0.77 [0.65-0.92], p = 0.003) and in-hospital mortality (SHR 0.70 [0.58-0.84], p  Corticosteroid in ICU-admitted patients with COVID-19 may be administered based on age, severity, baseline inflammation, and invasive mechanical ventilation. Early administration since symptom onset may prove harmful

Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients

Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19