Comparación entre dos tipos de gastrostomías quirúrgicas, abierta y laparoscópica, en nutrición enteral domiciliaria

Objetivo: Exponer las complicaciones de las gastrostomías quirúrgicas utilizadas como vía de soporte nutricional enteral domiciliario (SNED) y detectar si existen diferencias entre las dos técnicas usadas en nuestro medio: Cirugía abierta vs laparoscópica. Material y métodos: Estudio observacional descriptivo de carácter retrospectivo de las gastrostomías quirúrgicas realizadas entre los años 1994 y 2009 seguidas por nuestra unidad. Se han analizado las complicaciones detectadas en consulta durante el seguimiento de pacientes con SNED a través de gastrostomía quirúrgica realizada con técnica laparotómica abierta vs laparoscópica, valorando: fuga del contenido gástrico al exterior, irritación de la pared abdominal, presencia de exudado, presencia de exudado con cultivo positivo que requirió tratamiento antibiótico, quemadura o pérdida de sustancia de la zona periostomía, rotura de balón, úlcera de decúbito por la sonda y formación de granuloma. Resultados: Durante los años 1994-2009 se realizaron 57 gastrostomías quirúrgicas: 47 por técnica laparótomica (abierta) convencional y 10 por vía laparoscópica. La edad media de los pacientes fue de 57,51 ± 17,29 años. La causa más frecuente que motivó la realización de la gastrostomía quirúrgica fue el cáncer de esófago (38,6%) seguido de alteraciones neurológicas (26,3%) y tumores de cabeza y cuello (26,3%). El 97,9% de los pacientes a los que se realizó una gastrostomía quirúrgica abierta presentaron al menos una complicación, es decir que solo el 2,1% estuvieron libres de complicaciones; mientras que el 50% de los que se sometieron a una gastrostomía laparoscópica no tuvo ninguna. Las complicaciones más frecuentes fueron la presencia de fuga del contenido gástrico y la irritación de la pared abdominal que se presentaron en el 89,4% y 83% respectivamente de las gastrostomías laparotómicas frente a la aparición de solo el 30% de ambas complicaciones en las gastrostomías laparoscópicas siendo la diferencia estadísticamente significativa (p Aim: Exposing the complications of surgical gastrostomies used as way of home enteral nutritional support (HEN) and detecting the differences between the two techniques used in our environment: Open Surgery vs Laparoscopic Surgery. Material and methods: Retrospective descriptive observational study of the surgical gastrostomies performed between 1994 and 2009 followed up by our unit. Have been analyzed the complications detected in our practice during the follow-up of patients with HEN performed via open laparotomy vs. laparoscopic tecniques, assessing: leaks of gastric fluid to the exterior, abdominal wall irritation, presence of exudate, presence of exudate with positive culture that required antibiotical treatment, burning or loss of substance of the periostomic zone, breach of balloon, decubitus ulcer caused by the tube and formation of granuloma. Results: Between 1994 and 2009, 57 surgical gastrostomies were performed: 47 using the conventional laparotomic (open) tecnique and 10 laparoscopies. The average age of the patients was 57.51 ± 17.29 years old. The most common cause for the performance of surgical gastrostomy was esophageal cancer (38.6%) followed by neurologic alterations (26.3%) and head and neck tumors (26.3%). 97.9% of the patients who underwent to surgical gastrostomy presented at least one complication, meaning that only 2.1% were free of complications; meanwhile, 50% of the patients were laparoscopic gastrostomy was performed had none of these complications. The most common complications were the presence of leaks of gastric fluid and abdominal wall irritation that appeared on 89.4% and 83% respectively of the laparotomic gastrostomies versus the presence of only 30% of both complications in laparoscopic gastrostomies being the difference statistically significant (p < 0.01). Conclusions: After the introduction of the laparoscopic technique in the performance of surgical gastrostomies has been observed a decrease of the complications occured during the home enteral nutritional support related to surgical gastrostomies

Stereoscopic disambiguation of vector magnetograms: first applications to SO/PHI-HRT data

Spectropolarimetric reconstructions of the photospheric vector magnetic field are intrinsically limited by the 180$^\circ$-ambiguity in the orientation of the transverse component. So far, the removal of such an ambiguity has required assumptions about the properties of the photospheric field, which makes disambiguation methods model-dependent. The basic idea is that the unambiguous line-of-sight component of the field measured from one vantage point will generally have a non-zero projection on the ambiguous transverse component measured by the second telescope, thereby determining the ``true'' orientation of the transverse field. Such an idea was developed and implemented in the Stereoscopic Disambiguation Method (SDM), which was recently tested using numerical simulations. In this work we present a first application of the SDM to data obtained by the High Resolution Telescope (HRT) onboard Solar Orbiter during the March 2022 campaign, when the angle with Earth was 27 degrees. The method is successfully applied to remove the ambiguity in the transverse component of the vector magnetogram solely using observations (from HRT and from the Helioseismic and Magnetic Imager), for the first time. The SDM is proven to provide observation-only disambiguated vector magnetograms that are spatially homogeneous and consistent. A discussion about the sources of error that may limit the accuracy of the method, and of the strategies to remove them in future applications, is also presented.Comment: 32 pages, 12 figures, accepted in A&A on 09/07/202

End-to-end tests of the TuMag instrument for the SUNRISE III mission

Ground-based and airborne instrumentation for astronomy IX (2022), Montreal, jul 17-22, 2022.--Proceedings of SPIE - The International Society for Optical Engineering vol. 12184 Article number 121842FSUNRISE III mission is a one-meter aperture telescope onboard a balloon within NASA Long Duration Balloon Program. Three post-focus instruments are used for studying the Sun's dynamics and magnetism, among which the Tunable Magnetograph (TuMag) is a tunable imaging spectropolarimeter. TuMag is a diffraction-limited imager, a high sensitivity polarimeter (< 10(-3)), and a high-resolution spectrometer (Delta lambda similar to 65 m angstrom). It will be able to study solar magnetic fields at high spatial resolution (similar to 100 km on the solar surface). It will make images of the solar surface magnetic field after measuring the state of polarization of light within three selected spectral lines: the Fe I lines at 525.02 nm and 525.06 nm, and the Mg I b2 line at 517.27 nm. It will be sensitive to the solar vector magnetic fields and line-of-sight velocities, in the photospheric and chromospheric layers. TuMag will be the first solar magnetograph onboard an aerospace platform with the capability of tuning the solar line to be observed. In this paper the TuMag end-to-end tests carried out during the verification phase are described. These tests are performed to characterize and calibrate the instrument. Specifically, they determine the polarimetric and spectroscopic performances of the instrument as well as the image quality. The availability of a singular facility, an ISO6 clean room with a coelostat on the building roof, allowed the use of solar light during the verification campaign. This was key to a complete instrument verification due to the unique spectroscopic and polarimetric characteristics of solar light.The authors would like to thank Ministerio de Ciencia e Innovacion from the Spanish government for the support of this research via the grant Space Solar Physics RTI2018-096886-B-C5 and "Centro de Excelencia Severo Ochoa" grant SEV-2017-0709.Peer reviewe

Causas e impacto clínico de la desnutrición y caquexia en el paciente oncológico Causes and impact of hyponutrition and cachexia in the oncologic patient

La expresión máxima de desnutrición en el cáncer es la caquexia tumoral, que será responsable directa o indirecta de la muerte en un tercio de los pacientes con cáncer. Las causas de desnutrición en el cáncer están relacionadas con el tumor, con el paciente o con los tratamientos y de forma resumida podemos diferenciar 4 grandes mecanismos por los que puede aparecer desnutrición en el paciente canceroso: &bull; Escaso aporte de energía y nutrientes. &bull; Alteraciones de la digestión y/o absorción de nutrientes. &bull; Aumento de las necesidades. &bull; Alteraciones en el Metabolismo de los nutrientes. El tratamiento oncológico, en cualquiera de sus vertientes induce la aparición de desnutrición, sobre todo en aquellos casos en que se administran varios tratamientos para la curación del cáncer (cirugía, radioterapia y quimioterapia). La desnutrición en el paciente neoplásico produce una disminución de masa muscular que conlleva una pérdida de fuerza que tiene importantes consecuencias sobre el estado funcional del individuo, pues aumenta la dependencia de cuidados por terceros (familiares o cuidadores) y disminuye su calidad de vida. La desnutrición se asocia, además, a una menor respuesta a la radioterapia y a la quimioterapia, o a una peor tolerancia a éstas. La desnutrición también altera los mecanismos de cicatrización y aumenta el riesgo de complicaciones quirúrgicas tales como la deshiscencia de suturas e infecciones. Tanto las complicaciones infecciosas como las derivadas de la cirugía comportan un aumento de la estancia hospitalaria, circunstancias que contribuyen a elevar los costes de los tratamientos. En último término, no deben olvidarse los efectos de la desnutrición sobre la mortalidad, asociándose la pérdida de peso severa a una menor supervivencia.The maximal expression of hyponutrition in cancer is tumoral cachexia, which will direct or indirectly account for mortality in one third of cancer patients. Causes of hyponutrition in cancer are related with the tumor, the patient, or therapies, and summarily we may differentiate four main mechanisms by which hyponutrition may occur in cancer patients: &bull; Poor energy and nutrients intake &bull; Impairments of nutrient digestion and/or absorption &bull; Increased demands &bull; Impairments of nutrient metabolism Any modality of oncologic therapy induces hyponutrition occurrence, especially in those cases in which several therapies are administered to cure cancer (surgery,radiotherapy, chemotherapy). Hyponutrition in cancer patients produces a decrease in muscle mass, which leads to strength loss, having important consequences on functional status of the individual since it increases dependence on others (relatives, caregivers) and decreases quality of life. Besides, hyponutrition is associated to poorer response to radiotherapy and chemotherapy, or poorer tolerability of such therapies. Hyponutrition also impairs scarring mechanisms and increases the risk for surgical complications such as suture dehiscence or infections. Both infectious complications and surgically derived complications entail longer hospital staying, which contributes to increase management costs. Finally, effects of hyponutrition on mortality should not be neglected, with severe weight loss being associated to lower survival

Causes and impact of hyponutrition and cachexia in the oncologic patient

English Abstract; Journal Article; Review;The maximal expression of hyponutrition in cancer is tumoral cachexia, which will direct or indirectly account for mortality in one third of cancer patients. Causes of hyponutrition in cancer are related with the tumor, the patient, or therapies, and summarily we may differentiate four main mechanisms by which hyponutrition may occur in cancer patients: Poor energy and nutrients intake; Impairments of nutrient digestion and/or absorption; Increased demands; Impairments of nutrient metabolism; Any modality of oncologic therapy induces hyponutrition occurrence, especially in those cases in which several therapies are administered to cure cancer (surgery, radiotherapy, chemotherapy). Hyponutrition in cancer patients produces a decrease in muscle mass, which leads to strength loss, having important consequences on functional status of the individual since it increases dependence on others (relatives, caregivers) and decreases quality of life. Besides, hyponutrition is associated to poorer response to radiotherapy and chemotherapy, or poorer tolerability of such therapies. Hyponutrition also impairs scarring mechanisms and increases the risk for surgical complications such as suture dehiscence or infections. Both infectious complications and surgically derived complications entail longer hospital staying, which contributes to increase management costs. Finally, effects of hyponutrition on mortality should not be neglected, with severe weight loss being associated to lower survival.YesLa expresión máxima de desnutrición en el cáncer es la caquexia tumoral, que será responsable directa o indirecta de la muerte en un tercio de los pacientes con cáncer. Las causas de desnutrición en el cáncer están relacionadas con el tumor, con el paciente o con los tratamientos y de forma resumida podemos diferenciar 4 grandes mecanismos por los que puede aparecer desnutrición en el paciente canceroso: • Escaso aporte de energía y nutrientes. • Alteraciones de la digestión y/o absorción de nutrientes. • Aumento de las necesidades. • Alteraciones en el Metabolismo de los nutrientes. El tratamiento oncológico, en cualquiera de sus vertientes induce la aparición de desnutrición, sobre todo en aquellos casos en que se administran varios tratamientos para la curación del cáncer (cirugía, radioterapia y quimioterapia).La desnutrición en el paciente neoplásico produce una disminución de masa muscular que conlleva una pérdida de fuerza que tiene importantes consecuencias sobre el estado funcional del individuo, pues aumenta la depeny disminuye su calidad de vida. La desnutrición se asocia, además, a una menor respuesta a la radioterapia y a la quimioterapia, o a una peor tolerancia a éstas. La desnutrición también altera los mecanismos de cicatrización y aumenta el riesgo de complicaciones quirúrgicas tales como la deshiscencia de suturas e infecciones. Tanto lascomplicaciones infecciosas como las derivadas de la ciruía comportan un aumento de la estancia hospitalaria, circunstancias que contribuyen a elevar los costes de los tratamientos. En último término, no deben olvidarse los efectos de la desnutrición sobre la mortalidad, asociándose la pérdida de peso severa a una menor supervivencia

Comparación entre dos tipos de gastrostomías quirúrgicas, abierta y laparoscópica, en nutrición enteral domiciliaria

Aim: Exposing the complications of surgical gastrostomies used as way of home enteral nutritional support (HEN) and detecting the differences between the two techniques used in our environment: Open Surgery vs Laparoscopic Surgery. Material and methods: Retrospective descriptive observational study of the surgical gastrostomies performed between 1994 and 2009 followed up by our unit. Have been analyzed the complications detected in our practice during the follow-up of patients with HEN performed via open laparotomy vs. laparos-copic tecniques, assessing: leaks of gastric fluid to the exterior, abdominal wall irritation, presence of exudate, presence of exudate with positive culture that required antibiotical treatment, burning or loss of substance of the periostomic zone, breach of balloon, decubitus ulcer caused by the tube and formation of granuloma. Results: Between 1994 and 2009, 57 surgical gastrostomies were performed: 47 using the conventional laparotomic (open) tecnique and 10 laparoscopies. The average age of the patients was 57.51 ± 17.29 years old. The most common cause for the performance of surgical gastrostomy was esophageal cancer (38.6%) followed by neurologic alterations (26.3%) and head and neck tumors (26.3%). 97.9% of the patients who underwent to surgical gastrostomy presented at least one complication, meaning that only 2.1% were free of complications; meanwhile, 50% of the patients were laparoscopic gastrostomy was performed had none of these complications. The most common complications were the presence of leaks of gastric fluid and abdominal wall irritation that appeared on 89.4% and 83% respectively of the laparotomic gastrostomies versus the presence of only 30% of both complications in laparoscopic gastrostomies being the difference statistically significant (p < 0.01). Conclusions: After the introduction of the laparoscopic technique in the performance of surgical gastrostomies has been observed a decrease of the complications occured during the home enteral nutritional support related to surgical gastrosto-mies.Peer Reviewe

Brazilian scientific production on pharmaceutical care from 1990 to 2009

Brazilian scientific production on pharmaceutical care was identified based on articles indexed on the Medline, Embase, Lilacs, Web of Science and International Pharmaceutical Abstracts databases. Sixty-three articles published in both national and international journals were retrieved. With regard to authors, 72.3% were from the Southeast and South Regions, and 60.8% were affiliated to public universities. In relation to the type of studies, 85.7% were descriptive, and the most frequently researched fields were community pharmacies, hospitals and primary health care units. Articles were original in 65.1% of cases, updates in 20.6%, and reviews in 7.9%. An increase in publications commenced in 2006. In 31.7% of cases, authors had adopted a bibliographical study design, 28.6% qualitative study, 23.8% intervention, and 15.9% observational study design. The most researched subjects were elderly with chronic diseases. The importance of stimulating the conducting of experimental and qualitative studies, as well as amplifying authorship affiliated with the service area, foreign authors and with research in a wide variety of practice settings were highlighted. Despite the limited quantity of articles, an increase in their number as well as in their scope and quality is expected, so as to create further knowledge that contributes to the recognition of pharmacists' actions by patient healthcare teams.<br>Identificam-se características da produção científica brasileira sobre atenção farmacêutica, a partir de artigos indexados nas bases Medline, Embase, Lilacs, Web of Science e International Pharmaceutical Abstracts. Foram localizados 63 artigos em revistas nacionais e internacionais. Em relação aos autores, 72,3% pertenciam as Regiões Sudeste e Sul e 60,8% estavam vinculados a universidades públicas. Quanto ao tipo de pesquisa, 85,7% foram descritivas, sendo campos mais pesquisados: farmácias comunitárias, hospitais e unidades básicas de saúde. Os artigos foram considerados originais (65,1%), atualizações (20,6%) e revisões (7,9%). O aumento das publicações se deu a partir de 2006. Em 31,7% dos casos os autores optaram por estudo bibliográfico, 28,6% qualitativo, 23,8% de intervenção e 15,9% observacional. Os principais sujeitos pesquisados foram idosos com enfermidades crônicas. Aponta-se a importância de estimular a realização de estudos experimentais e qualitativos, ampliar a autoria vinculada à área de serviços, o vínculo com autores estrangeiros e a pesquisa em todos os ambientes de prática. Apesar da quantidade limitada de artigos espera-se aumento de seu número, abrangência e qualidade de forma a gerar conhecimento que contribua para o reconhecimento das ações do farmacêutico na equipe de atenção ao paciente

Higher Fluid Balance Increases the Risk of Death from Sepsis: Results from a Large International Audit∗

Objectives: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Design: Observational cohort study. Setting: Seven hundred and thirty ICUs in 84 countries. Patients: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. Measurements and Main Results: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. Conclusions: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death