Calidad microbiológica de una fórmula enteral lista para usar

Indexación: ScieloTo determinate and compare the microbiological quality of a ready to use enteral formula (EF): liquid ADN™ during different periods of time. Methods: The study was developed in the Hospital formula-preparing room. Twenty liters of EF were delivered in 40 plastic sterile bottles using aseptic technique, and were maintained at room temperature during 24 hours. Feed samples of 50 ml at time 0 and at 24 hours were obtained and frozen at _70º C, until they were investigated (40 feed samples of EF were cultivated at preparation time 0, and 24 hours). Mesophile count (Me), total coliform (TC) and faecal coliform (FC) bacteria were investigated. The feed samples were analized at the Microbiologic Laboratory of CESMEC. The microbial quality standards (MQS) were at time 0: < 10² UFC/ml of (Me), and no (TC) and (FC). At 24 hours: < 10³ UFC/ml of (Me), < 10 UFC/ml of (TC) and no (FC).The statistical data analysis was done using Stata program and Z test was used for proportions. The level of p < 0,05 was considered statistically significant. Results: The average of fulfilment (MQS) for liquid ADN™ at time 0, and 24 hours was 100% and 95% (p = 0,3) for Me. TC got 100% fulfilment (MQS) at any time. FC were not detected at any time. Conclusions: Liquid ADN™can be hung during 24 hours at room temperature.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182004000400005&nrm=is

Comparación entre nutrición enteral precoz y nutrición enteral tardía en el estado nutricional de pacientes gastrectomizados

Indexación: ScieloLa nutrición enteral (NE) es un método efectivo para cubrir los requerimientos nutricionales en pacientes que presentan un estado nutricional deteriorado. Objetivos: Comparar la Nutrición Enteral Precoz (NEP) versus Nutrición Enteral Tardía (NET) en la evolución clínica y nutricional de pacientes sometidos a gastrectomía total por Cáncer Gástrico. Material y Método: 18 pacientes con cáncer gástrico resecable, fueron estudiados con parámetros antropométricos, funcionales y bioquímicos que evalúan el estado nutricional, en el período preoperatorio y postoperatorio. Recibieron una fórmula enteral polimérica (1 kcal/ml) en el período postoperatorio. De manera aleatoria fueron asignados al tipo de nutrición (precoz o tardía). Resultados: El grupo con NEP presentó mejoría significativa del porcentaje de adecuación del pliegue bicipital y dinamometría. El grupo con NET presentó disminución significativa de la albuminemia. La distensión abdominal fue más frecuente en grupo con NEP. Conclusión: La Nutrición Enteral Precoz es un soporte nutricional seguro, eficaz y que trae consigo ventajas nutricionales en comparación con la Nutrición Enteral Tardía en el grupo de pacientes gastrectomizados totales por presentar cáncer gástrico.Enteral nutrition (EN) is an effective method to meet the nutritional requirements in patients who have a deteriorated nutritional status. Objectives: To compare clinical and nutritional performance oftwo groups: Early Enteral Nutrition (EEN) versus Late Enteral Nutrition (LEN) of patients undergoing to total gastrectomy for gastric cancer. Material and Methods: 18 patients with resectable gastric cancer were studied with anthropometric, functional and biochemical parameters to assess nutritional status in the preoperative and postoperative period. They received a polimeric enteral formula (1 kcal/ml) in the postoperative period. They were randomly assigned to the type of nutrition (early or late). Results: The group with EEN had a significant improvement in the bicipital fold adequacy percentage and dynamometry. The LEN group had a significant decrease of albumin. The bloating was more fre quent in the group with EEN. Conclusion: Early enteral nutrition is a safe nutritional support, effective and that brings nutritional benefits compared with late enteral nutrition in patients undergoing to total gastrectomy for gastric cancer.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-75182009000100002&nrm=is

Aplicación de un cuestionario de sueño y la escala de somnolencia de Epworth en un centro de salud familiar

Sleep disorders, especially sleep breathing disorders, have not been well studied in the patients attending a family health center in Chile. Sleep breathing disorders have been linked to cardiovascular and cerebrovascular diseases, which are important causes of morbidity and mortality. Method: We studied a randomized sample of 180 adult patients (135 women and 45 men, with a mean age of 45.6 years) consulting a public family health center with the Epworth Sleepiness Scale and a Sleep Questionnaire which include assessment of obesity, medical conditions, medications and smoking habit, blood pressure, sleep habits, snoring, breathing cessation, insomnia, daytime sleepiness and depressive symptomatology. Results: Hypertension was found in 37.2%, diabetes in 11.1%, dislipidemia in 19.4%, smoking in 34.4%. Body mass index ≥ of 30 Kg/m2 was found in 38.3%. Twenty five patients (13.9%) had an Epworth score ≥ of 15. Loud snoring was reported in 56.7%. Breathing cessation was reported by the spouses in 21.7%. Difficulty for sleep initiation was present in 21.7% and to maintain sleep in 21.7%. Daytime sleepiness was present in 29.4%. Twelve patients (6.7%) had the highest score in a visual analog scale for daytime somnolence. An affirmative answer for persistent sadness or low mood and loss of interest or pleasure in the last month was reported by 43.8% of the patients. Conclusion: It is noteworthy the high frequency of undiagnosed sleep disorders found in a population consulting by others pathologies. These results would be useful for the planning of public health programs which should include sleep disorders

Edoxaban versus warfarin in patients with atrial fibrillation

Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)

Ezetimibe added to statin therapy after acute coronary syndromes

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization ( 6530 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit