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ABSTRACT Objective: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. Data sources: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. Methods: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. Primary endpoint: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. Discussion: This systematic review with aggregate and individual patient data will address the clinical question, ‘what is the best blood glucose target for critically ill patients overall?’ Protocol version 0.4 - 06/26/2023 PROSPERO registration: CRD42021278869

RESUMO Objetivo: Não está claro qual é a meta ideal de concentração de glicose no sangue em pacientes em estado grave. Realizaremos uma revisão sistemática e uma metanálise com dados agregados e de pacientes individuais de estudos controlados e randomizados, comparando o controle intensivo da glicose com o controle liberal da glicose em adultos em estado grave. Fontes de dados: MEDLINE®, Embase, Cochrane Central Register of Clinical Trials e registros de ensaios clínicos (Organização Mundial da Saúde, clinical trials.gov). Os autores dos estudos qualificados serão convidados a fornecer dados individuais de pacientes. Os dados publicados em nível de ensaio qualificado que não apresentem alto risco de viés serão incluídos em uma metanálise de dados agregados se os dados individuais de pacientes não estiverem disponíveis. Métodos: Critérios de inclusão: ensaios clínicos controlados e randomizados que recrutaram pacientes adultos, com meta de glicemia ≤ 120mg/dL (≤ 6,6mmol/L) comparada a uma meta de concentração de glicemia mais alta com insulina intravenosa em ambos os grupos. Estudos excluídos: aqueles com meta de glicemia no limite superior no grupo de intervenção > 120mg/dL (> 6,6mmol/L), ou em que o controle intensivo de glicose foi realizado apenas no período intraoperatório, e aqueles em que a perda de seguimento excedeu 10% até a alta hospitalar. Desfecho primário: Mortalidade intra-hospitalar durante a admissão hospitalar. Desfechos secundários: Mortalidade e sobrevida em outros momentos, duração da ventilação mecânica invasiva, agentes vasoativos e terapia de substituição renal. Utilizaremos metanálise bayesiana de efeito randômico e modelos bayesianos hierárquicos para dados individuais de pacientes. Discussão: Essa revisão sistemática com dados agregados e de pacientes individuais abordará a questão clínica: Qual é a melhor meta de glicose no sangue de pacientes graves em geral? Protocolo versão 0.4 - 26/06/2023 Registro PROSPERO: CRD42021278869

https://doi.org/10.5935/2965-2774.20230162-en

Apoyo a la lactancia materna en Atención Primaria
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Pallás Alonso, Carmen Rosa

; Soriano Faura, Javier

; Colomer Revuelta, Julia

; Cortés Rico, Olga

; Esparza Olcina, Mª Jesús

; Galbe Sánchez-Ventura, José

; Gallego Iborra, Ana

; García Aguado, Jaime

; Merino Moína, Manuel

; Rando Diego, Álvaro

; San Miguel Muñoz, Mª José

; Sánchez Ruiz-Cabello, Francisco Javier

; Mengual Gil, José Mª

Pediatría Atención Primaria

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jun 2019, Volume 21 N. 82 Pages 191 - 201

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Human milk is recognized as the ideal nourishment for all children due to its proven health benefits for mother and child. World Health Organization recommends exclusive breastfeeding during the first six months of life and, at least until two years, complemented with other foods. This recommendation extends to sick and preterm newborns, with rare exceptions. Proofs on the protecting effect of breastfeeding for child and mother health are very robust relating to fourteen diseases: nine child diseases and five mother diseases. Support to breastfeeding in Primary Care has a favourable and consistent effect, with a minimum risk of adverse events and it requires affordable resources. It is suggested to implement in Primary Care Centers the recommended practices of the American Academy of Pediatrics or the 7 steps of Initiative Humanisation of Attendance to Birth and breastfeeding to prolong breastfeeding. It is suggested to train physicians in breastfeeding, involve breastfeeding consultant nurses and promote the peers’ support to prolong breastfeeding.

Resumen La leche humana se reconoce como el alimento idóneo para todos los niños por sus probados beneficios en la salud de la madre y del niño. La Organización Mundial de la Salud recomienda la lactancia materna exclusiva durante los primeros seis meses de la vida y, al menos hasta los dos años, complementada con otros alimentos. Esta recomendación se extiende a los recién nacidos enfermos y prematuros, salvo raras excepciones. Las pruebas sobre el efecto protector de la lactancia materna en la salud del niño y de la madre son muy robustas en relación con catorce enfermedades, nueve infantiles y cinco maternas. El apoyo a la lactancia materna desde Atención Primaria tiene un efecto favorable y consistente, con un riesgo de efectos adversos mínimo y que precisa una disponibilidad de recursos asumibles. En los centros de salud se sugiere implantar las prácticas recomendadas por la Academia Americana de Pediatría o los siete pasos de la Iniciativa de Humanización de la Asistencia al Nacimiento y Lactancia para prolongar la lactancia materna. Se sugiere formar a los médicos en lactancia materna, implicar a enfermeras consultoras en lactancia y favorecer el apoyo entre pares para prolongar la lactancia materna.

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CD4+CD69+ T cells and CD4+CD25+FoxP3+ Treg cells imbalance in peripheral blood, spleen and peritoneal lavage from pristane-induced systemic lupus erythematosus (SLE) mice
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Peixoto, Tatiana Vasconcelos

; Carrasco, Solange

; Botte, Domingos Alexandre Ciccone

; Catanozi, Sergio

; Parra, Edwin Roger

; Lima, Thaís Martins

; Ugriumov, Natasha

; Soriano, Francisco Garcia

; Mello, Suzana Beatriz Verissímo de

; Rodrigues, Caio Manzano

; Goldenstein-Schainberg, Cláudia

Advances in Rheumatology

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2019, Volume 59 elocation 30

Abstract: En | Text: En | PDF: En

Abstract Background: Adaptive immune cells, including CD4+CD69+ and CD4+CD25+FoxP3+ regulatory T (Treg) cells, are important for maintaining immunological tolerance. In human systemic lupus erythematosus (SLE), CD4+CD25+FoxP3+ Treg cells are reduced, whereas CD69 expression is increased, resulting in a homeostatic immune imbalance that may intensify autoreactive T cell activity. To analyze the mechanisms implicated in autotolerance failure, we evaluated CD4+CD69+ and CD4+CD25+FoxP3+ T cells and interleukin profiles in a pristane-induced SLE experimental model. Methods: For lupus induction, 26 female Balb/c mice received a single intraperitoneal 0.5 ml dose of pristane, and 16 mice received the same dose of saline. Blood and spleen samples were collected from euthanized mice 90 and 120 days after pristane or saline inoculation. Mononuclear cells from peripheral blood (PBMC), peritoneal lavage (PL) and splenocytes were obtained by erythrocyte lysis and cryopreserved for further evaluation by flow cytometry using the GuavaEasyCyte TM HT. After thawing, cells were washed and stained with monoclonal antibodies against CD3, CD4, CD8, CD25, CD28, CD69, FoxP3, CD14 and Ly6C (BD Pharmingen TM). Interleukins were quantified using Multiplex® MAP. The Mann-Whitney test and the Pearson coefficient were used for statistical analysis, and p < 0.05 considered significant. Results: Compared with the controls, SLE-induced animals presented increased numbers of CD4+CD69+ T cells in the blood on T90 and T120 (p = 0.022 and p = 0.008) and in the spleen on T120 (p = 0.049), but there were decreased numbers in the PL (p = 0.049) on T120. The percentage of Treg was lower in blood (p < 0.005 and p < 0.012) on T90 and T120, in spleen (p = 0.043) on T120 and in PL (p = 0.001) on T90. Increased numbers of CD4+ CD69+ T cells in the PL were positively associated with high IL-2 (p = 0.486) and IFN-γ (p = 0.017) levels, whereas reduced Treg cells in the blood were negatively correlated with TNFα levels (p = 0.043) and positively correlated with TGFβ1 (p = 0.038). Conclusion: Increased numbers of CD4+CD69+ T cells and reduced numbers of CD4+CD25+FoxP3+ Treg cells with an altered interleukin profile suggests loss of autotolerance in pristane-induced lupus mice, which is similar to human lupus. Therefore, this model is useful in evaluating mechanisms of cellular activation, peripheral tolerance and homeostatic immune imbalance involved in human SLE.

https://doi.org/10.1186/s42358-019-0072-x 861 downloads

Efecto de los antimaláricos sobre los diferentes dominios del índice de daño SLICC en pacientes de la cohorte GLADEL
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Pons-Estel, Guillermo J.

; Quintana, Rosana

; Wojdyla, Daniel

; Alarcón, Graciela S.

; Serrano, Rosa María

; Ugarte-Gil, Manuel

; Pimentel-Quiroz, Víctor

; Soriano, Enrique R.

; Catoggio, Luis J.

; Scolnik, Marina

; Sacnun, Mónica

; Saurit, Verónica

; Caeiro, Francisco

; Alvarellos, Alejandro

; Sarano, Judith

; García, Mercedes

; Onetti, Laura

; Drenkard, Cristina

; Berbotto, Guillermo

; Scherbarth, Hugo R.

; Sato, Emilia

; Bonfa, Eloisa

; Ferreira Borba, Eduardo

; Costallat, Lilian

; Xavier, Ricardo

; Tavares Brenol, Joao C.

; Da Silva, Nilzio A.

; Cavalcanti, Fernando

; Massardo, Loreto

; Jacobelli, Sergio

; Neira, Oscar

; Molina, José F

; Vásquez, Gloria

; Gómez-Puerta, José A.

; Alonso Gonzalez, Luis

; Iglesias Gamarra, Antonio

; Guibert-Toledano, Marlene

; Reyes, Gil A.

; Cardiel, Mario H.

; Pascual-Ramos, Virginia

; García de la Torre, Ignacio

; Barile, Leonor

; Silveira, Luis H.

; Amigo, Mary-Carmen

; Sauza del Pozo, María Josefina

; Acevedo-Vásquez, Eduardo M.

; Alfaro-Lozano, José

; Segami, María Inés

; Chacón-Díaz, Rosa

; Abadi, Isaac

; Esteva Spinetti, María H

; Pons-Estel, Bernardo A.

Revista argentina de reumatología

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sep 2018, Volume 29 N. 3 Pages 6 - 10

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Objective: To assess the effects of antimalarials (AM) over the items of the SLICC Damage Index (SDI). Methods: Patients with recent (≤2 years) diagnosis of systemic lupus erythematosus (SLE) from the GLADEL cohort were studied. End-point: increase in items SDI since cohort entry. Independent variables (socio-demographic, clinical, laboratory and treatment) were included. The effect of AM as a time dependent variable on most frequent SDI items (adjusting for potential confounders) was examined with a multivariable Cox regression model. Results: Of the 1466 patients included in this analysis, 1049 (72%) received AM with a median exposure time of 30 months (Q1-Q3: 11-57). Damage occurred in 665 (45%) patients during a median follow-up time of 24 months (Q1-Q3: 8-55). There were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular and 230 others less frequently represented damages. After adjusting for potential confounders at any time during follow-up, a lower risk of renal damage (HR 0.652; 95% CI: 0.472-0.901) and borderline for neuropsychiatric damage (HR 0.701, 95% CI: 0.481-1.024) was found. Conclusion: In the GLADEL cohort, after adjustment for possible confounding factors, AM were independently associated with a reduced risk of renal damage accrual.

Objetivos: Estimar el efecto de los antimaláricos (AM) sobre los diferentes dominios del índice de daño SLICC (SDI). Métodos: Se estudiaron pacientes con diagnóstico clínico reciente (≤2 años) de lupus eritematoso sistémico (LES) de la cohorte GLADEL. Variable de estudio: aumento en los dominios del SDI desde el ingreso a la cohorte. Variables independientes: características sociodemográficas, clínicas, laboratorio y tratamientos. El efecto de los AM, como variable dependiente del tiempo, sobre los dominios más frecuentes del SDI (ajustado por factores de confusión) fue examinado con un modelo de regresión de Cox multivariado. Resultados: De 1466 pacientes estudiados, 1049 (72%) recibieron AM con un tiempo medio de exposición de 30 meses (Q1-Q3: 11-57) y 665 pacientes (45%) presentaron daño durante un seguimiento medio de 24 meses (Q1-Q3: 8-55); 301 eventos fueron cutáneos, 208 renales, 149 neuropsiquiátricos, 98 musculoesqueléticos, 88 cardiovasculares y 230 otros. Después de ajustar por factores de confusión, el uso de AM se asoció a un menor riesgo de daño renal (HR 0,652; IC 95%: 0,472-0,901) y en el límite de la significancia estadística (HR 0,701, IC 95%: 0,481-1,024) para el dominio neuropsiquiátrico. Conclusión: En GLADEL, el uso de AM se asoció independientemente a un menor riesgo de daño acumulado renal.

162 downloads

Recomendaciones de seguimiento del prematuro tardío
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Martín Peinador, Yolanda

; García Reymundo, Mercedes

; Hurtado Suazo, José Antonio

; Calvo Aguilar, M.ª José

; Soriano Faura, Francisco Javier

; Ginovart Galiana, Gemma

; Jiménez Moya, Ana

; Demestre Guasch, Xavier

Pediatría Atención Primaria

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jun 2018, Volume 20 N. 78 Pages 195 - 200

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Prematurity continues to be the leading cause of neonatal and infant morbidity and mortality and stands as one of the most important health problems, especially in industrialized countries. Late preterm infants are those born between 34 and 36weeks of gestational age and represent 70-74% of all premature births. PT show a higher incidence of pathology compared to term infant and not only in the neonatal period but also during childhood, with higher rates of hospital readmissions and visits to emergency services, an increased risk of infections, of failure to thrive, respiratory problems and neurodevelopmental disorders. Our objective will be to anticipate diagnoses and apply early interventions, mainly at the level of neurodevelopment, which will increase the likelihood of better outcomes. In this line, from the working group SEN34-36 of the Spanish Society of Neonatology and in collaboration with the Spanish Association of Pediatrics of Primary Care, this document of Recommendations for the follow-up of the late preterm infanthas been edited in order to raise awareness among pediatricians and neonatologists about the most common pathologies in these babies, and on which we must focus our attention, thereby providing a working guide to the professionals involved in the follow-up of this group of premature infants.

Resumen La prematuridad continúa siendo la primera causa de morbimortalidad neonatal e infantil y constituye uno de los problemas de salud más importantes, sobre todo en la sociedad industrializada. La población de prematuros tardíos, que incluye a los niños nacidos entre las 34 y 36semanas de edad gestacional, representa el 70-74% de todos los prematuros. Los prematuros tardíos presentan mayor incidencia de patología comparados con los recién nacidos a término y no solo en el periodo neonatal sino también durante la infancia, con unas mayores tasas de rehospitalización y consulta a los servicios de urgencias, un mayor riesgo de infecciones, de fallo de medro, de problemas respiratorios y de trastornos del neurodesarrollo. Nuestro objetivo debe ser poder realizar diagnósticos e intervenciones precoces, principalmente a nivel del neurodesarrollo, que multiplicarán la probabilidad de buena evolución. En esta línea, desde el grupo de trabajo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, se ha desarrollado este documento de Recomendaciones de seguimiento del prematuro tardío, con el objetivo de sensibilizar a pediatras y neonatólogos de las patologías en las que los prematuros tardíos presentan mayor riesgo y sobre las que debemos focalizar nuestra atención, facilitando una guía de trabajo a los profesionales implicados en el seguimiento de este grupo de prematuros.

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Primer censo de unidades de heridas crónicas en España
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González de la Torre, Héctor

; Verdú Soriano, José

; García Fernández, Francisco Pedro

; Soldevilla Ágreda, Javier

Gerokomos

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2017, Volume 28 N. 3 Pages 142 - 150

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Introduction: Despite the growing interest in wound care units as an organizational model for the provision of services to people with chronic wounds, we do not have information about the number, distribution, functioning and characteristics of these structures in Spain. Objectives: To identify the units of specialized care of chronic wounds in our country and to carry out the first census of these. Methodology: Observational study of a descriptive cross-sectional type. A non - probabilistic sampling system was made up of three sampling steps. A questionnaire specifically designed for this purpose (CVI-Total for Pertinence = 0.96 and CVI-Total for Relevance = 0.94) was used to obtain dates, which included the collection of information on: Name, Location, Year of creation, Agency responsible and Scope of the units. Results: A total of 75 possible candidate units were detected in the three sampling stages. 44 units were recruited for the study, although 2 units had to be retired. Finally, a total of 42 units were included in the first census of wound units in Spain. Conclusions: The number of wound units in Spain is low, with a great disparity with respect to their geographical distribution by regions. In addition, these structures are subject to many changes. This leads to the disappearance and appearance of wounded units relatively quickly, although it seems to be an increasingly accepted organizational system in Spain, with an increasing number of these organizational structures in our country.

RESUMEN Introducción: A pesar del interés creciente por las unidades de heridas como modelo organizativo para la prestación de servicios a las personas con heridas crónicas, no tenemos información acerca del número, distribución, funcionamiento y características de estas estructuras en España. Objetivos: Identificar las unidades de atención especializada de heridas crónicas en nuestro país y realizar el primer censo de estas. Metodología: Estudio observacional de tipo descriptivo de corte transversal. Se realizó un sistema de muestreo no probabilístico compuesto por tres escalones de muestreo. Se utilizó un cuestionario específicamente diseñado para ello (CVI-Total para Pertinencia = 0,96 y CVI-Total para Relevancia = 0,94) para la obtención de datos, que incluyó la recogida de información sobre: nombre, localización, año de creación, organismo responsable y ámbito de localización de las unidades. Resultados: Un total de 75 posibles unidades candidatas a estudio fueron detectadas en los tres escalones de muestreo realizados. Se reclutaron 44 unidades para el estudio, si bien dos debieron ser retiradas. Finalmente, se incluyó un total de 42 unidades en el primer censo de unidades de heridas en el territorio español. Conclusiones: El número de unidades de heridas en nuestro país es bajo, y existe gran disparidad con respecto a su distribución geográfica por comunidades. Además, estas estructuras están sujetas a muchos cambios. Esto conlleva la desaparición y aparición de unidades de heridas con relativa rapidez, aunque parece que es un sistema organizativo cada vez más aceptado en España, existiendo un número creciente de estas estructuras organizativas en nuestro país.

1101 downloads

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"
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Sousa Oliveira-Filho, Ronaldo

; Ribeiro, Lia Mara Kauchi

; Caruso, Lucia

; Lima, Patricia Azevedo de

; Teixeira Damasceno, Nágila Raquel

; Garcia Soriano, Francisco

Nutrición Hospitalaria

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oct 2016, Volume 33 N. 5 Pages 1027 - 1035

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: Quality Indicators for Nutritional Therapy (QINT) allow a practical assessment of nutritional therapy (NT) quality. Objective: To apply and monitor QINT for critically ill patients at nutritional risk. Methods: Cross sectional study including critically ill patients > 18 years old, at nutritional risk, on exclusive enteral (ENT) or parenteral nutritional therapy (PNT) for > 72 hours. After three consecutive years, 9 QINT were applied and monitored. Statistical analysis was performed with SPSS version 17.0. Results: A total of 145 patients were included, 93 patients were receiving ENT, among then 65% were male and the mean age was 55.7 years (± 17.4); 52 patients were receiving PNT, 67% were male and the mean age was 58.1 years (± 17.4). All patients (ENT and PNT) were nutritionally screened at admission and their energy and protein needs were individually estimated. Only ENT was early initiated, more than 70% of the prescribed ENT volume was infused and there was a reduced withdrawal of enteral feeding tube. The frequency of diarrhea episodes and digestive fasting were not adequate in ENT patients. The proper supply of energy was contemplated only for PNT patients and there was an expressive rate of oral intake recovery in ENT patients. Conclusion: After three years of research, the percentage of QINT adequacy varied between 55%-77% for ENT and 60%-80% for PNT. The results were only made possible by the efforts of a multidisciplinary team and the continuous re-evaluation of the procedures in order to maintain the nutritional assistance for patients at nutritional risk.

Introducción: los indicadores de calidad en terapia nutricional (ICTN) permiten evaluar la calidad de la terapia nutricional (TN) de forma práctica. Objetivo: implementar y monitorizar los ICTN en pacientes críticos con riesgo nutricional. Métodos: estudio transversal con pacientes críticos > 18 años en riesgo nutricional, en terapia nutricional enteral (TNE) o parenteral (TNP) exclusiva a > 72 horas. Después de 3 años consecutivos, 9 ICTN fueron implementados y monitorizados. El análisis estadístico fue realizado con el software SPSS, versión 17.0. Resultados: fueron incluidos 145 pacientes, siendo 93 en TNE, 65% eran de sexo masculino, con edad promedio de 55,7 años (± 17,4); 52 pacientes que estaban en TNP, 67% eran de sexo masculino, con edad promedio de 58,1 años (± 17,4). Todos los pacientes (TNE y TNP) fueron cribados en la admisión, los cálculos de las necesidades calóricas y proteínicas fueron individualizados. Apenas la TNE fue precoz, > 70% del volumen prescrito fue administrado y fue visto una reducida pérdida de la sonda nasoenteral. Las frecuencias de diarrea y ayuno digestivo no fueron adecuadas en TNE. La administración adecuada de energía fue contemplada apenas en TNP y hubo una significativa tendencia de recuperación en la vía oral en TNE. Conclusión: después de 3 años de estudio, el porcentaje de adecuación de los ICTN varió entre 55%-77% para TNE y 60%-80% para TNP. Los resultados reflejan los esfuerzos del equipo multiprofesional de TN en mantener la calidad de la asistencia nutricional en los pacientes críticos con riesgo nutricional.

https://doi.org/10.20960/nh.563 1313 downloads

Cribado de la tuberculosis
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Mengual Gil, José María

; Merino Moína, Manuel

; Pallás Alonso, Carmen Rosa

; Sánchez Ruiz-Cabello, Francisco Javier

; Soriano Faura, Francisco Javier

; Colomer Revuelta, Julia

; Cortés Rico, Olga

; Esparza Olcina, María Jesús

; García Aguado, Jaime

; Martínez Rubio, Ana

Pediatría Atención Primaria

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mar 2016, Volume 18 N. 69 Pages 65 - 79

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

There is evidence that latent tuberculosis infection (LTBI) screening in low incidence areas, has a poor efficiency, many false positives and is not cost-effective. There is evidence that LTBI screening in groups at high risk of developing active tuberculosis infection (ATBI) improves the efficiency of the diagnostic tests as well as the risk-benefit balance and should take part of the strategies to reduce tuberculosis impact. Tuberculin skin test is still the best performing diagnostic test in the screening for latent tuberculosis infection in children and adolescents. PrevInfad recommendations (GRADE): 1. Universal screening of latent tuberculosis infection in children and adolescents of our country is not recommended. 2. Universal screening of latent tuberculosis infection in high risk groups of children and adolescents is recommended. 3. Tuberculin skin test (TST) as the first test for screening of latent tuberculosis infection in children and adolescents of our country is suggested. 4. IGRA for children and adolescents five or more years old with a positive TST and history of BCG vaccination, is suggested in order to improve the screening test specificity.

Hay pruebas de que el cribado universal de la infección tuberculosa latente (ITBL) en zonas de baja incidencia tiene un rendimiento pobre, un número elevado de falsos positivos y no es coste-efectivo. Hay evidencias de que el cribado de la ITBL en los grupos que tienen riesgo elevado de desarrollar una infección tuberculosa activa (ITBA) mejora el rendimiento de las pruebas diagnósticas, el balance beneficio-riesgo y debe formar parte de las estrategias para disminuir el impacto de la tuberculosis. Sobre el dilema de cuál de las tres estrategias (prueba cutánea de la tuberculina ENT#091;PCTENT#093; sola, determinación de la liberación de interferón gamma ENT#091;IGRAENT#093; solo o PCT seguida de IGRA) para el diagnóstico de la ITBL es la que ofrece mejor rendimiento, existe variabilidad tanto en las recomendaciones de las guías de práctica clínica (GPC) y las instituciones como en las conclusiones de los estudios sobre el tema, aunque la mayoría de las recomendaciones van en el mismo sentido que las que proponemos en este documento. La prueba cutánea de la tuberculina sigue siendo el test diagnóstico con mejor rendimiento para realizar el cribado de la infección tuberculosa latente en niños y adolescentes. Recomendaciones de PrevInfad (GRADE): 1. Se recomienda no realizar el cribado universal de la infección tuberculosa latente en los niños y adolescentes de nuestro país. 2. Se recomienda realizar el cribado de la infección tuberculosa latente en los niños y adolescentes que pertenecen a grupos de riesgo. 3. Se sugiere el uso de la prueba cutánea de la tuberculina (PCT) como primera prueba para el cribado de la infección tuberculosa latente en niños y adolescentes de nuestro país. 4. Se sugiere utilizar los IGRA para los niños y adolescentes de cinco o más años con PCT positiva y antecedente de vacunación con bacilo de Calmette-Guérin (BCG) para mejorar la especificidad de la prueba de cribado.

853 downloads

Nutrition therapy in sepsis: characterization and implications for clinical prognosis
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Campos Machado, Raquel Rodrigues

; Caruso, Lúcia

; Lima, Patricia de Azevedo

; Damasceno, Nágila Raquel Teixeira

; García Soriano, Francisco

Nutrición Hospitalaria

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sep 2015, Volume 32 N. 3 Pages 1281 - 1288

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: the inflammatory response caused by sepsis leads to metabolic changes, which may result in significant lean mass loss in septic patient. Because of this, when digestive tract is functional, nutritional therapy (NT) must be initiated within 48 hours of intensive treatment to reduce protein loss. Objective: to evaluate enteral nutritional therapy (ENT) in adult septic patients with exclusive ENT for ≥ 72 hours and length of stay ≥ 7 days in Intensive Care Unit and its relationship with clinical prognosis. Methods: we prospectively analyzed the adequacy of enteral nutrition administered, factors associated with non-conformity, gastrointestinal tolerance and outcome. Statistical tests of chi-square and Student�fs t as well as Mann-Whitney and Spearman and Pearson correlations (p < 0.05) were used. A multiple logistic regression model has been done by using the stepwise method to evaluate the association between predictors of clinical outcome. Results: 53 patients, 67.9% male and 52.8% elderly were enrolled in this study. The average time for starting ENT was 30 (23.5) hours, and 88.7% of patients achieved nutritional goal in 48 hours. The mean volume delivered in relation to prescribed was 78.9%. When the sample was stratified according to administered/ prescribed calories, patients who received < 80% had a higher mortality rate (p = 0.001) and the caloric intake . 80% was the determining factor in patients�f clinical prognosis (p = 0.021). Conclusion: septic patients received early enteral nutrition. The nutritional goal and the mean volume delivered in relation to the prescribed volume meet the intensive care guidelines. The nutritional support was associated with clinical outcome, and caloric intake ≥ 80% determining the clinical prognosis. The pauses caused by reflux were significant in the group of patients who died and it may be related to disease severity.

Introducción: la respuesta inflamatoria causada por sepsis provoca cambios metabólicos que pueden provocar una perdida de masa magra significativa en pacientes sépticos. Debido a ello, cuando el tracto digestivo es funcional la terapia nutricional (NT) debe iniciarse dentro de las 48 horas de tratamiento intensivo para reducir la perdida de proteína. Objetivo: evaluar la terapia nutricional enteral (TNE) en pacientes sépticos adultos con TNE exclusivo para ≥ 72 horas y duración de ≥ 7 días de estancia en la Unidad de Cuidados Intensivos y su relación con el pronostico clínico. Métodos: se analizaron prospectivamente la adecuación de la nutrición enteral administrada, los factores asociados con la falta de conformidad, la tolerancia gastrointestinal y el resultado. Se utilizaron pruebas estadísticas de chi-cuadrado y la t de Student, así como las correlaciones de Mann-Whitney y Spearman y Pearson (p < 0,05). Se ha realizado un modelo de regresión logística múltiple mediante el método paso a paso para evaluar la asociacion entre factores de predicción de la evolución clínica. Resultados: 53 pacientes, 67,9% hombres y 52,8% ancianos se inscribieron en este estudio. El tiempo promedio para el inicio de ENT fue de 30 (23,5) horas, y el 88,7% de los pacientes alcanzaron el objetivo nutricional en 48 horas. El volumen medio entregado en relación con el prescrito fue 78,9%. Cuando la muestra se estratifico según calorías prescritas/administradas, los pacientes que recibieron < 80% tenían una tasa de mortalidad mas alta (p = 0,001) y el consumo de calorías . 80% fue el factor determinante en el pronostico clínico de los pacientes (p = 0,021). Conclusión: los pacientes sépticos recibieron nutrición enteral precoz. El objetivo nutricional y el volumen medio entregado en relación con el volumen prescrito cumplen las directrices de cuidados intensivos. El soporte nutricional se asocio con el resultado clínico y la ingesta calórica ≥ 80% para determinar el pronostico clínico. Las pausas causadas por el reflujo fueron significativas en el grupo de pacientes que murieron y que pueden estar relacionadas con la gravedad de la enfermedad.

https://doi.org/10.3305/nh.2015.32.3.9266 1532 downloads

10.

Plasma cytokine expression after lower-limb compression in rats
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Sgarbi, Mauricio Wanderley Moral

; Silva Júnior, Bomfim Alves

; Peres, Carmem Maldonado

; Loureiro, Tatiana Carolina Alba

; Curi, Rui

; Soriano, Francisco Garcia

; Ribeiro, Daniel Araki

; Velasco, Irineu Tadeu

Revista Brasileira de Ortopedia

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feb 2015, Volume 50 N. 1 Pages 105 - 109

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVOS: a lesão muscular por esmagamento (lesão por compressão muscular) está associada a manifestações sistêmicas conhecidas como síndrome do esmagamento. A reação inflamatória sistêmica pode também ser desencadeada pela lesão muscular isolada. O objetivo deste estudo foi investigar os níveis plasmáticos de interleucinas (IL) 1, 6, 10 e TNF-α, marcadores de uma possível reação inflamatória sistêmica, após a lesão muscular isolada resultante da compressão de membros inferiores de ratos.MÉTODOS: ratos Wistar machos foram submetidos a uma hora de compressão dos membros inferiores por uma faixa de borracha. Os níveis plasmáticos de IL 1, 6, 10 e TNF-α foram medidos uma, duas e quatro horas após a liberação da compressão.RESULTADOS: os níveis plasmáticos de IL 10 diminuíram quando comparados com outros grupos com diferença estatisticamente significante (p < 0,05). Não houve detecção, pelo método, da presença de IL 1, 6 e TNF-α.CONCLUSÃO: nossos resultados demonstraram que as alterações dos níveis plasmáticos de IL 10 encontradas podem ser um sinal da presença de interleucinas circulantes nesse modelo de compressão de membros inferiores de ratos.

OBJECTIVES: Muscle injury due to crushing (muscle compression injury) is associated with systemic manifestations known as crush syndrome. A systemic inflammatory reaction may also be triggered by isolated muscle injury. The aim of this study was to investigate the plasma levels of interleukins (IL) 1, 6 and 10 and tumor necrosis factor alpha (TNF-α), which are markers for possible systemic inflammatory reactions, after isolated muscle injury resulting from lower-limb compression in rats.METHODS: Male Wistar rats were subjected to 1 h of compression of their lower limbs by means of a rubber band. The plasma levels of IL 1, 6 and 10 and TNF-α were measured 1, 2 and 4 h after the rats were released from compression.RESULTS: The plasma levels of IL 10 decreased in relation to those of the other groups, with a statistically significant difference (p < 0.05). The method used did not detect the presence of IL 1, IL 6 or TNF-α.CONCLUSION: Our results demonstrated that the changes in plasma levels of IL 10 that were found may have been a sign of the presence of circulating interleukins in this model of lower-limb compression in rats.

https://doi.org/10.1016/j.rboe.2014.12.004 1123 downloads

11.

O impacto das soluções hipertônica e salina fisiológica na reperfusão do trato gastrintestinal pós-isquemia em ratos
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Chimabucuro, Wilson Kohama

; Silva Junior, Bomfim Alves da

; Moretti, Ana Iochabel Soares

; Velasco, Irineu Tadeu

; Rios, Ester Correia Sarmento

; Soriano, Francisco Garcia

Revista Brasileira de Terapia Intensiva

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sep 2014, Volume 26 N. 3 Pages 277 - 286

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo: Investigar o papel de duas diferentes soluções salinas nos mecanismos de lesão após isquemia intestinal: estresse oxidativo e respostas inflamatórias. Métodos: Ratos Wistar foram submetidos a oclusão transitória da artéria mesentérica superior e estudados durante as 6 horas seguintes à reperfusão. Após randomização, os animais foram divididos em quatro grupos: Falso; Solução Hipertônica, os quais receberam infusão de solução salina hipertônica a 7,5% (4mL/kg de peso corpóreo); Solução Fisiológica, os quais receberam infusão de solução salina a 0,9% (33mL/kg); e Sem Tratamento. A infusão foi realizada imediatamente antes da reperfusão. Foram realizadas dosagens sequenciais de interleucina 6 e interleucina 10 no plasma. Foram coletadas amostras de tecidos (pulmão, fígado e intestino) para medir malondialdeído, mieloperoxidase e interleucina. Resultados: Em comparação ao Grupo Sem Tratamento, os animais que receberam volume (Grupos Solução Hipertônica e Solução Fisiológica) mostraram níveis tissulares mais baixos de malondialdeído, mieloperoxidase, interleucina 6 e interleucina 10. As concentrações plasmáticas de interleucina 6 e interleucina 10 foram mais altas nos animais tratados com solução hipertônica do que nos tratados com solução fisiológica e nos sem tratamento. Conclusão: Neste modelo de isquemia intestinal transitória, a manutenção adequada de volume intravascular diminuiu o estresse oxidativo e a síntese de marcadores de inflamação. Tanto a solução hipertônica quanto a fisiológica atenuaram os efeitos deletérios observados após isquemia intestinal.

https://doi.org/10.5935/0103-507X.20140039 4074 downloads

12.

Adequação dos balanços energético e proteico na nutrição por via enteral em terapia intensiva: quais são os fatores limitantes?
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Ribeiro, Lia Mara Kauchi

; Oliveira Filho, Ronaldo Sousa

; Caruso, Lucia

; Lima, Patricia Azevedo

; Damasceno, Nágila Raquel Teixeira

; Soriano, Francisco Garcia

Revista Brasileira de Terapia Intensiva

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apr 2014, Volume 26 N. 2 Pages 155 - 162

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo: Determinar os fatores que influenciam na adequação da terapia nutricional enteral em uma unidade de terapia intensiva. Métodos: Estudo prospectivo e observacional realizado em uma unidade de terapia intensiva entre 2010 e 2012. Foram incluídos pacientes >18 anos em terapia nutricional enteral exclusiva por ≥72 horas. As necessidades de energia e proteínas foram calculadas segundo protocolo da unidade. Foram coletados diariamente dados relacionados à nutrição enteral, causas de não conformidade e exames bioquímicos. Resultados: Dentre os pacientes internados na unidade, 93 foram avaliados, 82% iniciaram a terapia nutricional enteral precocemente e 80% atingiram a meta nutricional em <36 horas. Foram administrados 81,6% (±15,4) de volume de terapia nutricional enteral, com adequação de 82,2% (±16,0) de calorias, 82,2% (±15,9) de proteínas e balanço energético médio de -289,9 kcal/dia (±277,1). Houve correlação negativa da proteína C-reativa com o volume administrado e os balanços energético e proteico, e correlação positiva com o tempo para atingir a meta nutricional. A pausa para extubação foi a principal causa de interrupções (29,9% das horas de pausa) e os pacientes >60 anos apresentaram menor porcentagem de recuperação da via oral em relação aos mais jovens (p=0,014). Conclusão: O início precoce da terapia nutricional enteral, e a adequação do volume administrado, de energia e de proteínas estiveram de acordo com as diretrizes. A inadequação dos balanços energético e proteico parece estar associada à resposta inflamatória aguda (proteína C-reativa elevada). A principal causa de interrupção da oferta da terapia nutricional foi a pausa para extubação.

Objective: To determine the factors that influence the adequacy of enteral nutritional therapy in an intensive care unit. Methods: This prospective observational study was conducted in an intensive care unit between 2010 and 2012. Patients >18 years of age underwent exclusive enteral nutritional therapy for ≥72 hours. The energy and protein requirements were calculated according to the ICU protocols. The data regarding enteral nutrition, the causes of non-compliance, and the biochemical test results were collected daily. Results: Ninety-three patients admitted to the intensive care unit were evaluated. Among these patients, 82% underwent early enteral nutritional therapy, and 80% reached the nutritional goal in <36 hours. In addition, 81.6%±15.4% of the enteral nutrition volume was infused, with an adequacy of 82.2%±16.0% for calories, 82.2%±15.9% for proteins, and a mean energy balance of -289.9±277.1kcal/day. A negative correlation of C-reactive protein with the volume infused and the energy and protein balance was observed. In contrast, a positive correlation was found between C-reactive protein and the time required to reach nutritional goals. Extubation was the main cause for interrupting the enteral nutritional therapy (29.9% of the interruption hours), and the patients >60 years of age exhibited a lower percentage of recovery of the oral route compared with the younger patients (p=0.014). Conclusion: Early enteral nutritional therapy and the adequacy for both energy and protein of the nutritional volume infused were in accordance with the established guidelines. Possible inadequacies of energy and protein balance appeared to be associated with an acute inflammatory response, which was characterized by elevated C-reactive protein levels. The main cause of interruption of the enteral nutritional therapy was the time spent in extubation.

https://doi.org/10.5935/0103-507X.20140023 9823 downloads

13.

Redefinición del concepto y del abordaje de las lesiones por humedad: Una propuesta conceptual y metodológica para mejorar el cuidado de las lesiones cutáneas asociadas a la humedad (LESCAH)
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Torra i Bou, Joan-Enric

; Rodríguez Palma, Manuel

; Soldevilla Agreda, José Javier

; García Fernández, Francisco P.

; Sarabia Lavín, Raquel

; Zabala Blanco, Jaime

; Verdú Soriano, José

; Segovia Gómez, Teresa

Gerokomos

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jun 2013, Volume 24 N. 2 Pages 90 - 94

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

There are actually several problems with the concept of moisture lesions in our scientific (Spanish) community, frequently directly associated only to incontinence lesions. We propose and review the extend of the term LESCAH (Moisture associated skin damage) in Spanish for the definition of the inflammation and skin damage produced by different moisture sources like urine, faeces, sweat, wound exudate, saliva and mucus. We also propose the acronym CASPROT in order to agglutinate in a common framework the different concepts, aims and activities oriented to address moisture associated problems.

Actualmente se percibe una indefinición manifiesta acerca de la conceptualización y abordaje de las llamadas lesiones por humedad en los entornos clínicos, docentes e investigadores de nuestro país, que muy frecuentemente relacionan este término solo con las lesiones producidas por la orina y las heces. Dadas las diversas repercusiones que se intuye pueden tener este tipo de lesiones, se hace necesario consensuar y unificar los distintos aspectos relacionados con el cuidado de estas heridas. En el presente artículo, y siguiendo la tendencia internacional, se propone la adopción del término lesiones cutáneas asociadas a la humedad (LESCAH) para referirnos a la inflamación y erosión de la piel causada por la exposición prolongada a diversas fuentes de humedad, incluyendo la orina o las heces, el sudor, el exudado de la herida, el moco o la saliva. Desde esta premisa, se presentan y describen los diferentes tipos de LESCAH identificados en la clínica. Y finalmente, para facilitar la integración de la valoración, prevención y tratamiento de los pacientes con algún tipo de LESCAH, se propone un plan básico de actuación -denominado con el acrónimo CASPROT- con los distintos objetivos e intervenciones a realizar en cada fase.

4980 downloads

14.

Hypertonic saline solution reduces the inflammatory response in endotoxemic rats
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Theobaldo, Mariana Cardillo

; Barbeiro, Hermes Vieira

; Barbeiro, Denise Frediani

; Petroni, Ricardo

; Soriano, Francisco Garcia

Clinics

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dec 2012, Volume 67 N. 12 Pages 1463 - 1468

Abstract: En | Text: En | PDF: En

OBJECTIVE: Volume replacement in septic patients improves hemodynamic stability. This effect can reduce the inflammatory response. The objective of this study was to evaluate the effect of 7.5% hypertonic saline solution versus 0.9% normal saline solution for volume replacement during an inflammatory response in endotoxemic rats. METHODS: We measured cytokines (serum and gut), nitrite, and lipid peroxidation (TBARS) as indicators of oxidative stress in the gut. Rats were divided into four groups: control group (C) that did not receive lipopolysaccharide; lipopolysaccharide injection without treatment (LPS); lipopolysaccharide injection with saline treatment (LPS +S); and lipopolysaccharide injection with hypertonic saline treatment (LPS +H). Serum and intestine were collected. Measurements were taken at 1.5, 8, and 24 h after lipopolysaccharide administration. RESULTS: Of the four groups, the LPS +H group had the highest survival rate. Hypertonic saline solution treatment led to lower levels of IL-6, IL-10, nitric oxide, and thiobarbituric acid reactive substances compared to 0.9% normal saline. In addition, hypertonic saline treatment resulted in a lower mortality compared to 0.9% normal saline treatment in endotoxemic rats. Volume replacement reduced levels of inflammatory mediators in the plasma and gut. CONCLUSION: Hypertonic saline treatment reduced mortality and lowered levels of inflammatory mediators in endotoxemic rats. Hypertonic saline also has the advantage of requiring less volume replacement.

https://doi.org/10.6061/clinics/2012(12)18 2218 downloads Cited 1 time in SciELO

15.

Reposição volêmica com soluções salinas em pancreatite e perfil hepático de proteínas apoptóticas e de choque térmico
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Rios, Ester Correia Sarmento

; Moretti, Ana Iochabel Soares

; Souza, Heraldo Possolo de

; Velasco, Irineu Tadeu

; Soriano, Francisco Garcia

Revista Brasileira de Terapia Intensiva

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dec 2012, Volume 24 N. 4 Pages 326 - 333

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: A falência hepática é uma consequência da inflamação sistêmica após pancreatite aguda. Avaliou-se o efeito da reposição volêmica com soluções salinas fisiológicas ou hipertônica na produção hepática de citocinas e na expressão de proteínas ativadas por choque térmico e proteínas ligadas à apoptose durante a pancreatite aguda. MÉTODOS: Ratos Wistar foram divididos em quatro grupos: C - animais controles não submetidos à lesão e nem ao tratamento; NT - animais submetidos à indução de pancreatite aguda e não tratados; SN - animais submetidos à indução de pancreatite aguda e tratados com solução salina normal (NaCl 0,9%); SH - animais submetidos à pancreatite aguda e tratados com solução salina hipertônica (NaCl 7,5%). A pancreatite aguda foi induzida por infusão retrógrada transduodenal de taurocolato de sódio 2,5% no ducto pancreático. Após 4, 12 e 24 horas da indução da pancreatite aguda, analisaram-se, no fígado, TNF-α, IL-1β, IL-6 e IL-10, caspase-2, caspase-7, APAF-1, AIF, HSP60 e HSP90. RESULTADOS: A caspase-2 diminuiu nos grupos SN e SH (p<0,05 versus C) após 12 horas. APAF-1, AIF e HSP90 permaneceram inalterados. Após 4 horas da indução, a capsase-7 aumentou no grupo NT (p<0,01 versus C), embora se mantendo em níveis basais nos grupos reperfundidos. A HSP60 aumentou em todos os grupos após 4 horas (p<0,001 versus C). No entanto, o grupo SH mostrou menor expressão de HSP60 que o grupo SN (p<0,05). A solução salina hipertônica manteve a produção de citocinas em níveis normais. A reperfusão com volume com solução salina normal ou hipertônica, modulou significativamente a expressão de caspase-7. CONCLUSÃO: A reposição volêmica com solução salina normal ou hipertônica foi efetiva em reduzir a caspase-7. Entretanto, somente a solução salina hipertônica foi capaz de regular a produção de citocinas e a expressão de HSP60 em todos os momentos analisados.

OBJECTIVE: Liver failure can occur as a consequence of the systemic inflammation after acute pancreatitis. We assessed the effect of volume repositioning with hypertonic saline solution or normal saline on hepatic cytokine production and the expression of heat-shock proteins and apoptotic proteins after acute pancreatitis. METHODS: Wistar rats were divided in four groups: C - control animals that were not subjected to insult or treatment; NT - animals that were subjected to acute pancreatitis and received no treatment; normal saline - animals that were subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS - animals that were subjected to acute pancreatitis and received hypertonic saline solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10, caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. RESULTS: Casp2 decreased in the normal saline and hypertonic saline groups (p<0.05 versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged. At 4 h, Casp7 increased in the NT group (p<0.01 versus C), although it remained at the baseline levels in the reperfused groups. HSP60 increased in all of the groups at 4 h (p< 0.001 vs. C). However, the hypertonic saline group showed lower expression of HSP60 than the normal saline group (p<0.05). Hypertonic saline solution maintained the production of cytokines at normal levels. Volume reperfusion with normal or hypertonic saline significantly modulated the expression of Casp7. CONCLUSION: Volume replacement with hypertonic or normal saline was effective in reducing caspase 7. However, only hypertonic solution was capable of regulating cytokine production and HSP60 expression at all time points.

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