Articles publicats (Medicina i Cirurgia)

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    Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy
    (Frontiers Media, 2023-08-24) López Delgado, Juan Carlos; Servià Goixart, Lluís; Grau Carmona, Teodoro; Bordeje Laguna, Mª Luisa; Portugal Rodríguez, Esther; Lorencio Cardenas, Carol; Vera Artazcoz, Paula; Macaya Redin, Laura; Martínez Carmona, Juan Francisco; Marin Corral, Judith; Flordelis Lasierra, Jose Luis; Serón Arbeloa, Carlos; Alcazar Espin, Maravillas de las Nieves; Navas Moya, Elisabeth; Aldunate Calvo, Sara; Nieto Martino, Beatriz; Martínez de Lagran, Itziar
    Background and aims: Despite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN. Methods: Adult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores). Results: Of a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053-1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098-1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057-1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001-1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210-0.687, p = 0.016) was associated with lower need of PN. Conclusion: A higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.
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    GATEKEEPER's Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases
    (JMIR Publications, 2023) Batlle Garcia, Jordi de; Benítez, Iván; Moncusí Moix, Anna; Androutsos, Odysseas; Barbastro, Rosana Angles; Antonini, Alessio; Arana, Eunate; Cabrera-Umpierrez, Maria Fernanda; Cea, Gloria; Dafoulas, George Ε.; Folkvord, Frans; Fullaondo, Ane; Giuliani, Francesco; Huang, Hsiao-Ling; Innominato, Pasquale F.; Kardas, Przemyslaw; Lou, Vivian W.Q.; Manios, Yannis; Matsangidou, Maria; Mercalli, Franco; Mokhtari, Mounir; Pagliara, Silvio; Schellong, Julia; Stieler, Lisa; Votis, Konstantinos; Currás, Paula; Arredondo, Maria Teresa; Posada, Jorge; Guillén, Sergio; Pecchia, Leandro; Barbé Illa, Ferran; Torres, Gerard; Fico, Giuseppe
    Background: The World Health Organization’s strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europe’s geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence–based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space.
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    Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors
    (MDPI, 2022-12-05) Barea-Mendoza, Jesús Abelardo; Chico-Fernández, Mario; Quintana-Díaz, Manuel; Servià Goixart, Lluís; Fernández-Cuervo, Ana; Bringas-Bollada, María; Ballesteros Sanz, María Ángeles; García-Sáez, Íker; Pérez-Bárcena, Jon; Llompart-Pou, Juan Antonio
    Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.
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    Low-dose acetylsalicylic acid for cancer prevention considering risk factors: a retrospective cohort study
    (Elsevier, 2023) Florensa Cazorla, Dídac; Mateo Fornés, Jordi; Solsona Tehàs, Francesc; Galván, Leonardo; Mesas, Miquel; Piñol, Ramon; Espinosa-Leal , Leonardo; Godoy i García, Pere
    Purpose Aspirin (acetylsalicylic acid) has been reported to protect against certain cancers. However, patient-related risk factors may moderate protective effects, including excess weight, smoking, risky alcohol use, and diabetes. We explore the cancer-risk relationship between aspirin intake and those four factors. Methods Retrospective cohort study of cancers, aspirin intake, and four risk factors in persons aged ≥50 years. Participants received medication during 2007–2016, and cancers were diagnosed in 2012–2016. Adjusted hazard ratios (aHR) for 95% confidence intervals (95%CI) were calculated for aspirin intake and risk factors using Cox proportional hazard modeling. Results Of 118,548 participants, 15,793 consumed aspirin, and 4003 had cancer. Results indicated a significant protective effect of aspirin against colorectal (aHR: 0.7; 95%CI: 0.6–0.8), pancreatic (aHR: 0.5; 95%CI: 0.2–0.9), prostate (aHR: 0.6; 95%CI: 0.5–0.7) cancers and lymphomas (aHR: 0.5; 95%CI: 0.2–0.9), and also, although not significantly, against esophageal (aHR: 0.5; 95%CI: 0.2–1.8), stomach (aHR: 0.7; 95%CI: 0.4–1.3), liver (aHR: 0.7; 95%CI: 0.3–1.5), breast (aHR: 0.8; 95%CI: 0.6–1.0), and lung and bronchial (aHR: 0.9; 95%CI: 0.7–1.2) cancers. Aspirin intake was not significantly protective against leukemia (aHR: 1.0; 95%CI: 0.7–1.4) or bladder cancer (aHR: 1.0; 95%CI: 0.8–1.3). Conclusions Our results suggest that aspirin intake is associated with a reduced incidence of colorectal, pancreatic, and prostate cancers and lymphomas.
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    Study protocol for the epigenetic characterization of angor pectoris according to the affected coronary compartment: Global and comprehensive assessment of the relationship between invasive coronary physiology and microRNAs
    (Public Library of Science, 2023) Matute Blanco, Lucía; Fernández Rodríguez, Diego; Casanova Sandoval, Juan Manuel; Belmonte, Thalía; Benítez, Iván; Rivera, Kristian; García-Guimaraes, Marcos; Cortés Villar, Carlos; Peral Disdier, Vicente; Millán Segovia, Raúl; Barriuso, Ignacio; de Gonzalo Calvo, David; Barbé Illa, Ferran; Worner, Fernando
    Background: MicroRNAs (miRNAs) are noncoding RNAs involved in post-transcriptional genetic regulation with a proposed role in intercellular communication. miRNAs are considered promising biomarkers in ischemic heart disease. Invasive physiological evaluation allows a precise assessment of each affected coronary compartment. Although some studies have associated the expression of circulating miRNAs with invasive physiological indexes, their global relationship with coronary compartments has not been assessed. Here, we will evaluate circulating miRNAs profiles according to the coronary pattern of the vascular compartment affectation. Study and design: This is an investigator-initiated, multicentre, descriptive study to be conducted at three centres in Spain (NCT05374694). The study will include one hundred consecutive patients older than 18 years with chest pain of presumed coronary cause undergoing invasive physiological evaluation, including fractional flow reserve (FFR) and index of microvascular resistance (IMR). Patients will be initially classified into four groups, according to FFR and IMR: macrovascular and microvascular affectation (FFR≤0.80 / IMR≥25), isolated macrovascular affectation (FFR≤0.80 / IMR<25), isolated microvascular affectation (FFR>0.80 / IMR ≥25) and normal coronary indexes (FFR>0.80 / IMR<25). Patients with isolated microvascular affectation or normal indexes will also undergo the acetylcholine test and may be reclassified as a fifth group in the presence of spasm. A panel of miRNAs previously associated with molecular mechanisms linked to chronic coronary syndrome will be analysed using RT-qPCR. Conclusions: The results of this study will identify miRNA profiles associated with patterns of coronary affectation and will contribute to a better understanding of the mechanistic pathways of coronary pathology.