7 research outputs found
Evaluación de la capacidad de los niveles de expresión del gen FCER1A para identificar la presencia de sepsis en el paciente post-quirúrgico
No full textLa sepsis supone una disfunción orgánica potencialmente mortal causada por una respuesta disregulada a la infección, en la que el retraso diagnóstico/terapéutico ensombrece el pronóstico. Esto obliga al desarrollo de nuevos biomarcadores para el diagnóstico precoz. La evaluación de los niveles de expresión génica en pacientes sépticos ha permitido identificar una lista de genes con potencial utilidad en el diagnóstico de esta enfermedad, destacando el gen FCER1A (receptor del fragmento Fc de la IgE). Material y métodos. El objetivo principal de este proyecto fue evaluar la capacidad de los niveles de FCER1A para identificar la presencia de sepsis en pacientes post-quirúrgicos, de forma aislada, y en combinación con otros biomarcadores clásicos como la procalcitonina (PCT). Para ello se realizó un estudio de cohortes observacional prospectivo, analizando 154 muestras de sangre de pacientes postquirúrgicos (101 sépticos y 53 controles). Se compararon las características clínicas, los niveles de expresión del gen FCER1A, medidos por PCR digital, y los valores séricos de PCT entre grupos. Resultados. Los pacientes sépticos mostraron niveles de expresión de FCER1A significativamente menores respecto al grupo control. Además, los niveles de expresión de este gen correlacionaron de forma inversa con la gravedad de la enfermedad. El análisis multivariante mostró que la expresión aumentada del gen FCRE1A era un factor protector (OR=0,477) para presentar infección. El análisis AUROC reveló que la combinación del FCER1A con la PCT mejoraba la capacidad de detectar sepsis de la PCT, (AUROC [IC95%], p) PCT/FCER1A: (0,84 [0,72-0,87] <0,001), PCT: (0,80, [0,73-0,88], < 0,001). Conclusión. La expresión del gen FCER1 en combinación con la procalcitonina, consigue mejorar la sensibilidad de ésta sin perder especificidad para el diagnóstico de sepsis en el paciente postquirúrgico. Esto convierte al gen FCER1A en un complemento útil para el diagnóstico precoz de la sepsis.Grado en Medicin
«MARTA Y MARÍA»: ORTEGA Y EL DUALISMO. APROXIMACIÓN A LA NOCIÓN PRAGMÁTICA DE «CREENCIA»
No full textThanks to the study of the notion of «creencia» we discover Ortegaʼs way of fusing contemplative life and active life harmoniously together in the «vida de cada uno», thus resolving one of the most important dualisms of Western Philosophy. In was both by his antidualism as by his antifundamentalist strategy, that Ortega proved to be a very intense pragmatist philosophy author, especially in the period of the «segunda navegación».Por medio del estudio de la noción de «creencia» descubrimos de qué modo Ortega consiguió que la vida contemplativa (María) y la vida activa (Marta) quedaran armónicamente engarzadas en la «vida de cada uno», solucionando así uno de los dualismos más reciamente enquistados en la tradición filosófica de Occidente. Tanto por su pathos antidualista como por sus maneras antifundamentalistas, Ortega se nos revela como el autor de una filosofía de cuño intensamente pragmático, tanto más evidente cuanto más nos internamos en su «segunda navegación»
Safety of hospital discharge before return of bowel function after elective colorectal surgery
No full textBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
No full textAim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
No full textAim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
No full textAim Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56-1.87,P = 0.932). Conclusion In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study.
No full textAspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery.
This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis.
A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56-1.87, P = 0.932).
In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion
