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Search Results: 1 - 10 of 208762 matches for " L. Bordejé Laguna "
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Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Severe acute pancreatitis
Bordejé Laguna,L.; Lorencio Cárdenas,C.; Acosta Escribano,J.;
Nutrición Hospitalaria , 2011,
Abstract: severe acute pancreatitis (sap) causes local and systemic complications leading to high catabolic, hypermetabolic and hyperdynamic stress states with marked morbidity and mortality. in the last decade, nutritional support has become a key element in the treatment of sap. thus, specialized nutrition is indicated from admission, with enteral nutrition being preferred to parenteral nutrition. enteral nutrition should be initiated early using infusion through the jejunum beyond the ligament of treitz to minimize pancreatic stress. there are no specific studies that establish the type of diet to be used but experts recommend the use of polymeric diets. parenteral nutrition, without a specific formula, is indicated in patients with sap who are intolerant to enteral nutrition or when the clinical signs of pancreatitis are exacerbated or aggravated by enteral nutrition. even so, a minimal level of enteral infusion should be maintained to preserve the trophic effect of the intestinal mucosa. in the last few years, several studies of the administration of immunomodulatory diets in patients with sap have been carried out to demonstrate their effects on the course of the disease. however, there are few clear recommendations on the prognostic benefits of pharmaconutrient enriched diets in these patients. there is substantial scientific evidence suggesting that the only clear indication for pharmaconutrition in patients with sap is parenteral glutamine administration, which is recommended by all clinical guidelines with distinct grades of evidence.
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Severe acute pancreatitis Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Pancreatitis aguda grave
L. Bordejé Laguna,C. Lorencio Cárdenas,J. Acosta Escribano
Nutrición Hospitalaria , 2011,
Abstract: Severe acute pancreatitis (SAP) causes local and systemic complications leading to high catabolic, hypermetabolic and hyperdynamic stress states with marked morbidity and mortality. In the last decade, nutritional support has become a key element in the treatment of SAP. Thus, specialized nutrition is indicated from admission, with enteral nutrition being preferred to parenteral nutrition. Enteral nutrition should be initiated early using infusion through the jejunum beyond the ligament of Treitz to minimize pancreatic stress. There are no specific studies that establish the type of diet to be used but experts recommend the use of polymeric diets. Parenteral nutrition, without a specific formula, is indicated in patients with SAP who are intolerant to enteral nutrition or when the clinical signs of pancreatitis are exacerbated or aggravated by enteral nutrition. Even so, a minimal level of enteral infusion should be maintained to preserve the trophic effect of the intestinal mucosa. In the last few years, several studies of the administration of immunomodulatory diets in patients with SAP have been carried out to demonstrate their effects on the course of the disease. However, there are few clear recommendations on the prognostic benefits of pharmaconutrient enriched diets in these patients. There is substantial scientific evidence suggesting that the only clear indication for pharmaconutrition in patients with SAP is parenteral glutamine administration, which is recommended by all clinical guidelines with distinct grades of evidence. La pancreatitis aguda grave es una patología que cursa con complicaciones locales y sistémicas que condicionan una situación de estrés altamente catabólica, hipermetabólica e hiperdinámica con marcada morbimortalidad. En la última década, el soporte nutricional se ha convertido en uno de los puntos clave en el tratamiento de la pancreatitis aguda grave. Así, hay indicación de nutrición especializada desde el ingreso, siendo de elección la nutrición enteral sobre la nutrición parenteral administrada de forma precoz más allá del ligamento de treitz, para provocar el mínimo estímulo pancreático. No hay estudios específicos que nos aclaren cuál es el tipo de dieta a administrar, pero los expertos recomiendan la utilización de dietas poliméricas. La nutrición parenteral, sin una fórmula concreta, quedaría indicada en los pacientes con pancreatitis aguda grave que presentan intolerancia a la nutrición enteral o cuando se agravan los signos clínicos de pancreatitis al administrar la dieta enteral. Aun así, se recomienda mantener
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Gastrointestinal surgery
Sánchez álvarez,C.; Zabarte Martínez de Aguirre,M.; Bordejé Laguna,L.;
Nutrición Hospitalaria , 2011,
Abstract: gastrointestinal surgery and critical illness place tremendous stress on the body, resulting in a series of metabolic changes that may lead to severe malnutrition, which in turn can increase postsurgical complications and morbidity and mortality and prolong the hospital length of stay. in these patients, parenteral nutrition is the most widely used form of nutritional support, but administration of enteral nutrition early in the postoperative period is effective and well tolerated, reducing infectious complications, improving wound healing and reducing length of hospital stay. calorie-protein requirements do not differ from those in other critically-ill patients and depend on the patient's underlying process and degree of metabolic stress. in patients intolerant to enteral nutrition, especially if the intolerance is due to increased gastric residual volume, prokinetic agents can be used to optimize calorie intake. when proximal sutures are used, tubes allowing early jejunal feeding should be used. pharmaconutrition is indicated in these patients, who benefit from enteral administration of arginine, omega 3 and rna, as well as parenteral glutamine supplementation. parenteral nutrition should be started in patients with absolute contraindication for use of the gastrointestinal tract or as complementary nutrition if adequate energy intake is not achieved through the enteral route.
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Gastrointestinal surgery Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Cirugía del aparato digestivo
C. Sánchez álvarez,M. Zabarte Martínez de Aguirre,L. Bordejé Laguna
Nutrición Hospitalaria , 2011,
Abstract: Gastrointestinal surgery and critical illness place tremendous stress on the body, resulting in a series of metabolic changes that may lead to severe malnutrition, which in turn can increase postsurgical complications and morbidity and mortality and prolong the hospital length of stay. In these patients, parenteral nutrition is the most widely used form of nutritional support, but administration of enteral nutrition early in the postoperative period is effective and well tolerated, reducing infectious complications, improving wound healing and reducing length of hospital stay. Calorie-protein requirements do not differ from those in other critically-ill patients and depend on the patient's underlying process and degree of metabolic stress. In patients intolerant to enteral nutrition, especially if the intolerance is due to increased gastric residual volume, prokinetic agents can be used to optimize calorie intake. When proximal sutures are used, tubes allowing early jejunal feeding should be used. Pharmaconutrition is indicated in these patients, who benefit from enteral administration of arginine, omega 3 and RNA, as well as parenteral glutamine supplementation. Parenteral nutrition should be started in patients with absolute contraindication for use of the gastrointestinal tract or as complementary nutrition if adequate energy intake is not achieved through the enteral route. El estrés de la cirugía gastrointestinal y la enfermedad crítica representan una gran agresión sobre el organismo, lo que ocasiona una serie de cambios metabólicos que pueden conducir a una situación de desnutrición grave, con aumento de las complicaciones posquirúrgicas, mayor morbimortalidad y prolongación de la estancia hospitalaria. En estos enfermos la nutrición parenteral es la más utilizada, pero se ha visto que la nutrición enteral administrada de forma precoz en el postoperatorio es efectiva y bien tolerada, con disminución de las complicaciones infecciosas, mejoría de la cicatrización de las heridas y menor estancia hospitalaria. Las necesidades caloricoproteicas no difieren de las de otros pacientes críticos, y dependerán de la patología basal del paciente y de su grado de estrés metabólico. En caso de intolerancia a la nutrición enteral, en especial si se debe al aumento del residuo gástrico, se deben utilizar procinéticos para optimizar el aporte calórico. En caso de suturas proximales se debe recurrir a la colocación de sondas que permitan la nutrición en yeyuno de forma precoz. La farmaconutrición tiene efectos beneficiosos en este t ipo de enfermos, con indicación
Cirugía cardíaca en pacientes de edad avanzada Cardiac surgery in elderly patients
S. Just,T.M. Tomasa,P. Marcos,L. Bordejé
Medicina Intensiva , 2008,
Abstract: Objetivo. Comparar la morbilidad y la mortalidad de los pacientes de cirugía cardíaca de acuerdo a la edad inferior o superior a 75 a os. Dise o. Estudio descriptivo retrospectivo. Pacientes. Dos mil cuatrocientos setenta pacientes consecutivos ingresados en el postoperatorio inmediato tras cirugía cardíaca en nuestra Unidad de Medicina Intensiva entre noviembre de 2000 y diciembre de 2005. De ellos, 1.983 eran menores de 75 a os y 497 mayores de 75 a os. Se han incluido todos los pacientes con cirugía, tanto programada como urgente y emergente. Principales variables de interés. Factores de riesgo cardiovascular (diabetes mellitus, hipertensión arterial y dislipidemia), European System for Cardiac Operative Risk Evaluation (EuroSCORE) y EuroSCORE logístico, estancia, mortalidad, complicaciones durante la estancia en la Unidad de Cuidados Intensivos (UCI). Resultados. La mortalidad hospitalaria de los pacientes mayores de 74 a os fue significativamente superior (9,2% frente a 4,3%, p < 0,05). La morbilidad de los pacientes mayores de 74 también fue superior (EuroSCORE 8,2 ± 2,7 frente a 4,9 ± 3,3, p < 0,001). Tanto la estancia en la UCI como la estancia hospitalaria fueron significativamente superiores en los pacientes mayores de 74 a os. Conclusiones. En nuestra serie tanto la morbilidad como la mortalidad de los mayores de 74 es superior, lo que conlleva peores resultados en la cirugía cardíaca de estos pacientes. Objective. To compare morbidity and mortality of cardiac surgery patients according to age below or above 75 years. Design. Descriptive retrospective study. Patients. A total of 2,470 consecutive patients admitted to our Intensive Medicine Unit between November 2000 and December 2005 who were in the immediate postoperative period after cardiac surgery. Of these patients, 1,983 were younger than 75 years and 497 were older than 75 years. Main variables of interest. Cardiovascular risk factors (diabetes mellitus, arterial hypertension and dyslipidemia), EuroSCORE (European System for Cardiac Operative Risk Evaluation) and logistic EuroSCORE, length of stay, mortality, complications during Intensive Care Unit (ICU) stay. Results. In-hospital mortality of patients older than 74 years was significantly higher (9.2% versus 4.2%, p < 0.05). The morbidity of patients over 74 years of age was also significantly higher (EuroSCORE 8.2 ± 2.7 versus 4.9 ± 3.3, p < 0.001). Both ICU stay and hospital stay were significantly higher in those over 74 years of age. Conclusions. In our series both morbidity and mortality were higher in those older than 74 years
A Shock-Patching Code for Ultra-Relativistic Fluid Flows
L. Wen,A. Panaitescu,P. Laguna
Physics , 1996, DOI: 10.1086/304547
Abstract: We have developed a one-dimensional code to solve ultra-relativistic hydrodynamic problems, using the Glimm method for an accurate treatment of shocks and contact discontinuities. The implementation of the Glimm method is based on an exact Riemann solver and van der Corput sampling sequence. In order to improve computational efficiency, the Glimm method is replaced by a finite differencing scheme in those regions where the fluid flow is sufficiently smooth. The accuracy and convergence of this hybrid method is investigated in tests involving planar, cylindrically and spherically symmetric flows that exhibit strong shocks and Lorentz factors of up to ~2000. This hybrid code has proven to be successful in simulating the interaction between a thin, ultra-relativistic, spherical shell and a low density stationary medium, a situation likely to appear in Gamma-Ray Bursts, supernovae explosions, pulsar winds and AGNs.
Cirugía cardíaca en pacientes de edad avanzada
Just,S.; Tomasa,T.M.; Marcos,P.; Bordejé,L.; Torrabadella,P.; Moltó,H.P.; Moreno,J.A.; Castro,M.A.;
Medicina Intensiva , 2008,
Abstract: objective. to compare morbidity and mortality of cardiac surgery patients according to age below or above 75 years. design. descriptive retrospective study. patients. a total of 2,470 consecutive patients admitted to our intensive medicine unit between november 2000 and december 2005 who were in the immediate postoperative period after cardiac surgery. of these patients, 1,983 were younger than 75 years and 497 were older than 75 years. main variables of interest. cardiovascular risk factors (diabetes mellitus, arterial hypertension and dyslipidemia), euroscore (european system for cardiac operative risk evaluation) and logistic euroscore, length of stay, mortality, complications during intensive care unit (icu) stay. results. in-hospital mortality of patients older than 74 years was significantly higher (9.2% versus 4.2%, p < 0.05). the morbidity of patients over 74 years of age was also significantly higher (euroscore 8.2 ± 2.7 versus 4.9 ± 3.3, p < 0.001). both icu stay and hospital stay were significantly higher in those over 74 years of age. conclusions. in our series both morbidity and mortality were higher in those older than 74 years of age group, which entails worse results in cardiac surgery of these patients. keywords: cardiac surgery, sternotomy, cardiopulmonary bypass, mortality, postoperative care, elderly.
Cambio temporal en la huella ecológica de la región de Murcia y su uso como indicador de desertificación
E. Hernández Laguna,F. López Bermúdez
Papeles de Geografía , 2004,
Abstract: Numerosos estudios han alertado sobre el proceso de desertifi cación en la Región de Murcia, en el Sureste de la Península Ibérica. Su clima semiárido junto con la defi ciente gestión de sus fértiles suelos, son responsables de la degradación de sus recursos naturales. La Huella Ecológica de una población es una medida de la presión sobre la tierra en términos de hectáreas de tierra per capita necesarias para el sostenimiento de dicha población dada la tecnología usada. Junto con la biocapacidad de la tierra, HE mide la sostenibilidad del territorio. En este trabajo, se mide la HE de la Región de Murcia para dos a os consecutivos, 1995 y 2001. Un claro paralelismo es observado entre la variación de este indicador y la desertifi cación.
Integrated Sachs-Wolfe Effect for Gravitational Radiation
Pablo Laguna,Shane L. Larson,David Spergel,Nicolas Yunes
Physics , 2009, DOI: 10.1088/2041-8205/715/1/L12
Abstract: Gravitational waves are messengers carrying valuable information about their sources. For sources at cosmological distances, the waves will contain also the imprint left by the intervening matter. The situation is in close analogy with cosmic microwave photons, for which the large-scale structures the photons traverse contribute to the observed temperature anisotropies, in a process known as the integrated Sachs-Wolfe effect. We derive the gravitational wave counterpart of this effect for waves propagating on a Friedman-Robertson-Walker background with scalar perturbations. We find that the phase, frequency and amplitude of the gravitational waves experience Sachs-Wolfe type integrated effects, this in addition to the magnification effects on the amplitude from gravitational lensing. We show that for supermassive black hole binaries, the integrated effects could account for measurable changes on the frequency, chirp mass and luminosity distance of the binary, thus unveiling the presence of inhomogeneities, and potentially dark energy, in the Universe.
Impact of Relativistic Fireballs on External Matter : Numerical Models of Cosmological Gamma-Ray Bursts
A. Panaitescu,L. Wen,P. Laguna,P. Meszaros
Physics , 1996, DOI: 10.1086/304185
Abstract: We numerically model the interaction between an expanding fireball and a stationary external medium whose density is either homogeneous or varies with distance as a power-law. The evolution is followed until most of the fireball kinetic energy is converted into internal energy. The density, pressure and flow Lorentz factor profiles are shown at different stages, including shock and rarefaction wave reflections, for a fireball of initial bulk Lorentz factor Gamma = 100, both in the adiabatic and non-adiabatic (radiative) regimes. For cooling times shorter than the dynamic time, bolometric light-curves are computed for values of Gamma = 50, 100 and 200. We compare the numerical light-curves with analytic results, and find that for a homogeneous external medium there is a simple scaling relationship among light-curves obtained for different parameters. The light-curves for power-law external densities are similar in shape to those in the homogeneous case. We discuss the implications of a comparison of the results with observed Gamma-Ray Burst time histories.
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