Effects of Leucine Administration in Sarcopenia: A Randomized and Placebo-controlled Clinical Trial.

Treating sarcopenia in older individuals remains a challenge, and nutritional interventions present promising approaches in individuals that perform limited physical exercise. We assessed the efficacy of leucine administration to evaluate whether the regular intake of this essential amino acid can improve muscle mass, muscle strength and functional performance and respiratory muscle function in institutionalized older individuals. The study was a placebo-controlled, randomized, double-blind design in fifty participants aged 65 and over (ClinicalTrials.gov identifier NCT03831399). The participants were randomized to a parallel group intervention of 13 weeks' duration with a daily intake of leucine (6 g/day) or placebo (lactose, 6 g/day). The primary outcome was to study the effect on sarcopenia and respiratory muscle function. The secondary outcomes were changes in the geriatric evaluation scales, such as cognitive function, functional impairment and nutritional assessments. We also evaluated whether leucine administration alters blood analytical parameters and inflammatory markers. Administration of leucine was well-tolerated and significantly improves some criteria of sarcopenia in elderly individuals such as functional performance measured by walking time (p = 0.011), and improved lean mass index. For respiratory muscle function, the leucine-treated group improved significantly (p = 0.026) in maximum static expiratory force compared to the placebo. No significant effects on functional impairment, cognitive function or nutritional assessment, inflammatory cytokines IL-6, TNF-alpha were observed after leucine administration compared to the placebo. The use of l-leucine supplementation can have some beneficial effects on sarcopenia and could be considered for the treatment of sarcopenia in older individuals.

Characterization of a tooth microphone coupled to an oral appliance device: A new system for monitoring OSA patients.

Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, especially in elderly and obese populations. Despite constituting a serious health, social and economic problem, most patients remain undiagnosed and untreated due to limitations in current equipment. In this work, we propose a novel method to diagnose OSA and monitor therapy adherence and effectiveness at home in a non-invasive and inexpensive way: combining acoustic analysis of breathing and snoring sounds with oral appliance therapy (OA). Audiodontics has introduced a new sensor, a tooth microphone coupled to an OA device, which is the main pillar of this system. The objective of this work is to characterize the response of this sensor, comparing it with a commercial tracheal microphone (Biopac transducer). Signals containing OSA-related sounds were acquired simultaneously with the two microphones for that purpose. They were processed and analyzed in time, frequency and time-frequency domains, in a custom MATLAB interface. We carried out a single-event approach focused on breaths, snores and apnea episodes. We found that the quality of the signals obtained by both microphones was quite similar, although the tooth microphone spectrum concentrated more energy at the high-frequency band. This opens a new field of study about high-frequency components of snores and breathing sounds. These characteristics, together with its intraoral position, wireless option and combination with customizable OAs, give the tooth microphone a great potential to reduce the impact of sleep disorders, by enabling prompt detection and continuous monitoring of patients at home.

Characterization of microphones for snoring and breathing events analysis in mHealth.

Obstructive sleep apnea (OSA) is one of the most common sleep disorders, especially in elderly population. Despite its high prevalence and severe consequences, most patients remain undiagnosed due to serious limitations on the existing equipment. Efforts are being done to find cost-effective alternatives and mHealth solutions could play a key role. One promising approach in this context is the acoustic analysis of snoring. The sensor it requires is a microphone, which is widely available in different models and even integrated in smartphones. The objective of this work is to characterize and compare the responses of two commercial tracheal microphones and a mHealth-based microphone, as a proof-of-concept to evaluate their potential as sensors for OSA detection. To do that, we designed an experimental protocol to study OSA-related events (breaths, snores and apneas) simulated by 4 subjects. Test signals were simultaneously recorded with different microphones and posteriorly processed and analyzed. We accurately characterized the frequency response of the two commercial microphones, finding that one of them was too restrictive (bandwidth 50-250 Hz) and thus not suitable as snoring sensor for high-frequency acoustic analysis. Regarding smartphones, we studied the Samsung Galaxy S5 microphone. We found that, when located over the thorax, it provided quality signals comparable to those of tracheal microphones, with a broader frequency response. Further work is required, but this preliminary study suggests that acoustic analysis of snoring through mHealth solutions can be a feasible alternative to screen and monitor OSA patients at home.

mHealth tools for monitoring Obstructive Sleep Apnea patients at home: Proof-of-concept.

Obstructive Sleep Apnea (OSA) is a sleep disorder that affects mainly the adult and elderly population. Due to the high percentage of patients who remain undiagnosed and untreated because of limitations of current diagnosis methods, the management of OSA is an important social, scientific and economic problem that will be difficult to be assumed by health systems. On the other hand, smartphone platforms (mHealth systems) are being considered as an innovative solution, thanks to the integration of the essential sensors to obtain clinically relevant parameters in the same device or in combination with wireless wearable devices.

Clinical usefulness of therapeutic drug monitoring of voriconazole in a university hospital / / Utilidad clínica de la determinación de concentraciones plasmáticas de voriconazol en un hospital universitario

INTRODUCTION: The aim of this study was to assess the clinical usefulness of therapeutic drug monitoring (TDM) of voriconazole (VOR) in a university hospital. METHODS: A retrospective review was conducted on the clinical records of 52 patients treated with VOR and on whom TDM was performed. Steady-state trough plasma VOR concentration was measured at least 5 days after starting treatment. The therapeutic range of plasma VOR concentration was defined as 1-5.5 μg/mL. RESULTS: The most frequent underlying conditions in the study population were lung transplant (48.1%) and hematological malignancies (26.9%). At the first TDM in each patient, VOR levels were outside the therapeutic range in 16 (30.7%) cases: <1 µg/mL in 10 (19.2%) and >5.5 µg/mL in 6 (11.5%). Eleven patients (21.2%) experienced severe muscle weakness and had considerable difficulty walking. All these patients were receiving concomitant treatment with corticosteroids. Age younger than 30 years (p = .005) and cystic fibrosis as the underlying disease (p = .04) were factors associated with low VOR levels. Almost all patients who had VOR concentrations >1 µg/mL at the first TDM had a successful outcome (96%). CONCLUSIONS: Plasma VOR concentrations were outside the therapeutic range at the first TDM in 30% (16/52) of patients. Age younger than 30 years and cystic fibrosis were factors associated with low VOR levels. The potential interactions between corticosteroids and VOR should be highlighted, as they could be responsible for a high rate of muscle weakness observed in our patients. Prospective trials are needed to investigate VOR TDM and corticosteroid pharmacokinetics

INTRODUCCIÓN: Nuestro objetivo fue evaluar la utilidad clínica de la monitorización de la concentración plasmática (TMD) de voriconazol (VOR) en un hospital universitario. MÉTODOS: Revisión retrospectiva de las historias clínicas de 52 pacientes tratados con VOR en los que se realizó TDM. El intervalo terapéutico de la concentración plasmática de VOR fue definida entre 1 μg/mL y 5.5 μg/mL. RESULTADOS: Las condiciones subyacentes más frecuentes en la población de estudio fueron trasplante de pulmón (48,1%) y neoplasias hematológicas (26,9%). En la primera determinación de TMD de VOR estaban fuera del intervalo en 16 (30,7%) casos: < 1 µg/mL en 10 (19,2%) y > 5,5 µg/mL en 6 (11,5%). Once pacientes (21,2%) experimentaron debilidad muscular, éstos pacientes recibían tratamiento concomitante con corticosteroides. Los Factores asociados con bajos niveles de VOR observados fueron la edad menor a 30 años (p= 0,005) y la fibrosis quística (p = 0,04). Casi todos los pacientes que tenían concentraciones VOR > 1 µg/mL en la primera TDM tuvieron un resultado satisfactorio (96%). CONCLUSIONES: En 30% (16/52) de los pacientes, las concentraciones plasmáticas de VOR estaban fuera del intervalo terapéutico en la primera TDM. La edad menor a 30 años y la fibrosis quística fueron factores asociados con niveles bajos de VOR. Observamos una posible interacción entre corticoesteroides y voriconazol con debilidad muscular asociada en los pacientes tratados con ambos fármacos. Se necesitan estudios clínicos prospectivos en relación a las interacciones entre corticoesteroides y voriconazol

Clinical usefulness of therapeutic drug monitoring of voriconazole in a university hospital.

INTRODUCTION: The aim of this study was to assess the clinical usefulness of therapeutic drug monitoring (TDM) of voriconazole (VOR) in a university hospital. METHODS: A retrospective review was conducted on the clinical records of 52 patients treated with VOR and on whom TDM was performed. Steady-state trough plasma VOR concentration was measured at least 5 days after starting treatment. The therapeutic range of plasma VOR concentration was defined as 1-5.5µg/mL. RESULTS: The most frequent underlying conditions in the study population were lung transplant (48.1%) and hematological malignancies (26.9%). At the first TDM in each patient, VOR levels were outside the therapeutic range in 16 (30.7%) cases: <1µg/mL in 10 (19.2%) and >5.5µg/mL in 6 (11.5%). Eleven patients (21.2%) experienced severe muscle weakness and had considerable difficulty walking. All these patients were receiving concomitant treatment with corticosteroids. Age younger than 30 years (p=.005) and cystic fibrosis as the underlying disease (p=.04) were factors associated with low VOR levels. Almost all patients who had VOR concentrations >1µg/mL at the first TDM had a successful outcome (96%). CONCLUSIONS: Plasma VOR concentrations were outside the therapeutic range at the first TDM in 30% (16/52) of patients. Age younger than 30 years and cystic fibrosis were factors associated with low VOR levels. The potential interactions between corticosteroids and VOR should be highlighted, as they could be responsible for a high rate of muscle weakness observed in our patients. Prospective trials are needed to investigate VOR TDM and corticosteroid pharmacokinetics.

Interstitial lung disease associated to erlotinib treatment: a case report.

INTRODUCTION: Few cases of pulmonary toxicity related to epidermal growth factor receptor-targeted agents have been described. CASE PRESENTATION: We report a case of a 63-year-old white male with stage IV non-small cell lung cancer treated with erlotinib who developed a interstitial lung disease. CONCLUSION: Respiratory symptoms during treatment with erlotinib should alert clinicians to rule out pulmonary toxicity. Early erlotinib withdrawal and corticoid administration were successful.

[Usefulness and difficulties for the elaboration of the nursing discharge report, according to Hospital de Fuenlabrada (Spain) nursing group]. / Utilidad y dificultades para la realización del informe de enfermería al alta hospitalaria según las enfermeras del Hospital de Fuenlabrada.

OBJECTIVE: To evaluate the utility and difficulty of writing the nursing discharge report perceived by nurses working in the hospitalization unit of the Fuenlabrada Hospital in Spain. METHOD: We performed a cross-sectional, descriptive study in all nurses working in hospitalization units in the Fuenlabrada Hospital (Madrid) in the last trimester of 2006. A questionnaire was used to collect sociodemographic variables, variables related to perceived utility of the report in general and variables measuring the difficulty of completing the report. The questionnaires were delivered to the hospitalization units and collected personally. For the statistical analysis, the chi-square test and Student's t-test and/or analysis of variance were used. The SPSS/PC statistical package, version 12.0, was used. RESULTS: Seventy-four completed questionnaires were obtained (57.4 % of the population analyzed). Of the nurses surveyed, 61 (82.4 %) considered the report to be useful in assuring continuity of care and 57 nurses (77 %) thought it useful in providing information to the patients. In total, 60 nurses (82.1 %) considered the report's structure to be not very suitable or unsuitable. CONCLUSIONS: Nurses' satisfaction with the report is high. The report is seen as effective in assuring continuity of care and as useful to patients. However, the report's structure should be improved.

Evaluación del Proceso de Atención de los Usuarios que acuden a la Consulta Externa del Hospital Pediátrico Baca Ortíz de Quito en el año 2007 / Evaluation of the Process of Attention of the Users that you/they go to the External Consultation of the Pediatric Hospital Luggage Baca Ortíz of I Remove in the year 2007

El presente estudio se realizó en el Hospital de Niños Baca Ortíz de Quito, y tuvo como objetivo identificar las característica de la Atención en Consulta Externa del Hospital y analizar su oprganización para determinar como inciden dichas características sobre la calidad de atención y sobre la satisfacción de los pacientes.El estudio se realizó durante seis meses y fue descriptivo, analítico y transversal dirigido por una parte a la población de usuarios del Hospital (niños 0 a 13 años 11 meses, y sus familiares), y por otra, al personal que trabaja en la Consulta Externa. Los instrumentos utilizados incluyeron una Encuesta a usuarios externos, apicada a una muestra de 270 usuarios distribuidos en las seis especialidades de mayor demanda en Consulta Externa, una Lista de Chequeo para evaluar el desempeño y actitud del personal

Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study.

OBJECTIVE: To assess the feasibility and safety of the respiratory infection control (RIC) device, a silver-coated endotracheal tube, and its effect on bacterial burden in the airways. DESIGN: Prospective, randomized, single-blind, multiple-center study. SETTING: Three hospitals in Spain and one in the United States. PATIENTS: Patients were eligible adults who required mechanical ventilation for > or =24 hrs and did not have respiratory infections. One hundred forty-nine patients were intubated and analyzed for safety; 121 were intubated > or =24 hrs and analyzed for tube colonization; 67 had negative baseline quantitative endotracheal aspirates and were analyzed for quantitative endotracheal aspirates colonization. INTERVENTIONS: Intubation with the RIC device or a control endotracheal tube. MEASUREMENTS AND MAIN RESULTS: The RIC device was associated with delayed colonization on the tube compared with the control device at the threshold of ++, +++, or > or =10(4) colony-forming units/mL (p = .02, log-rank test; p = .10, Wilcoxon's test) and in quantitative endotracheal aspirates at > or =10(6) colony-forming units/mL (p = .08, log-rank test; p = .05, Wilcoxon's test). The RIC device was associated with reduced colonization rate by days on the tube (p = .04, Wilcoxon's test) and in quantitative endotracheal aspirates (p = .05, Wilcoxon's test) at the same thresholds. The RIC device was associated with lower maximal bacterial burden in tracheal aspirates for 7 days (mean log-transformed burden, 4.2 +/- 2.3 vs. 5.5 +/- 1.7 log colony-forming units/mL; p = .02, Wilcoxon's test). Other between-group differences favored the RIC device but were not significant. Five adverse events were considered device related, including three events in the RIC group and two events in the control group. CONCLUSIONS: In this prospectively planned, preliminary analysis, the RIC device was feasible and well tolerated. Larger studies are needed to determine whether delayed colonization, reduced colonization rate, and decreased bacterial burden will decrease the incidence of ventilator-associated pneumonia.

Prevention of infection in the intensive care unit: current advances and opportunities for the future.

Recent studies have contributed to our understanding of the risk factors and the impact of nosocomial infections in the ICU, allowing a more rational approach to the prevention of such infections. Ventilator-associated pneumonia, bloodstream infections, and outbreaks all occur in the presence of artificial devices. High antibiotic pressure, prolonged hospitalization, and the presence of comorbidities facilitate the selection of multiresistant strains in the ICU setting. In clinical practice, prevention is the more effective investment to reduce costs. Potential measures of control should focus on the patient, the microorganisms, and the device. A number of recent studies addressing these issues have been published and will be reviewed in this article.