Adalimumab for the Treatment of Non-Infectious Uveitis: A Real Life Experience.

OBJECTIVE: To describe the efficacy and safety of adalimumab for the treatment of non-infectious uveitis (NIU) in four Uveitis Units from tertiary Spanish hospitals. METHODS: Multicenter and retrospective clinical cohort study including all patients with NIU treated with adalimumab from January 2012 to October 2022 in four uveitis units was performed. Efficacy was measured with the number of relapses, ocular inflammation and reduction in immunosuppression and corticosteroid dosage before and after adalimumab use. We collected data regarding adverse effects and examined the immunogenicity of adalimumab. RESULTS: One hundred and twenty-two patients (59% females), with a mean age of 48.6 years (SD = 14.8) accounting for 217 eyes were included. The majority (92.6%) were Caucasian. Uveitis analyzed were predominantly panuveitis (34.7%), bilateral (77.9%), acute (41.5%), and non-granulomatous (90%). Most of them were immune mediated (42.6%), and the main reason to initiate adalimumab was refractory disease (96.7%). The analysis was statistically significant due to the reduction in the number of immunosuppressive drugs as well as the dose of oral corticosteroids and the number of relapses during follow-up (p < 0.001). The decrease in ocular inflammation parameters and the improvement in visual acuity (p < 0.05) were also significant. There were no deaths due to the drug and only one reported case of serious infection. In total, 10.9% of 73 patients tested developed anti-adalimumab antibodies and 4.1% lupus-like. CONCLUSIONS: We consider adalimumab as a leading drug in the treatment of NIU with high safety and efficacy.

Does stress response axis activation differ between patients with autoimmune disease and healthy people?

Many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic-pituitary-adrenal (HPA) axis, but the results are controversial. Our objective was to study differences in stress response axis activity between patients with autoimmune disease and healthy people. The study sample consisted of 97 women divided into four groups: 37 healthy women (HW), 21 with systemic lupus erythematosus (SLE), 21 with Sjögren's syndrome (SS), and 18 with systemic sclerosis (SSc). After being exposed to a stress task, participants' skin conductance and salivary cortisol levels were measured in order to assess their response to psychological stress. Diurnal cortisol concentrations were assessed by measuring salivary cortisol in samples collected five times over one day. In addition, self-administered questionnaires were used to assess psychological variables. A time × group interaction effect was found (p = 0.003) in salivary cortisol secretion in response to stressful challenge. The healthy group presented normal activation, the SS and SLE groups showed no activation, and the SSc group presented a similar activation pattern to the HW group, except at the time of recovery. Total cortisol production (AUCg) was higher in the SSc group than in the HW group (p = 0.001). Differences were also observed in the cortisol AUCg collected over one day between healthy women and patients with SLE (p = 0.004) as well as with SSc (p = 0.001): women with SLE and SSc presented higher total hormone production than healthy women. Patients with autoimmune disease present a different HPA axis response, which may contribute to the harmful effects of stress in these diseases.

Bioavailability of Bioactive Compounds from Reconstituted Grapefruit Juice as Affected by the Obtention Process.

Much attention has been paid to the health benefits of including fruits and vegetables in the diet. However, for the compounds responsible for this beneficial effect to be effective at the level of the human organism, they must be available for absorption after digestion. In this sense, in vivo studies are needed to demonstrate the bioavailability of these compounds and their physiological activity. In order to provide information in this regard, this study collects data on the levels of vitamin C (VC) and naringenin (NAG) in the blood serum of the 11 volunteer participants in this trial, before and after consuming two different grapefruit juices. The juices were prepared by rehydrating the grapefruit powder obtained by freeze-drying (FD) the fruit puree or by spray-drying (SD) the liquefied grapefruit. No significant differences (p > 0.05) neither by juice nor by participant were observed in any case. The mean relative increase of VC, NAG and the radical scavenging ability (RSA) in blood serum due to grapefruit juices intake was 12%, 28% and 26%, respectively. Just VC showed a positive and significant Pearson's correlation with RSA. The mean bioavailability of VC was quantified as 1.529 ± 0.002 mg VC/L serum per 100 mg of VC ingested.

Complicaciones relacionadas con la traqueotomía en pacientes pos-COVID-19 tratados con distintos dispositivos de oxigenoterapia / Tracheostomy-related complications in post-COVID-19 patients treated with different oxygen therapy devices

Objetivo: conocer las complicaciones relacionadas con la traqueotomía en pacientes pos-COVID-19 tratados con distintos dispositivos de oxigenoterapia y los factores asociados. Métodos: se llevó a cabo un estudio observacional retrospectivo en pacientes adultos portadores de una traqueotomía pos-COVID-19, que estuvieron ingresados en la Unidad de Semicríticos de Neumología del Hospital Universitario de Bellvitge (Madrid, España), de agosto de 2021 a mayo de 2022. Variables: sociodemográficas, clínicas, comorbilidades, relacionadas con la traqueotomía y sistemas de oxigenación, complicaciones. Se realizó análisis descriptivo y comparación de variables para identificar factores de riesgo asociados a dichas complicaciones.Resultados: se incluyeron a 28 pacientes. El 85,7% fue hombre. La mediana de edad fue de 65,50. La mediana de días de ingreso en UCI fue de 61,5 días. Las principales comorbilidades: hipertensión arterial (42,9%) y diabetes (35,7%). El 78,6% llevaba dispositivo alto flujo. El 32,1% presentó complicaciones relacionadas con el manejo de la traqueotomía. Las complicaciones más frecuentes fueron la presencia de tapón mucoso (33,3%) y la alteración en la consistencia de secreciones (33,3%). Presentaron más complicaciones los hombres que las mujeres (88,9% vs.11,1%), los pacientes con antecedentes de hábito tabáquico (66,7% vs. 33,3%, p= 0,028). Los pacientes que eran portadores de un dispositivo de alto flujo no presentaron casi ninguna complicación (94,7% frente a 5,3%, p= 0,007). Conclusiones: el uso de dispositivos de oxigenoterapia que incorporen humidificación activa y control de la temperatura es una alternativa útil para reducir las complicaciones asociadas a la pérdida de esta función fisiológica de la anatomía nasofaríngea en los pacientes con traqueotomía.(AU)

Objectives: to understand tracheostomy-related complications in post-COVID-19 patients treated with different oxygen therapy devices and their associated factors.Methods: an observational retrospective study was conducted in adult patients with post-COVID-19 tracheostomy, who were hospitalized at the Respiratory Semi-critical Care Unit of the Bellvitge University Hospital (Barcelona, Spain), from August 2021 to May 2022. The variables were: sociodemographic, clinical, comorbidities, associated with tracheostomy and oxygenation systems, complications. Descriptive analysis was conducted, as well as comparison of variables in order to identify the risk factors associated with said complications. Results: the study included 28 patients; 85.7% were male. Their median age was 65.50. The median number of hospitalization days at ICU was 61.5 days. Their main comorbidities: hypertension (42.9%) and diabetes (35.7%). High-flow devices were used by 78.6% of patients; 32.1% of them presented complications associated with tracheostomy management. The most frequent complications were the presence of mucous plug (33.3%) and an alteration in consistency of secretions (33.3%). Male patients presented more complications than female patients (88.9% vs.11.1%), as well as patients with a smoking history (66.7% vs. 33.3%, p= 0.028). Patients who were carriers of high-flow devices presented almost no complications (94.7% vs. 5.3%, p= 0.007). Conclusions: the use of oxygen therapy devices incorporating active humidification and temperature control is a useful option in order to reduce those complications associated with the loss of this physiological function of the nasopharyngeal anatomy in patients with tracheostomy.(AU)

Composition of Powdered Freeze-Dried Orange Juice Co-Product as Related to Glucose Absorption In Vitro.

The reuse of food by-products is crucial for the well-being of the planet. Considering the high content of nutrients and other bioactive compounds in many of them, investigating their suitability for use as human food ingredients is an interesting challenge. In this study, in addition to the proximate composition, phenol content and antioxidant activity (AOA = 3.2 mmol Trolox equivalent (TE)/100 g, db) of orange juice powder by-product (CoP), different in vitro properties related to carbohydrate metabolism have been characterised. Specifically, the glycaemic index (GI), the glycaemic load (GL), the glucose dialysis retardation index (GDRI = 13.6%), the glucose adsorption capacity (GAC = 22.5 mM) and the inhibition capacity of α-amylase (α-A = 46.9%) and α-glucosidase (α-G = 93.3%) of powdered orange juice waste have been determined and related to fibre and phenolics composition. Taking advantage of the high fibre content of the by-product (36.67%), its GL was calculated for a CoP dose that allows labelling the food to which it is added as a source of fibre. The low GI value (24.4%) and the low GL (0.918 g available carbohydrates per serving) allowed us to conclude that the product studied could be an interesting opportunity for the food industry to offer it as a healthy food ingredient to be included in the diet, especially for those suffering from type 2 diabetes mellitus. Of the total phenolic compounds (TP = 509 mg equivalent of gallic acid (GAE)/100 g, db), 68% were found in free fraction (FP), and their contribution to the total AOA was 40.6%, while this was 54.9% for the 32% of phenols bound to plant tissues (BP).

In Vitro Bioaccessibility of Bioactive Compounds of Freeze-Dried Orange Juice Co-Product Formulated with Gum Arabic and Modified Starch.

The large amount of waste generated by the orange juice industry has sparked the interest of many researchers in incorporating recycling systems and following a much more sustainable circular economy model. This work proposes the valorization of the co-product generated in the orange juice extraction industry after freeze-drying for its subsequent reuse as a natural ingredient in the food industry. In addition, the possible protective effect of gum Arabic and corn starch esterified with octenyl succinic groups, in proportions optimised in previous studies 0.25 and 0.45 g/g orange co-product dry solutes, on the main bioactive compounds of orange peel during the freeze-drying process has been studied. The samples were characterised for their content of vitamin C (ascorbic and dehydroascorbic acids), flavonoids (hesperidin and narirutin), total phenols and total carotenoids, as well as their antioxidant capacity (DPPH and FRAP assays). In addition, samples were digested, mimicking the human enzymatic oral gastro-intestinal digestion process, and the bioaccessibility of the bioactive compounds was evaluated. It was observed that the addition of both biopolymers improved the stability of the hydrophilic compounds during freeze-drying. This conservative effect was more remarkable for higher biopolymer concentrations. However, no protective effect on carotenoid compounds was observed. This trend was reflected in the antioxidant activity of the different samples. In addition, the incorporation of biopolymers improved the bioaccessibility of the bioactive compounds studied. In conclusion, the results supported the feasibility of the freeze-dried orange juice co-product as a natural, sustainable source of health-promoting compounds.

Free and Bound Phenolic Compounds Present in Orange Juice By-Product Powder and Their Contribution to Antioxidant Activity.

Interest in fruit/vegetable consumption is not always linked to a particular diet but rather derives from their high antioxidant activity (AOA), with potential health benefits provided, in part, by polyphenols. Although phenols can be found in free form (FP) or bound to plant tissues (BP), the experimental methodology most frequently used for the quantification of total phenols (TP) is based on the extraction of a portion of FP, which may justify the lack of correlation often found between them and AOA. In this context, four successive extractions were performed to obtain FP and BP of powdered orange juice by-product, and their contribution to the AOA was studied. The first extract (MeOH, 30 °C) can be assumed to be one of the conventional methods for the quantification of TP. Re-extraction with MeOH (60 °C) afforded the FP. Two subsequent basic and acidic extractions yielded the BP. Although the FPs were the most abundant, the AOA (DPPH method) of the last fraction of BP was of the same order found in the first fraction of FP. This highlights the interest in extracting the BP from the by-product of orange juice if its antioxidant capacity is to be exploited.

Influence of formulation on the quality and stability of a freeze-dried Mandarin product.

Consumers demand products of high quality, healthy, safe, and easy to manage. A freeze-dried fruit snack can meet this demand, but this kind of product may collapse rapidly, becoming highly sticky. To avoid this, adding biopolymers can improve their stability. Nevertheless, these biopolymers can negatively affect other quality characteristics such as the color, texture, and flavor. Therefore, selecting the best biopolymer or combination of biopolymers is an indispensable task to offer freeze-dried fruit. The aim of this study was to know the impact of gum Arabic, starch modified with octenyl succinic anhydrous, bamboo fiber and milk protein isolate on the color, glass transition temperature, and stability of some textural related properties of a freeze-dried mandarin snack. The study showed the convenience of incorporate mixtures of the considered biopolymers to mandarin puree as to ensure the crispy character of the snack, associated with its glassy state, without this having a significant impact on the product color. The best formulation was that obtained with a mix of gum Arabic and bamboo fiber.

Efficacy of cognitive-behavioural therapy for lifestyle modification in metabolic syndrome: a randomised controlled trial with a 18-months follow-up.

OBJECTIVE: To test the efficacy of cognitive-behavioural therapy (CBT) for lifestyle modification in patients with metabolic syndrome (MetS). DESIGN: 76 MetS patients completed this clinical trial, with 18 months follow-up. 45 participants from the experimental group (EG - CBT) and 31 to the control group (CG - usual care). The CBT programme was performed by a psychologist in a face-to-face group format, during 12 weekly sessions lasting 90 minutes. The intervention for the CG consisted of workshops with basic information about MetS and it's associated cardiovascular risk. MAIN OUTCOME MEASURES: Efficacy of (CBT) in (MetS) patients. RESULTS: Results showed reduction in weight (mean difference - MD -2.633, 95%CI [-4.322, -0.943]; p<.003), waist circumference (MD -2.944, 95%CI [-5.090, -0.798]; p<.008), body mass index (MD -0.915, 95%CI [-1.494, -0.335]; p<.003), systolic (MD -0.046, 95%CI [-0.685, -0.023]; p<.0002) diastolic blood pressure (MD -4.777, 95%CI [-7.750, -1.804]; p<.002), and cardiovascular risk score after 18 months. An increase in adherence to the Mediterranean diet and assertiveness and a reduction in anger were observed in EG. The CG did not show any significant differences. CONCLUSION: The CBT focused on changes in lifestyle seems to be effective in the reduction of MetS and cardiovascular risk factors. TRIAL REGISTRATION: Registered at clinicaltrials.gov (NCT02949622) - PROMETS (Multimodal Intervention Program for Patients with Metabolic Syndrome).

Characterization of the Orange Juice Powder Co-Product for Its Valorization as a Food Ingredient.

The citrus juice industry produces a large amount of fiber-rich waste and other bioactive compounds of great interest for their potential health benefits. This study focuses on the valorization of the co-product resulting from the extraction of orange juice to offer it as a versatile, healthy, high-quality, and stable natural food ingredient in powder form. To this end, the vitamin C (VC) content (ascorbic and dehydroascorbic acid, AA and DHAA), major flavonoids (hesperidin and narirutin, HES and NAT), and techno-functional properties (angle of repose, AoR; hygroscopicity and wettability; density and porosity; mean particle size, MPS; water retention capacity, WRC; oil holding capacity, ORC; emulsifying and foaming capacity, EC and FC; and emulsion and foam stability, ES and FS) have been characterized. In addition, considering that dehydrated foods with high sugar content require the incorporation of high molecular weight biopolymers for their physical stabilization, the influence of starch modified with octenyl succinic acid (OSA) and gum Arabic (GA) on these properties has been studied. The results obtained confirm the high quality of this co-product to be offered as a powdered food ingredient with nutraceutical potential. The addition of the studied biopolymers is recommended as it does not modify the flowability of the powder and favors both the encapsulation of the bioactive compounds, especially in the presence of GA, and the rehydration capacity.

Impact of the Freeze-Drying Conditions Applied to Obtain an Orange Snack on Energy Consumption.

Nowadays, the consumer is looking for healthier, more attractive, ready-to-eat, and safer foodstuffs than fresh products. Despite freeze drying being known for providing high added value products, it is a slow process which is conducted at low pressures, so, in terms of energy consumption, it turns out to be quite costly for the food industry. With the purpose of obtaining a freeze-dried orange puree, previously formulated with gum Arabic and bamboo fiber, which can be offered to consumers as a snack at a low economic cost, the impact of the process conditions on energy consumption has been considered. The product temperature evolution and the energy consumption were registered during the drying of frozen samples at different combinations of chamber pressures (5 and 100 Pa) and shelf temperatures (30, 40 and 50 °C). In each case, the time processing was adapted in order to obtain a product with a water content under 5 g water/100 g product. In this study, the secondary drying stage was considered to start when the product reached the shelf temperature and both the pressure and the temperature affected the duration of primary and secondary drying stages. The results obtained led to the conclusion that the shorter duration of the process when working at 50 °C results in significant energy saving. Working at a lower pressure also contributes to a shortening of the drying time, thus reducing the energy consumption: the lower the temperature, the more marked the effect of the pressure.

Incidencia de complicaciones y factores de riesgo asociados en pacientes intervenidos de neumonectomía / Incidence of complications and associated risk factors in patients undergoing pneumonectomy

Objetivo: conocer la incidencia de complicaciones e identificar los factores de riesgo asociados a complicaciones post-operatorias desarrolladas tras una neumonectomía.Método: se llevó a cabo un estudio observacional retrospectivo, cuya muestra se obtuvo del total de pacientes, mayores de 18 años, que estuvieron hospitalizados en el Servicio de Neumología y Cirugía Torácica del Hospital Universitario de Bellvitge (Barcelona), entre enero de 2016 y junio de 2020, que habían sido intervenidos de neumonectomía (derecha o izquierda). Variables de estudio: complicaciones durante la hospitalización, comorbilidades y factores de riesgo, además de otras variables demográficas y clínicas. Los datos se recogieron mediante una revisión de historias clínicas electrónicas. Se realizó análisis descriptivo y analítico. Se consideró significativa la diferencia si p< 0,05.Resultados: se incluyeron 24 pacientes, 75% varones (n=1 8). El 46% era fumador. La edad media (rango intercuatílico) fue de 66 (62-74) años. Las principales comorbilidades identificadas fueron: hipertensión arterial (46%; n= 11), diabetes mellitus (25%; n= 6) y EPOC (25%; n= 6). 83% (n= 20) intervenidos mediante toracotomía. 79% (n= 19) sometidos a neumonectomía izquierda y 42% (n= 10) con complicaciones post-operatorias. La complicación con mayor incidencia fue la arritmia cardiaca (17%; n= 4). La neumonectomía derecha se asoció con la aparición de complicaciones (p= 0,05). La media de días de estancia hospitalaria fue mayor en el grupo con complicaciones (9,5 frente a 7; p= 0,005).Conclusión: se detectaron complicaciones post-operatorias en cuatro de cada diez sujetos, siendo la más frecuente la arritmia cardiaca. La neumonectomía derecha se asoció significativamente a la aparición de complicaciones.(AU)

Objective: to understand the incidence of complications, and identify the risk factors associated with post-surgical complications developed after pneumonectomy.Method: a retrospective observational study was conducted; the sample was obtained from the group of >18-year-old patients hospitalized at the Pulmonology and Thoracic Surgery Unit of the Hospital Universitario de Bellvitge (Barcelona), between January, 2016 and June, 2020, who had undergone pneumonectomy (right or left). Study variables: complications during hospitalization, comorbidities and risk factors, besides other demographical and clinical variables. Data were collected through review of electronic clinical records. Descriptive and analytical analysis was conducted. The difference was considered significant if p< 0.05.Results: the study included 24 patients: 75% were male (n=1 8); 46% were smokers; and their mean age (interquartile range) was 66 (62-74) years. The main comorbidities detected were: hypertension (46%; n= 11), diabetes mellitus (25%; n= 6) and COPD (25%; n= 6); 83% (n= 20) underwent thoracotomy, and 79% (n= 19) underwent left pneumonectomy; 42% (n= 10) presented post-surgical complications. The complication with the highest incidence was cardiac arrythmia (17%; n= 4). Right pneumonectomy was associated with the development of complications (p= 0,05). The mean hospital stay was higher in the group with complications (9.5 vs. 7 days; p= 0.005).Conclusion: post-surgical complications were detected in 4 out of each ten subjects; the most frequent was cardiac arrythmia. Right pneumonectomy was significantly associated with the development of complications.(AU)

Quality of a powdered grapefruit product formulated with biopolymers obtained by freeze-drying and spray-drying.

Freeze-drying and spray-drying are two techniques used to produce dehydrated food products. Both techniques are easy to use and offer high sensory, nutritive value, and functional quality to foods. However, both processes become difficult for foods with high sugar and acid content, such as fruits. This is because these products, once dehydrated, moisten quickly, causing a change in their physical properties, mainly in the mechanical aspects related to the start of a caking phenomenon. Therefore, incorporating high molecular weight biopolymers that act as facilitators or processors, prevent the structural collapse of the product. The aim of this study was to select the best process, between freeze-drying or spray-drying, to obtain a powdered grapefruit product with the higher quality. The impact of the biopolymers used to stabilize the powdered product was also tested. The properties analyzed were the solubility, wettability, hygroscopicity, porosity, and color of the powder together with the flow behavior, both in air and water. The results of this study show that using the freeze-drying technique, products have a better flow behavior, greater porosity, and a color more like fresh grapefruit. Biopolymers, especially when in combination, have a positive effect on the quality parameters studied. PRACTICAL APPLICATION: The results of this study allow freeze-drying to be proposed as a process to obtain a grapefruit product with better properties, both powdered and rehydrated, than that obtained by spray-drying. On the other hand, although the incorporation of biopolymers is necessary to facilitate the process and stabilize the product, no significant differences have been found between the different formulations tested, although it seems that their combination favours some of the properties of the powder, such as solubility, hygroscopicity, wetting time and dispersibility.

Protective capacity of gum Arabic, maltodextrin, different starches, and fibers on the bioactive compounds and antioxidant activity of an orange puree (Citrus sinensis (L.) Osbeck) against freeze-drying and in vitro digestion.

Dehydrated fruit puree may be a convenient way to promote the healthy consumption of fruit based foods. Drying carriers, highly used by the food industry to stabilize dried fruit products, may show a potential encapsulating capacity of the biocompounds, that could also limit their bioaccesibility. This study analyzed the impact of gum Arabic (GA), bamboo fiber (BF), native corn starch, starch substituted with octenylsuccinic groups, pea fiber, and maltodextrin on the in vitro bioaccessibility of vitamin C (VC), total phenols (TP), and ß-carotene, as well as on the antioxidant capacity during the freeze-drying and in vitro digestion of an orange puree. Amongst the formulations studied, GA + BF was the most effective for phytochemicals protection of the freeze-dried orange puree during the intestinal stage of digestion, resulting in a higher TP and VC bioaccessibility (59% and 36%, respectively).

Impact of freeze-drying conditions on the sensory perception of a freeze-dried orange snack.

BACKGROUND: The health benefits provided by fruit mean that there is continuous interest in offering consumers new products to stimulate its consumption. To this end, dehydrated fruit snacks may be an interesting option. In this study, we evaluated the impact of freezing rate (slow and high), shelf temperature (40 and 50 °C), and working pressure (5 and 100 Pa) on the perception and acceptability of a freeze-dried orange snack obtained from an orange puree. RESULTS: Of the different freeze-drying conditions studied, working pressure was the variable with the greatest effect. The lowest working pressure (5 Pa) led to samples being obtained with a slightly lower water content, which was perceived with higher citrus flavor and crispiest. The highest pressure (100 Pa) led to samples with a greater water content, perceived with a more yellow intense color. Nevertheless, there is no significant consumer preference for any of the different processed samples. The number of force peaks, which is positively correlated with the crispness, shows a significant and negative correlation (r = -0.91) with the water content of the sample. CONCLUSION: The study revealed that considerations other than the sensory can determine the best conditions of the freeze-drying process with which to obtain an orange snack. The number of force peaks obtained from a penetration test may be proposed as a tool for instrumental analysis of the snack's crispness that supplies information closely resembling customer perception of this attribute. © 2021 Society of Chemical Industry.

Puntos clave en el fast-track a los pacientes intervenidos de cirugía torácica / Fast-track key points for patients undergoing thoracic surgery

OBJETIVO: conocer los puntos clave del fast-track en los pacientes intervenidos de cirugía torácica MÉTODO: revisión narrativa. Se usaron las bases de datos: CINHAL, Pubmed y Cochrane Library Plus. Términos de búsqueda: fast-track, thoracic surgery and ERAS. CRITERIOS DE INCLUSIÓN: estudios que trataran sobre fast-track en cirugía torácica (no resección traqueal ni cirugías de mediastino), mayores de 18 años, publicados en los 10 últimos años, idiomas inglés o español. RESULTADOS: se seleccionaron 17 artículos. Los resultados se dividieron en tres partes: 1) Periodo prequirúrgico, en el cual se da mucha importancia a la deshabituación tabáquica, la información que se le proporciona al paciente sobre la cirugía y su proceso evolutivo, el concepto "prehabilitación", el cribaje de malnutrición, enfermedades pulmonares y anemia, entre otros. 2) Proceso intraoperatorio, muy enfocado a la minimización de las técnicas quirúrgicas más agresivas, utilizar técnicas anestésicas más favorecedoras para el paciente, mantener la normotermia del paciente, hacer una ventilación protectora y reducir la carga de sueroterapia. 3) Periodo postquirúrgico, donde se reduce el tiempo de dieta absoluta del paciente, se favorece la movilización, se intenta controlar el dolor para evitar complicaciones, conocer los criterios de alta y ayudar a aumentar el empoderamiento del paciente para su correcta recuperación y evolución. CONCLUSIÓN: es importante conocer el papel de la figura enfermera en la implementación de un protocolo fast-track, ya que ayuda a reducir el estrés quirúrgico, disminuye los costes y la estancia hospitalaria, favorece al empoderamiento del paciente mediante una recuperación postquirúrgica precoz y trata al enfermo desde una perspectiva enfermera más holística

OBJECTIVE: to understand the fast-track key points in patients undergoing thoracic surgery. METHOD: a narrative review. The following databases were used: CINHAL, Pubmed and Cochrane Library Plus. Search terms: fast-track, thoracic surgery and ERAS. Inclusion criteria: studies dealing with fast-track in thoracic surgery (neither tracheal resection nor mediastinum surgery), >18-year-old, published in the past 10 years, in English or Spanish. RESULTS: seventeen (17) articles were selected. Results were classified into three parts: 1) Preoperative stage, assigning high importance to smoking cessation, information provided to patients about the surgery and its evolution process, the concept of "prehabilitation", screening for malnutrition, pulmonary conditions and anaemia, among others; 2) Intraoperative process, highly focused on minimizing the most aggressive surgical techniques, using anesthetic techniques more beneficial for patients, maintaining the patient in normothermia, conducting protective ventilation, and reducing the saline therapy load; 3) Postoperative period, where the time of absolute diet for the patient is reduced, mobilization is encouraged, pain is controlled to some extent in order to prevent complications, discharge criteria are understood, and patient empowerment is encouraged for their correct recovery and evolution. CONCLUSION: it is important to understand the role of the nurse in the implementation of a fast-track protocol, because it helps to reduce surgical stress, there is a reduction in cost and hospital stay, patient empowerment is encouraged through early postsurgical recovery, and the patient is treated from a more holistic nursing perspective

Análisis de las complicaciones postquirúrgicas tras cirugía de resección traqueal / Analysis of post-surgical complications after tracheal resection surgery

OBJETIVO: analizar la incidencia de las complicaciones postquirúrgicas de los pacientes intervenidos de resección traqueal o cricotraqueal, y los factores asociados a dichas complicaciones. MÉTODO: se llevó a cabo un estudio observacional analítico retrospectivo de todos los pacientes que ingresaron por resección traqueal en el Servicio de Cirugía Torácica del Hospital Universitario de Bellvitge (Barcelona) (periodo 2017-2019). Se revisaron las historias clínicas electrónicas: variables clínicas y presencia de complicaciones postquirúrgicas. Se realizó análisis descriptivo y bivariante. RESULTADOS: se incluyeron un total de 13 pacientes. La edad media fue de 65,6. El 54% fue mujer. Principales comorbilidades: hipertensión arterial (76,9%), diabetes (23%) y obesidad (34%). La estancia media en el servicio fue de 14,2 días. El 46% se so-metió a una resección cricotraqueal y el 54% a una resección traqueal. Los pacientes sometidos a una resección traqueal presentaron más complicaciones (71,4%) que las resecciones cricotraqueales (28,6%). El 53,8% de los pacientes tuvo complicaciones. En los sujetos con obesidad hubo un porcentaje de complicaciones superior a los no obesos. Los pacientes con complicaciones tuvieron una estancia media hospitalaria superior a los que no presentaron complicaciones (17,57 vs. 10,33 días). CONCLUSIONES: más de la mitad de los pacientes intervenidos de resección traqueal o cricotraqueal presentaron complicaciones postquirúrgicas, aunque con una incidencia baja: infección de la herida quirúrgica, disfagia, cambios en la voz, hematoma, reintubación y sangrado. Se objetivó mayor proporción de complicaciones en las personas con obesidad

OBJECTIVE: to analyze the incidence of post-surgical complications in patients undergoing tracheal or cricotracheal resection, and the factors associated with said complications. METHOD: an observational analytical retrospective study conducted in all patients admitted for tracheal resection at the Thoracic Surgery Unit of the Hospital Universitario de Bellvitge (period from 2017 to 2019). There was a review of electronic clinical records: sociodemographical variables, background and associated comorbidities, clinical variables, and presence of post-surgical complications. Descriptive and bivariate analysis was conducted. RESULTS: in total, 13 patients were included: their mean age was 65.6 years, and 54% were female. Main comorbidities: hypertension (76.9%), diabetes (23%) and obesity (34%). The mean stay at the Unit was 14.2 days. Of these patients, 46% underwent cricotracheal resection, and 54% underwent tracheal resection. Patients who underwent tracheal resection presented more complications (71.4%) than those with cricotracheal resections (28.6%). In total, 53.8% of patients presented complications. Obese patients presented a higher proportion of complications vs. non-obese patients. Patients with complications had a higher mean hospital stay vs. those who did not present complications (17.57 vs. 10.33 days). CONCLUSIONS: more than half of patients undergoing tracheal or cricotracheal resection presented post-surgical complications, though with a low incidence: surgical wound infection, dysphagia, changes in voice, bruising, reintubation, and bleeding. A higher proportion of complications was observed in patients with obesity