Optimisation of antithrombotic therapy in patients with acute coronary syndrome to reduce bleeding episodes.

AIM: The aim of the study was to evaluate the effectiveness of a multidisciplinary intervention to reduce the risk of bleeding associated with antithrombotic drugs in patients with acute coronary syndrome (ACS). METHODS: We designed a pre-post quasi-experimental intervention study using retrospective cohorts. The first cohort was analysed to detect correctable measures contributing to bleeding (PRE: January-July 2010). Second, a bundle of interventions was implemented and third, a second cohort of patients was evaluated to investigate the impact of our measures in bleeding reduction (POST: September 2011-February 2012). RESULTS: A total of 677 patients were included (377 in PRE and 300 in POST). The bundle of interventions was: Overdose avoidance measures: the percentage of patients overdosed was reduced by 66.3% (p < 0.001). Institutional protocol update to include the latest recommendations regarding bleeding prevention: In POST, the percentage of patients treated with fondaparinux increased (2.4% vs. 50.7%; p < 0.001). In PRE, 11 patients were treated with the combination of abciximab and bivalirudin; whereas in POST, only one patient received the combination (p = 0.016). Mandatory measurement of body weight: the percentage of patients with unknown body weight was reduced by 35% (p = 0.0001). In POST, the total bleeding rate was reduced by 29.2% (31.6% in PRE vs. 22.4%, p < 0.05, OR: 0.62; 95% CI: 0.44-0.88). It was necessary to implement the interventions in 11 patients to prevent one bleeding episode (95% CI: 7-39). CONCLUSION: The multidisciplinary programme has been effective in reducing bleeding episodes. The interventions were effective in reducing antithrombotic drugs overdosage, incorporating the use of fondaparinux to the NSTE-ACS therapeutic arsenal, limiting the use of bivalirudin with abciximab and obtaining body weight for most patients.

[Drug exposure associated with exacerbation of symptoms in patients with myasthenia gravis]. / Exposición a fármacos asociados a agravamiento de síntomas en pacientes con miastenia grave.

INTRODUCTION: Numerous drugs have been related to exacerbation of myasthenia gravis. So far there are no studies examining the extent of use of drugs related to exacerbation of myasthenia gravis. AIMS: We sought to assess the extent of use of drugs related to exacerbations and the annual incidence rate of exacerbations in a cohort of myasthenia gravis patients. We explored possible risk factors of severe exacerbations. PATIENTS AND METHODS: We performed a retrospective cohort study. We included adult patients followed in neurology department. We estimated frequencies, rates and built a recurrent events model. RESULTS: We included 91 patients. 94.51% of patients had at least one prescription of a drug. 51 patients had at least one prescription of a drug contraindicated according to its drug label. 145 exacerbation episodes were reported in 50 patients. The annual incidence rate of exacerbation episodes was 0.35. 48 exacerbations were severe (in 18 patients). The annual incidence rate of severe exacerbation episodes was 0.12. Generalized myasthenia gravis and thymectomy were associated with a higher risk of severe exacerbation episodes. CONCLUSIONS: Our patients were extensive and widespread exposed to drugs during the follow-up period but we did not find and association with severe exacerbation episodes. Just over half of the patients had at least one exacerbation episode during the study period, most of them were mild. Further studies with larger sample sizes are necessary to corroborate these conclusions and to study possible correlations between the use of drugs and the risk of exacerbation episodes.

TITLE: Exposición a fármacos asociados a agravamiento de síntomas en pacientes con miastenia grave.Introducción. Numerosos fármacos se han relacionado con el agravamiento de síntomas en pacientes con miastenia grave, pero hasta la fecha no existen estudios sobre la exposición a fármacos en estos pacientes. Objetivos. Describir el consumo de fármacos y calcular la tasa anual de episodios de exacerbación en una cohorte de pacientes con miastenia grave, y explorar posibles factores de riesgo de exacerbaciones graves. Pacientes y métodos. Estudio observacional longitudinal retrospectivo que incluye a pacientes adultos con miastenia grave seguidos en consulta. Cálculo de frecuencias, tasas y construcción de modelo de eventos repetidos. Resultados. De 91 pacientes incluidos, el 94,51% estuvo expuesto al menos a un fármaco durante el período de estudio (siete años y un mes). De ellos, 51 tuvieron al menos una prescripción de un fármaco contraindicado en la ficha técnica (56,04%). Se contabilizaron 145 exacerbaciones en 50 pacientes. La tasa anual de incidencia fue de 0,35 exacerbaciones por paciente y año. De estas exacerbaciones, 48 fueron graves (en 18 pacientes), con una tasa anual de incidencia de 0,12. Se halló una posible asociación entre diagnóstico de miastenia grave generalizada y timectomía, con un aumento del riesgo de episodios de exacerbación graves. Conclusiones. En esta cohorte se encontró una amplia exposición a fármacos, pero no asociación con el riesgo de episodios de exacerbación graves. Algo más de la mitad de pacientes tuvo al menos un episodio de exacerbación durante el período de estudio, la mayoría leves. Son necesarios estudios que corroboren estas conclusiones y puedan estudiar posibles correlaciones entre fármacos y el riesgo de episodios de exacerbación.

In vitro starch digestibility and fate of crocins in pasta enriched with saffron extract.

This work aims to study the effect of the addition of saffron extract on fresh pasta in-vitro digestibility. Fresh pasta was formulated with different concentrations of saffron extracts (0.2 and 0.4 %w/w), cooked at two different times (1.5 and 3 min), and in vitro digested (oral, gastric and intestinal stages). Oil was added to pasta before digestion to evaluate the presence of lipids on starch and crocin bioaccessibility. Saffron enrichment and oil addition slowed down the digestion of starch, thus, decreasing the glycemic index of pasta. Concentration of saffron and oil addition contributed to crocin release in the digestion fluids, with the opposite effect of cooking time. Isomerization from trans to cis was enhanced by both, cooking and oil addition. Bioaccessibility of total crocins varied from 2.9 ±â€¯1.1, to 97 ±â€¯3%. Finally, the trans:cis isomers distribution was only close to 50:50 in enriched-pasta cooked during 3 min or with oil addition.

[Evaluation of a rapid assay for detection of PBP2a Staphylococcus aureus]. / Evaluación de una prueba rápida para la detección de PBP2a en Staphylococcus aureus.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen causing both healthcare-associated and community-acquired infection. Rapid and accurate detection of this pathogen is crucial for the use of appropriate antimicrobial therapy and the control of nosocomial spread. METHODS: A total of 107 S. aureus strains were assayed for methicillin resistance: Vitek2® (bioMérieux), CHROMagarTM MRSA II (BD Becton Dickinson), disk diffusion in agar for cefoxitin 30 µg and immunochromatography PBP2a SA Culture Colony Test (AlereTM). The results of conventional tests were compared with the "gold standard" PCR test for mecA gene. RESULTS: Sensitivity and specificity were: disk diffusion for cefoxitin 100% and 100% respectively, Vitek2® 100 and 100%, CHROMagarTM MRSA II 100 and 96%, and ICPBP2a detection 98,25% and 100%. CONCLUSIONS: ICPBP2a Culture Colony Test (AlereTM) is fast, efficient and economical technique for detection of penicillin binding protein 2a (PBP2a) from isolates. This assay is a useful tool for the management of hospital outbreaks.

Effect of saffron (Crocus sativus L.) enrichment on antioxidant and sensorial properties of wheat flour pasta.

Saffron, used in cookery as a flavouring and colouring agent, is well-known for its antioxidant and beneficial health properties. In the present work, the effect of saffron addition (0-control, 0.1, 0.2 and 0.4%, w/w) in the formulation of fresh pasta was evaluated on textural, physical-chemical, and sensory properties of the cooked product. Content and retention of the bioactive molecules of saffron (crocins) were evaluated by HPLC along with the corresponding antioxidant activity of enriched pasta. The presence of saffron significantly influenced textural and physical-chemical properties of pasta. Higher saffron concentrations enhanced the antioxidant activity of pasta with the higher values of crocins in samples enriched with 0.4% saffron extract even after 3 min of cooking (4.23-5.06 mg/g db). Sensory analysis showed an increased acceptability of the saffron enriched pasta for all descriptors selected (visual aspect, colour, aroma, taste, chewiness, hardness, gumminess and overall acceptability).

Dietary acrylamide: What happens during digestion.

Acrylamide is a well-known potentially carcinogen compound formed during thermal processing as an intermediate of Maillard reactions. Three objectives were addressed: the impact of gastric digestion on acrylamide content of French Fries, chips, chicken nuggets, onions rings, breakfast cereals, biscuits, crackers, instant coffee and coffee substitute; the acrylamide content evolution during gastrointestinal digestion of French fries and chips; and the effectiveness of blanching and air-frying on acrylamide mitigation after gastrointestinal digestion. A significant increase (p-value <0.05) in acrylamide content was observed for most of the products after gastric digestion (maximum registered for sweet biscuits, from 30±8 to 150±48µg/kg). However, at the end of the intestinal stage, acrylamide values were statistically similar (p-value=0.132) for French fries and lower than the initial values (before digestion) in potato chips (p-value=0.027). Finally, the low acrylamide content found in blanched and air-fried samples, remained still lower than for deep fried samples even after gastrointestinal digestion.

Integrated Care Program for Older Adults: Analysis and Improvement.

OBJECTIVE: We aimed to in-depth analyse the Integrated Care Programme for older in- and out-patients implemented for more than 25 years at the Hospital Universitario de Getafe, in Madrid, Spain. We identify the strengths and barriers hindering the full operation, and we proposed a technological solution that overcame these constraints and facilitated integration. DESIGN: First, we carried out a comprehensive analysis of the integrated care program at the HUG following Case Study Research; the primary unit of analysis was the Geriatrics service and its clinical units. Secondary sources of analyses were professionals' insights (obtained thought direct observation and interviews) and statistics on the service. After the identification of the barriers preventing complete success; we designed a Health Information System and developed a mock-up that was validated with the professionals. Finally, we passed the specifications to the Information System Unit at the Hospital to develop and integrate the system into the hospital one. SETTING: The Geriatrics Service of the University Hospital of Getafe, pertaining to the public Healthcare System of the Region of Madrid (Spain). PARTICIPANTS: No patient participated in the study. All staff from the Geriatrics Service and the ICT manager of the hospital contributed to the design of the Health Information System; and 3 geriatricians from the Service and 1 primary care physician validated it. MEASUREMENTS: First, we qualitative analysed the Integrated Care Program taking as dimensions eight facilitators towards integrated care. In response, we proposed an integrated information system solution. Later, we interviewed the staff geriatricians to analyse the Integrated Care Programme. Finally, we validated our proposed system in terms of usability and user experience using the System Usability Score-SUS and the User Experience Questionnaire-UEQ, respectively. RESULTS: The Integrated Care Program has demonstrated a high impact since its launch; however, the lack of integration in terms of information system was hindering the full deployment. We have designed an integrated information system which has been validated by physicians and nurses from the Geriatrics Service in terms of usability. We obtained a SUS score of 81 (68 is considered to be the cut-off point for usable systems). Besides, the perception of these professionals on our system was 'Excellent' in 5 out of the 6 items covered by UEQ (Attractiveness, Perspicuity, Dependability, Stimulation and Novelty) and 'Good' in terms of the 1 remaining (Efficiency), where there is still room for improvement. CONCLUSIONS: Our dedicated Health Information System is a robust solution to bridge information gaps and facilitate the complete integration of our Integrated Care Programme for older in- and outpatients.

[Evaluation of an immunochromatographic test for the detection of OXA-48 carbapenemase]. / Evaluación de un ensayo inmunocromatográfico para la detección de carbapenemasa OXA-48.

OBJECTIVE: Detection and differentiation of various types of carbapenemases is crucial to their control and dissemination. OXA-48 is the most common carbapenemase in Spain and in our environment. The aim of this study is the evaluation of a new immunochromatographic test OXA-48 Card letitest (Coris, BioConcept Belgium) to detect this carbapenemase from solid media. METHODS: During the last year 151 strains of carbapenemase producing bacteria have been isolated, of which 136 were OXA-48 (126 Klebsiella pneumoniae, 1 Klebsiella oxytoca, 5 Escherichia coli, 4 Enterobacter cloacae), and 15 producing other carbapenemases . These 15 strains with other 73 carrying other resistance mechanisms (54 extended-spectrum ß-lactamases producers and 19 with other mechanisms) were used as negative controls. RESULTS: One hundred and thirty six strains carrying OXA-48 were positive with the test OXA-48 Card letitest and the 88 species used as controls were negative, resulting in a sensitivity and specificity of 100%. CONCLUSIONS: The OXA-48 Card letitest is simple, quick, safe and cheap (approx. 6€/test) and can be used in microbiology laboratories to confirm the production of OXA-48 carbapenemase in clinical isolates.

Odour characteristics of seafood flavour formulations produced with fish by-products incorporating EPA, DHA and fish oil.

Thermal degradation of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids was investigated. As a novelty, EPA, DHA or fish oil (FO) were incorporated as ω-fatty acid sources into model systems containing fish powder produced via Maillard reactions. Aroma composition of the resulting products was determined and complemented with sensory evaluation. Heating of the oils led to a fast decrease of both, EPA and DHA, and to the development of characteristic volatile compounds including hexanal, 2,4-heptadienal and 4-heptenal, the most abundant being (E,E)-2,4-heptadienal (132±44-329±122µmol/g). EPA and DHA addition to the model systems increased the concentration of these characteristic volatile compounds. However, it did not have a considerable impact on the development of characteristic Maillard reaction products, such as pyrazines and some aldehydes. Finally, the results of the sensory evaluation illustrated that panellists would chose samples fortified with FO as the ones with a more pleasant aroma.

Anti-inflammatory and antiulcer activity of Teucrium buxifolium.

Teucrium buxifolium Spanish endemic, have traditionally been used for the treatment of rheumatic and other inflammatory affections. In this work, phytochemical screening was carried out to ascertain the qualitative composition of this species and we have studied the anti-inflammatory and antiulcer activity of Teucrium buxifolium. This species has exhibited potent anti-inflammatory properties against experimentally-induced arthritis and carrageenin paw edema. Additionally, Teucrium buxifolium species have displayed significant antiulcer and cytoprotective activity.

Evaluación de la eficacia de la atención farmacéutica en pacientes con dermatitis atópica / Effectiveness evaluation of the pharmaceutical care in patients with atopic dermatitis

Introducción: La dermatitis atópica es una enfermedad inflamatoria y crónica de la piel que afecta en gran medida a la calidad de vida de los pacientes de la padecen. Objetivo: Evaluar la eficacia de la atención farmacéutica en pacientes con dermatitis atópica diagnosticada, valorando su impacto sobre la sintomatología y la adherencia al tratamiento. Métodos: Se realizó un estudio experimental longitudinal prospectivo en 50 pacientes con dermatitis atópica no controlada, llevando a cabo una actuación farmacéutica individualizada basada en tres estrategias: educación sanitaria, seguimiento farmacoterapéutico, e intervención sobre el cuidado dermocosmético. Se evaluó la sintomatología y la adherencia al tratamiento farmacológico de cada paciente, y su evolución tras la intervención. Resultados: Los datos obtenidos se analizaron mediante el test estadístico de McNemar, confirmando que el 79,17% de los pacientes graves y el 92,30% de los casos moderados mejoraron significativamente tras la intervención. El valor obtenido del estadístico (Z=3,49) indicó que las variables intervención farmacéutica y mejora del paciente no eran independientes, siendo la primera la causa de la segunda. Al inicio del estudio, el 42% de los pacientes eran incumplidores, mientras que al final del mismo sólo el 23,81% lo eran. Conclusión: Este estudio demuestra que la atención farmacéutica, y más concretamente el seguimiento farmacoterapéutico, son herramientas útiles y necesarias para reducir la sintomatología y mejorar la calidad de vida de los pacientes con dermatitis atópica

Introduction: Atopic dermatitis is an inflammatory and chronic skin disease that greatly affects the quality of life of patients suffering from it. Objective: To evaluate the efficacy of pharmaceutical care in patients with diagnosed atopic dermatitis, assessing its impact on symptomatology and adherence to treatment. Methods: A prospective longitudinal experimental study was conducted in 50 patients with uncontrolled atopic dermatitis, and an individualized pharmaceutical action was carried out based on three strategies: health education, pharmacotherapeutic follow-up, and intervention on the dermocosmetic routine. The symptomatology and adherence to the pharmacological treatment of each patient, and their evolution after the intervention were evaluated. Results: The data obtained were analyzed by means of the McNemar statistical test, confirming that 79.17% of the serious patients and 92.30% of the moderate cases improved significantly after the intervention. The value obtained from the statistic (Z = 3.49) indicated that the variables pharmaceutical intervention and patient improvement were not independent, the former being the cause of the latter. At the beginning of the study, 42% of the patients were noncompliant, while at the end of the study only 23.81% were noncompliant. Conclusion: This study demonstrates that pharmaceutical care, and more specifically pharmacotherapy follow-up, are useful and necessary tools to reduce symptomatology and improve the quality of life of patients with atopic dermatitis

Influence of processing on the volatile profile of strawberry spreads made with isomaltulose.

A new strawberry spread formulated with fructose and isomaltulose (replacing sucrose partially or totally) and a high percentage of fruit was developed in line with the new trend of healthier products. This work studies the influence of some process variables (percentage of sugar, pectin and citric acid, and time of thermal treatment) on the volatile profile of these spreads with different formulations. The ripeness of the raw strawberries influences the concentrations of some of the compounds in the spreads, such as isobutyl acetate, butyl butyrate, 3-hexen-1-yl acetate or propan-2-ol. The process conditions have an important effect on the volatile profiles. Most of the esters and alcohols decreased whereas 13 new compounds appear, mostly furans (furfural, 2-acetylfurane, 5-methyl furfural, mesifurane) and aldehydes (octanal, nonanal, decanal and benzaldeyhde). In general, the spreads formulated with sucrose-isomaltulose that contained higher levels of pectin and citric acid gave better results in the preservation of the original aromatic compounds in raw strawberries.

Wearable and mobile system to manage remotely heart failure.

Cardiovascular diseases (CVDs) account for 45% of all deaths in the western world according to the 2004 World Health Organization statistics report. Heart failure (HF), CVD's primary paradigm, mainly affects people older than 65. The European MyHeart Project's mission is to empower citizens to fight CVD by leading a preventative lifestyle and allowing early diagnosis. This paper presents the iterative design and development of the HF management system, part of MyHeart Project. The system daily measures vital body signals to assess HF. The methodology applied herein has involved stakeholders in an iterative process: concept validation, feasibility, efficiency, patients' experience, and patients' acceptance. The final solution allows patient self-management of their chronic condition.

Atención farmacéutica a pacientes en tratamiento con AINE / Pharmaceutical care to patients under treatment with NSAIDs

Introducción: La automedicación es, en general, una conducta presente en todas las sociedades, y con frecuencia se autoprescriben antiinflamatorios sin control sanitario y sin que el paciente sea consciente de la intensidad y gravedad de las reacciones adversas que pueden provocar. Desde la oficina de farmacia se debe realizar una correcta atención farmacéutica y mejorar los resultados de la farmacoterapia previniendo, detectando y resolviendo los problemas relacionados con medicamentos antes de que éstos den lugar a morbilidad y mortalidad. Objetivos: 1) Analizar los principios activos más demandados, así como la forma de dispensación más frecuente. 2) Valorar la eficacia y la eficiencia de los medicamentos en las enfermedades para las que se prescriben. 3) Evaluar el grado de conocimiento de los pacientes sobre su farmacoterapia. 4) Realizar un análisis del seguimiento farmacoterapéutico a pacientes crónicos. Material y métodos: Estudio observacional, prospectivo, monocéntrico y concurrente llevado a cabo en pacientes tratados con antiinflamatorios, mediante encuestas y seguimiento farmacoterapéutico de los pacientes crónicos. Resultados: Los pacientes refirieron una disminución en el grado de dolor de 4 puntos según la escala visual analógica (EVA). Se redujo un 23,3% el número de pacientes con presión arterial sistólica (PAS) >=140 mmHg, y un 13,3% los pacientes con presión arterial diastólica (PAD) >=90 mmHg. Más del 90% declararon conocer mejor su enfermedad y su tratamiento, y el 58% mejoraron su adherencia a éste. La calidad de vida del paciente se vio aumentada en casi un 10% según el test EuroQol-5D. Conclusiones: La atención farmacéutica se presenta como una alternativa de calidad muy eficaz para conseguir mejorar el resultado de los tratamientos y la asistencia sanitaria(AU)

Introduction: Self-medication is generally present in all societies. Nonsteroidal anti-infl ammatory medications are one of the most commonly self-administered drugs and many patients without being aware of their side effects that can cause. From the pharmacy must make a proper pharmaceutical care and improve outcomes of drug therapy in preventing, detecting and solving drug therapy problems before they result in morbidity and mortality. Objectives: 1) To analyze the most demanded active principle and the most common form of dispensation. 2) To assess the effectiveness and efficiency of drugs for diseases those are prescribed. 3) To analyze the level of awareness of patients regards their drug thera py. 4) To assess the impact of pharmaceutical care to chronic patients. Methodology: The method used was a single-center prospective observational study in patients receiving anti-infl ammatory by questionnaires drafted and pharmaceutical intervention at pharmaceutical care for chronic patients. Results: The patients reported a reduction of 4 points in degree of pain according to the visual analog scale (VAS). The number of patients with systolic blood pressure (SBP) >=140 mmHg, and the number of patients with diastolic blood pressure (DBP) >=90 mmHg, was reduced 23.3 and 13.3%, respectively. Over 90% reported understand better their disease and treatment, 58% improved adherence. The patient’s quality of life was increased by almost 10% according to the test EuroQol-5D. Conclusions: Pharmaceutical care is presented as a very effective quality alternative to achieve better treatment outcomes and healthcare(AU)

Adquisición de competencias transversales en alumnos de pregrado de Ciencias de la Salud en la Universidad Complutense: una experiencia positiva / Acquisition of general skills in undergraduate students in Health Sciences in the Complutense University: a positive experience

Introducción. Presentamos los resultados de la evaluación de las Jornadas Complutenses de Investigación para alumnos de pregrado en Ciencias de la Salud, una actividad académica con dos años de experiencia y una participación de 1.434 alumnos, creada en nuestra universidad para impulsar en los alumnos de pregrado habilidades comunicativas y de metodología en investigación. Sujetos y métodos. Mediante una encuesta anónima se evaluó en los alumnos el grado de satisfacción e interés(aprender metodología científica, aprender a hablar en público, etc.) y también en los moderadores de mesas(originalidad, planteamiento metodológico, presentación iconográfica, exposición oral, viabilidad y relevancia de las comunicaciones presentadas). Resultados. En las I Jornadas se inscribieron 500 alumnos, todos de la Universidad Complutense de Madrid (UCM), y se presentaron un total de 169 comunicaciones (129 orales, 40 pósters). En las II Jornadas lo hicieron 934 alumnos, 838 de la UCM y 96 de otras nueve universidades, y se presentaron un total de286 comunicaciones (180 orales, 106 pósteres). Conclusiones. Es una actividad en la que el alumno pasa a ser un gestor activo y difusor de aprendizaje, y potencia de una manera dinámica habilidades en comunicación científica. También tiene beneficios para el profesorado y la institución universitaria, que la convierten en una ‘terapia pedagógica holística’ (AU)

Introduction. We present here the results of the appraisal of the Complutense Conference on Research for undergraduate students in Health Sciences, an academic activity which has been running for two years, with the participation of 1,434students. It was set up in this University to encourage communication skills and research methodology among undergraduate students. Subjects and methods. By means of an anonymous survey, the levels of satisfaction and interest of the students were evaluated (learning scientific methodology, learning to speak in public, etc.); similarly, that of the panel moderators (originality, methodological approach, iconographic presentation, oral presentation, viability and relevance of presentations given). Results. The First Conference had 500 registered students, all from the Complutense University of Madrid (UCM), with a total of 169 presentations(129 oral, 40 poster). In the Second Conference there were934 students, 838 from the UCM and 96 from nine other universities, with a total of 286 presentations (180 oral, poster106). Conclusions. This is an activity in which the student becomes an active manager and imparter of learning, and dynamically reinforces his or her skills in science communication. It also has benefits for teachers and the University itself, making it a ‘holistic pedagogical therapy’ (AU)

Fibronectina sérica como marcador de infección respiratoria en UCI / Serum fibronectin as respiratory infection marker in ICU

Objetivo. La fibronectina (FBN) es una proteína moduladora de la fagocitosis y como tal podría relacionarse con los procesos infecciosos. Evaluamos la eficacia de la fibronectina sérica como marcador precoz de infección respiratoria en pacientes críticos bajo ventilación mecánica (VM). Diseño. Estudio prospectivo de casos-control. Ámbito. Unidad de Cuidados Intensivos (UCI) polivalente en Hospital de tercer nivel con 42 camas. Pacientes. Setenta y siete pacientes con VM sin signos de infección al ingreso (casos) y 55 pacientes tras cirugía programada como muestra de validación (controles). Intervenciones. FBN sérica y cultivos cualitativos de aspirado endobronquial (AE) el primer, cuarto y séptimo día (si mantenían la VM) con seguimiento hasta el día décimo. Variables. Variables demográficas, SOFA y APACHE II al ingreso y aparición de neumonía o traqueobronquitis durante el seguimiento. Resultados. Los casos presentaban niveles más bajos de FBN (0,24 ± 0,11 g/l frente 0,39 ± 0,29 g/l, p < 0,01), pero ni el diagnóstico, los índices de gravedad o el pronóstico en este grupo se relacionaron con la FBN. Los casos con aislamiento de algún microorganismo en AE no presentaron niveles de FBN diferentes al ingreso (0,23 ± 0,10 frente a 0,25 ± 0,12) (independientemente del grupo diagnóstico), así como al cuarto o séptimo día. Presentaron infección respiratoria 27 (35,1%) pacientes, neumonía 19 y traqueobronquitis en 8. La FBN no mostró diferencias significativas con el resto de casos en ninguna de las tres determinaciones realizadas. Conclusiones. La FBN sérica en pacientes ingresados en UCI no es marcador de gravedad ni se relaciona con el pronóstico, no mostrando tampoco utilidad como marcador de infección respiratoria

Objective. Fibronectin (FBN) is a phagocytosis modulating protein and, as such, could be related with the infectious condition. We evaluate the efficacy of serum fibronectin as an early marker of respiratory infection in critical patients receiving mechanical ventilation (MV). Design. Prospective study of cases-control. Scope. Polyvalent ICU in third level Hospital with 42 beds. Patients. Seventy seven patients with MV without signs of infection on admission (cases) and 55 patients after elective surgery as validation sample (controls). Interventions. Serum FBN and qualitative cultures of endobronchial aspirate (EA) on days 1, 4 and 7 (if MV was maintained) with follow-up to day 10. Variables. Demographic variables, SOFA and APACHE II on admission and appearance of pneumonia or tracheobronchitis during follow-up. Results. The cases had low levels of FBN (0.24 ± 0.11 g/l vs 0.39 ± 0.29, p < 0.01), however, neither the diagnosis, seriousness indexes or prognosis in this group were related with the FBN. Cases with isolation of some microorganism in EA did not have different FBN levels on admission (0.23 ± 0.10 vs 0.25 ± 0.12) (regardless of the diagnostic group) nor on the fourth or seventh day. A total of 27 (35.1) patients had respiratory infection, 19 pneumonia and 8 tracheobronchitis. FBN did not shown any significant differences with the remaining cases in any of the three measurements made. Conclusions. Serum FBN in patients hospitalized in the ICU is not a marker of seriousness nor is it related with prognosis. It also does not have any utility as a marker of respiratory infection