Nutritional and Educational Intervention to Recover a Healthy Eating Pattern Reducing Clinical Ileostomy-Related Complications.

The aim of this study was to evaluate a diet intervention implemented by our hospital in order to determinate its capacity to improve the eating pattern of patients with an ileostomy, facilitating the implementation new eating-related behaviors, reducing doubt and dissatisfaction and other complications. The study was conducted with a quasi-experimental design in a tertiary level hospital. The elaboration and implementation of a nutritional intervention consisting of a Mediterranean-diet-based set of menus duly modified that was reinforced by specific counseling at the reintroduction of oral diet, hospital discharge and first follow-up appointment. Descriptive, bivariate and multivariate analyses were performed. The protocol was approved by the competent Ethics Committee. The patients of the intervention group considered that the diet facilitated eating five or more meals a day and diminished doubt and concerns related to eating pattern. Most patients (86%) had a favorable experience regarding weight recovery and a significant reduction of all-cause readmissions and readmission with dehydration (p = 0.015 and p < 0.001, respectively). The intervention helped an effective self-management of eating pattern by patients who had a physical improvement related to hydration status, which, together with an improvement in weight regain, decreased the probability of readmissions.

Unhealthy gestational weight gain: Are we neglecting inadequate gestational weight gain?

OBJECTIVE: To evaluate the prevalence of unhealthy gestational weight gain and analyze the role of women´s knowledge about the recommendations, expectations, beliefs, counseling, and information provided by midwives as potential factors contributing to failure to meet recommendations. RESEARCH DESIGN/SETTING: A retrospective cross-sectional study was performed in a tertiary Hospital in Seville (Spain) between March and September 2019. A sample of 500 singleton pregnant women at or over 37 weeks of gestation completed a self-administered questionnaire during a prenatal visit. Gestational weight gain was categorized as healthy/excessive/inadequate, according to the Institute of Medicine, for 409 women. Descriptive, bivariate, and multivariate analysis was performed. FINDINGS: Inadequate and excessive gestational weight gain were 33.4% and 33.9%, respectively. A multivariate model for excessive gestational weight gain showed pre-gestational body mass index was a risk factor, while exercise and believing the weight gain was healthy were protective factors. The model for inadequate gestational weight gain showed knowledge of recommendations was a protective factor while believing gestational weight was healthy was a risk factor. KEY CONCLUSIONS: Unhealthy gestational weight gain is common. Inadequate gain from women with healthy pre-pregnancy body mass index who believed their gain was healthy, was almost as common as excessive gestational weight gain. As shown by our predictive model beliefs regarding healthy gestational weight gain may act either as a protective factor, in the excessive gain model, or as a risk factor, in the inadequate gain model, depending on women´s pre-pregnancy body mass index and despite knowledge of the recommendations. IMPLICATIONS FOR PRACTICE: Inadequate weight gain, and not only excessive gain, should be properly addressed during pregnancy. Healthy gestational weight gain should be approached by midwives with a combination of one-to-one and group antenatal care, where believes regarding healthy gestational weight gain should be addressed. Midwives should remain alert as we may be facing a new trend: increasing numbers of women presenting with inadequate gestational weight gain; with negative health implications for a healthy population. We recommend that midwives pay attention to women with a healthy pre-pregnancy Body Mass Index and who believe that their weight gain is correct because this profile frequently had an inadequate gestational weight gain.

Beneficios del ácido tranexámico en pacientes intervenidos de artroplastia de rodilla unilateral / Benefits of tranexamic acid in patients undergoing unilateral knee arthroplasty

Objetivo: analizar los beneficios clínicos del uso de ácido tranexámico (TXA) en pacientes intervenidos de artroplastia de rodilla unilateral.Método: se realizó un estudio analítico transversal en las áreas quirúrgicas de dos hospitales en Sevilla (España) en pacientes intervenidos de artroplastia de rodilla con uso de TXA y sin él. Se recogieron variables sociodemográficas, clínicas intra y post-operatorias (dolor, sangrado, autotransfusión, constantes vitales) y tiempo de estancia en la unidad de reanimación post-operatoria y en la unidad de hospitalización. La recogida de datos se llevó a cabo a través de la historia clínica, hojas de constantes vitales y a través de observación directa en el seguimiento. Se utilizaron pruebas de contraste de hipótesis no paramétricas con una significación de p≤ 0,05.Resultados: participaron 72 pacientes: 35 recibieron TXA y 37 no. La mayoría de los participantes era mujer de entre 70 y 79 años. En ambos grupos la lateralidad de la rodilla intervenida fue similar, predominando la izquierda (60% en los que recibieron TXA y 51,4% en los que no). Se halló una menor proporción de personas con hipertensión (p= 0,011) y con necesidad de autotransfusión (p< 0,001) que habían recibido TXA. En este grupo disminuyeron también los tiempos de estancia en las unidades de reanimación y hospitalización, el sangrado y el dolor, y aumentó la saturación de oxígeno (todo p< 0,05).Conclusiones: la administración de TXA produce mejoras significativas en la clínica y recuperación postquirúrgica y reduce la estancia en el hospital, lo que podría implicar mejoras en el flujo de trabajo y en los costes asociados.(AU)

Objective: to analyse the clinical benefits of the use of tranexamic acid (TXA) in patients undergoing unilateral knee arthroplasty.Method: a cross-sectional analytical study was conducted at the surgical areas of two hospitals in Seville (Spain), in patients who had undergone knee arthroplasty using TXA and without it. Sociodemographic variables were collected, as well as clinical variables during and after surgery (pain, bleeding, self-transfusion, vital signs), and time of stay at the post-operative Resuscitation Unit and the Hospitalization Unit. Data collection was conducted through clinical records, vital sign sheets, and direct observation during follow-up. Non-parametric hypothesis contrast tests were used, with a p≤ 0.05 significance.Results: the study included 72 patients: 35 received TXA and 37 did not. Most participants were 70-to-79-year-old women. In both arms, there was similar laterality of the operated knee, with prevalence of the left one (60% in those receiving TXA and 51.4% in those who did not). A lower proportion of persons with hypertension (p= 0.011) and who required self-transfusion (p< 0.001) was found among those receiving TXA. This arm also showed a reduction in the times of stay in the Resuscitation and Hospitalization Units, bleeding and pain, and an increase in oxygen saturation (everything p< 0.05).Conclusions: TXA administration causes significant improvements in clinical signs and post-surgical recovery, and reduces the hospital stay, which could result in improvements in the workflow and associated costs.(AU)

New susceptibility loci for severe COVID-19 by detailed GWAS analysis in European populations

Given the highly variable clinical phenotype of Coronavirus disease 2019 (COVID-19), a deeper analysis of the host genetic contribution to severe COVID-19 is important to improve our understanding of underlying disease mechanisms. Here, we describe an extended GWAS meta-analysis of a well-characterized cohort of 3,260 COVID-19 patients with respiratory failure and 12,483 population controls from Italy, Spain, Norway and Germany/Austria, including stratified analyses based on age, sex and disease severity, as well as targeted analyses of chromosome Y haplotypes, the human leukocyte antigen (HLA) region and the SARS-CoV-2 peptidome. By inversion imputation, we traced a reported association at 17q21.31 to a highly pleiotropic [~]0.9-Mb inversion polymorphism and characterized the potential effects of the inversion in detail. Our data, together with the 5th release of summary statistics from the COVID-19 Host Genetics Initiative, also identified a new locus at 19q13.33, including NAPSA, a gene which is expressed primarily in alveolar cells responsible for gas exchange in the lung.