Publications by authors named "Leticia Gutierrez"

6 Publications

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Cardiac arrest following unsuspected self-poisoning with doxylamine.

Ther Drug Monit 2022 Jan 11. Epub 2022 Jan 11.

Clinical Toxicology Unit, Clinical Analysis Department. Hospital Universitari Son Llàtzer. Research Institute of Health Sciences (IdISBa). Palma de Mallorca, Spain. Intensive Care Department. Hospital Universitari Son Llàtzer. Research Institute of Health Sciences (IdISBa). Palma de Mallorca, Spain. Intensive Care Department. Hospital Universitari Son Llàtzer. Research Institute of Health Sciences (IdISBa). Palma de Mallorca, Spain. Intensive Care Department. Hospital Universitari Son Llàtzer. Research Institute of Health Sciences (IdISBa). Palma de Mallorca, Spain. Cardiology Department. Hospital Universitari Son Llàtzer. Department of Medicine, Faculty of Medicine, University of the Balearic Islands. Research Institute of Health Sciences (IdISBa). Palma de Mallorca, Spain. Institute of Legal Medicine of the Balearic Islands. Ministry of Justice. Department of Medicine, Faculty of Medicine, University of the Balearic Islands. Palma de Mallorca, Spain. Institute of Legal Medicine of the Balearic Islands. Ministry of Justice. Department of Medicine, Faculty of Medicine, University of the Balearic Islands. Palma de Mallorca, Spain.

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http://dx.doi.org/10.1097/FTD.0000000000000960DOI Listing
January 2022

Total intravenous anesthesia in domestic chicken (Gallus gallus domesticus) with propofol alone or in combination with methadone, nalbuphine or fentanyl for ulna osteotomy.

Vet Anaesth Analg 2020 May 19;47(3):347-355. Epub 2020 Feb 19.

Department of Animal Medicine, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.

Objective: To compare the propofol infusion rate and cardiopulmonary effects during total intravenous anesthesia with propofol alone and propofol combined with methadone, fentanyl or nalbuphine in domestic chickens undergoing ulna osteotomy.

Study Design: Prospective, randomized, experiment trial.

Animals: A total of 59 healthy Hissex Brown chickens weighing 1.5 ± 0.2 kg.

Methods: Anesthesia was induced with propofol (9 mg kg) administered intravenously (IV) and maintained with propofol (1.2 mg kg minute) for 30 minutes. Birds were intubated and supplemented with 100% oxygen through a nonrebreathing circuit under spontaneous ventilation. Thereafter, each animal was randomly assigned to one of four groups: group P, no treatment; group PM, methadone (6 mg kg) intramuscularly (IM); group PN, nalbuphine IM (12.5 mg kg); and group PF, fentanyl IV (30 μg kg loading dose, 30 μg kg hour constant rate infusion). During the osteotomy surgery, the propofol infusion rate was adjusted to avoid movement of birds and provide adequate anesthesia. Pulse rate, invasive blood pressure, respiratory frequency, end-tidal carbon dioxide partial pressure (Pe'CO) and hemoglobin oxygen saturation (SpO) were recorded.

Results: Data were available from 58 chickens. The mean ± standard deviation propofol infusion rate (mg kg minute) for the duration of anesthesia was: group P, 0.81 ± 0.15; group PM, 0.66 ± 0.11; group PN, 0.60 ± 0.14; and group PF, 0.80 ± 0.07. Significant differences were P versus PM (p = 0.042), P versus PN (p = 0.002) and PF versus PN (p = 0.004). Pulse rate, blood pressure and SpO remained acceptable for anesthetized birds with minor differences among groups. Values of Pe'CO >60 mmHg (8 kPa) were observed in all groups.

Conclusions And Clinical Relevance: Methadone and nalbuphine, but not fentanyl, decreased the propofol infusion rate required for anesthesia maintenance, but resulted in no obvious benefit in physiological variables.
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http://dx.doi.org/10.1016/j.vaa.2020.01.008DOI Listing
May 2020

Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study.

Infect Dis Ther 2019 Sep 24;8(3):429-444. Epub 2019 May 24.

Hospital Clínico San Carlos, Madrid, Spain.

Introduction: We evaluated the diagnostic reliability of serum polymerase chain reaction (PCR) versus blood culture, abdominal fluid or both (composite measure) in patients receiving empirical antifungal treatment for suspected invasive candidiasis.

Methods: This observational, prospective, non-interventional, multicentre study in Spain enrolled 176 critically ill patients admitted to the intensive care unit. Separate blood samples for culture and serum PCR were taken before the start of antifungal therapy. Patient assessment was performed according to each site's usual clinical practice. The primary end point was concordance between serum PCR and blood culture. Secondary end points were concordance between serum PCR and a positive abdominal fluid sample or the composite measure. Quality indices included sensitivity, specificity, positive/negative predictive values (PPV/NPV) and kappa indices.

Results: Among 175 evaluable patients, rates of Candida detection were similar for serum PCR (n = 16/175, 9.1%) versus blood culture (n = 14/175, 8.0%). Quality indices for serum PCR relative to blood culture were: sensitivity 21.4%; specificity 91.9%; PPV 18.8%; NPV 93.1%; kappa index 0.125. Thirty-two abdominal fluid samples were positive. Quality indices for serum PCR versus abdominal fluid were: sensitivity 31.3%; specificity 83.0%; PPV 15.6%; NPV 92.3%; kappa index 0.100. Quality indices for serum PCR versus the composite measure were: sensitivity 15.8%; specificity 92.7%; PPV 37.5%; NPV 79.9%; kappa index 0.107.

Conclusion: The sensitivity of serum PCR for Candida detection was low and the rate of concordance was low between serum PCR and the other diagnostic techniques used to identify Candida infections. Hospital-based diagnostic tests need optimising to improve outcomes in patients with suspected invasive candidiasis.

Funding: Astellas Pharma Inc.
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http://dx.doi.org/10.1007/s40121-019-0248-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702528PMC
September 2019

Computerised sepsis protocol management. Description of an early warning system.

Enferm Infecc Microbiol Clin (Engl Ed) 2018 Feb 10;36(2):84-90. Epub 2017 Jan 10.

Unidad Multidisciplinar de Sepsis, Hospital Son Llàtzer, Palma de Mallorca, España.

Introduction: New strategies need to be developed for the early recognition and rapid response for the management of sepsis. To achieve this purpose, the Multidisciplinary Sepsis Team (MST) developed the Computerised Sepsis Protocol Management (PIMIS). The aim of this study was to evaluate the convenience of using PIMIS, as well as the activity of the MST.

Methods: An analysis was performed on the data collected from solicited MST consultations (direct activation of PIMIS by attending physician or telephone request) and unsolicited ones (by referral from the microbiology laboratory or an automatic referral via the hospital vital signs recording software [SIDCV]), as well as the hospital department, source of infection, treatment recommendation, and acceptance of this.

Results: Of the 1,581 first consultations, 65.1% were solicited consultations (84.1% activation of PIMIS and 15.9% by telephone). The majority of unsolicited consultations were generated by the microbiology laboratory (95.2%), and 4.8% from the SIDCV. Referral from solicited consultations were generated sooner (5.63days vs 8.47days; P<.001) and came from clinical specialties rather than from the surgical ward (73.0% vs 39.1%; P<.001). A recommendation was made for antimicrobial prescription change in 32% of first consultations. The treating physician accepted 78.1% of recommendations.

Conclusions: The high rate of solicited consultations and acceptance of recommended prescription changes suggest that a MST is seen as a helpful resource, and that PIMIS software is perceived to be useful and convenient to use, as it is the main source of referral.
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http://dx.doi.org/10.1016/j.eimc.2016.11.011DOI Listing
February 2018

Becoming Baby-Friendly and Transforming Maternity Care in a Safety-Net Hospital on the Texas-Mexico Border.

Nurs Womens Health 2016 Aug-Sep;20(4):378-90

Nurse leaders used the Centers for Disease Control and Prevention's survey on Maternity Practices in Infant Nutrition and Care, as well as Baby-Friendly Hospital Initiative guidelines, to transform maternity care in a safety-net hospital with more than 3,500 births annually. Implementing evidence-based guidelines to support breastfeeding was essential for a vulnerable population characterized by minimal prenatal care and high rates of diabetes, hypertension, obesity, and poverty. Research showing the importance of breastfeeding in protecting against these factors guided extensive changes in our maternity care model. The nursing and medical teams changed long-held practices that separated women from their newborns and observed substantial improvements in breastfeeding initiation and exclusive breastfeeding rates at discharge.
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http://dx.doi.org/10.1016/j.nwh.2016.07.005DOI Listing
July 2017

Retinal nerve fiber layer and macular thickness in patients with schizophrenia: Influence of recent illness episodes.

Psychiatry Res 2015 Sep 15;229(1-2):230-6. Epub 2015 Jul 15.

Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain; Department of Medicine and Psychiatry, University of Zaragoza, Spain.

Optical coherence tomography (OCT) has been recently used to investigate neuropsychiatric disorders. We aimed to study retinal OCT measures of patients with schizophrenia with respect to healthy controls, and to evaluate possible differences between recent illness episode (RIE) and non-recent illness episode (NRIE) patients. Thirty schizophrenia patients were classified as RIE (n=10) or NRIE (n=20), and compared with 30 matched controls. Statistical analyses included linear mixed-effects models to study the association between OCT measures and group membership. Multivariate models were used to control for potential confounders. In the adjusted linear mixed-effects regression model, patients had a significantly thinner retinal nerve fiber layer (RNFL) in overall measurements, and in the nasal, superior and inferior quadrants. Macular inner ring thickness and macular volume were also significantly smaller in patients than controls. Compared with controls, in the adjusted model only NRIE (but not RIE) patients had significantly reduced RNFL overall measures, superior RNFL, nasal RNFL, macular volume, and macular inner ring thickness. No significant correlation was found between illness duration and retinal measurements after controlling for age. In conclusion, retinal parameters observed using OCT in schizophrenia patients could be related to clinical status and merit attention as potential state biomarkers of the disorder.
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http://dx.doi.org/10.1016/j.psychres.2015.07.028DOI Listing
September 2015
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