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Soriano Hervás M, Robles-Hernández D, Serra A, Játiva-Porcar R, Gómez Quiles L, Maiocchi K, Llorca S, Climent MT, Llueca A. Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery. J Pers Med 2023; 13:1540. [PMID: 38003855 PMCID: PMC10672096 DOI: 10.3390/jpm13111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, University La Plana Hospital, Road from Vila-Real to Burriana, km 0.5, 12540 Castellón, Spain
| | - Anna Serra
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Rosa Játiva-Porcar
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Luis Gómez Quiles
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Karina Maiocchi
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - María Teresa Climent
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Antoni Llueca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
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Climent MT, Serra A, Gilabert-Estellés J, Gilabert-Aguilar J, Llueca A. Comparison of Peritoneal Carcinomatosis Scoring Methods in Predicting Resectability and Prognosis in Gynecologic Malignancies. J Clin Med 2021; 10:2553. [PMID: 34207720 PMCID: PMC8229310 DOI: 10.3390/jcm10122553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Peritoneal carcinomatosis is a disease's presentation in the advanced stages of many gynecologic tumours. The distribution and volume of the disease are the main factors in achieving complete debulking. Diagnostic laparoscopy is a technique to allow evaluation of the disease. This study's objective is to compare two laparoscopic scores (Fagotti's index and Sugarbaker's peritoneal cancer index (PCI)) and assess the diagnostic accuracy to select patients for neoadjuvant treatment and reduce unnecessary laparotomies. METHODS A non-randomised retrospective cohort study was conducted in patients with peritoneal carcinomatosis (ovarian and endometrial origin) who underwent laparoscopy and subsequent laparotomy. We evaluated the scores' ability to predict incomplete surgery and whether they were related to the patients' prognosis. RESULTS We included 34 patients, of which 23.5% received neoadjuvant chemotherapy. The rate of complete cytoreductive surgery was 79.4% (n = 27 patients). The highest sensitivity was obtained with a PCI value greater than 20. It was the best parameter to determine incomplete debulking. Survival curves were analysed according to the "cut off" established for each score, and statically significant differences were found using PCI with respect to Fagotti's Index. However, these differences were not found with Fagotti's score. CONCLUSION The best diagnostic method to classify patients with peritoneal cancer is the PCI. It could be adapted to each surgical team because it allows identifying the "cut off point", which depends on incomplete surgery rate.
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Affiliation(s)
- María Teresa Climent
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
| | - Anna Serra
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
| | - Juan Gilabert-Estellés
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain
| | - Juan Gilabert-Aguilar
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
| | - Antoni Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Department of Medicine, University of Jaume I, 12071 Castellón, Spain; (J.G.-E.); (J.G.-A.)
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Muñoz-Almaraz FJ, Climent MT, Guerrero MD, Moreno L, Pardo J. A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment. J Vis Exp 2020. [PMID: 31984961 DOI: 10.3791/59649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common MCI tests are time-consuming such that indiscriminate massive screening would not be cost-effective. Here, we describe a protocol that uses machine learning techniques to rapidly select candidates for further screening via a question-based MCI test. This minimizes the number of resources required for screening because only patients who are potentially MCI positive are tested further. This methodology was applied in an initial MCI research study that formed the starting point for the design of a selective screening decision tree. The initial study collected many demographic and lifestyle variables as well as details about patient medications. The Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE) were used to detect possible cases of MCI. Finally, we used this method to design an efficient process for classifying individuals at risk of MCI. This work also provides insights into lifestyle-related factors associated with MCI that could be leveraged in the prevention and early detection of MCI among elderly populations.
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Affiliation(s)
| | | | | | | | - Juan Pardo
- Embedded Systems and Artificial Intelligence Group, Universidad CEU Cardenal Herrera;
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Alacreu M, Pardo J, Azorín M, Climent MT, Gasull V, Moreno L. Importance of Increasing Modifiable Risk Factors Knowledge on Alzheimer's Disease Among Community Pharmacists and General Practitioners in Spain. Front Pharmacol 2019; 10:860. [PMID: 31474852 PMCID: PMC6704342 DOI: 10.3389/fphar.2019.00860] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/05/2019] [Indexed: 12/16/2022] Open
Abstract
Community pharmacists and general practitioners have daily contact with patients with Alzheimer's disease (AD) but the number of positive cases constantly increases every day. Thus, the aim of this research is to describe the level of AD knowledge among community pharmacists and general practitioners in Spain, in order to see where the biggest gaps in the knowledge are. Therefore, a cross-sectional study has been carried out, using the Alzheimer's disease knowledge survey (ADKS), among members of the Spanish Society of Primary Care Physicians and the Spanish Society of Family and Community Pharmacy to report the differences in AD knowledge in both professional collectives. The ADKS has been responded by 578 community pharmacists and 104 general practitioners and consists of a battery of 30 questions, whose possible answers are true or false. It assesses the AD knowledge in seven areas (impact on the disease, risk factors, course of the disease, diagnosis, care, treatment and symptoms). Results indicate that Spanish pharmacists and general practitioners have a high personal knowledge of AD, nevertheless, it is not associated with greater awareness. Both scored above 80% at the categories: diagnostic, treatment and symptoms. However, lower knowledge level (60% of correct answers) was found in those related to risk factors, such as the ignorance about hypercholesterolemia or hypertension as risk factors for the disease. Community pharmacists are already acting to control cardiovascular risk factors, but a wider knowledge of the relationship of these factors to AD is needed to act against these silent risk factors. Thus, pharmacists may also be involved in the management of AD that includes recognizing early symptoms for early detection of cognitive impairment. Hence, knowledge about risk factors is very important in developing this expanding role.
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Affiliation(s)
- Mónica Alacreu
- Embedded Systems and Artificial Intelligence Group (ESAI), Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Juan Pardo
- Embedded Systems and Artificial Intelligence Group (ESAI), Universidad CEU Cardenal Herrera, Valencia, Spain
| | - María Azorín
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Vicente Gasull
- Spanish Society of Primary Care Physicians (SEMERGEN), Valencia, Spain
| | - Lucrecia Moreno
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Valencia, Spain
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Rodilla E, Prats R, Bellver O, Reig J, Cunha P, Climent MT. Assessment of Arterial Stiffness by Brachial Oscillometry in Community Pharmacies for Managing Hypertension (COPHARTEN)☆. Artery Res 2019. [DOI: 10.2991/artres.k.191124.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Abstract
Cognitive dysfunction and dementia in the elderly population constitute a significant health problem due to their magnitude and seriousness. Patients with mild cognitive impairment (MCI) are at increased risk of developing some form of dementia, including Alzheimer disease. Epidemiological studies support the existence of preventable risks for cognitive impairment: vascular factors and lifestyle-related factors. The aim is to detect possible cases of cognitive impairment in people aged over 55 years in the community pharmacy area. Community pharmacists work in close contact with the population, especially chronic patients who periodically collect their medication in community pharmacies. Consequently, these health professionals can be trained to detect the most frequent warning signs and symptoms and to refer these individuals to the doctor for an early diagnosis of MCI.
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Affiliation(s)
- María Teresa Climent
- Farmacia comunitaria, Ollería, Valencia, España; Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC)
| | - Ana Molinero
- Farmacia comunitaria, Fuenlabrada, Madrid, España; Sociedad Española de Farmacia Familiar y Comunitaria (SEFAC); Facultad de Farmacia, Universidad de Alcalá de Henares, Madrid, España.
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Moreno-Royo L, Climent MT, Vilaplana AM, Arnedo A, Vilar J. [Life styles associated cognitive impairment. Study from the community pharmacy]. Rev Invest Clin 2013; 65:500-509. [PMID: 24687357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/21/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Frequency of cognitive impairment among people over 65 years old in community pharmacy. Study of asssociated factors, referral of cases to the specialist and inclusion in a program of health education. MATERIAL AND METHODS Cross-sectional study of prevalence, frequency, conducted in four pharmacies (two urban and two rural pharmacies) in the Autonomous Community of Valencia. PARTICIPANTS people over 65 years old who come to the pharmacy and who agree to participate in the study after signing an informed consent. It is used as the initial screening test, the Short Portable Mental State Questionnaire of Pfeiffer. Pfeiffer positive cases undergo a second test (Mini-Mental State Examination, NORMACODEM version). A questionnaire designed specifically for the study has been used to collect information. It includes questions to gain demographic data, questions on lifestyle and chronic diseases. We used analysis logistic regression multilevel. RESULTS 245 patients have participated (76% of respondents). 12.65% were detected to have cognitive impairment. In the Logistic regression analysis multivariate there is a relation between cognitive impairment and some variables: age, lack of reading habit, unusual reading habit, sleeping less than 6 or more than 8 hours a day. Only 12.9% wanted to be referred for clinical evaluation and 42% were included in a cognitive training program. CONCLUSIONS There are asssociation between lifestyle habits that are modifiable and cognitive impairment.
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