Javier Mateu-de Antonio

Comparative effects of olive oil-based and soyabean oil-based emulsions on infection rate and leucocyte count in critically ill patients receiving parenteral nutrition

Soyabean oil-based emulsions high in linoleic acid used in parenteral nutrition (PN) could interfere with immune function and may increase the risk of septic complications. Olive oil-based emulsions, high in oleic acid, could have fewer immune effects. We compared the effects of a soyabean oil-based emulsion v. an olive oil-based emulsion on infection rate, appearance of new infection episodes, leucocyte count (peak and evolution), acute-phase proteins, and major health outcomes in intensive care unit (ICU) adult patients receiving PN. The study was designed as an observational, retrospective, single-centre, cohort study in a general ICU. Patients in the SOYA cohort (n 16) received a soyabean oil-based emulsion and patients in the OLIVE cohort (n 23), an olive oil-based emulsion. Both cohorts had similar basal characteristics and received a similar energy load. The SOYA cohort received an oleic acid:linoleic acid ratio of 0.43 and the OLIVE cohort 2.99 (P < 0.001). No differences were observed in infection rate and appearance, acute-phase proteins, and major health outcomes. At the end of PN, blood leucocyte count decreased by 3.25 x 109 cells/l in the SOYA cohort and increased by 4.51 x 109 cells/l in the OLIVE cohort from baseline values (P = 0.036). Peak leucocyte count presented a trend for a higher value in the OLIVE cohort v. the SOYA cohort (18.86 v. 15.28 x 109 cells/l; P = 0.078). The use of an olive oil-based emulsion in PN had no effect on infection, acute-phase proteins, major health outcomes, and presented higher leucocyte count at the end of PN and a trend to higher peak leucocyte count when compared with soyabean oil-based emulsion in ICU patients.

LACK OF TOXICITY IN A CLADRIBINE EXTRAVASATION

pensing errors. Patient attendance was sporadic, making BP monitoring and management difficult and requiring the extrapolation of earlier visits for use in the final analysis. BP and HR evaluations and dosage adjustments were conducted with the assistance of a dedicated but ever-changing group of volunteer staff. This evaluation confirmed that the clinical outcomes in our underserved population were not adversely affected or enhanced by the formulary switch from lisinopril to benazepril.

Alcohol Ingestion and Topical Tacrolimus: A Disulfiram-Like Interaction?

documented their search strategy, 5 used a broad-based approach, while 5 used only MEDLINE. Interestingly, the articles where search methods were not described had a higher percentage of bibliographic articles not indexed in MEDLINE (2%) compared with those articles describing >3 search methods (1%). McAlister et al.4 reviewed 158 review articles from 6 general medical journals in 1996. These authors found that only 28% of these articles (n = 44) described how evidence was located for their reviews. A similar study by Mulrow5 in 1987 reported that only 2% (1 in 50) of review articles described their literature-searching methods. Our small study shows a growing trend, 2% (1987), 28% (1996), to now 50% (2003) of academic reviews describing their literature-searching methods, but this is far short of what should be part of every review article. The small number of non-MEDLINE references utilized in these academic review articles is worth pondering. Why did authors find so few non–MEDLINE-indexed articles that were worthy of inclusion? Are authors biased toward MEDLINE-indexed articles or are non–MEDLINEindexed articles of poor quality? Are non-MEDLINE articles difficult to obtain and therefore not utilized? It is possible that the 88% of the literature not included in MEDLINE is not of sufficient quality to be included. It is also possible that authors are searching only what is available and familiar to them and ignoring that trove of the literature that is perhaps difficult to obtain, published in other countries, and/or not as recognizable to us. Further research is necessary to fully explore these issues. Larger studies comparing review article bibliographies in different databases, such as EMBASE and Science Citation Index, could also shed additional light on this subject.