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Yárnoz Irazábal, María Concepción

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https://academica-e.unavarra.es/handle/2454/50185

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Yárnoz Irazábal

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María Concepción

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Ciencias de la Salud

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0000-0002-8873-5786

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750973

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811968

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2020 - 20245
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    PublicationOpen Access
    Prognostic relevance of preoperative immune, inflammatory, and nutritional biomarkers in patients undergoing gastrectomy for resectable gastric adenocarcinoma: an observational multicentre study
    (MDPI, 2024-06-11) Tur-Martínez, Jaume ; Rodríguez-Santiago, Joaquín; Osorio, Javier ; Miró, Mònica; Yárnoz Irazábal, María Concepción; Jofra, Mariona; Ferret, Georgina; Salvador-Roses, Helena; Fernández-Ananín, Sonia ; Clavell, Arantxa ; Luna, Alexis; Aldeano, Aurora; Olona, Carles; Hermoso, Judith; Güell-Farré, Mercè; Dal Cero, Mariagiulia; Gimeno, Marta; Pallarès, Natàlia; Pera, Manuel; Ciencias de la Salud; Osasun Zientziak
    Background: The aim of this study was to evaluate different preoperative immune, inflammatory, and nutritional scores and their best cut-off values as predictors of poorer overall survival (OS) and disease-free survival (DFS) in patients who underwent curative gastric cancer resection. Methods: This was a retrospective observational multicentre study based on data of the Spanish EURECCA Esophagogastric Cancer Registry. Time-dependent Youden index and log-rank test were used to obtain the best cut-offs of 18 preoperative biomarkers for OS and DFS. An adjusted Cox model with variables selected by bootstrapping was used to identify the best preoperative biomarkers, which were also analysed for every TNM stage. Results: High neutrophil-to-lymphocyte ratio (NLR), high monocyte systemic inflammation index (moSII), and low prognostic nutritional index (PNI) were identified as independent predictors of poor outcome: NLR > 5.91 (HR:1.73; 95%CI [1.23–2.43]), moSII >2027.12 (HR:2.26; 95%CI [1.36–3.78]), and PNI >40.31 (HR:0.75; 95%CI [0.58–0.96]) for 5-year OS and NLR > 6.81 (HR:1.75; 95%CI [1.24–2.45]), moSII > 2027.12 (HR:2.46; 95%CI [1.49–4.04]), and PNI > 40.31 (HR:0.77; 95%CI [0.60,0.97]) for 5-year DFS. These outcomes were maintained in the whole cohort for NLR and moSII (p < 0.05) but not in stage II and for PNI in all tumoral stages. The associations of NLR-PNI and moSII-PNI were also a relevant prognostic factor for OS. Conclusions: High NLR, high moSII (for stages I and III), and low PNI (regardless of tumour stage) were the most promising preoperative biomarkers to predict poor OS and DFS in gastric cancer patients treated with curative intent.
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    PublicationOpen Access
    Modelo en papel de anatomía de la región inguinal
    (2023) Blázquez Lautre, Lucas; Malón Insausti, Emilia; Insausti Serrano, Ana María; Yárnoz Irazábal, María Concepción; Brady, John; Ciencias de la Salud; Osasun Zientziak
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    PublicationOpen Access
    Blood cell indices as predictors of complicated appendicitis: a diagnostic study
    (Elsevier, 2023-09-29) Moreno Alfonso, Julio César; Molina Caballero, Ada; Yárnoz Irazábal, María Concepción; Pérez Martínez, Alberto; Ciencias de la Salud; Osasun Zientziak
    Background: Appendicitis in children is associated with diagnostic complexity leading to delayed diagnosis. Such delays risk progression to complicated appendicitis. This study investigates the potential of cellular indices, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-tolymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), to differentiate uncomplicated (UA) from complicated appendicitis (CA). Methods: Diagnostic study of pediatric patients with acute appendicitis admitted to our hospital from 2021 to 2022. NLR, dNLR, PLR and MLR were compared between groups. Results: A total of 182 patients were enrolled: 116 cases with CA (63 % male, age 9.6 +/- 5.5 years) and 66 patients with UA (67 % male, age 10.6 +/- 2.7 years). All blood cell indices were significantly higher in the CA group than in the UA group (p= <0.0001). NLR, dNLR and PLR have a good area under the receiver operating characteristic (ROC) curve, whereas MLR has a regular curve (0.735). PLR was the most accurate predictor of CA with a sensitivity of 60 %, specificity of 85 %, positive predictive value of 88 %, area under the ROC curve of 0.802 (95 % CI 0.737-0.866) and a cut-off point for the diagnosis of CA of 213.3. The post-test probability of CA for a positive result on PLR was 80 % (95 % CI 69-88). Conclusions: PLR seems to be the most accurate cellular index to differentiate uncomplicated from complicated appendicitis in children. It may be useful for prioritizing cases for surgery as a predictor of intraoperative findings and early postoperative courses.
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    PublicationOpen Access
    Postoperative physical rehabilitation in the elderly patient after emergency surgery: influence on functional, cognitive and quality of live recovery: study protocol for a randomized clinical trial
    (BMC, 2024) Esquiroz Lizaur, Irene; Zambom Ferraresi, Fabrício; Zambom Ferraresi, Fabíola; Ollo Martínez, Iranzu; Casa Marín, Antón de la; Martínez Velilla, Nicolás; Recreo Baquedano, Ana; Galbete Jiménez, Arkaitz; González Álvarez, Gregorio; Yárnoz Irazábal, María Concepción; Eguaras Córdoba, Inés; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
    Background: the progressive aging of the population has meant the increase in elderly patients requiring an urgent surgery. Older adults, especially those with frailty, have a higher risk for complications, functional and cognitive decline after urgent surgery. These patients have their functional and physiological reserve reduced which makes them more vulnerable to the effects of being bedridden. The consequences are at multiple levels emphasizing the functional loss or cognitive impairment, longer stays, mortality and institutionalization, delirium, poor quality of life and increased use of resources related to health. We aim to determine whether postoperative physical rehabilitation can prevent functional and cognitive decline and modify the posterior trajectory. Methods/design: this study is a randomized clinical trial, simple blinded, conducted in the Department of Surgery of a tertiary public hospital in Navarra (Hospital Universitario de Navarra), Spain. Patients > = 70 years old undergoing urgent abdominal surgery who meet inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent physical training programme, which will include progressive and supervised endurance, resistance and balance training for 4 weeks, twice weekly sessions with a total of 8 sessions, and the group control will receive the usual care. The primary outcome measure is the change in functional (SPPB) and cognitive status (Mini-Mental State Examination) and the change of quality of life (EuroQol-5D-VAS) during the study period. The secondary outcomes are postoperative complications, length of stay, delirium, mortality, use of health resources, functional status (Barthel Index and handgrip strength tests), cost per quality-adjusted life year and mininutritional assessment. The data for both the intervention group and the control group will be obtained at four different times: the initial visit during hospital admission and at months 1, 3 and 6 months after hospital discharge. Discussion: If our hypothesis is correct, this project could show that individualized and progressive exercise programme provides effective therapy for improving the functional capacity and achieve a better functional, cognitive and quality of life recovery. This measure, without entailing a significant expense for the administration, probably has an important repercussion both in the short- and long-term recovery, improving care and functional parameters and could determine a lower subsequent need for health resources. To verify this, we will carry out a cost-effectiveness study. The clinical impact of this trial can be significant if we help to modify the traditional management of the elderly patients from an illness model to a more person-centred and functionally oriented perspective. Moreover, the prescription of individualized exercise can be routinely included in the clinical practice of these patients. Trial registration: ClinicalTrials.gov Identifier: NCT05290532. Version 1. Registered on March 13, 2022.
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    PublicationUnknown
    Divertículo esofágico de tercio medio: una causa infrecuente de disfagia
    (Asociación Colombiana de Cirugía, 2020) Moreno Alfonso, Julio César; Eguaras Córdoba, Inés; Yárnoz Irazábal, María Concepción; Miranda-Murua, María del Coro; Ciencias de la Salud; Osasun Zientziak
    Mujer de 72 años estudiada por cuadro clínico de 1 año de disfagia e impactación con alimentos sólidos que han requerido tratamiento endoscópico. Se realiza endoscopia de vías digestivas altas que documenta un divertículo esofágico en tercio medio, manometría esofágica de alta resolución sin trastorno motor. El esofagograma y la tomografía axial computarizada de tórax muestran un divertículo en tercio medio de esófago lateral derecho de 7 cm de diámetro y base de 2.5 cm de diámetro. De manera programada se lleva a cabo diverticulectomía esofágica toracoscópica sin complicaciones.