Liver transplantation in the Intensive Care Unit: twenty years experience in a center medium income on Peru.

Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. OBJECTIVE: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. MATERIALS AND METHODS: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. RESULTS: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. CONCLUSIONS: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.

[Primary non function of hepatic allograft: 18 years experience of Guillermo Almenara Irigoyen National Hospital - EsSalud]. / No función primaria del injerto hepático: 18 años de experiencia del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud.

INTRODUCTION: The primary nonfunction of the graft (PNF) after liver transplantation is acute graft failure, in the absence of some causal factor, such as acute thrombosis of the hepatic artery or portal vein. OBJECTIVES: Describe the perioperative characteristics of Liver transplant patients who presented NFPI in the Transplant Department of the Guillermo Almenara Irigoyen Hospital. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study. From March 2000 to March 2018; 249 liver transplants were performed. The PNF was defined with y he criteria of OPTN/UNOS, manifested by increased transaminases (>3,000 UI/ml), coagulopathy (INR >2.5), high lactate levels (>4 mEq/l), PH in acidosis: PH arterial ≤7.30 and/or venous ≤7.25 and hemodynamic instability that requires support with vasoactive drugs. It can lead to death without emergency retransplantation. RESULTS: 8 patient with PNF were diagnosed with a prevalence of 3.7%, the age of recipients was 51.5±8.45 years, the base MELD score 13.13±3.8 (range 6-18). The characteristics of the donors, the age was 38.5±14.48 years, all ABO identical to the recipients, the geographical distribution: 7 of metropolitan Lima and 1 in Tacna. The cause of encephalic death 75% hemorrhagic DCV and 25% severe TEC. Regarding transoperative factors, the CIT 431±143 min [265 - 645 min], and WIT 81.8±46 min [57- 195 min], the stay in the ICU until the death of the patients was 11.13±9.3 days (range 2-31 days), 12.5% was retransplant. CONCLUSIONS: The prevalence of PNF after liver transplant in our center is 3.7%. Similar to the series reported by other center, and is associated with high mortality without retransplantation.

Real-Time Monitoring and Control of Urea Hydrolysis in Cyber-Enabled Nonwater Urinal System.

This research used a cyber-physical system (CPS) to monitor and control the extent of urea hydrolysis in nonwater urinals. Real-time pH and conductivity data were used to control urea hydrolysis inhibition under realistic restroom conditions with acetic acid addition. Variable urination frequencies and urination volumes were used to compare three conditions that affect the progression of urea hydrolysis. Mechanistic and conceptual models were created to evaluate the factors that influence the progression of urea hydrolysis in nonwater urinals. It was found that low urination volumes at low frequencies created ideal conditions for urea hydrolysis to progress. Alternatively, high urination volumes at high frequencies created pseudo-inhibitory conditions because it did not allow for sufficient reaction time or mixing with older urine in the urinal trap. The CPS was used to control urea hydrolysis inhibition by two logics: (1) reactively responding to a pH threshold and (2) predictively responding to past measurements using four lasso regression models. Results from the control logic experiments showed that acid was added once per hour under low use conditions and once in a 4 h experiment for high use conditions. The CPS allowed for full control of urine chemistry in the nonwater urinal, reducing the conditions (i.e., clogging and malodor) that have led to the removal of nonwater urinals in the United States.

[Portal vein thrombosis in patients undergoing to liver transplantation]. / Trombosis venosa portal en pacientes sometidos a trasplante de hígado.

INTRODUCTION: Portal venous thrombosis (PVT) is common in patients with liver cirrhosis, undergoing liver transplantation (LT); in our setting, this is the first publication with an emphasis on results and surgical strategies. OBJECTIVE: Was to review the case history of the Guillermo Almenara Irigoyen National Hospital, determine characteristics, types of PVT and surgical management. MATERIALS AND METHODS: We analyzed patients undergoing LT who presented PVT between March 2000 and Jun 2018. Of 255 liver transplants in 239 patients, 229 adults and 26 pediatric, these last were excluded. RESULTS: We found 27 patients had PVT (12.2%) diagnosed in pre and during LT, none with malignant PVT, the most frequent etiologies of cirrhosis were non-alcoholic steatohepatitis (37.4%), alcoholic steatohepatitis (22%), autoimmune hepatitis (AIH) (11%), virus B hepatitis (VBH) (7.4%) and others (11.5%). According to PVT grade: Yerdel I in ten patients (37%), Yerdel II in te patients (37%), Yerdel III in four patients (15%) and Yerdel IV in three patients (11%). Surgical strategy used: thrombectomy in 23 cases (85.2%), hemitransposition cavoportal in 2 cases (7.4%), reno-porto anastomosis with interposition of venous graft in 1 case (3.7%) and thrombectomy with interposition of venous graft in 1 case (3.7%). The re - PVT was present in two cases (7.5%). The PVT decreased patient survival after LT 1 year (81.2%), 3 years (78.4%) and 5 years (78.4%) compared with patients without PVT 1 year (84.6%) 3 years (82.3%) and 5 years (82.3%) respectively. CONCLUSIONS: Cirrhosis with PVT was clinically more unbalanced, survival decreased to a higher degree of PVT. Surgical behavior similar to other transplant centers. Early diagnosis is essential to take early surgical action and decrease morbidity and mortality after LT.

[Hepatopulmonar syndrome and liver transplantation: experience in the transplantation department of the Guillermo Almenara Irigoyen National Hospital - EsSalud]. / Síndrome hepatopulmonar y trasplante hepático: experiencia en el departamento de trasplantes del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud.

INTRODUCTION: Hepatopulmonary syndrome (HPS) is a serious complication of liver disease, which is characterized by the presence of intrapulmonary vasodilation and progressive hypoxemia. Liver transplantation is the only effective treatment. OBJECTIVE: To show our results of patients with hepatopulmonary syndrome undergoing liver transplantation. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study. From March 2000 to December 2016; 226 liver transplants were performed. Of the total, 25 patients were excluded: 12 retransplantation, 9 liver-kidney combined transplants, 2 transplants for acute liver failure, 2 transplants in non-cirrhotic patients. Of the 201 patients with pretransplant diagnosis of liver cirrhosis, 19 filled criteria for SHP; who were distributed according to age, sex, hypoxemia level (pO2), Child-Pugh score and MELD score. The reversibility hypoxemia after liver trasplantation was measured with a cut-off of p02 >75 mmHg. RESULTS: The prevalence of SHP in our series was 9.45%. The average age was 41 years (14-65); the M / F ratio of 1.65. The 78.94% (15/19) were adults. 89.5% (17/19) were Score of Child-Pugh B and C, and 68.4% had severe and very severe SHP. In 94.11% of patients, reversibility SHP founded. The early mortality rate (30 days) in patients with SHP was 10.4%. CONCLUSIONS: The prevalence of HPS in our series was 9.45%. Transplanted patients with and without SHP had similar survival.

[Liver transplant and hepatocellular carcinoma in Peru: outcome after 15 years in the transplant department of the Guillermo Almenara Hospital - EsSalud]. / Hepatocarcinoma y trasplante hepático en Perú: resultados de 15 años del Departamento de Trasplantes del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud.

Hepatocellular carcinoma (HCC) is a neoplasm with significant incidence and prevalence in the world. In large percentage it originates from a cirrhotic liver. Liver transplantation under special conditions is effective in the simultaneous treatment of both conditions. Information is scarce in Latin America. This is a cross-sectional study of the first 200 liver transplants of our series (Years 2000-2015). During this period, 26 (13%) patients had a diagnosis of HCC. Of the 26 transplanted with HCC, 21 (81%) patients were male. The average age was 59.7 years. The most frequent cirrhotic etiology was NASH with nine (35%) cases, followed by HCV and OH with six (23%). The average of AFP pre-transplant was 113.3. Downstaging was performed in four patients. The overall survival obtained is 90.9% over 5 years. The recurrence-free survival in our series is 95.5% at 5 years.

[Autoimmune hepatitis recurrence after liver transplantation: 15 years experience in Peru]. / Recurrencia de hepatitis autoinmune post trasplante hepático: experiencia de 15 años en el Perú.

INTRODUCTION: The recurrence of autoimmune hepatitis (HAI) following liver transplantation occurs between 8-68%. In our experience, autoimmune liver diseases are a major indication of liver transplantation. OBJECTIVE: To determine the recurrence of autoimmune hepatitis in 15 years of experience and to evaluate the risk factors associated with the recurrence of HAI. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study. From March 2000 to December 2015; 200 transplants were performed on 190 liver transplants; 36 patients were diagnosed for hepatic cirrhosis by HAI and underwent liver biopsy if transaminase (TGP-TGO >2 ULN) in 2 consecutive measurements. The diagnosis was made by histological criteria. RESULTS: The indication for hepatic transplantation for HAI was 19%. Mean age was 35 years (range 16-64 years) relationship between Sex F / M 2.2, the most common HAI subtype is type 1 (89%). The HAI histological recurrence was 31% (11/36). The mean follow-up was 54 months (range 8-169 months). CONCLUSIONS: Autoimmune hepatitis is the most frequent indication of liver transplantation in our experience, accounting for 19%. The recurrence of post-transplant HAI was 31%. No association was found between the degree of severity of histological activity in the explants and the type of HLA in the presentation of the recurrence.

Immune profiling by multiple gene expression analysis in patients at-risk and with type 1 diabetes.

There is a need for biomarkers to monitor the development and progression of type 1 DM. We analyzed mRNA expression levels for granzyme B, perforin, fas ligand, TNF-α, IFN-γ, Foxp3, IL-10, TGF-ß, IL-4, IL-6, IL-17, Activation-induced cytidine deaminase (AID) and Immunoglobulin G gamma chain (IgG) genes in peripheral blood of at-risk, new-onset and long-term type 1 DM , and healthy controls. The majority of the genes were suppressed in long-term type 1 DM compared to controls and new-onset patients. IFN-γ, IL-4 and IL-10 mRNA levels were significantly higher in new-onset compared to at-risk and long-term groups. There was decreased mRNA expression for AID and IgG and up-regulation of IFN-γ with age in controls. Data suggest an overall depressed immunity in long-term type 1 DM. Increased gene expression levels for IFN-γ, IL-4 and IL-10 in new-onset patients from at-risk patients might be used as potential markers for progression of the disease.

Effect of body condition score of does and use of bucks subjected to added artificial light on estrus response of Alpine goats.

The effects of body condition score of does and exposure to sexually active bucks after exposure to long-day artificial photoperiod were examined in mature anovulatory French Alpine goat in Northern Mexico. In June, goats in good (2.3 +/- 0.2, scale 1 to 4; n = 10) or poor (1.6 +/- 0.3; n = 10) body condition were exposed during 15 day to sexually active bucks, which had been exposed to long photoperiod (16:8-h light-dark cycle, starting in December). A third group of goats in good body condition was exposed to bucks kept under the natural photoperiod of this region (26 degrees N). All goats in good body condition exposed to bucks treated with prolonged photoperiod exhibited estrus behavior, whereas only 50% of the does in poor body condition showed estrous behavior during the 15-day buck exposure. None of the does in good body condition showed estrus when exposed to bucks under natural photoperiod. These results revealed that a good body condition is required for maximum estrus response in anestrous Alpine goats and that exposure of bucks to long photoperiod in winter is essential for an adequate stimulus to reestablish estrus cycles in anovulatory Alpine does in Northern Mexico.

Impact of acetic acid addition on nitrogen speciation and bacterial communities during urine collection and storage.

The rate of urea hydrolysis in nonwater urinals is influenced by the volume of urination events and the frequency of urinal use. Inhibition of urea hydrolysis with acetic acid addition has been demonstrated at the laboratory scale but it was not able to fully represent the conditions of a real restroom with real urine collection. The goal of this study was to understand the effects of acid addition for control of urea hydrolysis on nutrient concentrations and bacterial communities in human urine during collection and storage. Three control logics were used to determine the schedule of acid addition: (i) acid addition after every urination event, (ii) acid addition during periods of high building occupancy, and (iii) acid addition during periods of low building occupancy. Wifi logins were used to approximate building occupancy and to create the control logics used in the study. All three control logics were able to inhibit urea hydrolysis. The bacterial communities were identified to determine the impact of acid addition on the community structure. The collection of urine by nonwater urinals alone did not reduce the presence of enteric bacteria commonly found when collecting urine with urine-diverting toilets. Acid addition reduced the community diversity and created conditions for higher relative abundances of the order Enterobacteriales. Finally, results from stored acidified urine showed that urea hydrolysis inhibition is reversible and is influenced by the amount of acid added at the urinal. The amount of acid added can influence the rate of hydrolysis in the storage tanks and can be used to select for urea- or ammonia-nitrogen for nutrient recovery. This study is the first of its kind to inhibit urea hydrolysis in nonwater urinals in a real restroom with real urine, and is the first to identify the bacterial communities in urine collected solely with nonwater urinals.

A neonate with mucolipidosis II and transient secondary hyperparathyroidism.

Background Mucolipidosis II α/ß (ML II) is an autosomal recessive disease associated with the abnormality of lysosomal enzyme trafficking. Case presentation We present an unusual patient with: (a) marked skeletal anomalies with secondary hyperparathyroidism; (b) serum intact parathyroid hormone level normalized by 7 weeks but abnormally elevated serum alkaline phosphate persisted; and (c) two mutations identified in the GNPTAB gene. One mutation, c.3503_3504delTC, is the most common mutation in ML II. However, the second mutation, c.2896delA, is a rare mutation for which clinical presentation has not been described previously.

Oclusión basada en evidencia: rompiendo paradigmas / Occlusion based on evidence: breaking paradigms

La odontología basada en evidencias es una metodología que busca que las decisiones clínicas diarias que toman los profesionales en estomatología se encuentren fundamentadas en la evidencia científica, en ella se integran las experiencias clínicas, las necesidades, las preferencias del paciente y la evidencia clínicamente relevante más actual analizada por pares. Estos pilares son parte del proceso en la toma de decisiones para la atención al paciente. La odontología basada en evidencias surge de las exitosas experiencias obtenidas con el desarrollo e implementación de la medicina fundamentada en pruebas, al aplicar el método científico en la evaluación, planificación y toma de decisiones de las prestaciones sanitarias, sobre todo a través de los estudios controlados. En general, toda la práctica odontológica ha tenido grandes avances basados en evidencias, con hechos verídicos comprobados, pero los conceptos fundamentales de oclusión no han tenido una mejora cimentada en el conocimiento científico, prueba de ello es que se siguen ocupando teorías y conceptos de las filosofías de oclusión en la rehabilitación de muchos pacientes, seguimos creyendo en mitos y sofismas que no han podido ser demostrados. En esta revisión, demostramos los grandes avances en los conceptos de oclusión e invitamos a todos los odontólogos a romper los paradigmas de la oclusión antigua sin evidencias científicas y a utilizar las herramientas del método científico en la práctica clínica odontológica (AU)

Evidence-based dentistry is a strategy that seeks to ensure that the daily clinical decisions made by the dental professional are based on scientific evidence. It integrates the clinical experience of the dentist, the needs and preferences of the patient, and the most current relevant clinical evidence. All three are part of the decision-making process for patient care. Evidence-based dentistry arises from the successful experiences obtained with the development and implementation of evidence-based medicine, applying the scientific method in the evaluation, planning and decision-making of health benefits, especially through controlled studies. In general, all dental practice has had great advances based on evidence, with proven true facts, but the fundamental concepts of occlusion have not had an improvement based on scientific knowledge, proof of this is that theories and concepts continue to be used. of the philosophies of occlusion in patient rehabilitation, we follow myths and sophisms that have not been demonstrated, in this review, we demonstrate the great advances in the concepts of occlusion and we know all dentists to break the paradigms of the old occlusion without scientific evidence (AU)

Elaboración de modelos dentales didácticos en resina epóxica / Elaboration of didactic dental models in epoxy resin

Los modelos de estudio son un registro fundamental para el diagnóstico, el plan de tratamiento, la presentación de caso y la evaluación del progreso del tratamiento dental; son registros anatomofisiológicos de las arcadas dentarias que sirven para evaluar la dentición en los tres planos del espacio y la oclusión en la relación cúspide-fosa, en una dimensión estática y dinámica. Para obtener los modelos de estudio es imprescindible obtener impresiones totales con diversos materiales de impresión de los arcos dentarios, que reproduzcan fielmente todos los detalles anatómicos, para posteriormente obtener un modelo en yeso piedra. Los modelos obtenidos a partir de una impresión generalmente son a base de yeso odontológico, los cuales a pesar de sus mejoras aún conservan algunas características negativas como: baja resistencia a la fractura por impacto, baja resistencia al desgaste por abrasión, inestabilidad dimensional y radiopacidad que impide la simulación de procedimientos endodóncicos. Con la finalidad de mejorar la simulación en la práctica odontológica, se usa la resina epóxica que puede emplearse en la obtención de modelos, este material es más resistente y presenta una mayor resistencia a la abrasión; además es radiolúcido, por lo que es útil para la réplica de preparaciones y procedimientos de simulación endodóntica. Los detalles de la superficie obtenidos con resina epóxica son superiores a los obtenidos con yeso. El uso de simuladores es una herramienta educativa con la que se favorece la adquisición de ciertas habilidades, destrezas, técnicas y competencias necesarias para la formación de estudiantes o profesionales de odontología. En el presente trabajo se describe la técnica para la elaboración de modelos dentales didácticos en resina epóxica para utilizarlos en la enseñanza de la práctica odontológica (AU)

Study studies are a fundamental record for diagnosis, treatment plan, case presentation and evaluation of the progress of dental treatment. They are anatomo-physiological records of the dental arches to evaluate the dentition in the three planes of space and the occlusion in the cusp-fossa relationships, in a static and dynamic dimension. To obtain the study models, it is essential to obtain total impressions with various impression materials of the dental arches, which faithfully reproduce all the anatomical details, in order to later obtain a stone plaster model. Those obtained from an impression are generally based on dental plaster, which despite its improvements still retain some negative characteristics such as: low resistance to fracture by impact, low resistance to wear by abrasion, dimensional instability and radio opacity that prevents the simulation of endodontic procedures. In order to improve simulation in dental practice, the use of epoxy resin can be used to obtain models, this material is more resistant and has greater resistance to abrasion, it is radiolucent, which makes them Useful for replicating preparations and endodontic simulation procedures, the surface details obtained with epoxy resin are superior to those obtained with plaster. The use of simulators is an educational tool that favors the acquisition of certain abilities, skills, techniques and competencies necessary for the training of the student or professional in dentistry. In the present work, the technique for the elaboration of didactic dental models in epoxy resin to be used in the teaching of dental practice is described.(AU)

Influence of blood metabolites and body condition score at parturition on fertility and milk yield in Holstein cows / Influencia de metabolitos sanguíneos y condición corporal al parto sobre la fertilidad y producción de leche de vacas Holstein / Influência dos metabólitos sanguíneos e da condição corporal ao nascimento na fertilidade e produção de leite de vacas Holstein

Abstract Background: Variables associated with body tissue mobilization place dairy cows at greater risk of reproductive failure. Objective: To investigate the association between blood metabolites and body condition score (BCS) at the beginning of lactation and the reproductive efficiency and milk yield of Holstein cows in a hot environment. Methods: In total, 165 Holstein cows were selected for the study from which blood samples were taken to determine the concentration of various blood metabolites and their association with the reproductive efficiency and milk yield. Results: Cows with serum β-hydroxybutyrate (BHBA) ≤0.8 mmol/L one week postpartum were 3.3 times more likely to become pregnant at first service, and 2.2 times more likely to become pregnant before 80 d postpartum than cows with higher serum BHBA levels. The odds (OR 2.7; 95% CI 1.3-5.4; p<0.01) of a cow getting pregnant at first service were higher in cows with serum creatinine levels higher than 2.0 mg/dL one week postpartum than cows with lower blood levels of this metabolite. The BCS at 30 and 60 d postpartum that predicted pregnancy at first service and pregnancy to all services was 3.0. Blood urea nitrogen >15 mg/dL, creatinine <1.8 mg/dL, total protein ≤5.0 mg/dL one week postpartum, and >0.40 units of BCS loss during the first 30 d postpartum were critical threshold that predicted the likelihood of 305-d milk yield higher than 10,500 kg. Conclusions: Serum BHBA and creatinine one wk after calving as well as BCS 30 and 60 d post-calving provided reasonably accurate cut-off screening values to discriminate cows with better reproductive performance and higher 305-d milk yield.

Resumen Antecedentes: Las variables asociadas a mayor movilización de tejido corporal en vacas lecheras conducen a un mayor riesgo de falla reproductiva. Objetivo: Investigar la asociación entre los metabolitos sanguíneos y condición corporal (BCS) al comienzo de la lactancia y la eficiencia reproductiva y producción de leche de vacas Holstein en un ambiente caluroso. Métodos: En total, se seleccionaron 165 vacas Holstein de las cual se tomaron muestras de sangre para determinar la concentración de varios matabolitos sanguíneos, los cuales se asociaron con el desempeño reproductivo y producción de leche. Resultados: Las vacas con β-hidroxibutirato (BHBA) en suero ≤0,8 mmol/L una semana postparto tuvieron 3,3 veces más probabilidades de quedar preñadas en los primeros servicios, y 2,2 veces más probabilidades de quedar gestantes antes de los 80 días postparto que las vacas con mayores niveles séricos de BHBA. Las probabilidades (OR 2,7; IC 95% 1,3-5,4; p<0,01) de que una vaca se preñara en el primer servicio fueron mayores en vacas con niveles de creatinina en suero sanguíneo superiores a 2,0 mg/dL una semana postparto que las vacas con niveles más bajos de este metabolito en sangre. Una BCS de 3 a los 30 y 60 días postparto fue un buen predictor de la preñez al primer servicio y la gestación considerando todos los servicios. El nitrógeno ureico en sangre >15 mg/dL, la creatinina <1,8 mg/dL, la proteína total ≤5,0 mg/dL una semana después del parto y >0,40 unidades de pérdida de BCS durante los primeros 30 días postparto fueron los valores críticos para predecir una producción de leche a 305 días superior a 10.500 kg. Conclusiones: El BHBA y la creatinina en suero sanguíneo una semana postparto, así como la BCS 30 y 60 d después del parto, proporcionan valores razonablemente precisos para identificar las vacas que tendrán mejor desempeño reproductivo y mayor producción de leche a 305 días.

Resumo Antecedentes: A maior mobilização do tecido corporal das vacas leiteiras leva a um aumento do risco de falhas reprodutivas. Objetivo: Para investigar a relação entre os metabolitos sanguíneos e condição do corpo (BCS) para o início da lactação e eficiência reprodutiva e produção de leite de vacas Holstein num ambiente quente. Métodos: No total, foram selecionadas 165 vacas da raça Holandesa, das quais foram coletadas amostras de sangue para determinar a concentração de vários metabólitos sanguíneos, associados ao desempenho reprodutivo e à produção de leite das vacas. Resultados: As vacas com β-hidroxibutirato (BHBA) soro ≤0,8 mmol/L de uma semana após o nascimento foram 3,3 vezes mais probabilidade de engravidar nos primeiros serviços, e 2,2 vezes mais provável que seja grávida antes de 80 dias após o parto do que vacas com níveis séricos de BHBA mais elevados. As probabilidades (OR 2,7, IC de 95% 1,3-5,4, p<0,01) que uma vaca preñara primeiros serviços vacas foram maiores com níveis mais elevados de creatinina no soro do sangue >2,0 mg/dL, uma semana pós-parto do que vacas com níveis sanguíneos mais baixos deste metabolito. Um CC de 3 aos 30 e 60 dias pós-parto foi um bom predictor de gravidez no primeiro serviço e gestação, considerando todos os serviços. O azoto de ureia no sangue >15 mg/dL, creatinina <1,8 mg/dL e proteína total, ≤5,0 mg/dL uma semana após o parto e >0,40 unidades perda CC durante os primeiros 30 dias após o nascimento estavam valores críticos que previram produção de leite em 305 dias >10.500 kg. Conclusões: BHBA e creatinina sérica, uma semana após o parto, bem como CC 30 e 60 d após o parto, forneceram valores razoavelmente precisos para discriminar vacas com melhor desempenho reprodutivo e maior produção de leite em 305 dias.

Liver transplantation in the Intensive Care Unit: twenty years experience in a center medium income on Peru / Trasplante hepático en la Unidad de Cuidados Intensivos: veinte años de experiencia en un centro de mediano ingreso en el Perú

ABSTRACT Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.

RESUMEN El trasplante de hígado es el principal tratamiento para la enfermedad hepática en etapa terminal. El cuidado postoperatorio es un gran desafío para disminuir la morbimortalidad en los pacientes. En este sentido, el manejo en la UCI hepática permite manejo hemodinámico, monitoreo de coagulación, soporte renal, alteraciones electrolíticas, soporte respiratorio y destete temprano de ventilación mecánica y evaluación del injerto hepático. Objetivo: El presente estudio muestra los resultados del manejo de pacientes trasplantados de hígado en 20 años de experiencia en un centro de trasplante en un país de ingresos bajos a medios. Materiales y métodos: Se revisaron las historias clínicas de 273 pacientes adultos en UCI en el posoperatorio inmediato de trasplante hepático, desde el 20 de marzo de 2000 hasta el 30 de noviembre de 2020, incluyendo el efecto de la pandemia provocada por el COVID-19. Se excluyeron los pacientes con trasplante de hígado-riñón, retrasplantados, SPLIT y dominó. Resultados: La etiología más frecuente para LTx fue NASH (35%), la edad promedio fue de 49 años, MELD Score varió 15 - 20 (47,5%), 21 - 30 (46%) > 30 (6,2%). Estancia pretrasplante en UCI 7%, estancia media en UCI: 7,8 días. Admisión media APACHE: 14,9 puntos. Extubación weaning del 91,8% de los pacientes en UCI y Fast Track en el 8,2%. La complicación respiratoria más frecuente fue atelectasia 56,3%, neumonía (31,3%); FRA 1 (60,9%) y 11,1% con soporte de hemodiálisis (FRA 3). Inmunosupresión: Tacrolimus (8,9%). La mortalidad postoperatoria en la UCI fue del 6,2%. Conclusiones: El manejo del trasplante hepático en UCI es fundamental para lograr resultados óptimos en pacientes que presentan enfermedad hepática avanzada y requieren soporte vital avanzado en el postoperatorio inmediato y así optimizar la supervivencia del injerto.

Seguridad farmacológica de la ivermectina vía oral en gestantes / Pharmacologic safety of oral ivermectin in pregnant women

RESUMEN El presente estudio tuvo el propósito de conocer la seguridad farmacológica de la ivermectina por vía oral en gestantes. Se realizó una revisión sistemática de la información publicada en las bases de datos PubMed, MEDLINE, Scopus, Toxline, Registro de ensayos clínicos de la Organización Mundial de la Salud, lista de FDA de Estados Unidos, Clinical Trials y el Registro Central de Cochrane. Se revisó un total de 73 artículos de investigación publicados entre 1990 y 2020. Se eligió dos experimentos en animales, un estudio clínico y cinco analíticos. Se encontró que los estudios realizados en animales mostraron que la ivermectina se asoció a riesgo de aborto, malformaciones congénitas, muerte fetal y materna. En humanos, no se pudo determinar los efectos presentados en el estudio en animales. Se concluye que es necesario realizar estudios clínicos para establecer la presencia de efectos adversos en gestantes por el consumo de ivermectina.

ABSTRACT This study was intended to determine the pharmacological safety of oral ivermectin in pregnant women. A systematic review of information published in the PubMed, MEDLINE, Scopus, Toxline, World Health Organization Clinical Trials Registry, US FDA List, ClinicalTrials, and Cochrane Central Registry databases was conducted from 1990 through 2020. From a total of 73 research articles reviewed, two animal experiments, one clinical and five analytical experiments were studied. Animal studies were found to show that ivermectin was associated with the risk of micarriage, congenital malformations, stillbirth and maternal death. In humans, the effects presented in the animal study could not be determined. It is concluded that clinical studies are necessary to establish the presence of adverse effects in pregnant women from the consumption of ivermectin.

No función primaria del injerto hepático: 18 años de experiencia del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud / Primary non function of hepatic allograft: 18 years' experience of Guillermo Almenara Irigoyen National Hospital - EsSalud

RESUMEN Introducción : La no función primaria del injerto (NFPI) después del trasplante hepático es la falla aguda del injerto, en ausencia de algún factor causal, como trombosis aguda de arteria hepática o vena porta. Objetivos : Describir las características perioperatorias de los pacientes trasplantados de Hígado que presentaron NFPI en el Departamento de Trasplantes del Hospital Guillermo Almenara Irigoyen. Materiales y métodos : Estudio retrospectivo, descriptivo y transversal. Desde marzo del 2000 a marzo del 2018 se realizaron 249 Trasplantes de hígado. La NFPI fue definida con los criterios de OPTN/UNOS, se manifiesta por aumento de transaminasas (>3 000 UI/ml), coagulopatía (INR >2,5), niveles altos de lactato (>4 mEq/l), PH en acidosis: PH arterial ≤7,30 y/o PH venoso ≤7,25 e inestabilidad hemodinámica que requiere soporte con drogas vasoactivas; puede llevar a la muerte sin retrasplante de emergencia. Resultados : Se diagnosticaron 8 pacientes con NFPI siendo una prevalencia de 3,7% de 216 trasplantes de hígado en adultos, la edad de los receptores fue 51,5±8,45 años, score de MELD basal 13,13±3,8 (rango 6-18). Las características de los donantes, la edad fue 38,5±14,48, todos ABO idénticos al receptor, la distribución geográfica: 7 de Lima metropolitana y 1 en Tacna. La causa de muerte encefálica 75% ACV Hemorrágico y 25% TEC grave. Respecto a factores transoperatorios el TIF 431±143 min [265 - 645 min], y TIC 81,8±46 min [57- 195 min], La estancia en UCI hasta el deceso del paciente fue 11,13±9,3 días (rango 2-31 días), el 12,5% fue retrasplantado. Conclusiones : La prevalencia de NFPI en nuestro centro después del trasplante hepático es 3,7% similar a las series reportadas por otros centros, y se asocia con mortalidad alta sin retrasplante hepático.

ABSTRACT Introduction : The primary nonfunction of the graft (PNF) after liver transplantation is acute graft failure, in the absence of some causal factor, such as acute thrombosis of the hepatic artery or portal vein. Objectives : Describe the perioperative characteristics of Liver transplant patients who presented NFPI in the Transplant Department of the Guillermo Almenara Irigoyen Hospital. Materials and methods : Retrospective, descriptive and cross-sectional study. From March 2000 to March 2018; 249 liver transplants were performed. The PNF was defined with y he criteria of OPTN/UNOS, manifested by increased transaminases (>3,000 UI/ml), coagulopathy (INR >2.5), high lactate levels (>4 mEq/l), PH in acidosis: PH arterial ≤7.30 and/or venous ≤7.25 and hemodynamic instability that requires support with vasoactive drugs. It can lead to death without emergency retransplantation. Results : 8 patient with PNF were diagnosed with a prevalence of 3.7%, the age of recipients was 51.5±8.45 years, the base MELD score 13.13±3.8 (range 6-18). The characteristics of the donors, the age was 38.5±14.48 years, all ABO identical to the recipients, the geographical distribution: 7 of metropolitan Lima and 1 in Tacna. The cause of encephalic death 75% hemorrhagic DCV and 25% severe TEC. Regarding transoperative factors, the CIT 431±143 min [265 - 645 min], and WIT 81.8±46 min [57- 195 min], the stay in the ICU until the death of the patients was 11.13±9.3 days (range 2-31 days), 12.5% was retransplant. Conclusions : The prevalence of PNF after liver transplant in our center is 3.7%. Similar to the series reported by other center, and is associated with high mortality without retransplantation.

Trombosis venosa portal en pacientes sometidos a trasplante de hígado

Introducción: La trombosis venosa portal (TVP) es frecuente en los pacientes con cirrosis hepática, sometidos a trasplante hepático (TH); en nuestro medio, esta es la primera publicación con énfasis en resultados y estrategias quirúrgicas. Objetivo: Revisar la casuística del Hospital Nacional Guillermo Almenara Irigoyen, determinar características, tipos de TVP y el manejo quirúrgico. Materiales y métodos: Se analizaron las historias clínicas de los pacientes cirróticos sometidos a TH, que presentaron TVP, entre marzo 2000 a junio 2018. En dicho lapso se realizaron 255 trasplantes hepáticos en 239 pacientes, 229 adultos y 26 pediátricos; éstos últimos fueron excluidos. Resultados: Encontramos 27 pacientes con TVP (12,2%), diagnosticados en pre y durante el TH, ninguno de etiología maligna; las etiologías más frecuentes de la cirrosis fueron esteatohepatitis no alcohólica (37,4%), esteatohepatitis alcohólica (22%), hepatitis autoinmune (HAI) (11%), virus de hepatitis B (VHB) (7,4%) y otros (11,5%). Según la clasificación de Yerdel, encontramos: Grado I: 10 (37%), Grado II: 10 (37%), Grado III: 4 (15%) y Grado IV: 3 (11%). Las estrategias quirúrgicas empleadas fueron: trombectomía en 23 (85,2%); hemitransposición cavoportal en 2 (7,4%), anastomosis reno-portal con interposición de injerto venoso en 1 (3,7%) y la trombo-venectomía mas interposición de injerto venoso 1 (3,7%). En 2 casos se presentaron re-TVP (7,5%). Observamos que la TVP disminuyó la supervivencia del paciente posterior al TH: Al año (81,2%), 3 años (78,4%) y 5 años (78,4%) comparado con pacientes sin TVP 1 año (84,6%) 3 años (82,3%) y 5 años (82,3%). Conclusiones: Los pacientes cirróticos con TVP estuvieron clínicamente más descompensados, la supervivencia disminuyo a mayor grado de TVP. La conducta quirúrgica fue similar a otros centros trasplantadores; el diagnóstico temprano fue esencial para tomar una conducta quirúrgica anticipada y disminuir la morbimortalidad posterior al trasplante hepático.

Introduction: Portal venous thrombosis (PVT) is common in patients with liver cirrhosis, undergoing liver transplantation (LT); in our setting, this is the first publication with an emphasis on results and surgical strategies. Objective: Was to review the case history of the Guillermo Almenara Irigoyen National Hospital, determine characteristics, types of PVT and surgical management. Materials and methods: We analyzed patients undergoing LT who presented PVT between March 2000 and Jun 2018. Of 255 liver transplants in 239 patients, 229 adults and 26 pediatric, these last were excluded. Results: We found 27 patients had PVT (12.2%) diagnosed in pre and during LT, none with malignant PVT, the most frequent etiologies of cirrhosis were non-alcoholic steatohepatitis (37.4%), alcoholic steatohepatitis (22%), autoimmune hepatitis (AIH) (11%), virus B hepatitis (VBH) (7.4%) and others (11.5%). According to PVT grade: Yerdel I in ten patients (37%), Yerdel II in te patients (37%), Yerdel III in four patients (15%) and Yerdel IV in three patients (11%). Surgical strategy used: thrombectomy in 23 cases (85.2%), hemitransposition cavoportal in 2 cases (7.4%), reno-porto anastomosis with interposition of venous graft in 1 case (3.7%) and thrombectomy with interposition of venous graft in 1 case (3.7%). The re - PVT was present in two cases (7.5%). The PVT decreased patient survival after LT 1 year (81.2%), 3 years (78.4%) and 5 years (78.4%) compared with patients without PVT 1 year (84.6%) 3 years (82.3%) and 5 years (82.3%) respectively. Conclusions: Cirrhosis with PVT was clinically more unbalanced, survival decreased to a higher degree of PVT. Surgical behavior similar to other transplant centers. Early diagnosis is essential to take early surgical action and decrease morbidity and mortality after LT.

Guarda oclusal gnatológica: técnica de elaboración, procesado y polimerizado por microondas / Gnathological occlusal guard: technique of elaboration, processing and polymerization by microwaves

Los trastornos temporomandibulares (TTM) constituyen un problema en la población en general cuyos signos y síntomas tienen un carácter multifactorial que debe ser abordado de manera interdisciplinaria para poder brindar una mejor oportunidad de éxito y estética en los tratamientos. Las guardas oclusales forman parte del tratamiento en los TTM, se deben conocer sus indicaciones, contraindicaciones, ventajas y desventajas, debido a que las guardas oclusales cumplen ciertas funciones y objetivos. La guarda oclusal elaborada por la técnica de polimerización en microondas (GOTMI) reduce signifi cativamente el tiempo de elaboración en el laboratorio, proporciona un aparato de alta calidad y baja porosidad. La GOTMI es un aparato que proporciona un método indirecto y no invasivo modifi cando la oclusión, recuperando el tejido u órganos dentales perdidos, reorganiza la actividad refl eja neuromuscular, relaja la musculatura, promueve el reposicionamiento del disco articular, protege los dientes, oclusión y estructuras de sostén periodontal, además de mejorar la estética y la autoestima del paciente. La GOTMI disminuye el dolor en la ATM y la neuromusculatura, proporciona alivio a las cefaleas tensionales, elimina las interferencias oclusales, es un distribuidor de fuerzas oclusales, además de provocar un mayor número de contactos de igual intensidad de fuerza contra la superfi cie oclusal en todos los dientes. Existen varios métodos para la confección de las guardas oclusales, en el presente trabajo se describe la elaboración de una guarda oclusal programada con los principios de oclusión orgánica. La técnica de polimerización por microondas es innovadora debido a que este proceso consiste en la generación de calor dentro de la resina mediante ondas electromagnéticas producidas por un generador llamado magnetrón. Las moléculas de metilmetacrilato son capaces de orientarse por el campo electromagnético a una frecuencia de 2,450 MHz, y cambian su dirección cinco billones de veces por segundo aproximadamente, lo que implica numerosas colisiones intermoleculares y causa una rápida polimerización (AU)

Temporomandibular disorders (TMD) are a problem in the general population whose signs and symptoms have a multifactorial character that must be addressed by an interdisciplinary team to provide a better chance of success and aesthetic treatments. Occlusal guards are part of TMD treatment, you should know the indications, contraindications, advantages, and disadvantages, because the occlusal guards perform certain functions and objectives. The occlusal guard by Iztacala modifi cation provides an indirect and noninvasive method modifying occlusion, recovering the lost dental tissue or organs, reorganizes the neuromuscular refl ex activity, relaxes the muscles, promotes articular disc repositioning, protecting the teeth and supporting occlusion structures, it also improves aesthetics and self-esteem. The occlusal guard Iztacala modifi cation has the advantage of decreasing TMJ pain, provides relief to tension headaches, elimination of occlusal interferences, is a distributor of occlusal forces as well as causing a greater number of contacts equal intensity of force against the occlusal surface of all teeth. There are several methods for the fabrication of occlusal guards, in this paper the development of an occlusal guard programmed with the principles of organic occlusion is described, using as a basis a rigid acetate and acrylic for programming, in addition to providing your cosmetic use and function. The acquisition or denial of treatment with an occlusal splint depends on the choice, preparation, occlusal guard adjustment and patient cooperation (AU)

Hepatocarcinoma y trasplante hepático en Perú: resultados de 15 años del Departamento de Trasplantes del Hospital Nacional Guillermo Almenara Irigoyen - EsSalud / Liver transplant and hepatocellular carcinoma in Peru: outcome after 15 years in the transplant department of the Guillermo Almenara Hospital - EsSalud

El carcinoma hepatocelular (CHC) es una neoplasia con incidencia y prevalencia significativa en el mundo. Ésta en gran porcentaje se origina en el hígado cirrótico. El trasplante hepático bajo condiciones especiales, ha demostrado ser efectivo en el tratamiento simultáneo de ambas condiciones. En América latina la información es escasa. Este es un estudio de tipo descriptivo retrospectivo de corte transversal, cuyo universo es conformado por los primeros 200 trasplantes de hígado de nuestra serie (Años 2000-2015). Durante el periodo mencionado 26 (13%) pacientes tuvieron diagnóstico de CHC. De los 26 trasplantados con CHC, 21 (81%) pacientes fueron de sexo masculino. El promedio de edad fue 59,7 años. La etiología cirrótica más frecuente fue NASH con 9 (35%) casos, seguida de VHC y OH con 6 (23%). El promedio de AFP pre trasplante fue de 113,3. El ¨downstaging¨ fue realizado en 4 pacientes. La sobrevida global obtenida es de 90,9% a más de 5 años. La sobrevida libre de recurrencia en nuestra serie es de 95,5% a 5 años.

Hepatocellular carcinoma (HCC) is a neoplasm with significant incidence and prevalence in the world. In large percentage it originates from a cirrhotic liver. Liver transplantation under special conditions is effective in the simultaneous treatment of both conditions. Information is scarce in Latin America. This is a cross-sectional study of the first 200 liver transplants of our series (Years 2000-2015). During this period, 26 (13%) patients had a diagnosis of HCC. Of the 26 transplanted with HCC, 21 (81%) patients were male. The average age was 59.7 years. The most frequent cirrhotic etiology was NASH with nine (35%) cases, followed by HCV and OH with six (23%). The average of AFP pre-transplant was 113.3. Downstaging was performed in four patients. The overall survival obtained is 90.9% over 5 years. The recurrence-free survival in our series is 95.5% at 5 years.