[Approach to percutaneous nephrolithotomy. Comparison of the procedure in a one-shot versus the sequential with metal dilata]. / Abordaje para nefrolitotomía percutánea. Comparación del procedimiento en un solo paso contra la secuencial con dilatadores metálicos.

INTRODUCTION: Percutaneous nephrolithotomy is an efficient approach for treatment of different types of kidney stones. Various types of access techniques have been described like sequential dilatation and one-shot procedure. OBJECTIVE: To determine the differences in time of exposure to X-rays and hemoglobin levels between techniques. METHODS: Controlled clinical trial. Patients older than 18 years with complex/uncomplicated kidney stones, without urine infection were included. They were assigned randomly to one of the two techniques. Response variables were determined before and 24 h after procedures. RESULTS: 59 patients were included: 30 underwent one-shot procedure (study-group) and 29 sequential dilatation (control-group). Baseline characteristics were similar. Study group had a lower postoperative hemoglobin decline than control group (0.81 vs. 2.03 g/dl, respectively; p < 0.001); X-ray exposure time (69.6 vs. 100.62 s; p < 0.001) and postoperative creatinine serum levels (0.93 ± 0.29 vs. 1.13 ± 0.4 mg/dl; p = 0.039). No significant differences in postoperative morbidity were found. CONCLUSION: One-shot technique demonstrated better results compared to sequential dilatation.

Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial.

INTRODUCTION: Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely. OBJECTIVE: To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy. MATERIAL AND METHODS: Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed. RESULTS: Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49), 12 h (5.59 ± 1.33, 8.82 ± 0.79), 24 h (6.86 ± 1.49, 9.73 ± 0.45), day 4 (5.32 ± 2.10, 9.50 ± 0.59), day 7 (3.14 ± 1.03, 7.36 ± 1.39), and day 14 (2.14 ± 0.46, 5.45 ± 1.29). The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05), the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05), and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05). CONCLUSION: Oral administration of metronidazole is effective in pain management after hemorrhoidectomy.

Oral glutamine reduces myocardial damage after coronary revascularization under cardiopulmonary bypass. A randomized clinical trial.

BACKGROUND: Glutamine is the most abundant free amino acid in the body. It modulates immune cell function and is an important energy substrate for cells in critically ill patients. Reduction of injury cardiac markers had been observed in patients receiving intravenous glutamine and in a pilot study with oral glutamine. The aim of this study was to analyze the effect of preoperative oral supplementation of glutamine on postoperative serum levels of cardiac injury markers. METHODS: A randomized clinical trial was performed in 28 Mexican patients with ischemic heart disease who underwent cardiopulmonary bypass with extracorporeal circulation. Patients were randomly assigned to receive oral glutamine (0.5 g/kg/day) or maltodextrin 3 days before surgery. Cardiac injury markers as troponin-I, creatine phosphokinase, and creatine phosphokinase-Mb were measured at 1, 12, and 24 hours postoperatively. RESULTS: At 12 and 24 hours serum markers levels were significantly lower in the glutamine group compared with controls (p = 0.01 and p = 0.001, respectively) (p = 0.004 and p < 0.001, respectively). Overall, complications were significantly lower in the glutamine group (p = 0.01, RR = 0.54, 95% CI 0.31-0.93). Mortality was observed with 2 cases of multiple organ failure in control group and 1 case of pulmonary embolism in glutamine group (p = 0.50). CONCLUSION: Preoperative oral glutamine standardized at a dose of 0.5 g/kg/day in our study group showed a significant reduction in postoperative myocardial damage. Lower cardiac injury markers levels, morbidity and mortality were observed in patients receiving glutamine.

Antioxidant drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: What does evidence suggest?

AIM: To determine whether or not the use of antioxidant supplementation aids in the prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis. METHODS: A systematic review of randomized controlled trials (RCTs) was made to evaluate the preventive effect of prophylactic antioxidant supplementation in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The inclusion criteria included: acute post-endoscopic retrograde cholangiopancreatography pancreatitis in adults; randomized clinical trials with the use of any antioxidant as an intervention compared with placebo, to reduce PEP. The outcome measure was the incidence and severity of PEP. Twelve RCTs involving 3110 patients since 1999 were included. The antioxidants used were selenite, ß-carotene, and pentoxifylline (each one in one trial), N-acetylcysteine (NAC) in three trials, and allopurinol in six trials. The group of patients treated with NAC received different doses; either oral or intravenous, and allopurinol-treated patients received five different oral doses in two different administration periods. The results are expressed with raw numbers, proportions, as well as mean and standard deviations. The incidence of pancreatitis between groups was analyzed with Pearson's χ(2) test or Fisher's exact test (F). The main outcome is expressed as relative risks and 95%CI. RESULTS: The incidence of pancreatitis in all antioxidant treatment groups was 8.6%, whereas it was 9.7% in the control group. The antioxidants used were selenite, ß-carotene, and pentoxifylline (each one in one trial), NAC in three trials, and allopurinol in six trials. In allopurinol trials, three different dosifications were used; two trials reported a low dosage (of less than 400 mg), two trials reported a moderate dose (600 mg) and the remaining two employed higher doses (more than 900 mg). Supplementation was not associated with a significant reduction in the incidence of PEP [relative risk (RR) = 0.93; 95%CI: 0.82-1.06; P = 0.28]. In addition, the incidences of PEP in patients treated with allopurinol and those treated with other antioxidants were similar to that observed in patients who received the placebo (RR for trials with allopurinol, 0.92; 95%CI: 0.78-1.08; P = 0.31) and, with the use of other antioxidants, the incidence of PEP was 8.9%, whereas it was 9.7% in the control group (RR = 0.95; 95%CI: 0.77-1.18; P = 0.19). CONCLUSION: Antioxidant supplementation shows no beneficial effect on the incidence of PEP. There is a lack of robust trials to support the use of antioxidants for prevention.

Evaluación del estado nutricional al ingreso hospitalario y su asociación con la morbilidad y mortalidad en pacientes mexicanos / Nutritional status assessment at hospital admission and its association with morbidity and mortality in Mexican patients

Introducción: la desnutrición intrahospitalaria se ha descrito hace más de 70 años como un problema frecuente. En México se reportan cifras de entre el 20% al 50%; sin embargo no se ha estudiado su prevalencia ni su asociación con la morbilidad y mortalidad hospitalaria. Objetivos: evaluar el estado nutricional y su relación con la morbimortalidad hospitalaria en pacientes mexicanos. Métodos: cohorte prospectiva de pacientes que ingresaron en un hospital de referencia para una estancia hospitalaria mayor de 5 días. Se capturó peso, talla, índice de masa corporal (IMC), estado nutricional de acuerdo con la valoración global subjetiva (VGS) a su ingreso y egreso hospitalario, así como diagnóstico médico, complicaciones y mortalidad. Los datos fueron analizados mediante la prueba T de Student, prueba Chi-cuadrado y prueba Exacta de Fisher. Resultados: se incluyeron 610 pacientes en total, con un promedio de edad de 50,8 ± 17,32 años, 267 mujeres (43,8%) y 343 hombres (56,2%). Del total, 154 fueron catalogados con sospecha de desnutrición o desnutrición (pacientes expuestos, 25,2%) y 456 bien nutridos (pacientes no expuestos, 74,8%), con una relación de 1 a 3. La morbilidad total de la cohorte tuvo un RR = 2,70, IC 95 % (2,06-3,55) y la mortalidad con un RR = 2,64, IC 95% (1,74-4,0), siendo ambas estadísticamente signifi cativas (p = 0,001). Conclusiones: el diagnóstico de desnutrición al ingreso hospitalario constituye un factor de riesgo para el desarrollo de complicaciones y mortalidad. Este padecimiento al ingreso en comparación con el paciente que no presenta desnutrición incrementó el riesgo de mortalidad hasta en 2,64 veces (AU)

Introduction: Malnutrition after hospital admission has been described over 70 years as a very common health problem. In Mexico, data reported go from 20-50%, but the prevalence and its association with short-term morbidity and mortality has not been studied. Objectives: To evaluate the nutritional status and its association with hospital morbidity and mortality in adult Mexican patients. Methods: Prospective cohort study of 610 adult patients admitted in the Specialties Hospital, Western National Medical Center, with a hospital stay longer than 5 days and in whom weight and height could be measured. Nutritional diagnosis of patients at admission and discharge of the hospital, diagnosis of disease, complications and death were recorded. Nutritional status was obtained using the Subjective Global Assessment (SGA). Data was analyzed using Student ́s t Test, Chi-square Test and Fisher´s Exact Test. Results: A total of 610 patients were included with a mean age of 50.8 ± 17.32 years; 267 (43.8%) were female and 343 (56.2%) male. A total of 154 patients (25.2%) were in risk of malnutrition or malnourished and 456 (74.8%) well-nourished according to SGA, (p = 0.001). Difference in weight and BMI were statistically signifi cant between both groups (p = 0.001). The total cohort morbidity had a RR = 2.70, with 95% CI (2.06-3.55), and mortality RR = 2.64, with a 95% CI (1.74-4.0), both with a significant difference (p = 0.001). Conclusions: Malnutrition at hospital admission constitutes a risk factor for complications or mortality in patients admitted for more than 5 days. This condition at admission compared to a well-nourished patient increased risk of mortality by up to 2.64 times (AU)

Eficacia de metronidazol contra placebo en el control del dolor posterior a hemorroidectomía. Resultados de un ensayo clínico controlado / Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial

INTRODUCCIÓN: la enfermedad hemorroidal se presenta en 50% de adultos mayores a 40 años, siendo la principal indicación de cirugía anorrectal y el dolor su principal complicación. Múltiples fármacos, tópicos y sistémicos, se han investigado para control del dolor, no obstante no existe un tratamiento ideal. El metronidazol ha demostrado disminuirlo, pero su uso no se ha generalizado. OBJETIVOS: evaluar el efecto de administración oral de metronidazol versus placebo en el control del dolor posthemorroidectomía. MATERIAL Y MÉTODOS: ensayo clínico controlado en pacientes adultos con hemorroides grado III/IV. Los del grupo de estudio (GE) recibieron metronidazol 500 mg oral cada 8 horas por 7 días y los del grupo control (GC) placebo. Se evaluó dolor postquirúrgico con escala visual análoga (EVA), consumo de analgésicos y reincorporación al trabajo. RESULTADOS: se incluyeron 44 pacientes, 22 en cada grupo, sin diferencias en la distribución demográfica. La evaluación del dolor postquirúrgico fue de 3,86 ± 0,56 y 6,64 ± 1,49 para GE y GC a las 6 h, de 5,59 ± 1,33 y 8,82 ± 0,79 a las 12 h, 6,86 ± 1,49 y 9,73 ± 0,45 a las 24 h, 5,32 ± 2,10 y 9,50 ± 0,59 al cuarto, 3,14 ± 1,03 y 7,36 ± 1,39 al séptimo, 2,14 ± 0,46 y 5,45 ± 1,29 al 14 día, significativo a favor del GE. La primera dosis analgésica se requirió a las 7,09 ± 2,36 h en el GE y 21,27 ± 5,47 horas en el GC (p < 0,05); tiempo del consumo de analgésicos 6,86 ± 1,61 y 13,09 ± 2,48 días (p < 0,05) y reincorporación al trabajo a los 7,59 ± 1,56 y 14,73 ± 3,76 días (p < 0,05). CONCLUSIONES: la administración oral de metronidazol es eficaz para el control del dolor post-hemorroidectomía

INTRODUCTION: Hemorrhoidal disease occurs in 50% of people aged > 40 years and is the most common reason for anorectal surgery. Pain is the main complication. Multiple topical and systemic drugs have been investigated for pain control, but there is no ideal treatment. Metronidazole has been shown to decrease postoperative pain but is not used widely. OBJECTIVE: To evaluate the effect of oral metronidazole versus placebo and to assess postoperative pain following hemorrhoidectomy. MATERIAL AND METHODS: Controlled clinical trial in adult patients who underwent elective hemorrhoidectomy for grade III/IV hemorrhoids. Patients were assigned to receive metronidazole (500 mg q8 h orally; study group, SG) or placebo (control group, CG) for 7 days after surgery. Pain was assessed using a visual analog scale after surgery. Analgesic administration (time and use of analgesics) and resumption of daily life activities were also assessed. RESULTS: Forty-four patients were included, 22 in each group. Postoperative pain differed significantly between the SG and CG at 6 h (3.86 ± 0.56, 6.64 ± 1.49), 12 h (5.59 ± 1.33, 8.82 ± 0.79), 24 h (6.86 ± 1.49, 9.73 ± 0.45), day 4 (5.32 ± 2.10, 9.50 ± 0.59), day 7 (3.14 ± 1.03, 7.36 ± 1.39), and day 14 (2.14 ± 0.46, 5.45 ± 1.29). The first analgesia dose was required at 21.27 ± 5.47 h in the CG and 7.09 ± 2.36 h in the SG (p < 0.05), the time of analgesic use was 6.86 ± 1.61 days in the CG and 13.09 ± 2.48 days in the SG (p < 0.05), and resumption of daily activities occurred at 7.59 ± 1.56 days in the CG and 14.73 ± 3.76 days in the SG (p < 0.05). CONCLUSION: Oral administration of metronidazole is effective in pain management after hemorrhoidectomy