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Métodos Terapéuticos y Terapias MTCI
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1.
Rev Esp Quimioter ; 33(2): 151-175, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32080996

RESUMEN

This document gathers the opinion of a multidisciplinary forum of experts on different aspects of the diagnosis and treatment of Clostridioides difficile infection (CDI) in Spain. It has been structured around a series of questions that the attendees considered relevant and in which a consensus opinion was reached. The main messages were as follows: CDI should be suspected in patients older than 2 years of age in the presence of diarrhea, paralytic ileus and unexplained leukocytosis, even in the absence of classical risk factors. With a few exceptions, a single stool sample is sufficient for diagnosis, which can be sent to the laboratory with or without transportation media for enteropathogenic bacteria. In the absence of diarrhoea, rectal swabs may be valid. The microbiology laboratory should include C. difficile among the pathogens routinely searched in patients with diarrhoea. Laboratory tests in different order and sequence schemes include GDH detection, presence of toxins, molecular tests and toxigenic culture. Immediate determination of sensitivity to drugs such as vancomycin, metronidazole or fidaxomycin is not required. The evolution of toxin persistence is not a suitable test for follow up. Laboratory diagnosis of CDI should be rapid and results reported and interpreted to clinicians immediately. In addition to the basic support of all diarrheic episodes, CDI treatment requires the suppression of antiperistaltic agents, proton pump inhibitors and antibiotics, where possible. Oral vancomycin and fidaxomycin are the antibacterials of choice in treatment, intravenous metronidazole being restricted for patients in whom the presence of the above drugs in the intestinal lumen cannot be assured. Fecal material transplantation is the treatment of choice for patients with multiple recurrences but uncertainties persist regarding its standardization and safety. Bezlotoxumab is a monoclonal antibody to C. difficile toxin B that should be administered to patients at high risk of recurrence. Surgery is becoming less and less necessary and prevention with vaccines is under research. Probiotics have so far not been shown to be therapeutically or preventively effective. The therapeutic strategy should be based, rather than on the number of episodes, on the severity of the episodes and on their potential to recur. Some data point to the efficacy of oral vancomycin prophylaxis in patients who reccur CDI when systemic antibiotics are required again.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Antibacterianos/uso terapéutico , Clostridioides difficile/aislamiento & purificación , Continuidad de la Atención al Paciente , Análisis Costo-Beneficio , Diarrea/microbiología , Heces/microbiología , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Probióticos/uso terapéutico , Prevención Secundaria , Sociedades Médicas/normas , España , Manejo de Especímenes/métodos
2.
Histol Histopathol ; 24(12): 1487-98, 2009 12.
Artículo en Inglés | MEDLINE | ID: mdl-19795347

RESUMEN

The purpose of this study was to assess the effects of the addition of Nitroglycerin or Nicorandil to University of Wisconsin solution in long-term myocardial preservation. In a model of heterotopic heart transplantation in pigs, the donor heart was preserved for 24 hours by means of continuous perfusion in this solution, in the presence or absence of these drugs. During this period, the oxygenation and pH of the solution were measured, as were lactate concentrations and enzyme release. At regular intervals following reperfusion we measured the concentrations of enzymes, antioxidants, glutathione peroxidase, glutathione reductase, malondialdehyde, endothelin and nitrite, and, two hours later, samples of both ventricles were taken for a morphological study. In the treated groups there was a higher lactate production during preservation and, during reperfusion, the signs of contracture and the elevation of enzyme levels were more marked than in the untreated groups. In contrast, the glutathione reductase concentrations did not decrease during the first phase of reperfusion and were directly correlated with those of antioxidants, endothelin levels increased less than in the untreated groups and, in the case of nitroglycerin, the nitrite concentration was significantly greater than in the remaining groups. We conclude that nitroglycerin and nicorandil improved the oxidative state and endothelial function and did not produce substantial morphological changes, but increased cell necrosis and contracture, possibly due to the duration of ischemia.


Asunto(s)
Endotelio/efectos de los fármacos , Nicorandil/farmacología , Nitroglicerina/farmacología , Preservación de Órganos/métodos , Vasodilatadores/farmacología , Adenosina , Alopurinol , Animales , Antioxidantes/metabolismo , Calcio/análisis , Dióxido de Carbono/análisis , Creatina Quinasa/análisis , Endotelina-1/efectos de los fármacos , Endotelio/fisiología , Técnica del Anticuerpo Fluorescente Indirecta , Glucosa/análisis , Glutatión , Glutatión Peroxidasa/metabolismo , Glutatión Reductasa/metabolismo , Trasplante de Corazón/métodos , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/ultraestructura , Concentración de Iones de Hidrógeno , Inmunohistoquímica , Insulina , L-Lactato Deshidrogenasa/análisis , Ácido Láctico/análisis , Malondialdehído/análisis , Miocardio/metabolismo , Miocardio/ultraestructura , Nitritos/análisis , Soluciones Preservantes de Órganos , Oxígeno/análisis , Soluciones Farmacéuticas/farmacología , Rafinosa , Distribución Aleatoria , Porcinos , Factores de Tiempo
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