[Evolution of the carboxyhemoglobinemia and methemoglobinemia during endoscopic resection: An observational study]. / Évolution de la carboxyhémoglobinémie et de la méthémoglobinémie lors de résections endoscopiques : une étude observationnelle.

AIM OF THE STUDY: Combustion of organic tissues due to endoscopic resection could induce methemoglobin (MetHb) and carboxyhemoglobin (COHb) formation. The aim of this study is to evaluate MetHb and COHb formation in patients undergoing prostatic or bladder endoscopic procedures. METHODS: COHb and MetHb measurements were performed in 44 patients at the beginning and end of the procedure. A third measurement was done in patients who stayed more than one hour in the recovery room. Means were compared using Student t-test, simple regressions were used for quantitative variables and ANOVA for categorical variables. Multiple linear regressions were used for multivariate analysis. RESULTS: COHb increased by 0.5±0.9 % (95 % CI: 0.2 to 0.7 % P=0.001). MetHb increase was 0.0±0.4 % (95 % CI: -0.1 to 0.2 % P=0.552). In univariate analysis, the variables associated with COHb increase are the length of surgery, the amount of irrigation fluid and location (prostate or bladder) of the procedure. In the multivariate model, COHb increase is associated with the amount of liquid and the location. CONCLUSION: MetHb did not increase during endoscopic surgery. In contrast, COHb increases, and can, in some patients, exceed 2-4 %. This could be responsible for a decreased angina threshold in patients with ischemic heart disease. LEVEL OF EVIDENCE: 4.

Farmaconutrición parenteral con selenio en la sepsis / Pharmaconutrition with parenteral selenium in sepsis

La enfermedad crítica se caracteriza por estrés oxidativo, el cual conduce a una disfunción orgánica múltiple, siendo dicha disfunción secundaria a sepsis la causa más frecuente de mortalidad en la unidad de cuidados intensivos. Durante las últimas 2 décadas, se ha acumulado una evidencia creciente a favor del uso de los micronutrientes antioxidantes en los pacientes críticos. De acuerdo con la evidencia reciente, la terapéutica con selenio puede ser considerada como la piedra angular dentro de las estrategias antioxidantes en la sepsis. El selenio, administrado como selenito de sodio o ácido selenioso, se comporta como un fármaco o nutrofármaco con efecto citotóxico y prooxidante cuando una dosis de carga en forma de bolo intravenoso es administrada en la fase precoz de la sepsis grave y el shock séptico. Hasta el momento, diversos estudios fase ii sobre suplementación de selenio han demostrado que esta estrategia es capaz de disminuir la mortalidad, la severidad de la disfunción orgánica y las infecciones. En el futuro próximo, nuevos estudios fase iii deberán confirmar los efectos de la farmaconutrición parenteral con selenio en la sepsis. En la presente revisión se discute la evidencia actual sobre la farmaconutrición con selenio en la sepsis

Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed o improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phaseiitrials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduceinfections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phaseiiiclinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis síndrome

[Pharmaconutrition with parenteral selenium in sepsis]. / Farmaconutrición parenteral con selenio en la sepsis.

Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome.

[Selenium supplementation in critically ill patients: pharmacological issues and current evidence]. / Suplementación con selenio en el paciente crítico: aspectos farmacológicos y evidencia actual.

High dose intravenous selenium may be associated with a significant reduction in mortality among critically ill patients with systemic inflammation. Currently, parenteral selenium as sodium selenite seems to be a cornerstone of the antioxidant defence in the critically ill. So far, several clinical trials have evaluated the effects of selenium in monotherapy or as part of a multi-micronutrient approach, on relevant clinical end points for critically ill patients. Nonetheless, the results from these studies have sometimes been contradictory. We now have a better understanding of the pharmacokinetics of the initial and transient pro-oxidant effect of an intravenous bolus followed by the antioxidant effect of continuous infusion, which seems efficacious and safe among critically ill patients. Clinical confirmation of the potentially advantageous synergism between selenium and glutamine may soon be forthcoming but the most appropriate and the optimum time of supplementation remains undetermined. Short-term intravenous selenite (bolus injection plus continuous infusion) has shown to be safe and capable of optimizing serum selenium and antioxidant selenoenzymes activities. However, additional dose-ranging trials are necessary to elucidate an optimal and safe posology with confirmed pharmacokinetic profiles before more definitive phase III trials can be conducted.

Suplementación con selenio en el paciente crítico: aspectos farmacológicos y evidencia actual / Selenium supplementation in critically ill patients: Pharmacological issues and current evidence

Los antioxidantes y en particular el selenio parenteral parecen vincularse con una reducción significativa de la mortalidad en los pacientes críticos con Síndrome de Respuesta Inflamatoria Sistémica (SRIS). Actualmente, el selenio parenteral es considerado la piedra angular dentro de la estrategia de tratamiento antioxidante en los pacientes críticos. En los últimos años, diferentes estudios clínicos han evaluado el impacto clínico del uso de selenio intravenoso (selenito) aportado como monoterapia o asociado a otros micronutrientes antioxidantes ("cócteles antioxidantes"). Sin embargo, los resultados de estos estudios no han sido concluyentes. En la actualidad existe una mejor comprensión sobre la farmacocinética y farmacodinamia del selenio intravenoso, siendo reconocido el efecto pro-oxidante del bolo intravenoso inicial así como el efecto antioxidante de la infusión continua. Sin embargo, la dosis óptima y el tiempo de suplementación de selenio no han sido aun definidos planteándose la existencia de una posible sinergia entre selenio y glutamina parenteral. Esta revisión analiza la evidencia actual sobre la suplementación de selenio en pacientes críticos con SRIS. El uso de altas dosis de selenio por vía parenteral (bolo inicial e infusión continua) parece ser una estrategia segura y efectiva en optimizar los niveles séricos de selenio y la actividad de ciertas selenoenzimas antioxidantes tales como la Glutatión Peroxidasa y la Selenoproteína P. Sin embargo, son necesarios nuevos estudios sobre la posología y farmacocinética del selenio en pacientes críticos. Estas pesquisas deberían demostrar un beneficio definitivo del uso de selenio sobre end point clínicos de relevancia (AU)

High dose intravenous selenium may be associated with a significant reduction in mortality among critically ill patients with systemic inflammation. Currently, parenteral selenium as sodium selenite seems to be a cornerstone of the antioxidant defence in the critically ill. So far, several clinical trials have evaluated the effects of selenium in monotherapy or as part of a multi-micronutrient approach, on relevant clinical end points for critically ill patients. Nonetheless, the results from these studies have sometimes been contradictory. We now have a better understanding of the pharmacokinetics of the initial and transient pro-oxidant effect of an intravenous bolus followed by the antioxidant effect of continuous infusion, which seems efficacious and safe among critically ill patients. Clinical confirmation of the potentially advantageous synergism between selenium and glutamine may soon be forthcoming but the most appropriate and the optimum time of supplementation remains undetermined. Short-term intravenous selenite (bolus injection plus continuous infusion) has shown to be safe and capable of optimizing serum selenium and antioxidant selenoenzymes activities. However, additional dose-ranging trials are necessary to elucidate an optimal and safe posology with confirmed pharmacokinetic profiles before more definitive phase III trials can be conducted (AU)

A preliminary study of a measure of role-play competence in psychodynamic interpersonal therapy.

We report a 15-item role-play competence measure. Ratings by three judges of 34 role plays from psychodynamic interpersonal therapy training showed good inter-rater (.73-.79) and internal reliability (.84-.96). Validity was supported as scores were statistically significantly associated with psychotherapy experience. Most participants achieved satisfactory ratings supporting the training.

Assessing psychological well-being: a holistic investigation of NHS employees.

A substantial body of research has investigated the effects of work on the psychological well-being of employees. However, there has been little assessment of the ways in which workplace factors (such as job demands, working conditions, inter-personal relations and workplace change) interact with personal factors (such as work-life balance, family circumstances, key personality traits or demographic characteristics) to affect psychological health. This article reports findings from a study which aimed to construct and test a comprehensive model of the influences on employee well-being within the UK National Health Service (NHS). The results show that psychological well-being is influenced by a complex array of personal, environmental and work factors. A key finding is that there are clear associations between workplace change and well-being and between work-life (im)balance and well-being. These effects appear to be independent of one another and therefore require separate attention from managers and employers.

Self-poisoning with Colchicum autumnale L. flowers.

UNLABELLED: A 44-year-old man ingested about 40 flowers of Colchicum autumnale L. The patient presented with nausea, vomiting, and abdominal pain 2 hours after ingestion and had diarrhea 14 hours after ingestion. Hematological values remained within normal range. Treatment was mainly supportive. The outcome was favorable. The intoxication was confirmed by high-performance liquid chromatography-mass spectrometry. Maximal colchicine levels were 4.34 ng/mL at 13 hours in plasma and 5.43 ng/mL at 16 hours in erythrocytes. CONCLUSION: We report one of the few symptomatic cases of Colchicum autumnale L. poisoning confirmed by toxicological analysis.

Phosphate supplementation for hypophosphataemia and parenteral nutrition.

Routine detection and treatment of acute hypophosphataemia is important in intensive care unit and many other hospitalized patients, but metabolic bone disease and hypophosphataemia are still experienced as a result of parenteral nutrition. A significantly common problem that faces the compounding pharmacist when formulating parenteral nutrition regimens is the difficulty associated with the successful avoidance of calcium phosphate precipitation. Although incorporation of the normal calcium and phosphate requirements into regimens for metabolically stable adults is usually achievable, it can prove impossible in paediatric and neonatal mixtures when using the standard inorganic sources that are currently licensed for use in the UK and USA. In other countries, where organic compounds are routinely available, this problem does not exist.

Practical implications of nutritional support during continuous renal replacement therapy.

Continuous blood membrane interactions during continuous renal replacement therapy cause bioincompatibility and low grade inflammatory reactions with potentially adverse consequences on protein metabolism and immunocompetence. In designing a nutritional program for patients receiving this treatment, these adverse metabolic effects, especially the loss of nutritional substrates, must be considered. This review provides a practical overview of nutritional support in acute renal failure, including assessment techniques, determination of nutrient needs, and appropriate intervention for patient support.

Technical aspects of trace element supplementation.

Routine supplementation of total parenteral nutrition mixtures with the readily available single or combination trace elements products is becoming more widespread. As more is learned about deficiency syndromes and monitoring techniques, so too must we understand more about the physicochemical interactions between individual trace elements and other nutrients, that could ultimately affect bioavailability. Expert pharmaceutical assessment of these complex reactions, that have been demonstrated to occur in solution, becomes increasingly important in order to optimize the efficacy of micronutrient therapy.